When is a CLABSI not a CLABSI?

We’ve blogged often about problems with how current NHSN definitions are applied in the era of public reporting and "zero" cheerleading. The results of a recent EIN survey are now available online, and confirm that we all ought to take publicly-reported CLABSI data with a few large grains of salt. When presented with a vignette that clearly meets the NHSN CLABSI definition, fewer than half of respondents reported that they would definitely call a CLABSI when the organism is VRE or Klebsiella, with more than a quarter stating they would classify the case as a secondary bacteremia (secondary, presumably, to gastroenteritis in a patient with diarrhea and fecal leukocytes). Most reported that their hospitals used clinical judgment (e.g. consensus panels, clinician vetoes) in their CLABSI surveillance, and 75% of respondents wanted at least some subjectivity to remain in any CLABSI definition. Needless to say, these findings spell trouble for public reporting and a level playing field for inter-hospital comparisons.