Why validation is important

A new study in the American Journal of Infection Control describes the validation of publicly reported central line associated bloodstream infection (CLABSI) data in Colorado. The study encompassed a review of data from ICUs at 35 acute care hospitals and 8 LTACHs for the first quarter of 2010. Charts of 519 patients with positive blood cultures were reviewed. Results of this study, as well as 3 other statewide CLABSI validation projects are summarized below.

	Sensitivity	Specificity
Connecticut	48%	99%
New York	74%	95%
Oregon	72%	99%
Colorado	83%	99%

These 4 studies show that 17-53% of CLABSI cases were misclassified as non-CLABSIs, primarily due to labeling CLABSIs as secondary bacteremias. Interestingly, the Colorado study attempted to delineate the underlying causes of misclassification. Two reasons were found to be significant: lack of an electronic medical record or data mining software, and review of potential cases by an infectious diseases physician (i.e., post-surveillance certification).

Given all the attention paid to publicly reported HAI data and the important implications with regards to reimbursement, it's imperative that hospitals produce valid data. However, validation projects remain infrequent due to their cost. We have a long way to go...