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Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infection: Results from a Field Test of a New National Healthcare Safety Network Definition

  • Isaac See (a1) (a2), Martha Iwamoto (a1), Kathy Allen-Bridson (a1), Teresa Horan (a1), Shelley S. Magill (a1) and Nicola D. Thompson (a1)...



To assess challenges to implementation of a new National Healthcare Safety Network (NHSN) surveillance definition, mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI).


Multicenter field test.


Selected locations of acute care hospitals participating in NHSN central line-associated bloodstream infection (CLABSI) surveillance.


Hospital staff augmented their CLABSI surveillance for 2 months to incorporate MBI-LCBI: a primary bloodstream infection due to a selected group of organisms in patients with either neutropenia or an allogeneic hematopoietic stem cell transplant with gastrointestinal graft-versus-host disease or diarrhea. Centers for Disease Control and Prevention (CDC) staff reviewed submitted data to verify whether CLABSIs met MBI-LCBI criteria and summarized the descriptive epidemiology of cases reported.


Eight cancer, 2 pediatric, and 28 general acute care hospitals including 193 inpatient units (49% oncology/bone marrow transplant [BMT], 21% adult ward, 20% adult critical care, 6% pediatric, 4% step-down) conducted field testing. Among 906 positive blood cultures reviewed, 282 CLABSIs were identified. Of the 103 CLABSIs that also met MBI-LCBI criteria, 100 (97%) were reported from oncology/BMT locations. Agreement between hospital staff and CDC classification of reported CLABSIs as meeting the MBI-LCBI definition was high (90%; k= 0.82). Most MBI-LCBIs (91%) occurred in patients meeting neutropenia criteria. Some hospitals indicated that their laboratories' methods of reporting cell counts prevented application of neutropenia criteria; revised neutropenia criteria were created using data from field testing.


Hospital staff applied the MBI-LCBI definition accurately. Field testing informed modifications for the January 2013 implementation of MBI-LCBI in the NHSN.


Corresponding author

Centers for Disease Control and Prevention, 1600 Clifton Road NE A-24, Atlanta, GA 30333 (


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1.Pyrek, KM. Public reporting of infections and the CLABSI mandate. Infect Control Today. January 17, 2011. http.// Accessed January 9, 2013.
2.Fraser, TG, Gordon, SM. CLABSI rates in immunocompromised patients: a valuable patient centered outcome? Clin Infect Dis 2011;52(12):14461450.
3.Sexton, DJ, Chen, LF, Anderson, DJ. Current definitions of central line-associated bloodstream infection: is the emperor wearing clothes? Infect Control Hosp Epidemiol 2010;31(12):12861289.
4.Worth, LJ, Slavin, MA, Brown, GV, Black, J. Catheter-related bloodstream infections in hematology: time for standardized surveillance? Cancer 2007;109(7):12151226.
5.Pehar, M, Ristaino, P, Budd, AP, et al. Application of the National Healthcare Safety Network (NHSN) central line associated bloodstream infection (CLA-BSI) definition to oncology patients: impact in the trenches. In: Program and Abstracts of the Fifth Decennial International Conference on Healthcare-Associated infections. March 18-22, 2010; Atlanta, GA. Abstract 660.
6.DiGiorgio, MJ, Fatica, C, Oden, M, et al.Development of a modified surveillance definition of central line-associated bloodstream infections for patients with hematologic malignancies. Infect Control Hosp Epidemiol 2012;33(9):865868.
7.Freeman, JT, Elinder-Camburn, A, McClymont, C, et al.Central line-associated bloodstream infections in adult hematology patients with febrile neutropenia: an evaluation of surveillance definitions using differential time to blood culture positivity. Infect Control Hosp Epidemiol 2013;34(1):8992.
8.Steinberg, JP, Robichaux, C, Tejedor, SC, Reyes, MD, Jacob, JT. Distribution of pathogens in central line-associated bloodstream infections among patients with and without neutropenia following chemotherapy: evidence for a proposed modification to the current surveillance definition. Infect Control Hosp Epidemiol 2013;34(2):171175.
9.Blijlevens, NM, Donnelly, JP, De Pauw, BE. Mucosal barrier injury biology, pathology, clinical counterparts and consequences of intensive treatment for haematological malignancy: an overview. Bone Marrow Transplant 2000;25(12):12691278.
10.Central Line—Associated Bloodstream Infection (CLABSI) Event. National Healthcare Safety Network website, Accessed January 9, 2013.
11.CDC Locations and Descriptions—Patient Safety Component Manual. National Healthcare Safety Network website, Accessed January 9, 2013.
12.Przepiorka, D, Weisdorf, D, Martin, P, et al.Consensus conference on acute GVHD grading. Bone Marrow Transplant 1995;15:825858.
13.Tomblyn, M, Chiller, T, Einsele, H, et al.Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biol Blood Marrow Transplant 2009;15(10):11431238.
14.Freifeld, AG, Bow, EJ, Sepkowitz, KA, et al.Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 2011;52(4):e56e93.


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