A Call for Standardized Infection Detection Practices

As hospitals brace themselves against financial penalties and public reporting of catheter infections, a test score that all the world can see, a disturbing report released last week says all hospitals are not taking the same exam.

In fact, they are taking the test in different ways, submitting answers to just some of the questions, says Matthew F. Niedner MD, assistant professor of pediatrics and communicable diseases at Mott Children's Hospital in Ann Arbor, MI.

When he and his team asked 16 pediatric intensive care units to explain the standards they use to look for, measure, and report catheter-associated bloodstream infections, he discovered that some hospitals look a lot more aggressively than others.

"There is substantial variability in catheter-associated bloodstream infection practices on multiple fronts: from the application of diagnostic strategies to interpretations of the CDC definition itself," he and colleagues wrote in October's edition of the American Journal of Infection Control.

In the article, entitled in part "The Harder You Look, The More You Find," he explains that some hospitals have written policies but others don't. Some hospitals include some reports of infections from some catheter sites but not others. Some test daily when a child has a low-grade fever but others, not so much.

He says his study, done in conjunction with the 2008 National Association of Children's Hospitals and Related Institutions Pediatric Intensive Care Unit Patient Care FOCUS Group, was "the first stab" at trying to understand whether units with more aggressive surveillance practices result in higher infection rates.

And, he says, his findings raise a compelling argument to standardize the way all hospitals look for such infections—not just pediatric institutions, but adult acute care facilities, too.

"If we're now to be judged and have our economic prosperity attached to these performance metrics...some of the energy being put into this problem ought to be applied to establishing and implementing standardized practices, at the clinician level," he said.

Niedner's team did not look at variability in adult care institutions, but, he says, "the principles are extrapolatable."