Factors Related to the Accurate Application of NHSN Surveillance Definitions for CAUTI and CLABSI in Texas Hospitals

Background Previous studies indicate inconsistent knowledge and application of the National Healthcare Safety Network (NHSN) surveillance definitions used to report Healthcare Associated Infections (HAI). Our study aims to determine factors associated with accurate application of the surveillance criteria. Methods Members of Texas Infection Prevention (IP) professional organizations were emailed a web-based survey in January 2020. Respondents answered demographic and other questions related to 2019 NHSN trainings completed and applied NHSN definitions to case scenarios on Catheter-Associated Urinary Tract Infection (CAUTI) and Central Line-Associated Bloodstream Infection (CLABSI). This cross-sectional study used logistic regression models to estimate associations between years of experience, hours spent on surveillance, NHSN trainings, and respondents’ ability to identify correct HAI criterion. Results Eighty-eight IPs responded to the survey. Twenty-five of 65 respondents (38%) who completed CAUTI training identified correct CAUTI criterion and 6 of 63 (10%) who completed CLABSI training identified correct CLABSI criterion. CAUTI training was associated with higher odds of accurately identifying CAUTI (Odds Ratio (OR) = 4.92, 95% Confidence Interval (CI): 1.2, 20.5) after adjusting for years of experience and hours spent on surveillance. Similar patterns of association were observed between completion of CLABSI training and correctly identifying CLABSI, but the result was not significant (OR = 2.35, 95% CI: 0.2, 23.8). Compared to those spending less time on NHSN surveillance ( 16 hours/week) had lower odds of identifying CAUTI but higher odds of identifying CLABSI. Conclusions Limited studies demonstrate variability in the accurate application of NHSN surveillance definitions. Possible factors contributing to this variability are also lacking. Our results suggest that recent NHSN training and more years of IP experience may be associated with increased accuracy of HAI identification. However, spending more time with NHSN surveillance every week may not improve one's ability to identify CAUTI.