Hypotension Definition Variability Among Infection Preventionists: An APIC Chapter Survey

BACKGROUND The National Healthcare Safety Network (NHSN) does not provide a specific value for hypotension. The NHSN Safety Protocol directs facilities to “use the vital sign parameter(s) as stated in its policies and procedures for clinical practices.” Variation in defining hypotension criteria affects comparability of data, public reporting, and reimbursement. An Association for Professionals in Infection Control and Epidemiology (APIC) chapter's surveillance special interest group (SIG) posits the definition for hypotension as applied to laboratory-confirmed bloodstream infection (LCBI-2) central line associated bloodstream infection (CLABSI) varies widely among the healthcare facilities within its membership. METHODS The surveillance SIG developed a five-question survey to review facility-defined hypotension utilized in NHSN CLABSI surveillance. Survey questions addressed facility name, type of facility, and hypotension definition. The web-based survey was emailed in March 2018 to chapter members. The infection preventionist (IP) primarily responsible for reporting CLABSI at each facility was asked to complete the survey. The distribution of responses was evaluated. RESULTS Thirty-three IPs from 28 unique facilities responded. Twenty-six of the 28 facilities (93%) were acute care hospitals; two (7%) were long term acute care hospitals. The survey revealed 15 unique definitions for hypotension with both quantitative and qualitative elements. Quantitative results included a single systolic blood pressure CONCLUSIONS Such wide variation in facility-defined hypotension impacts identification and reporting of not just CLABSI, but also the intra-abdominal infection criteria NHSN uses for secondary bloodstream infections and surgical site infections.