Blog | Thursday, March 5, 2015

Clamoring for CLAMBI


Last month we blogged on updated National Healthcare Safety Network surveillance definitions and we bemoaned the fact that central line associated mucosal barrier injury bloodstream infections (CLAMBI) are not being separated from central line-associated bloodstream infections (CLABSI) for public reporting, and more importantly for the CMS pay-for-performance programs. These infections are particularly common in patients with hematologic malignancies, are due to the translocation of enteric flora into the bloodstream, and unlike true CLABSIs are not preventable.

A new paper in Infection Control and Hospital Epidemiology from Northwestern University demonstrates why this is important. All cases of CLABSI were identified over a 14-month period on 2 inpatient hem/onc/BMT units (72 beds). The cases were further subdivided into “true” CLABSIs (i.e., not associated with mucosal barrier injury) and CLAMBIs. A total of 66 infections were identified, of which 47 (71%) were CLAMBIs. Erichia coli, Enterococci and Viridans streptococci accounted for 62% of the pathogens isolated.

The authors note that at the present time CLABSIs identified outside of ICUs are not publicly reported nationally; however, the CLAMBI patients spillover into ICUs. At Northwestern, 12% of ICU CLABSIs were determined to actually be CLAMBIs.

Is it any wonder that tertiary care hospitals are disproportionately affected by CMS penalties? This is just one of many reasons.

Michael B. Edmond, MD, FACP, is the Chief Quality Officer at the University of Iowa Hospitals and Clinics. This post originally appeared at the blog Controversies in Hospital Infection Prevention.