Does NHSI Define CLABSI?
No, NHS Improvement (NHSI) does not provide its own definition for CLABSI; instead, international guidelines consistently recommend using the CDC/NHSN (Centers for Disease Control and Prevention/National Healthcare Safety Network) uniform surveillance methods and definitions for CLABSI surveillance. 1
Standard CLABSI Definition Source
The CDC/NHSN definition is the internationally recognized standard that should be employed for CLABSI surveillance, including in UK healthcare settings where NHSI operates. 1
The CDC defines CLABSI as a primary bloodstream infection in a patient who had a central venous catheter within 48 hours before infection onset, with no other identifiable source of infection. 2, 3, 4
When the interval between infection onset and device use exceeds 48 hours, compelling evidence must link the infection to the central line. 3, 5
Why CDC/NHSN Definitions Are Universal
International guidelines explicitly direct healthcare facilities to employ CDC/NHSN uniform surveillance methods and definitions rather than developing institution-specific or country-specific criteria. 1
The International Society for Infectious Diseases 2024 update mandates that establishments implementing CLABSI prevention must have an infection prevention team tasked with identifying patients who meet the CLABSI definition using these standardized criteria. 1
CLABSI rates should be calculated by dividing the number of CLABSIs by total central line-days, then multiplying by 1,000, following CDC/NHSN methodology. 1
Important Distinction: CLABSI vs CRBSI
CLABSI is a broader epidemiological surveillance definition used for infection control monitoring, while CRBSI (catheter-related bloodstream infection) requires definitive microbiological evidence that the catheter is the infection source. 2
The CDC/NHSN uses CLABSI for surveillance purposes, but this may overestimate true catheter-related infections and should not solely guide individual patient management decisions without CRBSI confirmation. 2
CRBSI diagnosis requires either positive catheter tip culture (≥15 CFU by semiquantitative method or ≥10² CFU by quantitative method) with matching peripheral blood culture, or paired quantitative blood cultures with a ratio ≥3:1 (catheter to peripheral). 2, 3
Practical Implications for UK Practice
UK facilities should implement the CDC/NHSN CLABSI definition for surveillance and benchmarking, as this allows international comparison and aligns with evidence-based prevention bundles. 1
The negative predictive value of CDC/NHSN criteria is excellent (97.1%), making it reliable for screening purposes. 6
Modified or institution-specific CLABSI definitions have been tested but have not proven superior to CDC/NHSN criteria and may complicate benchmarking efforts. 6, 7