Comment from Kilroy, Amy
Amy KilroySupportBusiness
Summary: Amy Kilroy, representing Providence Alaska Medical Center, advocates for expanding the NHSN definition of patient injection to include unauthorized injections by non-healthcare personnel (such as visitors or family members). She argues that the current definition, which only covers self-injection, creates inaccuracies in risk adjustment and fails to reflect the clinical reality of the opioid crisis.
NHSN CLABSI Patient Injection Exclusion- I am requesting that NHSN reevaluate the patient injection (PI) exclusion language contained within Chapter 4, Bloodstream Infection Event (Central Line-Associated Bloodstream Infection and Non-central Line Associated Bloodstream Infection), page 4-11. NHSN currently recognizes injection-related contamination of a vascular access device as an important non-healthcare-related risk factor when performed by the patient. However, the same risk mechanism exists when a visitor, family member, or other non-healthcare individual injects substances into a patient's central line.
From a surveillance perspective, the biologic risk of bloodstream infection arises from unauthorized access to the vascular system and breach of aseptic technique. Limiting consideration to strictly to patient self-injection may result in clinically equivalent injection exposure events by visitors as being classified differently despite equal contamination risk. I recommend NHSN consider expanding the exclusion to documented unauthorized injections by non-healthcare personnel when supported by objective evidence such as direct observation, witness statements, security investigations, or other provider documentation. This approach would preserve reproducibility while improving surveillance specificity and alignment with real-world clinical scenarios. Use of this expanded definition will increase the internal validity of the data will encompass the evolving reality of healthcare today.