PT  - JOURNAL ARTICLE
AU  - Leekha, Surbhi
AU  - Robinson, Gwen L
AU  - Jacob, Jesse T
AU  - Fridkin, Scott
AU  - Shane, Andi
AU  - Sick-Samuels, Anna
AU  - Milstone, Aaron M
AU  - Nair, Rajeshwari
AU  - Perencevich, Eli
AU  - Puig-Asensio, Mireia
AU  - Kobayashi, Takaaki
AU  - Mayer, Jeanmarie
AU  - Lewis, Julia
AU  - Bleasdale, Susan
AU  - Wenzler, Eric
AU  - Mena Lora, Alfredo J
AU  - Baghdadi, Jonathan
AU  - Schrank, Gregory M
AU  - Wilber, Eli
AU  - Aldredge, Amalia A
AU  - Sharp, Joseph
AU  - Dyer, Kelly E
AU  - Kendrick, Lea
AU  - Ambalam, Viraj
AU  - Borgetti, Scott
AU  - Carmack, Anna
AU  - Gushiken, Alexis
AU  - Patel, Ashka
AU  - Reddy, Sujan
AU  - Brown, Clayton H
AU  - Dantes, Raymund B
AU  - Harris, Anthony D
ED  - ,
TI  - Evaluation of hospital-onset bacteraemia and fungaemia in the USA as a potential healthcare quality measure: a cross-sectional study
AID  - 10.1136/bmjqs-2023-016831
DP  - 2024 Aug 01
TA  - BMJ Quality & Safety
PG  - 487--498
VI  - 33
IP  - 8
4099  - http://qualitysafety.bmj.com/content/33/8/487.short
4100  - http://qualitysafety.bmj.com/content/33/8/487.full
SO  - BMJ Qual Saf2024 Aug 01; 33
AB  - Background Hospital-onset bacteraemia and fungaemia (HOB) is being explored as a surveillance and quality metric. The objectives of the current study were to determine sources and preventability of HOB in hospitalised patients in the USA and to identify factors associated with perceived preventability.Methods We conducted a cross-sectional study of HOB events at 10 academic and three community hospitals using structured chart review. HOB was defined as a blood culture on or after hospital day 4 with growth of one or more bacterial or fungal organisms. HOB events were stratified by commensal and non-commensal organisms. Medical resident physicians, infectious disease fellows or infection preventionists reviewed charts to determine HOB source, and infectious disease physicians with training in infection prevention/hospital epidemiology rated preventability from 1 to 6 (1=definitely preventable to 6=definitely not preventable) using a structured guide. Ratings of 1–3 were collectively considered ‘potentially preventable’ and 4–6 ‘potentially not preventable’.Results Among 1789 HOB events with non-commensal organisms, gastrointestinal (including neutropenic translocation) (35%) and endovascular (32%) were the most common sources. Overall, 636/1789 (36%) non-commensal and 238/320 (74%) commensal HOB events were rated potentially preventable. In logistic regression analysis among non-commensal HOB events, events attributed to intravascular catheter-related infection, indwelling urinary catheter-related infection and surgical site infection had higher odds of being rated preventable while events with neutropenia, immunosuppression, gastrointestinal sources, polymicrobial cultures and previous positive blood culture in the same admission had lower odds of being rated preventable, compared with events without those attributes. Of 636 potentially preventable non-commensal HOB events, 47% were endovascular in origin, followed by gastrointestinal, respiratory and urinary sources; approximately 40% of those events would not be captured through existing healthcare-associated infection surveillance.Discussion Factors identified as associated with higher or lower preventability should be used to guide inclusion, exclusion and risk adjustment for an HOB-related quality metric.Data are available upon reasonable request. Deidentified data are available upon reasonable request from the corresponding author.