RT Journal Article
SR Electronic
T1 Evaluation of hospital-onset bacteraemia and fungaemia in the USA as a potential healthcare quality measure: a cross-sectional study
JF BMJ Quality & Safety
JO BMJ Qual Saf
FD BMJ Publishing Group Ltd
SP 487
OP 498
DO 10.1136/bmjqs-2023-016831
VO 33
IS 8
A1 Leekha, Surbhi
A1 Robinson, Gwen L
A1 Jacob, Jesse T
A1 Fridkin, Scott
A1 Shane, Andi
A1 Sick-Samuels, Anna
A1 Milstone, Aaron M
A1 Nair, Rajeshwari
A1 Perencevich, Eli
A1 Puig-Asensio, Mireia
A1 Kobayashi, Takaaki
A1 Mayer, Jeanmarie
A1 Lewis, Julia
A1 Bleasdale, Susan
A1 Wenzler, Eric
A1 Mena Lora, Alfredo J
A1 Baghdadi, Jonathan
A1 Schrank, Gregory M
A1 Wilber, Eli
A1 Aldredge, Amalia A
A1 Sharp, Joseph
A1 Dyer, Kelly E
A1 Kendrick, Lea
A1 Ambalam, Viraj
A1 Borgetti, Scott
A1 Carmack, Anna
A1 Gushiken, Alexis
A1 Patel, Ashka
A1 Reddy, Sujan
A1 Brown, Clayton H
A1 Dantes, Raymund B
A1 Harris, Anthony D
A1 
YR 2024
UL http://qualitysafety.bmj.com/content/33/8/487.abstract
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.