All cause hospital-onset bacteremia reporting metric
Abstract:
Background: Hospital acquired infections (HAIs) are a major driver of morbidity and cost in health systems. Central Line Associated Blood Stream Infections (CLABSIs) require intensive surveillance and review. All cause hospital-onset bacteremia (HOB) may be a simpler reporting metric, correlates with CLABSI, and is viewed positivity by HAI experts. Despite ease in collection, the proportion of HOBs that are actionable and preventable is unknown. Moreover, quality improvement strategies targeting it may be more challenging. In this study, we describe the bedside provider-perceived sources of HOB in order to provide insight into this new metric as a target for HAI prevention.
Methods: All cases of HOB in 2019 from an academic tertiary care hospital were retrospectively reviewed. Information was collected to assess provider-perceived etiology and associated clinical factors (microbiology, severity, mortality, and management). HOB was categorized as preventable or not preventable based on the perceived source from the care team and management decisions. Preventable causes included device-associated bacteremias, pneumonias, surgical complications, and contaminate blood cultures.
Results: Of the 392 instances of HOB, 56.0% (n=220) had episodes that were determined not preventable by providers. Excluding blood culture contaminates, the most common cause of preventable HOB was secondary to CLABSIs (9.9%, n=39). Of the HOBs that were not preventable, the most common sources were gastrointestinal/abdominal (n=62), neutropenic translocation (n=37), and endocarditis (n=23). Patients with HOB were generally medically complex with an average Charlson comorbidity index of 4.97. This translated into a higher average length of stay (29.23 vs 7.56, p<0.001) and higher inpatient mortality (OR 8.3, CI [6.32-10.77]) when compared to admissions without HOB.
Conclusions: The majority of HOBs were not preventable and the HOB metric may be a marker of a sicker patient population making it a less actionable target for quality improvement. Standardization across patient mix is important if the metric becomes linked to reimbursement. If the HOB metric were to be used in lieu of CLABSI, large tertiary care health systems that house sicker patients may be unfairly financially penalized for caring for more medically complex patients.
Reference:
Stack MA, Dbeibo L, Fadel W, Kelley K, Sadowski J, Beeler C. Etiology and Utility of Hospital-onset Bacteremia as a Safety Metric for Targeted Harm Reduction. Am J Infect Control. 2023 Jun 7:S0196-6553(23)00409-1. doi: 10.1016/j.ajic.2023.06.002. Epub ahead of print. PMID: 37295676.