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Development and evaluation of a structured guide to assess the preventability of hospital-onset bacteremia and fungemia

Published online by Cambridge University Press:  28 January 2022

Gregory M. Schrank*
Affiliation:
Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
Anna Sick-Samuels
Affiliation:
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
Susan C. Bleasdale
Affiliation:
Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
Jesse T. Jacob
Affiliation:
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Raymund Dantes
Affiliation:
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Runa H. Gokhale
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Jeanmarie Mayer
Affiliation:
Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah
Preeti Mehrotra
Affiliation:
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Sapna A. Mehta
Affiliation:
Department of Medicine, NYU Grossman School of Medicine, New York, New York
Alfredo J. Mena Lora
Affiliation:
Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
Susan M. Ray
Affiliation:
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Chanu Rhee
Affiliation:
Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Jorge L. Salinas
Affiliation:
University of Iowa Hospital & Clinics, Iowa City, Iowa
Susan K. Seo
Affiliation:
Department of Medicine, Joan and Sanford Weil Cornell Medical College, New York, New York
Andi L. Shane
Affiliation:
Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
Gita Nadimpalli
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Aaron M. Milstone
Affiliation:
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
Gwen Robinson
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Clayton H. Brown
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Anthony D. Harris
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Surbhi Leekha*
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
*
Author for correspondence: Gregory M. Schrank, E-mail: gschrank@som.umaryland.edu. Or Surbhi Leekha, E-mail: sleekha@som.umaryland.edu.
Author for correspondence: Gregory M. Schrank, E-mail: gschrank@som.umaryland.edu. Or Surbhi Leekha, E-mail: sleekha@som.umaryland.edu.

Abstract

Objective:

To assess preventability of hospital-onset bacteremia and fungemia (HOB), we developed and evaluated a structured rating guide accounting for intrinsic patient and extrinsic healthcare-related risks.

Design:

HOB preventability rating guide was compared against a reference standard expert panel.

Participants:

A 10-member panel of clinical experts was assembled as the standard of preventability assessment, and 2 physician reviewers applied the rating guide for comparison.

Methods:

The expert panel independently rated 82 hypothetical HOB scenarios using a 6-point Likert scale collapsed into 3 categories: preventable, uncertain, or not preventable. Consensus was defined as concurrence on the same category among ≥70% experts. Scenarios without consensus were deliberated and followed by a second round of rating.

Two reviewers independently applied the rating guide to adjudicate the same 82 scenarios in 2 rounds, with interim revisions. Interrater reliability was evaluated using the κ (kappa) statistic.

Results:

Expert panel consensus criteria were met for 52 scenarios (63%) after 2 rounds.

After 2 rounds, guide-based rating matched expert panel consensus in 40 of 52 (77%) and 39 of 52 (75%) cases for reviewers 1 and 2, respectively. Agreement rates between the 2 reviewers were 84% overall (κ, 0.76; 95% confidence interval [CI], 0.64–0.88]) and 87% (κ, 0.79; 95% CI, 0.65–0.94) for the 52 scenarios with expert consensus.

Conclusions:

Preventability ratings of HOB scenarios by 2 reviewers using a rating guide matched expert consensus in most cases with moderately high interreviewer reliability. Although diversity of expert opinions and uncertainty of preventability merit further exploration, this is a step toward standardized assessment of HOB preventability.

Type
Original Article
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION. An abstract of this research was accepted to the Sixth Decennia International Conference on Healthcare-Associated Infections in March 2020 and was published in Infection Control and Hospital Epidemiology in November 2020.

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