Hostname: page-component-8448b6f56d-dnltx Total loading time: 0 Render date: 2024-04-18T20:09:58.663Z Has data issue: false hasContentIssue false
  • English
  • Français

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 Open the ORCID record for Gregory M. Schrank [Opens in a new window] ,
Anna Sick-Samuels Open the ORCID record for Anna Sick-Samuels [Opens in a new window] ,
Susan C. Bleasdale ,
Jesse T. Jacob Open the ORCID record for Jesse T. Jacob [Opens in a new window] ,
Raymund Dantes Open the ORCID record for Raymund Dantes [Opens in a new window] ,
Runa H. Gokhale ,
Jeanmarie Mayer ,
Preeti Mehrotra Open the ORCID record for Preeti Mehrotra [Opens in a new window] ,
Sapna A. Mehta  and
Alfredo J. Mena Lora Open the ORCID record for Alfredo J. Mena Lora [Opens in a new window]
...Show all authors
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.
Get access Rights & Permissions [Opens in a new window]

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
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 10 , October 2022 , pp. 1326 - 1332
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

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.

References

Goto, M, Al-Hasan, MN. Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe. Clin Microbiol Infect 2013;19:501–509.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention. 2019 National and State Healthcare-Associated Infections Progress Report. Atlanta: CDC; 2019.Google Scholar
Page, B, Klompas, M, Chan, C, et al. Surveillance for healthcare-associated infections: hospital-onset adult sepsis events versus current reportable conditions. Clin Infect Dis 2021;73:1013–1019.Google ScholarPubMed
Masnick, M, Morgan, DJ, Sorkin, JD, et al. Can national healthcare-associated infections (HAIs) data differentiate hospitals in the United States? Infect Control Hosp Epidemiol 2017;38:1167–1171.CrossRefGoogle ScholarPubMed
Lin, MY, Hota, B, Khan, YM, et al. Quality of traditional surveillance for public reporting of nosocomial bloodstream infection rates. JAMA 2010;304:2035–2041.CrossRefGoogle ScholarPubMed
Szymczak, J, Coffin, S. How mandatory public reporting undermines infection prevention: an ethnographic study. IDWeek 2014. Philadelphia, PA, 2014.Google Scholar
Rock, C, Thom, KA, Harris, AD, et al. A multicenter longitudinal study of hospital-onset bacteremia: time for a new quality outcome measure? Infect Control Hosp Epidemiol 2016;37:143–148.Google ScholarPubMed
Dantes, RB, Rock, C, Milstone, AM, et al. Preventability of hospital onset bacteremia and fungemia: a pilot study of a potential healthcare-associated infection outcome measure. Infect Control Hosp Epidemiol 2019;40:358–361.CrossRefGoogle ScholarPubMed
Dantes, RB, Abbo, LM, Anderson, D, et al. Hospital epidemiologists’ and infection preventionists’ opinions regarding hospital-onset bacteremia and fungemia as a potential healthcare-associated infection metric. Infect Control Hosp Epidemiol 2019;40:536–540.CrossRefGoogle ScholarPubMed
Warye, KL, Murphy, DM. Targeting zero healthcare-associated infections. Am J Infect Control 2008;36:683–684.CrossRefGoogle Scholar
Centers for Disease Control and Prevention Epicenters Program. Centers for Disease Control and Prevention website. https://www.cdc.gov/hai/epicenters/index.html. Updated November 18, 2015. Accessed January 11, 2022.Google Scholar
Magill, SS, O’Leary, E, Janelle, SJ, et al. Changes in prevalence of health care-associated infections in US hospitals. N Engl J Med 2018;379:1732–1744.Google Scholar
Wisplinghoff, H, Bischoff, T, Tallent, SM, et al. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004;39:309–317.CrossRefGoogle ScholarPubMed
Dalkey, N, Helmer, O. An experimental application o the DELPHI method to the use of experts. Manage Sci 1963;9:458–467.CrossRefGoogle Scholar
Schwendimann, R, Blatter, C, Dhaini, S, et al. The occurrence, types, consequences and preventability of in-hospital adverse events—a scoping review. BMC Health Serv Res 2018;18(1):521.Google ScholarPubMed
Rhee, C, Jones, TM, Hamad, Y, et al. Prevalence, underlying causes, and preventability of sepsis-associated mortality in US acute-care hospitals. JAMA Netw Open 2019;2(2):e187571.CrossRefGoogle ScholarPubMed
Bonnal, C, Mourvillier, B, Bronchard, R, et al. Prospective assessment of hospital-acquired bloosdstream infections: how many may be preventable? Qual Saf Health Care 2010;19(5):e30.Google ScholarPubMed
Bernstein, K. F SJ, Aguilar MD, et al. The RAND/UCLA Appropriateness Method User’s Manual. Santa Monica, CA: RAND; 2001.Google Scholar
Landis, JR, Koch, GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159–174.CrossRefGoogle ScholarPubMed
Viera, AJ, Garrett, JM. Understanding interobserver agreement: the kappa statistic. Fam Med 2005;37:360–363.Google ScholarPubMed
Nabhan, M, Elraiyah, T, Brown, DR, et al. What is preventable harm in healthcare? A systematic review of definitions. BMC Health Serv Res 2012;12:128.Google ScholarPubMed
Umscheid, CA, Mitchell, MD, Doshi, JA, et al. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol 2011;32:101–114.CrossRefGoogle ScholarPubMed
Schreiber, PW, Sax, H, Wolfensberger, A, et al. The preventable proportion of healthcare-associated infections 2005–2016: systematic review and meta-analysis. Infect Control Hosp Epidemiol 2018;39:1277–1295.CrossRefGoogle ScholarPubMed
Meddings, J, Saint, S, Fowler, KE, et al. The Ann Arbor criteria for appropriate urinary catheter use in hospitalized medical patients: results obtained by using the RAND/UCLA appropriateness method. Ann Intern Med 2015;162 suppl 9:S1–S34.CrossRefGoogle Scholar
Bramesfeld, A, Wrede, S, Richter, K, et al. Development of quality indicators and data assessment strategies for the prevention of central venous catheter-related bloodstream infections (CRBSI). BMC Infect Dis 2015;15:435.CrossRefGoogle Scholar
Supplementary material: File

Schrank et al. supplementary material

Schrank et al. supplementary material

Download Schrank et al. supplementary material(File)
File 50.5 KB