scholarly journals Development and Evaluation of a Structured Tool to Assess the Preventability of Hospital-Onset Bacteremia and Fungemia

2020 ◽  
Vol 41 (S1) ◽  
pp. s31-s32
Author(s):  
Gregory Schrank ◽  
Anna Sick-Samuels ◽  
Susan Bleasdale ◽  
Jesse Jacob ◽  
Raymund Dantes ◽  
...  
Keyword(s):  
Expert Panel ◽  
Bloodstream Infections ◽  
Surgical Site Infections ◽  
Kappa Statistic ◽  
Central Line ◽  
Expert Consensus ◽  
Source Attribution ◽  
Healthcare Epidemiology ◽  
Catheter Infections ◽  
Hospital Acquired

Background: Hospital-onset bacteremia and fungemia (HOB) may be a preventable hospital-acquired condition and a potential healthcare quality measure. We developed and evaluated a tool to assess the preventability of HOB and compared it to a more traditional consensus panel approach. Methods: A 10-member healthcare epidemiology expert panel independently rated the preventability of 82 hypothetical HOB case scenarios using a 6-point Likert scale (range, 1= “Definitively or Almost Certainly Preventable” to 6= “Definitely or Almost Certainly Not Preventable”). Ratings on the 6-point scale were collapsed into 3 categories: Preventable (1–2), Uncertain (3–4), or Not preventable (5–6). Consensus was defined as concurrence on the same category among ≥70% expert raters. Cases without consensus were deliberated via teleconference, web-based discussion, and a second round of rating. The proportion meeting consensus, overall and by predefined HOB source attribution, was calculated. A structured HOB preventability rating tool was developed to explicitly account for patient intrinsic and extrinsic healthcare-related risks (Fig. 1). Two additional physician reviewers independently applied this tool to adjudicate the same 82 case scenarios. The tool was iteratively revised based on reviewer feedback followed by repeat independent tool-based adjudication. Interrater reliability was evaluated using the Kappa statistic. Proportion of cases where tool-based preventability category matched expert consensus was calculated. Results: After expert panel round 1, consensus criteria were met for 29 cases (35%), which increased to 52 (63%) after round 2. Expert consensus was achieved more frequently for respiratory or surgical site infections than urinary tract and central-line–associated bloodstream infections (Fig. 2a). Most likely to be rated preventable were vascular catheter infections (64%) and contaminants (100%). For tool-based adjudication, following 2 rounds of rating with interim tool revisions, agreement between the 2 reviewers was 84% for cases overall (κ, 0.76; 95% CI, 0.64–0.88]), and 87% for the 52 cases with expert consensus (κ, 0.79; 95% CI, 0.65–0.94). Among cases with expert consensus, tool-based rating matched expert consensus in 40 of 52 (77%) and 39 of 52 (75%) cases for reviewer 1 and reviewer 2, respectively. The proportion of cases rated “uncertain“ was lower among tool-based adjudicated cases with reviewer agreement (15 of 69) than among cases with expert consensus (23 of 52) (Fig. 2b). Conclusions: Healthcare epidemiology experts hold varying perspectives on HOB preventability. Structured tool-based preventability rating had high interreviewer reliability, matched expert consensus in most cases, and rated fewer cases with uncertain preventability compared to expert consensus. This tool is a step toward standardized assessment of preventability in future HOB evaluations.Funding: NoneDisclosures: None

Prevention of healthcare associated infections

2019 ◽  
pp. 233-304 ◽  
Author(s):  
Nizam Damani
Keyword(s):  
Prevention And Control ◽  
Bloodstream Infections ◽  
Surgical Site Infections ◽  
Central Line ◽  
Infection Prevention And Control ◽  
Healthcare Associated Infections ◽  
Tract Infections ◽  
Healthcare Associated ◽  
Hospital Acquired ◽  
And Control

This chapter provides the most up-to-date advice on infection prevention and control (IPC) of the four most common healthcare-associated infections (HAIs). These are: surgical site infections; infection associated with peripheral IV line/cannula and central line-associated bloodstream infections (CLABSIs); catheter-associated urinary tract infections (CAUTI); and hospital-acquired and ventilator-acquired pneumonias (VAP). The chapter examines and summarizes various key elements and discusses implementation of HAI care bundles and high impact interventions which are necessary to reduce these infections.

Distribution of Pathogens in Central Line–Associated Bloodstream Infections among Patients with and without Neutropenia following Chemotherapy Evidence for a Proposed Modification to the Current Surveillance Definition

2013 ◽  
Vol 34 (2) ◽  
pp. 171-175 ◽  
Author(s):  
James P. Steinberg ◽  
Chad Robichaux ◽  
Sheri Chernetsky Tejedor ◽  
Mary Dent Reyes ◽  
Jesse T. Jacob
Keyword(s):  
Bloodstream Infections ◽  
Central Line ◽  
University Hospitals ◽  
Central Venous ◽  
E Coli ◽  
National Healthcare Safety Network ◽  
Proposed Modification ◽  
Definition Of ◽  
Hospital Acquired ◽  
Study Hospital

Objective.Many bloodstream infections (BSIs) occurring in patients with febrile neutropenia following cytotoxic chemotherapy are due to translocation of intestinal microbiota. However, these infections meet the National Healthcare Safety Network (NHSN) definition of central line-associated BSIs (CLABSIs). We sought to determine the differences in the microbiology of NHSN-defined CLABSIs in patients with and without neutropenia and, using these data, to propose a modification of the CLABSI definition.Design.Retrospective review.Setting.Two large university hospitals over 18 months.Methods.All hospital-acquired BSIs occurring in patients with central venous catheters in place were classified using the NHSN CLABSI definition. Patients with postchemotherapy neutropenia (500 neutrophils/mm3or lower) at the time of blood culture were considered neutropenic. Pathogens overrepresented in the neutropenic group were identified to inform development of a modified CLABSI definition.Results.Organisms that were more commonly observed in the neutropenic group compared with the nonneutropenic group includedEscherichia coli(22.7% vs 2.5%;P< .001) but not other Enterobacteriaceae,Enterococcus faecium(18.2% vs 6.1%;P= .002), and streptococci (18.2% vs 0%;P< .001). Application of a modified CLABSI definition (removing BSI with enterococci, streptococci, orE. coli) excluded 33 of 66 neutropenic CLABSIs and decreased the CLABSI rate in one study hospital with large transplant and oncology populations from 2.12 to 1.79 cases per 1,000 line-days.Conclusions.Common gastrointestinal organisms were more common in the neutropenia group, suggesting that many BSIs meeting the NHSN criteria for CLABSI in the setting of neutropenia may represent translocation of gut organisms. These findings support modification of the NHSN CLABSI definition.

Costs of ambulatory pediatric healthcare-associated infections: Central-line–associated bloodstream infection (CLABSIs), catheter-associated urinary tract infection (CAUTIs), and surgical site infections (SSIs)

2020 ◽  
Vol 41 (11) ◽  
pp. 1292-1297
Author(s):  
Michael L. Rinke ◽  
Suzette O. Oyeku ◽  
William J. H. Ford ◽  
Moonseong Heo ◽  
Lisa Saiman ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Ambulatory Surgery ◽  
Bloodstream Infections ◽  
Surgical Site Infections ◽  
Central Line ◽  
Healthcare Associated Infections ◽  
Retrospective Case ◽  
Additional Costs ◽  
Tract Infections ◽  
Healthcare Associated

AbstractObjective:Ambulatory healthcare-associated infections (HAIs) occur frequently in children and are associated with morbidity. Less is known about ambulatory HAI costs. This study estimated additional costs associated with pediatric ambulatory central-line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTI), and surgical site infections (SSIs) following ambulatory surgery.Design:Retrospective case-control study.Setting:Four academic medical centers.Patients:Children aged 0–22 years seen between 2010 and 2015 and at risk for HAI as identified by electronic queries.Methods:Chart review adjudicated HAIs. Charges were obtained for patients with HAIs and matched controls 30 days before HAI, on the day of, and 30 days after HAI. Charges were converted to costs and 2015 USD. Mixed-effects linear regression was used to estimate the difference-in-differences of HAI case versus control costs in 2 models: unrecorded charge values considered missing and a sensitivity analysis with unrecorded charge considered $0.Results:Our search identified 177 patients with ambulatory CLABSIs, 53 with ambulatory CAUTIs, and 26 with SSIs following ambulatory surgery who were matched with 382, 110, and 75 controls, respectively. Additional cost associated with an ambulatory CLABSI was $5,684 (95% confidence interval [CI], $1,005–$10,362) and $6,502 (95% CI, $2,261–$10,744) in the 2 models; cost associated with a CAUTI was $6,660 (95% CI, $1,055, $12,145) and $2,661 (95% CI, −$431 to $5,753); cost associated with an SSI following ambulatory surgery at 1 institution only was $6,370 (95% CI, $4,022–$8,719).Conclusions:Ambulatory HAI in pediatric patients are associated with significant additional costs. Further work is needed to reduce ambulatory HAIs.

scholarly journals 585. Shifting Focus Toward Healthcare-Associated Bloodstream Infections: Need for More NICU-Specific NHSN Definitions

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S276-S277
Author(s):  
Sonali D Advani ◽  
Thomas Murray ◽  
Matthew Bizzarro
Keyword(s):  
Neonatal Intensive Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Mucosal Barrier ◽  
Source Attribution ◽  
Chi Square ◽  
Mortality And Morbidity ◽  
Source Of Infection ◽  
Chi Square Test ◽  
Healthcare Associated

Abstract Background Healthcare-associated bloodstream infections (HABSIs) are a significant cause of mortality and morbidity in the neonatal intensive care unit (NICU) population. Our objectives were to review the epidemiology of HABSIs in our NICU and to examine the applicability of National Healthcare Safety Network (NHSN) definitions to the NICU population. Methods We performed a retrospective review of all neonates admitted to the 54-bed level IV NICU at Yale-New Haven Children’s Hospital with a HABSI between January 1, 2013 and December 31, 2018. HABSI was defined as a positive blood culture at >72 hours of life growing an organism not considered a contaminant. Clinical definitions per treating NICU team and NHSN site-specific definitions were compared for source attribution using McNemar’s Chi-square test. Results We identified 88 HABSIs with an incidence rate of 0.81 per 1,000 patient-days. Only 13% of these were central line-associated bloodstream infections (CLABSIs). Infants with a HABSI had median birth weight and gestational age of 830 grams and 26 weeks, respectively, with a high percentage requiring mechanical ventilation parenteral nutrition and vascular access (Table 1). Sepsis-related mortality was 24%. The majority of HABSIs were caused by gram-positive and gram-negative bacteria (Figure 1). Most were secondary to necrotizing enterocolitis, pneumonia or a source that was not identified (Table 2). NHSN definitions were less likely to identify a source compared with clinical definitions per NICU treating team (P < 0.001, Table 2). Fifty percent of patients without an identified source of infection by NHSN criteria were identified with a Mucosal Barrier Injury (MBI) organism, likely causing bacteremia from gut translocation. Conclusion HABSIs occur in premature babies with comorbidities, and are more prevalent than CLABSIs. Gut translocation with MBI organisms may be an important unidentified source of HABSIs in neonates. With the increasing focus on HABSI prevention, there is a need for better NHSN definitions for source attribution of bloodstream infections in neonates. Disclosures All authors: No reported disclosures.

Impact of Hospital Operating Margin on Central Line–Associated Bloodstream Infections Following Medicare’s Hospital-Acquired Conditions Payment Policy

2015 ◽  
Vol 37 (1) ◽  
pp. 100-103 ◽  
Author(s):  
Michael S. Calderwood ◽  
Louise E. Vaz ◽  
Alison Tse Kawai ◽  
Robert Jin ◽  
Melisa D. Rett ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Central Line ◽  
Differential Impact ◽  
Payment Policy ◽  
Operating Margin ◽  
Hospital Acquired Conditions ◽  
Operating Margins ◽  
Additional Payment ◽  
Hospital Acquired ◽  
Present On Admission

AbstractIn October 2008, Medicare ceased additional payment for hospital-acquired conditions not present on admission. We evaluated the policy’s differential impact in hospitals with high vs low operating margins. Medicare’s payment policy may have had an impact on reducing central line–associated bloodstream infections in hospitals with low operating margins.Infect. Control Hosp. Epidemiol. 2015;37(1):100–103

scholarly journals The Standardization of Hospital-Acquired Infection Rates Using Prediction Models in Iran: Observational Study of National Nosocomial Infection Registry Data

10.2196/33296 ◽  
2021 ◽  
Vol 7 (12) ◽  
pp. e33296
Author(s):  
Neda Izadi ◽  
Koorosh Etemad ◽  
Yadollah Mehrabi ◽  
Babak Eshrati ◽  
Seyed Saeed Hashemi Nazari
Keyword(s):  
Internal Medicine ◽  
Infectious Disease ◽  
Prediction Models ◽  
Scientific Evidence ◽  
Bloodstream Infections ◽  
Surgical Site Infections ◽  
Infection Rates ◽  
Hospital Acquired Infection ◽  
Tract Infections ◽  
Hospital Acquired

Background Many factors contribute to the spreading of hospital-acquired infections (HAIs). Objective This study aimed to standardize the HAI rate using prediction models in Iran based on the National Healthcare Safety Network (NHSN) method. Methods In this study, the Iranian nosocomial infections surveillance system (INIS) was used to gather data on patients with HAIs (126,314 infections). In addition, the hospital statistics and information system (AVAB) was used to collect data on hospital characteristics. First, well-performing hospitals, including 357 hospitals from all over the country, were selected. Data were randomly split into training (70%) and testing (30%) sets. Finally, the standardized infection ratio (SIR) and the corrected SIR were calculated for the HAIs. Results The mean age of the 100,110 patients with an HAI was 40.02 (SD 23.56) years. The corrected SIRs based on the observed and predicted infections for respiratory tract infections (RTIs), urinary tract infections (UTIs), surgical site infections (SSIs), and bloodstream infections (BSIs) were 0.03 (95% CI 0-0.09), 1.02 (95% CI 0.95-1.09), 0.93 (95% CI 0.85-1.007), and 0.91 (95% CI 0.54-1.28), respectively. Moreover, the corrected SIRs for RTIs in the infectious disease, burn, obstetrics and gynecology, and internal medicine wards; UTIs in the burn, infectious disease, internal medicine, and intensive care unit wards; SSIs in the burn and infectious disease wards; and BSIs in most wards were >1, indicating that more HAIs were observed than expected. Conclusions The results of this study can help to promote preventive measures based on scientific evidence. They can also lead to the continuous improvement of the monitoring system by collecting and systematically analyzing data on HAIs and encourage the hospitals to better control their infection rates by establishing a benchmarking system.

scholarly journals Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals: 2014 Update

2014 ◽  
Vol 35 (S2) ◽  
pp. S89-S107 ◽  
Author(s):  
Jonas Marschall ◽  
Leonard A. Mermel ◽  
Mohamad Fakih ◽  
Lynn Hadaway ◽  
Alexander Kallen ◽  
...  
Keyword(s):  
Acute Care ◽  
Bloodstream Infections ◽  
Acute Care Hospitals ◽  
Central Line ◽  
Guidance Document ◽  
American Hospital ◽  
American Hospital Association ◽  
Healthcare Associated ◽  
Healthcare Epidemiology ◽  
Practical Recommendations

Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their central line-associated bloodstream infection (CLABSI) prevention efforts. This document updates “Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.

scholarly journals Comparison of Total Hospital-Acquired Bloodstream Infections to Central Line–Associated Bloodstream Infections and Implications for Outcome Measures in Infection Control

2013 ◽  
Vol 34 (9) ◽  
pp. 984-986 ◽  
Author(s):  
Surbhi Leekha ◽  
Shanshan Li ◽  
Kerri A. Thom ◽  
Michael Anne Preas ◽  
Brian S. Caffo ◽  
...  
Keyword(s):  
Intensive Care ◽  
Infection Control ◽  
Bloodstream Infection ◽  
Intensive Care Units ◽  
Outcome Measures ◽  
Bloodstream Infections ◽  
Central Line ◽  
Total Hospital ◽  
Prevention Intervention ◽  
Hospital Acquired

The validity of the central line-associated bloodstream infection (CLABSI) measure is compromised by subjectivity. We observed significant decreases in both CLABSIs and total hospital-acquired bloodstream infections (BSIs) following a CLABSI prevention intervention in adult intensive care units. Total hospital-acquired BSIs could be explored as an adjunct, objective CLABSI measure.

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