Hospital epidemiologists' and infection preventionists' opinions regarding hospital-onset bacteremia and fungemia as a potential healthcare-associated infection metric

Abstract

Objective: To ascertain opinions regarding etiology and preventability of hospital-onset bacteremia and fungemia (HOB) and perspectives on HOB as a potential outcome measure reflecting quality of infection prevention and hospital care.

Design: Cross-sectional survey.

Participants: Hospital epidemiologists and infection preventionist members of the Society for Healthcare Epidemiology of America (SHEA) Research Network.

Methods: A web-based, multiple-choice survey was administered via the SHEA Research Network to 133 hospitals.

Results: A total of 89 surveys were completed (67% response rate). Overall, 60% of respondents defined HOB as a positive blood culture on or after hospital day 3. Central line-associated bloodstream infections and intra-abdominal infections were perceived as the most frequent etiologies. Moreover, 61% thought that most HOB events are preventable, and 54% viewed HOB as a measure reflecting a hospital's quality of care. Also, 29% of respondents' hospitals already collect HOB data for internal purposes. Given a choice to publicly report central-line-associated bloodstream infections (CLABSIs) and/or HOB, 57% favored reporting either HOB alone (22%) or in addition to CLABSI (35%) and 34% favored CLABSI alone.

Conclusions: Among the majority of SHEA Research Network respondents, HOB is perceived as preventable, reflective of quality of care, and potentially acceptable as a publicly reported quality metric. Further studies on HOB are needed, including validation as a quality measure, assessment of risk adjustment, and formation of evidence-based bundles and toolkits to facilitate measurement and improvement of HOB rates.

Fig. 1.

Perceived etiologies of hospital-onset bacteremia and fungemia (HOB) among hospital epidemiologists and infection control practitioners.*n = 76. *Survey respondents were asked: “Most facilities do not assess the etiology of hospital-onset bacteremia; however, in your opinion, for your facility overall, what proportion of hospital-onset bacteremia/fungemia do you think is attributable to: (these categories are not mutually exclusive and do not need to add to 100%)”

Fig. 2.

Proportion of hospital-onset bacteremia and fungemia (HOB) perceived as preventable under current infection prevention and clinical practices.*n = 74. *Survey respondents were asked: “A proportion of hospital-onset bacteremia/fungemia at your facility is likely preventable with current infection prevention and clinical practice. In your opinion, at your institution, what would the increase be in hospital-onset bacteremia rate if current infection prevention and clinical practices were removed?”

Fig. 3.

Infection prevention improvement initiatives perceived as most likely to reduce hospital-onset bacteremia and fungemia (HOB).*n = 76. *Survey respondents were asked: “In your opinion, how likely are the following specific infection practices to reduce hospital-onset bacteremia/fungemia?”