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Preventability of Hospital Onset Bacteremia and Fungemia: A Pilot Study of a Potential New Indicator of Healthcare-Associated Infections

BACKGROUND: Central-line associated bloodstream infections (CLABSI) are a subset of hospital-onset bacteremia and fungemia (HOB), a potential indicator of healthcare-associated infections (HAIs) that can be objectively and directly obtained from electronic health records. We undertook a pilot study...

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Autores principales: Dantes, Raymund, Rock, Clare, Milstone, Aaron M, Jacob, Jesse T, Chernetsky-Tejedor, Sheri, Harris, Anthony D, Leekha, Surbhi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5632060/
http://dx.doi.org/10.1093/ofid/ofx163.336
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author Dantes, Raymund
Rock, Clare
Milstone, Aaron M
Jacob, Jesse T
Chernetsky-Tejedor, Sheri
Harris, Anthony D
Leekha, Surbhi
author_facet Dantes, Raymund
Rock, Clare
Milstone, Aaron M
Jacob, Jesse T
Chernetsky-Tejedor, Sheri
Harris, Anthony D
Leekha, Surbhi
author_sort Dantes, Raymund
collection PubMed
description BACKGROUND: Central-line associated bloodstream infections (CLABSI) are a subset of hospital-onset bacteremia and fungemia (HOB), a potential indicator of healthcare-associated infections (HAIs) that can be objectively and directly obtained from electronic health records. We undertook a pilot study to elucidate the causes and determine the preventability of HOB. METHODS: HOB was defined as growth of a microorganism from a blood culture obtained ≥3 calendar days after admission in a hospitalized patient. A random sampling of HOB events across 2 academic hospitals and a pediatric intensive care unit in a third academic hospital were identified between October 1, 2014 and September 30, 2015. Medical records were reviewed to identify potential risk factors and sources of bacteremia. Two physicians used underlying patient factors, microorganism, and other clinical data to rate the preventability of each HOB event in an “ideal hospital” on a 6-point Likert scale. RESULTS: Medical records for 60 HOB events (20 in each hospital) were reviewed. The most common organisms were coagulase-negative Staphylococcus (28%) and Candida spp. (17%) (Figure 1). The most likely sources of bacteremia and fungemia included CLABSI (28%) and skin contaminants/commensals (17%) (Figure 2). Forty-nine percent of HOB events not attributed to skin commensals were rated as potentially preventable (Figure 3). Fifty percent of HOB events randomly sampled across 2 hospitals occurred in an intensive care unit. Central venous catheters, urinary catheters, and mechanical ventilation were present in the previous 2 days among 73%, 20%, and 25% of all HOB events, respectively. Only 10% of all HOB events occurred in a patient without an indwelling device. Only 20% of HOB events resulted in a National Healthcare Safety Network (NHSN) reported CLABSI. CONCLUSION: Half of HOB events are potentially preventable in this pilot study. HOB may be an indicator for a large number of preventable HAIs not currently measured by NHSN. Larger studies across a variety of hospital settings are needed assess the generalizability of these results the implications of HOB surveillance for infection prevention practices and patient outcomes. DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-56320602017-11-07 Preventability of Hospital Onset Bacteremia and Fungemia: A Pilot Study of a Potential New Indicator of Healthcare-Associated Infections Dantes, Raymund Rock, Clare Milstone, Aaron M Jacob, Jesse T Chernetsky-Tejedor, Sheri Harris, Anthony D Leekha, Surbhi Open Forum Infect Dis Abstracts BACKGROUND: Central-line associated bloodstream infections (CLABSI) are a subset of hospital-onset bacteremia and fungemia (HOB), a potential indicator of healthcare-associated infections (HAIs) that can be objectively and directly obtained from electronic health records. We undertook a pilot study to elucidate the causes and determine the preventability of HOB. METHODS: HOB was defined as growth of a microorganism from a blood culture obtained ≥3 calendar days after admission in a hospitalized patient. A random sampling of HOB events across 2 academic hospitals and a pediatric intensive care unit in a third academic hospital were identified between October 1, 2014 and September 30, 2015. Medical records were reviewed to identify potential risk factors and sources of bacteremia. Two physicians used underlying patient factors, microorganism, and other clinical data to rate the preventability of each HOB event in an “ideal hospital” on a 6-point Likert scale. RESULTS: Medical records for 60 HOB events (20 in each hospital) were reviewed. The most common organisms were coagulase-negative Staphylococcus (28%) and Candida spp. (17%) (Figure 1). The most likely sources of bacteremia and fungemia included CLABSI (28%) and skin contaminants/commensals (17%) (Figure 2). Forty-nine percent of HOB events not attributed to skin commensals were rated as potentially preventable (Figure 3). Fifty percent of HOB events randomly sampled across 2 hospitals occurred in an intensive care unit. Central venous catheters, urinary catheters, and mechanical ventilation were present in the previous 2 days among 73%, 20%, and 25% of all HOB events, respectively. Only 10% of all HOB events occurred in a patient without an indwelling device. Only 20% of HOB events resulted in a National Healthcare Safety Network (NHSN) reported CLABSI. CONCLUSION: Half of HOB events are potentially preventable in this pilot study. HOB may be an indicator for a large number of preventable HAIs not currently measured by NHSN. Larger studies across a variety of hospital settings are needed assess the generalizability of these results the implications of HOB surveillance for infection prevention practices and patient outcomes. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2017-10-04 /pmc/articles/PMC5632060/ http://dx.doi.org/10.1093/ofid/ofx163.336 Text en © The Author 2017. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Dantes, Raymund
Rock, Clare
Milstone, Aaron M
Jacob, Jesse T
Chernetsky-Tejedor, Sheri
Harris, Anthony D
Leekha, Surbhi
Preventability of Hospital Onset Bacteremia and Fungemia: A Pilot Study of a Potential New Indicator of Healthcare-Associated Infections
title Preventability of Hospital Onset Bacteremia and Fungemia: A Pilot Study of a Potential New Indicator of Healthcare-Associated Infections
title_full Preventability of Hospital Onset Bacteremia and Fungemia: A Pilot Study of a Potential New Indicator of Healthcare-Associated Infections
title_fullStr Preventability of Hospital Onset Bacteremia and Fungemia: A Pilot Study of a Potential New Indicator of Healthcare-Associated Infections
title_full_unstemmed Preventability of Hospital Onset Bacteremia and Fungemia: A Pilot Study of a Potential New Indicator of Healthcare-Associated Infections
title_short Preventability of Hospital Onset Bacteremia and Fungemia: A Pilot Study of a Potential New Indicator of Healthcare-Associated Infections
title_sort preventability of hospital onset bacteremia and fungemia: a pilot study of a potential new indicator of healthcare-associated infections
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5632060/
http://dx.doi.org/10.1093/ofid/ofx163.336
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