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

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.

Preventing nosocomial bloodstream infections (NBSIs) by implementing hospitalwide, department-level, self-investigations: A NBSIs frontline ownership intervention

“…Several studies addressed preventable risk factors for NBSI acquisition in hospitalwide settings in recent years; most were based on evaluations by infection control professionals. 10–12 These findings bring a new perspective on the importance of including patients’ personal care providers (physicians and nurses without formal expertise in infection control activities) in the process of investigating NBSI events hospitalwide and daily, and they demonstrate self-investigation reduce NBSI rates.…”

“…However, data focusing on specific educational interventions to reduce NBSI events in hospitalwide settings are limited. [7][8][9][10][11][12][13][14] Increasing staff awareness of preventable NBSI risk factors is a crucial step in reducing NBSI incidence. We assumed that selfinvestigation of NBSI events, conducted by healthcare providers (physicians and nurses without formal training in infection control practice) of patients who acquired NBSI "under their watch," might effectively increase staff awareness.…”

Epidemiology and preventability of hospital-onset bacteremia and fungemia in 2 hospitals in India

“…A framework to determine the preventability of an HOB event was adapted from US studies 2 , 4 by including medical conditions encountered in LMICs (Supplementary Table ). Then, 10 subject-matter experts (Supplementary Table ) evaluated the HOB preventability framework through an online survey and an in-person meeting that was held on November 20, 2019, at Washington University School of Medicine in St. Louis.…”

Evaluation of hospital-onset bacteraemia and fungaemia in the USA as a potential healthcare quality measure: a cross-sectional study

“…Therefore, prior to embarking on a larger evaluation of HOB, we developed and applied an expert consensus approach to refine and validate a preventability assessment guide for HOB. 6 The objectives of the current study were (1) to determine the sources of HOB in a large, diverse sample of hospitalised patients in the USA, (2) to estimate the proportion of cases perceived to be preventable using the validated assessment guide and (3) to identify factors associated with perceived preventability. The results of this study will advance an understanding of prevention opportunities related to HOB and inform development of an appropriate subset of HOB as a potential quality measure.…”