Infection Control & Hospital Epidemiology
judged to be potentially preventable with current recommenda- tions in an ideal healthcare setting. For HOB to serve as a meaningful and actionable quality mea-
sure, a substantial and quantifiable proportion of these events should be preventable with good clinical care and infection preven- tion practices. In this study, to judgeHOBpreventability, physician adjudicators weighed the underlying patient susceptibility and the preventability of the microorganism and source of infection. To simplify this process, we created a grid with suggested preventabil- ity ratings based on these 2 dimensions of susceptibility and infec- tion type (Fig. 1).Weacknowledge that our list of clinical scenarios was not exhaustive, and an important qualitative finding was the need to develop expert consensus using a systematic framework to determine the preventability of a wider range of potential HOB clinical scenarios. Standardized provider training and calculation of interrater reliability was not assessed in this pilot study but should be performed in a larger study. The role of skin commensal organisms in an HOB measure
must also be considered; nearly one-third of bacteremia events in this study and 38% of bacteremias among already hospitalized patients in another study were due to skin commensal organisms.7 Because skin commensal bacteremia events most often do not re- present true infection, arguably these may not “count” the same as noncommensal bacteremias in a quality measure. However, blood cultures with skincommensals are often initially interpreted as true infections, and they frequently result in unnecessary antibiotic use and prolonged hospitalization.8,9 Furthermore, skin commensal contamination is preventable with proper blood culture collection techniques, and reduction of blood culture contamination is a rel- evant goal for quality improvement.10 An important finding of this study is that only 20% of HOB
events resulted in an NHSN-reported CLABSI, suggesting that HOBevents beyond CLABSIs are preventable and should be evalu- ated as targets for prevention. Although broad generalizations about microorganisms, clinical sources, and preventability cannot be drawn from this limited study, we demonstrated an approach for assessing preventability of HOB events. Larger studies across a variety of hospital settings are needed to assess the generalizabil- ity of these results, understand current risk factors for HOB, and develop prevention strategies.
Author ORCIDs. Raymund B. Dantes, 0000-0002-6726-6343
361
Acknowledgments. The findings and conclusions are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Financial support. C.R., A.M.M., J.T.J., A.D.H., and S.L. are supported by the Centers for Disease Control Prevention Epicenters Program. A.D.H. is also sup- ported by the National Institutes of Health (grant no. 5K24AI079040-05).
Conflicts of interest. The authors report no financial conflicts of interest related to this article.
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