Surveillance for Healthcare-Associated Infections: Hospital-Onset Adult Sepsis Events Versus Current Reportable Conditions. (29th March 2021)

• Record Type: Journal Article
• Authors: Page, Brady; Klompas, Michael; Chan, Christina; Filbin, Michael R; Dutta, Sayon; McEvoy, Dustin S; Clark, Roger; Leibowitz, Matthew; Rhee, Chanu
• Is Part Of: Clinical infectious diseases. Volume 73:Number 6(2021)
• Page Start: 1013
• Page End: 1019
• Publication Date: 2021-03-29
• Subjects: sepsis -- healthcare-associated infections -- adult sepsis event -- surveillance; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciab217
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: US hospitals are required by the Centers for Medicare and Medicaid Services to publicly report central line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), Clostridioides diffficile, methicillin-resistant Staphylococcus aureus bacteremia, and selected surgical site infections for benchmarking and pay-for-performance programs. It is unclear, however, to what extent these conditions capture the full breadth of serious healthcare-associated infections (HAIs). The Centers for Disease Control and Prevention's (CDC's) hospital-onset Adult Sepsis Event (HO-ASE) definition could facilitate more comprehensive and efficient surveillance for serious HAIs, but the overlap between HO-ASE and currently reportable HAIs is unknown. Methods: We retrospectively assessed the overlap between HO-ASEs and reportable HAIs among adults hospitalized between June 2015–June 2018 in 3 hospitals. Medical record reviews were conducted for 110 randomly selected HO-ASE cases to determine clinical correlates. Results: Among 282 441 hospitalized patients, 2301 (0.8%) met HO-ASE criteria and 1260 (0.4%) had reportable HAIs. In-hospital mortality rates were higher with HO-ASEs than reportable HAIs (28.6% vs 12.9%). Mortality rates for HO-ASE missed by reportable HAIs were substantially higher than mortality rates for reportable HAIs missed by HO-ASE (28.1% vs 6.3%). Reportable HAIs were only present in 334/2301 (14.5%) HO-ASEs, most commonly CLABSIs (6.0% of HO-ASEs), C. difficile (5.0%), and CAUTIs (3.0%). On medical record review, most HO-ASEs were caused by pneumonia (39.1%, of which only 34.9% were ventilator-associated), bloodstream infections (17.4%, of which only 10.5% were central line–associated), non– C. difficile intra-abdominal infections (14.5%), urinary infections (7.3%, of which 87.5% were catheter-associated), and skin/soft tissue infections (6.4%). Conclusions: CDC's HO-ASE definition detects many serious nosocomial infections missed by currently reportable HAIs. HO-ASE surveillance could increase the efficiency and clinical significance of surveillance while identifying new targets for prevention. Abstract : Centers for Disease Control and Preventions hospital-onset Adult Sepsis Event (HO-ASE) surveillance criteria detect many serious nosocomial infections missed by current healthcare-associated infection surveillance and reporting metrics. Routine HO-ASE surveillance could increase surveillance efficiency and completeness while identifying new targets for prevention and quality improvement.