Beyond Central Lines and Foley Catheters: Unraveling Hospital-onset Bacteremia and Fungemia

Session Description: All United States hospitals track and report central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) via the National Healthcare Safety Network’s healthcare-associated infection tracking system. Recently, the Centers for Disease Control and Prevention has invited voluntary reporting of a new digital quality measure (dQM) for hospital-onset bacteremia and fungemia (HOB). Further, the Centers for Medicare and Medicaid Services has signaled its intention to employ dQMs in the Hospital-Acquired Condition Reduction Program. The expectation is that the current CLABSI measure (and some authors have included the methicillin-resistant Staphylococcus aureus measure) will ultimately be replaced by the HOB dQM.

The implications of a broader measure for bloodstream infections – one based on microbiology findings irrespective of organism or device – will be profound. Only 20 percent of all HOB is attributable to CLABSI. Of the identifiable sources of non-CLABSI HOB, the largest percentage of infections have a urinary source. Yet while 8 percent of CAUTIs progress to HOB, three times as many cases of HOB result from non-CAUTI hospital-onset urinary tract infections. Forward-thinking organizations will increase their attention of non-device-related infections as they work to mitigate all sources of HOB.

This session will examine HOB with special attention to the causes with the greatest potential for preventability. Early studies have suggested that two-thirds of HOB is preventable while recent research has estimated preventability to be 36 percent of non-commensal HOB events and 74 percent of commensal events. In addition, comprehensive HOB prevention strategies will be reviewed including the recently-released HOB Prevention and Care Implementation Guide from the National Quality Forum.