Clinical Report: Establishing a Framework for National Monitoring of HAI

Background

Healthcare-associated infections (HAIs) have seen a significant decline in the US, with a 27% reduction in prevalence from 2015 to 2023. Despite this progress, the majority of HAIs are now unrelated to medical devices or surgical procedures. Hospital-onset bacteremia and fungemia (HOB) provides a broader framework for monitoring these infections.

Data Highlights

Key Findings

• HOB captures nosocomial bloodstream infections without regard to device presence or recent procedures.
• Elevated HOB rates are associated with factors such as long-term dialysis and active malignant neoplasm.
• 71.1% of the variance in HOB event rates can be explained by patient and hospital characteristics.
• Substantial between-hospital variation in HOB rates persists even after adjustment for characteristics.
• Monitoring blood culture contamination is crucial due to its clinical consequences for patients.

Clinical Implications

The findings suggest that HOB can serve as an effective quality measure for monitoring HAIs, particularly as central line-associated bloodstream infection rates decline. Enhanced surveillance and understanding of HOB can inform prevention strategies and improve patient outcomes.

Conclusion

The establishment of HOB as a quality measure addresses a critical gap in HAI surveillance, reflecting the need for comprehensive monitoring of hospital-acquired infections.

Related Resources & Content

1. Bedard-Lapointe et al., Ontario Health Insurance Plan, 2024 -- Establishing a Framework for National Monitoring of HAI
2. Epidemiological Analysis of Bloodstream Infections Acquired in Hospitals Among Haemato-Oncology Patients in Geneva, Switzerland
3. Influence of Institutional and National Factors on Process and Outcome Metrics in Critically Ill Patients with Hospital-Acquired Bloodstream Infections
4. Surveillance Strategies and Definitions for Healthcare-Associated Infections in Intensive Care Units by the ECDC
5. Infection — Guidelines from the German Society for Infectious Diseases on Promoting Rational Antibiotic Use in Hospitals
6. NHSN Bacteremia & Fungemia Surveillance: Hospital Onset Bacteremia | NHSN | CDC
7. Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals – SHEA
8. Surveillance for Candida auris — United States, 2022–2024