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

• Type of Material: Article
• Authors: Gregory M Schrank, University of Maryland Baltimore; Anna Sick-Samuels, Johns Hopkins University; Susan C Bleasdale, University of Illinois at Chicago; Jesse Jacob, Emory University; Raymund Dantes, Emory University; Runa H Gokhale, Centers for Disease Control and Prevention, Atlanta; Jeanmarie Mayer, University of Utah; Preeti Mehrotra, Harvard Medical School; Sapna A Mehta, NYU Grossman School of Medicine; Alfredo Mena J Lora, University of Illinois at Chicago; Susan Ray, Emory University; Chanu Rhee, Harvard Medical School; Jorge L Salinas, University of Iowa Hospital & Clinics; Susan K Seo, Joan and Sanford Weil Cornell Medical College; Andi L Shane, Emory University; Gita Nadimpalli, University of Maryland, Baltimore; Aaron M Milstone, Johns Hopkins University; Gwen Robinson, University of Maryland, Baltimore; Clayton H Brown, University of Maryland, Baltimore; Anthony D Harris, University of Maryland, Baltimore; Surbhi Leekha, University of Maryland, Baltimore
• Language: English
• Date: 2022-01-28
• Publisher: CAMBRIDGE UNIV PRESS
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1017/ice.2021.528
• Title of Journal or Parent Work: INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY
• Volume: 43
• Issue: 10
• Start Page: 1326
• End Page: 1332
• Grant/Funding Information: This work was supported by the Centers for Disease Control and Prevention Epicenters Program (U01CK000556-01). S.K.S. is supported in part by the NIH/NCI Cancer Center support grant (P30 CA008748).
• Keywords: QUALITY; AGREEMENT; BLOOD-STREAM INFECTIONS; SURVEILLANCE; Public, Environmental & Occupational Health; Life Sciences & Biomedicine; Infectious Diseases; CARE-ASSOCIATED INFECTIONS; Science & Technology

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.