Summary
Background
Healthcare-associated Staphylococcus aureus bloodstream infection (HA-SAB) causes preventable harm in hospitalized patients.
Currently, there is no standardized method available to review HA-SAB events in order
to identify and target preventable risks requiring action at an organizational level.
Aim
To develop a tool to classify SAB events, and the necessary response actions, according
to the degree of preventability.
Methods
Following a literature review, a tool was developed. Consensus feedback and development
of the tool was sought from experts (N = 11) in healthcare-associated infection surveillance using a Delphi technique. The
completed tool was retrospectively applied to HA-SAB events (N = 43) that occurred at a large healthcare organization.
Findings
Survey completion rates were high (91–100%). Clinicians' poor adherence to infection
prevention practices and lack of engagement with feedback processes was established
as the key modifiable element. A second key theme was the need for structured and
detailed response actions. This feedback was incorporated into the tool and refined
until consensus on all elements was achieved. Pilot application of the tool found
that 56% of HA-SAB events were highly or possibly preventable; modifiable factors
for HA-SAB prevention were not present in the remainder of cases.
Conclusion
A prevention assessment and response tool was successfully developed via a consensus
method to assist organizations in investigating and responding to individual cases
of HA-SAB and identify future priority areas for SAB reduction strategies. Wider use
of the tool with routine surveillance activities is required to evaluate impact upon
infection prevention programmes and patient outcomes.
Keywords
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References
- Staphylococcus aureus bacteremia: epidemiology, pathophysiology, and management strategies.Clin Infect Dis. 2009; 48 (S231–7)https://doi.org/10.1086/598189
- Bloodstream infections associated with hospital care 2017–18: Australian hospital statistics.2019 (Available at:) ([last accessed March 2019])
- Risk factors and mortality of healthcare-associated and community-acquired Staphylococcus aureus bacteraemia.Clin Microbiol Infect. 2012; 18: 862-869https://doi.org/10.1111/j.1469-0691.2011.03679.x
- Predictors of mortality in Staphylococcus aureus bacteremia.Clin Microbiol Rev. 2012; 25: 362-386https://doi.org/10.1128/CMR.05022-11
- Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management.Clin Microbiol Rev. 2015; 28: 603-661https://doi.org/10.1128/cmr.00134-14
- Feedback to clinicians on preventable factors can reduce hospital onset Staphylococcus aureus bacteraemia rates.J Hosp Infect. 2011; 79: 108-114https://doi.org/10.1016/j.jhin.2011.04.023
- Predictors of nosocomial bloodstream infections in older adults.J Am Geriatr Soc. 2011; 59: 622-627https://doi.org/10.1111/j.1532-5415.2010.03289.x
- Risk factors for health care-associated infections: from better knowledge to better prevention.Am J Infect Control. 2017; 45 (e103–e7)https://doi.org/10.1016/j.ajic.2017.03.036
- Predicting hospital-acquired infections by scoring system with simple parameters.PLoS One. 2011; 6e23137https://doi.org/10.1371/journal.pone.0023137
- Central line-associated bloodstream infections in Australian ICUs: evaluating modifiable and non-modifiable risks in Victorian healthcare facilities.Epidemiol Infect. 2017; 145: 3047-3055https://doi.org/10.1017/S095026881700187X
- Preventability of hospital onset bacteremia and fungemia: a pilot study of a potential healthcare-associated infection outcome measure.Infect Control Hosp Epidemiol. 2019; 40: 358-361https://doi.org/10.1017/ice.2018.339
- Implementation guide for surveillance of Staphylococcus aureus bacteraemia.2011 (Available at:) ([last accessed February 2019])
- The Delphi technique: myths and realities.J Adv Nurs. 2003; 41: 376-382https://doi.org/10.1046/j.1365-2648.2003.02537.x
- The Delphi method as a research tool: an example, design considerations and applications.Inform Manag. 2004; 42: 15-29https://doi.org/10.1016/j.im.2003.11.002
- The role of public health surveillance: information for effective action in public health.Morb Mortal Wkly Rep. 1992; 41: 207-218
- What is preventable harm in healthcare? A systematic review of definitions.BMC Health Serv Res. 2012; 12: 128https://doi.org/10.1186/1472-6963-12-128
- Reporting of healthcare-associated Staphylococcus aureus bloodstream infections as a severity assessment code 1 (SAC1).2018 (Available at:) ([last accessed February 2020])
- Zero risk for CLABSI … is this realistic?.Crit Care Med. 2012; 40: 657-658https://doi.org/10.1097/CCM.0b013e3182372ba6
- Zero tolerance for healthcare-associated MRSA bacteraemia: is it realistic?.J Antimicrob Chemother. 2014; 69: 2238-2245https://doi.org/10.1093/jac/dku128
- The preventable proportion of nosocomial infections: an overview of published reports.J Hosp Infect. 2003; 54: 258-266https://doi.org/10.1016/S0195-6701(03)00150-6
- Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs.Infect Control Hosp Epidemiol. 2011; 32: 101-114https://doi.org/10.1086/657912
- “Never events”: not every hospital-acquired infection is preventable.Clin Infect Dis. 2009; 49: 743-746https://doi.org/10.1086/604719
- The “zero risk” concept for hospital-acquired infections: a risky business!.Clin Infect Dis. 2009; 49: 747-749https://doi.org/10.1086/604720
Article info
Publication history
Published online: June 11, 2021
Accepted:
June 5,
2021
Received:
April 9,
2021
Identification
Copyright
© 2021 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
