Hospital Onset Bacteremia: Addressing the Silent Threat to Patient Safety
Hospital Onset Bacteremia (HOB) is a significant and evolving challenge in healthcare settings. As healthcare-associated infections (HAIs) have long been a focus of prevention programs, HOB represents a broader and increasingly relevant threat, calling for comprehensive surveillance and prevention initiatives. Here, we delve into the current landscape of HOB, why it matters, and how healthcare facilities can adapt to meet these challenges.
Understanding HOB: Beyond CLABSI
HOB encompasses bloodstream infections identified on or after day four of hospital admission, whether associated with vascular access devices (VADs) or not. Unlike central line-associated bloodstream infections (CLABSIs), which are device-specific, HOB adopts a wider lens to include all causes of bloodstream infections, reflecting a more comprehensive quality metric.
The Impact of HOB: Costs, Outcomes, and Quality Metrics
Recent studies show that HOB cases, whether CLABSI or non-CLABSI, result in increased lengths of stay, higher hospital costs, and elevated mortality rates. Non-CLABSI cases occur approximately four times more often compared to CLABSI cases, highlighting the need for change for devices beyond central lines.[1]
Implementing HOB as a quality indicator will capture a wider patient population and potentially promote harm reduction initiatives. The Centers for Medicare & Medicaid Services (CMS) have proposed expanding surveillance and payment adjustments tied to HOB outcomes, underscoring the urgency for hospitals to adopt preventive measures and this is currently under testing with volunteering facilities.
Key Contributors to HOB
HOB often stems from gaps in infection prevention practices, challenges in maintaining sterile techniques, and insufficient resources for vascular access device management. The COVID-19 pandemic exacerbated these issues, with a focus on simply keeping patients safe and hospitals up and running, we saw an in increase in infection and a decrease in trained staff.[2]
The Role of Innovative Technology in Preventing HOB
Vascular access devices play a critical role in patient care, but they also represent significant risk factors for HOB. At Access Vascular Inc. (AVI), we are addressing this challenge with our novel catheter material designed to reduce thrombus. Devices such as our HydroPICC® and HydroMID® catheters leverage proprietary MIMIX® technology to deliver superior performance in reducing complications associated with vascular access. These advancements exemplify the innovative approaches needed to improve patient outcomes and reduce the burden of HOB in healthcare settings.
Much of the HOB reporting to CMS is anticipated to be automated. This means the infection prevention staff that normally adjudicates potential CLABSI to determine the root cause – and whether the suspected CLABSI is in fact reportable – will no longer have that option. HOB reporting will be integrated into the hospital data stream, and any adjudication activities will need to take place post-submission. Whether or not reported numbers can be adjusted based on the later fact-finding is yet to be determined.
So the technology question again is whether having another layer of support or protection or even defense through your vascular access device could help in this process – both for the sake of the patients and the facility.
Core Components of HOB Prevention Programs
Addressing HOB requires a multi-faceted approach involving technical expertise, leadership, and team-based collaboration. Effective prevention strategies include:
Comprehensive VAD Lifecycle Management: From selection and insertion to maintenance and removal, each phase presents opportunities for infection prevention.
Implementation of Preventive Bundles: Standardized approaches incorporating advanced antimicrobial dressings, ultrasound-guided placements, and patient decolonization practices.
Staffing and Education: Adequate training for vascular access specialists and infection preventionists is critical for sustaining high compliance with preventive practices.
Diagnostic Stewardship: Leveraging advanced diagnostic tools to ensure timely and accurate identification of infections.
Data Utilization: Real-time monitoring and analysis of infection trends to guide decision-making and policy development.
The Path Forward: Building HOB Prevention Teams
Creating an effective HOB prevention program hinges on assembling a multidisciplinary team, including infection preventionists, vascular access managers, clinical staff, microbiology experts, and quality improvement professionals. Collaboration across these roles ensures a holistic approach to tackling HOB, improving patient outcomes, and reducing healthcare costs.
What’s Next
As the healthcare landscape continues to evolve, addressing HOB is a priority – for patients, for hospitals and clinicians. At Access Vascular, we are committed to advancing vascular access with our team of vascular access educators and our unprecedented technology that directly supports patient care.
If you’d like to learn more, here are a list of key resources that might help you explore this issue further:
References
1. Yu, et al. Characteristics, costs, and outcomes associated with central-line–associated bloodstream infection and hospital-onset bacteremia and fungemia in US hospitals. ICHE 2023.
2. Garcia et al.Recommendations for Change in Infection Prevention Programs and Practice. AJIC 2022.