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

Development and evaluation of a structured guide to assess the preventability of hospital-onset bacteremia and fungemia. Infection control and hospital epidemiology Schrank, G. M., Sick-Samuels, A., Bleasdale, S. C., Jacob, J. T., Dantes, R., Gokhale, R. H., Mayer, J., Mehrotra, P., Mehta, S. A., Mena Lora, A. J., Ray, S. M., Rhee, C., Salinas, J. L., Seo, S. K., Shane, A. L., Nadimpalli, G., Milstone, A. M., Robinson, G., Brown, C. H., Harris, A. D., Leekha, S., CDC Prevention Epicenters Program 1800: 1-7

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 kappa (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 (kappa, 0.76; 95% confidence interval [CI], 0.64-0.88]) and 87% (kappa, 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.

View details for DOI 10.1017/ice.2021.528

View details for PubMedID 35086601