By Kalvin Yu, MD, FIDSA, Vice President of Medical Affairs for North America

Clinical studies have reported that hospital onset bacteremia (HOB) and false-positive blood cultures can have significant impacts on outcomes, length of stay and cost of care. There is broad diversity of opinion about the leading sources of HOB, but there is consensus that different sources of HOB are preventable or partially preventable. That dichotomy illustrates why HOB might seem challenging; without clarity on its leading sources, it is difficult to optimize prevention efforts.

As part of an ongoing partnership, BD worked with the American Hospital Association (AHA) to heighten awareness of the salient issues regarding HOB through an AHA-conducted survey of 200 hospital leaders. The AHA recently published the results of the survey, which revealed the following perceptions of HOB: 

• 45% of respondents already were tracking HOB and another 20% planned to do so as soon as possible. The rest were waiting for specific developments (e.g., from the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention, the National Healthcare Safety Network [NHSN] or measure endorsement by the federal consensus-based entity).
   
• Central-line catheters and urinary sources (regardless of whether a catheter is used) are at the top tier of perceived HOB sources, followed by respiratory/pneumonia issues, with wounds, surgical-site complications, mechanical ventilation and skin and soft tissue infection at another level. It is notable that most perceived sources align with The Joint Commission and CMS reportable events and metrics. This fact was considered a starting point to help inform HOB prevention initiatives and may represent an opportunity for existing hospital associated infection initiatives and interdisciplinary teams to collaborate on HOB bundle efforts.
   
• Respondents identified best practices they would like included in an “HOB bundle.” These include more granular visibility to HOB sources and respective prevention measures, timely pathogen identification if HOB occurs and, lastly, improvement in time to definitive therapy for HOB cases.
   
• In light of the CMS Conditions of Participation requiring antimicrobial stewardship programs in March 2020 for acute care hospitals, respondents reported that streamlined microbiology lab workflows and communication with antimicrobial stewardship programs (ASPs) may help facilitate faster identification and therapy for HOB events.
   
• Respondents are optimistic that an HOB quality metric will improve patient safety and care, but expressed concerns about how metrics should be structured, achieving reporting consistency and the potential resources needed for reporting.

These findings underscore the need for additional work in standardizing prevention workflows and indexing on the laboratory-antimicrobial stewardship axis when HOB does occur. As hospitals continue to recover from the COVID-19 pandemic and manage their resources, the best practices that may mitigate a bacteremic event, and timely identification and commencement of appropriate therapy when it does occur will be critical in addressing HOB.

The full report can be accessed here. We will continue to share key insights on HOB trends and how hospital leaders can address them.