Prospective assessment of hospital-acquired bloosdstream infections: how many may be preventable?
OBJECTIVE
To determine the proportion of preventable hospital-acquired bloodstream infections (HA-BSIs), the authors prospectively examined consecutive cases in a large university hospital over an 18-month period.


METHODS
Medical charts were assessed with the physician in charge of the patient within 4&emsp14;days after HA-BSI diagnosis to determine whether the infection was healthcare-related. Preventability was assessed using a validated tool. Results of 378 HA-BSIs (incidence rate, 1.00 per 1000 patient-days), 341 were first HA-BSI episodes in a patient, and 272 (79.8%) were secondary to an identifiable source, of whom 196 (57.5%) were related to medical management. These 196 HA-BSIs were related to an invasive procedure (n=163), a non-invasive medical management (n=30) or both (n=3).


RESULTS
Of the 272 patients with HA-BSIs from identifiable sources, 55 (20.2%) had no underlying disease, 115 (42.3%) had an ultimately fatal underlying disease, 99 (36.4%) had a rapidly fatal disease, and three (1.1%) were not evaluated. Of the 196 iatrogenic HA-BSIs, 66 were considered preventable (most of them being related to an intravascular catheter), 84 were of uncertain preventability, and 46 were not preventable. In total, 66 of the 341 HA-BSIs (19.4%) were considered preventable, and 191 (56.0%) were not preventable.


CONCLUSIONS
Although evaluation of the preventability of hospital-associated adverse events has been reported to be difficult and of limited reliability, our simple method may help to identify wards or HA-BSI types that warrant in-depth evaluation.
Infection Control Unit, Bichat-Claude Bernard University Hospital, Assistance Publique-Hôpitaux de Paris, and Paris VII Denis Diderot University, Paris, France.
Christine
C
Bonnal
Bruno
B
Mourvillier
Régis
R
Bronchard
Danielle
D
de Paula
Laurence
L
Armand-Lefevre
François
F
L'heriteau
Jean-Luc
JL
Quenon
Jean-Christophe
JC
Lucet
D000368:Aged; D000369:Aged, 80 and over; D017848:Blood-Borne Pathogens / Q000302:isolation & purification*; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011446:Prospective Studies