Only 13% of hospital-onset sepsis cases met current U.S. criteria for reportable healthcare-associated infections, but an expanded surveillance system could catch many of these potentially preventable events, a recent study found.
The study, published Sept. 17 in JAMA Network Open, analyzed 558,037 admissions of adults 18 and older at nine Mass General Brigham acute care hospitals between January 2021 and December 2023. Patients with hospital-onset sepsis were identified using the CDC’s Adult Sepsis Event criteria. In total, 5,212 patients, or 0.9%, had hospital-onset sepsis. Researchers randomly selected 250 cases for detailed record reviews by two physicians to determine the likelihood and source of infection. Then 100 infection-related cases were selected for preventability assessments considering patients’ intrinsic risks and extrinsic healthcare-related factors.
“Hospital-onset sepsis events identify serious complications of hospitalization that are largely missed by current HAI surveillance programs yet are highly morbid and often preventable,” the study’s authors wrote. “Hospital-onset sepsis surveillance could provide a more comprehensive framework for identifying preventable harms and expanding opportunities for quality improvement.”
Here are seven findings.
1. Of 250 events reviewed, 198 were deemed attributable to infections and 52 to noninfectious conditions.
2. Ninety-three of the 250 patients, or 37%, died in the hospital.
3. Respiratory infections were the source of 56% of infection-related events, followed by primary bloodstream infections at 17% and intra-abdominal infections at 15%.
4. Only 25 of the 198 events, or 13%, met surveillance criteria for currently reportable HAIs, and only 44 events, or 22%, had positive blood cultures with hospital-onset bacteremia.
5. Among 100 cases evaluated for preventability, 31% were potentially preventable.
6. Missed opportunities in early infection management included delays in subspecialty consultation in 12% of preventability cases, source control in 10% and microbiologic investigation in 5%.
7. Other medical care gaps included inadequate treatment of constipation, which led to urinary retention or stercoral colitis that triggered sepsis, in 5% of events, and suboptimal management of fluid overload, which led to progressive respiratory failure, in 2%.
