using diagnosis code , you ’ ll find that there are variables between hospitals and in many cases is far below what you might see from clinical data directly . The other thing is that changes in coding thresholds are evolving over time ; they can be an unreliable basis for surveillance . Luckily , the CDC has come to the rescue . It has created a much better way for us to conduct surveillance for sepsis , and that is using their EHR-based surveillance definition for sepsis called ‘ Adult Sepsis Events .’” Klompas said that it uses detailed EHR-data to identify patients with suspected infection and organ dysfunction ( an implementation toolkit is available that describes the required data elements , how to organize them , and provides analytic code for event detection at : cdc . gov / sepsis / clinicaltools ).
Just how does hospital-onset Adult Sepsis Event surveillance compare to current reportable conditions ? “ My colleagues and I have been answering this question by retrospectively applying the HO-ASE criteria to EHR data from 282,441 hospitalizations in three hospitals and compared case counts , overlap , and mortality for CLABSI , CAUTI , C . difficile , MRSA bacteremia , and SSI ,” Klompas said . “ The number of patients with HO-ASE is enormous , just under 2,500 , much higher compared to CLABSI , CAUTI , SSI , HO-MRSA and HO-CDI . We also looked at the mortality rates and for HO-ASE it was also very high compared to SSI , CAUTI and CLABSI , although less so for HO-MRSA at just over 1,500 cases . HO-ASE is revealing a very large set of patients who right now we are missing from our current surveillance strategy and who have very bad outcomes and should be on our radars so that we can design prevention programs around them . All told , we found
2,301 hospital-onset Adult Sepsis Events , with 0.8 events per 100 hospitalizations , and 28.9 percent mortality . Contrast this 1,260 reportable HAIs , with 0.4 events per 100 hospitalizations and 12.9 percent mortality . The overlap was even smaller , with 334 HAIs and 31 percent mortality . In essence , HO-ASE identified a large number of high-mortality hospital-onset infections missed by current reportables .”
Klompas continued , “ Are we finding the appropriate events ? Are we finding the serious events that merit the concentration , the focus , the effort that we put into it while some of the downstream public reporting benchmarking and pay-for-performance criteria that is tied to some of these metrics . Although I think there are limitations to our reportables , I am not necessarily arguing that we connect them all together , particularly in the current COVID-19 era when we are seeing a significant increase in the SIR of CLABSI . Certainly , this is not the time to let go of these other reportables , but I think what this analysis reveals is that there is a larger world of very serious HAIs that we are missing , and yet new technologies in the electronic age are allowing us a pathway toward identifying them , capturing them and putting them under surveillance .”
References :
CDC . 2019 National and State Healthcare-Associated Infections Progress Report . Dixon RE . Control of Healthcare-Associated Infections , 1961-2011 . Morbidity and Mortality Weekly Report . Oct . 7 , 2011 / 60 ( 04 ); 58-63
SHEA Decennial Day 2021 plenary session . Data for Action : The Future of Surveillance for Healthcare-Associated Infections and Antimicrobial Resistance . April 12 , 2021 .
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