Abstract
IntroductionThe contribution of healthcare-associated infections (HAI) to mortality can be estimated using statistical methods, but mortality review (MR) is better suited for routine use in clinical settings. The European Centre for Disease Prevention and Control recently introduced MR into its HAI surveillance.AimWe evaluate validity and reproducibility of three MR measures.MethodsThe on-site investigator, usually an infection prevention and control doctor, and the clinician in charge of the patient independently reviewed records of deceased patients with bloodstream infection (BSI), pneumonia, Clostridioides difficile infection (CDI) or surgical site infection (SSI), and assessed the contribution to death using 3CAT: definitely/possibly/no contribution to death; WHOCAT: sole cause/part of causal sequence but not sufficient on its own/contributory cause but unrelated to condition causing death/no contribution, based on the World Health Organization’s death certificate; QUANT: Likert scale: 0 (no contribution) to 10 (definitely cause of death). Inter-rater reliability was assessed with weighted kappa (wk) and intra-cluster correlation coefficient (ICC). Reviewers rated the fit of the measures.ResultsFrom 2017 to 2018, 24 hospitals (11 countries) recorded 291 cases: 87 BSI, 113 pneumonia , 71 CDI and 20 SSI. The inter-rater reliability was: 3CAT wk 0.68 (95% confidence interval (CI): 0.61–0.75); WHOCAT wk 0.65 (95% CI: 0.58–0.73); QUANT ICC 0.76 (95% CI: 0.71–0.81). Inter-rater reliability ranged from 0.72 for pneumonia to 0.52 for CDI. All three measures fitted ‘reasonably’ or ‘well’ in > 88%.ConclusionFeasibility, validity and reproducibility of these MR measures was acceptable for use in HAI surveillance.
Highlights
The contribution of healthcare-associated infections (HAI) to mortality can be estimated using statistical methods, but mortality review (MR) is better suited for routine use in clinical settings
Clostridioides difficile infection were selected for evaluation as these HAI are recorded within two HAINet modules (European surveillance of healthcareassociated infections in intensive care units [13] and European surveillance of C. difficile infections [14]) and are both frequent and associated with increased mortality [2]
Our study demonstrated that the inter-rater reliability of three mortality review measures for the contribution of HAI to death, measured with wk and percentage agreement, was moderate to strong, depending on the type of HAI
Summary
The contribution of healthcare-associated infections (HAI) to mortality can be estimated using statistical methods, but mortality review (MR) is better suited for routine use in clinical settings. Methods: The on-site investigator, usually an infection prevention and control doctor, and the clinician in charge of the patient independently reviewed records of deceased patients with bloodstream infection (BSI), pneumonia, Clostridioides difficile infection (CDI) or surgical site infection (SSI), and assessed the contribution to death using 3CAT: definitely/possibly/. Healthcare-associated infections (HAI) are a major public health problem affecting more than 90,000 patients on any given day in European acute care hospitals, which results in an estimated 4.5 million cases each year [1]. The attributable mortality of HAI is difficult to assess because of various competing causes of death in severely ill patients, especially in intensive care units (ICU). Potential sources of bias, such as heterogeneity in multicentre studies and time-dependency of the observed outcome, need to be taken into account [5,9], and the results can be difficult
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