Personalized infection prevention and control: identifying patients at risk of healthcare-associated infection

S Stewart,C Robertson,S Kennedy,K Kavanagh,L Haahr,S Manoukian,H Mason,S Dancer,B Cook,J Reilly

doi:10.1016/j.jhin.2021.03.032

Abstract

Few healthcare-associated infection (HAI) studies focus on risk of HAI at the point of admission. Understanding this will enable planning and management of care with infection prevention at the heart of the patient journey from the point of admission. To determine intrinsic characteristics of patients at hospital admission and extrinsic events, during the two years preceding admission, that increase risk of developing HAI. An incidence survey of adults within two hospitals in NHS Scotland was undertaken for one year in 2018/19 as part of the Evaluation of Cost of Nosocomial Infection (ECONI) study. The primary outcome measure was developing any HAI using recognized case definitions. The cohort was derived from routine hospital episode data and linkage to community dispensed prescribing data. The risk factors present on admission observed as being the most significant for the acquisition of HAI were: being treated in a teaching hospital, increasing age, comorbidities of cancer, cardiovascular disease, chronic renal failure and diabetes; and emergency admission. Relative risk of developing HAI increased with intensive care unit, high-dependency unit, and surgical specialties, and surgery <30 days before admission and a total length of stay of >30 days in the two years to admission. Targeting patients at risk of HAI from the point of admission maximizes the potential for prevention, especially when extrinsic risk factors are known and managed. This study proposes a new approach to infection prevention and control (IPC), identifying those patients at greatest risk of developing a particular type of HAI who might be potential candidates for personalized IPC interventions.

Highlights

Healthcare-associated infections (HAIs) are a threat to patient safety; they affect patients in all healthcare settings contributing significantly to morbidity and mortality and cost of care [1,2]
63,890 admissions treated within study hospital during study period with length of stay (LOS) >1 day Excludes 17 HAI records that did not link*
More than half of the admissions had been admitted to hospital at least once in the preceding two years (54.5%) and more than onetenth (12.8%) were patients who had been in hospital for >30 days in the preceding two years

Summary

Introduction

Healthcare-associated infections (HAIs) are a threat to patient safety; they affect patients in all healthcare settings contributing significantly to morbidity and mortality and cost of care [1,2]. HAI describes multiple infection types that can affect any organ; these infections range from urinary tract infections to bloodstream infections (BSIs) [4] Risk factors for these vary, and as the incidence of HAI at the hospital population level is relatively low, specific infection prevention and control (IPC) measures should be targeted at individuals at increased risk of developing particular HAIs. Identifying and understanding potential risk factors is an essential step in reducing individual risk of developing HAI. Many risk factors have been described for specific populations, for example intensive care unit (ICU) patients’ risk of pneumonia [5e14] These studies are by nature retrospective and include risks encountered by patients until the point that they develop HAI. A recent systematic review identified a wide range of intrinsic and extrinsic risk factors and concluded that there was a need to identify patients who are most at risk of HAI, in order to maximize patient safety [19]

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