Hospital Onset Bacteremia

• Community-onset bacteremia rate per 100 admissions 

• Hospital-onset test intensity 

• Community-onset test intensity 

• Hospital-onset test prevalence 

• ICU admissions, % 

• Mean length-of-stay 

• Bed size 

• Patients aged 41-64y, % 

• Patients aged >80 y, % 

Reference: Yu KC, Ye G, Edwards JR, et al. Hospital-onset bacteremia and fungemia: An evaluation of predictors and feasibility of benchmarking comparing two risk-adjusted models among 267 hospitals. Infect Control Hosp Epidemiol 2002;43(10):1317–1325. 

References: 

1. Surbhi Leekha, Robinson GL, Jacob JT, et al. Evaluation of hospital-onset bacteraemia and fungaemia in the USA as a potential healthcare quality measure: a cross-sectional study. BMJ Quality & Safety. 2024;33(8):487–498.  
2.  Centers for Disease Control and Prevention. Current HAI progress report. Published November 4, 2022. Available at: Current HAI Progress Report | HAIs | CDC

 Recommendations: 

1. Healthcare facilities should maintain standardized processes for appropriate blood culture collection when bloodstream infection is clinically suspected, including adherence to recommended specimen collection techniques to reduce contamination and improve diagnostic accuracy [1]. 
2. When a patient develops a first positive blood culture on or after hospital day 4, clinical teams should evaluate the patient for potential sources of infection, including assessment of invasive devices, recent procedures, and other possible healthcare-associated exposures [1, 2]. 
3. Clinical management should include prompt initiation of antimicrobial therapy when bloodstream infection is suspected, followed by reassessment and modification of therapy based on microbiologic results and the patient’s clinical response, consistent with antimicrobial stewardship principles [1, 2]. 

References: 

1. National Quality Forum. Hospital‑Onset Bacteremia and Fungemia Playbook. Washington, DC; 2024. 
2. Dantes RB, Abbo LM, Anderson D, et al. Hospital epidemiologists’ and infection preventionists’ opinions regarding hospital-onset bacteremia and fungemia as a potential healthcare-associated infection metric. Infect Control Hosp Epidemiol. 2019;40(5):536-540. 

• A patient can have a single HOB event per Hospital Stay 

• The date for the HOB will be attributed to the earliest date that a blood specimen is collected that has a bacterial or fungal organism identified on or after hospital day 4 

• HOB Infection Timeframe: Any subsequent positive blood culture findings during the subsequent 14 days will be considered part of the initial HOB event 

Refer to the NHSN Bacteremia & Fungemia Surveillance Module Protocol for a complete list of definitions.  

For the purposes of this measure, hospital-onset events are identified based on the timing of specimen collection. A blood culture specimen collected on or after hospital day 4 (where the day of admission is hospital day 1) may indicate a potential hospital-onset bacteremia or fungemia event. 

Interpretation of positive blood cultures should consider the identified organism and clinical context, as some organisms may represent contamination related to specimen collection rather than true bloodstream infection. Facilities should evaluate microbiology results in accordance with established infection surveillance and laboratory practices. 

All relevant and laboratory and microbiology data (orders and results) should be available within the EHR and exposed using the FHIR Release 4 standard. Microbiology test results should be codified using HL7 standardized terminology (e.g., appropriate laboratory and organism codes) to support consistent identification of eligible results across systems. Refer to the NHSN dQM Overview of Required FHIR Resources and Standards Adherence for additional information. 

This version of the measure uses the  Acute Care Hospital (ACH) Monthly Reporting Profiles in the NHSN dQM Content Package IG. Please refer to the NHSN FHIR Portal for additional information on FHIR-based digital quality measures. 

Refer to the NHSN dQM Reporting Implementation Guide for the standard framework for reporting data to NHSN using a dQM with an initial population of inpatient, emergency department, and observation encounters. 

An HOB event occurs when a patient has a bacterial or fungal organism identified from a blood specimen collected on the 4th calendar day of admission or later (where the date of admission to an inpatient location is calendar day 1).  

• A patient can have a single HOB event per Hospital Stay 

• The date for the HOB will be attributed to the earliest date that a blood specimen is collected that has a bacterial or fungal organism identified on or after hospital day 4 

1. Bacterial skin commensals: The organism must NOT be included in the value set for bacterial skin commensals. 
2. Previous matching COB or O-COB Event: A bacterial or fungal organism identified from a blood culture collected on hospital day 4 or later is excluded from an HOB event if the patient has an O-COB or COB event during the same Hospital Stay with at least one matching organism.  
3. Previous HOB event: A patient with a previous HOB event is excluded from additional HOB events during the same Hospital Stay. 

O-COB: Outpatient Community-onset Bacteremia & Fungemia Event 

COB: Community-onset Bacteremia & Fungemia Event