Are SABs equally preventable? Development of a tool by Delphi method to help hospitals target the modifiable risk factors causing SAB infections
Ms Daniela Karanfilovska1, Prof Allen Cheng1,2,3, A/Prof Denis Spelman2, A/Prof Leon Worth1,2,4
1Infection Prevention & Healthcare Epidemiology Unit, Alfred Health, Melbourne, Australia
2Department of Infectious Diseases, Alfred Health, Melbourne, Australia
3Department of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
4Victorian Healthcare-Associated Infection Surveillance Coordinating Centre (VICNISS), Melbourne, Australia
Current surveillance definitions fail to account for modifiable and non-modifiable factors that contribute to healthcare-associated Staphylococcus aureus bloodstream infection (HA-SAB). We developed a tool to classify these infections by their degree of ‘preventability’ to assist organisations with targeting their responses at the most preventable HA-SABs.
The literature was reviewed for definitions of preventable harm and causative factors for HA-SAB, and a tool was drafted. A Delphi Technique was used to survey experts (n=11) in infection prevention (IP) to refine the tool. The completed tool was retrospectively piloted on HA-SAB events at Alfred Health (n=43).
Expert feedback was incorporated into the tool, with consensus achieved after four survey rounds. Three categories of HA-SAB, with tailored organisational responses for each classification, were established in the tool. ‘Highly preventable’ infections involved a clear breach in IP practices, and ‘possibly preventable’ infections were associated with healthcare interventions where a specific IP breach was not evident. ‘Not actionable’ events were those where the source of infection does not appear amenable to local change. Pilot application of the completed tool found that 56% of HA-SAB events were highly or possibly preventable, with modifiable factors not identified in the remainder of reviewed cases.
A Prevention Assessment and Response Tool was successfully developed using a Delphi Technique to assist organisations with investigating and responding to HA-SAB events, and to identify future priority areas for HA-SAB reductions. Wider use of the tool is required to evaluate utility and impact on patient outcomes.
Daniela is a senior infection prevention nurse consultant at Alfred Health in Melbourne, Victoria. Her key professional interests include vascular access, preventing infections in immunocompromised patients, and quality improvement and safety within healthcare organisations. Daniela completed the Master of Public Health at Monash University in 2018.