What question did this study set out to answer?

To quantify and investigate the causes of hospital-onset bacteremia and fungemia in a large academic healthcare system.

January 14, 2026Open Forum Infectious Diseases0 citationsOpen Access

A New Strategy Against Healthcare-Associated Infections: A Tertiary Academic Healthcare System-wide Surveillance of Hospital-Onset Bacteremia and Fungemia

SJSean H P JungUniversity of San Diego AFAryeh FeldheimUC San Diego Health System SAShira AbelesUniversity of California, San Diego

Key Points

To quantify and investigate the causes of hospital-onset bacteremia and fungemia in a large academic healthcare system.
Retrospective review of hospital-onset bacteremia and fungemia events from 7/1/23 to 6/30/24.
Events defined by bacterial or fungal pathogens isolated from blood cultures collected on the 4th calendar day of admission or later.
Used NHSN laboratory-confirmed bloodstream infection (LCBI)-2 definition to identify true infections versus contamination.
Identified a total of 381 bacteremia events, with 340 potential hospital-onset events.
Reported 82 events as healthcare-associated infections, with 10 deemed contamination.
Surveillance highlighted a number of clinically relevant device-associated bloodstream infections that were excluded from NHSN reporting.

Abstract

Abstract Background Healthcare-associated infections (HAIs) are recognized as a substantial cause of preventable harm and are associated with excess morbidity and mortality in patients. National Healthcare Safety Network(NHSN) has proposed surveillance of Hospital-onset Bacteremia and Fungemia (HOB) to increase the yield of bloodstream infections (BSI) and care improvement opportunities in acute care hospitals. We sought to quantify and investigate the causes of HOBs at a large academic acute care hospital system.Table 1.Admissions with HOB EventsNote: Number, (Percentage) Methods HOB events, defined as bacterial or fungal pathogens isolated from a blood culture collected between 7/1/23 and 6/30/24 on the 4th calendar day of admission (HD4) or later, were retrospectively reviewed. Only one event was recorded per admission. The NHSN laboratory-confirmed bloodstream infection (LCBI)-2 definition was used to distinguish contamination from infection due to common commensals.Table 2.Total HOBs Events with Clinical SignificanceNote: Number, (Percentage). HOB = Hospital-Onset Bacteremia and Fungemia. Device-Associated = Peripheral intravenous catheter or Foley catheter associated. Not Device-Associated = Clear secondary source of bloodstream infection other than clinical devices. Exclusion/Secondary Criteria = Laboratory Confirmed Bloodstream Infections meeting exclusion criteria or secondary criteria. Results A total of 381 bacteremia events (BE) were identified. Of those, 41 BE were presented on admission and were excluded, leaving 340 potential HOB events (Figure 1). Eighty-two were reported to NHSN as HAIs, and ten were deemed contamination without clinical significance. Two hundred forty-eight HOBs did not meet NHSN HAI criteria for reporting (Table 1). Of those, 132 met LCBI definitions but met exclusion criteria or secondary criteria. The remaining 116 cases were further evaluated for potentially preventable or non-preventable causes of BSIs. Twenty-one cases were deemed device-associated such as peripheral intravenous catheters or Foley catheters however not matching CAUTI criteria. Ninety-five cases were not device-associated (Table 2). Conclusion HOB surveillance has identified a significant portion of clinically relevant device-associated bloodstream infections, such as those related to peripheral intravenous (PIV) lines, that are currently excluded from the NHSN HAI surveillance system. The nationwide implementation of a simplified measure for healthcare-associated bloodstream infections may help healthcare systems concentrate on more effective quality improvement initiatives. Disclosures All Authors: No reported disclosures

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