1366. Which comorbid conditions should we be analyzing as risk factors for healthcare-associated infections?
Session: Poster Abstract Session: HAI: Epidemiologic Methods
Friday, October 28, 2016
Room: Poster Hall
Posters
  • IDWeek poster_Harris.pdf (404.4 kB)
  • Background:

    Our objective was to determine which comorbid conditions are causally related to central line associated bloodstream infection (CLABSI) and surgical site infection (SSI) based on expert opinion.

    Methods:

    Using the Delphi technique, we administered an iterative, two-round survey broken up by a conference call to 9 infectious disease and infection control experts from the United States. Thirty-five different comorbid conditions that are components of the Charlson and Elixhauser comorbidity indices were rated from 1 (not at all related) to 5 (strongly related) by each expert, based on perceived relatedness with the outcome, separately for CLABSI and SSI. We assessed expert consensus development by change in the inter-quartile range (IQR) and standard deviation (SD) of ratings between rounds 1 and 2. To assign final expert consensus on causal relatedness for each comorbid condition, all of the following three criteria had to be met at the end of the second round: 1) a majority (> 50%) of experts rating the condition at 3 (somewhat related) or higher, 2) IQR 1 or less, and 3) SD < 1.

    Results:

    Nine experts participated in both surveys and the conference call. From round 1 to round 2, the IQR and SD respectively decreased for ratings of 21 (60%) and 33 (94%) comorbid conditions for CLABSI, and for 17 (49%) and 32 (91%) comorbid conditions for SSI, suggesting improvement in consensus among experts. Based on our criteria for expert consensus, at the end of round 2, 13/35 (37%) and 17/35 (49%) comorbid conditions were perceived as causally related to CLABSI and SSI respectively (Figure 1).

    Conclusion:

    Our results lead to a list of comorbid conditions that should be further explored for risk factor studies of CLABSI and SSI and be used in conjunction with statistical significance to guide risk adjustment for these outcomes.  This Delphi method can be used for other infectious disease studies. 

     

    Anthony D. Harris, MD, MPH, FIDSA, FSHEA1, Lisa Pineles, MA1, Deverick Anderson, MD, MPH, FIDSA, FSHEA2, Keith F. Woeltje, MD, PhD, FSHEA3, William E. Trick, MD4, Keith S. Kaye, MD, MPH5, Deborah S. Yokoe, MD, MPH, FIDSA, FSHEA6, Ann-Christine Nyquist, MD, MSPH, FPIDS7, David P. Calfee, MD, MS, FIDSA, FSHEA8 and Surbhi Leekha, MBBS, MPH1, (1)Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, (2)Division of Infectious Diseases, Duke University Medical Center, Durham, NC, (3)BJC HealthCare, St. Louis, MO, (4)Rush University Medical Center, Chicago, IL, (5)Detroit Medical Center, Detroit, MI, (6)Medicine, Brigham and Women's Hospital, Boston, MA, (7)University of Colorado School of Medicine/Children’s Hospital of Colorado, Aurora, CO, (8)Weill Cornell Medicine, New York, NY

    Disclosures:

    A. D. Harris, AHRQ: Grant Investigator , Research grant

    L. Pineles, AHRQ: Grant Investigator , Research grant

    D. Anderson, AHRQ: Expert panel member , Honorarium for participation in expert panel

    K. F. Woeltje, AHRQ: Expert panel member , Honorarium for participating in expert panel

    W. E. Trick, AHRQ: Expert panel member , Honorarium for participating in expert panel

    K. S. Kaye, AHRQ: Expert panel member for research grant , Honorarium for participating in expert panel

    D. S. Yokoe, AHRQ: Expert panel member for research grant , Honorarium for participating in expert panel

    A. C. Nyquist, AHRQ: Expert panel member for research grant , Honorarium for participating in expert panel

    D. P. Calfee, AHRQ: Expert panel member for research grant , Honorarium for participating in expert panel

    S. Leekha, AHRQ: Grant Investigator , Research grant

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.