Hospital-onset bacteremia (HOB), a common condition amongst burn patients, is often connected to the severity of the burn and surgical wound care, rather than substandard hospital care. These findings raise significant concerns about the validity of HOB as an isolated quality metric for burn centers, highlighting the potential unfairness in value-based care benchmarking.
HOB, characterized by positive blood cultures diagnosed following the first 72 hours of hospital stay, has been suggested as an integral indicator of quality pertaining to value-based purchasing programs. Recent data from a high-volume regional burn center, however, challenge this perspective, indicating that this metric may not accurately correspond to the quality of care, particularly for burn patients.
Patients recovering from burn injuries face a heightened risk of bloodstream infections due to factors including the severity of the injury, necessary surgical interventions. Burn patients often experience significant skin barrier disruption, need for multiple surgeries, and extended reliance on central venous access, all of which substantially increase the risk of infection.
The study involved the analysis of data from 1612 admissions to a burn intensive care unit over a six year period (September 2018 – December 2024). Results revealed 202 episodes of bacteremia, affecting 5.6% of all admitted patients, with a majority (88.6%) identified as HOB. A striking finding revealed the high incidence rate of bacteremia in patients suffering from larger burns (with over 30% total body surface area (TBSA) burned), identified by extensive injury and prolonged hospitalization.
Notably, a strong temporal link was observed between episodes of bacteremia and surgical wound procedures, highlighting that the majority of these cases did not stem from preventable device-related causes, but rather the physiological implications of significant tissue manipulation and microbial translocation.
This study challenges the notion of tying HOB to poor quality of care in burn patients. Instead, it demonstrates it as a reflection of nonmodifiable factors including burn size, the need for repeat surgical intervention, and prolonged hospital stays. As such, a one-size-fits-all approach to quality benchmarking might penalize specialized burn centers caring for complex cases. This calls for additional multicenter research aimed at better defining modifiable risk factors and creating suitable quality measurement frameworks for burn units.