A common criticism on the association between a HAI and the death of a patient is that patients die with the HAI and not because of the HAI (37). The present study demonstrates that clinicians frequently think otherwise and that a mortality review can be performed with reasonable inter‐rater reliability. Still, clinicians sometimes fear the judgement of hospital management or medico‐legal consequences if they perform a mortality review with explicit outcome statements. These anticipated consequences are a major barrier for widespread adoption of an otherwise feasible mortality review. It is important that stakeholders understand that neither the death of a patient with an HAI, nor the HAI itself are necessarily preventable, and support clinical staff, as improved insight into the contribution of HAIs to patients’ morbidity and mortality is an important driver of quality improvement processes and interventions to prevent HAI. Conclusion Although the construct validity of mortality review is difficult to assess because there is no recent gold‐standard for the assessment of the contribution of an HAI to death, this study showed that the validity and reproducibility of the three mortality review measures that were evaluated was acceptable for use in European surveillance of HAI. The performance of the three measures was comparable and the perceived fit of the three outcomes was predominantly reasonable or good. Most reviewers preferred the WHO categories (WHOCAT) that better account for the different levels of causality assessment and the quantitative scale (QUANT) which was perceived as more neutral than other measures. Further standardization of the measures for surveillance purposes through training and the use of case vignettes may increase robustness and comparability across hospitals and countries. INVESTIGATORS Members of the HAI‐Net Mortality review study group: Meander Sips, Maximilian Edlinger‐Stanger, Michael Hiesmayr, Joke Denolf, Marc Nauwynck, Amine Si Ali, Caroline Jannière‐Nartey, Elodie Munier‐Marion, Guillaume Grillet, Marie‐Aline Robaux, Antonella Agodi, Giacomo Castiglione, Marinella Astuto, Davide Durì, Ieva Kisieliene, Meri Varkila, Paula van Ooik, Ed Kuijper, Monique Crobach, Grażyna Biesiada, Clara Carvalho, Camila Tapadinhas, Rita Corte‐Real, Sofia Cardoso, Maria Barroso, Heloisa Castro, Ana Josefina Pinheiro Marques, Dulce Pascoalinho, Adriana Ribeiro, Filomena Freitas, J Ricardo Gimeno Costa, F Xavier Nuvials Casals, Richard Pugh, Anne Savey, David A. 122 Chapter 6
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