1312. Risk Adjustment for Healthcare Facility-Onset C. difficile Infection and MRSA Bacteremia Reporting in NHSN
Session: Oral Abstract Session: Challenges in C. difficile Infection Surveillance
Saturday, October 20, 2012: 10:30 AM
Room: SDCC 29 ABCD

Background: The Multidrug-Resistant Organism and Clostridium difficile Infection (MDRO/CDI) Module was implemented in the National Healthcare Safety Network (NHSN) in March 2009 to allow reporting of CDI, methicillin-resistant Staphylococcus aureus (MRSA), and other MDROs. State mandated reporting drove initial participation, but the Centers for Medicare and Medicaid Services will incentivize reporting of these two infections from acute care hospitals beginning in 2013. The use of these data for inter-facility comparisons and public reporting highlight the immediate need for adequate risk adjustment methods.

Methods: During 2010-2011, participating facilities reported all unique positive specimens (collected >14 days after a previous positive specimen) for CDI and MRSA bacteremia (blood specimens) to NHSN.  Events were categorized as community-onset (CO, collected ≤3 days after admission) or healthcare facility-onset (HO, collected >3 days after admission). HO CDI and HO MRSA bacteremia incidence rates (per 10,000 and 1,000 patient-days, respectively) were calculated and compared by facility characteristics to identify potential risk adjustment variables using negative binomial testing.

Results: In 2010, 715 facilities from 28 states monitored CDI events in NHSN. A total of 20,803 HO CDI events were reported from 5,757,846 admissions and 28,279,284 patient-days. CDI incidence rates differed significantly by facility teaching type, bedsize, test type, and CO prevalence (Table). MRSA bacteremia was monitored in 548 facilities from 29 states. A total of 1,078 HO MRSA bacteremia events were reported from 3,807,920 admissions and 17,427,005 patient-days. MRSA bacteremia incidence rates differed significantly by teaching type and bedsize.

Conclusion: These facility characteristics will be assessed using multivariable analysis to determine risk adjustment for the HO CDI and HO MRSA bacteremia Standardized Infection Ratios (SIRs).

 

 

                  CDI                                      MRSA Bacteremia

 

Rate

p-value

 

Rate

p-value

Teaching Type

 

 

 

 

 

        Major

8.6

---

 

0.1

---

        All Other

6.7

<0.0001

 

0.05

<0.0001

Facility Bedsize

 

 

 

 

 

        ≤200

6.7

---

 

0.05

---

        201-500

7.0

0.0005

 

0.05

---

        501+

8.9

<0.0001

 

0.1

<0.0001

Test Type

 

 

 

 

 

        PCR

8.3

---

 

---

---

        All Other

6.6

<0.0001

 

---

---

CO Prevalence

Continuous

<0.0001

 

---

---

 

Maggie Dudeck, MPH, CPH1, Paul Malpiedi, MPH2, Jonathan Edwards, MStat1, Scott Fridkin, MD, FSHEA1, L. Clifford Mcdonald, MD1 and Dawn Sievert, PhD1, (1)Centers for Disease Control and Prevention, Division of Healthcare Quality Promotion (DHQP), Atlanta, GA, (2)Centers for Disease Control and Prevention, Division of Healthcare Quality Promotion, Atlanta, GA

Disclosures:

M. Dudeck, None

P. Malpiedi, None

J. Edwards, None

S. Fridkin, None

L. C. Mcdonald, None

D. Sievert, None

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