1089. Healthcare-associated infection rates in safety net and non-safety net hospitals 2006-2011
Session: Poster Abstract Session: Surveillance of HAIs: Implementation and National Perspectives
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C

Background:   Safety net hospitals serving largely poor patients usually operate under constrained resources and may have a harder time responding to new policy initiatives.  In October 2008, CMS implemented a policy that eliminated additional payments to hospitals for preventable complications.  It is unknown if the policy led to fewer health care associated infections (HAIs) at safety net hospitals. We sought to determine the effects of the non-payment for preventable complications (NPPC) policy on central line associated blood stream infections (CLABSI) and catheter associated urinary tract infections (CAUTI), in safety net and non-safety net hospitals.

Methods: We included data from adult critical care units among eligible hospitals reporting to the CDC's National Healthcare Safety Network (NHSN) from 1/2006-3/2011.  We assigned participant hospitals to disproportionate share hospital (DSH) index quartiles based on prior DSH cutoff determinations derived from all CMS hospitals, with the highest quartile representing a safety net hospital. Quarterly infection rates per device day for CLABSI and CAUTI were graphed during the study period by DSH quartile. We used generalized linear mixed models, clustering by hospital and hospital unit, to examine whether the effect of the policy on CLABSI and CAUTI rates differed across DSH quartiles, adjusted for secular trends.

Results:   Among 257 hospitals providing CLABSI data, 20% were considered safety net hospitals. Of 134 hospitals providing CAUTI data, 16% were considered safety net hospitals.  CLABSI rates appeared to decline over time for all hospitals (Figure 1).  In contrast, CAUTI rates appeared stable over time with little difference between safety-net and hospitals in the other DSH quartiles (Figure 2). In adjusted models, the CMS policy did not differentially affect the rate of decline for CLABSI or for CAUTI by DSH quartile (p = 0.48 and p=0.73).

Conclusion:   After accounting for secular trends, we found no evidence that the NPPC policy had a differential impact on infection rates across quartiles of DSH index.

Louise Elaine Vaz, MD1,2, Ashish Jha, MD, MPH3, Alison Tse Kawai, ScD, SM2, Robert Jin, MS2, Michael S. Calderwood, MD, MPH2,4 and Grace M. Lee, MD, MPH1,2, (1)Division of Infectious Diseases and Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA, (2)Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, (3)Harvard School of Public Health, Boston, MA, (4)Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA


L. E. Vaz, None

A. Jha, None

A. T. Kawai, None

R. Jin, None

M. S. Calderwood, None

G. M. Lee, None

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