840. Association Between Healthcare Facility Connectedness and the Incidence of Clostridium difficile Infections, Washington and Oregon
Session: Oral Abstract Session: Clostridium difficile
Thursday, October 27, 2016: 2:30 PM
Room: 388-390

Background: Nearly 500,000 Clostridium difficile infections (CDI) occur annually in the U.S. Prevention efforts have traditionally focused on individual healthcare facilities, without regard to the potential impact of frequent and heterogeneous interfacility patient sharing on CDI incidence. We developed measures of interfacility connectedness and assessed the association between those measures and incident CDI.

Methods: We determined the cumulative annual incidence of CDI using facility-level surveillance data reported to the National Healthcare Safety Network in 2013. Claims data from the Centers for Medicaid and Medicare Services from WA and OR were used to capture patient movement and compute social network connectivity measures (i.e., weighted indegree). We developed a multivariate negative binomial generalized linear model with a log link to examine the association between the annual facility-level CDI incidence and connectedness, adjusting for hospital-level factors.

Results:  Medicare patients received care at 475 healthcare facilities, including 137 hospitals and 338 skilled nursing facilities, with connections depicted in Figure 1. Hospitals in the highest two quartiles of weighted overall indegree were independently associated with increased CDI incidence, controlling for test-type, teaching status, and bed size (Table 1). 

Conclusion: Connectedness to other healthcare facilities is independently associated with facility-level CDI incidence; hospitals that were most highly connected had significantly higher rates. Hospitals with high connectivity might provide a target group for coordinated public health interventions to reduce CDI regionally.

Figure 1: Connectedness of healthcare facilities by facility type sharing Medicare patients, WA and OR

Table 1: Adjusted rate ratios of cumulative annual CDI incidence, WA and OR

Rate ratio

95% CI

P-value

CDI Test Type

          NAAT v. EIA

1.22

0.86

1.73

0.27

          Non-NAAT, non-EIA others v. EIA

1.03

0.38

2.83

0.95

Hospital Bed Size Quartile

          Q2 v. Q1

0.82

0.39

1.75

0.61

          Q3 v. Q1

0.68

0.31

1.52

0.35

          Q4 v. Q1

0.96

0.42

2.21

0.92

Teaching Status

          Teaching  v. non-teaching

0.93

0.70

1.24

0.60

Weighted Indegree Quartile

          Q2 v. Q1

2.78

1.25

6.15

0.01

          Q3 v. Q1

3.62

1.54

8.50

0.003

          Q4 v. Q1

3.45

1.41

8.42

0.01

Rachel Slayton, PhD, MPH1, James Baggs, PhD1, Kelly Mccormick, MSPH1, Katherine Elligson, PhD2 and John Jernigan, MD, MS1, (1)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, (2)Oregon Public Health Division, Portland, OR

Disclosures:

R. Slayton, None

J. Baggs, None

K. Mccormick, None

K. Elligson, None

J. Jernigan, None

See more of: Clostridium difficile
See more of: Oral Abstract Session

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.