In 2014-2015, CDI accounted for more than half of all healthcare-associated infections (HAI) reported by California hospitals. The CDPH HAI Program used an administrative dataset from the California Office of Statewide Health Planning and Development (OSHPD) to identify admission source (e.g., home, skilled nursing facility), length of stay, payer category, and outcome (e.g., death) of patients with CDI reported by California hospitals via NHSN.
We merged NHSN CDI events with OSHPD hospital discharge data for the period January 1, 2014, to December 31, 2015. NHSN classifies CDI cases as community onset (CO) if the CDI test specimen was collected during the first three hospital days and hospital onset (HO) if collected on day four or later. We used OSHPD discharge records that listed CDI as a diagnosis (ICD-9-CM: 00845 and ICD-10-CM: A047 codes). We matched NHSN CDI records with OSHPD hospital discharge records by hospital, admission date, and date of birth.
Hospitals reported 58,841 NHSN inpatient incident and recurrent CDI events in 2014-2015. We matched 42,172 (71.7%) NHSN CDI records with an OSHPD hospital discharge record; 60.5% of matched cases were CO-CDI and 39.5% were HO-CDI. Sources of admission included home (78.2%; CO: 81.0% and HO: 74.0%), skilled nursing/intermediate care facility (10.7%; CO: 10.9% and HO: 10.4%), acute care hospital (6.0%; CO: 3.2% and HO: 10.4%), and residential care facility (1.7%; CO: 2.0% and HO: 1.4%). Payers included Medicare (61.8%), Medi-Cal (18.7%), and private insurance (16.8%). The median length of stay for CO cases was 5 days (interquartile range [IQR]: 3-9), and for HO cases, 15 days (IQR: 9-25); 8.7% (CO: 7.1% and HO: 11.2%) of patients with CDI died during hospitalization.
Our analysis demonstrates use of an administrative dataset to supplement NHSN HAI data. Patients with CDI were predominantly admitted from home and had prolonged hospitalizations and substantial in-hospital mortality. We are evaluating use of these data to identify hospital admissions at various time intervals before and after CDI events. The CDPH HAI Program is using these analyses to inform CDI prevention outreach to California health care facilities and provider networks.
E. Epson, None