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Evaluation of the National Healthcare Safety Network standardized infection ratio risk adjustment for healthcare-facility-onset Clostridioides difficile infection in intensive care, oncology, and hematopoietic cell transplant units in general acute-care hospitals

Published online by Cambridge University Press:  13 February 2020

Christopher R. Polage Open the ORCID record for Christopher R. Polage [Opens in a new window] ,
Kathleen A. Quan ,
Keith Madey ,
Frank E. Myers ,
Debbra A. Wightman ,
Sneha Krishna ,
Jonathan D. Grein ,
Laurel Gibbs ,
Deborah Yokoe  and
Shannon C. Mabalot
...Show all authors
Christopher R. Polage*
Affiliation:
Department of Pathology and Laboratory Medicine, University of California Davis School of Medicine, Sacramento, California Division of Infectious Diseases, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California Department of Pathology, Duke University School of Medicine, Durham, North Carolina
Kathleen A. Quan
Affiliation:
Epidemiology and Infection Prevention, University of California Irvine Health, Orange, California
Keith Madey
Affiliation:
Epidemiology and Infection Prevention, University of California Irvine Health, Orange, California
Frank E. Myers
Affiliation:
Infection Prevention and Clinical Epidemiology Unit, University of California San Diego Health, San Diego, California
Debbra A. Wightman
Affiliation:
Infection Prevention and Clinical Epidemiology Unit, University of California San Diego Health, San Diego, California
Sneha Krishna
Affiliation:
Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, California
Jonathan D. Grein
Affiliation:
Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, California
Laurel Gibbs
Affiliation:
Department of Hospital Epidemiology and Infection Prevention, University of California San Francisco Health, San Francisco, California
Deborah Yokoe
Affiliation:
Department of Hospital Epidemiology and Infection Prevention, University of California San Francisco Health, San Francisco, California Division of Infectious Diseases, Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California
Shannon C. Mabalot
Affiliation:
Infection Prevention and Clinical Epidemiology, Sharp Memorial Hospital, Sharp HealthCare, San Diego, California
Raymond Chinn
Affiliation:
Infection Prevention and Clinical Epidemiology, Sharp Memorial Hospital, Sharp HealthCare, San Diego, California
Amy Hallmark
Affiliation:
Clinical Epidemiology and Infection Prevention, Ronald Reagan UCLA Medical Center, University of California Los Angeles Health, Los Angeles, California
Zachary Rubin
Affiliation:
Clinical Epidemiology and Infection Prevention, Ronald Reagan UCLA Medical Center, University of California Los Angeles Health, Los Angeles, California Division of Infectious Diseases, Department of Medicine, David Geffen UCLA School of Medicine, Los Angeles, California
Michael Fontenot
Affiliation:
Hospital Epidemiology and Infection Prevention, University of California Davis Health System, Sacramento, California
Stuart Cohen
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California Hospital Epidemiology and Infection Prevention, University of California Davis Health System, Sacramento, California
David Birnbaum
Affiliation:
School of Population and Public Health, Principal Applied Epidemiology, University of British Columbia, British Columbia
Susan S. Huang
Affiliation:
Epidemiology and Infection Prevention, University of California Irvine Health, Orange, California Division of Infectious Diseases, Department of Internal Medicine, University of California Irvine School of Medicine, Orange, California Health Policy Research Institute University of California Irvine School of Medicine, Orange, California
Francesca J. Torriani
Affiliation:
Infection Prevention and Clinical Epidemiology Unit, University of California San Diego Health, San Diego, California Division of Infectious Diseases, Department of Medicine, University of California San Diego, La Jolla, California
*
Author for correspondence: Christopher R. Polage, E-mail: [email protected]
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Abstract

Objective:

To evaluate the National Health Safety Network (NHSN) hospital-onset Clostridioides difficile infection (HO-CDI) standardized infection ratio (SIR) risk adjustment for general acute-care hospitals with large numbers of intensive care unit (ICU), oncology unit, and hematopoietic cell transplant (HCT) patients.

Design:

Retrospective cohort study.

Setting:

Eight tertiary-care referral general hospitals in California.

Methods:

We used FY 2016 data and the published 2015 rebaseline NHSN HO-CDI SIR. We compared facility-wide inpatient HO-CDI events and SIRs, with and without ICU data, oncology and/or HCT unit data, and ICU bed adjustment.

Results:

For these hospitals, the median unmodified HO-CDI SIR was 1.24 (interquartile range [IQR], 1.15–1.34); 7 hospitals qualified for the highest ICU bed adjustment; 1 hospital received the second highest ICU bed adjustment; and all had oncology-HCT units with no additional adjustment per the NHSN. Removal of ICU data and the ICU bed adjustment decreased HO-CDI events (median, −25%; IQR, −20% to −29%) but increased the SIR at all hospitals (median, 104%; IQR, 90%–105%). Removal of oncology-HCT unit data decreased HO-CDI events (median, −15%; IQR, −14% to −21%) and decreased the SIR at all hospitals (median, −8%; IQR, −4% to −11%).

Conclusions:

For tertiary-care referral hospitals with specialized ICUs and a large number of ICU beds, the ICU bed adjustor functions as a global adjustment in the SIR calculation, accounting for the increased complexity of patients in ICUs and non-ICUs at these facilities. However, the SIR decrease with removal of oncology and HCT unit data, even with the ICU bed adjustment, suggests that an additional adjustment should be considered for oncology and HCT units within general hospitals, perhaps similar to what is done for ICU beds in the current SIR.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 4 , April 2020 , pp. 404 - 410
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved

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Footnotes

a

Authors of equal contribution.

PREVIOUS PRESENTATION: This work was presented as an oral abstract at IDWeek 2019, on October 3, 2019, in Washington, DC.

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