Impact of Hospital Operating Margin on Central Line–Associated Bloodstream Infections Following Medicare’s Hospital-Acquired Conditions Payment Policy

Calderwood, Michael S.; Vaz, Louise Elaine; Kawai, Alison Tse; Jin, Robert; Rett, Melisa; Grant, Patricia; Lee, Grace M.

doi:10.1017/ice.2015.250

Cited by 5 publications

(5 citation statements)

References 7 publications

(14 reference statements)

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“…On the other hand, from 2008 to 2014 the rate of CLABSIs decreased about 50% in the United States [28], while the BC rate declined from 2008 to 2010 [26]. Calderwood and colleagues highlighted that after implementation of the Pay for Performance policy the CLABSI rates decreased in hospitals operating at a financial loss, but in those operating at a financial profit the CLABSI rate was not affected by the policy [29]. In summary, the impact of the Pay for Perfomance system on the CLABSI rate in the United States is still unclear.…”

Section: Discussionmentioning

confidence: 99%

Nudge to better care - blood cultures and catheter-related bloodstream infections in Germany at two points in time (2006, 2015)

Salm

Schwab

Behnke

et al. 2018

Antimicrob Resist Infect Control

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BackgroundBlood cultures (BCs) are the gold standard for diagnosing sepsis and are prerequisite for a targeted antibiotic treatment and essential for patient outcomes. Aim of the study was to analyze the frequency of BCs, the rate of central line-associated bloodstream infections (CLABSIs) and to study the association between both parameters on intensive care units in Germany over time.MethodsCross-sectional studies at two points in time (2006, 2015) on ICUs participating in the German hospital infection surveillance system. CLABSIs were defined according to the Center for Disease Control and Prevention (CDC). Univariable and multivariable analyses were performed using generalized linear models.ResultsA total of 639 ICUs participated in 2006 or 2015 and 90 ICUs (“core group”) in both years. Overall, 2,427,921 patient days from 644,575 patients were analyzed. In the ICU core group the frequency of BCs per 1000 patient days doubled from 57.8 (interquartile range [IQR] 29.8–101.2; 2006) to 128.2 (IQR 71.6–183.2; 2015). In the same time, the pooled median CLABSI rate decreased from 0.8 (IQR 0–1.9; 2006) per 1000 central-line catheter days to 0.2 (IQR 0–0.9; 2015).ConclusionsFrom 2006 to 2015 the frequency of BCs increased on ICUs in Germany and is now within the recommended 100 to 200 BCs sets per 1000 patient days.

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Section: Discussionmentioning

confidence: 99%

Nudge to better care - blood cultures and catheter-related bloodstream infections in Germany at two points in time (2006, 2015)

Salm

Schwab

Behnke

et al. 2018

Antimicrob Resist Infect Control

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“…We included data from acute care hospitals reporting prospective surveillance data from level III NICUs and PICUs to the Center for Disease Control and Prevention’s NHSN. Study hospitals were a subset of those enrolled in the Preventing Avoidable Infectious Complications by Adjusting Payment (PAICAP) study . Hospitals were included if they reported CLABSIs from the NICU or CLABSIs or CAUTIs from the PICU.…”

Section: Methodsmentioning

confidence: 99%

Health Care–Associated Infections Among Critically Ill Children in the US, 2013-2018

et al. 2020

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IMPORTANCE Central catheter-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) increase morbidity, mortality, and health care costs in pediatric patients. OBJECTIVE To examine changes over time in CLABSI and CAUTI rates between 2013 and 2018 in neonatal intensive care units (NICUs) and pediatric intensive care units (PICUs) using prospective surveillance data from community hospitals, children's hospitals, and pediatric units within general hospitals. DESIGN, SETTING, AND PARTICIPANTSThis time series study included 176 US hospitals reporting pediatric health care-associated infection surveillance data to the National Healthcare Safety Network from January 1, 2013, to June 30, 2018. Patients aged 18 years or younger admitted to PICUs or level III NICUs were included in the analysis. MAIN OUTCOMES AND MEASURESThe primary outcomes were device-associated rates of CLABSI in NICUs and PICUs and CAUTI in PICUs (infections per 1000 device-days). Secondary outcomes included population-based rates (infections per 10 000 patient-days) and device utilization (device-days per patient-days). Regression models were fit using generalized estimating equations to assess yearly changes in CLABSI and CAUTI rates, adjusted for birth weight (Յ1500 vs >1500 g) in neonatal models. RESULTSOf the 176 hospitals, 132 hospitals with NICUs and 114 hospitals with PICUs contributed data. Of these, NICUs reported 6 064 172 patient-days and 1 363 700 central line-days and PICUs reported 1 999 979 patient-days, 925 956 central catheter-days, and 327 599 indwelling urinary catheter-days. In NICUs, there were no significant changes in yearly trends in device-associated (incidence rate ratio [IRR] per year, 0.99; 95% CI, 0.95-1.03) and population-based (IRR, 0.96; 95% CI, 0.92-1.00) CLABSI rates or central catheter utilization (odds ratio [OR], 0.97; 95% CI, 0.95-1.00). Results were similar in PICUs, with device-associated (IRR, 1.03; 95% CI, 0.99-1.07) and population-based (IRR, 1.03; 95% CI, 0.99-1.07) CLABSI rates and central catheter utilization (OR, 0.99; 95% CI, 0.97-1.01) remaining stable. While device-associated CAUTI rates in PICUs also remained unchanged over time (IRR, 0.97; 95% CI, 0.91-1.03), population-based CAUTI rates significantly decreased by 8% per year (IRR, 0.92; 95% CI, 0.86-0.98) and indwelling urinary catheter utilization significantly decreased by 6% per year (OR, 0.94; 95% CI, 0.91-0.96). CONCLUSIONS AND RELEVANCERecent trends in CLABSI rates noted in this study among critically ill neonates and children in a large cohort of US hospitals indicate that past gains have held, without evidence of further improvements, suggesting novel approaches for CLABSI prevention are needed. Modest improvements in population-based CAUTI rates likely reflect more judicious use of urinary catheters.

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“…We included hospitals participating in the Preventing Avoidable Infectious Complications by Adjusting Payment (PAICAP) study that focused on evaluating the impact of financial policies on infection rates in the National Healthcare Safety Network (NHSN). 3 We identified 287 hospitals that reported SSI surveillance data on ≥1 operative procedure in pediatric patients. Because enrollment in PAICAP was focused on Centers for Medicare and Medicaid Services (CMS) payment policies, nearly all hospitals in PAICAP are general hospitals caring for pediatric patients, and only a few are freestanding children’s hospitals.…”

Section: Methodsmentioning

confidence: 99%

Pediatric surgical site infections in 287 hospitals in the United States, 2015–2018

Mathew

Salinas

Hsu

et al. 2022

Infect. Control Hosp. Epidemiol.

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Impact of Hospital Operating Margin on Central Line–Associated Bloodstream Infections Following Medicare’s Hospital-Acquired Conditions Payment Policy

Cited by 5 publications

References 7 publications

Nudge to better care - blood cultures and catheter-related bloodstream infections in Germany at two points in time (2006, 2015)

Nudge to better care - blood cultures and catheter-related bloodstream infections in Germany at two points in time (2006, 2015)

Health Care–Associated Infections Among Critically Ill Children in the US, 2013-2018

Pediatric surgical site infections in 287 hospitals in the United States, 2015–2018

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