P-1148. Patient Harm Events: Hospital-Onset Bacteremia vs CMS-Reportable Events

TL;DR

This study compares a new hospital-onset bacteremia metric to traditional CMS metrics for identifying healthcare-associated infections and finds differences in event types and infection patterns.

Contribution

The study introduces a laboratory-reported hospital-onset bacteremia metric as a potential alternative to CMS-reportable events for identifying patient harm.

Findings

HOB-only events were more common than CMS-only or Overlap events.

Gram-negative and polymicrobial infections were more prevalent in the CMS-only group.

Switching to HOB would increase identified harm events but may reduce CAUTI and SSI cases.

Abstract

CMS requires hospitals to report rates of CLABSI, CAUTI, SSI after colon surgery and abdominal hysterectomy, hospital-onset MRSA bacteremia, and hospital-onset C. difficile infection (HO-CDI) to NHSN. With any process that requires manual adjudication, discrepancies in data accuracy exist. To identify patient harm and to maximize data accuracy, a laboratory-reported hospital-onset bacteremia (HOB) event has been proposed as an alternative to certain CMS-reportable events.

The goal of this study is to compare the performance of the proposed HOB metric with traditional CMS metrics for the identification and prognosis of HAI.Table 1.Source of Infection and HAI Group

Source of Infection and HAI Group

This is a retrospective cohort study of patients hospitalized between 1/1/22 and 12/31/23 at a 500-bed academic safety net hospital in Denver, CO. Patients >18 years old with a positive blood culture on hospital day 4 or greater OR a CMS-reportable HAI were eligible for inclusion; those with HO-CDI were excluded. Patients were categorized into 3 mutually exclusive groups: HOB-only if the HAI was not reportable to CMS; CMS-only if the HAI did not involve bacteremia; or Overlap if the HAI involved bacteremia and was reported to CMS.

Overall, 199 HAIs were identified in 185 patients by HOB or a current CMS metric. There were 109 HOB-only events (54.8%) in 97 patients, 49 CMS-only events (24.6%) in 49 patients, and 41 Overlap events (20.6%) in 39 patients. Age, gender, race, ethnicity, and preferred language did not differ between the 3 groups. The 6-month mortality was not different between the three groups (28.4% vs 20.4% vs 24.4% respectively, P=0.553).

While CLABSI was most prevalent in the Overlap group, CAUTI and SSI were more strongly represented in the CMS-only group than in the HOB or Overlap groups (Table 1).

Infections due to Gram negative organisms were more prevalent in the CMS-only than in the HOB-only or Overlap groups (69.4% vs 41.3% vs 14.6%, P< 0.0001) as were polymicrobial infections (32.7% vs 11.0% vs 4.9%, P=0.0003).

A change from current CMS-reported HAI events to HOB would lead to an overall increased number of identified patient harm events; however, CAUTI and SSI events would likely decrease. Care should be taken to ensure that the SSI events captured by HOB reflect emergent, urgent, and elective surgery types.

All Authors: No reported disclosures

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