Abstract: FR-PO423
Bloodstream Infection Standardized Infection Ratios among ESKD Networks
Session Information
- Hemodialysis Epidemiology and Outcomes
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Lamping, Leticia A., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Navarrete, Jose E., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Jarrell, Bria Marchelle, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Hoxworth, Tamara L., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Keenan, John, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Barbre, Kira, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Meng, Lu, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Clark, Stephanie, Centers for Medicare and Medicaid Services, Baltimore, Maryland, United States
- Houseal, Delia, Centers for Medicare and Medicaid Services, Baltimore, Maryland, United States
- Novosad, Shannon, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Edwards, Jonathan, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Benin, Andrea L., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Bell, Jeneita, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
Background
Individuals receiving hemodialysis are at increased risk for bloodstream infections (BSIs), and risk varies by vascular access type and sociodemographic characteristics. The Centers for Medicare and Medicaid Services’ End Stage Renal Disease Quality Incentive Program (ESRD QIP) tracks the quality of dialysis care, including bloodstream infections. The ESRD Network Program is the administrative governing body for the ESRD QIP. There are 18 geographically defined ESRD Programs that serve the US and its territories to improve cost-effectiveness, ensure and improve quality of care for dialysis patients, encourage kidney transplantation and home dialysis, and assist patients to return to work. We compared BSI standardized infection ratios (SIRs) across the 18 ESRD network regions between 2018 and 2022.
Methods
This study included data reported to the CDC’s National Healthcare Safety Network (NHSN) by outpatient dialysis facilities from 2018-2022. SIRs were calculated as the number of observed infections over the number of predicted infections based on 2014 national aggregate data. A SIR of <1 indicated that fewer BSIs occurred than expected. Pooled SIRs were calculated for each region for each year. The 18 ESRD regions were anonymized using alphabetic codes assigned based on highest to lowest 2018 SIR. The Goodman Kruskal Gamma statistic was used to examine whether the rank order of BSI SIRs among 18 ESRD regions varied significantly between 2018 and 2022.
Results
A total of 6,516 and 6,709 outpatient hemodialysis facilities reported data for 2018 and 2022, respectively. The overall pooled BSI SIR was 0.724 (95% CI 0.715-0.734) in 2018 and 0.367 (95% CI 0.361-0.373) in 2022. Compared to 2018, all ESRD regions had significantly lower SIRs in 2022 (p<0.05). The Goodman Kruskal Gamma statistic was 0.3, indicating substantial shifts in regions' SIR rankings between 2018 and 2022. Rankings improved by 6 or more for ESRD networks K, O, and Q in the South, and Network P in the Midwest.
Conclusion
BSI SIRs improved from 2018 to 2022 and the rank order of BSI SIRs by region changed significantly over this time. Further investigation of changes in sociodemographics and facility-level characteristics by ESRD region is warranted.