Healthcare-Associated Infection Rates and Device Utilization Ratios in Long-Term Acute Care Hospitals Reporting to the National Healthcare Safety Network

Background:

Long-term acute care hospitals (LTACHs) provide skilled, intensive care for patients with complex medical conditions for prolonged periods.  Little is known about healthcare-associated infection (HAI) rates or device utilization (DU) ratios in LTACHs.  In 2008, the National Healthcare Safety Network (NHSN) added LTACH as a facility type to the reporting system.  Prior to this, LTACH data could only be reported if an acute care hospital included an LTACH location as a specialty care area (i.e., hospital-within-hospital, HWH). 

Objective:

To determine the number of LTACHs reporting to NHSN from 01/08-04/09 and to calculate rates of HAIs (temporary [nontunneled] and permanent [tunneled/implanted]) central line-associated bloodstream infections (TCLAB, PCLAB), catheter-associated urinary tract infections (CAUTI), and ventilator-associated pneumonias (VAP) and DU ratios among these hospitals, comparing free-standing (FS) to HWH LTACHs. 

Methods:

Descriptive statistics were used to evaluate the numbers of LTACHs reporting over the time period.  Pooled mean and median TCLAB, PCLAB, CAUTI, and VAP rates per 1000 device days and DU ratios were calculated.  HAI rates were compared between FS and HWH LTACHs using Poisson regression analysis and nonparametric tests.  DU ratios were compared using nonparametric tests.  All analyses were performed using SAS, version 9.2.

Results:

48 LTACHs reported to NHSN in 2008, and a total of 50 (22 FS and 28 HWH) were reporting as of April 2009.  Pooled mean and median HAI rates and DU ratios for FS and HWH LTACHs are presented in the Table.  Although the pooled mean TCLAB rate was significantly higher in FS compared to HWH LTACHs, the medians were not different; four FS LTACHs had notably higher TCLAB rates compared to the others and thus were influential data points.  Pooled mean and median DU ratios for temporary central lines were significantly higher in HWH compared to FS LTACHs; other DU ratios were comparable between LTACH types.

Conclusions:  

This is the first evaluation of surveillance data from LTACHs reporting to NHSN.  Comparing different LTACH types, greater variability in TCLAB rates was noted in FS compared to HWH LTACHs, and higher temporary central line DU was noted in HWH LTACHs.  Further exploration of the different levels of patient acuity in LTACHs may allow for additional stratification when reporting rates and provide more meaningful data.