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.