Abstract: TH-PO887
Bloodstream Infection (BSI) Rates in Catheter Patients Are Markedly Higher in Hemodialysis Facilities with Lower Proportions of Catheters
Session Information
- Dialysis: Infection
November 02, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 610 Dialysis: Infection
Authors
- Brown, Robert S., Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Brickel, Kristin M, DaVita, Naugatuck, Connecticut, United States
- Davis, Roger B., Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
Background
BSI rates of HD patients with catheters (CVC) are greater than with other accesses. Medicare assesses financial penalties and lower Five-Star ratings to high CVC facilities, prompting a study of BSI rates in CVC patients relative to facility CVC percentages.
Methods
CROWNWeb and NHSN data from all 171 Medicare facilities providing adult outpatient HD in the IPRO ESRD Network of New England throughout 2015 (mean, 12,626 patients/mo) compared BSI rates of CVC and non-CVC patients based upon facility proportion of CVCs, patient census, batch submitting organization and season.
Results
There were an average of 74+40 HD patients with 9+6 (13%) having CVC accesses per facility. Mean BSI/100 pt-mo was 0.50+1.0 for all accesses, 3.0+8.7 for CVC, and 0.21+0.72 for non-CVC patients (relative risk of BSI for CVC vs non-CVC patient, 10.7, 95%CI 8.7, 13.2, P=<0.0001). Surprisingly, annual BSI rates in CVC patients were negatively correlated with the facility’s proportion of CVCs (−0.247, P=0.001) but positively correlated in non-CVC patients (0.147, P=0.056).
Facilities with <5%, 5-10%, 10-15%, 15-20%, >20% CVCs have BSI rates of 11.7, 3.5, 2.5, 1.8, 1.6 per 100 pt-mo, respectively, in CVC patients (P=<0.0001). This striking difference was not seen in non-CVC patients (P=0.07, risk ratios in figure). Smaller providers have 1.3-2.6 times the BSI rates of the 4 large dialysis organizations (4.6 vs 1.8-3.6 BSI/100pt-mo, P=0.01) despite similar CVC proportions. There was no effect of facility census or season.
Conclusion
HD facilities with the lowest proportion of CVCs have significantly higher BSI rates (up to 6.9 times) in their CVC patients. This large difference may be explained by “dilution” of CVC patients with those in the lower risk non-CVC pool and by better training and experience in facilities with higher CVC proportions and the larger dialysis organizations. BSI rates in CVC patients may be a better quality parameter than CVC percentage.