Is central line type an independent risk factor of central line-associated bloodstream infection in a neonatal intensive care unit population? Experiences at a pediatric hospital in South Texas.

Background: Central line-associated bloodstream infection (CLABSI) causes significant harm in neonatal intensive care unit (NICU) patients. However, data regarding risk factors and prevention strategies for CLABSI in NICU patients is limited. Objective: To examine risk factors for CLABSI in a NICU population, with particular interest in central line type and site placement. Design: Retrospective case-control study. Setting: NICU (Level IV, 67 bed) at a pediatric hospital in South Texas. Participants: All central line insertions and subsequent CLABSI cases were extracted from the EHR for NICU admissions occurring from January 1, 2018, to November 3, 2022 (N = 1,356), along with potential CLABSI risk factors. Methods: Central line insertions resulting in CLABSI (N = 35) were compared to instances without CLABSI (N = 1,321) using bivariate and multivariate analysis, with propensity score matching. Results: Multivariate risk factors include implantable device (odds ratio [OR] = 14.5, P < .001), neck site placement (OR = 7.2, P < .001), and device dwell time (OR = 5.6, P = .001), as well as years 2021 (OR = 5.1, P = .017) and 2022 (OR = 5.9, P = .011). This indicates the odds of contracting CLABSI are 14.5 times higher when an implantable central line is used compared to the reference category (PICC devices). When cases are paired with matched controls, likelihood of CLABSI is 7.1% higher in patients with an implantable device than in similar patients with other central lines (p = 0.034). Conclusions: Implantable central lines are an independent risk factor for CLABSI in NICU patients at this facility.

A Free Mobile Application Improves the Efficiency of Hand Hygiene Observation Collection: Experiences at a Pediatric Hospital in South Texas.

Hand hygiene (HH) is the most important means of reducing hospital-acquired infections. However, compliance at health care facilities remains deficient. A process improvement study was conducted at a 191-bed, pediatric hospital in South Texas evaluating a free mobile application for HH surveillance, compared to traditional pen-and-paper methods. Using a series of Plan-Do-Study-Act (PDSA) cycles, the application was piloted on a small scale and then trialed facilitywide from June to November 2021. The number of HH audits was compared to the preceding period using percentage change analysis. The mobile application resulted in 7,388 HH observations collected, compared with 3,082 previously, representing a 140% increase. Two staff roles in the process (data entry and analysis) were eliminated, as observations were pushed directly to the infection preventionist, eliminating approximately eight hours of staff time monthly. The application enabled almost real-time updates to the HH surveillance dashboard and improved the detailedness of the data as more variables were collected during each HH observation. This is a practical alternative for innovating HH observation compared with more sophisticated and expensive HH surveillance technology.

Evaluation of a statewide collaborative focused on antibiotic usage surveillance and stewardship in New York State Hospitals.

BACKGROUND: To prepare NYS hospitals for reporting in The National Health Care Safety Network's Antimicrobial Use and Resistance (AUR) Module, the Health care Association of New York State (HANYS) launched a voluntary Antibiotic Stewardship Collaborative (ASC) in late 2015 with 2 aims (1) assist hospitals in developing the infrastructure necessary to track and report antibiotic usage; (2) educate hospitals on antibiotic stewardship. This study evaluates the characteristics of hospitals opting to participate in the ASC and their experiences in the program, as well as the effects of one year of participation (2016) on hospital-acquired C. difficile infection (HA-CDI) rates. METHODS: Difference in means testing of clinical and non-clinical characteristics were performed to understand the "type" of hospital joining the ASC; semi-structured interviews were conducted to understand reasons for opting in or out of the ASC and experiences in the program; and a multivariate regression analysis with a difference-in-differences approach was used to assess the impact on HA-CDI rates. RESULTS: Hospitals with a greater number of annual discharges (P < .001) located in urban areas (P = .03) were more likely to join the ASC. All participants in the ASC (N = 44/184) successfully implemented the necessary infrastructure to track and report antibiotic usage data, despite this being the most cited challenge and main reason hospitals opted not to participate. While HA-CDI rates decreased to a greater extent for participating hospitals (ß = -0.153), this was not statistically significant (P = .191). CONCLUSIONS: HANYS' ASC proved an effective and well-received strategy for encouraging hospitals, particularly large, urban facilities, to take concrete steps to strengthen their antibiotic stewardship efforts and prepare for potential mandates requiring antibiotic usage tracking and reporting. However, a reduction in HA-CDI resulting from these efforts remains to be seen.

Inter-organizational information sharing and bundled payment reimbursement: Do hospitals in the US use health information exchange to collaborate?

OBJECTIVE: The purpose of this study is to examine the relationship between the greater need for information generated by bundled payment reimbursement and the use of Health Information Exchange (HIE). METHODS: The study is based on a secondary data analysis using theAmerican Hospital Association (AHA) Healthcare IT Database and the AHA Annual Survey. A logistic regression was used to test the likelihood of hospitals participating in HIE if they were involved in bundled payment reimbursement. Negative binomial, ordered logistic and Poisson regression models were used to determine the associations between bundled payment reimbursement and health information sharing in terms of breadth, volume, and diversity, respectively. RESULTS: Hospitals in bundled payment programs were more likely to send and receive information through HIE and tosend information to different types of health providers but not to receive. They were also more likely to exchange different types of health information and to use HIE more often. CONCLUSIONS: The greater need for collaboration of hospitals participating in bundled payment programs was associated with greater information sharing among organizations through HIE, but different providers involved in the episode of care play different roles in HIE.