Use of a Central Catheter Maintenance Bundle in Long-Term Acute Care Hospitals.

OBJECTIVE: Evidence-based guidelines have resulted in decreases in bloodstream infections associated with central catheters (CLABSIs) in hospital intensive care units. However, relatively little is known about CLABSI incidence and prevention in long-term acute care hospitals (LTACHs). METHODS: A central catheter maintenance bundle was implemented in 30 LTACHs, and compliance with the bundle was tracked for 6 months. CLABSI rates were monitored for 14 months before and 14 months after the bundle was implemented. RESULTS: The pooled mean CLABSI rate (No. of infections per 1000 days with a central catheter) was 1.28 before the bundle and 0.96 after the bundle (repeated measures general linear model; F1,58 = 6.973; P = .01; partial η(2) = .11). From 14 months before to 14 months after the bundle was implemented, the mean number of CLABSIs per LTACH decreased by 4.5 (95% CI, 1.85-7.15). Time series modeling showed a significant decrease in the mean hospital CLABSI rate after the bundle was implemented (-0.511 CLABSI/1000 catheter days, SE = 0.050), indicating an immediate effect of the bundle. The mean hospital CLABSI rate was decreasing slightly before the bundle was implemented and continued to decrease at a reduced rate after the bundle was implemented. CONCLUSION: The bundle resulted in a significant and sustained reduction in CLABSI rates in 30 LTACHs for 14 months. These results encourage the development and implementation of similar bundles as effective strategies for infection reduction in LTACHs.

Long-term acute care hospitals have low impact on medicare readmissions to short-term acute care hospitals.

The relative contribution of long-term acute care hospital (LTACH) to short-term acute care hospital (STACH) Medicare patient readmissions is important because of the high acuity of LTACH patients. A retrospective cohort study was conducted to determine the magnitude of LTACH Medicare heart failure (HF) and pneumonia (PN) inpatient readmissions to STACHs within 30 days of LTACH admission and the relative contribution of LTACH patient readmissions to each STACH's total readmissions. Seventy-five for-profit LTACHs and their associated host or primary referral STACHs were studied. An average of 8% HF and 8% PN LTACH Medicare inpatients were readmitted to host or primary referral STACHs within 30 days of admission, representing 0.4% and 0.8% of the total number of HF and PN Medicare patients, respectively, readmitted to the STACHs in fiscal year 2010. The low rates of readmission from LTACHs to STACHs suggest an appropriate level of care for the LTACHs studied.