Disadvantaged Neighborhoods are a Risk Factor for Hospital-Acquired Infections

Author(s):
Camden Gardner; Arielle Hodari Gupta; Ilan Rubinfeld; Jeffrey Johnson

Background:

The Hospital-Acquired Condition (HAC) reduction program governs portions of hospital reimbursement to incentivize quality treatment. Healthcare quality programs also influence brand perception which is leveraged in marketing. Rooted in these strategies is the notion that the occurrence of hospital-acquired infections (HAIs) solely reflects the performance of the health system. However, the communities treated by these institutions are not equal regarding risk factors to wellbeing. Recognizing the influence social determinates have on patient health, we examined the potential relationship between neighborhood deprivation and our National Healthcare Safety Network (NHSN) labelled infections which define patient safety and healthcare quality for the Center for Medicare & Medicaid Services (CMS).

Hypothesis:

Surgical patients with increased area deprivation index have a higher risk of NHSN labelled HAIs.

Methods:

Surgical patients encountered between 2014 to 2022 were queried from a healthcare administration database spanning five hospitals. Demographic, baseline health, and case variables were analyzed in relation to area deprivation index (ADI) and the HAIs of CLABSI, CAUTI, and C. difficile infection. Univariate statistical tests and multivariate logistic regression were performed to highlight the relationship between patient variables, including transfer status, and the occurrence of HAIs. The dataset was deidentified and the project deemed exempt from IRB review. The analysis was produced with the R programing language.

Results:

The cohort contained 161,444 surgical encounters with an average State ADI of five and a National ADI of 66. The overall rate of HAIs was 0.5% (874) with 198 (0.1%) cases of CLABSI, 222 (0.1%) cases of CAUTI, and 487 (0.3%) cases of C. difficile infection. The majority of demographic, baseline health, and case variables exhibited statistical significance across the occurrence of HAIs at the univariate level. Across the three HAIs of interest, both National and State ADI was higher in patients with CLABSI (p-value: <0.001), CAUTI (p-value: <0.001); C. difficile (p-value: <0.001). Multivariate analysis did not find ADI related to HAIs (State, OR 1.00; p-value: 0.85; National, OR: 1.00; p-value: 0.83).

Conclusions:

Patients experiencing HAIs are likely to have increased area deprivation, but this correlation is not supported when adjusted for confounding variables. Potentially explaining the success of historical intrahospital quality initiatives.