Hospital-Nursing Home Transfer Patterns and Influence on Nursing Home Clostridium difficile Infection Rates

BACKGROUND: Little is known as to how hospital C. difficile infection (CDI) may impact nursing home (NH) CDI, or how patient transfers may modify this relationship. This study aims to examine a possible association between hospital and NH CDI rates, and whether NH CDI rates are influenced by patient transfers from hospital to NH. METHODS: Patient transfers among the 5 hospitals and 34 NHs in Monroe County, NY were identified from the Minimum Data Set (MDS) 3.0 and Medicare Provider Analysis and Review files for 2011–13, and aggregated to the NH level. NH and hospital CDI rates were obtained from Emerging Infections Program CDI population surveillance and National Healthcare Safety Network data, respectively. Multivariate negative binomial regression modeled the association between hospital CDI rate (weighted by hospital-to-NH transfers/overall transfers among hospitals and NHs) and NH CDI rate, controlling for NH covariates from NH Compare and the Online Survey, Certification, and Reporting files. Patient transfer networks between hospitals and NHs were constructed, and basic network analysis of transfer patterns was conducted to confirm contributing factors to NH CDI rates from the multivariate model. RESULTS: When weighted hospital CDI rate increased by 1%, NH CDI rate increased by 18% (P = 0.016). Antibiotic and feeding tube prevalence were associated with a 4% and 8% increase in NH CDI rate, respectively (P≤0.014). Network analysis confirmed multivariate results and detected hospital-NH pairs with high edge weights (number of transfers) where NHs receiving patients from hospitals with high CDI rates had higher CDI rates. Network clustering methods were used to identify 2 sub-networks within overall annual networks and clusters of hospital-NH pairs for targeted intervention. CONCLUSION: Hospital CDI rate, adjusting for patient transfers, is associated with higher NH CDI rates in multivariate and network analyses, suggesting that NHs with a large inflow of patients from hospitals may need to implement stricter infection prevention practices to reduce transmission among residents. By identifying regional sub-networks, network analysis can also be used to actively manage facility CDI and prevent spread to other healthcare facilities. DISCLOSURES: All authors: No reported disclosures.