Session : SHEA Decennial Distinguished Oral Abstract Awards

202 - Decreased Hospitalizations and Costs from Infection in 16 Nursing Homes in the SHIELD OC Regional Decolonization Initiative

Oral Abstract

Location: On Demand

Background: SHIELD OC (Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, CA) was a CDC-funded regional decolonization intervention from April 2017-July 2019 involving 38 hospitals, nursing homes (NHs), and long-term acute care hospitals (LTACHs) to reduce MDROs. Decolonization in NH and LTACHs consisted of universal antiseptic bathing with chlorhexidine (CHG) for routine bathing and showering plus nasal iodophor decolonization (M-F, twice daily every other week). Hospitals used universal CHG in ICUs and provided daily CHG and nasal iodophor to patients in contact precautions. We sought to evaluate whether decolonization reduced hospitalization and associated healthcare costs due to infection among residents of NHs participating in SHIELD compared to non-participating NHs.

Methods: Medicaid insurer data covering NH residents in OC were used to calculate hospitalization rates due to a primary diagnosis of infection (counts per member-quarter), hospital bed days/member-quarter, and expenditures/member-quarter from Q4 2015 to Q2 2019. We used time-series design and a segmented regression analysis to evaluate changes attributable to the SHIELD OC intervention among participating and non-participating NHs.

Results: Across the SHIELD OC intervention period, intervention NHs experienced a 44% decrease in hospitalization rates, a 43% decrease in hospital bed days, and a 53% decrease in Medicaid expenditures when comparing the last quarter of the intervention to the baseline period (See Figure). This translated to a significant downward slope with a reduction of 4% per quarter in hospital admissions due to infection (P < 0 .001), a reduction of 7% per quarter in hospitalization days due to infection (P < 0 .001), and a reduction of 9% per quarter in Medicaid expenditures (P=0.019) per NH resident.

Conclusions: The universal CHG bathing and nasal decolonization intervention adopted by NHs in the SHIELD OC collaborative resulted in large meaningful reductions in hospitalization events, hospitalization days, and healthcare expenditures among Medicaid-insured NH residents. The findings led CalOptima, the Medicaid provider in Orange County, CA, to launch a NH incentive program which provides dedicated training and covers the cost of CHG and nasal iodophor for OC NHs that enroll.

Presenting Author(s)

Gabrielle Gussin, MS

Doctoral Student
University of California, Irvine

Disclosure: No Disclosure

Slides Slides and Audio

Co-Author(s)

JM

James A. McKinnell, MD

Assistant Professor of Medicine
LA BioMed at Harbor-UCLA Medical Center
Torrance, California

Disclosure: No Disclosure
RS

Raveena Singh, MA

Program Coordinator
University of California, Irvine
Irvine, California

Disclosure: No Disclosure
KK

Ken Kleinman, PhD

Associate Professor
University of Massachusetts
Amherst, Massachusetts

Disclosure: No Disclosure
LM

Loren G. Miller, MD, MPH

Harbor UCLA
Torrance, California

Disclosure: No Disclosure
RS

Raheeb Saavedra, AS

Research Associate
University of California, Irvine
Irvine, California

Disclosure: No Disclosure
LH

Lauren Heim, MPH

Research Associate
University of California, Irvine
Irvine, California

Disclosure: No Disclosure
ME

Marlene Estevez, BA

Research Associate
University of California, Irvine
Irvine, California

Disclosure: No Disclosure
TC

Tabitha D. Catuna, MPH

Research Associate
University of California, Irvine
Irvine, California

Disclosure: No Disclosure
EL

Eunjung Lee, MD PhD

Physician
Soonchunhyang University Hospital
Irvine, California

Disclosure: No Disclosure
TT

Thomas Tjoa, MPH MS

Research Associate
University of California, Irvine
Irvine, California

Disclosure: No Disclosure
RS

Rachel Slayton, PhD, MPH

Mathematical Modeling Unit Lead
Centers for Disease Control and Prevention
Atlanta, Georgia

Disclosure: No Disclosure
Nimalie D. Stone, MD, MS

Long Term Care Team Lead
CDC Division of Healthcare Quality and Promotion
Atlanta, Georgia

Disclosure: No Disclosure
JJ

John A. Jernigan, MD, MS

Director, Office of Prevention Research and Evaluation
Centers for Disease Control and Prevention
Atlanta, Georgia

Disclosure: No Disclosure
MZ

Matthew Zahn, MD, MPH

Medical Epidemiologist
Orange County Department of Health
Irvine, California

Disclosure: No Disclosure
LJ

Lynn Janssen, MS

Epidemiologist
California Department of Public Health
Sacramento, California

Disclosure: No Disclosure
SG

Shruti K. Gohil, MD, MPH

Assistant Professor
University of California, Irvine
Irvine, California

Disclosure: No Disclosure
ST

Steven Tam, MD

Physician
University of California, Irvine
Irvine, California

Disclosure: No Disclosure
PR

Philip A. Robinson, MD

Physician
Hoag Hospital
Irvine, California

Disclosure: Gilead Sciences Inc.: Scientific Research Study Investigator
SP

Steven Park, MD PhD

Associate Professor
University of California, Irvine
Irvine, California

Disclosure: No Disclosure
RW

Robert A. Weinstein, MD

Professor
Rush University Medical Center
Chicago, Illinois

Disclosure: No Disclosure
Mary K. Hayden, MD, FIDSA, FSHEA

Director, Division of Infectious Diseases; Director, Division of Clinical Microbiology, Professor of Medicine and Pathology
Rush University Medical Center
Chicago, Illinois

Disclosure: Clorox : Grant/Research Support (Status: Terminated --- 2018); Medline : Other Financial or Material Support (Status: Terminated --- 2019), Provided product at no charge to healthcare facilities for research projects on which I am Co_i (Status: Terminated --- 2019); Molnlycke : Other Financial or Material Support (Status: Terminated --- 2019), Provided product at no charge to healthcare facilities for research projects on which I am Co_i (Status: Terminated --- 2019); Sage/Stryker : Other Financial or Material Support (Status: Terminated --- 2019), Provided product at no charge to healthcare facilities for research projects on which I am Co_i (Status: Terminated --- 2019)
CB

Cassiana Bittencourt, MD

Physician
University of California, Irvine
Orange, California

Disclosure: No Disclosure
EP

Ellena M. Peterson, PhD

PhD
University of California, Irvine
Irvine, California

Disclosure: No Disclosure
Susan S. Huang, MD, MPH

Professor
University of California, Irvine
Irvine, CA

Disclosure: Medline : Conducted clinical trials and studies in which participating hospitals and nursing homes received contributed antiseptic product (Status: Ongoing), Other Financial or Material Support (Status: Ongoing); Molnlycke : Conducted clinical trials and studies in which participating hospitals and nursing homes received contributed antiseptic product (Status: Terminated --- Feb 2016), Other Financial or Material Support (Status: Terminated --- Feb 2016); Stryker (Sage) : Conducted clinical trials and studies in which participating hospitals and nursing homes received contributed antiseptic product (Status: Terminated --- June 2019), Other Financial or Material Support (Status: Terminated --- June 2019); Xttrium : Conducted clinical trials and studies in which participating hospitals and nursing homes received contributed antiseptic product (Status: Terminated --- June 2019), Other Financial or Material Support (Status: Terminated --- June 2019)