A comparison of standardized bloodstream infection ratios across end stage renal disease networks

Background: Individuals receiving hemodialysis are at an increased risk of infection including bloodstream infections (BSIs). Numerous factors may impact a patient’s risk of having a BSI including vascular access type and geographic location. The End Stage Renal Disease Quality Incentive Program (ESRD QIP) was established by the Centers for Medicare and Medicaid Services (CMS) and utilizes a network of 18 geographically defined ESRD agencies that serve all U.S. and territories. The main objective of this study was to evaluate the regional/geographical impact on risk of dialysis patients’ BSI rates and the BSI Standardized Infection Ratio (SIR) performance of facilities in each of the 18 ESRD Network regions across a four-year span (2019-2022). Methods: Datasets were created using original data obtained from the National Healthcare Safety Network from each of the performance years (2019-2022). A mean SIR was calculated for each of the 18 ESRD Network regions per performance year and then ranked from lowest to highest SIR to evaluate performance. Yearly changes in rank were also identified for each region across the four performance years. Each of the 18 ESRD network locations were anonymized to remove identifiable information using a letter of the alphabet to identify individual ESRD network regions. Results: More than 7,000 outpatient hemodialysis facilities were analyzed with a total of 24,415 BSI SIRs analyzed. Geographically, the analysis found that Network region B remained among the top six networks all four years, whereas Network regions O and R remained in the bottom six networks for those same four years. Thisstudy’s results provide geographic specificity in BSI prevalence for further examination on regional disparities. Future evaluation of infection prevention measures among the 18 ESRD networks would be beneficial.