P-1148. Patient Harm Events: Hospital-Onset Bacteremia vs CMS-Reportable Events

Abstract Background CMS requires hospitals to report rates of CLABSI, CAUTI, SSI after colon surgery and abdominal hysterectomy, hospital-onset MRSA bacteremia, and hospital-onset C. difficile infection (HO-CDI) to NHSN. With any process that requires manual adjudication, discrepancies in data accuracy exist. To identify patient harm and to maximize data accuracy, a laboratory-reported hospital-onset bacteremia (HOB) event has been proposed as an alternative to certain CMS-reportable events. The goal of this study is to compare the performance of the proposed HOB metric with traditional CMS metrics for the identification and prognosis of HAI.Table 1.Source of Infection and HAI Group Methods This is a retrospective cohort study of patients hospitalized between 1/1/22 and 12/31/23 at a 500-bed academic safety net hospital in Denver, CO. Patients >18 years old with a positive blood culture on hospital day 4 or greater OR a CMS-reportable HAI were eligible for inclusion; those with HO-CDI were excluded. Patients were categorized into 3 mutually exclusive groups: HOB-only if the HAI was not reportable to CMS; CMS-only if the HAI did not involve bacteremia; or Overlap if the HAI involved bacteremia and was reported to CMS. Results Overall, 199 HAIs were identified in 185 patients by HOB or a current CMS metric. There were 109 HOB-only events (54.8%) in 97 patients, 49 CMS-only events (24.6%) in 49 patients, and 41 Overlap events (20.6%) in 39 patients. Age, gender, race, ethnicity, and preferred language did not differ between the 3 groups. The 6-month mortality was not different between the three groups (28.4% vs 20.4% vs 24.4% respectively, P=0.553). While CLABSI was most prevalent in the Overlap group, CAUTI and SSI were more strongly represented in the CMS-only group than in the HOB or Overlap groups (Table 1). Infections due to Gram negative organisms were more prevalent in the CMS-only than in the HOB-only or Overlap groups (69.4% vs 41.3% vs 14.6%, P< 0.0001) as were polymicrobial infections (32.7% vs 11.0% vs 4.9%, P=0.0003). Conclusion A change from current CMS-reported HAI events to HOB would lead to an overall increased number of identified patient harm events; however, CAUTI and SSI events would likely decrease. Care should be taken to ensure that the SSI events captured by HOB reflect emergent, urgent, and elective surgery types. Disclosures All Authors: No reported disclosures