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Abstract
Nursing home residents are often susceptible to infection due to advanced age, increased comorbidities, and frequent receipt of ongoing complex medical care. Healthcare-associated infections (HAIs) in the nursing home setting contribute to significant morbidity and costs among residents. Since 2022, the Centers for Medicare and Medicaid Services (CMS) has published an annual risk-standardized rate of HAIs requiring hospitalization for all certified nursing homes in the United States. The primary objectives of this study are to measure which nursing home characteristics and staffing measures are associated with the risk-standardized rate of HAIs requiring hospitalization and to measure associations between the HAI rate and newly mandated minimum CMS staffing standards. This retrospective cohort study utilized two multivariable regression models to quantify the associations between nursing home characteristics, including measures of registered nurse (RN), licensed practical nurse (LPN) and nurse aide staffing hours per resident-day (HPRD) and the risk-standardized rate of HAIs requiring hospitalization in fiscal year 2022. A third multivariable linear regression model was used to quantify the association between the HAI rate and if a nursing home had met newly mandated CMS minimum staffing standards.
Among 14,886 CMS certified nursing homes, the risk standardized rate of HAIs requiring hospitalization was reported for 11,431 (83%) and had a mean value of 7.0 per 100 residents. In a multivariable model, for-profit and government ownership (compared to non-profit), higher average number of beds, location inside a hospital, and higher RN staffing levels were associated with higher rates of HAIs requiring hospitalization. Adjusting for nursing home characteristics, having high LPN staffing was associated with higher odds of having an HAI rate categorized as worse than the national average. Nursing homes who met the minimum staffing standards were associated with 0.43 fewer HAIs requiring hospitalization per 100 residents, which translates to an estimated 3,477 potentially preventable infections.
Nursing homes should strive to prevent HAIs requiring hospitalization to improve care for their residents. From this analysis, increasing RN HPRD and meeting the minimum staffing standards were two strategies that were associated with reduced HAI rates.