Presentation (CTI)

Problem Statement: Healthcare-associated infections (HAIs) impose an annual economic burden of nearly $10 billion with CAUTI labor costs exceeding $31000 per case. This study evaluates Centers for Medicare and Medicaid Services’ CoP 485.64, a transformative policy mandating stewardship measures for reimbursement in low-resource Critical Access Hospitals (CAHs). By analyzing CAUTI trends- a relatively stable metric during the COVID-19 era, we highlight how targeted policies overcome systemic barriers to mitigate AMR and enhance patient safety.
Description: This study analyzed National Healthcare and Safety Network (NHSN) data from 2017 to 2023 to evaluate the impact of CoP 485.64 on CAUTIs in CAHs. Using Standardized Infection Ratio as the primary metric, trends were examined across intensive care units (ICUs), non-ICUs and overall facilities. Time series and scatter plots were generated in R software to visualize infection trajectories and identify patterns linked to ASP implementation.
Lessons Learned: Implementation of CoP 485.64 in 2019 increased compliance in CAHs, with reporting hospitals rising from 835 in 2017 to 1063 in 2023. While initial infection rates dipped around 2019, coinciding with policy adoption, CAUTI cases rose considerably, reflecting pandemic-related constraints. ICU trends showed a 45% change and a statistically significant decline in CAUTI cases from 2021 to 2022 signaling recovery and potential policy effectiveness as healthcare systems adapted post-COVID. Post-2019 SIR trends lacked statistical significance, emphasizing the need for sustained resources and investments to optimize antimicrobial stewardship outcomes and reduced healthcare costs.
Stakeholder Perspective: The upward trend in CAUTI cases pandemic-related stressors rather than a failure of CoP 485.64, which established a foundation for infection prevention. The policy directly affects multiple stakeholders: for administrators, compliance with CoP ensures continued eligibility for Medicare and Medicaid reimbursements, placing pressure on leadership to allocate resources towards infection control, antimicrobial stewardship teams and clinicians face the dual responsibility of adhering to evidence based antimicrobial practices while balancing patient specific care needs. For patients, the policy’s success translates directly into improved safety, reduced HAIs and better outcomes. This study highlights the untapped potential of NHSN data for evaluating policy impacts. While resource disparities may hinder uniform policy effectiveness, targeted investments and further research are crucial to enhance implementation and sustained reductions in CAUTI rates. Evidence-based policies remain essential for advancing cost-effective and equitable infection prevention.