Health Care Associated Infections in 2017 Acute Care Hospitals Christina Brandeburg, MPH Epidemiologist Katherine T. Fillo, Ph.D, RN-BC Director of Clinical Quality Improvement Eileen McHale, RN, BSN Healthcare Associated Infection Coordinator Public Health Council July 11, 2018
Introduction Healthcare-associated infections (HAIs) are infections that patients acquire during the course of receiving treatment for other conditions within a healthcare setting. HAIs are among the leading causes of preventable death in the United States, affecting 1 in 25 hospitalized patients, accounting for an estimated 722,000 infections and an associated 75,000 deaths during hospitalization.* The Massachusetts Department of Public Health (DPH) developed this data update as a component of the Statewide Infection Prevention and Control Program created pursuant to Chapter 58 of the Acts of 2006. • Massachusetts law provides DPH with the legal authority to conduct surveillance, and to investigate and control the spread of communicable and infectious diseases. (MGL c. 111,sections 6 & 7) • DPH implements this responsibility in hospitals through the hospital licensing regulation. (105 CMR 130.000) • Section 51H of chapter 111 of the Massachusetts General Laws authorizes the Department to collect HAI data and disseminate the information publicly to encourage quality improvement. (https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXVI/Chapter111/Section51H) Magill SS, Edwards JR, Bamberg W, et al. Multistate point-prevalence survey of health care-associated infections. 2 N Engl J Med. 2014; 370:1198-208.
Purpose This HAI presentation is the ninth annual Public Health Council update: • It is an important component of larger efforts to reduce preventable infections in health care settings; • It presents an analysis of progress on infection prevention within Massachusetts acute care hospitals; • It is based upon work supported by state funds and the Centers for Disease Control and Prevention (CDC); and • It provides an overview of antibiotic resistance and stewardship activities. 3
Methods This data summary includes the following statewide measures for the 2017 calendar year (January 1, 2017 – December 31, 2017) as reported to the CDC’s National Healthcare Safety Network (NHSN). The DPH required measures are consistent with the Centers for Medicare and Medicaid Services quality reporting measures. • Central line associated bloodstream infections (CLABSI) in intensive care units • Catheter associated urinary tract infections (CAUTI) in intensive care units • Specific surgical site infections (SSI); and • Specific facility wide laboratory identified events (LabID). *National baseline data for each measure are based on a statistical risk model derived from 2015 national data. *All data were extracted from NHSN on June 11 th , 2018. 4
Measures • Standardized Infection Ratio (SIR)* Actual Number of Infections Standardized Infection Ratio (SIR) = Predicted Number of Infections * When the actual number is equal to the predicted number the SIR = 1.0 • Central Line Utilization Ratio Number of Central Line Days Central Line Utilization Ratio = Number of Patient Days • Urinary Catheter Utilization Ratio Urinary Catheter Utilization Ratio = Number of Urinary Catheter Days Number of Patient Days 5
How to Interpret SIRs and 95% Confidence Intervals (CIs) Significantly higher than predicted Not significantly different than predicted SIR Significantly lower than predicted The green horizontal bar represents the SIR, and the blue vertical bar represents the 95% confidence interval (CI). The 95% CI measures the probability that the true SIR falls between the two parameters. • If the blue vertical bar crosses 1.0 (highlighted in orange ), then the actual rate is not statistically significantly different from the predicted rate. • If the blue vertical bar is completely above or below 1.0, then the actual is statistically significantly different from the predicted rate. 6
Massachusetts Central Line-Associated Bloodstream Infection (CLABSI) SIR, by ICU Type January 1, 2017-December 31, 2017 5.0 Key Findings 4.5 4.0 Three ICU types 3.5 experienced a significantly lower 3.0 number of infections SIR 2.5 than predicted, based 2.0 on 2015 national aggregate data: 1.5 Medical (T) 1.0 Medical /Surgical (T) 0.5 Surgical 0.0 Burn Cardiac Cardiothoracic Medical (T) Medical (NT) Medical/Surgical (T) Medical/Surgical (NT) Neurosurgical Pediatric Surgical Trauma One ICU type experienced a significantly higher number of infections than predicted, based on 2015 national aggregate data: ICU Type Burn NT=Not major teaching T= Major teaching SIR Upper and Lower Limit 7
CLABSI Adult & Pediatric ICU Pathogens for 2016 and 2017 Calendar Year 2016 Calendar Year 2017 January 1, 2016 – December 31, 2016 January 1, 2017 – December 31, 2017 n=176 n=165 Staphylococcus Staphylococcus aureus (not aureus (not MRSA) MRSA) Yeast/Fungus Methicillin- 8% Methicillin- Yeast/Fungus 7% (other) resistant resistant (other) 11% Staphylococ Staphylococ 14% 5% 2% Candida albicans Coagulase- 10% negative Coagulase- Candida albicans Staphylococcus negative 12% 16% Staphylococcus 17% Multiple Organisms 11% Multiple Enterococcus sp. Organisms 9% 10% Enterococcus sp. Gram-positive 16% Gram-negative bacteria (other) bacteria Gram-negative 5% 17% Gram-positive bacteria bacteria (other) 24% 6% 8
Massachusetts CLABSI SIR in NICUs, by Birth Weight Category January 1, 2017-December 31, 2017 4.0 Key Findings 3.5 Infants weighing 3.0 1001 grams-1500 grams at birth 2.5 experienced a significantly higher SIR 2.0 number of infections than predicted, 1.5 based on 2015 national aggregate 1.0 data. 0.5 There were 20 CLABSIs reported in 0.0 this ICU type. ≤750 g 751-1000 g 1001-1500 g 1501-2500 g >2500 g Birth Weight SIR Upper and Lower Limit 9
CLABSI NICU Pathogens for 2016 and 2017 Calendar Year 2016 Calendar Year 2017 January 1, 2016 – December 31, 2016 January 1, 2017 – December 31, 2017 n=28 n=20 Candida and Multiple other Organisms Yeast/Fungus Multiple 7% 5% Organisms 10% Gram-negative bacteria (other) Staphylococcus Staphylococcus 18% Gram-negative aureus (not aureus (not bacteria (other) MRSA) MRSA) 10% 39% 40% Escherichia coli 5% Enterococcus sp. Escherichia coli 5% 18% Methicillin- resistant Coagulase- Coagulase- Staphylococcus negative negative aureus (MRSA) Staphylococcus Staphylococcus 4% 25% 14% 10
State CLABSI SIR Key Findings 2.0 For the past three years, adult ICUs 1.5 experienced a significantly lower number of infections SIR than predicted, 1.0 based on 2015 national aggregate data. 0.5 Over the past three years, neonatal ICUs have seen a decrease 0.0 2015 2016 2017 in the number of Calendar Year infections. Adult Pediatric Neonatal 11
State Central Line (CL) Utilization Ratios 0.7 Key Findings Discontinuing 0.6 unnecessary central lines can reduce the 0.5 risk for infection. Utilization Ratio 0.4 Central line (CL) utilization has remained relatively 0.3 unchanged between 2015 and 2017. 0.2 0.1 0.0 2015 2016 2017 *The CL utilization ratio is Calendar Year calculated by dividing the number of CL days by the Adult Pediatric Neonatal number of patient days. 12
Massachusetts Catheter-Associated Urinary Tract infection (CAUTI) SIR, by ICU Type January 1, 2017-December 31, 2017 3.5 Key Findings 3.0 Two ICU types 2.5 experienced a significantly lower 2.0 number of infections SIR than predicted, 1.5 based on 2015 national aggregate 1.0 data: Medical /Surgical (T) 0.5 Trauma 0.0 Burn Cardiac Cardiothoracic Medical (T) Medical (NT) Medical/Surgical (T) Medical/Surgical (NT) Neurosurgical Pediatric Surgical Trauma One ICU type experienced a significantly higher number of infections than predicted, based on 2015 national aggregate ICU Type data: NT=Not major teaching Neurosurgical T= Major teaching SIR Upper and Lower Limit 13
CAUTI Adult & Pediatric ICU Pathogens for 2016 and 2017 Calendar Year 2016 Calendar Year 2017 January 1, 2016 – December 31, 2016 January 1, 2017 – December 31, 2017 n=290 n=305 Staphylococcus Staphylococcus aureus (not aureus (not Multiple Multiple MRSA) MRSA) Organisms Organisms 2% 2% 6% 8% Gram-negative Gram-negative bacteria (other) bacteria (other) 14% Escherichia coli Escherichia coli 13% 34% 35% Gram-positive Gram-positive bacteria (other) bacteria (other) 8% 8% Enterococcus sp. Enterococcus sp. 8% 10% Coagulase- Pseudomonas Pseudomonas Coagulase- negative aeruginosa aeruginosa negative Staphylococcus Klebsiella 12% Klebsiella 13% Staphylococcus 2% pneumoniae pneumoniae 3% 12% 10% 14
State CAUTI SIR 2.0 Key Findings Over the past three years, pediatric ICUs 1.5 have seen an increase in the number of infections but are no different SIR 1.0 than predicted, based on 2015 national aggregate data. 0.5 There were 13 CAUTIs reported by 0.0 10 pediatric ICUs. 2015 2016 2017 Calendar Year Adult Pediatric 15
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