SLIDE 1 Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 1 Infection Prevention Data Submission and Analysis
Linda R. Greene, RN, MPS,CIC,FAPIC Manager, Infection Prevention UR Highland Hospital Rochester, NY linda_greene@urmc.rochester.edu
Objectives
Discuss how to calculate basic infection rates Describe how this information is used by the National
Healthcare safety network ( NHSN
Explain Standardized Infection Ratios (SIRs) Identify how the TAP report can be used to drive
improvement
Let’s Start at the Beginning
Let’s talk about :
Ratios Proportions Rates
SLIDE 2 Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 2
Ratios
Number or rate of events/items/persons/etc. in group 1 Number or rate of events/items/persons/etc. in group 2 A hospital with 420 inpatient beds has 3 IPs. 420 / 3 (x100) = 140 inpatient beds per IP Ratio of inpatient beds to IPs is 140:1. x 10n
Proportions
Number of events/persons with a particular characteristic Total number of events/persons (of which the numerator is a subset)
During 2019 a hospital had 50 CAUTIs, of which 18 were on
the neuro surgical ICU 18 / 50 (x102) = 36 CAUTIs in males per 100 CAUTIs = 36% of CAUTIs were in males x 10n
Rates
Several definitions of rates exist For NHSN, we will focus on incidence rates Incidence rates are the measure of the frequency of
- ccurrence of new cases of infection over a defined time
period
The numerator is the number of patients The denominator is the number of patients at risk
SLIDE 3 Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 3
Device Infections
We use line days or urinary catheter days to calculate the device infection rate for a particular period of time Usually it is per 1,000 line days Why use 1000?
Line days
For the month of January, your ICU had one 1 CLABSI and 500 line days What would your CLABSI rate be ? 1/500 =.002 x1000= 2.0
Examples
Location summaryYQ months clabcount numcldays CLABRate numpatdays LineDU
ICU 2019Q1 3 2 463 4.32 1113 0.416
SLIDE 4 Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 4
Prevalence Rate
Prevalence, sometimes referred to as prevalence
rate, is the proportion of persons in a population who have a particular disease or attribute at a specified point in time or over a specified period of time.
We often see this method used to calculate pressure
ulcers, etc.
Prevalence Rates used in Public Health
A point-prevalence survey that was conducted in the United States in 2011 showed that 4% of hospitalized patients had a health care–associated infection. We repeated the survey in 2015 to assess changes in the prevalence of health care–associated infections during a period of national attention to the prevention of such infections Pneumonia, gastrointestinal infections (most of which were due to Clostridium difficile [now Clostridioides difficile]), and surgical-site infections were the most common health care–associated infections. Patients’ risk of having a health care–associated infection was 16% lower in 2015 than in 2011
Prevalence Rate
On June 30th of 2019, there were 4 patients in your
ICU who had a gram negative multiply resistant
- rganism out of 130 patients
On August 30th of 2019 2 of the 4 patients remained in
the ICU and 3 new patients with MDROs were identified and there were 128 patients
What is your prevalence rate for June? Patients / total number x100
SLIDE 5 Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 5
Understanding the SIR
The SIR is a ratio Number of observed infections/ number of predicted Predicted comes from 2015 baseline data Turns data into a single number that can be applied across institutions
https://www.cdc.gov/nhsn/pdfs/ps-analysis-resources/nhsn-sir-guide.pdf
Let’s Try This
You had 1 infection in your ICU this quarter, your predicted is 2.4 1/ 2.4 =0.416
Basic Statistical Tools Every IP Should Be Able to Use
The P Value (in plain English) Statistic relating whether or not the sample supports the tested hypothesis What You Need to Know:
- P values are most often set at .05
- Results that are less than .05 are deemed statistically
significant because. . .
- .05 = 95% confidence that the result did not occur by chance
alone
SLIDE 6 Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 6
Null hypothesis:
Your infection rate and the benchmark infection rate
are the same.
Alternative hypothesis:
Your infection rate and the benchmark infection rate
are different.
SIR 1 2 Same Better Worse
Standardized Infection Ratios Interpretation of the SIR
SIR = 1
The number of infections is around what would be
expected.
SIR >1
The number of infections is higher than expected (worse).
SIR <1
The number of infections is lower than expected (better).
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Facility Number of Procedures Performed Number of Infections Expected Number of Infections SIR SIR p‐value 95% Confidence Interval for SIR A 290 1 5.8 0.2 0.03 0.0, 0.9 B 80 4 1.5 2.6 0.65 0.7, 6.7 C 1500 75 28.5 2.6 0.01 2.1, 3.3 CABG‐Related Surgical Site Infections Facility Number of Procedures Performed Number of Infections Expected Number of Infections SIR SIR p‐value 95% Confidence Interval for SIR A 290 1 5.8 0.2 0.03 0.0, 0.9 B 80 4 1.5 2.6 0.65 0.7, 6.7 C 1500 75 28.5 2.6 0.01 2.1, 3.3 CABG‐Related Surgical Site Infections
Standardized Infection Ratios
SIR 1 2 Same Better Worse
α = 0.05
SLIDE 7 Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 7
Facility SIR SIR p‐value A 0.2 0.03 B 2.6 0.65 C 2.6 0.01 Facility SIR SIR p‐value A 0.2 0.03 B 2.6 0.65 C 2.6 0.01
Standardized Infection Ratios
1 5 2 3 4 6 7
SIR
α = 0.05 Facility SIR SIR p‐value 95% Confidence Interval for SIR A 0.2 0.03 0.0, 0.9 B 2.6 0.65 0.7, 6.7 C 2.6 0.01 2.1, 3.3 Facility SIR SIR p‐value 95% Confidence Interval for SIR A 0.2 0.03 0.0, 0.9 B 2.6 0.65 0.7, 6.7 C 2.6 0.01 2.1, 3.3
The SIR and p-value
Remember: p-value is a probability Helps determine rarity…how rare is this outcome that it
could not have happened by chance alone? Is our SIR different from 1? (where 1 indicates that the #
- bserved is equal to the # predicted)
Is our rate different from the NHSN pooled mean?
The SIR and p-value
If the p-value is very small (less than 1 in 20 or 5% or
0.05; hence p<0.05): For example, if p<0.05, conclude that our SIR is
“significantly different” than 1
OTHERWISE (i.e., if p>0.05) conclude that our CAUTI
SIR is no different than 1
NOTE: p<0.05 is a convenient cut-point that is widely
accepted
SLIDE 8 Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 8
SIR and the 95% CI
NHSN produces a p-value and 95% confidence interval
with each SIR – both can be used to assess significance of the SIR
A 95% CI is an interval for which we have a high
degree of confidence that it contains the true SIR The upper and lower limits are used to determine the
significance and accuracy (or precision) of the SIR
SIR and the 95% CI
Allows you to assess variability of an estimated SIR If the confidence interval includes the value of 1, then the
SIR is not significant i.e., if the lower bound is ≤ 1 and the upper bound is ≥ 1, then
the SIR is not significant.
New from NHSN
Percentile
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TAP report and SIR Example
SLIDE 10 Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 10
TAP Strategy
Target → Assess → Implement
Target facilities using TAP Report function available in NHSN
Assess gaps in infection prevention in targeted facilities/units using Facility Assessment Tools
Implement interventions to address the gaps in infection prevention using Implementation Guidance
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Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 11
Where to begin?
Start with important terms:
Cumulative Attributable Difference (CAD) A measure to target prevention to reach HAI goals CAD = the number of infection to prevent in order to
reach the SIR Goal
CAD Practical Application
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Advantages
Can be used in annual risk assessment Helps care providers have realistic goals Prioritize units at the facility level
Data across Hospitals
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Communication Next Steps
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Your Report Resources Questions
