SC ACA Implementation Committee Quality and Outcomes Work Group - - PowerPoint PPT Presentation

SC ACA Implementation Committee – Quality and Outcomes Work Group Jerry Gibson DHEC ‐ State Epidemiologist 6/3/2011

HIDA

Hospital Infections Disclosure Act Passed in May 2006, requiring inpatient acute care

hospitals to report to the SC DHEC selected hospital acquired infections and selected infection prevention processes

HIDA (cont)

Since 2007, inpatient rehabilitation and long‐term

acute care (LTAC) facilities have been added.

Currently, 79 facilities report on central line associated

bloodstream infections (CLABSIs) and certain surgical site infections (SSIs)

6/29/06 DHEC internal meeting Aug 06 CDC Training for DHEC Nov 06 Begin Training for ICPs at APIC Jan 07 ICPs begin to pilot NHSN Feb 07 DHEC begins pilot analysis

• f data

May 07 ICPs begin formal entry of data into NHSN Nov 07 DHEC accesses 6-month

• f data in

NHSN to begin analysis July 07 DHEC gets funding ??? 1/31/08 DHEC publishes 1st report Feb 08 DHEC begins QA of data Feb 09 DHEC submits 1st Report to legislature Aug 06 1st Advisory Committee meeting

Timeline for Activities Required for Compliance with Hospital Infections Disclosure Law May 06 Law passed

National Healthcare Safety Network

A secure, internet

based surveillance system through which facilities can report their data on hospital associated infections

What is a Standardized Infection Ratio (SIR)?

The SIR is a summary measure used to track HAIs at a

national, state, and local level over time.

Method of calculating is similar to the Standardized

Mortality Ratio

The SIR compares the actual number of HAIs reported to

the baseline experience

Adjusted for several risk factors that have been found to be

significantly associated with differences in infection incidence.

An SIR greater than 1.0 indicates that more HAIs were

• bserved than predicted; an SIR less than 1.0 means fewer

HAIs were observed than predicted

Mandatory Reporting of Healthcare‐associated Infection Rates ‐ 2009

www.APIC.org

*

Central lines access large veins, catheter tip is near heart, may remain in place for weeks or months Central line‐associated bloodstream infection = CLABSI

CLABSI

Crude mortality 10‐40% Attributable mortality 2‐15% Prolongation of hospitalization 5‐20

days

Attributable cost $34,000‐$56,000

Central Line Locations # Hospitals monitoring Locations Total # Central Line Days Total # Infection s % Lower SIR % Not Different SIR % Higher SIR Comments All Adult Inpatient Units 62 247,473 329 4.84% (3) 82.26% (51) 1.61% (1) Seven hospitals (11.29%) had too few central line days to calculate a statistical percentage Adult Critical Care Units 52 134,929 228 7.69% (4) 84.62% (44) 5.77% (3) One hospital (1.92%) had too few central line days Pediatric Inpatient 16 9833 10 6.25% (1) 56.25% (9) 0% Six hospitals (37.5%) had too few central line days Pediatric Critical Care Unit 5 7371 11 20% (1) 80% (4) 0% N/A Inpatient Rehab Unit 16 12,804 14 0% 87.5% (14) 6.25% (1) One hospital (6.25%) had too few central line days LTAC 7 50,279 77 0% 100% 0% N/A Heme/Onc Unit 8 35,566 53 25% (2) 75% (6) 0% N/A Pediatric Heme/Onc Unit 3 6378 15 0% 100% 0% N/A Bone Marrow Transplant Unit 1 810 0% 100% 0% N/A

SIRs for CLABSI, all SC hospitals calendar year 2010, by patient care unit

SC CLABSI DATA

**Although not from 2010 data, it should be noted

that in March 2011, the CDC released data showing that, of 17 states with a mandate for reporting CLABSIs to NHSN, South Carolina was the only state to demonstrate a significant decrease in CLABSI SIRs. South Carolina’s CLABSI rate dropped 30% July to December 2009 when compared to January to June 2009, in continuously reporting facilities. (www.cdc.gov/vital signs)

PICU CLABSI SIR Trend Graph (Only Includes Medical and Medical/Surgival PICUs)

1.61 3 1.18 1.01 0.53

0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 Jan 08 - Jun 08 Jul 08 - Dec 08 Jan 09 - Jun 09 Jul 09 - Dec 09 Jan 10 - Dec 10 Trend Point Standardized Infection Ratio SIR O=E ?? CI Source: DHEC, Bureau of Disease Control - HAI Section

Continuation of Hospital Report

Surgical Site Infections

In SC, we monitor SSIs from:

Coronary Artery Bypass Graft (CABG) Hip Replacements Knee Replacements Abdominal Hysterectomies Colectomies (in facilities with <200 beds) Previously collected cholecystectomies, but site dropped

because very low infection rates

SIR

SIR= observed

expected

For SSIs, calculated using logistical regression

model

Risk factors vary by procedure, but include patient

age, ASA score, surgery duration, medical school affiliation, gender, type of anesthesia used, hospital bed size, wound class, trauma and others

Surgical Procedures # Hospitals performing procedure Total # Procedures Total # Infections % Lower SIR % Not Different SIR % Higher SIR Comments* Coronary Artery Bypass Graft (Chest and Donor Incision) 16 3930 29 0% 93.75% (15) 6.25% (1) N/A Coronary Artery Bypass Graft (Chest Incision) 12 293 1 0% 33.33% (4) 0% * Eight Hospitals (66.67%) had too few procedures to calculate statistical percentage

Hysterectomy (Abdominal)

49 5337 44 0% 75.51% (37) 2.04% (1) Eleven hospitals (22.45%) had too few procedures Hip Prosthesis -

• Replacement

53 6684 81 0% 73.58% (39) 5.66% (3) Eleven hospitals (20.75%) had too few procedures Knee Prosthesis

• -Replacement

50 10,394 69 0% 82% (41) 6% (3) Six hospitals (12%) had too few procedures Colon Surgery 34 1,246 36 0% 58.82% (20) 5.88% (2) Twelve hospitals (35.29%) had too few procedures

Surgical site infections, six sites, all SC hospitals, calendar year 2010

Example of an Individual Hospital Report SC was one of only 5 states that validated all

• Reports. Rates were

significantly higher in those states, due to better reporting.

Microorganisms Number Isolates Percent Candida species and other yeasts 147 17.8 Enterococcus species (includes VRE) 143 17.3 Vancomycin resistant enterococcus (VRE only - % of total isolates) 41 (5.0) Coagulase negative Staphylococcus species 140 16.9 Staphylococcus aureus (includes MRSA) 104 12.6 Methicillin resistant Staphylococcus aureus (MRSA) only - % of total positive isolates) 66 (8.0) Klebsiella species 77 9.3 Enterobacter species 39 4.7 Escherichia coli 33 4.0 Pseudomonas species 25 3.0 Serratia species 22 2.7 Streptococcus species 18 2.2 Acinetobacter species 15 1.8 Stenotrophomonas maltophilia 7 0.8 Citrobacter species 7 0.8 Proteus species 6 0.7 Bacteroides species 5 0.6 Other anaerobes 5 0.6 Providencia species 4 0.5 Morganella species 4 0.5 Burkholderia species 3 0.4 Clostridium species 3 0.4

Validation

SC is one of few states that validates data entered into

NHSN by facilities

One of only five states that perform actual chart reviews Especially important to identify “system” errors Also helps DHEC to establish and maintain good

relationships with IPs

In 2009 CDC report on infection rates from 10 states

with “mature” reporting, CDC concluded that the states doing validation had significantly better reporting completeness(including SC and NY).

Provides framework to ensure progress towards

five‐year national prevention targets as described in the HHS Action Plan in the following areas:

Develop or Enhance Public Health HAI Program

Infrastructure

Surveillance, Detection, Reporting, and Response Prevention Evaluation, Oversight, and Communication

Hospital Infections Disclosure Act (HIDA) Web Sites

DHEC Public Reports

www.scdhec.gov/hai

Information for Hospitals

www.scdhec.gov/hidainfo