Infection Prevention Boot Camp I for the Novice January 16 ‐ 17, 2020 Infection Preventionist 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 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 1
Infection Prevention Boot Camp I for the Novice January 16 ‐ 17, 2020 Infection Preventionist Ratios Number or rate of events/items/persons/etc. in group 1 x 10 n Number or rate of events/items/persons/etc. in group 2 A hospital with 420 inpatient beds has 3 IPs. 420 / 3 (x10 0 ) = 140 inpatient beds per IP Ratio of inpatient beds to IPs is 140:1. Proportions Number of events/persons with a particular characteristic x 10 n 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 (x10 2 ) = 36 CAUTIs in males per 100 CAUTIs = 36% of CAUTIs were in males Rates Several definitions of rates exist For NHSN, we will focus on incidence rates Incidence rates are the measure of the frequency of occurrence 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 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 2
Infection Prevention Boot Camp I for the Novice January 16 ‐ 17, 2020 Infection Preventionist 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 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 3
Infection Prevention Boot Camp I for the Novice January 16 ‐ 17, 2020 Infection Preventionist 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 organism 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 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 4
Infection Prevention Boot Camp I for the Novice January 16 ‐ 17, 2020 Infection Preventionist 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 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 5
Infection Prevention Boot Camp I for the Novice January 16 ‐ 17, 2020 Infection Preventionist Standardized Infection Ratios 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. Same Better Worse 0 1 2 SIR 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). 17 Standardized Infection Ratios α = 0.05 CABG ‐ Related Surgical Site Infections CABG ‐ Related Surgical Site Infections Number of Number of Expected Expected Procedures Procedures Number of Number of Number of Number of SIR SIR 95% Confidence 95% Confidence Facility Facility Performed Performed Infections Infections Infections Infections SIR SIR p ‐ value p ‐ value Interval for SIR Interval for SIR A A 290 290 1 1 5.8 5.8 0.2 0.2 0.03 0.03 0.0, 0.9 0.0, 0.9 B B 80 80 4 4 1.5 1.5 2.6 2.6 0.65 0.65 0.7, 6.7 0.7, 6.7 C C 1500 1500 75 75 28.5 28.5 2.6 2.6 0.01 0.01 2.1, 3.3 2.1, 3.3 Same Better Worse 0 1 2 SIR Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 6
Infection Prevention Boot Camp I for the Novice January 16 ‐ 17, 2020 Infection Preventionist Standardized Infection Ratios α = 0.05 95% 95% Confidence Confidence SIR SIR SIR SIR Interval for Interval for Facility SIR Facility SIR Facility SIR Facility SIR p ‐ value p ‐ value p ‐ value p ‐ value SIR SIR A A A A 0.2 0.2 0.2 0.2 0.03 0.03 0.03 0.03 0.0, 0.9 0.0, 0.9 B B B B 2.6 2.6 2.6 2.6 0.65 0.65 0.65 0.65 0.7, 6.7 0.7, 6.7 C C C C 2.6 2.6 2.6 2.6 0.01 0.01 0.01 0.01 2.1, 3.3 2.1, 3.3 0 1 2 3 4 5 6 7 SIR 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 # observed 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 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 7
Infection Prevention Boot Camp I for the Novice January 16 ‐ 17, 2020 Infection Preventionist 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 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 8
Infection Prevention Boot Camp I for the Novice January 16 ‐ 17, 2020 Infection Preventionist TAP report and SIR Example Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 9
Infection Prevention Boot Camp I for the Novice January 16 ‐ 17, 2020 Infection Preventionist 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 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 10
Infection Prevention Boot Camp I for the Novice January 16 ‐ 17, 2020 Infection Preventionist 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 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 11
Recommend
More recommend
