Tennessee s Tenth Report on Healthcare-Associated Infections: Overview of Report, Methodology, and Format

Transcription

1 Tennessee s Tenth Report on Healthcare-Associated Infections: Overview of Report, Methodology, and Format TDH HAI Team September 3, 2015

2 Acknowledgements THA/TCPS for hosting this webinar TDH HAI Team CSTE HAI Data Analysis and Presentation Standardization Workgroup Everyone who collected and reported the data!

3 Objectives Background Explain standardized infection ratio (SIR) Describe SIR calculations Aggregate TN Data Describe structure of Tennessee s report on HAI Draft examples Report for Healthcare Consumers

4 Standardized Infection Ratio (SIR) SIR = Observed O HAIs Predicted P HAIs To calculate O, sum the number of HAIs among a group To calculate P, requires the use of the appropriate aggregate data (risk-adjusted rates) (e.g., national NHSN data for ) SIR > 1.0: # infections are HIGHER than predicted SIR= 1.5: # infections = 50% HIGHER than predicted SIR < 1.0: # infections are LOWER than predicted SIR= 0.4: # infections = 60% LOWER than predicted

5 Facility-Specific Data This report follows minimum thresholds for presenting rates and/or SIRs (based on CDC recommendations): At least 50 device days (central line or urinary catheter days) for CLABSI/CAUTI At least 20 procedures for SSI CMS does not report facility-specific SIRs for facilities with <1.0 predicted infection This report follows this convention and will not report facility-specific SIRs for facilities with <1.0 predicted infection

6 Risk Adjustment

7 CLABSI/CAUTI Risk Adjustment Facility Type Infection Type Location(s) NHSN National Baseline Year(s) Acute Care Hospitals CLABSI CAUTI Adult/Pediatric ICUs and Wards, Neonatal ICUs Adult/Pediatric ICUs and Wards Long-Term Acute Care (LTAC) Facilities Inpatient Rehabilitation Facilities (IRF) CLABSI/CAUTI All locations 2013 CAUTI All IRF locations (includes freestanding IRFs and IRF units within acute care hospitals) 2013

8 Annual NHSN Report Edwards JR et al. Am J Infect Control 2009;37:

9 SSI Risk Adjustment Model Procedures Included* SSI Events Included All SSI SIR All (inpatient and outpatient) Superficial incisional primary SSI Deep incisional primary SSI Organ/space SSI Identified on admission, readmission & via post-discharge surveillance Complex Admission/ Readmission (A/R) SIR Complex 30-day SSI Used for CMS IPPS Inpatient only Inpatient only In-plan only Adult patients (>18 yrs) COLO and HYST Deep incisional primary SSI Organ/space SSI Identified on admission or readmission to your facility Deep incisional primary Organ/space Within 30 days of procedure *Procedures with outlier or missing/incomplete variables are excluded from all SSI SIR models

10 SSI Risk Adjustment COLO HYST All SSI SIR Age Anesthesia ASA, >2vs 2 Duration Endoscope Medical school affiliation Bed size Wound class Age Anesthesia ASA (1, 2, 3/4/5) Duration Endoscope Bed size Complex A/R SIR* Age, 75 vs >75 ASA, >2 vs 2 Duration Endoscope Medical school affiliation Bed size Wound class Age ASA (1, 2, 3/4/5) Duration Bed size

11 Logistic Regression Model Number of predicted infections calculated with a logistic regression model: logit (p ) = α + β1 X1+ β2 X2 + β3 X3 + β4 X4 Patient-level risk adjustment performed, summed across population Risk factors vary by procedure type

12 LabID Event Risk Adjustment LabID Event Adjustment MRSA - Bacteremia CDI CO Admission Prevalence Rate Facility Bed Size ( 400 vs. <400) Major Teaching vs. Other Test Type (NAAT/PCR vs. EIA vs. Other) CO Admission Prevalence Rate Facility Bed Size (>245 vs vs. 100) Major Teaching vs. Graduate Teaching vs. Other

13 Binomial Regression Model Predicted = e ( β0+β1 X1+ β2 X2 ) *patient days SIRs available for data since 2012 Patient- and facility-level risk factors included in adjustment Observed infections: MRSA bacteremia: Number of healthcare-onset MRSA blood LabID events with no previous positive MRSA blood culture within 14 days CDI: Number incident* healthcare-onset CDI LabID events *incident refers to a CDI LabID event from a specimen obtained >8 weeks after the most recent CDI LabID Event (or with no previous CDI LabID Event documented) for that patient

14 State Aggregate Data

15 Tennessee s Tenth Report Aggregate Data State-aggregate data: CLABSI in adult, ped, and neonatal ICUs (Jan 2012-Dec 2014) CLABSI in adult/ped medical, surgical, and med/surg wards (Apr 2014-Dec 2014) CLABSI in LTACs (Jan Dec 2014) CAUTI in adult and pediatric ICUs (Jan Dec 2014) CAUTI in adult/ped medical, surgical, and med/surg wards (Jul 2014-Dec 2014) CAUTI in LTACs and IRFs (Oct Dec 2014) SSI (COLO and HYST) (Jan Dec 2014) SSI (CBGB/C) (Jan Dec 2014) LabID Events (MRSA bacteremia and CDI) for acute care hospitals and LTACs (Jan Dec 2014)

16 Central Line-Associated Blood Stream Infections (CLABSI)

17 CLABSI (Adult/Pediatric ICU) SIRs by Quarter, TN (Jan Dec 2014) Provisional Data

18 CLABSI (Neonatal ICU) SIRs by Quarter, TN (Jul Dec 2014) Provisional Data

19 CLABSI (Adult/Pediatric Wards) SIRs by Quarter, TN (Apr Dec 2014) Provisional Data

20 CLABSI (LTAC) SIRs by Quarter, TN (Jan Dec 2014) Provisional Data

21 CLABSI (LTAC) Crude Rate by Quarter, TN (Jul Dec 2014) Provisional Data

22 Catheter-Associated Urinary Tract Infections (CAUTI)

23 CAUTI (Adult/Pediatric ICU) SIRs by Quarter, TN (Jan Dec 2014) Provisional Data

24 CAUTI (Adult/Pediatric Wards) SIRs by Quarter, TN (Jul Dec 2014) Provisional Data

25 CAUTI (LTAC) SIRs by Quarter, TN (Jan Dec 2014) Provisional Data

26 CAUTI (LTAC) Crude Rate by Quarter, TN (Oct Dec 2014) Provisional Data

27 CAUTI (IRF) SIRs by Quarter, TN (Jan Dec 2014) Provisional Data

28 CAUTI (IRF) Crude Rate by Quarter, TN (Oct Dec 2014) Provisional Data

29 Surgical Site Infections (SSI)

30 SSI (CBGB/C) SIRs by Quarter, TN (Jan Dec 2014) Provisional Data

31 SSI (COLO) SIRs by Quarter, TN (Jan Dec 2014) Provisional Data

32 SSI (HYST) SIRs by Quarter, TN (Jan Dec 2014) Provisional Data

33 Laboratory-Identified (LabID) Events

34 MRSA Bacteremia LabID Event (Acute Care Hospital) SIRs by Quarter, TN (Jan Dec 2014) Provisional Data

35 CDI LabID Event (Acute Care Hospital) SIRs by Quarter, TN (Jan Dec 2014) Provisional Data

36 Healthcare Personnel Influenza Vaccination

37 Healthcare Personnel Influenza Vaccination Data (Acute Care Hospitals) TN FLU SEASON HEALTHCARE PERSONNEL CATEGORY No. MEAN HCP VACCINATION RATE DISTRIBUTION OF HCP VACCINATION RATE 10% 25% 50% 75% 90% 2014/ /2014 Employees % 68.5% 75.8% 86.7% 97.5% 98.7% Licensed Independent Practitioners Students/Trainees/ Volunteers % 29.0% 54.3% 66.6% 91.1% 100% % 49.7% 76.3% 93.1% 100% 100% Overall % 67.2% 73.4% 84.1% 92.1% 96.6% Employees % 65.1% 75.4% 84.6% 96.4% 98.7% Licensed Independent Practitioners Students/Trainees/ Volunteers % 19.4% 35.5% 63.6% 87.5% 97.3% % 37.1% 66.7% 90.0% 99.0% 100% Overall % 63.5% 68.0% 80.8% 90.8% 95.8% Data reported as of August 13, 2015 No. = number of facilities reporting HCP = Healthcare Personnel Provisional Data

38 Healthcare Personnel Influenza Vaccination Data (LTACs) TN, 2014/2015 Flu Season FLU SEASON HEALTHCARE PERSONNEL CATEGORY No. MEAN HCP VACCINATION RATE DISTRIBUTION OF HCP VACCINATION RATE 10% 25% 50% 75% 90% 2014/2015 Employees % 69.1% 84.7% 92.4% 98.4% 99.7% Licensed Independent Practitioners Students/Trainees/ Volunteers % 0.6% 53.6% 74.2% 87.9% 100% % 16.7% 95.2% 98.3% 100% 100% Overall % 48.3% 81.6% 85.8% 91.5% 97.1% Data reported as of August 13, 2015 No. = number of facilities reporting HCP = Healthcare Personnel Provisional Data

39 Healthcare Personnel Influenza Vaccination Data (IRFs) TN, 2014/2015 Flu Season FLU SEASON HEALTHCARE PERSONNEL CATEGORY No. MEAN HCP VACCINATION RATE DISTRIBUTION OF HCP VACCINATION RATE 10% 25% 50% 75% 90% 2014/2015 Employees % 64.1% 74.4% 82.3% 95.8% 97.8% Licensed Independent Practitioners Students/Trainees/ Volunteers % 0.0% 50.0% 70.8% 98.2% 100% % 50.0% 79.2% 95.9% 100% 100% Overall % 63.6% 77.1% 83.7% 95.5% 97.1% Data reported as of August 13, 2015 No. = number of facilities reporting HCP = Healthcare Personnel Provisional Data

40 Facility-Specific Data

41 Overview: Facility-Specific Data Acute Care Hospitals CLABSI in adult, pediatric, and neonatal ICUs ( ); excluding burn and trauma units CAUTI in adult and pediatric ICUs ( ) SSI (COLO and HYST) ( ) LabID Event (MRSA and CDI) ( ) Healthcare Personnel Influenza Vaccination Summary (2014/15 Flu Season)

42 Overview: Facility-Specific Data, cont. Facility-specific CLABSI SIR, all ICUs combined (excluding burn and trauma) and Neonatal ICUs Number of ICUs Number of observed CLABSIs Number of predicted CLABSIs Number of central line-days SIR Graphical representation SIR point estimates + 95% confidence intervals Color coded to reflect statistical significance compared to national (NHSN ) SIR of 1.0

43 Overview: Facility-Specific Data, cont. Facility-specific CAUTI SIR, all ICUs combined Number of ICUs Number of observed CAUTIs Number of predicted CAUTIs Number of urinary catheter days SIR Graphical representation SIR point estimates + 95% confidence intervals Color coded to reflect statistical significance compared to national (NHSN- 2009) SIR of 1.0

44 Overview: Facility-Specific Data, cont. Facility-specific SSI SIR, by procedure (COLO and HYST) Number of observed SSIs Number of predicted SSIs Number of procedures performed SIR Graphical representation SIR point estimates + 95% confidence intervals Color coded to reflect statistical significance compared to national (NHSN ) SIR of 1.0

45 Overview: Facility-Specific Data, cont. Facility-specific SSI SIR, by procedure (COLO and HYST) Note: Facility-specific data uses Complex A/R SIR which includes only: Inpatient Procedures Deep incisional primary (DIP) and Organ/space SSIs SSIs identified during admission (A) or readmission (R) to your facility More details: pdf

46 Overview: Facility-Specific Data, cont. Facility-specific LabID SIR (MRSA and CDI) Number of observed healthcare-onset (HO) events Number of predicted healthcare-onset (HO) events Number of patient days SIR Graphical representation SIR point estimates + 95% confidence intervals Color coded to reflect statistical significance compared to national (NHSN ) SIR of 1.0

47 Overview: Facility-Specific Data, cont. Healthcare Personnel Influenza Vaccination Summary ( ) Healthcare Personnel Vaccinated (%) Employees Licensed Independent Practitioners Students/Trainees/Volunteers Overall Graphical representation Bar graph Color-coded to reflect progress toward HHS Healthy People 2020 Goal (90%)

48 Facility-Specific SIR Figures

49 Interpreting Facility-Specific SIR Figures CAUTI Standardized Infection Ratio (SIR) for Adult and Pediatric Intensive Care Units in Acute Care Facilities, Tennessee, 01/01/ /31/2014 Data Reported as of August 13, 2015 N = number of types of units reporting OBS = observed number of CAUTI PRED = statistically 'predicted' number of CAUTI, based on NHSN baseline data SIR = standardized infection ratio (observed/predicted number of CAUTI) UCD = number of urinary catheter days N/A = Data not shown for facilities with <50 urinary catheter days / SIR not calculated for facilities with <1 predicted infection ** Significantly higher than national baseline ^^ Significantly lower than national baseline * Zero infections, but not statistically significant

50 Interpreting Facility-Specific SIR Figures, cont. CAUTI Standardized Infection Ratio (SIR) for Adult and Pediatric Intensive Care Units in Acute Care Facilities, Tennessee, 01/01/ /31/2014 Standardized infection ratio (SIR), summary measure for each facility Data Reported as of August 13, 2015 N = number of types of units reporting OBS = observed number of CAUTI PRED = statistically 'predicted' number of CAUTI, based on NHSN baseline data SIR = standardized infection ratio (observed/predicted number of CAUTI) UCD = number of urinary catheter days N/A = Data not shown for facilities with <50 urinary catheter days / SIR not calculated for facilities with <1 predicted infection ** Significantly higher than national baseline ^^ Significantly lower than national baseline * Zero infections, but not statistically significant

51 Interpreting Facility-Specific SIR Figures, cont. CAUTI Standardized Infection Ratio (SIR) for Adult and Pediatric Intensive Care Units in Acute Care Facilities, Tennessee, 01/01/ /31/2014 Reporting period: January December 2014 Data Reported as of August 13, 2015 N = number of types of units reporting OBS = observed number of CAUTI PRED = statistically 'predicted' number of CAUTI, based on NHSN baseline data SIR = standardized infection ratio (observed/predicted number of CAUTI) UCD = number of urinary catheter days N/A = Data not shown for facilities with <50 urinary catheter days / SIR not calculated for facilities with <1 predicted infection ** Significantly higher than national baseline ^^ Significantly lower than national baseline * Zero infections, but not statistically significant

52 Interpreting Facility-Specific SIR Figures, cont. CAUTI Standardized Infection Ratio (SIR) for Adult and Pediatric Intensive Care Units in Acute Care Facilities, Tennessee, 01/01/ /31/2014 Facility names in alphabetical order, all ICU types included Data Reported as of August 13, 2015 N = number of types of units reporting OBS = observed number of CAUTI PRED = statistically 'predicted' number of CAUTI, based on NHSN baseline data SIR = standardized infection ratio (observed/predicted number of CAUTI) UCD = number of urinary catheter days N/A = Data not shown for facilities with <50 urinary catheter days / SIR not calculated for facilities with <1 predicted infection ** Significantly higher than national baseline ^^ Significantly lower than national baseline * Zero infections, but not statistically significant

53 Interpreting Facility-Specific SIR Figures, cont. CAUTI Standardized Infection Ratio (SIR) for Adult and Pediatric Intensive Care Units in Acute Care Facilities, Tennessee, 01/01/ /31/2014 Total number of ICU types in each facility Data Reported as of August 13, 2015 N = number of types of units reporting OBS = observed number of CAUTI PRED = statistically 'predicted' number of CAUTI, based on NHSN baseline data SIR = standardized infection ratio (observed/predicted number of CAUTI) UCD = number of urinary catheter days N/A = Data not shown for facilities with <50 urinary catheter days / SIR not calculated for facilities with <1 predicted infection ** Significantly higher than national baseline ^^ Significantly lower than national baseline * Zero infections, but not statistically significant

54 Interpreting Facility-Specific SIR Figures, cont. CAUTI Standardized Infection Ratio (SIR) for Adult and Pediatric Intensive Care Units in Acute Care Facilities, Tennessee, 01/01/ /31/2014 Total number of observed CAUTIs in each facility across all ICUs Data Reported as of August 13, 2015 N = number of types of units reporting OBS = observed number of CAUTI PRED = statistically 'predicted' number of CAUTI, based on NHSN baseline data SIR = standardized infection ratio (observed/predicted number of CAUTI) UCD = number of urinary catheter days N/A = Data not shown for facilities with <50 urinary catheter days / SIR not calculated for facilities with <1 predicted infection ** Significantly higher than national baseline ^^ Significantly lower than national baseline * Zero infections, but not statistically significant

55 Interpreting Facility-Specific SIR Figures, cont. CAUTI Standardized Infection Ratio (SIR) for Adult and Pediatric Intensive Care Units in Acute Care Facilities, Tennessee, 01/01/ /31/2014 Total number of predicted CAUTIs in each facility across all ICUs Data Reported as of August 13, 2015 N = number of types of units reporting OBS = observed number of CAUTI PRED = statistically 'predicted' number of CAUTI, based on NHSN baseline data SIR = standardized infection ratio (observed/predicted number of CAUTI) UCD = number of urinary catheter days N/A = Data not shown for facilities with <50 urinary catheter days / SIR not calculated for facilities with <1 predicted infection ** Significantly higher than national baseline ^^ Significantly lower than national baseline * Zero infections, but not statistically significant

56 Interpreting Facility-Specific SIR Figures, cont. CAUTI Standardized Infection Ratio (SIR) for Adult and Pediatric Intensive Care Units in Acute Care Facilities, Tennessee, 01/01/ /31/2014 Total number of urinary catheter days in each facility across all ICUs Data Reported as of August 13, 2015 N = number of types of units reporting OBS = observed number of CAUTI PRED = statistically 'predicted' number of CAUTI, based on NHSN baseline data SIR = standardized infection ratio (observed/predicted number of CAUTI) UCD = number of urinary catheter days N/A = Data not shown for facilities with <50 urinary catheter days / SIR not calculated for facilities with <1 predicted infection ** Significantly higher than national baseline ^^ Significantly lower than national baseline * Zero infections, but not statistically significant

57 Interpreting Facility-Specific SIR Figures, cont. CAUTI Standardized Infection Ratio (SIR) for Adult and Pediatric Intensive Care Units in Acute Care Facilities, Tennessee, 01/01/ /31/2014 Standardized infection ratio (SIR) for each facility across all ICUs (observed/ predicted) Data Reported as of August 13, 2015 N = number of types of units reporting OBS = observed number of CAUTI PRED = statistically 'predicted' number of CAUTI, based on NHSN baseline data SIR = standardized infection ratio (observed/predicted number of CAUTI) UCD = number of urinary catheter days N/A = Data not shown for facilities with <50 urinary catheter days / SIR not calculated for facilities with <1 predicted infection ** Significantly higher than national baseline ^^ Significantly lower than national baseline * Zero infections, but not statistically significant

58 Interpreting Facility-Specific SIR Figures, cont. CAUTI Standardized Infection Ratio (SIR) for Adult and Pediatric Intensive Care Units in Acute Care Facilities, Tennessee, 01/01/ /31/2014 Point estimate of the SIR (1.9 for Hospital E) Data Reported as of August 13, 2015 N = number of types of units reporting OBS = observed number of CAUTI PRED = statistically 'predicted' number of CAUTI, based on NHSN baseline data SIR = standardized infection ratio (observed/predicted number of CAUTI) UCD = number of urinary catheter days N/A = Data not shown for facilities with <50 urinary catheter days / SIR not calculated for facilities with <1 predicted infection ** Significantly higher than national baseline ^^ Significantly lower than national baseline * Zero infections, but not statistically significant

59 Facility-Specific HCP Influenza Vaccination Figures

60 Interpreting Facility-Specific HCP Flu Vaccination Figures

61 Facility-Specific Summary Pages

62 Interpreting Facility-Specific Summary Pages

63 Interpreting Facility-Specific Summary Pages, cont. Facility information: Check this carefully

64 Interpreting Facility-Specific Summary Pages, cont. Healthcare-Associated Infections (HAI) Summary: Details facility-specific reporting requirements for your facility

65 Interpreting Facility-Specific Summary Pages, cont. Standardized Infection Ratio (SIR) Data Table: Summarize facility-specific 2014 data

66 Interpreting Facility-Specific Summary Pages, cont. Healthcare Personnel Influenza Vaccination data, 2014/2015 Influenza Season

67 SIR Caterpillar Plots <1 Predicted Infection

68 SIR Caterpillar Plots Reporting Period: for CLABSI, CAUTI, SSI for LabID Events (MRSA/CDI)

69 SIR Caterpillar Plots Number of unit types reporting (CLABSI/CAUTI only)

70 SIR Caterpillar Plots Number of observed infections

71 SIR Caterpillar Plots Number of predicted infections

72 SIR Caterpillar Plots Number of: Central line days (CLABSI) Urinary catheter days (CAUTI) Procedures (SSI) Patient days (MRSA/CDI LabID Events)

73 SIR Caterpillar Plots Standardized infection ratio (SIR) Observed/Predicted Infections

74 SIR Caterpillar Plots 2014 Tennessee SIR

75 SIR Caterpillar Plots NHSN Baseline SIR

76 SIR Caterpillar Plots Point estimate of the SIR (1.4 for 2012)

77 SIR Caterpillar Plots Interpretation: This facility s 2014 SIR (0.8) was not significantly different from the NHSN baseline SIR of 1

78 TN s Report on HAIs for Healthcare Consumers

79 Report for Healthcare Consumers Written to an audience of healthcare consumers Simplified tables and information

80 Interpreting HAI Data Tables How Does This Facility Compare to the National Experience? Colors and symbols are used to help you quickly understand and interpret the facility s data. This is the take-home message about healthcare-associated infections in this facility. Indicates that the facility had fewer infections than were predicted (better than the national experience) = Indicates that the facility had about the same number of infections as were predicted (same as the national experience) Indicates that the facility had more infections than were predicted (worse than the national experience) No Conclusion: Indicates that this facility reported data, but there was not enough information to make a reliable comparison to the national experience (number of predicted infections was less than 1).

81 HAI Data Tables

82 HAI Data Tables

83 Interpreting Healthcare Worker Flu Vaccination Data Tables How Does This Facility Compare to the Healthy People 2020 Goal? 1. Vaccination is higher (better) than the Healthy People 2020 Goal: better 2. Vaccination is similar to the Healthy People 2020 Goal: = same 3. Vaccination is lower (worse) than the Healthy People 2020 Goal: worse

84 Healthcare Worker Flu Vaccination Data Tables

85 Frequently Asked Questions (FAQs)

86 FAQs Q: My facility entered 9 HYST procedures but I only see 3. Why? A: In this report, we use the Complex Admission/Readmission SIR. This metric only includes inpatients procedures, and deep incisional primary (DIP) and organ/space SSIs identified during admission or readmission to your facility.

87 FAQs Q: This report shows 22 LabID events but I entered 30 for Why? A: The LabID SIR includes healthcare-onset events only (i.e., specimen was collected on or after day 4 of admission). For MRSA, only blood specimens are included. If you entered an event that was within 14 days of another event for the same location and the same patient, it is not included in the SIR, but may still appear on your line list.

88 FAQs Q: My facility s name is incorrect in the report. A: If your facility s name has changed since the last report, you need to notify the HAI team by sending an to HAI.Health@tn.gov. Q: My facility s bed size is listed incorrectly A: We use the 2014 NHSN annual survey to gather this information for the 10 th report. If your survey is wrong, please correct it and notify us via HAI.Health@tn.gov.

89 FAQs Q: The person who should have received the preview report didn t receive it OR Someone who should not have received the preview report received it A: Please let us know at HAI.health@tn.gov

90 Questions? Contact TDH HAI Team at with any corrections by close of business Tuesday, September 8th