jueves, 19 de abril de 2012

CDC - Q and A Summary Data Report - HAI

CDC - Q and A Summary Data Report - HAI

CDC's National Healthcare Safety Network (NHSN)
Healthcare-associated Infections Summary Data Reports
Q and A

What are these reports?
The National and State Healthcare-associated Infections (HAI) Standardized Infection Ratio Reports give a snapshot of where the country stands in its efforts to prevent HAIs. They provide both national and state-specific information and are based on data that is reported to CDC’s National Healthcare Safety Network (NHSN).

How can these reports be used?
These data are being used for two important purposes. From the national perspective, these reports measure progress toward HAI prevention goals outlined in the U.S. Department of Health and Human Services Action Plan to Prevent Healthcare-associated InfectionsExternal Web Site Icon. The state level information helps assess impact of state-based HAI prevention programs and also alerts states if there are certain facilities with significantly more infections than other local facilities.
What do these reports tell us about how states are doing at preventing central line-associated bloodstream infections?
A central line is a tube that is placed in a large vein of a patient's neck or chest to give important medical treatment. When not put in correctly or kept clean, central lines can become a freeway for germs to enter the body and cause serious bloodstream infections. These reports show decreases in national central line-associated bloodstream infection (CLABSI) incidence. These encouraging findings reflect the work of clinicians and facilities; local, state, and federal government; and cross-cutting partnership groups that have taken on CLABSI prevention efforts. We hope that all states and healthcare facilities will be motivated to continue and strengthen efforts preventing CLABSIs.
What do these reports tell us about progress in preventing surgical site infections?
The report also includes a national snapshot of the infection risk linked to ten common surgical procedures. Although there was an overall, national decrease in surgical site infections (SSIs) in 2010, only one procedure showed a substantial decrease in infections between 2009 and 2010. This procedure, coronary artery bypass grafting, improves blood flow to the heart in people who have severe coronary heart disease.
What do these reports tell us about progress in preventing catheter-associated urinary tract infections?
The report shows a national decrease in catheter-associated urinary tract infections between 2009 and 2010. The report provides information about reductions in CAUTIs among critical care patients and non-critical care patients. The encouraging infection reductions seen in U.S. hospitals reflect the work of clinicians and facilities; local, state, and federal government; and cross-cutting partnership groups that have taken on infection prevention efforts.
What is the next step?
The next step is for CDC to continue to strengthen its work with healthcare facilities and health departments in their efforts to begin or expand their own statewide HAI surveillance and prevention efforts.
What is a standardized infection ratio (SIR)?
The standardized infection ratio (SIR) is a summary measure used to track HAIs at a national, state, or facility level over time. The SIR adjusts for the fact that each healthcare facility treats different types of patients. For example, the experience with HAIs at a hospital with a large burn unit (a location where patients are more at risk of acquiring infections) cannot be directly compared to a facility without a burn unit.
The method of calculating an SIR is similar to the method used to calculate the Standardized Mortality Ratio (SMR), a statistic widely used in public health to analyze mortality data. In HAI data analysis, the SIR compares the actual number of HAIs in a facility or state with the baseline U.S. experience (i.e., standard population), adjusting for several risk factors that have been found to be most associated with differences in infection rates.
In other words, an SIR significantly greater than 1.0 indicates that more HAIs were observed than predicted, accounting for differences in the types of patients followed. Conversely, an SIR of significantly less than 1.0 indicates that fewer HAIs were observed than predicted.
What does it mean that some states are validating their data?
Healthcare facilities and states are encouraged to validate, or double-check, their infection data. In many cases, validating data involves completing an assessment to ensure that all of the required infections were captured in the system. Currently, states that are validating are using different systems. For example, some may evaluate one facility while others may look more broadly. CDC is working with states to determine best practices and to develop standards for validation that can assist states in their validation efforts.
Will a state that looks hard for infections have a higher SIR?
States that validate data and employ other advanced tools for detecting HAIs are likely to discover and report more infections. For that reason, we have indicated in the report those states that are validating data so that these efforts are taken into consideration when evaluating the state's performance.
What does "predicted number of infections" mean?
The predicted number is an estimated number of HAIs based on infections reported to NHSN during January 2006–December 2008. This is known as the standard population. This number is risk adjusted and includes data collected from all facilities—under state mandates or not. To calculate the SIR, CDC compares the number of infections that occurred during a certain time period to the number in this standard population.
How do these reports adjust for different types of patients seen in different hospitals?
Hospitals may see different patients, referred to as a hospital’s patient mix. The CLABSI and CAUTI SIRs are adjusted by type of patient care location, hospital affiliation with a medical school, and bed size of the patient care location. Other factors, such as facility bed size, were not associated with differences in the SIR and therefore were not included in SIR risk adjustment. For SSI SIRs, risk models were constructed specifically for this report, evaluating all available procedure-related risk factors (e.g., duration of surgery, surgical wound class, use of endoscopes, status as re-operation, patient age, and patient assessment at time of anesthesiology [ASA score]) to provide the best possible adjustment for differences in patient-mix within each type of surgery.
What are some reasons a state SIR is higher than 1.0?
In many cases, high SIRs simply reflect a need for stronger HAI prevention efforts. Several other factors such as validation of reported data may also play a role.
It is important to note that an SIR of less than 1.0 is a positive finding, but it does not mean that the work is done. Research has shown that rates of HAIs can be reduced further.
What are some reasons a state SIR is lower than 1.0?
In many cases, low SIRs are a reflection of robust HAI prevention strategies. These scenarios are exciting, and CDC is working with such facilities and states to learn and share best practices. CDC is also considering the degree, if any, of under-reporting of HAIs in these data. It is important to note that the reports are not meant to compare states. These reports are meant to look at how an individual state is doing and to track a state’s prevention over time.
It is important to note that an SIR of less than 1.0 is a positive finding, but it does not mean that the work is done. Research has shown that rates of HAIs can be reduced further.
Why is NHSN a good surveillance tool to measure HAIs?
The benefits of NHSN include standard methods and definitions, online training modules, user support, and facility comparison tools. About half of all U.S. hospitals successfully report to NHSN, making it the largest HAI reporting system available.
What is the benefit of state HAI reporting?
CDC believes public reporting of HAIs is an important component of national HAI elimination and overall healthcare transparency efforts. Research shows that when healthcare facilities and clinicians are aware of their infection issues and implement concrete strategies to prevent them, rates of certain hospital infections can be decreased by more than 70 percent. Infection data can give healthcare facilities and public health agencies the knowledge needed to design, implement, and evaluate prevention strategies that protect patients and save lives.
Why is NHSN a good surveillance tool to measure HAIs?
NHSN provides standard methods and definitions to ensure consistent data quality. The NHSN team provides online training modules, user support, and facility comparison tools. Almost all U.S. hospitals successfully report to NHSN, making it the largest and most accurate HAI reporting system available.
What is CDC doing about the states with high SIRs?
CDC is taking a proactive approach with all states. The agency offers training and technical assistance to states to help them identify and assist healthcare facilities whose performance does not reflect effective prevention work. Understanding SIRs will allow states to implement prevention efforts in areas where problems exist and to show prevention impact over time.
Does my state have a legislative mandate to report healthcare-associated infection data?
Currently, 33 states and the District of Columbia have reporting. In addition to the District of Columbia, 28 states use NHSN to meet their reporting requirements. Please see the state-based HAI prevention website for more information.
My facility wants to do more to track and reduce infection rates. How can I find out more information?
NHSN provides a secure way to track and analyze HAI data, which can help improve infection rates. For more information about NHSN and enrollment in NHSN, facilities should contact their local or state health department and visit CDC's NHSN web site. CDC also provides prevention tools and guidelines to assist facilities and states.

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