National and State Healthcare-associated Infections Standardized Infection Ratio Report
Using Data Reported to the National Healthcare Safety Network
The National Healthcare Safety Network (NHSN) is a public health surveillance system that the Centers for Disease Control and Prevention’s (CDC) Division of Healthcare Quality Promotion (DHQP) maintains and supports as a mainstay of its healthcare-associated infection (HAI) prevention program. NHSN is used by healthcare facilities in all 50 states; Washington, D.C.; and Puerto Rico. As of December 2012, 30 states and Washington, D.C. required, or have plans to require, use of NHSN for state-specific HAI reporting mandates. Hospitals participating in the Centers for Medicare and Medicaid Services (CMS) Hospital Inpatient Quality Reporting (IQR) Program use NHSN to report HAI data as part of the program’s requirements, including central line-associated bloodstream infections (CLABSI) among adult, pediatric, and neonatal intensive care unit patients beginning in January 2011; in January 2012 required reporting of catheter-associated urinary tract infections (CAUTI) among adult and pediatric intensive care unit patients and surgical site infections (SSI) among colon surgery and abdominal hysterectomy patients began. The HAI data reported via NHSN to CMS are used to qualify hospitals for their annual payment update and for public reporting at the Department of Health and Human Services Hospital Compare web site (1).
Since NHSN’s inception in 2005, DHQP has used HAI data from the system for national-level analysis and reporting. Past reporting includes summary data that define the benchmarks used for inter-facility comparison (such as location-specific, device-associated infection rates) (2), risk adjustment models for surgical site infections (3), or summarized antimicrobial resistance data for each HAI type reported (4). Starting in 2009, summary measures of HAIs, national and state-specific, were reported using the standardized infection ratio (SIR) (5). This current SIR report again provides a summary of the characteristics of facilities reporting to NHSN by state and the key metrics of the HAI experience for the United States in 2011. State-specific summary statistics are again presented for CLABSI in this report. However, this report expands upon the 2010 SIR report to include national burden estimates for CLABSI among critical care patients and SSI among select surgical patients; the estimated average reimbursement paid by CMS attributable to a CLABSI also is presented. The goals of this report are to summarize available HAI data on CLABSIs, SSIs, and CAUTIs at the national level for 2011 and to provide an additional perspective on the progress of HAI prevention nationally by comparison to the 2010 experience. This progress report also provides an indication of the extent to which HAI prevention goals established by the Department of Health and Human Services (HHS) Action Plan to Prevent HAIs and by states have been achieved.