Table 1a. Characteristics of facilities reporting to NHSN by State 1, 2011: Central Line-associated Bloodstream Infections (CLABSI)2
in State 3
by State Mandate4
|Healthcare Facilities Reporting to NHSN||No. of
by State Mandate4
|Healthcare Facilities Reporting to NHSN|
|Locations (n)2||No.||% 6||Data
Footnotes for Tables 1a, 1b and 1c:
- United States, Washington, D.C., and Puerto Rico.
- Data included in this report are from 2010 and 2011 from acute care facility ICUs (critical care units), NICUs (see footnote 8), and wards (for this report wards also include step-down and specialty care areas [hematology/oncology, bone marrow transplant]). Long term acute care facilities and locations, inpatient rehabilitation facilities and locations, dialysis facilities and locations, and long term care facilities (skilled nursing facilities) are not included in this report.
- The number of acute care facilities in a state was obtained using a list of facilities with Centers for Medicare and Medicaid Services Certification Numbers (CCNs) which was last updated on June 1, 2012. Acute care facilities for which data is included in this report (children’s, critical access, psychiatric, and acute short stay hospitals) were identified in the file and counted. Facilities sharing the same CCN in the NHSN database were identified and added to the count from the CCN file. Military and VA hospitals were identified using the 2009 American Hospital Association survey of healthcare facilities and added to the count from the CCN file. Long term acute care facilities, inpatient rehabilitation facilities, and long term care facilities (skilled nursing facilities) were excluded from the count. Because of this methodology, this count may differ slightly from counts provided by state regulatory authorities.
- The number of acute care facilities eligible to report the HAI type under a state mandate, for states in which a mandate exists to report that HAI type to the state health department using NHSN at the beginning of each reporting period. This number is reported to CDC by the state health department. If no state mandate existed at the beginning of a reporting period, this number is zero. If no mandate existed at the beginning of the reporting period, but was implemented during the reporting period, the value of this column is "M" for midyear implementation. Since state mandates regarding surgical procedures vary greatly by procedure type, the presence or absence of a mandate involving any surgical procedure for acute care facilities is indicated by Yes/No.
- Yes indicates that the state health department reported the completion of either or both of the following validation studies of NHSN data reported during the reporting period: data quality assessment of missing or implausible values along with state health department followup with identified facilities, and detection of outlier facilities along with state health department followup with identified facilities. Yesa indicates that the state completed one or both of these activities and also conducted an audit of medical records (although intensity of auditing activities [i.e., number of facilities audited and number of medical records reviewed] varies by state). Information on validation efforts was requested from all states, regardless of the presence of a legislative mandate for the particular HAI type. Some states without mandatory reporting of a given HAI to the state health department have performed validation on NHSN data that is voluntarily shared with them by facilities.
- This measure is calculated using multiple data sets. It is calculated by dividing “No. of Healthcare Facilities Reporting to NHSN” by “No. of Facilities in State,” and multiplying by 100. The denominator comes from the process described in footnote 3 above. The numerator comes from the NHSN system, and includes all facilities for which data were reported for at least one month during the 12 month reporting period. For CLABSI, this does not include facilities for which zero central line days were reported for all 12 months; for CAUTI this does not include facilities for which zero urinary catheter days were reported for all 12 months; for SSI, this does not include facilities for which zero of the selected procedures were performed for all 12 months. In states with a mandate to report HAI data using NHSN, some facilities in the count of facilities in the state might not be included in the mandate (e.g., facilities do not have the units or perform the procedures covered by the mandate; or the mandate covers only facilities above a certain bed size); or, some facilities included in the mandate might have reported zero central line days, zero urinary catheter days, or zero of the procedure types performed for the full 12-month period.
- This metric is the rate at which facilities submitted data to NHSN during the reporting period. It is calculated by dividing the number of months of data submitted to NHSN by the total number of months of data eligible to be submitted, and multiplying by 100. For CLABSI or CAUTI, a month in which zero device days were reported is not counted in the numerator; for SSI, a month in which zero of the procedure types were performed is not counted in the numerator. For SSI, this is calculated by dividing the number of months that at least 1 procedure was reported to NHSN by the total number of months any procedure could have been reported, multiplied by 100. For example, if a state has two facilities reporting to NHSN, then 24 total months of data could have been submitted to NHSN in a 12-month period. If those two facilities sent in 24 total months of data, the state participation percent is 100%. If one facility submitted data for 8 months and the other for 4 months, then the state participation percent is 50% (data were reported for 12 of 24 total months). For states with a mandate, it is possible for this percentage to be less than 100 for several reasons, including that some facilities reporting might not be covered by the mandate, might only be submitting selected months of data, or might not have had any central line days, urinary catheter days or procedures in a given month to report.
- NICU locations included are those classified by NHSN CDC location codes as Level II/III and Level III neonatal critical care areas. A Level II/III neonatal critical care area is defined by NHSN as a combined nursery housing both Level II and III newborns and infants. A Level III neonatal critical care area is defined by NHSN as a hospital NICU organized with personnel and equipment to provide continuous life support and comprehensive care for extremely high-risk newborn infants and those with complex and critical illness. Level III is subdivided into four levels differentiated by the capability to provide advanced medical and surgical care.
- SSIs included are those following select surgical procedures approximating procedures covered by SCIP, using NHSN-defined SSIs that were classified as deep incisional or organ/space, and were detected during admission or upon readmission. The SCIP procedures are listed in Appendix A.