american journal of infection control - centers for … · m.a. dudeck et al. / american journal of...

American Journal of Infection Control 41 (2013) 1148-66

lable at ScienceDirect

Contents lists avai

American Journal of Infection Control

journal h omepage w wwaj ic jou r n a l org

American Journal of Infection Control

Special article

National Healthcare Safety Network (NHSN) report data summary for 2012 Device-associated module

Margaret A Dudeck MPH CPH Lindsey M Weiner MPH Katherine Allen-Bridson RN BSN MScPH Paul J Malpiedi MPH Kelly D Peterson BBA Daniel A Pollock MD Dawn M Sievert PhD Jonathan R Edwards MStat Division of Healthcare Quality Promotion National Center for Emerging Zoonotic and Infectious Diseases Centers for Disease Control and Prevention Public Health Service US Department of Health and Human Services Atlanta Georgia

This report is a summary of Device-associated (DA) Module data collected by hospitals participating in the National Healthcare Safety Network (NHSN) for events occurring from January through December 2012 and reported to the Centers for Disease Control and Prevention (CDC) by July 1 2013 This report updates previously published DA Module data from NHSN and provides contemporary comparative rates1 Figure 1 provides a brief summary of key findings from this report This report complements other NHSN reports including national and state-specific reports of standardshyized infection ratios (SIRs) for select health care-associated infecshytions (HAIs)23

NHSN data collection reporting and analysis are organized into four components Patient Safety Healthcare Personnel Safety Biovigilance and Long-term Care and use standardized methods and definitions in accordance with specific module protocols4567 Institutions may use modules singly or simultashyneously but once selected they must be used for a minimum of one calendar month for the data to be included in CDC analyses All infections are categorized using standard CDC definitions that include laboratory and clinical criteria5-7 The DA Module within the Patient Safety Component may be used by facilities other than general acute care hospitals including inpatient rehabilishytation facilities (IRFs) and long term acute care hospitals (LTACHs) NHSN facilities contributing HAI surveillance data to this report did so voluntarily in response to state mandatory reporting requirements or in compliance with the Centers for Medicare and Medicaid Servicesrsquo (CMSrsquos) Quality Reporting Programs89 CDC aggregated these data into a single national database for 2012 consistent with the stated purposes of NHSN which are to

Address correspondence to Margaret A Dudeck MPH CPH National Center for Emerging Zoonotic and Infectious Diseases Centers for Disease Control and Prevention 1600 Clifton Road NE MS A-24 Atlanta GA 30329

E-mail address mdudeckcdcgov (MA Dudeck) This report is public domain and can be copied freely

0196-6553$0000 - Published by Elsevier Inc on behalf of the Association for Professiohttpdxdoiorg101016jajic201309002

bull Collect data from a sample of health care facilities in the United States to permit valid estimation of the magnitude of adverse events among patients and health care personnel

bull Collect data from a sample of health care facilities in the United States to permit valid estimation of the adherence to practices known to be associated with prevention of these adverse events

bull Analyze and report collected data to permit recognition of trends

bull Provide facilities with risk-adjusted metrics that can be used for inter-facility comparisons and local quality improvement activities

bull Assist facilities in developing surveillance and analysis methods that permit timely recognition of patient and health care worker safety problems and prompt intervention with appropriate measures

bull Conduct collaborative research studies with NHSN memshyber facilities (eg describe the epidemiology of emerging health care-associated infection [HAI] and pathogens assess the importance of potential risk factors further characterize HAI pathogens and their mechanisms of resistance and evaluate alternative surveillance and prevention strategies)

bull Comply with legal requirements e including but not limited to state or federal laws regulations or other requirements e for mandatory reporting of health care facility-specific adverse event prevention practice adherence and other public health data

bull Enable health care facilities to report HAI and prevention practice adherence data via NHSN to the US Centers for Medicare and Medicaid Services (CMS) in fulfillment of CMSrsquos quality measurement reporting requirements for those data

bull Provide state departments of health with information that identifies the health care facilities in their state that participate in NHSN

bull Provide to state agencies at their request facility-specific NHSN patient safety component and health care personnel safety

nals in Infection Control and Epidemiology Inc

1149 MA Dudeck et al American Journal of Infection Control 41 (2013) 1148-66

Fig 1 Highlights from this report

component adverse event and prevention practice adherence data for surveillance prevention or mandatory public reporting

Patient- and facility-specific data reported to CDC are kept confidential in accordance with sections 304 306 and 308(d) of the Public Health Service Act (42 USC 242b 242k and 242m(d))

METHODS

Data collection methods

For reporting to the DA Module health care facility personnel responsible for infection prevention and patient safety may choose with consideration of state mandates federal reporting programs and prevention initiatives to collect data on central line-associated bloodstream infections (CLABSI) ventilator-associated pneumonias (VAP) or urinary catheter-associated urinary tract infections (CAUTI) that occur in patients staying in a patient care location such as a critical or intensive care unit (ICU) specialty care area or inpatient ward In NHSN locations are further stratified according to patient population adults children or neonates (in tables pediatric and neonatal locations are so noted) In neonatal intensive care unit (NICU) locations (level III or level IIIII) infection preshyventionists (IPs) collect data on CLABSI or VAP that occur in patients in each of five birth-weight categories (750 g 751-1000 g 1001 shy1500 g 1501 - 2500 g and gt2500 g) data on CAUTI are not collected as part of the NHSN protocols in any NICU location Corshyresponding location-specific denominator data consisting of patient-days and specific device-days are also collected by IPs or other trained personnel

In non-NICU locations the device-days consist of the total number of central line-days urinary catheter-days or ventilator-

days For specialty care areas and oncology units such as hemashytologyoncology and hematopoietic stem cell transplant locations central line-days are split into those with only a permanent central line vs those with temporary central lines (with or without a permanent central line) In NICU locations the device-days consist of the total number of central line-days (inclusive of umbilical catheters) or ventilator-days for each birth-weight category

Data analysis methods

Compared to the previous report five new locations d gastrointestinal ward pediatric orthopedic ward inpatient hospice ward solid tumor ward and pediatric inpatient rehabilitation facility e had sufficient data to be included in this report1

Locations were further stratified by facility type unit bed size andor major teaching status to determine if pooled mean rates medians and empirical distributions significantly difshyfered between two groups for all DA infections if differences were present the strata were retained for reporting Comshyparisons of pooled mean rates were performed using Poisson regression These comparisons could be influenced by potential outlier rates from locations with disproportionately large deshynominators Therefore greater weight was given to the results of nonparametric tests comparing the medians for location shift and empirical distributions for assessing differences across the range of reported rates These nonparametric comparisons by definition require no validity assumptions and provide test results that are not subject to the potential weighting influence of high or low rates with large denominators Comparisons of the pooled mean median and percentile distribution were made if there were at least 50 locations contributing to one or more strata and at least


Table 1 NHSN facilities contributing data used in this report

Hospital type N ()

Childrenrsquos 70 (16) Critical access 324 (73) General including acute trauma and teaching 3200 (720) Long-term acute care 465 (105) Military 34 (08) Oncology 12 (03) Orthopedic 14 (03) Psychiatric 10 (02) Rehabilitation 237 (53) Surgical 51 (11) Veteransrsquo Affairs 12 (03) Womenrsquos 6 (01) Womenrsquos and Childrenrsquos 9 (02) Total 4444

20 locations contributing to the percentile distribution in both strata

Existing strata were retained for adult combined medical surgical ICUs medical ICUs and surgical ICUs The data for adult combined medicalsurgical ICUs were split by medical school affiliation and unit bedsize resulting in three groups ldquomajor teachingrdquo ldquoall othersrdquo with unit bedsize 15 beds and ldquoall othersrdquo with unit bedsize gt15 The data for adult medical ICUs and adult surgical ICUs were split into two groups by teaching status Hospitals self-identified their teaching hospital status through the annual NHSN facility survey A major teaching hospital was defined as a hospital that has a program for medical students and post-graduate medical training Locations within critical access hospitals (CAHs) were compared to their counterparts in all other acute care hospitals The statistical evidence indicated that there was a significant difference in these strata and therefore data from CAHs have been reported separate from all other location types Adult hematologyoncology locations were also evaluated to assess importance of status as an oncology hospital but differshyences were not significant and no new strata for this population were retained

Device utilization (DU) was calculated as a ratio of device-days to patient-days for each location type As such the DU of a locashytion is one measure of the use of invasive devices and constitutes an extrinsic risk factor for health care-associated infection10 DU may also serve as a marker for severity of illness of patients (ie more severely ill patients are more likely to require an invasive device) which is another reflection of the intrinsic susceptibility to infection

Data from at least 5 different reporting units of a given location type were used to determine pooled mean DA infection rates and DU ratios Percentile distributions were determined if there were data from at least 20 different locations excluding rates or DU ratios for locations that did not report at least 50 device-days or patient-days Because of these requirements the number of locations contributing data may vary among the tables

RESULTS

In 2012 4444 enrolled facilities reported at least one month of DA denominator data for some patient cohorts under surveillance These 4444 facilities were located in 53 states territories and the District of Columbia and were predominantly general acute care

hospitals (Table 1) 27 of all facilities that reported data were smaller organizations of 50 beds or less comprised mostly of acute care hospitals that were not identified as critical access Among LTACHs and IRFs 59 and 86 respectively were categorized as physically free-standing from a hospital setting (Table 2) Where data volume was sufficient for this report we tabulated DA infecshytion rates and DU ratios for January through December 2012 (Tables 3-10) Data on the specific criteria used to report DA infections are provided in Tables 11-18

Tables 3-6 update and augment previously published DA rates and DU ratios by type of non-NICU locations1 Based on results of statistical comparisons data from CAHs are reported separately from all other acute care hospitals These data are further stratified into combined critical care units and combined non-critical care units

Tables 7-10 update and augment the previously published DA rates and DU ratios by birth-weight category for NICU locations1 Beginning in January 2012 CLABSI data in NICU locations were no longer collected according to central line type (ie central line and umbilical catheter) therefore CLABSI rates and DU ratios for NICUs are not stratified by line type in this report

Tables 11-18 provide data on select attributes of the DA infecshytions for each location For example Tables 11 12 15 and 16 show the frequency and percent distribution of the specific sites of CLABSI and the criteria used for identifying these infections Note that for these tables criteria 2 and 3 which involve common commensals only have been combined

DISCUSSION

This report summarizes the HAI data reported to the DA module of NHSN during 2012 Compared to the health care facility types for which HAI data were summarized in the last published report in this report there is a slight increase in smaller hospitals IRFs and LTACHs1 Based on the number of facilities reporting overall contribution from all facility types to the device-associated module increased by 15 from the last report1 This increase in reporting is largely attributable to health care facilitiesrsquo participation in CMSrsquos Quality Reporting Programs which require participants to use NHSN as the tool to report CLABSI data from all acute care hospital adult pediatric and neonatal ICUs (effective as of January 2011) and all LTACH locashytions as well as CAUTI data from all acute care hospital adult and pediatric ICUs and all LTACH and IRF locations (effective as of January 2012)89 While this growth impacted the volume of reporting in these designated settings there is also an indication of increased participation in ward locations for CLABSI and CAUTI surveillance

Extensive analyses of the impact of facility type and medical school affiliation on all DA infection rates were performed for select locations Medical school affiliation continues to be a significant factor for all three DA infection rates andor percentile distributions in medical ICUs and surgical ICUs All DA infection rate pooled means in this report continue to be higher in those locations stratified as major teaching compared to their non-major teaching counterparts This suggests room for targeted prevention efforts in these settings that care for higher complexity patients Addishytionally medical school affiliation and bed size both continue to be significant factors in DA infection rates for medicalsurgical ICUs Note that while the CLABSI rates between unit bedsize strata in medicalsurgical ldquoall otherrdquo ICUs are equal (Table 3) the


Table 2 Enrolled NHSN facilities contributing data used in this report by facility type and bedsize

Bed size category

50 51-200 201-500 gt500

Facility type N () N () N () N () Total N ()

Acute care hospitals 802 (180) 1596 (359) 1086 (244) 258 (58) 3742 (842) Major teaching 16 (04) 99 (22) 215 (48) 145 (33) 475 (107) Graduate teaching 33 (07) 202 (45) 238 (54) 55 (12) 528 (119) Undergraduate teaching 16 (04) 63 (14) 38 (08) 3 (01) 120 (27) Nonteaching 737 (166) 1232 (277) 595 (134) 55 (12) 2619 (589)

Long term acute care hospitals 274 (62) 181 (41) 10 (02) 0 (00) 465 (105) Free-standing 104 (23) 161 (36) 9 (02) 0 (00) 274 (62) Within a hospital 170 (38) 20 (05) 1 (00) 0 (00) 191 (43)

Inpatient rehabilitation facilities 102 (23) 131 (29) 3 (01) 1 (00) 237 (53) Free-standing 82 (18) 118 (26) 3 (01) 1 (00) 204 (46) Within a health care facility 20 (05) 13 (03) 0 (00) 0 (00) 33 (07)

Total 1178 (265) 1908 (429) 1099 (247) 259 (58) 4444

Major Facility has a program for medical students and post-graduate medical training Graduate Facility has a program for post-graduate medical training (ie residency andor fellowships) Undergraduate Facility has a program for medical students only Free-standingwithin a hospital or health care facility Describes physical placement of LTACH or IRF and does not define financial or administrative relationship with other health care facility types Does not include inpatient rehabilitation facilities reporting to NHSN as locations within enrolled acute care hospitals

Table 3 Pooled means and key percentiles of the distribution of laboratory-confirmed central line associated BSI rates and central line utilization ratios by type of location DA module 2012

Central line-associated BSI rate Percentile

Type of location No of locationsy No of CLABSI Central line-days Pooled mean 10 25 50 (median) 75 90

Acute Care Hospitals Critical Care Burn 73 (72) 265 78825 34 00 07 22 52 93 Medical Major teaching 231 (230) 792 625053 13 00 05 11 19 28

Medical All other 459 (433) 684 627374 11 00 00 05 15 29

Medical cardiac 409 (403) 630 597529 11 00 00 08 16 25 Medicalsurgical Major teaching 328 (324) 940 765267 12 00 00 10 18 30

Medicalsurgical All other 15 beds 1690 (1562) 1226 1312634 09 00 00 00 12 26

Medicalsurgical All other gt 15 beds 803 (801) 1894 2110694 09 00 00 07 14 22

Neurologic 55 (54) 83 80900 10 00 00 05 16 25 Neurosurgical 174 361 314752 11 00 00 09 19 28 Pediatric cardiothoracic 41 189 134529 14 00 08 13 21 25 Pediatric medical 33 (24) 29 24297 12 00 00 06 27 38 Pediatric medicalsurgical 317 (293) 573 401074 14 00 00 08 21 29 Pediatric surgical 6 3 3457 09 Prenatal 6 (3) 1 376 27 Respiratory 10 18 15254 12 Surgical Major teaching 178 529 445486 12 00 03 09 18 28

Surgical All other 210 (203) 357 387095 09 00 00 07 15 25

Surgical cardiothoracic 459 (457) 803 950847 08 00 00 05 12 20 Trauma 153 547 341619 16 00 05 13 24 39

Step-Down Units Adult step-down (post-critical care) 585 (570) 527 667879 08 00 00 00 12 23 Step-down NICU (level II) 42 (20) 4 5096 08 00 00 00 00 00 Pediatric step-down (post-critical care) 14 26 13962 19

Inpatient Wards Acute stroke 20 15 14038 11 00 00 00 14 34 Antenatal 18 (6) 1 1554 06 Behavioral healthpsychiatry 104 (31) 5 9032 06 00 00 00 00 00 Burn 17 21 8877 24 Gastrointestinal 6 19 10619 18 Genitourinary 14 (12) 19 17005 11 Geronotology 10 (9) 3 5940 05 Gynecology 51 (28) 6 10916 05 00 00 00 00 11 Jail 14 (12) 12 7350 16 Labor and delivery 57 (2) 0 802 00 Labor delivery recovery postpartum suite 111 (16) 4 3182 13 Medical 917 (877) 962 1080386 09 00 00 00 13 25

(continued on next page)


Table 3 continued



Medicalsurgical 2048 (1932) 1592 1938992 08 00 00 00 11 22 Neurologic 64 (63) 54 64719 08 00 00 00 14 26 Neurosurgical 63 (61) 44 54802 08 00 00 00 08 22 Orthopedic 274 (247) 78 172241 05 00 00 00 00 17 Orthopedic trauma 21 (20) 26 22588 12 00 00 04 16 21 Pediatric medical 52 (47) 48 49399 10 00 00 00 11 23 Pediatric medicalsurgical 286 (216) 226 212654 11 00 00 00 11 23 Pediatric orthopedic 10 (3) 1 2034 05 Pediatric rehabilitation - non-IRFz 8 8 4418 18 Pediatric surgical 14 15 15668 10 Postpartum 155 (23) 2 3647 05 00 00 00 00 00 Pulmonary 41 69 66228 10 00 00 07 13 27 Rehabilitation - non-IRFz 32 (26) 4 15786 03 00 00 00 00 00 Surgical 507 (482) 452 555766 08 00 00 03 14 28 Telemetry 298 (293) 241 277559 09 00 00 00 13 27 Vascular Surgery 25 21 37652 06 00 00 00 13 19 Well-Baby Nursery 16 (3) 0 486 00

Chronic Care Unitsx

Chronic care 24 18 24932 07 00 00 00 09 18 Inpatient hospice 5 0 3089 00 Ventilator dependent unit 7 15 13193 11

Critical Access Hospitals Critical care unitsjj 153 (74) 10 17942 06 00 00 00 00 00 Non-critical care units 181 (126) 21 37932 06 00 00 00 00 00

Long-Term Acute Care Hospitals

Adult critical care 63 147 90703 16 00 00 11 26 44 Adult ward 574 (564) 1967 1879822 10 00 00 08 16 24

Inpatient Rehabilitation Facilities Adult rehabilitation units - Freestanding 69 (64) 17 44818 04 00 00 00 00 10 Adult rehabilitation units - Within health care facility 323 (288) 86 133910 06 00 00 00 00 24

Central line utilization ratioyy Percentile

Type of location No of locationsy Central line-days Patient-days Pooled mean 10 25 50 (median) 75 90

Acute Care Hospitals Critical Care Burn 73 78825 165242 048 021 032 046 061 075 Medical Major teaching 231 625053 1065875 059 039 050 059 068 076


Medical cardiac 409 597529 1421371 042 018 030 041 056 069 Medicalsurgical Major teaching 328 (327) 765267 1380023 055 027 041 053 065 071


Medical Surgical All other gt 15 beds 803 2110694 4378657 048 029 040 051 060 069

Neurologic 55 (54) 80900 160483 050 022 035 049 059 074 Neurosurgical 174 314752 721754 044 025 035 043 053 063 Pediatric cardiothoracic 41 134529 187490 072 052 059 076 087 091 Pediatric medical 33 (29) 24297 56936 043 010 021 029 039 048 Pediatric medicalsurgical 317 (313) 401074 880238 046 015 023 036 051 060 Pediatric surgical 6 3457 9252 037 Prenatal 6 376 6974 005 Respiratory 10 15254 32728 047 Surgical Major teaching 178 445486 753588 059 037 047 058 070 077




Inpatient Wards Acute stroke 20 14038 111017 013 006 009 011 014 016 Antenatal 18 1554 27399 006 Behavioral healthpsychiatry 104 9032 257975 004 000 001 001 003 005 Burn 17 8877 41957 021 Gastrointestinal 6 10619 38469 028 Genitourinary 14 17005 72775 023



Table 3 continued



Geronotology 10 5940 51878 011 Gynecology 51 (50) 10916 124952 009 001 002 004 008 014 Jail 14 7350 46237 016 Labor and delivery 57 (56) 802 53708 001 000 001 001 003 006 Labor delivery recovery postpartum suite 111 (110) 3182 147766 002 000 001 001 003 006 Medical 917 (911) 1080386 6325631 017 006 009 015 021 030 Medicalsurgical 2048 (2038) 1938992 13323221 015 005 008 012 017 026 Neurologic 64 64719 460682 014 006 009 014 018 021 Neurosurgical 63 54802 400128 014 006 008 014 018 022 Orthopedic 274 172241 1629594 011 002 005 008 013 017 Orthopedic Trauma 21 22588 149270 015 003 010 015 017 021 Pediatric medical 52 49399 234474 021 004 008 016 026 039 Pediatric medicalsurgical 286 (284) 212654 1142975 019 002 005 010 022 034 Pediatric orthopedic 10 2034 12684 016 Pediatric rehabilitation - non-IRFz 8 4418 24829 018 Pediatric surgical 14 15668 70738 022 Postpartum 155 3647 318836 001 000 000 001 002 004 Pulmonary 41 66228 290991 023 010 014 022 031 038 Rehabilitation - non-IRFz 32 15786 122348 013 003 006 011 018 031 Surgical 507 (506) 555766 3336490 017 005 009 014 021 027 Telemetry 298 277559 2111059 013 005 009 013 017 023 Vascular surgery 25 37652 178330 021 009 011 019 027 040 Well-Baby Nursery 16 (14) 486 11649 004

Chronic Care Unitsx

Chronic care unit 24 (23) 24932 104024 024 004 009 017 033 061 Inpatient hospice 5 3089 10670 029 Ventilator dependent unit 7 13193 41749 032




Inpatient Rehabilitation Facilities Adult rehabilitation units - Freestanding 69 44818 578554 008 002 004 006 010 015 Adult rehabilitation units - Within health care facility 323 (322) 133910 1394340 010 004 006 008 012 016

BSI bloodstream infection CLABSI central line-associated BSI NICU neonatal intensive care unit Number of CLABSI

x 1 000Number of central line - days

yThe number in parentheses is the number of locations meeting minimum requirements for percentile distributions (ie 50 device days for rate distributions 50 patient days for device utilization ratios) if less than total number of locations If this number is lt20 percentile distributions are not calculated yyNumber of central line - days

Number of patient - days

zIncludes only in-hospital rehabilitation wards that are not defined as inpatient rehabilitation facilities (IRF) per the CMS Inpatient Rehabilitation Facility Quality Reporting Program xIncludes chronic care locations within the general acute care hospital setting jjCombines all critical care unit types within critical access hospitals Combines all units not identified as critical care (eg inpatient wards step-down units) within critical access hospitals Includes free-standing long-term acute care hospitals and long-term acute care locations within the general acute care hospital setting Includes free-standing inpatient rehabilitation facilities and inpatient rehabilitation facilities within the acute care hospital setting as defined by the CMS Inpatient Rehabilitation Facility Quality Reporting Program

percentile distributions were shown to be significantly different as a result of nonparametric statistical tests Therefore this stratification by unit bedsize in ldquoall otherrdquo medicalsurgical ICUs was retained Adult hematologyoncology locations were not further stratified by hospital type (ie oncology hospital vs all other acute care hospitals) as the results of the statistical tests indicated that the differences in the strata were not statistically significant In 2013 oncology and general acute care hospitals were provided with fourteen oncology-specific CDC locations with which to identify for device-associated infection surveilshylance As the volume of these data become sufficient future

analyses will continue to assess any potential differences in this specialized population

In 2012 facilities participating in NHSN were able to designate themselves as CAHs This information allowed for the comparshyison of DA rates and DU ratios in these hospitals to all other hospitals The results of the statistical tests indicated that DA rates and DU ratios in CAHs are significantly different from all other hospitals and therefore CAHs are now able to compare themselves to pooled means generated from like-hospitals This allows for more targeted prevention efforts in this unique setting


Table 4 Pooled means and key percentiles of the distribution of laboratory-confirmed permanent and temporary central line-associated BSI rates and central line utilization ratios by type of speciality care areaoncology location DA module 2012

Permanent Central line-associated BSI rate Percentile

Permanent central Type of location No of locationsy No of PCLABSI line-days Pooled mean 10 25 50 (median) 75 90

Specialty Care AreaOncology General hematologyoncology Hematopoietic stem cell transplant Pediatric general hematologyoncology Pediatric hematopoietic stem cell transplant Solid organ transplant Solid tumor

178 (174) 54 (53)

46 16

20 (17) 6

402 256 257 93 20 15

300231 118924 151942 33176 11675 18032

13 22 17 28 17 08

00 00 00

00 04 06

08 13 11

17 29 24

30 50 35

Temporary Central line-associated BSI ratez Percentile

Type of location No of locationsy No of TCLABSI Temporary central

line-days Pooled mean 10 25 50 (median) 75 90


185 (180) 56 44

15 (13) 23 (22)

6

491 294 94 22 64 17

257889 109591 40141 9549

44202 6730

19 27 23 23 14 25

00 00 00

00

00 05 00

04

12 24 20

12

25 37 28

19

45 48 45

34

Permanent Central line utilization ratiox Percentile

Permanent central Type of location No of locationsy line-days Patient-days Pooled mean 10 25 50 (median) 75 90


178 (177) 54 46 16 20 6

300231 118924 151942 33176 11675 18032

999114 243340 243377 46688

106289 77293

030 049 062 071 011 023

010 014 036

002

018 029 047

004

025 044 060

007

039 063 072

010

052 083 085

026

Temporary Central line utilization ratiojj Percentile

Type of location No of locationsy Temporary central

line-days Patient-days Pooled mean 10 25 50 (median) 75 90


185 (184) 56 44 15

23 (22) 6

257889 109591 40141 9549

44202 6730

1044242 252048 224294 45420

127153 78482

025 043 018 021 035 009

009 011 005

015

014 024 009

019

020 044 013

034

033 062 022

049

044 079 036

073

BSI bloodstream infection PCLABSI permanent central line-associated BSI TCLABSI temporary central line-associated BSI Number of PCLABSI

x 1 000Number of permanent central line - days

yThe number in parentheses is the number of locations meeting minimum requirements for percentile distributions (ie 50 device days for rate distributions 50 patient days for device utilization ratios) if less than total number of locations If this number is lt20 percentile distributions are not calculated

Number of TCLABSI z x 1 000Number of temporary central line - days Number of permanent central line - daysx

Number of patient - days Number of temporary central line - daysk


In producing this report there were several areas identified for which prevention activities and further investigation may be needed both at the national and local levels For example the CLABSI pooled mean rate for LTACH critical care units is higher than most other critical care unit types (Table 3) Similarly the CAUTI pooled mean rate for LTACH wards is higher than CAUTI pooled mean rates in the majority of other ward-level locations (Table 5) Further when compared to the previous report CAUTI rates have increased in every critical care unit type with the exception of ldquoSurgical critical care e all othersrdquo (Table 5)1 Additional key find-ings from this report can be found in Figure 1

Tables 11-18 were included to aid the reader in interpreting the DA infection rates data One important use of data in these tables is to better understand the distribution of DA infections by type of reporting criterion nationally For example nearly 85 of the CLABSIs from adult and pediatric ICUs and inpatient wards were identified using criterion (1) which attributes the CLABSI to a recognized pathogen however for NICUs only 70 used this criterion resulting in a greater percentage of CLABSIs in this pop-ulation that were identified with common commensals Similarly the specific type of ventilator-associated pneumonia (VAP) most frequently reported regardless of location was the clinical criterion


Table 5 Pooled means and key percentiles of the distribution of urinary catheter-associated UTI rates and urinary catheter utilization ratios by type of location DA module 2012

Urinary catheter-associated UTI rate Percentile

Type of location No of locationsy No of CAUTI Urinary catheter-days Pooled mean 10 25 50 (median) 75 90

Acute Care Hospitals Critical care units Burn 73 384 82039 47 00 17 43 81 115 Medical Major teaching 230 2181 741268 29 04 13 23 39 55


Medical cardiac 405 1517 703734 22 00 06 18 34 49 MedicalSurgical Major teaching 328 (325) 2280 935001 24 00 09 20 35 52

MedicalSurgical All other 15 beds 1688 (1651) 2521 2032215 12 00 00 06 18 32

MedicalSurgical All other gt15 beds 797 4387 2766887 16 00 06 13 22 33

Neurologic 55 (54) 441 118556 37 03 17 28 50 79 Neurosurgical 173 2464 489391 50 11 27 43 62 83 Pediatric cardiothoracic 32 (31) 61 28823 21 00 08 21 34 50 Pediatric medical 30 (21) 35 10389 34 00 00 10 31 67 Pediatric medicalsurgical 297 (268) 452 166710 27 00 00 16 38 60 Pediatric surgical 5 (4) 1 1346 07 Respiratory 9 30 19324 16 Surgical Major teaching 176 1800 558102 32 06 15 27 45 66


Surgical cardiothoracic 456 (455) 1657 939044 18 00 04 14 25 38 Trauma 153 (152) 1991 490351 41 09 16 33 56 82

Specialty Care AreasOncology General hematologyoncology 148 (143) 257 119248 22 00 00 16 36 57 Hematopoietic stem cell transplant 42 (38) 41 21134 19 00 00 08 34 73 Pediatric general hematologyoncology 24 (18) 9 3252 28 Pediatric hematopoietic stem cell transplant 5 (2) 1 277 36 Solid organ transplant 16 37 22667 16 Solid tumor 6 58 25785 22

Step-down Units Adult step-down (post-critical care) 470 (466) 1139 615962 18 00 00 12 27 46 Pediatric step-down (post-critical care) 12 (7) 1 970 10

Inpatient Wards Acute stroke 15 26 17456 15 Antenatal 15 (12) 2 2234 09 Behavioral healthpsychiatry 118 (50) 32 11605 28 00 00 00 32 91 Burn 16 (15) 32 6061 53 Genitourinary 12 (11) 11 11409 10 Gerontology 11 8 7489 11 Gynecology 59 (51) 26 29614 09 00 00 00 11 31 Jail 11 (7) 6 3372 18 Labor and delivery 95 (69) 15 28435 05 00 00 00 00 16 Labor delivery recovery postpartum suite 167 (144) 30 63794 05 00 00 00 00 12 Medical 813 (788) 1334 882392 15 00 00 10 24 45 MedicalSurgical 1825 (1765) 2752 2038073 14 00 00 08 21 36 Neurologic 56 (55) 159 78211 20 00 06 16 30 53 Neurosurgical 48 175 61879 28 00 09 23 38 53 Orthopedic 249 (239) 425 356156 12 00 00 08 21 32 Orthopedic trauma 17 68 31586 22 Pediatric medical 33 (16) 6 4188 14 Pediatric medicalsurgical 209 (111) 55 31738 17 00 00 00 14 66 Pediatric orthopedic 5 (4) 1 2086 05 Pediatric rehabilitation - non-IRFz 5 (1) 1 245 41 Pediatric surgical 12 (8) 4 5846 07 Postpartum 215 (195) 61 115138 05 00 00 00 00 24 Pulmonary 29 (28) 88 44393 20 00 07 14 22 47 Rehabilitation - non-IRFz 37 (31) 29 11285 26 00 00 00 49 62 Surgical 458 (450) 1099 647041 17 00 00 12 26 48 Telemetry 207 (203) 400 286809 14 00 00 11 21 36 Vascular surgery 20 25 23153 11 00 00 06 12 27 Well-baby nursery 6 (0) 0 24 00

Chronic Care Unitsx

Chronic care 30 (29) 31 14553 21 00 00 00 36 43 Chronic care rehabilitation unit 12 (10) 6 2278 26 Inpatient hospice 5 2 5509 04 Ventilator dependent unit 5 40 8311 48

Critical Access Hospitals



Table 5 continued



Critical care unitsjj 140 (119) 25 35833 07 00 00 00 00 38 Non-critical care units 276 (239) 173 98900 17 00 00 00 30 62



Inpatient Rehabilitation Facilities Adult rehabilitation units - Freestanding 286 (260) 348 119422 29 00 00 11 48 93 Adult rehabilitation units - Within hospital 888 (662) 569 180177 32 00 00 00 45 99 Pediatric rehabilitation units - Within hospital 10 (5) 2 1087 18

Urinary catheter utilization ratioyy Percentile

Type of location No of locationsy Urinary catheter-days Patient days Pooled mean 10 25 50 (median) 75 90






Neurologic 55 118556 157449 075 048 064 076 085 088 Neurosurgical 173 489391 713836 069 046 061 072 080 086 Pediatric cardiothoracic 32 28823 129344 022 007 016 020 030 036 Pediatric medical 30 (27) 10389 49809 021 005 009 013 021 034 Pediatric medicalsurgical 297 (292) 166710 775828 021 008 013 019 026 032 Pediatric surgical 5 1346 3792 035 Respiratory 9 19324 32296 060 Surgical Major teaching 176 558102 745658 075 055 067 077 084 089



Specialty Care AreasOncology General hematologyoncology 148 (147) 119248 812884 015 007 010 014 020 028 Hematopoietic stem cell transplant 42 21134 192836 011 003 005 008 016 023 Pediatric general hematologyoncology 24 3252 113041 003 001 001 002 003 008 Pediatric hematopoietic stem cell transplant 5 277 8384 003 Solid organ transplant 16 22667 94290 024 Solid tumor 6 25785 78482 033

Step-down Units Adult step-down (post-critical care) 470 (469) 615962 2480340 025 011 017 025 037 050 Pediatric step-down (post-critical care) 12 970 37889 003

Inpatient Wards Acute stroke 15 17456 77769 022 Antenatal 15 2234 33101 007 Behavioral healthpsychiatry 118 11605 318371 004 000 001 002 004 006 Burn 16 6061 35863 017 Genitourinary 12 11409 65152 018 Gerontology 11 7489 60604 012 Gynecology 59 (58) 29614 170866 017 005 011 015 023 038 Jail 11 3372 37316 009 Labor and delivery 95 (94) 28435 168958 017 001 006 011 021 035 Labor delivery recovery postpartum suite 167 (166) 63794 411335 016 005 009 013 018 029 Medical 813 (809) 882392 5552794 016 007 011 015 020 026 MedicalSurgical 1825 (1814) 2038073 11501523 018 009 012 017 022 029 Neurologic 56 78211 376137 021 008 014 019 024 034 Neurosurgical 48 61879 315157 020 010 015 019 024 035 Orthopedic 249 (248) 356156 1389082 026 011 017 025 033 043 Orthopedic trauma 17 31586 132749 024 Pediatric medical 33 (32) 4188 102201 004 000 001 002 004 010 Pediatric medicalsurgical 209 (205) 31738 654343 005 001 001 003 007 012 Pediatric orthopedic 5 2086 11202 019 Pediatric rehabilitation - non-IRFz 5 245 6965 004 Pediatric surgical 12 5846 48474 012



Table 5 continued



Postpartum 215 115138 880621 013 003 008 012 017 024 Pulmonary 29 44393 206424 022 009 014 018 030 051 Rehabilitation - non-IRFz 37 (36) 11285 113203 010 004 006 009 013 024 Surgical 458 647041 2887968 022 011 016 022 029 039 Telemetry 207 286809 1484465 019 011 014 019 025 030 Vascular surgery 20 23153 139105 017 006 011 015 020 027 Well-baby nursery 6 (4) 24 1024 002

Chronic Care Unitsx

Chronic care 30 (27) 14553 95809 015 004 007 013 017 028 Chronic care rehabilitation unit 12 2278 26153 009 Inpatient hospice 5 5509 10670 052 Ventilator dependent unit 5 8311 28901 029




Inpatient Rehabilitation Facilities Adult rehabilitation units - Freestanding 286 119422 1382477 009 003 005 008 010 015 Adult rehabilitation units - Within hospital 888 (887) 180177 2171747 008 002 005 007 011 017 Pediatric rehabilitation units - Within hospital 10 1087 13564 008

UTI urinary tract infection CAUTI catheter-associated UTI Number of CAUTI

x 1 000Number of urinary catheter - days

yThe number in parentheses is the number of locations meeting minimum requirements for percentile distributions (ie 50 device days for rate distributions 50 patient days for device utilization ratios) if less than total number of locations If this number is lt20 percentile distributions are not calculated zIncludes only in-hospital rehabilitation wards that are not defined as inpatient rehabilitation facilities (IRF) per the CMS Inpatient Rehabilitation Facility Quality Reporting Program xIncludes chronic care locations within the general acute care hospital setting jjCombines all critical care unit types within critical access hospitals Combines all units not identified as critical care (eg inpatient wards step-down units) within critical access hospitals Includes free-standing long-term acute care hospitals and long-term acute care locations within the general acute care hospital setting Includes free-standing inpatient rehabilitation facilities and inpatient rehabilitation facilities within the acute care hospital setting as defined by the CMS Inpatient Rehabilitation Facility Quality Reporting Program yyNumber of urinary catheter - days x 1 000


Table 6 Pooled means and key percentiles of the distribution of ventilator-associated PNEU rates and ventilator utilization ratios by type of location DA module 2012

Ventilator-associated PNEU rate Percentile

Type of location No of locationsy No of VAP Ventilatoredays Pooled mean 10 25 50 (median) 75 90

Acute Care Hospitals Critical Care Units Burn 36 (34) 86 19503 44 00 00 11 67 109 Medical Major teaching 112 (111) 205 212392 10 00 00 05 16 29




Medicalsurgical All other gt15 beds 405 (400) 666 711280 09 00 00 04 13 28

Neurologic 23 62 20859 30 00 00 02 25 70 Neurosurgical 76 (74) 210 98026 21 00 00 15 29 38 Pediatric cardiothoracic 20 9 36187 02 00 00 00 02 06 Pediatric medical 16 (9) 2 6634 03 Pediatric medicalsurgical 142 (132) 113 147441 08 00 00 00 09 24 Pediatric surgical 5 (4) 1 2328 04 Respiratory 7 4 6037 07 Surgical Major teaching 81 (80) 280 127251 22 00 06 15 31 56



Table 6 continued





Specialty Care AreasOncology Hematopoietic stem cell transplant 5 0 1951 00

Step-Down Units Adult step-down (post-critical care) 102 (82) 31 42462 07 00 00 00 00 18 Pediatric step-down (post-critical care) 5 (4) 1 5813 02 Step-down NICU (level II) 7 (1) 0 119 00

Inpatient Wards Medical 39 (22) 3 6472 05 00 00 00 00 14 Medicalsurgical 64 (35) 22 25731 09 00 00 00 00 13 Pediatric medical 6 (5) 0 2026 00 Pediatric medicalsurgical 11 (8) 0 3146 00 Pulmonary 9 (8) 7 7241 10 Surgical 8 (1) 0 107 00 Telemetry 10 (5) 1 1770 06

Critical Access Hospitals Critical care unitsz 67 (14) 3 2964 10 Non-critical care unitsx 9 (1) 4 2660 15

Long-Term Acute Care Hospitalsjj

Adult critical care 18 (17) 8 12544 06 Adult ward 195 (190) 103 316632 03 00 00 00 03 14

Ventilator utilization ratio Percentile

Type of location No of locationsy Ventilatoredays Patient-days Pooled mean 10 25 50 (median) 75 90

Acute Care Hospitals Critical Care Units Burn 36 19503 71198 027 008 015 023 034 043 Medical Major teaching 112 212392 477003 045 028 037 045 054 063




Medicalsurgical All other gt15 beds 405 711280 2114095 034 019 025 033 041 049

Neurologic 23 20859 64005 033 010 020 033 039 042 Neurosurgical 76 98026 323269 030 016 024 030 039 045 Pediatric cardiothoracic 20 36187 86054 042 025 034 041 050 054 Pediatric medical 16 6634 21470 031 Pediatric medicalsurgical 142 (141) 147441 400413 037 012 019 030 042 048 Pediatric surgical 5 (4) 2328 8039 029 Respiratory 7 6037 22926 026 Surgical Major teaching 81 127251 320792 040 023 029 040 048 053




Step-Down Units Adult step-down (post-critical care) 102 (101) 42462 437346 010 001 003 006 013 024 Pediatric step-down (post-critical care) 5 5813 19832 029 Step-down NICU (level II) 7 (6) 119 4073 003

Inpatient Wards Medical 39 6472 209363 003 000 000 002 004 007 Medicalsurgical 64 25731 378747 007 000 001 002 005 013 Pediatric medical 6 2026 25314 008 Pediatric medicalsurgical 11 3146 62702 005 Pulmonary 9 7241 51428 014 Surgical 8 107 15644 001 Telemetry 10 1770 42097 004



Table 6 continued



Critical Access Hospitals Critical care unitsz

Non-critical care unitsx


Adult critical care Adult ward

67 (54) 9 (9)

18 (17) 195

2964 2660

12544 316632

30983 12632

41665 1474536

010 021

030 021

001

007

004

012

007

019

012

029

016

039

VAP ventilator-associated pneumonia Number of VAP

x 1 000Number of ventilator - days

yThe number in parentheses is the number of locations meeting minimum requirements for percentile distributions (ie 50 device days for rate distributions 50 patient days for device utilization ratios) if less than total number of locations If this number is lt20 percentile distributions are not calculated zCombines all critical care unit types within critical access hospitals xCombines all units not identified as critical care (eg inpatient wards step-down units) within critical access hospitals jjIncludes free-standing long-term acute care hospitals and long-term acute care locations within the general acute care hospital setting

Number of ventilator - days


Table 7 Pooled means and key percentiles of the distribution of central line-associated BSI rates and central line utilization ratios for level III NICUs DA module 2012


Birth-weight category No of locationsy No of CLABSI Central line-days Pooled mean 10 25 50 (median) 75 90

750 grams 380 (334) 420 185851 23 0 0 15 37 75 751-1000 grams 401 (339) 256 160230 16 0 0 0 26 46 1001-1500 grams 418 (370) 195 172732 11 0 0 0 16 39 1501-2500 grams 415 (338) 104 161361 06 0 0 0 0 23 gt2500 grams 422 (322) 136 176853 08 0 0 0 03 20

Central line utilization ratioz Percentile

Birth-weight category No of locationsy Central line-days Patient-days Pooled Mean 10 25 50 (median) 75 90



x 1 000Number of central line - days yThe number in parentheses is the number of locations meeting minimum requirements for percentile distributions (ie 50 device days for rate distributions 50 patient days for device utilization ratios) if less than total number of locations If this number is lt20 percentile distributions are not calculated Number of central line - daysz Number of patient - days

Table 8 Pooled means and key percentiles of the distribution of central line-associated BSI rates and central line utilization ratios for level IIIII NICUs DA module 2012





Birth-weight category No of locationsy Central line-days Patient-days Pooled mean 10 25 50 (median) 75 90




yThe number in parentheses is the number of locations meeting minimum requirements for percentile distributions (ie 50 device days for rate distributions 50 patient days for device utilization ratios) if less than total number of locations If this number is lt20 percentile distributions are not calculated Number of central line - daysz Number of patient - days


Table 9 Pooled means and key percentiles of the distribution of ventilator-associated PNEU rates and ventilator utilization ratios for level III NICUs DA module 2012


Birth-weight category No of locationsy No of VAP Ventilator-days Pooled mean 10 25 50 (median) 75 90


Ventilator utilization ratioz Percentile

Birth-weight category No of locationsy Ventilator-days Patient-days Pooled mean 10 25 50 (median) 75 90


VAP ventilator-associated pneumonia NICU neonatal intensive care unit Number of VAP


yThe number in parentheses is the number of locations meeting minimum requirements for percentile distributions (ie 50 device days for rate distributions 50 patient days for device utilization ratios) if less than total number of locations If this number is lt20 percentile distributions are not calculated Number of ventilator - daysz Number of patient - days

Table 10 Pooled means and key percentiles of the distribution of ventilator-associated PNEU rates and ventilator utilization ratios for level IIIII NICUs DA module 2012










Table 11 Distribution of criteria for central line-associated laboratory-confirmed BSI by location 2012

LCBI

Type of location Criterion 1 n () Criterion 23 n () Total

Acute Care Hospitals Critical Care Burn 251 (947) 14 (53) 265 Medical Major teaching 692 (874) 100 (126) 792

Medical All other 560 (819) 124 (181) 684

Medical cardiac 487 (773) 143 (227) 630 Medicalsurgical Major teaching 803 (854) 137 (146) 940

Medicalsurgical All other 15 beds 996 (812) 230 (188) 1226

Medicalsurgical All other gt 15 beds 1542 (814) 352 (186) 1894

Neurologic 63 (759) 20 (241) 83 Neurosurgical 275 (762) 86 (238) 361


1161

Table 11 continued

MA Dudeck et al American Journal of Infection Control 41 (2013) 1148-66

LCBI


Pediatric cardiothoracic Pediatric medical Pediatric medicalsurgical Pediatric surgical Prenatal Respiratory Surgical Major teaching

Surgical All other

Surgical cardiothoracic Trauma

Step-Down Units Adult step-down (post-critical care) Step-down NICU (level II) Pediatric step-down (post-critical care)

Inpatient Wards Acute stroke Antenatal Behavioral healthpsychiatry Burn Gastrointestinal Genitourinary Geronotology Gynecology Jail Labor and delivery Labor delivery recovery postpartum suite Medical Medicalsurgical Neurologic Neurosurgical Orthopedic Orthopedic trauma Pediatric medical Pediatric medicalsurgical Pediatric orthopedic Pediatric rehabilitation - non-IRF Pediatric surgical Postpartum Pulmonary Rehabilitation - non-IRF Surgical Telemetry Vascular Surgery Well-Baby Nursery

Chronic Care Unitsy

Chronic care Inpatient hospice Ventilator dependent unit





Inpatient Rehabilitation Facilities

Adult rehabilitation units - Freestanding Adult rehabilitation units - Within health care facility

TOTAL

154 (815) 24 (828)

466 (813) 3 (1000) 1 (1000)

16 (889)

443 (837)

276 (773) 657 (818) 458 (837)

459 (871) 2 (500)

21 (808)

14 (933)

4 (800) 19 (905) 18 (947) 13 (684) 2 (667) 5 (833)

11 (917) 0 4 (1000)

854 (888) 1349 (847)

43 (796) 37 (841) 65 (833) 21 (808) 43 (896)

195 (863) 1 (1000) 8 (1000)

13 (867) 2 (1000)

60 (870) 3 (750)

388 (858) 212 (880) 20 (952) 0

14 (778) 0

15 (1000)

7 (700) 16 (762)

132 (898) 1734 (882)

17 (1000) 77 (895)

14065 (842)

35 (185) 5 (172)

107 (187)

2 (111)

86 (163)

81 (227) 146 (182) 89 (163)

68 (129) 2 (500) 5 (192)

1 (67) 1 (1000) 1 (800) 2 (95) 1 (53) 6 (316) 1 (333) 1 (167) 1 (83) 0 0 (00)

108 (112) 243 (153) 11 (204) 7 (159)

13 (167) 5 (192) 5 (104)

31 (137)

2 (133)

9 (130) 1 (250)

64 (142) 29 (120) 1 (48) 0

4 (222) 0

3 (300) 5 (238)

15 (102) 233 (118)

9 (105) 2645 (158)

189 29

573 3 1

18

529

357 803 547

527 4

26

15 1 5

21 19 19 3 6

12 0 4

962 1592

54 44 78 26 48

226 1 8

15 2

69 4

452 241 21 0

18 0

15

10 21

147 1967

17 86

16710

BSI bloodstream infection LCBI laboratory-confirmed BSI5

Includes only in-hospital rehabilitation wards that are not defined as inpatient rehabilitation facilities (IRF) per the CMS Inpatient Rehabilitation Facility Quality Reporting Program yIncludes chronic care locations within the general acute care hospital setting zCombines all critical care unit types within critical access hospitals xCombines all units not identified as critical care (eg inpatient wards step-down units) within critical access hospitals jjIncludes free-standing long-term acute care hospitals and long-term acute care locations within the general acute care hospital setting Includes free-standing inpatient rehabilitation facilities and inpatient rehabilitation facilities within the acute care hospital setting as defined by the CMS Inpatient Rehabilitation Facility Quality Reporting Program


Table 12 Distribution of criteria for permanent and temporary central line-associated laboratory-confirmed BSI by location 2012

LCBI

Type of Location Criterion 1 n () Criterion 23 n () Total

Permanent Central Line General hematologyoncology 308 (766) 94 (234) 402 Hematopoietic stem cell transplant 200 (781) 56 (219) 256 Pediatric general hematologyoncology 187 (728) 70 (272) 257 Pediatric hematopoietic stem cell transplant 67 (720) 26 (280) 93 Solid organ transplant 16 (800) 4 (200) 20 Solid tumor 11 (733) 4 (267) 15

Total 789 (756) 254 (244) 1043 Temporary Central Line General hematologyoncology 399 (813) 92 (187) 491 Hematopoietic stem cell transplant 229 (779) 65 (221) 294 Pediatric general hematologyoncology 73 (777) 21 (223) 94 Pediatric hematopoietic stem cell transplant 17 (773) 5 (227) 22 Solid organ transplant 57 (891) 7 (109) 64 Solid tumor 10 (588) 7 (412) 17

Total 785 (799) 197 (201) 982


Table 13 Distribution of specific sites of urinary catheter-associated UTI by location 2012

Type of location SUTI n () ABUTI n () Total

Acute Care Hospitals Critical care units Burn 382 (995) 2 (05) 384 Medical Major teaching 2150 (986) 31 (14) 2181


Medical cardiac 1497 (987) 20 (13) 1517 MedicalSurgical Major teaching 2244 (984) 36 (16) 2280

MedicalSurgical All other 15 beds 2472 (981) 49 (19) 2521

MedicalSurgical All other gt15 beds 4323 (985) 64 (15) 4387

Neurologic 437 (991) 4 (09) 441 Neurosurgical 2459 (998) 5 (02) 2464 Pediatric cardiothoracic 60 (984) 1 (16) 61 Pediatric medical 35 (1000) 35 Pediatric medicalsurgical 450 (996) 2 (04) 452 Pediatric surgical 1 (1000) 1 Respiratory 29 (967) 1 (33) 30 Surgical Major teaching 1782 (991) 17 (09) 1799

Surgical All other 910 (991) 8 (09) 918

Surgical cardiothoracic 1628 (982) 29 (18) 1657 Trauma 1973 (991) 18 (09) 1991

Specialty Care AreasOncology General hematologyoncology 253 (984) 4 (16) 257 Hematopoietic stem cell transplant 39 (951) 2 (49) 41 Pediatric general hematologyoncology 9 (1000) 9 Pediatric hematopoietic stem cell transplant 1 (1000) 1 Solid organ transplant 35 (946) 2 (54) 37 Solid tumor 58 (1000) 58

Step-down Units Adult step-down (post-critical care) 1120 (983) 19 (17) 1139 Pediatric step-down (post-critical care) 1 (1000) 1

Inpatient Wards Acute stroke 25 (962) 1 (38) 26 Antenatal 2 (1000) 2 Behavioral healthpsychiatry 31 (969) 1 (31) 32 Burn 30 (938) 2 (63) 32 Genitourinary 11 (1000) 11 Gerontology 8 (1000) 8 Gynecology 25 (962) 1 (38) 26 Jail 5 (833) 1 (167) 6 Labor and delivery 15 (1000) 15 Labor delivery recovery postpartum suite 30 (1000) 30


MA Dudeck et al American Journal of Infection Control 41 (2013) 1148-66 1163

Table 13 continued


Medical 1320 (990) 14 (10) 1334 MedicalSurgical 2711 (985) 40 (15) 2751 Neurologic 159 (1000) 159 Neurosurgical 175 (1000) 175 Orthopedic 422 (993) 3 (07) 425 Orthopedic trauma 68 (1000) 68 Pediatric medical 6 (1000) 6 Pediatric medicalsurgical 55 (1000) 55 Pediatric orthopedic 1 (1000) 1 Pediatric rehabilitation - non-IRF 1 (1000) 1 Pediatric surgical 4 (1000) 4 Postpartum 61 (1000) 61 Pulmonary 87 (989) 1 (11) 88 Rehabilitation - non-IRF 28 (966) 1 (34) 29 Surgical 1082 (985) 17 (15) 1099 Telemetry 390 (975) 10 (25) 400 Vascular surgery 25 (1000) 25 Well-baby nursery 0

Chronic Care Unitsy

Chronic care 30 (968) 1 (32) 31 Chronic care rehabilitation unit 6 (1000) 6 Inpatient hospice 2 (1000) 2 Ventilator dependent unit 39 (975) 1 (25) 40

Critical Access Hospitals Critical care unitsz 25 (1000) 25 Non-critical care unitsx 167 (965) 6 (35) 173


Adult critical care 145 (980) 3 (20) 148 Adult ward 2490 (981) 47 (19) 2537


Adult rehabilitation units - Freestanding 345 (994) 2 (06) 347 Adult rehabilitation units - Within hospital 560 (984) 9 (16) 569 Pediatric rehabilitation units - Within hospital 2 (1000) 2

TOTAL 36344 (986) 505 (14) 36849

UTI urinary tract infection SUTI symptomatic UTI ABUTI asymptomatic bacteremic UTI6


Table 14 Distribution of specific sites of ventilator-associated pneumonia by location 2012

Type of location PNU1 n () PNU2 n () PNU3 n () Total

Acute Care Hospitals Critical Care Units Burn 25 291 61 709 86 Medical Major teaching 127 620 74 361 4 20 205

Medical All other 119 623 65 340 7 37 191

Medical cardiac 88 652 46 341 1 07 135 Medicalsurgical Major teaching 208 559 160 430 4 11 372

Medicalsurgical All other 15 beds 267 637 138 329 14 33 419

Medicalsurgical All other gt15 beds 454 682 201 302 11 17 666

Neurologic 24 387 37 597 1 16 62 Neurosurgical 114 543 95 452 1 05 210 Pediatric cardiothoracic 6 667 2 222 1 111 9 Pediatric medical 1 500 1 500 2 Pediatric medicalsurgical 80 708 28 248 5 44 113 Pediatric surgical 1 1000 1 Respiratory 4 1000 4 Surgical Major teaching 157 561 122 436 1 04 280



Table 14 continued


Surgical All other 89 464 98 510 5 26 192

Surgical cardiothoracic 194 608 119 373 6 19 319 Trauma 232 457 275 541 1 02 508

Specialty Care AreasOncology Hematopoietic stem cell transplant 0

Step-Down Units Adult step-down (post-critical care) 26 839 5 161 31 Pediatric step-down (post-critical care) 1 1000 1 Step-down NICU (level II) 0

Inpatient Wards Medical 2 667 1 333 3 Medicalsurgical 4 182 17 773 1 45 22 Pediatric medical 0 Pediatric medicalsurgical 0 Pulmonary 6 857 1 143 7 Surgical 0 Telemetry 1 1000 1

Critical Access Hospitals Critical care units 3 1000 3 Non-critical care unitsy 2 500 1 250 1 250 4

Long-Term Acute Care Hospitalsz

Adult critical care 7 875 1 125 8 Adult ward 78 757 24 233 1 10 103

Total 2320 586 1572 397 65 16 3957

PNU1 clinically defined pneumonia PNU2 pneumonia with specific laboratory findings PNU3 pneumonia in immunocompromised patients7

Combines all critical care unit types within critical access hospitals yCombines all units not identified as critical care (eg inpatient wards step-down units) within critical access hospitals zIncludes free-standing long-term acute care hospitals and long-term acute care locations within the general acute care hospital setting

Table 15 Table 17 Distribution of specific sites and criteria for central line-associated laboratory- Distribution of specific sites of ventilator-associated pneumonia among Level III confirmed BSI among Level III NICUs by birthweight 2012 NICUs by birthweight 2012

LCBI Birth-weight category PNU1 n () PNU2 n () PNU3 n () Total

Birth-weight category Criterion 1 n () Criterion 23 n () Total 750 grams 60 619 34 351 3 31 97 751-1000 grams 30 638 17 362 47

750 grams 316 752 104 248 420 1001-1500 grams 10 714 4 286 14

751-1000 grams 176 688 80 313 256 1501-2500 grams 1 250 3 750 4

1001-1500 grams 135 692 60 308 195 gt2500 grams 7 700 3 300 10

1501-2500 grams 76 731 28 269 104 Total 108 628 61 355 3 17 172

gt2500 grams 101 743 35 257 136 Total 804 724 307 276 1111 PNU1 clinically defined pneumonia PNU2 pneumonia with specific laboratory

findings PNU3 pneumonia in immunocompromised patients7


Table 18 Table 16 Distribution of specific sites of ventilator-associated pneumonia among Level IIIII Distribution of specific sites and criteria for central line-associated laboratory- NICUs by birthweight 2012 confirmed BSI among Level IIIII NICUs by birthweight 2012

Birth-weight category PNU1 n () PNU2 n () PNU3 n () Total LCBI

750 grams 54 711 20 263 2 26 76 Birth-weight category Criterion 1 n () Criterion 23 n () Total 751-1000 grams 29 879 3 91 1 30 33

1001-1500 grams 5 625 2 250 1 125 8750 grams 211 703 89 297 300 1501-2500 grams 2 400 2 400 1 200 5751-1000 grams 127 645 70 355 197 gt 2500 grams 4 800 1 200 51001-1500 grams 73 635 42 365 115 Total 94 740 28 220 5 39 1271501-2500 grams 49 731 18 269 67

gt2500 grams 43 632 25 368 68 PNU1 clinically defined pneumonia PNU2 pneumonia with specific laboratoryTotal 503 673 244 327 747



(PNU1) which relies on the somewhat subjective interpretations of clinical findings

As diverse types of facilities continue to participate in NHSN either voluntarily or by mandate the need for careful scrutiny

of the data increases NHSN will continue to assess how chanshyging facility composition and changes in the proportion ofdata contributed by facility types impact the rates and theirdistributions so that the best possible risk-adjusted comparative data may be provided in future reports


To improve the reliability of data reported to NHSN several protocol changes were introduced in January 2013 The majority of these changes were with respect to timing and implementation of two-day rules to clarify infections that are health care-associated association of device use to HAI and attribution of HAI to an inpatient location after transfer or to a hospital after discharge In addition NHSN added criteria for mucosal barrier injury laboratory-confirmed bloodstream infections which have not been removed or accounted for separately in this report Finally the VAP definition no longer applies to adult patients (ie 18 years of age) and this definition has been replaced by ventilator-associated events (VAEs)11 We will carefully assess the potential impact of these changes on HAI incidence as these data are reported

For those who do not report to NHSN but would like to use these data for comparison the information must first be collected from your hospital in accordance with the methods described for NHSN5-7 Refer to Appendices A and B for further instructions Appendix A discusses the calculation of infection rates and DU ratios for the DA Module Appendix B gives a step-by-step method for interpretation of percentiles of infecshytion rates or DU ratios Although a high rate or ratio (gt90th percentile) does not necessarily define a problem it does suggest an area for further investigation Similarly a low rate or ratio (lt10th percentile) may be the result of inadequate infection detection

Facilities should use the data in this report and their own data to guide local prevention strategies and other quality improvement efforts to reduce the occurrence of infections as much as possible The data presented in this report can be used to prioritize prevention efforts in those patient care areas that are shown to have the highest incidence of DA infections andor high device utilization Facilities may also wish to set targets based on the percentile distributions provided in this report in an effort to strive for lower rates and greater prevenshytion success

The authors are indebted to the NHSN participants for their ongoing efforts to monitor infections and improve patient safety We also gratefully acknowledge our colleagues in the Division of Healthcare Quality Promotion who tirelessly supshyport this unique public health network especially our colleashygues in

NHSN Education and Data Quality Assurance Team NHSN Development Team NHSN Protocol and Public Reporting Team NHSN Statistics Team NHSN User Support Team

The findings and conclusions of the report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention

References

1 Dudeck MA Horan TC Peterson KD Allen-Bridson K Morrell GC Pollock DA et al National Healthcare Safety Network (NHSN) report data summary for 2011 device-associated module Am J Infect Control 2013 41286-300

2 Malpiedi PJ Peterson KD Soe MM Edwards JR Scott II RD Wise ME et al 2011 National and State Healthcare-Associated Infection Standardized Infection Ratio Report Published February 11 2013 Available from http wwwcdcgovhaipdfsSIRSIR-Report_02_07_2013pdf Accessed August 7 2013

3 Sievert DM Ricks P Edwards JR Schneider A Patel J Srinivasan A et al Antimicrobial-Resistant Pathogens Associated with Healthcare-Associated Infections Summary of Data Reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention 2009-2010 Infect Control Hosp Epidemiol 2013341-14

4 Centers for Disease Control and Prevention Outline for healthcare-associated infection surveillance Available from httpwwwcdcgovnhsnPDFSOutlineFor HAISurveillancepdf Accessed August 1 2013

5 Centers for Disease Control and Prevention Protocol for reporting Central Line-Associated Bloodstream Infections to the National Healthcare Safety Network (in use during 2012) Available from httpwwwcdcgovhaipdfsNHSN 4PSC_CLABSSAMPLEpdf Accessed August 1 2013

6 Centers for Disease Control and Prevention Protocol for reporting Catheter-Associated Urinary Tract Infections to the National Healthcare Safety Network (in use during 2011) Available from httpwwwcdcgovhaipdfs NHSN7pscCAUTISAMPLEpdf Accessed August 1 2013

7 Horan TC Andrus M Dudeck MA CDCNHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting Am J Infect Control 200836309-32

8 Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and FY 2012 Rates Final Rule Fed Regist August 18 20117651476-846

9 Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2012 Final Rule Fed Regist August 5 20117647836-915

10 Jarvis WR Edwards JR Culver DH Hughes JM Horan T Emori TG et al Nosocomial infection rates in adult and pediatric intensive care units in the United States Am J Med 199191(Suppl 3B)185S-91S

11 Centers for Disease Control and Prevention Ventilator-associated events Available from httpwwwcdcgovnhsnacute-care-hospitalvaeindexhtml Accessed July 10 2013

APPENDIX A HOW TO CALCULATE A DEVICE-ASSOCIATED INFECTION RATE AND DEVICE UTILIZATION RATIO WITH DEVICE-ASSOCIATED MODULE DATA

Calculation of device-associated infection rate

Step 1 Decide upon the time period for your analysis It may be a month a quarter 6 months a year or some other period

Step 2 Select the patient population for analysis eg the type of location or a birthweight category in a NICU

Step 3 Select the infections to be included in the numerator They must be site-specific and must have occurred in the selected patient population Their date of onset must be during the selected time period

Step 4 Determine the number of device-days which is used as the denominator of the rate Device-days are the total number of days of exposure to the device (central line ventilator or urinary catheter) by all of the patients in the selected population during the selected time period

Example Five patients on the first day of the month had one or more central lines in place five on day 2 two on day 3 five on day 4 three on day 5 four on day 6 and four on day 7 Adding the number of patients with central lines on days 1 through 7 we would have 5thorn5thorn2thorn5thorn3thorn4thorn4frac1428 central line-days for the first week If we continued for the entire month the number of central line-days for the month is simply the sum of the daily counts

Step 5 Calculate the device-associated infection rate (per 1000 device-days) using the following formula


Number of device-associated infections for an infection site Device-associated Infection Rate frac14 x 1 000

Number of device-days

Number of central line-associated BSI Example Central line-associated BSI rate per 1 000 central line-days frac14 x 1 000

Number of central line-days

Calculation of device utilization (DU) ratio

Steps 1 2 4 Same as device-associated infection rates plus determine the number of patient-days which is used as the denominator of the DU ratio Patient-days are the total number of days that patients are in the location during the selected time period

Example Ten patients were in the unit on the first day of the month 12 on day 2 11 on day 3 13 on day 4 10 on day 5 6 on day 6 and 10 on day 7 and so on If we counted the patients in the unit from days 1 through 7 we would add 10 thorn 12 thorn 11 thorn 13 thorn 10 thorn 6 thorn 10 for a total of 72 patient-days for the first week of the month If we continued for the entire month the number of patient-days for the month is simply the sum of the daily counts

Step 5 Calculate the DU ratio with the following formula

Number of device-days DU Ratio frac14

Number of patient-days

With the number of device-days and patient-days from the examples above DU frac14 2872 frac14 039 or 39 of patient-days were also central line-days for the first week of the month

Step 6 Examine the size of the denominator for your hospitalrsquos rate or ratio Rates or ratios may not be good estimates of the ldquotruerdquo rate or ratio for your hospital if the denominator is small ie lt50 device-days or patient-days Step 7 Compare your hospitalrsquos location-specific rates orratios with those found in the tables of this report Refer to Appendix B for interpretation of the percentiles of the ratesratios

APPENDIX B INTERPRETATION OF PERCENTILES OF INFECTION RATES OR DEVICE UTILIZATION RATIOS

Step 1 Evaluate the rate (ratio) you have calculated for your hospital and confirm that the variables in the rate (both numerator and denominator) are identical to the rates (ratios) in the table

Step 2 Examine the percentiles in each of the tables and look for the 50th percentile (or median) At the 50th percentile 50 of the hospitals have lower rates (ratios) than the median and 50 have higher rates (ratios) Step 3 Determine if your hospitalrsquos rate (ratio) is above or below this median

Determining whether your hospitalrsquos rate or ratio is a HIGH outlier

Step 4 If it is above the median determine whether the rate (ratio) is above the 75th percentile At the 75th percentile 75 of the hospitals had lower rates (ratios) and 25 of the hospital had higher rates (ratios) Step 5 If the rate (ratio) is above the 75th percentile determine whether it is above the 90th percentile If it is then the rate (ratio) is an outlier which may indicate a problem

Determining whether your hospitalrsquos rate or ratio is a LOW outlier

Step 6 If it is below the median determine whether the rate (ratio) is below the 25th percentile At the 25th percentile 25 of the hospitals had lower rates (ratios) and 75 of the hospitals had higher rates (ratios) Step 7 If the rate (ratio) is below the 25th percentile determine whether it is below the 10th percentile If the rate is then it is a low outlier which may be due to underreporting of infections If the ratio is below the 10th percentile it is a low outlier and may be due to infrequent andor short duration of device use

Note Device-associated infection rates and device utilization ratios should be examined together so that preventive measures may be appropriately targeted For example you find that the ventilator-associated pneumonia rate for a certain type of ICU is consistently above the 90th percentile and the ventilator utilization ratio is routinely between the 75th and 90th percentile Since the ventilator is a significant risk factor for pneumonia you may want to limit the duration of ventilation whenever possible (ie decrease unnecessary use) while at the same time optimize infection prevention strategies in patients for which ventilator use is required


Methods



Results

Discussion

References

Appendix A How to calculate a device-associated infection rate and device utilization ratio with device-associated module data



Appendix B Interpretation of percentiles of infection rates or device utilization ratios

Determining whether your hospitals rate or ratio is a HIGH outlier

Determining whether your hospitals rate or ratio is a LOW outlier


Fig 1 Highlights from this report

component adverse event and prevention practice adherence data for surveillance prevention or mandatory public reporting

Patient- and facility-specific data reported to CDC are kept confidential in accordance with sections 304 306 and 308(d) of the Public Health Service Act (42 USC 242b 242k and 242m(d))

METHODS


For reporting to the DA Module health care facility personnel responsible for infection prevention and patient safety may choose with consideration of state mandates federal reporting programs and prevention initiatives to collect data on central line-associated bloodstream infections (CLABSI) ventilator-associated pneumonias (VAP) or urinary catheter-associated urinary tract infections (CAUTI) that occur in patients staying in a patient care location such as a critical or intensive care unit (ICU) specialty care area or inpatient ward In NHSN locations are further stratified according to patient population adults children or neonates (in tables pediatric and neonatal locations are so noted) In neonatal intensive care unit (NICU) locations (level III or level IIIII) infection preshyventionists (IPs) collect data on CLABSI or VAP that occur in patients in each of five birth-weight categories (750 g 751-1000 g 1001 shy1500 g 1501 - 2500 g and gt2500 g) data on CAUTI are not collected as part of the NHSN protocols in any NICU location Corshyresponding location-specific denominator data consisting of patient-days and specific device-days are also collected by IPs or other trained personnel

In non-NICU locations the device-days consist of the total number of central line-days urinary catheter-days or ventilator-

days For specialty care areas and oncology units such as hemashytologyoncology and hematopoietic stem cell transplant locations central line-days are split into those with only a permanent central line vs those with temporary central lines (with or without a permanent central line) In NICU locations the device-days consist of the total number of central line-days (inclusive of umbilical catheters) or ventilator-days for each birth-weight category


Compared to the previous report five new locations d gastrointestinal ward pediatric orthopedic ward inpatient hospice ward solid tumor ward and pediatric inpatient rehabilitation facility e had sufficient data to be included in this report1

Locations were further stratified by facility type unit bed size andor major teaching status to determine if pooled mean rates medians and empirical distributions significantly difshyfered between two groups for all DA infections if differences were present the strata were retained for reporting Comshyparisons of pooled mean rates were performed using Poisson regression These comparisons could be influenced by potential outlier rates from locations with disproportionately large deshynominators Therefore greater weight was given to the results of nonparametric tests comparing the medians for location shift and empirical distributions for assessing differences across the range of reported rates These nonparametric comparisons by definition require no validity assumptions and provide test results that are not subject to the potential weighting influence of high or low rates with large denominators Comparisons of the pooled mean median and percentile distribution were made if there were at least 50 locations contributing to one or more strata and at least



Hospital type N ()






RESULTS






DISCUSSION





Bed size category

50 51-200 201-500 gt500





Total 1178 (265) 1908 (429) 1099 (247) 259 (58) 4444

















Table 3 continued




Chronic Care Unitsx




















Table 3 continued




Chronic Care Unitsx



















178 (174) 54 (53)

46 16

20 (17) 6

402 256 257 93 20 15

300231 118924 151942 33176 11675 18032

13 22 17 28 17 08

00 00 00

00 04 06

08 13 11

17 29 24

30 50 35





185 (180) 56 44

15 (13) 23 (22)

6

491 294 94 22 64 17

257889 109591 40141 9549

44202 6730

19 27 23 23 14 25

00 00 00

00

00 05 00

04

12 24 20

12

25 37 28

19

45 48 45

34




178 (177) 54 46 16 20 6

300231 118924 151942 33176 11675 18032

999114 243340 243377 46688

106289 77293

030 049 062 071 011 023

010 014 036

002

018 029 047

004

025 044 060

007

039 063 072

010

052 083 085

026





185 (184) 56 44 15

23 (22) 6

257889 109591 40141 9549

44202 6730

1044242 252048 224294 45420

127153 78482

025 043 018 021 035 009

009 011 005

015

014 024 009

019

020 044 013

034

033 062 022

049

044 079 036

073
























Chronic Care Unitsx





Table 5 continued






















Table 5 continued




Chronic Care Unitsx





















Table 6 continued


























Table 6 continued







67 (54) 9 (9)

18 (17) 195

2964 2660

12544 316632

30983 12632

41665 1474536

010 021

030 021

001

007

004

012

007

019

012

029

016

039















































LCBI









1161

Table 11 continued


LCBI



Surgical All other




Chronic Care Unitsy








TOTAL

154 (815) 24 (828)

466 (813) 3 (1000) 1 (1000)

16 (889)

443 (837)

276 (773) 657 (818) 458 (837)

459 (871) 2 (500)

21 (808)

14 (933)

4 (800) 19 (905) 18 (947) 13 (684) 2 (667) 5 (833)

11 (917) 0 4 (1000)

854 (888) 1349 (847)

43 (796) 37 (841) 65 (833) 21 (808) 43 (896)

195 (863) 1 (1000) 8 (1000)

13 (867) 2 (1000)

60 (870) 3 (750)

388 (858) 212 (880) 20 (952) 0

14 (778) 0

15 (1000)

7 (700) 16 (762)

132 (898) 1734 (882)

17 (1000) 77 (895)

14065 (842)

35 (185) 5 (172)

107 (187)

2 (111)

86 (163)

81 (227) 146 (182) 89 (163)

68 (129) 2 (500) 5 (192)

1 (67) 1 (1000) 1 (800) 2 (95) 1 (53) 6 (316) 1 (333) 1 (167) 1 (83) 0 0 (00)

108 (112) 243 (153) 11 (204) 7 (159)

13 (167) 5 (192) 5 (104)

31 (137)

2 (133)

9 (130) 1 (250)

64 (142) 29 (120) 1 (48) 0

4 (222) 0

3 (300) 5 (238)

15 (102) 233 (118)

9 (105) 2645 (158)

189 29

573 3 1

18

529

357 803 547

527 4

26

15 1 5

21 19 19 3 6

12 0 4

962 1592

54 44 78 26 48

226 1 8

15 2

69 4

452 241 21 0

18 0

15

10 21

147 1967

17 86

16710





LCBI




Total 785 (799) 197 (201) 982

















Table 13 continued



Chronic Care Unitsy







TOTAL 36344 (986) 505 (14) 36849













Table 14 continued










Total 2320 586 1572 397 65 16 3957






750 grams 316 752 104 248 420 1001-1500 grams 10 714 4 286 14

751-1000 grams 176 688 80 313 256 1501-2500 grams 1 250 3 750 4

1001-1500 grams 135 692 60 308 195 gt2500 grams 7 700 3 300 10

1501-2500 grams 76 731 28 269 104 Total 108 628 61 355 3 17 172





















References










































Methods



Results

Discussion

References









Hospital type N ()






RESULTS






DISCUSSION





Bed size category

50 51-200 201-500 gt500





Total 1178 (265) 1908 (429) 1099 (247) 259 (58) 4444

















Table 3 continued




Chronic Care Unitsx




















Table 3 continued




Chronic Care Unitsx



















178 (174) 54 (53)

46 16

20 (17) 6

402 256 257 93 20 15

300231 118924 151942 33176 11675 18032

13 22 17 28 17 08

00 00 00

00 04 06

08 13 11

17 29 24

30 50 35





185 (180) 56 44

15 (13) 23 (22)

6

491 294 94 22 64 17

257889 109591 40141 9549

44202 6730

19 27 23 23 14 25

00 00 00

00

00 05 00

04

12 24 20

12

25 37 28

19

45 48 45

34




178 (177) 54 46 16 20 6

300231 118924 151942 33176 11675 18032

999114 243340 243377 46688

106289 77293

030 049 062 071 011 023

010 014 036

002

018 029 047

004

025 044 060

007

039 063 072

010

052 083 085

026





185 (184) 56 44 15

23 (22) 6

257889 109591 40141 9549

44202 6730

1044242 252048 224294 45420

127153 78482

025 043 018 021 035 009

009 011 005

015

014 024 009

019

020 044 013

034

033 062 022

049

044 079 036

073
























Chronic Care Unitsx





Table 5 continued






















Table 5 continued




Chronic Care Unitsx





















Table 6 continued


























Table 6 continued







67 (54) 9 (9)

18 (17) 195

2964 2660

12544 316632

30983 12632

41665 1474536

010 021

030 021

001

007

004

012

007

019

012

029

016

039















































LCBI









1161

Table 11 continued


LCBI



Surgical All other




Chronic Care Unitsy








TOTAL

154 (815) 24 (828)

466 (813) 3 (1000) 1 (1000)

16 (889)

443 (837)

276 (773) 657 (818) 458 (837)

459 (871) 2 (500)

21 (808)

14 (933)

4 (800) 19 (905) 18 (947) 13 (684) 2 (667) 5 (833)

11 (917) 0 4 (1000)

854 (888) 1349 (847)

43 (796) 37 (841) 65 (833) 21 (808) 43 (896)

195 (863) 1 (1000) 8 (1000)

13 (867) 2 (1000)

60 (870) 3 (750)

388 (858) 212 (880) 20 (952) 0

14 (778) 0

15 (1000)

7 (700) 16 (762)

132 (898) 1734 (882)

17 (1000) 77 (895)

14065 (842)

35 (185) 5 (172)

107 (187)

2 (111)

86 (163)

81 (227) 146 (182) 89 (163)

68 (129) 2 (500) 5 (192)

1 (67) 1 (1000) 1 (800) 2 (95) 1 (53) 6 (316) 1 (333) 1 (167) 1 (83) 0 0 (00)

108 (112) 243 (153) 11 (204) 7 (159)

13 (167) 5 (192) 5 (104)

31 (137)

2 (133)

9 (130) 1 (250)

64 (142) 29 (120) 1 (48) 0

4 (222) 0

3 (300) 5 (238)

15 (102) 233 (118)

9 (105) 2645 (158)

189 29

573 3 1

18

529

357 803 547

527 4

26

15 1 5

21 19 19 3 6

12 0 4

962 1592

54 44 78 26 48

226 1 8

15 2

69 4

452 241 21 0

18 0

15

10 21

147 1967

17 86

16710





LCBI




Total 785 (799) 197 (201) 982

















Table 13 continued



Chronic Care Unitsy







TOTAL 36344 (986) 505 (14) 36849













Table 14 continued










Total 2320 586 1572 397 65 16 3957






750 grams 316 752 104 248 420 1001-1500 grams 10 714 4 286 14

751-1000 grams 176 688 80 313 256 1501-2500 grams 1 250 3 750 4

1001-1500 grams 135 692 60 308 195 gt2500 grams 7 700 3 300 10

1501-2500 grams 76 731 28 269 104 Total 108 628 61 355 3 17 172





















References










































Methods



Results

Discussion

References









Bed size category

50 51-200 201-500 gt500





Total 1178 (265) 1908 (429) 1099 (247) 259 (58) 4444

















Table 3 continued




Chronic Care Unitsx




















Table 3 continued




Chronic Care Unitsx



















178 (174) 54 (53)

46 16

20 (17) 6

402 256 257 93 20 15

300231 118924 151942 33176 11675 18032

13 22 17 28 17 08

00 00 00

00 04 06

08 13 11

17 29 24

30 50 35





185 (180) 56 44

15 (13) 23 (22)

6

491 294 94 22 64 17

257889 109591 40141 9549

44202 6730

19 27 23 23 14 25

00 00 00

00

00 05 00

04

12 24 20

12

25 37 28

19

45 48 45

34




178 (177) 54 46 16 20 6

300231 118924 151942 33176 11675 18032

999114 243340 243377 46688

106289 77293

030 049 062 071 011 023

010 014 036

002

018 029 047

004

025 044 060

007

039 063 072

010

052 083 085

026





185 (184) 56 44 15

23 (22) 6

257889 109591 40141 9549

44202 6730

1044242 252048 224294 45420

127153 78482

025 043 018 021 035 009

009 011 005

015

014 024 009

019

020 044 013

034

033 062 022

049

044 079 036

073
























Chronic Care Unitsx





Table 5 continued






















Table 5 continued




Chronic Care Unitsx





















Table 6 continued


























Table 6 continued







67 (54) 9 (9)

18 (17) 195

2964 2660

12544 316632

30983 12632

41665 1474536

010 021

030 021

001

007

004

012

007

019

012

029

016

039















































LCBI









1161

Table 11 continued


LCBI



Surgical All other




Chronic Care Unitsy








TOTAL

154 (815) 24 (828)

466 (813) 3 (1000) 1 (1000)

16 (889)

443 (837)

276 (773) 657 (818) 458 (837)

459 (871) 2 (500)

21 (808)

14 (933)

4 (800) 19 (905) 18 (947) 13 (684) 2 (667) 5 (833)

11 (917) 0 4 (1000)

854 (888) 1349 (847)

43 (796) 37 (841) 65 (833) 21 (808) 43 (896)

195 (863) 1 (1000) 8 (1000)

13 (867) 2 (1000)

60 (870) 3 (750)

388 (858) 212 (880) 20 (952) 0

14 (778) 0

15 (1000)

7 (700) 16 (762)

132 (898) 1734 (882)

17 (1000) 77 (895)

14065 (842)

35 (185) 5 (172)

107 (187)

2 (111)

86 (163)

81 (227) 146 (182) 89 (163)

68 (129) 2 (500) 5 (192)

1 (67) 1 (1000) 1 (800) 2 (95) 1 (53) 6 (316) 1 (333) 1 (167) 1 (83) 0 0 (00)

108 (112) 243 (153) 11 (204) 7 (159)

13 (167) 5 (192) 5 (104)

31 (137)

2 (133)

9 (130) 1 (250)

64 (142) 29 (120) 1 (48) 0

4 (222) 0

3 (300) 5 (238)

15 (102) 233 (118)

9 (105) 2645 (158)

189 29

573 3 1

18

529

357 803 547

527 4

26

15 1 5

21 19 19 3 6

12 0 4

962 1592

54 44 78 26 48

226 1 8

15 2

69 4

452 241 21 0

18 0

15

10 21

147 1967

17 86

16710





LCBI




Total 785 (799) 197 (201) 982

















Table 13 continued



Chronic Care Unitsy







TOTAL 36344 (986) 505 (14) 36849













Table 14 continued










Total 2320 586 1572 397 65 16 3957






750 grams 316 752 104 248 420 1001-1500 grams 10 714 4 286 14

751-1000 grams 176 688 80 313 256 1501-2500 grams 1 250 3 750 4

1001-1500 grams 135 692 60 308 195 gt2500 grams 7 700 3 300 10

1501-2500 grams 76 731 28 269 104 Total 108 628 61 355 3 17 172





















References










































Methods



Results

Discussion

References








Table 3 continued




Chronic Care Unitsx




















Table 3 continued




Chronic Care Unitsx



















178 (174) 54 (53)

46 16

20 (17) 6

402 256 257 93 20 15

300231 118924 151942 33176 11675 18032

13 22 17 28 17 08

00 00 00

00 04 06

08 13 11

17 29 24

30 50 35





185 (180) 56 44

15 (13) 23 (22)

6

491 294 94 22 64 17

257889 109591 40141 9549

44202 6730

19 27 23 23 14 25

00 00 00

00

00 05 00

04

12 24 20

12

25 37 28

19

45 48 45

34




178 (177) 54 46 16 20 6

300231 118924 151942 33176 11675 18032

999114 243340 243377 46688

106289 77293

030 049 062 071 011 023

010 014 036

002

018 029 047

004

025 044 060

007

039 063 072

010

052 083 085

026





185 (184) 56 44 15

23 (22) 6

257889 109591 40141 9549

44202 6730

1044242 252048 224294 45420

127153 78482

025 043 018 021 035 009

009 011 005

015

014 024 009

019

020 044 013

034

033 062 022

049

044 079 036

073
























Chronic Care Unitsx





Table 5 continued






















Table 5 continued




Chronic Care Unitsx





















Table 6 continued


























Table 6 continued







67 (54) 9 (9)

18 (17) 195

2964 2660

12544 316632

30983 12632

41665 1474536

010 021

030 021

001

007

004

012

007

019

012

029

016

039















































LCBI









1161

Table 11 continued


LCBI



Surgical All other




Chronic Care Unitsy








TOTAL

154 (815) 24 (828)

466 (813) 3 (1000) 1 (1000)

16 (889)

443 (837)

276 (773) 657 (818) 458 (837)

459 (871) 2 (500)

21 (808)

14 (933)

4 (800) 19 (905) 18 (947) 13 (684) 2 (667) 5 (833)

11 (917) 0 4 (1000)

854 (888) 1349 (847)

43 (796) 37 (841) 65 (833) 21 (808) 43 (896)

195 (863) 1 (1000) 8 (1000)

13 (867) 2 (1000)

60 (870) 3 (750)

388 (858) 212 (880) 20 (952) 0

14 (778) 0

15 (1000)

7 (700) 16 (762)

132 (898) 1734 (882)

17 (1000) 77 (895)

14065 (842)

35 (185) 5 (172)

107 (187)

2 (111)

86 (163)

81 (227) 146 (182) 89 (163)

68 (129) 2 (500) 5 (192)

1 (67) 1 (1000) 1 (800) 2 (95) 1 (53) 6 (316) 1 (333) 1 (167) 1 (83) 0 0 (00)

108 (112) 243 (153) 11 (204) 7 (159)

13 (167) 5 (192) 5 (104)

31 (137)

2 (133)

9 (130) 1 (250)

64 (142) 29 (120) 1 (48) 0

4 (222) 0

3 (300) 5 (238)

15 (102) 233 (118)

9 (105) 2645 (158)

189 29

573 3 1

18

529

357 803 547

527 4

26

15 1 5

21 19 19 3 6

12 0 4

962 1592

54 44 78 26 48

226 1 8

15 2

69 4

452 241 21 0

18 0

15

10 21

147 1967

17 86

16710





LCBI




Total 785 (799) 197 (201) 982

















Table 13 continued



Chronic Care Unitsy







TOTAL 36344 (986) 505 (14) 36849













Table 14 continued










Total 2320 586 1572 397 65 16 3957






750 grams 316 752 104 248 420 1001-1500 grams 10 714 4 286 14

751-1000 grams 176 688 80 313 256 1501-2500 grams 1 250 3 750 4

1001-1500 grams 135 692 60 308 195 gt2500 grams 7 700 3 300 10

1501-2500 grams 76 731 28 269 104 Total 108 628 61 355 3 17 172





















References










































Methods



Results

Discussion

References








Table 3 continued




Chronic Care Unitsx



















178 (174) 54 (53)

46 16

20 (17) 6

402 256 257 93 20 15

300231 118924 151942 33176 11675 18032

13 22 17 28 17 08

00 00 00

00 04 06

08 13 11

17 29 24

30 50 35





185 (180) 56 44

15 (13) 23 (22)

6

491 294 94 22 64 17

257889 109591 40141 9549

44202 6730

19 27 23 23 14 25

00 00 00

00

00 05 00

04

12 24 20

12

25 37 28

19

45 48 45

34




178 (177) 54 46 16 20 6

300231 118924 151942 33176 11675 18032

999114 243340 243377 46688

106289 77293

030 049 062 071 011 023

010 014 036

002

018 029 047

004

025 044 060

007

039 063 072

010

052 083 085

026





185 (184) 56 44 15

23 (22) 6

257889 109591 40141 9549

44202 6730

1044242 252048 224294 45420

127153 78482

025 043 018 021 035 009

009 011 005

015

014 024 009

019

020 044 013

034

033 062 022

049

044 079 036

073
























Chronic Care Unitsx





Table 5 continued






















Table 5 continued




Chronic Care Unitsx





















Table 6 continued


























Table 6 continued







67 (54) 9 (9)

18 (17) 195

2964 2660

12544 316632

30983 12632

41665 1474536

010 021

030 021

001

007

004

012

007

019

012

029

016

039















































LCBI









1161

Table 11 continued


LCBI



Surgical All other




Chronic Care Unitsy








TOTAL

154 (815) 24 (828)

466 (813) 3 (1000) 1 (1000)

16 (889)

443 (837)

276 (773) 657 (818) 458 (837)

459 (871) 2 (500)

21 (808)

14 (933)

4 (800) 19 (905) 18 (947) 13 (684) 2 (667) 5 (833)

11 (917) 0 4 (1000)

854 (888) 1349 (847)

43 (796) 37 (841) 65 (833) 21 (808) 43 (896)

195 (863) 1 (1000) 8 (1000)

13 (867) 2 (1000)

60 (870) 3 (750)

388 (858) 212 (880) 20 (952) 0

14 (778) 0

15 (1000)

7 (700) 16 (762)

132 (898) 1734 (882)

17 (1000) 77 (895)

14065 (842)

35 (185) 5 (172)

107 (187)

2 (111)

86 (163)

81 (227) 146 (182) 89 (163)

68 (129) 2 (500) 5 (192)

1 (67) 1 (1000) 1 (800) 2 (95) 1 (53) 6 (316) 1 (333) 1 (167) 1 (83) 0 0 (00)

108 (112) 243 (153) 11 (204) 7 (159)

13 (167) 5 (192) 5 (104)

31 (137)

2 (133)

9 (130) 1 (250)

64 (142) 29 (120) 1 (48) 0

4 (222) 0

3 (300) 5 (238)

15 (102) 233 (118)

9 (105) 2645 (158)

189 29

573 3 1

18

529

357 803 547

527 4

26

15 1 5

21 19 19 3 6

12 0 4

962 1592

54 44 78 26 48

226 1 8

15 2

69 4

452 241 21 0

18 0

15

10 21

147 1967

17 86

16710





LCBI




Total 785 (799) 197 (201) 982

















Table 13 continued



Chronic Care Unitsy







TOTAL 36344 (986) 505 (14) 36849













Table 14 continued










Total 2320 586 1572 397 65 16 3957






750 grams 316 752 104 248 420 1001-1500 grams 10 714 4 286 14

751-1000 grams 176 688 80 313 256 1501-2500 grams 1 250 3 750 4

1001-1500 grams 135 692 60 308 195 gt2500 grams 7 700 3 300 10

1501-2500 grams 76 731 28 269 104 Total 108 628 61 355 3 17 172





















References










































Methods



Results

Discussion

References












178 (174) 54 (53)

46 16

20 (17) 6

402 256 257 93 20 15

300231 118924 151942 33176 11675 18032

13 22 17 28 17 08

00 00 00

00 04 06

08 13 11

17 29 24

30 50 35





185 (180) 56 44

15 (13) 23 (22)

6

491 294 94 22 64 17

257889 109591 40141 9549

44202 6730

19 27 23 23 14 25

00 00 00

00

00 05 00

04

12 24 20

12

25 37 28

19

45 48 45

34




178 (177) 54 46 16 20 6

300231 118924 151942 33176 11675 18032

999114 243340 243377 46688

106289 77293

030 049 062 071 011 023

010 014 036

002

018 029 047

004

025 044 060

007

039 063 072

010

052 083 085

026





185 (184) 56 44 15

23 (22) 6

257889 109591 40141 9549

44202 6730

1044242 252048 224294 45420

127153 78482

025 043 018 021 035 009

009 011 005

015

014 024 009

019

020 044 013

034

033 062 022

049

044 079 036

073
























Chronic Care Unitsx





Table 5 continued






















Table 5 continued




Chronic Care Unitsx





















Table 6 continued


























Table 6 continued







67 (54) 9 (9)

18 (17) 195

2964 2660

12544 316632

30983 12632

41665 1474536

010 021

030 021

001

007

004

012

007

019

012

029

016

039















































LCBI









1161

Table 11 continued


LCBI



Surgical All other




Chronic Care Unitsy








TOTAL

154 (815) 24 (828)

466 (813) 3 (1000) 1 (1000)

16 (889)

443 (837)

276 (773) 657 (818) 458 (837)

459 (871) 2 (500)

21 (808)

14 (933)

4 (800) 19 (905) 18 (947) 13 (684) 2 (667) 5 (833)

11 (917) 0 4 (1000)

854 (888) 1349 (847)

43 (796) 37 (841) 65 (833) 21 (808) 43 (896)

195 (863) 1 (1000) 8 (1000)

13 (867) 2 (1000)

60 (870) 3 (750)

388 (858) 212 (880) 20 (952) 0

14 (778) 0

15 (1000)

7 (700) 16 (762)

132 (898) 1734 (882)

17 (1000) 77 (895)

14065 (842)

35 (185) 5 (172)

107 (187)

2 (111)

86 (163)

81 (227) 146 (182) 89 (163)

68 (129) 2 (500) 5 (192)

1 (67) 1 (1000) 1 (800) 2 (95) 1 (53) 6 (316) 1 (333) 1 (167) 1 (83) 0 0 (00)

108 (112) 243 (153) 11 (204) 7 (159)

13 (167) 5 (192) 5 (104)

31 (137)

2 (133)

9 (130) 1 (250)

64 (142) 29 (120) 1 (48) 0

4 (222) 0

3 (300) 5 (238)

15 (102) 233 (118)

9 (105) 2645 (158)

189 29

573 3 1

18

529

357 803 547

527 4

26

15 1 5

21 19 19 3 6

12 0 4

962 1592

54 44 78 26 48

226 1 8

15 2

69 4

452 241 21 0

18 0

15

10 21

147 1967

17 86

16710





LCBI




Total 785 (799) 197 (201) 982

















Table 13 continued



Chronic Care Unitsy







TOTAL 36344 (986) 505 (14) 36849













Table 14 continued










Total 2320 586 1572 397 65 16 3957






750 grams 316 752 104 248 420 1001-1500 grams 10 714 4 286 14

751-1000 grams 176 688 80 313 256 1501-2500 grams 1 250 3 750 4

1001-1500 grams 135 692 60 308 195 gt2500 grams 7 700 3 300 10

1501-2500 grams 76 731 28 269 104 Total 108 628 61 355 3 17 172





















References










































Methods



Results

Discussion

References






















Chronic Care Unitsx





Table 5 continued






















Table 5 continued




Chronic Care Unitsx





















Table 6 continued


























Table 6 continued







67 (54) 9 (9)

18 (17) 195

2964 2660

12544 316632

30983 12632

41665 1474536

010 021

030 021

001

007

004

012

007

019

012

029

016

039















































LCBI









1161

Table 11 continued


LCBI



Surgical All other




Chronic Care Unitsy








TOTAL

154 (815) 24 (828)

466 (813) 3 (1000) 1 (1000)

16 (889)

443 (837)

276 (773) 657 (818) 458 (837)

459 (871) 2 (500)

21 (808)

14 (933)

4 (800) 19 (905) 18 (947) 13 (684) 2 (667) 5 (833)

11 (917) 0 4 (1000)

854 (888) 1349 (847)

43 (796) 37 (841) 65 (833) 21 (808) 43 (896)

195 (863) 1 (1000) 8 (1000)

13 (867) 2 (1000)

60 (870) 3 (750)

388 (858) 212 (880) 20 (952) 0

14 (778) 0

15 (1000)

7 (700) 16 (762)

132 (898) 1734 (882)

17 (1000) 77 (895)

14065 (842)

35 (185) 5 (172)

107 (187)

2 (111)

86 (163)

81 (227) 146 (182) 89 (163)

68 (129) 2 (500) 5 (192)

1 (67) 1 (1000) 1 (800) 2 (95) 1 (53) 6 (316) 1 (333) 1 (167) 1 (83) 0 0 (00)

108 (112) 243 (153) 11 (204) 7 (159)

13 (167) 5 (192) 5 (104)

31 (137)

2 (133)

9 (130) 1 (250)

64 (142) 29 (120) 1 (48) 0

4 (222) 0

3 (300) 5 (238)

15 (102) 233 (118)

9 (105) 2645 (158)

189 29

573 3 1

18

529

357 803 547

527 4

26

15 1 5

21 19 19 3 6

12 0 4

962 1592

54 44 78 26 48

226 1 8

15 2

69 4

452 241 21 0

18 0

15

10 21

147 1967

17 86

16710





LCBI




Total 785 (799) 197 (201) 982

















Table 13 continued



Chronic Care Unitsy







TOTAL 36344 (986) 505 (14) 36849













Table 14 continued










Total 2320 586 1572 397 65 16 3957






750 grams 316 752 104 248 420 1001-1500 grams 10 714 4 286 14

751-1000 grams 176 688 80 313 256 1501-2500 grams 1 250 3 750 4

1001-1500 grams 135 692 60 308 195 gt2500 grams 7 700 3 300 10

1501-2500 grams 76 731 28 269 104 Total 108 628 61 355 3 17 172





















References










































Methods



Results

Discussion

References








Table 5 continued






















Table 5 continued




Chronic Care Unitsx





















Table 6 continued


























Table 6 continued







67 (54) 9 (9)

18 (17) 195

2964 2660

12544 316632

30983 12632

41665 1474536

010 021

030 021

001

007

004

012

007

019

012

029

016

039















































LCBI









1161

Table 11 continued


LCBI



Surgical All other




Chronic Care Unitsy








TOTAL

154 (815) 24 (828)

466 (813) 3 (1000) 1 (1000)

16 (889)

443 (837)

276 (773) 657 (818) 458 (837)

459 (871) 2 (500)

21 (808)

14 (933)

4 (800) 19 (905) 18 (947) 13 (684) 2 (667) 5 (833)

11 (917) 0 4 (1000)

854 (888) 1349 (847)

43 (796) 37 (841) 65 (833) 21 (808) 43 (896)

195 (863) 1 (1000) 8 (1000)

13 (867) 2 (1000)

60 (870) 3 (750)

388 (858) 212 (880) 20 (952) 0

14 (778) 0

15 (1000)

7 (700) 16 (762)

132 (898) 1734 (882)

17 (1000) 77 (895)

14065 (842)

35 (185) 5 (172)

107 (187)

2 (111)

86 (163)

81 (227) 146 (182) 89 (163)

68 (129) 2 (500) 5 (192)

1 (67) 1 (1000) 1 (800) 2 (95) 1 (53) 6 (316) 1 (333) 1 (167) 1 (83) 0 0 (00)

108 (112) 243 (153) 11 (204) 7 (159)

13 (167) 5 (192) 5 (104)

31 (137)

2 (133)

9 (130) 1 (250)

64 (142) 29 (120) 1 (48) 0

4 (222) 0

3 (300) 5 (238)

15 (102) 233 (118)

9 (105) 2645 (158)

189 29

573 3 1

18

529

357 803 547

527 4

26

15 1 5

21 19 19 3 6

12 0 4

962 1592

54 44 78 26 48

226 1 8

15 2

69 4

452 241 21 0

18 0

15

10 21

147 1967

17 86

16710





LCBI




Total 785 (799) 197 (201) 982

















Table 13 continued



Chronic Care Unitsy







TOTAL 36344 (986) 505 (14) 36849













Table 14 continued










Total 2320 586 1572 397 65 16 3957






750 grams 316 752 104 248 420 1001-1500 grams 10 714 4 286 14

751-1000 grams 176 688 80 313 256 1501-2500 grams 1 250 3 750 4

1001-1500 grams 135 692 60 308 195 gt2500 grams 7 700 3 300 10

1501-2500 grams 76 731 28 269 104 Total 108 628 61 355 3 17 172





















References










































Methods



Results

Discussion

References








Table 5 continued




Chronic Care Unitsx





















Table 6 continued


























Table 6 continued







67 (54) 9 (9)

18 (17) 195

2964 2660

12544 316632

30983 12632

41665 1474536

010 021

030 021

001

007

004

012

007

019

012

029

016

039















































LCBI









1161

Table 11 continued


LCBI



Surgical All other




Chronic Care Unitsy








TOTAL

154 (815) 24 (828)

466 (813) 3 (1000) 1 (1000)

16 (889)

443 (837)

276 (773) 657 (818) 458 (837)

459 (871) 2 (500)

21 (808)

14 (933)

4 (800) 19 (905) 18 (947) 13 (684) 2 (667) 5 (833)

11 (917) 0 4 (1000)

854 (888) 1349 (847)

43 (796) 37 (841) 65 (833) 21 (808) 43 (896)

195 (863) 1 (1000) 8 (1000)

13 (867) 2 (1000)

60 (870) 3 (750)

388 (858) 212 (880) 20 (952) 0

14 (778) 0

15 (1000)

7 (700) 16 (762)

132 (898) 1734 (882)

17 (1000) 77 (895)

14065 (842)

35 (185) 5 (172)

107 (187)

2 (111)

86 (163)

81 (227) 146 (182) 89 (163)

68 (129) 2 (500) 5 (192)

1 (67) 1 (1000) 1 (800) 2 (95) 1 (53) 6 (316) 1 (333) 1 (167) 1 (83) 0 0 (00)

108 (112) 243 (153) 11 (204) 7 (159)

13 (167) 5 (192) 5 (104)

31 (137)

2 (133)

9 (130) 1 (250)

64 (142) 29 (120) 1 (48) 0

4 (222) 0

3 (300) 5 (238)

15 (102) 233 (118)

9 (105) 2645 (158)

189 29

573 3 1

18

529

357 803 547

527 4

26

15 1 5

21 19 19 3 6

12 0 4

962 1592

54 44 78 26 48

226 1 8

15 2

69 4

452 241 21 0

18 0

15

10 21

147 1967

17 86

16710





LCBI




Total 785 (799) 197 (201) 982

















Table 13 continued



Chronic Care Unitsy







TOTAL 36344 (986) 505 (14) 36849













Table 14 continued










Total 2320 586 1572 397 65 16 3957






750 grams 316 752 104 248 420 1001-1500 grams 10 714 4 286 14

751-1000 grams 176 688 80 313 256 1501-2500 grams 1 250 3 750 4

1001-1500 grams 135 692 60 308 195 gt2500 grams 7 700 3 300 10

1501-2500 grams 76 731 28 269 104 Total 108 628 61 355 3 17 172





















References










































Methods



Results

Discussion

References








Table 6 continued


























Table 6 continued







67 (54) 9 (9)

18 (17) 195

2964 2660

12544 316632

30983 12632

41665 1474536

010 021

030 021

001

007

004

012

007

019

012

029

016

039















































LCBI









1161

Table 11 continued


LCBI



Surgical All other




Chronic Care Unitsy








TOTAL

154 (815) 24 (828)

466 (813) 3 (1000) 1 (1000)

16 (889)

443 (837)

276 (773) 657 (818) 458 (837)

459 (871) 2 (500)

21 (808)

14 (933)

4 (800) 19 (905) 18 (947) 13 (684) 2 (667) 5 (833)

11 (917) 0 4 (1000)

854 (888) 1349 (847)

43 (796) 37 (841) 65 (833) 21 (808) 43 (896)

195 (863) 1 (1000) 8 (1000)

13 (867) 2 (1000)

60 (870) 3 (750)

388 (858) 212 (880) 20 (952) 0

14 (778) 0

15 (1000)

7 (700) 16 (762)

132 (898) 1734 (882)

17 (1000) 77 (895)

14065 (842)

35 (185) 5 (172)

107 (187)

2 (111)

86 (163)

81 (227) 146 (182) 89 (163)

68 (129) 2 (500) 5 (192)

1 (67) 1 (1000) 1 (800) 2 (95) 1 (53) 6 (316) 1 (333) 1 (167) 1 (83) 0 0 (00)

108 (112) 243 (153) 11 (204) 7 (159)

13 (167) 5 (192) 5 (104)

31 (137)

2 (133)

9 (130) 1 (250)

64 (142) 29 (120) 1 (48) 0

4 (222) 0

3 (300) 5 (238)

15 (102) 233 (118)

9 (105) 2645 (158)

189 29

573 3 1

18

529

357 803 547

527 4

26

15 1 5

21 19 19 3 6

12 0 4

962 1592

54 44 78 26 48

226 1 8

15 2

69 4

452 241 21 0

18 0

15

10 21

147 1967

17 86

16710





LCBI




Total 785 (799) 197 (201) 982

















Table 13 continued



Chronic Care Unitsy







TOTAL 36344 (986) 505 (14) 36849













Table 14 continued










Total 2320 586 1572 397 65 16 3957






750 grams 316 752 104 248 420 1001-1500 grams 10 714 4 286 14

751-1000 grams 176 688 80 313 256 1501-2500 grams 1 250 3 750 4

1001-1500 grams 135 692 60 308 195 gt2500 grams 7 700 3 300 10

1501-2500 grams 76 731 28 269 104 Total 108 628 61 355 3 17 172





















References










































Methods



Results

Discussion

References








Table 6 continued







67 (54) 9 (9)

18 (17) 195

2964 2660

12544 316632

30983 12632

41665 1474536

010 021

030 021

001

007

004

012

007

019

012

029

016

039















































LCBI









1161

Table 11 continued


LCBI



Surgical All other




Chronic Care Unitsy








TOTAL

154 (815) 24 (828)

466 (813) 3 (1000) 1 (1000)

16 (889)

443 (837)

276 (773) 657 (818) 458 (837)

459 (871) 2 (500)

21 (808)

14 (933)

4 (800) 19 (905) 18 (947) 13 (684) 2 (667) 5 (833)

11 (917) 0 4 (1000)

854 (888) 1349 (847)

43 (796) 37 (841) 65 (833) 21 (808) 43 (896)

195 (863) 1 (1000) 8 (1000)

13 (867) 2 (1000)

60 (870) 3 (750)

388 (858) 212 (880) 20 (952) 0

14 (778) 0

15 (1000)

7 (700) 16 (762)

132 (898) 1734 (882)

17 (1000) 77 (895)

14065 (842)

35 (185) 5 (172)

107 (187)

2 (111)

86 (163)

81 (227) 146 (182) 89 (163)

68 (129) 2 (500) 5 (192)

1 (67) 1 (1000) 1 (800) 2 (95) 1 (53) 6 (316) 1 (333) 1 (167) 1 (83) 0 0 (00)

108 (112) 243 (153) 11 (204) 7 (159)

13 (167) 5 (192) 5 (104)

31 (137)

2 (133)

9 (130) 1 (250)

64 (142) 29 (120) 1 (48) 0

4 (222) 0

3 (300) 5 (238)

15 (102) 233 (118)

9 (105) 2645 (158)

189 29

573 3 1

18

529

357 803 547

527 4

26

15 1 5

21 19 19 3 6

12 0 4

962 1592

54 44 78 26 48

226 1 8

15 2

69 4

452 241 21 0

18 0

15

10 21

147 1967

17 86

16710





LCBI




Total 785 (799) 197 (201) 982

















Table 13 continued



Chronic Care Unitsy







TOTAL 36344 (986) 505 (14) 36849













Table 14 continued










Total 2320 586 1572 397 65 16 3957






750 grams 316 752 104 248 420 1001-1500 grams 10 714 4 286 14

751-1000 grams 176 688 80 313 256 1501-2500 grams 1 250 3 750 4

1001-1500 grams 135 692 60 308 195 gt2500 grams 7 700 3 300 10

1501-2500 grams 76 731 28 269 104 Total 108 628 61 355 3 17 172





















References










































Methods



Results

Discussion

References





























LCBI









1161

Table 11 continued


LCBI



Surgical All other




Chronic Care Unitsy








TOTAL

154 (815) 24 (828)

466 (813) 3 (1000) 1 (1000)

16 (889)

443 (837)

276 (773) 657 (818) 458 (837)

459 (871) 2 (500)

21 (808)

14 (933)

4 (800) 19 (905) 18 (947) 13 (684) 2 (667) 5 (833)

11 (917) 0 4 (1000)

854 (888) 1349 (847)

43 (796) 37 (841) 65 (833) 21 (808) 43 (896)

195 (863) 1 (1000) 8 (1000)

13 (867) 2 (1000)

60 (870) 3 (750)

388 (858) 212 (880) 20 (952) 0

14 (778) 0

15 (1000)

7 (700) 16 (762)

132 (898) 1734 (882)

17 (1000) 77 (895)

14065 (842)

35 (185) 5 (172)

107 (187)

2 (111)

86 (163)

81 (227) 146 (182) 89 (163)

68 (129) 2 (500) 5 (192)

1 (67) 1 (1000) 1 (800) 2 (95) 1 (53) 6 (316) 1 (333) 1 (167) 1 (83) 0 0 (00)

108 (112) 243 (153) 11 (204) 7 (159)

13 (167) 5 (192) 5 (104)

31 (137)

2 (133)

9 (130) 1 (250)

64 (142) 29 (120) 1 (48) 0

4 (222) 0

3 (300) 5 (238)

15 (102) 233 (118)

9 (105) 2645 (158)

189 29

573 3 1

18

529

357 803 547

527 4

26

15 1 5

21 19 19 3 6

12 0 4

962 1592

54 44 78 26 48

226 1 8

15 2

69 4

452 241 21 0

18 0

15

10 21

147 1967

17 86

16710





LCBI




Total 785 (799) 197 (201) 982

















Table 13 continued



Chronic Care Unitsy







TOTAL 36344 (986) 505 (14) 36849













Table 14 continued










Total 2320 586 1572 397 65 16 3957






750 grams 316 752 104 248 420 1001-1500 grams 10 714 4 286 14

751-1000 grams 176 688 80 313 256 1501-2500 grams 1 250 3 750 4

1001-1500 grams 135 692 60 308 195 gt2500 grams 7 700 3 300 10

1501-2500 grams 76 731 28 269 104 Total 108 628 61 355 3 17 172





















References










































Methods



Results

Discussion

References







1161

Table 11 continued


LCBI



Surgical All other




Chronic Care Unitsy








TOTAL

154 (815) 24 (828)

466 (813) 3 (1000) 1 (1000)

16 (889)

443 (837)

276 (773) 657 (818) 458 (837)

459 (871) 2 (500)

21 (808)

14 (933)

4 (800) 19 (905) 18 (947) 13 (684) 2 (667) 5 (833)

11 (917) 0 4 (1000)

854 (888) 1349 (847)

43 (796) 37 (841) 65 (833) 21 (808) 43 (896)

195 (863) 1 (1000) 8 (1000)

13 (867) 2 (1000)

60 (870) 3 (750)

388 (858) 212 (880) 20 (952) 0

14 (778) 0

15 (1000)

7 (700) 16 (762)

132 (898) 1734 (882)

17 (1000) 77 (895)

14065 (842)

35 (185) 5 (172)

107 (187)

2 (111)

86 (163)

81 (227) 146 (182) 89 (163)

68 (129) 2 (500) 5 (192)

1 (67) 1 (1000) 1 (800) 2 (95) 1 (53) 6 (316) 1 (333) 1 (167) 1 (83) 0 0 (00)

108 (112) 243 (153) 11 (204) 7 (159)

13 (167) 5 (192) 5 (104)

31 (137)

2 (133)

9 (130) 1 (250)

64 (142) 29 (120) 1 (48) 0

4 (222) 0

3 (300) 5 (238)

15 (102) 233 (118)

9 (105) 2645 (158)

189 29

573 3 1

18

529

357 803 547

527 4

26

15 1 5

21 19 19 3 6

12 0 4

962 1592

54 44 78 26 48

226 1 8

15 2

69 4

452 241 21 0

18 0

15

10 21

147 1967

17 86

16710





LCBI




Total 785 (799) 197 (201) 982

















Table 13 continued



Chronic Care Unitsy







TOTAL 36344 (986) 505 (14) 36849













Table 14 continued










Total 2320 586 1572 397 65 16 3957






750 grams 316 752 104 248 420 1001-1500 grams 10 714 4 286 14

751-1000 grams 176 688 80 313 256 1501-2500 grams 1 250 3 750 4

1001-1500 grams 135 692 60 308 195 gt2500 grams 7 700 3 300 10

1501-2500 grams 76 731 28 269 104 Total 108 628 61 355 3 17 172





















References










































Methods



Results

Discussion

References









LCBI




Total 785 (799) 197 (201) 982

















Table 13 continued



Chronic Care Unitsy







TOTAL 36344 (986) 505 (14) 36849













Table 14 continued










Total 2320 586 1572 397 65 16 3957






750 grams 316 752 104 248 420 1001-1500 grams 10 714 4 286 14

751-1000 grams 176 688 80 313 256 1501-2500 grams 1 250 3 750 4

1001-1500 grams 135 692 60 308 195 gt2500 grams 7 700 3 300 10

1501-2500 grams 76 731 28 269 104 Total 108 628 61 355 3 17 172





















References










































Methods



Results

Discussion

References








Table 13 continued



Chronic Care Unitsy







TOTAL 36344 (986) 505 (14) 36849













Table 14 continued










Total 2320 586 1572 397 65 16 3957






750 grams 316 752 104 248 420 1001-1500 grams 10 714 4 286 14

751-1000 grams 176 688 80 313 256 1501-2500 grams 1 250 3 750 4

1001-1500 grams 135 692 60 308 195 gt2500 grams 7 700 3 300 10

1501-2500 grams 76 731 28 269 104 Total 108 628 61 355 3 17 172





















References










































Methods



Results

Discussion

References








Table 14 continued










Total 2320 586 1572 397 65 16 3957






750 grams 316 752 104 248 420 1001-1500 grams 10 714 4 286 14

751-1000 grams 176 688 80 313 256 1501-2500 grams 1 250 3 750 4

1001-1500 grams 135 692 60 308 195 gt2500 grams 7 700 3 300 10

1501-2500 grams 76 731 28 269 104 Total 108 628 61 355 3 17 172





















References










































Methods



Results

Discussion

References














References










































Methods



Results

Discussion

References





























Methods



Results

Discussion

References







american journal of infection control - centers for … · m.a. dudeck et al. / american journal of...

Documents