Diving into DataCommunicating Data from OPH Quarterly Reports

Healthcare-associated Infections and Emerging Infectious Diseases Workshops

January 28, 2020: Metairie

February 4, 2020: Bossier City

February 5, 2020: Lafayette

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The speaker does not have a financial or non-financial relationship with a commercial interest that would create a conflict of interest with this presentation.

Disclosure Statement

Objectives

Describe the Standardized Infection Ratio (SIR) and Standardized Utilization Ratio (SUR).

Describe the Cumulative Attributable Difference (CAD), rates, percentiles, and stratification.

Interpret the statistics.

By the end of this presentation, attendees will be able to:

Mentimeter Question #1

Can you explain what an SIR and SUR are?Yes, duh.No.Maybe.

1. Go to www.menti.com on either your mobile device or computer’s web browser.

2. Use the code shown on the screen to participate in live polling for this activity.

3. See results.

www.menti.com

Enter Code

Standardized Infection Ratio (SIR)

Compares the actual number of device days reported to what would be predicted, given the standard population, adjusting for several factors.

A summary measure used to track HAIs at a national, state, or local level over time.

The SIR adjusts for various facility and/or patient-level factors that contribute to HAI risk within each facility.

CLABSI, MBI-LCBI, CAUTI, SSI, CDI, MRSA, VAE

What is the SIR?

Standardized Infection Ratio

𝑆𝑆𝑆𝑆𝑆𝑆 = 𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂 𝑂𝑂 𝐻𝐻𝐻𝐻𝐻𝐻𝑂𝑂𝑃𝑃𝑂𝑂𝑂𝑂𝑂𝑂𝑃𝑃𝑃𝑃𝑃𝑃𝑂𝑂𝑂𝑂 𝑃𝑃 𝐻𝐻𝐻𝐻𝐻𝐻𝑂𝑂

Example:

𝑆𝑆𝑆𝑆𝑆𝑆 = 𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂 𝑂𝑂 𝐻𝐻𝐻𝐻𝐻𝐻𝑂𝑂𝑃𝑃𝑂𝑂𝑂𝑂𝑂𝑂𝑃𝑃𝑃𝑃𝑃𝑃𝑂𝑂𝑂𝑂 𝑃𝑃 𝐻𝐻𝐻𝐻𝐻𝐻𝑂𝑂

= 86.75

=1.190

How is the SIR Calculated?

Standardized Infection Ratio

If the SIR > 1.0, then more HAIs were observed than predicted, based on the 2015 national aggregate data.

If the SIR < 1.0, then fewer HAIs were observed than predicted, based on the 2015 national aggregate data.

If the SIR= 1.0, then the same number of HAIs were observed as predicted, based on the 2015 national aggregate data.

How do I interpret the SIRs?

Standardized Utilization Ratio (SUR)

The number of device days divided by the number of patient days. SUR is a measure of device use on a given unit (relative to the number of patient days) and is shown as a percent.

A summary measure used to track device use at a national, state, or local, or facility level over time.

Central lines, urinary catheters, and ventilators.

What is the SUR?

Central Lines Indwelling Urinary Catheters Ventilators

Standardized Utilization Ratio

S𝑈𝑈𝑆𝑆 = # 𝑜𝑜𝑜𝑜 𝐷𝐷𝑂𝑂𝑂𝑂𝑃𝑃𝑃𝑃𝑂𝑂 𝐷𝐷𝐷𝐷𝐷𝐷𝑂𝑂# 𝑜𝑜𝑜𝑜 𝑃𝑃𝐷𝐷𝑃𝑃𝑃𝑃𝑂𝑂𝑃𝑃𝑃𝑃 𝐷𝐷𝐷𝐷𝐷𝐷𝑂𝑂

The DU of a location is one measure of the use of invasive devices

Example:

S𝑈𝑈𝑆𝑆 = # 𝑜𝑜𝑜𝑜 𝐷𝐷𝑂𝑂𝑂𝑂𝑃𝑃𝑃𝑃𝑂𝑂 𝐷𝐷𝐷𝐷𝐷𝐷𝑂𝑂# 𝑜𝑜𝑜𝑜 𝑃𝑃𝐷𝐷𝑃𝑃𝑃𝑃𝑂𝑂𝑃𝑃𝑃𝑃 𝐷𝐷𝐷𝐷𝐷𝐷𝑂𝑂

= 2872

= 0.39

39% of patient-days were also central line-days for the first week of the month.

How is the SUR calculated?

Variable Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Total

Device days

5 5 2 5 3 4 4 28

Patient Days

10 12 11 13 10 6 10 72

Interpreting the Quarterly SUR Report

A SUR greater than 1.0 indicates that more device days were observed than predicted.

A SUR less than 1.0 indicates that fewer device days were observed than predicted.

Fewer device-days were observed than predicted More device-days were observed than predicted

1.00.0 ∞

Standardized Infection Ratio (SIR) Standardized Utilization Ratio (SUR)

𝑆𝑆𝑆𝑆𝑆𝑆 =𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂 (𝑂𝑂) 𝑆𝑆𝐼𝐼𝐼𝐼𝑂𝑂𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝑂𝑂𝑃𝑃𝑂𝑂𝑂𝑂𝑂𝑂𝐼𝐼𝐼𝐼𝐼𝐼𝑂𝑂𝑂𝑂 (𝑃𝑃) 𝑆𝑆𝐼𝐼𝐼𝐼𝑂𝑂𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝐼𝑂𝑂 𝑆𝑆𝑈𝑈𝑆𝑆 =

𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂 𝑂𝑂 𝐷𝐷𝑂𝑂𝑂𝑂𝐼𝐼𝐼𝐼𝑂𝑂 𝐷𝐷𝐷𝐷𝐷𝐷𝑂𝑂𝑃𝑃𝑂𝑂𝑂𝑂𝑂𝑂𝐼𝐼𝐼𝐼𝐼𝐼𝑂𝑂𝑂𝑂 𝑃𝑃 𝐷𝐷𝑂𝑂𝑂𝑂𝐼𝐼𝐼𝐼𝑂𝑂 𝐷𝐷𝐷𝐷𝐷𝐷𝑂𝑂

Facility Rankings Facilities are ranked according to their device utilization

in ascending order.

The facility ranked #1 has the highest device utilization, whereas the last facility has the lowest device utilization.

It is ideal to be ranked toward the end of this list. SURs are reported in conjunction with statistical significance.

As you read the “Your Rank” column, fill in the blank in the following statement: “My facility is among the top ___ highest utilizing facilities for this device type.”

Facilities ranked 1 through 10 are considered to be among the worst-performing for device utilization.

ACH

IRF

CAH

LTAC

Report Example #1

Fewer device-days were observed than predicted More device-days were observed than predicted

1.00.0 ∞

Report Example #2

Fewer device-days were observed than predicted More device-days were observed than predicted

1.00.0 ∞

Report Example #3

Fewer device-days were observed than predicted More device-days were observed than predicted

1.00.0 ∞

Cumulative Attributable Difference

The number of infections that need to be prevented within a group, facility, or unit to achieve an HAI reduction goal, or SIRgoal.

The CAD is calculated by subtracting a numerical prevention target from an observed number of HAIs.

The prevention target is the product of the predicted number of HAIs and a standardized infection ratio goal (SIRgoal).

What is the CAD?

Cumulative Attributable Difference

Standardized infection ratio target (used as a multiplier in the CAD formula).HHS target SIRs are used in the NHSN TAP reports to calculate the CADs.The 2013 HHS targets for specific infections are as follows:CAUTI: Reduce by 25% SIRgoal = 0.75CDI: Reduce by 30% SIRgoal = 0.70CLABSI: Reduce by 50% SIRgoal = 0.50

While CDC uses HHS targets for the NHSN TAP reports, the SIRgoal may be adjusted and specified for any infection ratio target.

𝐶𝐶𝐶𝐶𝐷𝐷 = 𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂𝑂 − (𝑃𝑃𝑂𝑂𝑂𝑂𝑂𝑂𝐼𝐼𝐼𝐼𝐼𝐼𝑂𝑂𝑂𝑂 𝑥𝑥 𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝑆𝐼𝐼𝐷𝐷𝑆𝑆)

How do I calculate the CAD?

Cumulative Attributable Difference

A positive value indicates excess infections, or additional burden of infections, than what would be predicted based on the SIR goal.

A negative CAD value indicates fewer infections than predicted based on the same SIR goal.

The higher the CAD, the larger burden of excess infections within the facility or location.

For example, if a facility has a CAD of 16.3 when they run a TAP Report with an SIR goal of 0.50, the interpretation would be,

“The facility would have needed to prevent 17 infections to reach their SIR goal of 0.50 during this time period”.

How do I interpret the CAD?

Mentimeter Question #2

Do you feel like these rates would be useful to your facility?Yes, love it!No, thanks.

1. Go to www.menti.com on either your mobile device or computer’s web browser.

2. Use the code shown on the screen to participate in live polling for this activity.

3. See results.

www.menti.com

Enter Code

Enhanced Data from the Quarterly TAP Reports

TAP reports rank facilities (or locations) by the cumulative attributable difference (CAD), which is the number of infections that must be prevented to achieve a HAI reduction goal.

Facilities are secondarily ranked by device utilization.

The CAD can help to prioritize the facilities (or locations) where the greatest prevention impact could be achieved.

Ranking occurs for overall Hospital CAD (highest to lowest) and by location within the hospital.

The quarterly SUR report communicates infection risk to which patients are exposed through device utilization.

TAP Interventions for the Prevention of CLABSIPerform daily audits to assess whether each

central line is still needed.

Reeducate personnel at regular intervals about central line insertion, handling and maintenance, and whenever related policies, procedures, supplies, or equipment changes.

Empower staff to stop non-emergent insertion if proper procedures are not followed.

Ensure efficient access to supplies for central line insertion and maintenance (i.e. create a bundle with all needed supplies). Use hospital-specific or collaborative-based performance measures to ensure compliance with recommended practices.

TAP Interventions for the Prevention of CAUTI Nurse-driven protocol for catheter removal

Implementing a nurse-driven protocol

Ex-Foley-Ate Slide Set

Urinary Catheter Paper-based Removal Reminder

Electronic Removal Reminder

Summary

The SIR compares the observed number of HAIs to what was predicted.

The SUR compares the observed number of device days to what was predicted.

The CAD reports the number of infections that need to be prevented to achieve an HAI reduction goal.

Reports communicate infection risk to which patients are exposed through device utilization.

“We’re here for you!”

Questions and Answers

Alexa Ramirez, MPH

Healthcare-associated Infections and Antibiotic Resistance Program

Phone: 504-568-8289

Alexa.Ramirez@la.gov