Presentation by Jerry Gibson, SC DHEC- Hospital Infection Database
Presentation by Jerry Gibson, SC DHEC- Hospital Infection Database
Presentation by Jerry Gibson, SC DHEC- Hospital Infection Database
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<strong>SC</strong> ACA Implementation Committee – Quality and<br />
Outcomes Work Group<br />
<strong>Jerry</strong> <strong>Gibson</strong><br />
<strong>DHEC</strong> ‐ State Epidemiologist<br />
6/3/2011
HIDA<br />
• <strong>Hospital</strong> <strong>Infection</strong>s Disclosure Act<br />
• Passed in May 2006, requiring inpatient acute care<br />
hospitals to report to the <strong>SC</strong> <strong>DHEC</strong> selected hospital<br />
acquired infections and selected infection prevention<br />
processes
HIDA (cont)<br />
• Since 2007, inpatient rehabilitation and long‐term<br />
acute care (LTAC) facilities have been added.<br />
• Currently, 79 facilities report on central line associated<br />
bloodstream infections (CLABSIs) and certain surgical<br />
site infections (SSIs)
Timeline for Activities Required for Compliance with <strong>Hospital</strong> <strong>Infection</strong>s<br />
Disclosure Law<br />
6/29/06<br />
<strong>DHEC</strong><br />
internal<br />
meeting<br />
Aug 06<br />
1 st Advisory<br />
Committee<br />
meeting<br />
Aug 06<br />
CDC<br />
Training<br />
for<br />
<strong>DHEC</strong><br />
Feb 07<br />
<strong>DHEC</strong><br />
begins<br />
pilot<br />
analysis<br />
of data<br />
July 07<br />
<strong>DHEC</strong><br />
gets<br />
funding<br />
???<br />
Nov 07<br />
<strong>DHEC</strong><br />
accesses<br />
6-month<br />
of data in<br />
NHSN to<br />
begin<br />
analysis<br />
1/31/08<br />
<strong>DHEC</strong><br />
publishes<br />
1 st report<br />
Feb 08<br />
<strong>DHEC</strong><br />
begins<br />
QA of<br />
data<br />
Feb 09<br />
<strong>DHEC</strong><br />
submits 1 st<br />
Report to<br />
legislature<br />
May 06<br />
Law<br />
passed<br />
Nov 06<br />
Begin<br />
Training<br />
for ICPs<br />
at APIC<br />
Jan 07<br />
ICPs<br />
begin to<br />
pilot<br />
NHSN<br />
May 07<br />
ICPs<br />
begin<br />
formal<br />
entry of<br />
data<br />
into<br />
NHSN
National Healthcare Safety<br />
Network<br />
• A secure, internet<br />
based surveillance<br />
system through<br />
which facilities can<br />
report their data on<br />
hospital associated<br />
infections
What is a Standardized <strong>Infection</strong><br />
Ratio (SIR)?<br />
• The SIR is a summary measure used to track HAIs at a<br />
national, state, and local level over time.<br />
• Method of calculating is similar to the Standardized<br />
Mortality Ratio<br />
• The SIR compares the actual number of HAIs reported to<br />
the baseline experience<br />
• Adjusted for several risk factors that have been found to be<br />
significantly associated with differences in infection<br />
incidence.<br />
• An SIR greater than 1.0 indicates that more HAIs were<br />
observed than predicted; an SIR less than 1.0 means fewer<br />
HAIs were observed than predicted
Mandatory Reporting of Healthcare‐associated <strong>Infection</strong><br />
Rates ‐ 2009<br />
*<br />
www.APIC.org
Central lines access large<br />
veins, catheter tip is near<br />
heart, may remain in place<br />
for weeks or months<br />
Central line‐associated<br />
bloodstream infection =<br />
CLABSI
CLABSI<br />
•Crude mortality 10‐40%<br />
•Attributable mortality 2‐15%<br />
•Prolongation of hospitalization 5‐20<br />
days<br />
•Attributable cost $34,000‐$56,000
SIRs for CLABSI,<br />
all <strong>SC</strong> hospitals<br />
calendar year<br />
2010, <strong>by</strong> patient<br />
care unit<br />
Central Line<br />
Locations<br />
All Adult<br />
Inpatient<br />
Units<br />
Adult<br />
Critical<br />
Care Units<br />
Pediatric<br />
Inpatient<br />
Pediatric<br />
Critical<br />
Care Unit<br />
Inpatient<br />
Rehab Unit<br />
# <strong>Hospital</strong>s<br />
monitoring<br />
Locations<br />
Total #<br />
Central<br />
Line<br />
Days<br />
Total #<br />
<strong>Infection</strong><br />
s<br />
% Lower<br />
SIR<br />
% Not<br />
Different<br />
SIR<br />
62 247,473 329 4.84% (3) 82.26%<br />
(51)<br />
52 134,929 228 7.69% (4) 84.62%<br />
(44)<br />
16 9833 10 6.25% (1) 56.25%<br />
(9)<br />
5 7371 11 20% (1) 80%<br />
(4)<br />
16 12,804 14 0% 87.5%<br />
(14)<br />
%<br />
Higher<br />
SIR<br />
Comments<br />
1.61% (1) Seven<br />
hospitals<br />
(11.29%) had too<br />
few central line<br />
days to calculate<br />
a statistical<br />
percentage<br />
5.77% (3) One hospital<br />
(1.92%) had too<br />
few central line<br />
days<br />
0% Six hospitals<br />
(37.5%) had too<br />
few central line<br />
days<br />
0% N/A<br />
6.25% (1) One hospital<br />
(6.25%) had too<br />
few central line<br />
days<br />
LTAC 7 50,279 77 0% 100% 0% N/A<br />
Heme/Onc<br />
Unit<br />
8 35,566 53 25%<br />
(2)<br />
75%<br />
(6)<br />
0% N/A<br />
Pediatric<br />
Heme/Onc<br />
Unit<br />
Bone<br />
Marrow<br />
Transplant<br />
Unit<br />
3 6378 15 0% 100% 0% N/A<br />
1 810 0 0% 100% 0% N/A
<strong>SC</strong> CLABSI DATA<br />
• **Although not from 2010 data, it should be noted<br />
that in March 2011, the CDC released data showing<br />
that, of 17 states with a mandate for reporting<br />
CLABSIs to NHSN, South Carolina was the only<br />
state to demonstrate a significant decrease in<br />
CLABSI SIRs. South Carolina’s CLABSI rate<br />
dropped 30% July to December 2009 when<br />
compared to January to June 2009, in continuously<br />
reporting facilities. (www.cdc.gov/vital signs)
PICU CLABSI SIR Trend Graph<br />
(Only Includes Medical and Medical/Surgival PICUs)<br />
5<br />
4.5<br />
SIR O=E ?? CI<br />
4<br />
3.5<br />
Standardized <strong>Infection</strong> Ratio<br />
3<br />
2.5<br />
2<br />
1.5<br />
1.61<br />
3<br />
1<br />
1.18<br />
1.01<br />
0.5<br />
Source: <strong>DHEC</strong>, Bureau of Disease Control - HAI Section<br />
0.53<br />
0<br />
Jan 08 - Jun 08 Jul 08 - Dec 08 Jan 09 - Jun 09 Jul 09 - Dec 09 Jan 10 - Dec 10<br />
Trend Point
Continuation of<br />
<strong>Hospital</strong> Report
Surgical Site <strong>Infection</strong>s<br />
• In <strong>SC</strong>, we monitor SSIs from:<br />
• Coronary Artery Bypass Graft (CABG)<br />
• Hip Replacements<br />
• Knee Replacements<br />
• Abdominal Hysterectomies<br />
• Colectomies (in facilities with
SIR<br />
• SIR= observed<br />
expected<br />
• For SSIs, calculated using logistical regression<br />
model<br />
• Risk factors vary <strong>by</strong> procedure, but include patient<br />
age, ASA score, surgery duration, medical school<br />
affiliation, gender, type of anesthesia used,<br />
hospital bed size, wound class, trauma and others
Surgical site infections, six sites, all <strong>SC</strong> hospitals, calendar year 2010<br />
Surgical<br />
Procedures<br />
# <strong>Hospital</strong>s<br />
performing<br />
procedure<br />
Total #<br />
Procedures<br />
Total #<br />
<strong>Infection</strong>s<br />
% Lower<br />
SIR<br />
% Not<br />
Different<br />
SIR<br />
% Higher<br />
SIR<br />
Comments*<br />
Coronary<br />
Artery Bypass<br />
Graft (Chest<br />
and Donor<br />
Incision)<br />
16 3930 29 0% 93.75% (15) 6.25%<br />
(1)<br />
N/A<br />
Coronary<br />
Artery Bypass<br />
Graft (Chest<br />
Incision)<br />
12 293 1 0% 33.33% (4) 0% * Eight<br />
<strong>Hospital</strong>s (66.67%) had too<br />
few procedures to calculate<br />
statistical percentage<br />
Hysterectomy<br />
(Abdominal)<br />
49 5337 44 0% 75.51%<br />
(37)<br />
2.04%<br />
(1)<br />
Eleven<br />
hospitals (22.45%) had too<br />
few procedures<br />
Hip Prosthesis -<br />
-Replacement<br />
53 6684 81 0% 73.58% (39) 5.66%<br />
(3)<br />
Eleven<br />
hospitals (20.75%) had too<br />
few procedures<br />
Knee Prosthesis<br />
--Replacement<br />
50 10,394 69 0% 82%<br />
(41)<br />
6%<br />
(3)<br />
Six<br />
hospitals (12%) had too few<br />
procedures<br />
Colon Surgery 34 1,246 36 0% 58.82% (20) 5.88%<br />
(2)<br />
Twelve hospitals (35.29%)<br />
had too few procedures
Example of an Individual<br />
<strong>Hospital</strong> Report<br />
<strong>SC</strong> was one of only 5<br />
states that validated all<br />
Reports. Rates were<br />
significantly higher in<br />
those states, due to<br />
better reporting.
Microorganisms<br />
Number<br />
Isolates<br />
Percent<br />
Candida species and other yeasts 147 17.8<br />
Enterococcus species (includes VRE) 143 17.3<br />
Vancomycin resistant enterococcus (VRE only - % of total isolates) 41 (5.0)<br />
Coagulase negative Staphylococcus species 140 16.9<br />
Staphylococcus aureus (includes MRSA) 104 12.6<br />
Methicillin resistant Staphylococcus aureus<br />
isolates)<br />
(MRSA) only - % of total positive<br />
66 (8.0)<br />
Klebsiella species 77 9.3<br />
Enterobacter species 39 4.7<br />
Escherichia coli 33 4.0<br />
Pseudomonas species 25 3.0<br />
Serratia species 22 2.7<br />
Streptococcus species 18 2.2<br />
Acinetobacter species 15 1.8<br />
Stenotrophomonas maltophilia 7 0.8<br />
Citrobacter species 7 0.8<br />
Proteus species 6 0.7<br />
Bacteroides species 5 0.6<br />
Other anaerobes 5 0.6<br />
Providencia species 4 0.5<br />
Morganella species 4 0.5<br />
Burkholderia species 3 0.4<br />
Clostridium species 3 0.4
Validation<br />
• <strong>SC</strong> is one of few states that validates data entered into<br />
NHSN <strong>by</strong> facilities<br />
• One of only five states that perform actual chart reviews<br />
• Especially important to identify “system” errors<br />
• Also helps <strong>DHEC</strong> to establish and maintain good<br />
relationships with IPs<br />
• In 2009 CDC report on infection rates from 10 states<br />
with “mature” reporting, CDC concluded that the states<br />
doing validation had significantly better reporting<br />
completeness(including <strong>SC</strong> and NY).
• Provides framework to ensure progress towards<br />
five‐year national prevention targets as described<br />
in the HHS Action Plan in the following areas:<br />
• Develop or Enhance Public Health HAI Program<br />
Infrastructure<br />
• Surveillance, Detection, Reporting, and Response<br />
• Prevention<br />
• Evaluation, Oversight, and Communication
<strong>Hospital</strong> <strong>Infection</strong>s Disclosure Act<br />
(HIDA) Web Sites<br />
•<strong>DHEC</strong> Public Reports<br />
• www.scdhec.gov/hai<br />
•Information for <strong>Hospital</strong>s<br />
•www.scdhec.gov/hidainfo
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