The Washington State Department of Health (DOH) maintains three dashboards for reportable health care-associated infections (HAIs):
- The Device-Associated HAI Dashboard contains information on CAUTI (catheter-associated urinary tract infection) and CLABSI (central line-associated bloodstream infection);
- The LabID Dashboard includes information on laboratory-identified (LabID) HAIs, CDI (Clostridioides difficile infection) and MRSA (methicillin-resistant Staphylococcus aureus) bloodstream infections; and
- The Surgical Site Infection Dashboard contains information on surgical site infections (SSIs), specifically COLO (following colon surgery) and HYST (following abdominal hysterectomies).
Metrics and Reading This Dashboard
Purpose and Data Considerations
This dashboard analyzes the performance of Washington State hospitals in preventing HAIs. It does this by comparing the number of reported HAIs to the expected count for that year. This comparison illustrates whether a hospital had more, fewer, or a similar number of infections compared to the national baseline or experience.
Before reviewing this report, please consider:
- The information provided is preliminary. While hospitals and the Washington State Healthcare Associated Infection/Antibiotic Resistance (HAI/AR) National Healthcare Safety Network (NHSN) Epidemiology Program worked to ensure accuracy and completeness, it's important to note that the data is self-reported and hasn't undergone formal validation or double-checking. Therefore, these numbers should be interpreted cautiously until validation is finalized as they are subject to potential changes.
- Results from the Washington State HAI/AR NHSN Epidemiology Program might vary from those published elsewhere, like the Centers for Medicare & Medicaid Services (CMS) Hospital Compare website. These differences could stem from various factors such as using data from different time periods, types of facilities, units or locations within facilities, patient demographics, or employing distinct analysis methods.
- The dashboards use the Standardized Infection Ratio (SIR), the preferred summary measure for monitoring HAIs. The SIR considers various factors across hospitals, like patient types, procedures, hospital size, and affiliations with medical schools. Although rates might seem more straightforward than the SIR, they don't show variations in risk among different populations. For further details on the SIR, refer to page 3.
- Hospitals may vary in how they report infections. Hospitals with greater infection prevention resources and personnel might detect and report more infections compared to hospitals with fewer resources dedicated to infection prevention.
- Numbers alone don't show how a hospital is at stopping infections. This report assesses hospital performance in a given year and measures it against the national baseline. It's crucial not only to review the SIR interpretation for each hospital but also to consider the overall count of patient or device days and the total identified infections within that period.
HAI-Specific Considerations
CDI
LabID CDI events use lab data. A positive result doesn't mean the person was sick, and it doesn't require clinical information. This makes it simpler to track CDI. In the LabID dashboard, only tests done more than three days after someone is admitted to the hospital are counted as hospital onset CDIs.
CAUTI
CAUTI data are only included beginning in 2020. Before that, the Washington State Department of Health received combined state data that could not be for this dashboard.
MRSA
MRSA data are only included beginning in 2020. Before that, the Washington State Department of Health received combined state data, which couldn't be used for this dashboard.
LabID MRSA events use lab data. Sometimes, even if someone isn't sick, the test shows they have MRSA, making it easier to track. In this dashboard, only tests done more than three days after someone is admitted to the hospital count as infections starting in the hospital.
National Healthcare Safety Network (NHSN)
National Healthcare Safety Network (NHSN) is a free and secure web-based data management system developed and maintained by the Centers for Disease Control and Prevention (CDC). The data included in these dashboards are reported to the CMS, CDC, and WA DOH through NHSN.
National Targets
Two national targets are included in the dashboards: the 2015 National Baseline and the 2020 Health and Human Services (HHS) HAI Target Goal.
2015 National Baseline
In 2015, the CDC established a new baseline using all the HAIs reported to NHSN to compare data. HAI prevention progress is measures against NHSN infection data using models that consider how likely a group of patients is to get an infection. When the SIR is under the National Baseline of 1, it means there were fewer infections than expected.
2020 HHS HAI Action Plan Target
The 2020 U.S. Department of Health and Human Services (HHS) set specific goals for reducing infections in healthcare through the National Action Plan to Prevent Health Care-Associated Infections. These goals vary for different types of infections. There are also plans to update these goals in the future.
Timeline
The HAI dashboards show yearly information reported to NHSN beginning the year these conditions became reportable in Washington. The data are downloaded from NHSN after it has been finalized for the last quarter of the reported year and sent to the CMS. If there are any changes to the data after this point, they would not show in the dashboard. You can find when the dashboard data was last updated at the bottom of each dashboard.
Standardized Infection Ratio (SIR)
Explanation
The SIR helps track HAIs over time and can be calculated for different groups like units, facilities, states, and the entire country. It evens out differences between healthcare places. Each time, the SIR compares the actual infections reported to the expected ones based on the 2015 baseline, which varies for each infection type and facility’s individual risk. Lower SIRs mean better performance. For more information on the SIR, see A Guide to the SIR.
Interpretation
Colors and symbols are used to make it easy for you to see if the SIR is statistically significant. They give you the main idea about how well the facility is doing for that specific HAI measure.
Table 1: SIR Interpretation Guide
| SIR Value | Symbol | Table Text | Interpretation |
|---|---|---|---|
| <1.0 |
|
Better than predicted |
There were fewer infections than predicted. If a facility has a CAUTI SIR of 0.75, they experienced 25% fewer events than expected. |
| 1.0 |
|
Same as expected | The SIR ratio is not significantly different than 1.0 meaning the number of infections was close to or the same as the number predicted. |
| >1.0 |
|
Worse than predicted |
There were more infections than predicted. If a facility has a CAUTI SIR of 1.5, they experienced 50% more events than predicted. |
| N/A |
|
No conclusion | There was not enough information to make a reliable comparison to the national experience. |
Interpretation Notes
The "Same as Expected" label is used when the SIR is not significantly different from 1.0. This happens when the confidence interval includes 1.0. Most facilities usually fall under this category.
A SIR is not calculated when the number of predicted infections is less than 1.0. According to national baseline data, when the expected infections are under 1.0, it means the risk to patients is incredibly low, so there's no expectation of one type of infection in that group of patients.
Definition of Terms
Device-Associated HAIs: Healthcare-associated infections related to the devices used in health care facilities, for example, catheters.
Device Days: A daily count of the number of patients in a patient care location with at least one device.
Patient Days: A daily count of the number of patients in a patient care location.
Standardized Infection Ratio (SIR): This measure divides the number of observed events by the number of predicted events. A value of 1 indicates that the facility observed the same number of events as were predicted. Lower SIR values are better.
95% Confidence Interval (CI): There is a high degree of confidence (95%) that the true SIR lies within this range of values. If this range includes the value of 1, then the SIR is not statistically significant (i.e., the number of observed infections or events is not significantly different than the number predicted). A confidence interval cannot be calculated if the SIR is not calculated.
Acronyms
ACH - Acute Care Hospital
CAH - Critical Access Hospital
CAUTI - Catheter-associated urinary tract infection
CDC - Centers for Disease Control and Prevention
CDI - Clostridioides (formerly Clostridium) difficile infection
CI - Confidence Interval
CLABSI - Central-line associated bloodstream infections
CMS - Centers for Medicare and Medicaid Services
DOH - Department of Health
HAI - Healthcare-Associated Infection
HHS - US Department of Health and Human Services
HO - Healthcare Facility Onset
LabID - Laboratory-Identified
LTACH - Long-Term Acute Care Hospital
MRSA - Methicillin-resistant Staphylococcus aureus
NHSN - National Healthcare Safety Network
SIR - Standardized Infection Ratio
WA - Washington State