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Understanding the standardized infection ratio ( SI R)
Daniel M. Saman, DrPH, MPH, CPH Research Scientist Essentia Institute of Rural Health Chief Epidemiologist Health Watch USA Health Watch USA, Annual Conference, November 2, 2012
Understanding the standardized infection ratio ( SI R) Daniel M. - - PowerPoint PPT Presentation
Understanding the standardized infection ratio ( SI R) Daniel M. - - PowerPoint PPT Presentation
Understanding the standardized infection ratio ( SI R) Daniel M. Saman, DrPH, MPH, CPH Research Scientist Essentia Institute of Rural Health Chief Epidemiologist Health Watch USA Health Watch USA, Annual Conference, November 2, 2012
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SI R
The SIR is calculated by dividing the number of observed
infections by the number of expected infections. The number
- f expected infections, in the context of statistical prediction,
is calculated using CLABSI rates from a standard population during a baseline time period. The baseline period for CLABSI SIR calculations is 2006-2008 NHSN aggregate as reported in the NHSN Report. Therefore SIRs are calculated for CLABSI data in 2009 and forward.
NOTE: The SIR will be calculated only if the number of
expected HAIs (numExp) is ≥ 1. When the numExp is <1, this indicates that, based on the NHSN aggregate rates, the central line-day count in your facility or location is too low to calculate a precise SIR and comparative statistics.
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The CLABSI SIRs are adjusted for patient mix by type
- f patient care location, hospital affiliation with a
medical school, and bed size of the patient care location.
The predicted number is an estimated
number of HAIs based on infections reported to NHSN during January 2006– December 2008.
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Large KY Hospitals
KY Hospitals > 5000 central line days Only King’s Daughters is for profit
Hospital Name City County Name CLABSI Central Line Days Observed Cases Predicted cases CLABSI SIR (Obs / Predicted) Rate (per 1000 line days) SAINT JOSEPH HOSPITAL LEXINGTON FAYETTE 9414 2 15.222 0.13 0.21 BAPTIST HOSPITAL EAST LOUISVILLE JEFFERSON 5619 2 8.429 0.24 0.36 ST ELIZABETH MEDICAL CENTER NORTH COVINGTON KENTON 6515 4 12.429 0.32 0.61 KING'S DAUGHTERS' MEDICAL CENTER ASHLAND BOYD 5453 3 8.412 0.36 0.55 CENTRAL BAPTIST HOSPITAL LEXINGTON FAYETTE 6728 5 10.448 0.48 0.74 JEWISH HOSPITAL & ST MARY'S HEALTHCARE LOUISVILLE JEFFERSON 11856 20 22.672 0.88 1.69 UNIVERSITY OF KENTUCKY HOSPITAL LEXINGTON FAYETTE 16274 40 42.957 0.93 2.46 UNIVERSITY OF LOUISVILLE HOSPITAL LOUISVILLE JEFFERSON 8915 22 22.848 0.96 2.47 NORTON HOSPITALS, INC LOUISVILLE JEFFERSON 30814 81 63.626 1.27 2.63
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Top Perform ers, Low est SI R and Highest Line Days
Hospital Name City State CLABSI Central Line Days Observed Cases Predicted Cases CLABSI SIR (Obs / Predicted) Rate (per 1000 line days) Hospital Type SAINT JOSEPH HOSPITAL Lexington KY 9414 2 15.222 0.13 0.21 NonProfit WEST VIRGINIA UNIVERSITY HOSPITALS Morgantown WV 9580 1 22.768 0.04 0.10 NonProfit JPS HEALTH NETWORK Fort Worth TX 10026 3 22.514 0.13 0.30 Govt MORTON PLANT HOSPITAL Clearwater FL 10299 1 16.299 0.06 0.10 NonProfit MOBILE INFIRMARY Waynesboro GA 10321 2 22.58 0.09 0.19 NonProfit ST DAVIDS MEDICAL CENTER Austin TX 10518 21.724 0.00 ForProfit MERCY GENERAL HOSPITAL Sacramento CA 10811 18.092 0.00 NonProfit HARPER UNIVERSITY HOSPITAL Detroit MI 10865 3 25.73 0.12 0.28 ForProfit ST LUKES HOSPITAL OF KANSAS CITY Kansas City MO 11064 3 24.744 0.12 0.27 Govt DESERT SPRINGS HOSPITAL Las Vegas NV 11922 1 17.883 0.06 0.08 ForProfit THE QUEENS MEDICAL CENTER Honolulu HI 12067 25.133 0.00 NonProfit RIVERSIDE METHODIST HOSPITAL Columbus OH 13566 3 28.195 0.11 0.22 NonProfit CEDARS-SINAI MEDICAL CENTER Los Angeles CA 22029 3 45.981 0.06 0.14 NonProfit
National hospitals
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Problem s w ith SI R
Most states (> 97% ) are at a reduced risk Facility, med school affiliation,
adjustments may not be necessary
- Apparently correcting for inherently increased
risk
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Solutions
The peak of the
histogram is at SIR= 0.35
We believe this is an
“obtainable” SIR
If a majority of hospitals
can achieve this, then the “baseline” of 1.0 is set too high; baseline should be set at peak, 0.35
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