Toward the rational use of standardized infection ratios. May edit data at any time to improve accuracy and completeness may join nhsn groups to confer rights for data access healthcare organizations, cdph join one or more facilities within a group cannot see each others data are mandated to allow cdph access to specific nhsn data signed a data use agreement with cdc which allows cms access. Although the nhsn recommends the reporting of superficial incisional ssis, only 1 of 3 standardized infection ratio sir models used by the nshn include superficial ssis cases. Understanding relationship between hai rate and sir. The national healthcare safety network nhsn is a secure, internetbased surveillance system that was established by the division of healthcare quality promotion at the centers for disease control and prevention cdc in 2005, and it is used by the cdc, healthcare facilities, state health departments, and other agencies and organizations to. Modeled rates of ssi predicted by nhsn ranged from 1. Surgical site infection ssi rates in the united states. There are three main ssi sir models available from nhsn, each briefly described in the table below.
The sir is especially useful when evaluating two different design options. The sir is only calculated if the predicted number of hais is. Illinois hospital report card and consumer guide to health. Cdc nhsn hai measures the cdc calculates standardized infection ratios sirs for the clabsi, cauti, ssi, mrsa bacteremia, and cdi measures. There are multiple ssi sir options each containing slightly different. Outcomes were mrsa standardized infection ratio sir and cdi sir. Jul 17, 2017 minnesota nhsn user group july 20, 2017 reminders for best sound quality, dial in at 1. Nhsn uses either a logistic regression model or a negative binomial regression model to perform this calculation. Cdcs healthcareassociated infections community interface. We recommend that you use the 20062008 baseline rates in order 1 to be consistent with nhsns sir calculation and 2. Cdc nhsn measures cms calculates the clabsi, cauti, ssi, mrsa, and cdi hai measures using chart abstracted data submitted by hospitals via the nhsn. Knowing just the numbers of infections identified by surveillance activities is not sufficient to identify the risk probability of infection occurring in the facility residents.
Nhsn uses the following operative procedure coding systems. The standardized infection ratio sir is a summary measure used to track hais at a national, state, or local level over time. Most commonly isolated pathogen during clabsi is staphylococcus aureus. If the confidence interval includes the value of 1 as in this example, then the sir is not significant the number of observed. Comparison of nhsn baselines ssi old baseline each nhsn operative code had a separate set of predictive risk factors. Public health ontario acknowledges the financial support of the ontario government.
Logistic regression models are used when there is an opportunity for a single outcome for each. The nhsn sir calculation model currently used used by cms includes only two risk factor adjustment variables. Nhsn provides facilities, states, regions, and the nation with data needed to identify problem areas, measure progress of prevention efforts, and ultimately eliminate healthcareassociated infections. Best practices for surveillance of health careassociated.
Fiscal year 2020 hospitalacquired conditions reduction. Used to track hais at a national, state, or local level over time austs for patients of varying risk within each facility dj compares the actual number of hais reported with the baseline u. Best practices for surveillance of health careassociated infections in patient and resident populations. The sir will be calculated only if the number of predicted hais numpred in the nhsn application, previously known as numexp is. Prior to 2015, the sir was calculated using a single statistical model for all. Pdf public reporting of health careassociated surveillance. The 2 models were 1 a model that included all variables currently collected in the janis system and 2 a model that included only patient characteristics and not variables related to the. The 95% confidence interval is a range of values in which the true sir is thought to lie.
Proceduresevents were excluded from the sir calculation if. National healthcare safety network nhsn overview chapter. This table lists some of the risk factors found to be significant for nhsn operative procedure categories. Tolson, national nosocomial infections surveillance system, surgical site infection ssi rates in the united states, 19921998. This rule was instituted to avoid the calculation and interpretation. This model was developed by nhsn for teaching purposes to show how a ssi sir is derived this example should not be used to calculate a patients risk of ssi in your facility. In 2015, cdc modified the risk adjustment factors used in the models and updated national baseline data that are used as a basis for comparison in sir calculations. The nhsn ssi events are included in the numerator based on the date of procedure and not the date of event because the procedure carries the risk for infection and since the event is linked to the procedure, we are able to determine the relationship between surgery exposure and infection outcome that way. Nhsn produces ssi sirs using several different risk models, with each one including a different. Toward the rational use of standardized infection ratios to.
Infection prevention news duke infection control outreach. The clabsi, cauti, ssi, mrsa bacteremia, and cdi measures are adjusted at the hospital level and patient care unit level. Getting the most from nhsn resources october 2012 updated. All ssi models adults all ssi models peds complex ar models adults complex ar models peds complex 30day models adults colo and hyst mrsa bacteremia labid cdi labid vae sirs developed for total vae, and ivac plus.
Final recommendations for updating the qualitybased. Infections caused by multiple organisms of similar origin at the same site single infection in a patient with a previously established nosocomial infection, a second nosocomial infection should be recorded in two situations. American journal of infection control 7 s bundlessi. The standardized infection ratio for central lineassociated bloodstream infections was 0. However, the sir for the all ssi adult model, reported under the sir column sirall is the most likely value. The ssi rates published in the last nhsn report 2006 2008 data include all sites of ssi, however, new multivariable risk models using only the subset of ssi deep incisional and organspace ssi detected during admission or upon readmission to the index facility will be. Infectious disease epidemiology 2011 statewide nhsn surgical. Nhsn collects and analyzes healthcareassociated infections hai data reported from across the nation to help track hai incidence, identify opportunities to eliminate hais, and measure the progress of hai prevention efforts. Transition to the 2015 rebaseline guidance for ltchs. The centers for disease control and prevention cdc is committed to protecting patients and healthcare workers from adverse healthcare events and promoting safety, quality, and value in. Sample introductory language defining the sir if used in the report. Surgical site infection ssi models and reports there are different ssi models, each has 2 separate reports, by procedure and by surgeon under the 2015 baseline bs2 all ssi adult data sir all ssi pediatric data sir complex admissionreadmission ar adult ssi sir complex ar pediatric ssi sir complex 30day ssi sir.
Cdcs national healthcare safety network is the nations most widely used healthcareassociated infection tracking system. Pdf introduction we retrospectively analyzed a consecutive group of patients operated for bone tumors of extremity and pelvis who received only. Nhsn uses risk models and facility patient days to calculate the number of predicted ho mrsa bacteremia events at a facility. Under the 2015 baseline, nhsn started using four separate cdi models based on facility type. We recommend that you use the 20062008 baseline rates in order 1 to be consistent with nhsns sir calculation and 2 to have meaningful trended data over time. The weighted mean colon ssi rate for all included articles was 11. Nhsns guide to the sir updated march 2019 pdf iconpdf 2 mb a comprehensive guide to nhsns sir, including risk factors used in the sir calculations. Risk adjustment factors included in the sir calculation. Vbp webinar slides 10 19 15 quality reporting center. Methods for composing hai reports and key concepts for.
Any missing risk factors duration models constructed from 2015 national healthcare safety network nhsn data, which represents a standard population. Ssi risk adjustment risk models developed for each nhsn operative procedure includes only those risk factors found to increase ssi risk for that procedure every patient undergoing a procedure in your hospital has a ssi risk probability calculated by nhsn your hospitals predicted number of ssi is the sum of your. Stratification calculation of rates separately in multiple categories for risk adjustment nnis example. This means that nonprimary closure techniques will be included in the sir calculation. Health care systems with electronic health information systems may improve the efficiency time spent to find a positive case of their ssi surveillance activities and improve reliability by. Nhsn patient care locations for saar calculations the nhsn au measure is comprised of 16 saars, each of which summarizes au for a specified combination of patient care locations and antimicrobial agents. Numerators number of infections number of patients infected note. Infectious disease epidemiology 2011 statewide nhsn. The method of calculating an sir is similar to the method used to calculate the standardized mortality.
Advanced analysis in national healthcare safety network. Progress in reducing hais, as assessed by nhsn data, is tracked using a standardized infection ratio sir. Nhsn s guide to the sur updated october 2018 cdcpdf pdf 1 mb a comprehensive guide to the nhsn s sur, including significant factors used in the sur calculations under the 2015 baseline. The first two models, the all ssi sir and the complex ar ssi sir models, are available for proceduresssi occurring in both adults and pediatric patients, while the third model, the complex 30day ssi sir is available for proceduresssi. The first two models, the all ssi sir and the complex ar ssi sir models, are available for proceduresssi occurring in both adults and pediatric patients, while the third model, the complex 30day ssi sir is available for proceduresssi occurring in adults only. Frequently asked questions about definition changes, the sir, and the 2015 rebaseline. Considerations for facilities without an nhsncalculated sir the nhsn standardized infection ratio. We developed 2 multiple logistic regression models for sir calculation and compared the probabilities of hospitallevel expected ssi between these models. Below is an example of an sir table for ssi surveillance that occurred for inplan. This document describes how to calculate and interpret the ssi sir. The 2 models were 1 a model that included all variables currently collected in the janis system and 2 a model that included only patient characteristics and not.
Surgical site infection risk factors and risk stratification. The operative procedure codes are required to determine the correct nhsn operative procedure category to be reported. When a catheter tube is placed in a large vein and not put in correctly or kept clean, it can become a way for germs to enter the body and cause serious infections in the blood central line. Mdhhs sharp nhsn users conference call wednesday, february 28. Ssi, and excludes superficial incisional infections. We estimated state and time fixedeffects models with timevariant controls, and we weighted our analyses for the number of hospitals in the state.
The key explanatory variable was the percentage of hospitals that meet the core elements in each state. The national healthcare safety network, of the centers for disease control and prevention cdc, is the nations most widely used health careassociated infection tracking system. The sir is a summary measure that can be used to track hais over time and can be calculated on a variety of levels, including unit, facility, state, and nation. This report focuses on trends in nhsn ssi aggregate data from acute care. Rationally, however, only patientrelated variables should be included in the sir model. Serious superficial incisional surgical site infections. If ssi event count is less than you re expecting, keep in mind which model you are using example. The ssi sir is calculated for facilities who enroll in nhsn as acute care hospitals or critical access hospitals. Nhsn uses risk models and facility patient days to calculate the number of predicted ho cdi events at a facility. National healthcare safety network nhsn, 2015 surgical site infections ssi a surgical site infection ssi is an infection that occurs after surgery at the site where the. The national nosocomial infections surveillance system basic ssi risk index, clinical infectious diseases, volume.
Sirs are currently calculated in nhsn for the following hai types. The predicted number is a riskadjusted estimate that is determined using national baseline data. Reported number of hais sirs reported centralline days, urinary catheter days. Advanced analysis in national healthcare safety network nhsn. Any missing risk factors duration nhsn is a secure, internetbased surveillance system that was established by the division of healthcare quality promotion at the centers for disease control and prevention cdc in 2005, and it is used by the cdc, healthcare facilities, state health departments, and other agencies and organizations to track hais. Calculating, generating reports, and presenting the data. Trends in knee arthroplasty kpro surgical site infections ssi.
The national healthcare safety network transitioned from surgical site infection ssi rates to the standardized infection ratio sir calculated by statistical models that included perioperative factors surgical approach and surgery duration. National healthcare safety network nhsn patient safety component manual. Complex ar and complex 30day models will not include superficial incisional primary infections i. To avoid skewed data, bmi outlier values are excluded from the ssi sir calculations. Under the 2015 sir baseline, procedures, regardless of closure methods, are included in the sir calculation, as long as the inclusion criteria for the models are met and none of the ssi event exclusion criteria apply.
An incidence rate is typically used to measure the frequency of occurrence of new cases of infection. How to calculate savingstoinvestment ratios budgeting. Additionally, ssi data reported to cms do not include superficial incisional ssi cases. The procedure risk is calculated from improved risk models. In order to enforce a minimum precision criterion, sirs are currently not calculated when the number of predicted infections is less than 1.
Since 2009, infection data has been reported to the nhsn to track the national progress of the reduction of hais. For more a more technical explanation of the sir calculation, please see the national healthcare safety network nhsn october 2010 newsletter at. There were no identifiable trends in colon ssi rates over time in the published literature fig. The sir adjusts for various facility andor patientlevel factors that contribute to hai risk within each facility. Use 2017 data for new baseline current baseline uses 2014 data. During the 1st qtr, there were 6 cl infections with 730 cl days reported in the icu dividing the number of events by the central line days, the clabsi rate for the icu is 8. Remember that the ssi risk index data are no longer being published, and the ssi sir would be much more difficult to derive manually. If any of the ssi event indicator variables is equal to 1, then the ssi event is included in the corresponding ssi model.
The sir is calculated only if the number of predicted infections is. Saars are generated for six specified groupings of adult and pediatric patient care locations. The purpose of this task is to develop a surveillance tool that detects downstream manifestations of surgical site infection ssi in electronic data. The sir compares the number of hais observed to the predicted number of infections. Logistic regression models are used when there is an opportunity for a single outcome for each exposure e. May edit data at any time to improve accuracy and completeness may join nhsn groups to confer rights for data access allow healthcare organizations to analyze data from member facilities facilities within a group cannot see each others data california hospitals mandated to join the.
Determining which ssis are included in the ssi sirs. Rates per 100 procedures are higher for colos than for hyst. Clabsi, cauti, ssicolo, ssihyst, mrsa bacteremia labid, cdi labid. An ssi surgical site infection sir can also be calculated using the same calculation process as for clabsi data. Sir for colon surgery colo and abdominal hysterectomy hyst surgical site ssi remains higher than the nhsn baseline across all 12 quarters 20152017.
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