Special Edition on Infection Prevention & Control | Page 16

2020 National Acute-Care Hospital HAI Metrics
Measure (and data source) Progress made by 2016 2020 Target (from 2015 baseline)
CLABSI (NHSN) 10% reduction 50% reduction
CAUTI (NHSN) 6% relative reduction 25% reduction
Invasive MRSA (NHSN/EIP2) 8% reduction 50% reduction
Hospital-onset MRSA (NHSN) 6% reduction 50% reduction
Hospital-onset CDI (NHSN) 7% reduction 30% reduction
SSI (NHSN) Data released in 2018 30% reduction
Clostridium diff hospitalizations (HCUP)
Data pending release
30% reduction
progress in preventing HAIs. This 2014 survey had
reported that pneumonia had become at the time
the most common HAI in the U.S., accounting for
22 percent of infections. The second most common
infections cited by the 2014 report were surgical site
(22 percent), followed by gastrointestinal (17 percent),
urinary tract (13 percent), and bloodstream infections
(10 percent). The 2014 report also noted the top
organisms leading to HAIs: Clostridium difficile
(12 percent), followed by Staphylococcus (11 percent),
Klebsiella (10 percent) and Escherichia coli (9 percent),
Enterococcus (9 percent), and Pseudomonas (7
percent). The 2014 report also indicated that
nationally, there was a 44 percent decrease in central
line-associated bloodstream infections between 2008
and 2012; a 20 percent decrease in infections related
to the 10 surgical procedures tracked in the report
between 2008 and 2012; a 4 percent decrease in
hospital-onset MRSA between 2011 and 2012; and
a 2 percent decrease in hospital-onset C. difficile
infections between 2011 and 2012.
In October 2016, the U.S. Department of Health
and Human Services (HHS) announced new targets
for the national acute-care hospital metrics for the
National Action Plan to Prevent Health Care-Associated
Infections: Road Map to Elimination (HAI Action
Plan). The targets use data from calendar year 2015
as a baseline — and are in effect for a five-year period
from 2015 to 2020. The new targets replaced the
previous targets that expired in December 2013.
As we know, standardized infection ratios (SIRs)
measure progress in reducing HAIs compared to
the 2015 baseline time-period. The SIR is the ratio
of the observed number of infections (events) to
the number of predicted infections (events) for a
summarized timeframe. In addition to SIRs, the 2018
report includes the standardized utilization ratios
(SURs), which measure device use by comparing the
number of observed device days to the number of
predicted device days.
In the 2018 report, national SIRs and SURs were
calculated for all strata that met the inclusion criteria.
Each national metric was compared to the 2015
national baseline of 1 and was compared to the
national metric from the prior year. Both comparisons
provide information on a national level about the
amount of device use and HAIs in U.S. hospitals.
Facility-specific SIRs and SURs were calculated
if the facility had at least one predicted HAI (SIR),
or device day (SUR). These facility-specific SIRs and
SURs were used to create percentile distributions
for each infection and device type if at least 20
facilities had sufficient data to calculate an SIR or
SUR. Percentile distributions among the national data
were shown in increments of 5, from 5-95 percent;
key percentiles were calculated for state-level data
(10 percent, 25 percent, 50 percent, 75 percent,
90 percent). Additionally, the facility-specific SIRs/
SURs were compared to the nominal value of 1,
equal to the national baseline SIR/SUR for each
infection and device type; if at least 10 facilities
in each category had sufficient data to calculate
the metric, the percent of facilities with an SIR/
SUR significantly higher or lower than the national
value was calculated both nationally and by state.
For the 2018 report, each state’s 2018 SIR was
compared against three benchmarks to assess
progress in HAI prevention: the current 2018
Healthcare
organizations
(HCOs) are
challenged with
staff turnover
and holding
front-line staff
accountable
to ‘doing the
right thing
every time.’ In
addition, HCOs
lack strategies
to consistently
monitor clinical
care.”
16 IP&C Special Edition June 2020 • www.healthcarehygienemagazine.com