Chapter 1 Executive Summary

Pennsylvania was one of the first states to recognize the threat that healthcare-associated infections (HAIs) posed to patient safety. In 2008, Act 52 mandated all HAIs be reported to the National Healthcare Safety Network (NHSN) and annual progress reports be compiled to serve as a reference and to document progress toward HAI elimination. Since then, Pennsylvania Department of Health (DOH) has expanded its role beyond tracking HAIs and now also responds to outbreaks in health care facilities, assesses and provides recommendations for infection control practices, provides subject matter expertise, and raises awareness of antibiotic stewardship principles and practices.

This annual HAI report presents metrics that have been adjusted to account for differences between hospitals so that they can be compared to each other and ranked. The following HAIs are included in this report: central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI) and surgical site infections (SSI) from seven procedures. HAI metrics, are reported from all types of hospitals, specifically, psychiatric, acute care, critical access, inpatient rehabilitation, long term acute care, and children’s hospitals.

Two metrics are reported. First, the standardized infection ratio (SIR) compares the number of reported infections to a predicted number of infections. Second, the standardized utilization ratio (SUR) compares the percent of patients with a device (central line or urinary catheter) to a predicted percentage of device use. In both metrics the predicted number is calculated from the 2015 baseline national NHSN data. The hospital level metrics have been aggregated at the state and hospital type levels for each HAI.

This report differs significantly from previous Pennsylvania HAI reports in analysis, content, and format. The standardized infection ratio (SIR) is calculated using national data, not just data from Pennsylvania hospitals. This permits comparison of Pennsylvania facilities to each other and to hospitals across the country. The year in which the 2016 HAIs are compared is 2015. Previous Pennsylvania HAI reports computed rates adjusted to data in the same year and CDC SIRs through 2014 used reference data from 2007 or 2008, depending on the type of infection. The diversity of HAIs included in this report has been reduced as described above. The report is published on the DOH website with interactive tables for users to identify lists of hospitals of their choosing.

The implications of these changes on interpreting the data are numerous. The SIRs can be comparable to national SIRs that are adjusted with the same methodology. They are not comparable to previous Pennsylvania reports. Hospitals can calculate their SIRs at any point in time through analysis files within NHSN. The baseline HAI rate is reset lower than previously and corresponds to a new national SIR of approximately 1.0 in 2015 for each HAI. The number of cases cannot be compared to previous reports due to different inclusion and exclusion criteria. The statistical method used to adjust for differences between hospitals accounts for more hospital-specific characteristics making the analysis more robust.

Catheter-associated urinary tract infections (CAUTIs) Among the 1,428,640 patient urinary catheter days, 1,658 CAUTIs were reported to NHSN from 285 Pennsylvania hospitals. The state SIR was 0.98, nearly identical to the national experience in 2015. The SIR in critical access hospitals was highest (SIR = 1.91, 95% Confidence Interval [CI]: 1.0-3.3) and in children’s hospitals was lowest (SIR = 0.83, 95% CI: 0.5-1.3). The urinary catheter standardized utilization ratio (SUR) was 0.88 among 295 hospitals, below the 2015 national average in 2015. One-third of the 12 psychiatric hospitals used no urinary catheters, one-third used urinary catheter lines four through 19 times more than similar national hospitals, and one third had SURs that ranged between 0.69 and 1.08.

Central Line-Associated Blood Stream Infections (CLABSIs) Among 1,483,452 patient central line catheter days, 1,439 CLABSIs were reported to NHSN from 273 hospitals. The state SIR was 0.96, slightly below the national experience in 2015. The SIR in critical access hospitals was highest (SIR = 1.98, 95% CI: 0.5-5.4) and in acute care hospitals was lowest (SIR = 0.92, 95%CI: 0.9-1.0): Pennsylvania hospitals reporting using fewer central lines than predicted (SUR = 0.90; n = 295). One acute care hospital used central lines 15 times more than similar hospitals.

Surgical Site Infections (SSI) In 2016, 166 Pennsylvania hospitals performed at least one of the seven surgical procedures tracked for surgical site surveillance. Hospitals reported 118,847 surgical procedures from the seven surgical types and 1,435 SSIs were identified. Knee prosthesis surgery was most common and represented 37.5 percent of the total procedures. The SIRs for each surgery type were 0.88 (95% CI: 0.6-1.2) for cardiac surgery, 0.9 (95% CI: 0.7-1.2 for cardiac bypass surgery with two incisions, 0.81 (95% CI: 0.4-1.5) for cardiac bypass surgery with one incision, 0.82 (95% CI: 0.7-0.9) for colon surgery, 0.93 (95% CI: 0.8-1.1) for hip prosthesis surgery, 1.04 (95% CI: 0.8-1.3) for abdominal hysterectomy surgery, and 1.02 (95% CI: 0.9-1.2) for knee prosthesis surgery. Knee replacement surgeries performed at critical access hospitals had SIRs over twice the predicted number (SIR = 2.27, 95% CI: 0.6-6.2) although it didn’t reach statistical significance. Colon surgery performed at children’s hospitals had a SIR of 0.51 (95% CI: 0.1-1.4) and cardiac surgery performed at children’s hospitals also had a low SIR (0.69) but neither reached statistical significance.