Chapter 5 Conclusions

The 2016 report is the ninth report published by DOH since reporting was mandated by the 2007 amendment to the MCARE Act. This report is similar to the first annual report in that trends are not shown and comparisons to previous years are not advised. However, this report provides HAI statistics that can be compared with the national experience in 2015 when the same SSI adjustment model is used. Overall, CLABSIs and CAUTIs in Pennsylvania occurred on par with the national experience in 2015; however, the national objective is to have SIRs of 0.5 for CLABSIs and 0.75 for CAUTIs by 2020 (U.S. Department of Health and Human Services 2016). Deep infections resulting from surgeries listed in this report are at or below the national experience in 2015, and none have SIRs that are statistically significantly lower than 1.0. Interestingly, SSI SIRs among patients with either a deep or superficial infection were frequently lower than those with only a deep infection (Appendix A). This suggests that patients and staff are good at caring for the incision site, whereas infection control practices during the most invasive part of the procedure could be improved upon.

Examination of the SIRs by type of hospital revealed that critical access hospitals (CAH) have opportunities for improvement with respect to CLABSI, CAUTI, and knee replacement surgery. Overall, these hospitals had about two times as many infections as similar hospitals in the 2015 national experience. However, the number of infections that occurred at CAHs was very small (three, 12 and three, respectively) compared with that from large hospitals.

Readers of this report are encouraged to explore the data tables by sorting and selecting the data to create customized lists of hospitals. For example, the user can sort hospitals by SIR to find those with less than one predicted infection and then examine the number of HAIs that were reported and compare that to the number predicted for each hospital. Specifically consider two hospitals each with no SIR. For example, a hospital with one HAI and 0.98 predicted is different from one with one HAI and 0.4 predicted, although that difference could not be reflected with the SIR. Alternatively, the user could filter hospitals to include those located in a county of interest and then sort the list by SIR to find those with the highest and lowest SIRs. The reader could also compare HAIs with the number of predicted infections among small hospitals as with the selections described above.

The data also provide hospital quality control offices with notice that zero HAIs is an attainable achievement for many Pennsylvania hospitals. In reviewing the hospitals with zero CAUTIs, the largest number of predicted CAUTIs is 6.6. All hospitals with less than 6.6 predicted CAUTI’s should make it their goal to have zero CAUTIs. Two-hundred-twenty-three (78 percent) hospitals had less than 6.6 predicted infections, and they accounted for 441 CAUTIs (25 percent of all). For hospitals with more than 6.6 predicted CAUTIs, the smallest SIR was 0.23. For the seven largest hospitals that contributed 23 percent of the state’s urinary catheter days and more than 50 predicted CAUTIs each, the smallest SIR was 0.887. If the other six hospitals were able to lower their SIRs to 0.887, 104 CAUTIs would be prevented each year.

Because the number of predicted HAIs varies by type of HAI, hospitals are encouraged to explore the data for each HAI separately and be aggressive in setting attainable goals. Pennsylvania hospitals are encouraged to identify similar hospitals, determine the lowest SIR and set a goal to meet that SIR. They are additionally encouraged to use available free consultative resources from the Patient Safety Authority (PSA), Quality Insights, and the Hospital and Healthsystem Association of Pennsylvania to implement evidence-based practices to reduce HAIs, particularly CLABSIs and CAUTIs. Outreach to similar hospitals to ask how they achieved such low HAIs is encouraged and moving towards a goal of zero HAIs is still the nation’s and Pennsylvania’s goal.

It is important to note that DOH works collaboratively with a variety of stakeholder organizations to promote health care quality and reduce the incidence of healthcare-associated infections. In addition, two governmental partners, the PSA and the Pennsylvania Health Care Cost Containment Council (PHC4), have specific roles under Act 52 and work closely with DOH on HAI prevention and control. Readers of the annual report are encouraged to examine companion reports published by PSA and PHC4. The PSA annual report for 2016 describes PSA HAI-related activities and can be found at http://patientsafetyauthority.org. The PHC4 report titled, “The Impact of Healthcare-Associated Infections in Pennsylvania, 2010,” examines costs, mortality, readmissions and underlying health conditions associated with HAIs. It can be found at http://www.phc4.org.