Chapter 1 Executive Summary

Pennsylvania was one of the first states to recognize the harmful impact that healthcare-associated infections (HAIs) had on patient outcomes and quality of life related to additional medical treatment, loss of time, and financial burden. As a result, in 2007, the Pennsylvania General Assembly amended the Medical Care Availability and Reduction of Error (MCARE) Act by adding a new chapter (Pennsylvania Act 52) to address the reduction and prevention of HAIs in Pennsylvania. This law includes requirements for hospitals to report all HAI events into the National Healthcare Safety Network (NHSN), a secure internet-based data collection/reporting system managed by the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention (CDC). The use of NHSN provides standardized HAI case definitions and allows for analysis and comparison to hospitals located throughout the nation. As required by Act 52, the department analyzes HAI data reported to NHSN, summarizes the findings and releases an annual report that documents progress that Pennsylvania hospitals have made in implementing HAI prevention strategies to encourage statewide reduction of HAIs.

This 2017 report is the 10th report to be released by the department and the 2nd to use an interactive online format. These data demonstrate an overall continued decline in HAIs. However, the reader must be aware that this report does not include data from nursing homes, long term care facilities, ambulatory surgical centers, or other outpatient care centers and only includes information from Pennsylvania acute care, critical access, inpatient rehabilitation, long-term acute care, psychiatric, and children’s hospitals for the calendar year 2017. Results are presented for a subset of NHSN HAI types, 2 device utilization rates, and 2 proxy infection events [Laboratory-Identified Events (LabID)]. Included are:

  1. Central line-associated bloodstream infections (CLABSI)
  2. Catheter-associated urinary tract infections (CAUTI)
  3. Surgical site infections (SSI) for 7 procedure types
    • Abdominal hysterectomies (HYST)
    • Colon surgeries (COLO)
    • Cardiac surgeries (CARD)
    • Coronary bypass with chest incision and donor incisions (CBG with 2 incisions)
    • Coronary bypass with chest incision only (CBG with 1 incision)
    • Hip prosthesis (HPRO)
    • Knee prothesis (KPRO)
  4. Urinary catheter utilization
  5. Central line utilization
  6. Clostridioides difficile lab events (CDI LabID)
  7. Methicillin-resistant Staphylococcus aureus blood specimen events (MRSA LabID)

This report presents HAI results using 2 NHSN metrics to gauge the progress in reducing HAIs.

  1. The standardized infection ratio (SIR) compares the number of reported infections with the number of predicted infections based on 2015 baseline data. The SIR is adjusted to account for factors that impact the risk of acquiring an HAI and are statistically related to the occurrence of the HAI. Factors may be either facility-related or, for surgical site infections, patient characteristics.
  2. The standardized utilization ratio (SUR) compares the actual number of device days reported with the number of predicted device days based on 2015 national baseline data. It is adjusted for facility characteristics.

In both metrics, the predicted number is calculated from the 2015 NHSN national baseline data, which uses 2015 reported HAI data. Comparisons of SIRs and SURs can only be made when the baseline data are from the same timeframe. Readers are cautioned that the SIRs in this report cannot be compared to Pennsylvanian HAI reports prior to 2016. These SIRs can be compared to data from the 2016 annual report and CDC HAI progress reports that use the 2015 national baseline.

The metrics are calculated using aggregate data reported by included Pennsylvania hospitals and are presented for the entire commonwealth, by hospital type and by individual hospitals.

Healthcare-Associated Infections in Hospital Settings by Type: Number of Infections (Cases), Standardized Infection Ratio (SIR), and Number of Infections Needed to Prevent to Reach National SIR Goal (Goal) | Pennsylvania 2017

HAI Type Acute care hospitals Critical access hospitals Long term acute care hospitals Inpatient rehabilita-tion facilities Children’s hospitals Psychia-tric hospitals
CAUTI
Cases 1218 8 96 105 21 2
SIR 0.85 0.95 1.19 1.37 1.23 0.48
Goal* (SIR= 0.75) -139 -2 -36 -48 -8 Goal met
CLABSI
Cases 899 1 91 24 140 Not measured
SIR 0.76 0.68 1.05 1.08 0.97
Goal* (SIR= 0.5) -311 Goal met -48 -13 -68
COLO SSI
Cases 346 Combined with acute care Not measured Not measured Not measured Not measured
SIR 0.81
Goal* (SIR= 0.7) -47
HYST SSI
Cases 77 Combined with acute care Not measured Not measured Not measured Not measured
SIR 0.91
Goal* (SIR= 0.7) -18
CDI LabID
Cases 4100 Not measured 228 265 Not measured Not measured
SIR 0.85 1.19 0.87
Goal* (SIR= 0.70) -713 -93 -53
MRSA LabID
Cases 352 Not measured 44 6 6 Not measured
SIR 0.78 1.19 0.47 1.09
Goal* (SIR= 0.50) -126 -30 Goal Met -3
* Goal: The number of cases needed to be prevented in order to meet the 2020 national reduction SIR goal set by United States Department of Health and Human Services (HHS)

2017 Catheter-associated urinary tract infections (CAUTIs) Among the 1,364,079 patient urinary catheter days, 1,450 CAUTIs were reported to NHSN from 295 Pennsylvania hospitals. The state SIR was 0.89, which was statistically significantly lower than the 2015 NHSN national baseline (95% CI: 0.85-0.94). The SIR in inpatient rehabilitation facilities was highest (SIR: 1.37, 95% CI: 1.13-1.66), and it was lowest in psychiatric hospitals (SIR: 0.48, 95% CI: 0.08-1.60). Eleven hospitals had SIRs greater than 1.0. To meet the 2020 United States Department of Health and Human Services (HHS) HAI CAUTI goal of a 25% reduction in CAUTIs compared to those predicted in 2015, 231 additional infections need to be prevented. The urinary catheter SUR was 0.86 (95% CI: 0.86-0.86) among 166 acute care hospitals. The SUR was highest among psychiatric hospitals (SUR: 1.72, 95% CI: 1.67-1.78).

2017 Central line-associated blood stream infections (CLABSIs) Among 1,409,018 patient central line days, 1,155 CLABSIs were reported to NHSN from 279 hospitals. The state SIR was 0.81, statistically significantly less than the 2015 national baseline (95% CI: 0.76-0.86). The SIR in inpatient rehabilitation facilities was highest (SIR:1.08, 95% CI: 0.71-1.58) and in critical access hospitals was lowest (SIR: 0.68, 95%CI: 0.03-3.38). Four hospitals had statistically significant SIRs that were greater than 1.0. To meet the 2020 HHS HAI CLABSI goal of a 50% reduction in cases compared with the number predicted in 2015, 440 reported additional infections need to be prevented. Pennsylvania acute care hospitals report using fewer central lines than predicted (SUR: 0.85, 95% CI: 0.85-0.85).

2017 Surgical site infections (SSI) In 2017, 172 Pennsylvania hospitals performed at least 1 of the 7 surgical procedures tracked for surgical site infection surveillance. Hospitals reported 119,219 of these surgical procedures and 798 (deep tissue or organ space) SSIs were later identified. Knee replacement surgery was the most common and represented 37.7% of all the surgical procedures. The SIRs for each surgery type were 0.78 (95% CI: 0.53-1.12) for CARD, 0.94 (95% CI: 0.72-1.21) for CBG with 2 incisions, 0.83 (95% CI: 0.36-1.64) for CBG with 1 incision, 0.81 (95% CI: 0.73-0.90) for COLO, 0.91 (95% CI: 0.78-1.06) for HPRO, 0.91 (95% CI: 0.72-1.13) for HYST, and 0.81 (95% CI: 0.68-0.97) for KPRO. Three hospitals had statistically significant SIRs greater than 1.0 for HYST, KPRO and CBG with two incisions. Two hospitals had statistically significant COLO SIRs greater than 1.0. One hospital had a statistically significant HPRO SIR greater than 1.0. To meet the 2020 HHS COLO SSI goal of a 30% reduction in cases compared with the number predicted in 2015, 47 additional infections need to be prevented. To meet the same 2020 HHS HYST goal, 18 additional infections need to be prevented.

2017 Clostridioides difficile infections (CDI LabID) Among the 7,678,209 patient days, 4,658 CDI LabID events were reported from 283 hospitals. CDI LabID events from children’s, critical access, and psychiatric hospitals are not required to be reported into NHSN. The SIR from acute care hospitals was 0.85, statistically lower than predicted from the 2015 national baseline (95%CI: 0.8-0.9). The highest CDI SIR was among long-term acute care hospitals (SIR 1.18, 95% CI: 1.04-1.35). Fifteen hospitals had statistically significant SIRs greater than 1.0. To meet the 2020 HHS HAI CDI goal of a 30% reduction in cases compared with the number predicted in 2015, 871 CDI LabID events need to be prevented.

2017 Methicillin-resistant Staphylococcus aureus Blood Infections (MRSA LabID) Among the 8,174,228 patient days, 408 MRSA LabID events were reported from 285 hospitals. MRSA LabID events from children’s, critical access, and psychiatric hospitals are not required to be reported into NHSN. The state SIR was 0.82, statistically lower than predicted from the 2015 national baseline (95% CI: 0.74-0.90). The highest SIR was among long-term acute care facilities (SIR 1.61, 95% CI: 1.18-2.14). Four hospitals had statistically significant SIRs that were greater than 1.0. To meet the 2020 HHS MRSA LabID goal of a 50% reduction in cases compared with the number predicted in 2015, 158 MRSA LabID events need to be prevented.

According to CDC, each day, approximately 1 in 31 U.S. patients has at least 1 infection in association with his or her hospital care, underscoring the need for improvements in patient care practices in US health care facilities1. While much progress has been made, opportunities yet exist to prevent HAIs in a variety of settings. Currently, the Department recommends that hospitals train and audit staff and processes to adhere to national guidelines to prevent HAIs and perform surveillance to identify HAI clusters or outbreaks.2