American Journal of Infection Control 41 (2013) 1148-66
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American Journal of Infection Control
American Journal of Infection Control
journal homepage: www.ajicjournal.org
Special article
National Healthcare Safety Network (NHSN) report, data summary for 2012, Device-associated module Margaret A. Dudeck MPH, CPH *, Lindsey M. Weiner MPH, Katherine Allen-Bridson RN, BSN, MScPH, Paul J. Malpiedi MPH, Kelly D. Peterson BBA, Daniel A. Pollock MD, Dawn M. Sievert PhD, Jonathan R. Edwards MStat Division of Healthcare Quality Promotion, National Center for Emerging, Zoonotic, and Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, U.S. Department of Health and Human Services, Atlanta, Georgia
This report is a summary of Device-associated (DA) Module data collected by hospitals participating in the National Healthcare Safety Network (NHSN) for events occurring from January through December 2012 and reported to the Centers for Disease Control and Prevention (CDC) by July 1, 2013. This report updates previously published DA Module data from NHSN and provides contemporary comparative rates.1 Figure 1 provides a brief summary of key findings from this report. This report complements other NHSN reports, including national and state-specific reports of standardized infection ratios (SIRs) for select health care-associated infections (HAIs).2,3 NHSN data collection, reporting, and analysis are organized into four components: Patient Safety, Healthcare Personnel Safety, Biovigilance, and Long-term Care, and use standardized methods and definitions in accordance with specific module protocols.4,5,6,7 Institutions may use modules singly or simultaneously, but once selected, they must be used for a minimum of one calendar month for the data to be included in CDC analyses. All infections are categorized using standard CDC definitions that include laboratory and clinical criteria.5-7 The DA Module within the Patient Safety Component may be used by facilities other than general acute care hospitals, including inpatient rehabilitation facilities (IRFs) and long term acute care hospitals (LTACHs). NHSN facilities contributing HAI surveillance data to this report did so voluntarily, in response to state mandatory reporting requirements or in compliance with the Centers for Medicare and Medicaid Services’ (CMS’s) Quality Reporting Programs.8,9 CDC aggregated these data into a single national database for 2012, consistent with the stated purposes of NHSN, which are to:
* Address correspondence to Margaret A. Dudeck, MPH, CPH, National Center for Emerging, Zoonotic, and Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE MS A-24, Atlanta, GA 30329. E-mail address: [email protected] (M.A. Dudeck). This report is public domain and can be copied freely.
Collect data from a sample of health care facilities in the United States to permit valid estimation of the magnitude of adverse events among patients and health care personnel. Collect data from a sample of health care facilities in the United States to permit valid estimation of the adherence to practices known to be associated with prevention of these adverse events. Analyze and report collected data to permit recognition of trends. Provide facilities with risk-adjusted metrics that can be used for inter-facility comparisons and local quality improvement activities. Assist facilities in developing surveillance and analysis methods that permit timely recognition of patient and health care worker safety problems and prompt intervention with appropriate measures. Conduct collaborative research studies with NHSN member facilities (eg, describe the epidemiology of emerging health care-associated infection [HAI] and pathogens, assess the importance of potential risk factors, further characterize HAI pathogens and their mechanisms of resistance, and evaluate alternative surveillance and prevention strategies). Comply with legal requirements e including but not limited to state or federal laws, regulations, or other requirements e for mandatory reporting of health care facility-specific adverse event, prevention practice adherence, and other public health data. Enable health care facilities to report HAI and prevention practice adherence data via NHSN to the U.S. Centers for Medicare and Medicaid Services (CMS) in fulfillment of CMS’s quality measurement reporting requirements for those data. Provide state departments of health with information that identifies the health care facilities in their state that participate in NHSN. Provide to state agencies, at their request, facility-specific, NHSN patient safety component and health care personnel safety
0196-6553/$00.00 - Published by Elsevier Inc. on behalf of the Association for Professionals in Infection Control and Epidemiology, Inc. http://dx.doi.org/10.1016/j.ajic.2013.09.002
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Fig 1. Highlights from this report.
component adverse event and prevention practice adherence data for surveillance, prevention, or mandatory public reporting. Patient- and facility-specific data reported to CDC are kept confidential in accordance with sections 304, 306, and 308(d) of the Public Health Service Act (42 USC 242b, 242k, and 242m(d)).
days. For specialty care areas and oncology units, such as hematology/oncology and hematopoietic stem cell transplant locations, central line-days are split into those with only a permanent central line vs those with temporary central lines (with or without a permanent central line). In NICU locations, the device-days consist of the total number of central line-days (inclusive of umbilical catheters), or ventilator-days for each birth-weight category.
METHODS Data collection methods
Data analysis methods
For reporting to the DA Module, health care facility personnel responsible for infection prevention and patient safety may choose, with consideration of state mandates, federal reporting programs, and prevention initiatives, to collect data on central line-associated bloodstream infections (CLABSI), ventilator-associated pneumonias (VAP), or urinary catheter-associated urinary tract infections (CAUTI) that occur in patients staying in a patient care location such as a critical or intensive care unit (ICU), specialty care area, or inpatient ward. In NHSN, locations are further stratified according to patient population: adults, children, or neonates (in tables, pediatric and neonatal locations are so noted). In neonatal intensive care unit (NICU) locations (level III or level II/III), infection preventionists (IPs) collect data on CLABSI or VAP that occur in patients in each of five birth-weight categories (750 g, 751-1,000 g, 1,001 1,500 g, 1,501 - 2,500 g, and >2,500 g); data on CAUTI are not collected as part of the NHSN protocols in any NICU location. Corresponding location-specific denominator data consisting of patient-days and specific device-days are also collected by IPs or other trained personnel. In non-NICU locations, the device-days consist of the total number of central line-days, urinary catheter-days, or ventilator-
Compared to the previous report, five new locations d gastrointestinal ward, pediatric orthopedic ward, inpatient hospice ward, solid tumor ward, and pediatric inpatient rehabilitation facility e had sufficient data to be included in this report.1 Locations were further stratified by facility type, unit bed size and/or major teaching status to determine if pooled mean rates, medians, and empirical distributions significantly differed between two groups for all DA infections; if differences were present, the strata were retained for reporting. Comparisons of pooled mean rates were performed using Poisson regression. These comparisons could be influenced by potential outlier rates from locations with disproportionately large denominators. Therefore, greater weight was given to the results of nonparametric tests comparing the medians for location shift and empirical distributions for assessing differences across the range of reported rates. These nonparametric comparisons by definition require no validity assumptions and provide test results that are not subject to the potential weighting influence of high or low rates with large denominators. Comparisons of the pooled mean, median and percentile distribution were made if there were at least 50 locations contributing to one or more strata and at least
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Table 1 NHSN facilities contributing data used in this report Hospital type Children’s Critical access General, including acute, trauma, and teaching Long-term acute care Military Oncology Orthopedic Psychiatric Rehabilitation Surgical Veterans’ Affairs Women’s Women’s and Children’s Total
N (%) 70 (1.6) 324 (7.3) 3,200 (72.0) 465 (10.5) 34 (0.8) 12 (0.3) 14 (0.3) 10 (0.2) 237 (5.3) 51 (1.1) 12 (0.3) 6 (0.1) 9 (0.2) 4,444
20 locations contributing to the percentile distribution in both strata. Existing strata were retained for adult combined medical/ surgical ICUs, medical ICUs, and surgical ICUs. The data for adult combined medical/surgical ICUs were split by medical school affiliation and unit bedsize, resulting in three groups: “major teaching,” “all others” with unit bedsize 15 beds, and “all others” with unit bedsize >15. The data for adult medical ICUs and adult surgical ICUs were split into two groups by teaching status. Hospitals self-identified their teaching hospital status through the annual NHSN facility survey. A major teaching hospital was defined as a hospital that has a program for medical students and post-graduate medical training. Locations within critical access hospitals (CAHs) were compared to their counterparts in all other acute care hospitals. The statistical evidence indicated that there was a significant difference in these strata and therefore, data from CAHs have been reported separate from all other location types. Adult hematology/oncology locations were also evaluated to assess importance of status as an oncology hospital, but differences were not significant and no new strata for this population were retained. Device utilization (DU) was calculated as a ratio of device-days to patient-days for each location type. As such, the DU of a location is one measure of the use of invasive devices and constitutes an extrinsic risk factor for health care-associated infection.10 DU may also serve as a marker for severity of illness of patients (ie more severely ill patients are more likely to require an invasive device) which is another reflection of the intrinsic susceptibility to infection. Data from at least 5 different reporting units of a given location type were used to determine pooled mean DA infection rates and DU ratios. Percentile distributions were determined if there were data from at least 20 different locations, excluding rates or DU ratios for locations that did not report at least 50 device-days or patient-days. Because of these requirements, the number of locations contributing data may vary among the tables.
RESULTS In 2012, 4,444 enrolled facilities reported at least one month of DA denominator data for some patient cohorts under surveillance. These 4,444 facilities were located in 53 states, territories, and the District of Columbia and were predominantly general acute care
hospitals (Table 1); 27% of all facilities that reported data were smaller organizations of 50 beds or less, comprised mostly of acute care hospitals that were not identified as critical access. Among LTACHs and IRFs, 59% and 86%, respectively, were categorized as physically free-standing from a hospital setting (Table 2). Where data volume was sufficient for this report, we tabulated DA infection rates and DU ratios for January through December 2012 (Tables 3-10). Data on the specific criteria used to report DA infections are provided in Tables 11-18. Tables 3-6 update and augment previously published DA rates and DU ratios by type of non-NICU locations.1 Based on results of statistical comparisons, data from CAHs are reported separately from all other acute care hospitals. These data are further stratified into combined critical care units and combined non-critical care units. Tables 7-10 update and augment the previously published DA rates and DU ratios by birth-weight category for NICU locations.1 Beginning in January 2012, CLABSI data in NICU locations were no longer collected according to central line type (ie, central line and umbilical catheter); therefore, CLABSI rates and DU ratios for NICUs are not stratified by line type in this report. Tables 11-18 provide data on select attributes of the DA infections for each location. For example, Tables 11, 12, 15 and 16 show the frequency and percent distribution of the specific sites of CLABSI and the criteria used for identifying these infections. Note that for these tables, criteria 2 and 3, which involve common commensals only, have been combined.
DISCUSSION This report summarizes the HAI data reported to the DA module of NHSN during 2012. Compared to the health care facility types for which HAI data were summarized in the last published report, in this report there is a slight increase in smaller hospitals, IRFs, and LTACHs.1 Based on the number of facilities reporting, overall contribution from all facility types to the device-associated module increased by 15% from the last report.1 This increase in reporting is largely attributable to health care facilities’ participation in CMS’s Quality Reporting Programs which require participants to use NHSN as the tool to report CLABSI data from all acute care hospital adult, pediatric, and neonatal ICUs (effective as of January 2011) and all LTACH locations, as well as CAUTI data from all acute care hospital adult and pediatric ICUs, and all LTACH and IRF locations (effective as of January 2012).8,9 While this growth impacted the volume of reporting in these designated settings, there is also an indication of increased participation in ward locations for CLABSI and CAUTI surveillance. Extensive analyses of the impact of facility type and medical school affiliation on all DA infection rates were performed for select locations. Medical school affiliation continues to be a significant factor for all three DA infection rates and/or percentile distributions in medical ICUs and surgical ICUs. All DA infection rate pooled means in this report continue to be higher in those locations stratified as major teaching compared to their non-major teaching counterparts. This suggests room for targeted prevention efforts in these settings that care for higher complexity patients. Additionally, medical school affiliation and bed size both continue to be significant factors in DA infection rates for medical/surgical ICUs. Note that while the CLABSI rates between unit bedsize strata in medical/surgical “all other” ICUs are equal (Table 3), the
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Table 2 Enrolled NHSN facilities contributing data used in this report by facility type and bedsize Bed size category 50 Facility type Acute care hospitals Major teaching Graduate teaching Undergraduate teaching Nonteaching Long term acute care hospitals Free-standing Within a hospital Inpatient rehabilitation facilities Free-standing Within a health care facility* Total
51-200
N (%) 802 16 33 16 737 274 104 170 102 82 20 1,178
N (%)
(18.0) (0.4) (0.7) (0.4) (16.6) (6.2) (2.3) (3.8) (2.3) (1.8) (0.5) (26.5)
1,596 99 202 63 1,232 181 161 20 131 118 13 1,908
(35.9) (2.2) (4.5) (1.4) (27.7) (4.1) (3.6) (0.5) (2.9) (2.6) (0.3) (42.9)
>500
201-500 N (%) 1,086 215 238 38 595 10 9 1 3 3 0 1,099
N (%)
(24.4) (4.8) (5.4) (0.8) (13.4) (0.2) (0.2) (0.0) (0.1) (0.1) (0.0) (24.7)
258 145 55 3 55 0 0 0 1 1 0 259
Total N (%)
(5.8) (3.3) (1.2) (0.1) (1.2) (0.0) (0.0) (0.0) (0.0) (0.0) (0.0) (5.8)
3,742 (84.2) 475 (10.7) 528 (11.9) 120 (2.7) 2,619 (58.9) 465 (10.5) 274 (6.2) 191 (4.3) 237 (5.3) 204 (4.6) 33 (0.7) 4,444
Major: Facility has a program for medical students and post-graduate medical training. Graduate: Facility has a program for post-graduate medical training (ie, residency and/or fellowships). Undergraduate: Facility has a program for medical students only. Free-standing/within a hospital or health care facility: Describes physical placement of LTACH or IRF and does not define financial or administrative relationship with other health care facility types. *Does not include inpatient rehabilitation facilities reporting to NHSN as locations within enrolled acute care hospitals. Table 3 Pooled means and key percentiles of the distribution of laboratory-confirmed central line associated BSI rates and central line utilization ratios, by type of location, DA module, 2012 Central line-associated BSI rate* Type of location Acute Care Hospitals Critical Care Burn Medical Major teaching Medical All other Medical cardiac Medical/surgical Major teaching Medical/surgical All other 15 beds Medical/surgical All other > 15 beds Neurologic Neurosurgical Pediatric cardiothoracic Pediatric medical Pediatric medical/surgical Pediatric surgical Prenatal Respiratory Surgical Major teaching Surgical All other Surgical cardiothoracic Trauma Step-Down Units Adult step-down (post-critical care) Step-down NICU (level II) Pediatric step-down (post-critical care) Inpatient Wards Acute stroke Antenatal Behavioral health/psychiatry Burn Gastrointestinal Genitourinary Geronotology Gynecology Jail Labor and delivery Labor, delivery, recovery, postpartum suite Medical
Percentile No. of locationsy
No. of CLABSI
Central line-days
Pooled mean
10%
25%
50% (median)
75%
90%
73 (72)
265
78,825
3.4
0.0
0.7
2.2
5.2
9.3
231 (230)
792
625,053
1.3
0.0
0.5
1.1
1.9
2.8
459 (433) 409 (403)
684 630
627,374 597,529
1.1 1.1
0.0 0.0
0.0 0.0
0.5 0.8
1.5 1.6
2.9 2.5
328 (324)
940
765,267
1.2
0.0
0.0
1.0
1.8
3.0
1,690 (1,562)
1,226
1,312,634
0.9
0.0
0.0
0.0
1.2
2.6
803 (801) 55 (54) 174 41 33 (24) 317 (293) 6 6 (3) 10
1,894 83 361 189 29 573 3 1 18
2,110,694 80,900 314,752 134,529 24,297 401,074 3,457 376 15,254
0.9 1.0 1.1 1.4 1.2 1.4 0.9 2.7 1.2
0.0 0.0 0.0 0.0 0.0 0.0
0.0 0.0 0.0 0.8 0.0 0.0
0.7 0.5 0.9 1.3 0.6 0.8
1.4 1.6 1.9 2.1 2.7 2.1
2.2 2.5 2.8 2.5 3.8 2.9
178
529
445,486
1.2
0.0
0.3
0.9
1.8
2.8
210 (203) 459 (457) 153
357 803 547
387,095 950,847 341,619
0.9 0.8 1.6
0.0 0.0 0.0
0.0 0.0 0.5
0.7 0.5 1.3
1.5 1.2 2.4
2.5 2.0 3.9
585 (570) 42 (20) 14
527 4 26
667,879 5,096 13,962
0.8 0.8 1.9
0.0 0.0
0.0 0.0
0.0 0.0
1.2 0.0
2.3 0.0
20 18 (6) 104 (31) 17 6 14 (12) 10 (9) 51 (28) 14 (12) 57 (2) 111 (16) 917 (877)
15 1 5 21 19 19 3 6 12 0 4 962
14,038 1,554 9,032 8,877 10,619 17,005 5,940 10,916 7,350 802 3,182 1,080,386
1.1 0.6 0.6 2.4 1.8 1.1 0.5 0.5 1.6 0.0 1.3 0.9
0.0
0.0
0.0
1.4
3.4
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
1.1
0.0
0.0
0.0
1.3
2.5
(continued on next page)
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Table 3 continued Central line-associated BSI rate* Type of location Medical/surgical Neurologic Neurosurgical Orthopedic Orthopedic trauma Pediatric medical Pediatric medical/surgical Pediatric orthopedic Pediatric rehabilitation - non-IRFz Pediatric surgical Postpartum Pulmonary Rehabilitation - non-IRFz Surgical Telemetry Vascular Surgery Well-Baby Nursery Chronic Care Unitsx Chronic care Inpatient hospice Ventilator dependent unit Critical Access Hospitals Critical care unitsjj Non-critical care units{ Long-Term Acute Care Hospitals{ Adult critical care Adult ward Inpatient Rehabilitation Facilities** Adult rehabilitation units - Freestanding Adult rehabilitation units - Within health care facility
Percentile No. of locationsy
No. of CLABSI
Central line-days
Pooled mean
10%
25%
50% (median)
75%
90%
1,592 54 44 78 26 48 226 1 8 15 2 69 4 452 241 21 0
1,938,992 64,719 54,802 172,241 22,588 49,399 212,654 2,034 4,418 15,668 3,647 66,228 15,786 555,766 277,559 37,652 486
0.8 0.8 0.8 0.5 1.2 1.0 1.1 0.5 1.8 1.0 0.5 1.0 0.3 0.8 0.9 0.6 0.0
0.0 0.0 0.0 0.0 0.0 0.0 0.0
0.0 0.0 0.0 0.0 0.0 0.0 0.0
0.0 0.0 0.0 0.0 0.4 0.0 0.0
1.1 1.4 0.8 0.0 1.6 1.1 1.1
2.2 2.6 2.2 1.7 2.1 2.3 2.3
0.0 0.0 0.0 0.0 0.0 0.0
0.0 0.0 0.0 0.0 0.0 0.0
0.0 0.7 0.0 0.3 0.0 0.0
0.0 1.3 0.0 1.4 1.3 1.3
0.0 2.7 0.0 2.8 2.7 1.9
24 5 7
18 0 15
24,932 3,089 13,193
0.7 0.0 1.1
0.0
0.0
0.0
0.9
1.8
153 (74) 181 (126)
10 21
17,942 37,932
0.6 0.6
0.0 0.0
0.0 0.0
0.0 0.0
0.0 0.0
0.0 0.0
63 574 (564)
147 1,967
90,703 1,879,822
1.6 1.0
0.0 0.0
0.0 0.0
1.1 0.8
2.6 1.6
4.4 2.4
69 (64) 323 (288)
17 86
44,818 133,910
0.4 0.6
0.0 0.0
0.0 0.0
0.0 0.0
0.0 0.0
1.0 2.4
No. of locationsy
Central line-days
Patient-days
2,048 64 63 274 21 52 286 10
(1,932) (63) (61) (247) (20) (47) (216) (3) 8 14 155 (23) 41 32 (26) 507 (482) 298 (293) 25 16 (3)
Central line utilization ratioyy Type of location Acute Care Hospitals Critical Care Burn Medical Major teaching Medical All other Medical cardiac Medical/surgical Major teaching Medical/surgical All other 15 beds Medical Surgical All other > 15 beds Neurologic Neurosurgical Pediatric cardiothoracic Pediatric medical Pediatric medical/surgical Pediatric surgical Prenatal Respiratory Surgical Major teaching Surgical All other Surgical cardiothoracic Trauma Step-Down Units Adult step-down (post-critical care) Step-down NICU (level II) Pediatric step-down (post-critical care) Inpatient Wards Acute stroke Antenatal Behavioral health/psychiatry Burn Gastrointestinal Genitourinary
Percentile Pooled mean
10%
25%
50% (median)
75%
90%
73
78,825
165,242
0.48
0.21
0.32
0.46
0.61
0.75
231
625,053
1,065,875
0.59
0.39
0.50
0.59
0.68
0.76
459 (454) 409
627,374 597,529
1,403,932 1,421,371
0.45 0.42
0.12 0.18
0.23 0.30
0.41 0.41
0.57 0.56
0.69 0.69
328 (327)
765,267
1,380,023
0.55
0.27
0.41
0.53
0.65
0.71
1,690 (1,669)
1,312,634
3,774,615
0.35
0.10
0.19
0.33
0.49
0.62
803 55 (54) 174 41 33 (29) 317 (313) 6 6 10
2,110,694 80,900 314,752 134,529 24,297 401,074 3,457 376 15,254
4,378,657 160,483 721,754 187,490 56,936 880,238 9,252 6,974 32,728
0.48 0.50 0.44 0.72 0.43 0.46 0.37 0.05 0.47
0.29 0.22 0.25 0.52 0.10 0.15
0.40 0.35 0.35 0.59 0.21 0.23
0.51 0.49 0.43 0.76 0.29 0.36
0.60 0.59 0.53 0.87 0.39 0.51
0.69 0.74 0.63 0.91 0.48 0.60
178
445,486
753,588
0.59
0.37
0.47
0.58
0.70
0.77
210 (208) 459 (458) 153
387,095 950,847 341,619
717,985 1,428,269 631,876
0.54 0.67 0.54
0.33 0.37 0.35
0.44 0.50 0.45
0.55 0.68 0.54
0.66 0.81 0.63
0.75 0.90 0.70
585 (583) 42 (40) 14
667,879 5,096 13,962
3,188,720 79,525 51,428
0.21 0.06 0.27
0.08 0.01
0.12 0.03
0.19 0.06
0.29 0.09
0.40 0.15
20 18 104 17 6 14
14,038 1,554 9,032 8,877 10,619 17,005
111,017 27,399 257,975 41,957 38,469 72,775
0.13 0.06 0.04 0.21 0.28 0.23
0.06
0.09
0.11
0.14
0.16
0.00
0.01
0.01
0.03
0.05
(continued on next page)
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Table 3 continued Central line utilization ratioyy Type of location Geronotology Gynecology Jail Labor and delivery Labor, delivery, recovery, postpartum suite Medical Medical/surgical Neurologic Neurosurgical Orthopedic Orthopedic Trauma Pediatric medical Pediatric medical/surgical Pediatric orthopedic Pediatric rehabilitation - non-IRFz Pediatric surgical Postpartum Pulmonary Rehabilitation - non-IRFz Surgical Telemetry Vascular surgery Well-Baby Nursery Chronic Care Unitsx Chronic care unit Inpatient hospice Ventilator dependent unit Critical Access Hospitals Critical care unitsjj Non-critical care units{ Long-Term Acute Care Hospitals# Adult critical care Adult ward Inpatient Rehabilitation Facilities** Adult rehabilitation units - Freestanding Adult rehabilitation units - Within health care facility
Percentile No. of locationsy
Central line-days
Patient-days
Pooled mean
10 51 (50) 14 57 (56) 111 (110) 917 (911) 2,048 (2,038) 64 63 274 21 52 286 (284) 10 8 14 155 41 32 507 (506) 298 25 16 (14)
5,940 10,916 7,350 802 3,182 1,080,386 1,938,992 64,719 54,802 172,241 22,588 49,399 212,654 2,034 4,418 15,668 3,647 66,228 15,786 555,766 277,559 37,652 486
51,878 124,952 46,237 53,708 147,766 6,325,631 13,323,221 460,682 400,128 1,629,594 149,270 234,474 1,142,975 12,684 24,829 70,738 318,836 290,991 122,348 3,336,490 2,111,059 178,330 11,649
0.11 0.09 0.16 0.01 0.02 0.17 0.15 0.14 0.14 0.11 0.15 0.21 0.19 0.16 0.18 0.22 0.01 0.23 0.13 0.17 0.13 0.21 0.04
24 (23) 5 7
24,932 3,089 13,193
104,024 10,670 41,749
153 (136) 181 (177)
17,942 37,932
63 574 (573) 69 323 (322)
10%
25%
50% (median)
75%
90%
0.01
0.02
0.04
0.08
0.14
0.00 0.00 0.06 0.05 0.06 0.06 0.02 0.03 0.04 0.02
0.01 0.01 0.09 0.08 0.09 0.08 0.05 0.10 0.08 0.05
0.01 0.01 0.15 0.12 0.14 0.14 0.08 0.15 0.16 0.10
0.03 0.03 0.21 0.17 0.18 0.18 0.13 0.17 0.26 0.22
0.06 0.06 0.30 0.26 0.21 0.22 0.17 0.21 0.39 0.34
0.00 0.10 0.03 0.05 0.05 0.09
0.00 0.14 0.06 0.09 0.09 0.11
0.01 0.22 0.11 0.14 0.13 0.19
0.02 0.31 0.18 0.21 0.17 0.27
0.04 0.38 0.31 0.27 0.23 0.40
0.24 0.29 0.32
0.04
0.09
0.17
0.33
0.61
113,098 415,592
0.16 0.09
0.06 0.03
0.10 0.04
0.17 0.07
0.23 0.10
0.34 0.16
90,703 1,879,822
147,465 3,069,199
0.62 0.61
0.53 0.30
0.66 0.52
0.78 0.66
0.88 0.76
0.93 0.86
44,818 133,910
578,554 1,394,340
0.08 0.10
0.02 0.04
0.04 0.06
0.06 0.08
0.10 0.12
0.15 0.16
BSI, bloodstream infection; CLABSI, central line-associated BSI; NICU, neonatal intensive care unit. Number of CLABSI 1; 000. * Number of central line days y The number in parentheses is the number of locations meeting minimum requirements for percentile distributions (ie, 50 device days for rate distributions, 50 patient days for device utilization ratios) if less than total number of locations. If this number is 15 beds Neurologic Neurosurgical Pediatric cardiothoracic Pediatric medical Pediatric medical/surgical Pediatric surgical Respiratory Surgical Major teaching Surgical All other Surgical cardiothoracic Trauma Specialty Care Areas/Oncology General hematology/oncology Hematopoietic stem cell transplant Pediatric general hematology/oncology Pediatric hematopoietic stem cell transplant Solid organ transplant Solid tumor Step-down Units Adult step-down (post-critical care) Pediatric step-down (post-critical care) Inpatient Wards Acute stroke Antenatal Behavioral health/psychiatry Burn Genitourinary Gerontology Gynecology Jail Labor and delivery Labor, delivery, recovery, postpartum suite Medical Medical/Surgical Neurologic Neurosurgical Orthopedic Orthopedic trauma Pediatric medical Pediatric medical/surgical Pediatric orthopedic Pediatric rehabilitation - non-IRFz Pediatric surgical
Percentile No. of locationsy
Urinary catheter-days
Patient days
73
82,039
163,298
0.50
0.24
0.35
0.48
0.64
0.84
230
741,268
1,061,826
0.70
0.53
0.64
0.73
0.79
0.85
460 (456) 405
852,627 703,734
1,401,026 1,393,767
0.61 0.50
0.32 0.29
0.50 0.42
0.64 0.54
0.74 0.66
0.82 0.76
328 (327)
935,001
1,371,681
0.68
0.46
0.58
0.69
0.77
0.83
1,688 (1,670)
2,032,215
3,800,961
0.53
0.31
0.45
0.60
0.72
0.79
797 55 173 32 30 (27) 297 (292) 5 9
2,766,887 118,556 489,391 28,823 10,389 166,710 1,346 19,324
4,338,434 157,449 713,836 129,344 49,809 775,828 3,792 32,296
0.64 0.75 0.69 0.22 0.21 0.21 0.35 0.60
0.46 0.48 0.46 0.07 0.05 0.08
0.59 0.64 0.61 0.16 0.09 0.13
0.70 0.76 0.72 0.20 0.13 0.19
0.77 0.85 0.80 0.30 0.21 0.26
0.82 0.88 0.86 0.36 0.34 0.32
176
558,102
745,658
0.75
0.55
0.67
0.77
0.84
0.89
209 (205) 456 (455) 153
491,868 939,044 490,351
708,482 1,417,609 631,132
0.69 0.66 0.78
0.52 0.41 0.60
0.64 0.55 0.71
0.75 0.70 0.80
0.82 0.80 0.86
0.88 0.89 0.93
148 (147) 42 24 5 16 6
119,248 21,134 3,252 277 22,667 25,785
812,884 192,836 113,041 8,384 94,290 78,482
0.15 0.11 0.03 0.03 0.24 0.33
0.07 0.03 0.01
0.10 0.05 0.01
0.14 0.08 0.02
0.20 0.16 0.03
0.28 0.23 0.08
470 (469) 12
615,962 970
2,480,340 37,889
0.25 0.03
0.11
0.17
0.25
0.37
0.50
17,456 2,234 11,605 6,061 11,409 7,489 29,614 3,372 28,435 63,794 882,392 2,038,073 78,211 61,879 356,156 31,586 4,188 31,738 2,086 245 5,846
77,769 33,101 318,371 35,863 65,152 60,604 170,866 37,316 168,958 411,335 5,552,794 11,501,523 376,137 315,157 1,389,082 132,749 102,201 654,343 11,202 6,965 48,474
0.22 0.07 0.04 0.17 0.18 0.12 0.17 0.09 0.17 0.16 0.16 0.18 0.21 0.20 0.26 0.24 0.04 0.05 0.19 0.04 0.12
0.00
0.01
0.02
0.04
0.06
0.05
0.11
0.15
0.23
0.38
0.01 0.05 0.07 0.09 0.08 0.10 0.11
0.06 0.09 0.11 0.12 0.14 0.15 0.17
0.11 0.13 0.15 0.17 0.19 0.19 0.25
0.21 0.18 0.20 0.22 0.24 0.24 0.33
0.35 0.29 0.26 0.29 0.34 0.35 0.43
0.00 0.01
0.01 0.01
0.02 0.03
0.04 0.07
0.10 0.12
15 15 118 16 12 11 59 (58) 11 95 (94) 167 (166) 813 (809) 1,825 (1,814) 56 48 249 (248) 17 33 (32) 209 (205) 5 5 12
(continued on next page)
M.A. Dudeck et al. / American Journal of Infection Control 41 (2013) 1148-66
1157
Table 5 continued Urinary catheter utilization ratioyy
Percentile No. of locationsy
Type of location Postpartum Pulmonary Rehabilitation - non-IRFz Surgical Telemetry Vascular surgery Well-baby nursery Chronic Care Unitsx Chronic care Chronic care rehabilitation unit Inpatient hospice Ventilator dependent unit Critical Access Hospitals Critical care unitsjj Non-critical care units{ Long-Term Acute Care Hospitals# Adult critical care Adult ward Inpatient Rehabilitation Facilities** Adult rehabilitation units - Freestanding Adult rehabilitation units - Within hospital Pediatric rehabilitation units - Within hospital
Urinary catheter-days
Patient days
Pooled mean
10%
25%
50% (median)
75%
90%
215 29 37 (36) 458 207 20 6 (4)
115,138 44,393 11,285 647,041 286,809 23,153 24
880,621 206,424 113,203 2,887,968 1,484,465 139,105 1,024
0.13 0.22 0.10 0.22 0.19 0.17 0.02
0.03 0.09 0.04 0.11 0.11 0.06
0.08 0.14 0.06 0.16 0.14 0.11
0.12 0.18 0.09 0.22 0.19 0.15
0.17 0.30 0.13 0.29 0.25 0.20
0.24 0.51 0.24 0.39 0.30 0.27
30 (27) 12 5 5
14,553 2,278 5,509 8,311
95,809 26,153 10,670 28,901
0.15 0.09 0.52 0.29
0.04
0.07
0.13
0.17
0.28
140 (129) 276 (239)
35,833 98,900
118,365 609,462
0.30 0.16
0.19 0.08
0.31 0.12
0.43 0.16
0.54 0.22
0.66 0.30
61 588 (587)
57,468 1,282,295
128,089 2,757,396
0.45 0.47
0.35 0.20
0.46 0.35
0.65 0.46
0.80 0.57
0.87 0.66
286 888 (887) 10
119,422 180,177 1,087
1,382,477 2,171,747 13,564
0.09 0.08 0.08
0.03 0.02
0.05 0.05
0.08 0.07
0.10 0.11
0.15 0.17
UTI, urinary tract infection; CAUTI, catheter-associated UTI. Number of CAUTI 1; 000. * Number of urinary catheter days y The number in parentheses is the number of locations meeting minimum requirements for percentile distributions (ie, 50 device days for rate distributions, 50 patient days for device utilization ratios) if less than total number of locations. If this number is 15 beds Neurologic Neurosurgical Pediatric cardiothoracic Pediatric medical Pediatric medical/surgical Pediatric surgical Respiratory Surgical Major teaching
Percentile No. of locationsy
No. of VAP
Ventilatoredays
Pooled mean
10%
25%
50% (median)
75%
90%
36 (34)
86
19,503
4.4
0.0
0.0
1.1
6.7
10.9
112 (111)
205
212,392
1.0
0.0
0.0
0.5
1.6
2.9
223 (197) 178 (170)
191 135
206,731 139,864
0.9 1.0
0.0 0.0
0.0 0.0
0.0 0.0
1.3 1.5
3.4 3.6
152 (145)
372
234,972
1.6
0.0
0.0
0.9
2.2
3.9
841 (660)
419
383,926
1.1
0.0
0.0
0.0
1.2
3.6
405 (400) 23 76 (74) 20 16 (9) 142 (132) 5 (4) 7
666 62 210 9 2 113 1 4
711,280 20,859 98,026 36,187 6,634 147,441 2,328 6,037
0.9 3.0 2.1 0.2 0.3 0.8 0.4 0.7
0.0 0.0 0.0 0.0
0.0 0.0 0.0 0.0
0.4 0.2 1.5 0.0
1.3 2.5 2.9 0.2
2.8 7.0 3.8 0.6
0.0
0.0
0.0
0.9
2.4
81 (80)
280
127,251
2.2
0.0
0.6
1.5
3.1
5.6
(continued on next page)
1158
M.A. Dudeck et al. / American Journal of Infection Control 41 (2013) 1148-66
Table 6 continued Ventilator-associated PNEU rate* Type of location Surgical All other Surgical cardiothoracic Trauma Specialty Care Areas/Oncology Hematopoietic stem cell transplant Step-Down Units Adult step-down (post-critical care) Pediatric step-down (post-critical care) Step-down NICU (level II) Inpatient Wards Medical Medical/surgical Pediatric medical Pediatric medical/surgical Pulmonary Surgical Telemetry Critical Access Hospitals Critical care unitsz Non-critical care unitsx Long-Term Acute Care Hospitalsjj Adult critical care Adult ward
Percentile No. of locationsy
No. of VAP
Ventilatoredays
Pooled mean
10%
25%
50% (median)
75%
90%
93 (88) 207 (203) 75 (74)
192 319 508
96,388 190,785 141,314
2.0 1.7 3.6
0.0 0.0 0.0
0.0 0.0 0.8
0.9 0.6 2.6
2.8 2.5 6.0
5.9 5.1 9.4
5
0
1,951
0.0
102 (82) 5 (4) 7 (1)
31 1 0
42,462 5,813 119
0.7 0.2 0.0
0.0
0.0
0.0
0.0
1.8
(22) (35) (5) (8) (8) (1) (5)
3 22 0 0 7 0 1
6,472 25,731 2,026 3,146 7,241 107 1,770
0.5 0.9 0.0 0.0 1.0 0.0 0.6
0.0 0.0
0.0 0.0
0.0 0.0
0.0 0.0
1.4 1.3
67 (14) 9 (1)
3 4
2,964 2,660
1.0 1.5
8 103
12,544 316,632
0.6 0.3
0.0
0.0
0.0
0.3
1.4
Pooled mean
10%
25%
50% (median)
75%
90%
39 64 6 11 9 8 10
18 (17) 195 (190)
{
Percentile
Ventilator utilization ratio Type of location
Acute Care Hospitals Critical Care Units Burn Medical Major teaching Medical All other Medical cardiac Medical/surgical Major teaching Medical/surgical All other 15 beds Medical/surgical All other >15 beds Neurologic Neurosurgical Pediatric cardiothoracic Pediatric medical Pediatric medical/surgical Pediatric surgical Respiratory Surgical Major teaching Surgical All other Surgical cardiothoracic Trauma Specialty Care Areas/Oncology Hematopoietic stem cell transplant Step-Down Units Adult step-down (post-critical care) Pediatric step-down (post-critical care) Step-down NICU (level II) Inpatient Wards Medical Medical/surgical Pediatric medical Pediatric medical/surgical Pulmonary Surgical Telemetry
No. of locationsy
Ventilatoredays
36
19,503
71,198
0.27
0.08
0.15
0.23
0.34
0.43
112
212,392
477,003
0.45
0.28
0.37
0.45
0.54
0.63
223 (220) 178 (177)
206,731 139,864
606,883 547,699
0.34 0.26
0.08 0.09
0.16 0.16
0.28 0.25
0.42 0.33
0.55 0.40
152 (150)
234,972
618,025
0.38
0.16
0.25
0.37
0.46
0.54
841 (815)
383,926
1,616,191
0.24
0.05
0.10
0.19
0.32
0.43
405 23 76 20 16 142 (141) 5 (4) 7
711,280 20,859 98,026 36,187 6,634 147,441 2,328 6,037
2,114,095 64,005 323,269 86,054 21,470 400,413 8,039 22,926
0.34 0.33 0.30 0.42 0.31 0.37 0.29 0.26
0.19 0.10 0.16 0.25
0.25 0.20 0.24 0.34
0.33 0.33 0.30 0.41
0.41 0.39 0.39 0.50
0.49 0.42 0.45 0.54
0.12
0.19
0.30
0.42
0.48
81
127,251
320,792
0.40
0.23
0.29
0.40
0.48
0.53
93 (92) 207 (206) 75
96,388 190,785 141,314
281,455 606,801 301,607
0.34 0.31 0.47
0.15 0.15 0.34
0.22 0.20 0.41
0.32 0.29 0.47
0.41 0.39 0.53
0.47 0.49 0.63
1,951
22,808
0.09
102 (101) 5 7 (6)
42,462 5,813 119
437,346 19,832 4,073
0.10 0.29 0.03
0.01
0.03
0.06
0.13
0.24
39 64 6 11 9 8 10
6,472 25,731 2,026 3,146 7,241 107 1,770
209,363 378,747 25,314 62,702 51,428 15,644 42,097
0.03 0.07 0.08 0.05 0.14 0.01 0.04
0.00 0.00
0.00 0.01
0.02 0.02
0.04 0.05
0.07 0.13
5
Patient-days
(continued on next page)
M.A. Dudeck et al. / American Journal of Infection Control 41 (2013) 1148-66
1159
Table 6 continued Ventilator utilization ratio{
Percentile No. of locationsy
Type of location Critical Access Hospitals Critical care unitsz Non-critical care unitsx Long-Term Acute Care Hospitalsjj Adult critical care Adult ward
Ventilatoredays
Patient-days
Pooled mean
10%
25%
50% (median)
75%
90%
0.01
0.04
0.07
0.12
0.16
0.07
0.12
0.19
0.29
0.39
67 (54) 9 (9)
2,964 2,660
30,983 12,632
0.10 0.21
18 (17) 195
12,544 316,632
41,665 1,474,536
0.30 0.21
VAP, ventilator-associated pneumonia. Number of VAP 1; 000. * Number of ventilator days y The number in parentheses is the number of locations meeting minimum requirements for percentile distributions (ie, 50 device days for rate distributions, 50 patient days for device utilization ratios) if less than total number of locations. If this number is 2,500 grams
380 401 418 415 422
(334) (339) (370) (338) (322)
No. of CLABSI
Central line-days
Pooled mean
10%
25%
50 % (median)
75%
90%
420 256 195 104 136
185,851 160,230 172,732 161,361 176,853
2.3 1.6 1.1 0.6 0.8
0 0 0 0 0
0 0 0 0 0
1.5 0 0 0 0
3.7 2.6 1.6 0 0.3
7.5 4.6 3.9 2.3 2.0
Central line utilization ratioz Birth-weight category
Percentile
No. of locationsy
750 grams 751-1,000 grams 1,001-1,500 grams 1,501-2,500 grams >2,500 grams
380 401 418 415 422
(346) (369) (407) (410) (412)
Central line-days
Patient-days
Pooled Mean
10%
25%
50% (median)
75%
90%
185,851 160,230 172,732 161,361 176,853
455,113 457,406 653,953 908,957 738,196
0.41 0.35 0.26 0.18 0.24
0.27 0.21 0.13 0.05 0.06
0.33 0.27 0.18 0.08 0.09
0.42 0.34 0.24 0.13 0.15
0.55 0.46 0.35 0.22 0.26
0.67 0.60 0.49 0.37 0.42
BSI, bloodstream infection; CLABSI, central line-associated BSI; NICU, neonatal intensive care unit. Number of CLABSI 1; 000. * Number of central line days y The number in parentheses is the number of locations meeting minimum requirements for percentile distributions (ie, 50 device days for rate distributions, 50 patient days for device utilization ratios) if less than total number of locations. If this number is 2,500 grams
377 443 524 555 555
(283) (312) (373) (351) (313)
No. of CLABSI
Central line-days
Pooled mean
10%
25%
50% (median)
75%
90%
300 197 115 67 68
118,042 101,014 123,617 109,035 112,147
2.5 2.0 0.9 0.6 0.6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
4.9 3.3 0 0 0
10.1 7.8 3.4 1.9 1.4
Central line utilization ratioz Birth-weight category 750 grams 751-1,000 grams 1,001-1,500 grams 1,501-2,500 grams >2,500 grams
Percentile
No. of locationsy 377 443 524 555 555
(311) (356) (466) (532) (528)
Central line-days
Patient-days
Pooled mean
10%
25%
50% (median)
75%
90%
118,042 101,014 123,617 109,035 112,147
310,004 304,330 484,544 756,073 614,939
0.38 0.33 0.26 0.14 0.18
0.23 0.19 0.11 0.04 0.05
0.33 0.27 0.17 0.06 0.07
0.45 0.36 0.25 0.10 0.11
0.57 0.47 0.35 0.17 0.19
0.75 0.61 0.49 0.28 0.29
BSI, bloodstream infection; CLABSI, central line-associated BSI; NICU, neonatal intensive care unit. Number of CLABSI 1; 000. * Number of central line days y The number in parentheses is the number of locations meeting minimum requirements for percentile distributions (ie, 50 device days for rate distributions, 50 patient days for device utilization ratios) if less than total number of locations. If this number is 2,500 grams
Percentile
No. of locationsy 157 163 167 165 167
(133) (123) (95) (83) (87)
No. of VAP
Ventilator-days
Pooled mean
10%
25%
50% (median)
75%
90%
97 47 14 4 10
73,987 39,689 22,701 20,945 30,305
1.3 1.2 0.6 0.2 0.3
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2.0 0 0 0 0
4.4 4.0 2.1 0 0
Ventilator utilization ratioz Birth-weight category 750 grams 751-1,000 grams 1,001-1,500 grams 1,501-2,500 grams >2,500 grams
Percentile No. of locationsy 157 163 167 165 167
(143) (149) (157) (163) (162)
Ventilator-days
Patient-days
Pooled mean
10%
25%
50% (median)
75%
90%
73,987 39,689 22,701 20,945 30,305
195,281 171,975 225,630 308,507 272,791
0.38 0.23 0.10 0.07 0.11
0.21 0.08 0.02 0.01 0.02
0.28 0.14 0.04 0.02 0.03
0.38 0.20 0.07 0.04 0.06
0.50 0.35 0.14 0.08 0.11
0.65 0.48 0.26 0.18 0.19
VAP, ventilator-associated pneumonia; NICU, neonatal intensive care unit. Number of VAP 1; 000. * Number of ventilator days y The number in parentheses is the number of locations meeting minimum requirements for percentile distributions (ie, 50 device days for rate distributions, 50 patient days for device utilization ratios) if less than total number of locations. If this number is 2,500 grams
Percentile
No. of locations 147 157 184 194 201
y
(110) (100) (75) (54) (58)
No. of VAP
Ventilator-days
Pooled mean
10%
25%
50% (median)
75%
90%
76 33 8 5 5
44,399 23,481 14,065 12,029 16,163
1.7 1.4 0.6 0.4 0.3
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2.4 0 0 0 0
5.8 5.6 0 0 0
Ventilator utilization ratioz Birth-weight category 750 grams 751-1,000 grams 1,001-1,500 grams 1,501-2,500 grams >2,500 grams
Percentile y
No. of locations 147 157 184 194 201
(121) (137) (166) (188) (189)
Ventilator-days
Patient-days
Pooled mean
10%
25%
50% (median)
75%
90%
44,399 23,481 14,065 12,029 16,163
117,397 106,652 151,764 246,360 194,888
0.38 0.22 0.09 0.05 0.08
0.25 0.09 0.03 0.01 0.02
0.30 0.16 0.05 0.02 0.02
0.43 0.22 0.08 0.03 0.05
0.53 0.33 0.14 0.05 0.08
0.71 0.45 0.24 0.09 0.13
VAP, ventilator-associated pneumonia; NICU, neonatal intensive care unit. Number of VAP 1; 000. * Number of ventilator days y The number in parentheses is the number of locations meeting minimum requirements for percentile distributions (ie, 50 device days for rate distributions, 50 patient days for device utilization ratios) if less than total number of locations. If this number is 15 beds Neurologic Neurosurgical
Criterion 1 n (%)
Criterion 2/3 n (%)
Total
251 (94.7)
14 (5.3)
265
692 (87.4)
100 (12.6)
792
560 (81.9) 487 (77.3)
124 (18.1) 143 (22.7)
684 630
803 (85.4)
137 (14.6)
940
996 (81.2)
230 (18.8)
1,226
1,542 (81.4) 63 (75.9) 275 (76.2)
352 (18.6) 20 (24.1) 86 (23.8)
1,894 83 361 (continued on next page)
M.A. Dudeck et al. / American Journal of Infection Control 41 (2013) 1148-66
1161
Table 11 continued LCBI Type of location Pediatric cardiothoracic Pediatric medical Pediatric medical/surgical Pediatric surgical Prenatal Respiratory Surgical Major teaching Surgical All other Surgical cardiothoracic Trauma Step-Down Units Adult step-down (post-critical care) Step-down NICU (level II) Pediatric step-down (post-critical care) Inpatient Wards Acute stroke Antenatal Behavioral health/psychiatry Burn Gastrointestinal Genitourinary Geronotology Gynecology Jail Labor and delivery Labor, delivery, recovery, postpartum suite Medical Medical/surgical Neurologic Neurosurgical Orthopedic Orthopedic trauma Pediatric medical Pediatric medical/surgical Pediatric orthopedic Pediatric rehabilitation - non-IRF* Pediatric surgical Postpartum Pulmonary Rehabilitation - non-IRF* Surgical Telemetry Vascular Surgery Well-Baby Nursery Chronic Care Unitsy Chronic care Inpatient hospice Ventilator dependent unit Critical Access Hospitals Critical care unitsz Non-critical care unitsx Long-Term Acute Care Hospitalsjj Adult critical care Adult ward Inpatient Rehabilitation Facilities{ Adult rehabilitation units - Freestanding Adult rehabilitation units - Within health care facility TOTAL
Criterion 1 n (%) 154 24 466 3 1 16
(81.5) (82.8) (81.3) (100.0) (100.0) (88.9)
Criterion 2/3 n (%)
Total
2 (11.1)
189 29 573 3 1 18
443 (83.7)
86 (16.3)
529
276 (77.3) 657 (81.8) 458 (83.7)
81 (22.7) 146 (18.2) 89 (16.3)
357 803 547
459 (87.1) 2 (50.0) 21 (80.8)
68 (12.9) 2 (50.0) 5 (19.2)
527 4 26
14 (93.3)
1 (6.7) 1 (100.0) 1 (80.0) 2 (9.5) 1 (5.3) 6 (31.6) 1 (33.3) 1 (16.7) 1 (8.3) 0 0 (0.0) 108 (11.2) 243 (15.3) 11 (20.4) 7 (15.9) 13 (16.7) 5 (19.2) 5 (10.4) 31 (13.7)
4 (80.0) 19 (90.5) 18 (94.7) 13 (68.4) 2 (66.7) 5 (83.3) 11 (91.7) 0 4 (100.0) 854 (88.8) 1,349 (84.7) 43 (79.6) 37 (84.1) 65 (83.3) 21 (80.8) 43 (89.6) 195 (86.3) 1 (100.0) 8 (100.0) 13 (86.7) 2 (100.0) 60 (87.0) 3 (75.0) 388 (85.8) 212 (88.0) 20 (95.2) 0
35 (18.5) 5 (17.2) 107 (18.7)
2 (13.3) 9 (13.0) 1 (25.0) 64 (14.2) 29 (12.0) 1 (4.8) 0
15 1 5 21 19 19 3 6 12 0 4 962 1,592 54 44 78 26 48 226 1 8 15 2 69 4 452 241 21 0
14 (77.8) 0 15 (100.0)
4 (22.2) 0
18 0 15
7 (70.0) 16 (76.2)
3 (30.0) 5 (23.8)
10 21
132 (89.8) 1,734 (88.2)
15 (10.2) 233 (11.8)
147 1,967
9 (10.5) 2,645 (15.8)
17 86 16,710
17 (100.0) 77 (89.5) 14,065 (84.2)
BSI, bloodstream infection; LCBI, laboratory-confirmed BSI.5 *Includes only in-hospital rehabilitation wards that are not defined as inpatient rehabilitation facilities (IRF) per the CMS Inpatient Rehabilitation Facility Quality Reporting Program. y Includes chronic care locations within the general acute care hospital setting. z Combines all critical care unit types within critical access hospitals. x Combines all units not identified as critical care (eg, inpatient wards, step-down units) within critical access hospitals. jj Includes free-standing long-term acute care hospitals and long-term acute care locations within the general acute care hospital setting. { Includes free-standing inpatient rehabilitation facilities and inpatient rehabilitation facilities within the acute care hospital setting, as defined by the CMS Inpatient Rehabilitation Facility Quality Reporting Program.
1162
M.A. Dudeck et al. / American Journal of Infection Control 41 (2013) 1148-66
Table 12 Distribution of criteria for permanent and temporary central line-associated laboratory-confirmed BSI by location, 2012 LCBI Type of Location Permanent Central Line General hematology/oncology Hematopoietic stem cell transplant Pediatric general hematology/oncology Pediatric hematopoietic stem cell transplant Solid organ transplant Solid tumor Total Temporary Central Line General hematology/oncology Hematopoietic stem cell transplant Pediatric general hematology/oncology Pediatric hematopoietic stem cell transplant Solid organ transplant Solid tumor Total
Criterion 1 n (%)
Criterion 2/3 n (%)
Total
308 200 187 67 16 11 789
(76.6) (78.1) (72.8) (72.0) (80.0) (73.3) (75.6)
94 56 70 26 4 4 254
(23.4) (21.9) (27.2) (28.0) (20.0) (26.7) (24.4)
402 256 257 93 20 15 1,043
399 229 73 17 57 10 785
(81.3) (77.9) (77.7) (77.3) (89.1) (58.8) (79.9)
92 65 21 5 7 7 197
(18.7) (22.1) (22.3) (22.7) (10.9) (41.2) (20.1)
491 294 94 22 64 17 982
BSI, bloodstream infection; LCBI, laboratory-confirmed BSI.5
Table 13 Distribution of specific sites of urinary catheter-associated UTI by location, 2012 Type of location Acute Care Hospitals Critical care units Burn Medical Major teaching Medical All other Medical cardiac Medical/Surgical Major teaching Medical/Surgical All other, 15 beds Medical/Surgical All other, >15 beds Neurologic Neurosurgical Pediatric cardiothoracic Pediatric medical Pediatric medical/surgical Pediatric surgical Respiratory Surgical Major teaching Surgical All other Surgical cardiothoracic Trauma Specialty Care Areas/Oncology General hematology/oncology Hematopoietic stem cell transplant Pediatric general hematology/oncology Pediatric hematopoietic stem cell transplant Solid organ transplant Solid tumor Step-down Units Adult step-down (post-critical care) Pediatric step-down (post-critical care) Inpatient Wards Acute stroke Antenatal Behavioral health/psychiatry Burn Genitourinary Gerontology Gynecology Jail Labor and delivery Labor, delivery, recovery, postpartum suite
SUTI n (%)
ABUTI n (%)
Total
382 (99.5)
2 (0.5)
384
2,150 (98.6)
31 (1.4)
2,181
1,408 (97.9) 1,497 (98.7)
30 (2.1) 20 (1.3)
1,438 1,517
2,244 (98.4)
36 (1.6)
2,280
2,472 (98.1)
49 (1.9)
2,521
4,323 437 2,459 60 35 450 1 29
64 4 5 1
1 (3.3)
4,387 441 2,464 61 35 452 1 30
1,782 (99.1)
17 (0.9)
1,799
910 (99.1) 1,628 (98.2) 1,973 (99.1)
8 (0.9) 29 (1.8) 18 (0.9)
918 1,657 1,991
(98.4) (95.1) (100.0) (100.0) (94.6) (100.0)
4 (1.6) 2 (4.9)
257 41 9 1 37 58
1,120 (98.3) 1 (100.0)
19 (1.7)
1,139 1
1 (3.8)
26 2 32 32 11 8 26 6 15 30
253 39 9 1 35 58
25 2 31 30 11 8 25 5 15 30
(98.5) (99.1) (99.8) (98.4) (100.0) (99.6) (100.0) (96.7)
(96.2) (100.0) (96.9) (93.8) (100.0) (100.0) (96.2) (83.3) (100.0) (100.0)
(1.5) (0.9) (0.2) (1.6)
2 (0.4)
2 (5.4)
1 (3.1) 2 (6.3)
1 (3.8) 1 (16.7)
(continued on next page)
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1163
Table 13 continued Type of location
SUTI n (%)
Medical Medical/Surgical Neurologic Neurosurgical Orthopedic Orthopedic trauma Pediatric medical Pediatric medical/surgical Pediatric orthopedic Pediatric rehabilitation - non-IRF* Pediatric surgical Postpartum Pulmonary Rehabilitation - non-IRF* Surgical Telemetry Vascular surgery Well-baby nursery Chronic Care Unitsy Chronic care Chronic care rehabilitation unit Inpatient hospice Ventilator dependent unit Critical Access Hospitals Critical care unitsz Non-critical care unitsx Long-Term Acute Care Hospitalsjj Adult critical care Adult ward Inpatient Rehabilitation Facilities{ Adult rehabilitation units - Freestanding Adult rehabilitation units - Within hospital Pediatric rehabilitation units - Within hospital TOTAL
ABUTI n (%)
Total
1,320 2,711 159 175 422 68 6 55 1 1 4 61 87 28 1,082 390 25
(99.0) (98.5) (100.0) (100.0) (99.3) (100.0) (100.0) (100.0) (100.0) (100.0) (100.0) (100.0) (98.9) (96.6) (98.5) (97.5) (100.0)
14 (1.0) 40 (1.5)
30 6 2 39
(96.8) (100.0) (100.0) (97.5)
1 (3.2)
1 (2.5)
31 6 2 40
25 (100.0) 167 (96.5)
6 (3.5)
25 173
3 (2.0) 47 (1.9)
148 2,537
2 (0.6) 9 (1.6)
347 569 2 36,849
3 (0.7)
1 1 17 10
145 (98.0) 2,490 (98.1) 345 560 2 36,344
1,334 2,751 159 175 425 68 6 55 1 1 4 61 88 29 1,099 400 25 0
(99.4) (98.4) (100.0) (98.6)
(1.1) (3.4) (1.5) (2.5)
505 (1.4)
UTI, urinary tract infection; SUTI, symptomatic UTI; ABUTI, asymptomatic bacteremic UTI.6 *Includes only in-hospital rehabilitation wards that are not defined as inpatient rehabilitation facilities (IRF) per the CMS Inpatient Rehabilitation Facility Quality Reporting Program. y Includes chronic care locations within the general acute care hospital setting. z Combines all critical care unit types within critical access hospitals. x Combines all units not identified as critical care (eg, inpatient wards, step-down units) within critical access hospitals. jj Includes free-standing long-term acute care hospitals and long-term acute care locations within the general acute care hospital setting. { Includes free-standing inpatient rehabilitation facilities and inpatient rehabilitation facilities within the acute care hospital setting, as defined by the CMS Inpatient Rehabilitation Facility Quality Reporting Program.
Table 14 Distribution of specific sites of ventilator-associated pneumonia by location, 2012 Type of location Acute Care Hospitals Critical Care Units Burn Medical Major teaching Medical All other Medical cardiac Medical/surgical Major teaching Medical/surgical All other 15 beds Medical/surgical All other >15 beds Neurologic Neurosurgical Pediatric cardiothoracic Pediatric medical Pediatric medical/surgical Pediatric surgical Respiratory Surgical Major teaching
PNU1 n (%)
PNU2 n (%)
PNU3 n (%)
Total
25
29.1%
61
70.9%
86
127
62.0%
74
36.1%
4
2.0%
205
119 88
62.3% 65.2%
65 46
34.0% 34.1%
7 1
3.7% 0.7%
191 135
208
55.9%
160
43.0%
4
1.1%
372
267
63.7%
138
32.9%
14
3.3%
419
454 24 114 6 1 80 1 4
68.2% 38.7% 54.3% 66.7% 50.0% 70.8% 100.0% 100.0%
201 37 95 2 1 28
30.2% 59.7% 45.2% 22.2% 50.0% 24.8%
11 1 1 1
1.7% 1.6% 0.5% 11.1%
5
4.4%
666 62 210 9 2 113 1 4
157
56.1%
122
43.6%
1
0.4%
280
(continued on next page)
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Table 14 continued Type of location
PNU1 n (%)
Surgical All other Surgical cardiothoracic Trauma Specialty Care Areas/Oncology Hematopoietic stem cell transplant Step-Down Units Adult step-down (post-critical care) Pediatric step-down (post-critical care) Step-down NICU (level II) Inpatient Wards Medical Medical/surgical Pediatric medical Pediatric medical/surgical Pulmonary Surgical Telemetry Critical Access Hospitals Critical care units* Non-critical care unitsy Long-Term Acute Care Hospitalsz Adult critical care Adult ward Total
89 194 232
PNU2 n (%) 46.4% 60.8% 45.7%
98 119 275
PNU3 n (%) 51.0% 37.3% 54.1%
5 6 1
Total 2.6% 1.9% 0.2%
192 319 508 0
26 1
83.9% 100.0%
5
16.1%
2 4
66.7% 18.2%
1 17
33.3% 77.3%
6
85.7%
1
14.3%
1
100.0%
3 2
100.0% 50.0%
1
7 78 2,320
87.5% 75.7% 58.6%
1 24 1,572
31 1 0 3 22 0 0 7 0 1
1
4.5%
25.0%
1
25.0%
3 4
12.5% 23.3% 39.7%
1 65
1.0% 1.6%
8 103 3,957
PNU1, clinically defined pneumonia; PNU2, pneumonia with specific laboratory findings; PNU3, pneumonia in immunocompromised patients.7 *Combines all critical care unit types within critical access hospitals. y Combines all units not identified as critical care (eg, inpatient wards, step-down units) within critical access hospitals. z Includes free-standing long-term acute care hospitals and long-term acute care locations within the general acute care hospital setting.
Table 15 Distribution of specific sites and criteria for central line-associated laboratoryconfirmed BSI among Level III NICUs by birthweight, 2012 LCBI
Birth-weight category
Birth-weight category
Criterion 1 n (%)
Criterion 2/3 n (%)
Total
750 grams 751-1,000 grams 1,001-1,500 grams 1,501-2,500 grams >2,500 grams Total
316 176 135 76 101 804
104 80 60 28 35 307
420 256 195 104 136 1,111
75.2% 68.8% 69.2% 73.1% 74.3% 72.4%
24.8% 31.3% 30.8% 26.9% 25.7% 27.6%
BSI, bloodstream infection; LCBI, laboratory-confirmed BSI.5
Table 16 Distribution of specific sites and criteria for central line-associated laboratoryconfirmed BSI among Level II/III NICUs by birthweight, 2012 LCBI Birth-weight category
Criterion 1 n (%)
Criterion 2/3 n (%)
Total
750 grams 751-1,000 grams 1,001-1,500 grams 1,501-2,500 grams >2,500 grams Total
211 127 73 49 43 503
89 70 42 18 25 244
300 197 115 67 68 747
70.3% 64.5% 63.5% 73.1% 63.2% 67.3%
Table 17 Distribution of specific sites of ventilator-associated pneumonia among Level III NICUs by birthweight, 2012
29.7% 35.5% 36.5% 26.9% 36.8% 32.7%
750 grams 751-1,000 grams 1,001-1,500 grams 1,501-2,500 grams >2,500 grams Total
PNU1 n (%) 60 30 10 1 7 108
61.9% 63.8% 71.4% 25.0% 70.0% 62.8%
PNU2 n (%)
PNU3 n (%)
Total
34 17 4 3 3 61
3
3.1%
3
1.7%
97 47 14 4 10 172
35.1% 36.2% 28.6% 75.0% 30.0% 35.5%
PNU1, clinically defined pneumonia; PNU2, pneumonia with specific laboratory findings; PNU3, pneumonia in immunocompromised patients.7
Table 18 Distribution of specific sites of ventilator-associated pneumonia among Level II/III NICUs by birthweight, 2012 Birth-weight category
PNU1 n (%)
PNU2 n (%)
PNU3 n (%)
Total
750 grams 751-1,000 grams 1,001-1,500 grams 1,501-2,500 grams > 2,500 grams Total
54 29 5 2 4 94
20 3 2 2 1 28
2 1 1 1
2.6% 3.0% 12.5% 20.0%
5
3.9%
76 33 8 5 5 127
71.1% 87.9% 62.5% 40.0% 80.0% 74.0%
26.3% 9.1% 25.0% 40.0% 20.0% 22.0%
PNU1, clinically defined pneumonia; PNU2, pneumonia with specific laboratory findings; PNU3, pneumonia in immunocompromised patients.7
BSI, bloodstream infection; LCBI, laboratory-confirmed BSI.5
(PNU1) which relies on the somewhat subjective interpretations of clinical findings. As diverse types of facilities continue to participate in NHSN, either voluntarily or by mandate, the need for careful scrutiny
of the data increases. NHSN will continue to assess how changing facility composition and changes in the proportion of data contributed by facility types impact the rates and their distributions so that the best possible risk-adjusted comparative data may be provided in future reports.
M.A. Dudeck et al. / American Journal of Infection Control 41 (2013) 1148-66
To improve the reliability of data reported to NHSN, several protocol changes were introduced in January 2013. The majority of these changes were with respect to timing and implementation of two-day rules to clarify infections that are health careassociated, association of device use to HAI, and attribution of HAI to an inpatient location after transfer or to a hospital after discharge. In addition, NHSN added criteria for mucosal barrier injury laboratory-confirmed bloodstream infections, which have not been removed or accounted for separately in this report. Finally, the VAP definition no longer applies to adult patients (ie, 18 years of age) and this definition has been replaced by ventilator-associated events (VAEs).11 We will carefully assess the potential impact of these changes on HAI incidence as these data are reported. For those who do not report to NHSN but would like to use these data for comparison, the information must first be collected from your hospital in accordance with the methods described for NHSN.5-7 Refer to Appendices A and B for further instructions. Appendix A discusses the calculation of infection rates and DU ratios for the DA Module. Appendix B gives a step-by-step method for interpretation of percentiles of infection rates or DU ratios. Although a high rate or ratio (>90th percentile) does not necessarily define a problem, it does suggest an area for further investigation. Similarly, a low rate or ratio (
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American Journal of Infection Control
American Journal of Infection Control
journal homepage: www.ajicjournal.org
Special article
National Healthcare Safety Network (NHSN) report, data summary for 2012, Device-associated module Margaret A. Dudeck MPH, CPH *, Lindsey M. Weiner MPH, Katherine Allen-Bridson RN, BSN, MScPH, Paul J. Malpiedi MPH, Kelly D. Peterson BBA, Daniel A. Pollock MD, Dawn M. Sievert PhD, Jonathan R. Edwards MStat Division of Healthcare Quality Promotion, National Center for Emerging, Zoonotic, and Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, U.S. Department of Health and Human Services, Atlanta, Georgia
This report is a summary of Device-associated (DA) Module data collected by hospitals participating in the National Healthcare Safety Network (NHSN) for events occurring from January through December 2012 and reported to the Centers for Disease Control and Prevention (CDC) by July 1, 2013. This report updates previously published DA Module data from NHSN and provides contemporary comparative rates.1 Figure 1 provides a brief summary of key findings from this report. This report complements other NHSN reports, including national and state-specific reports of standardized infection ratios (SIRs) for select health care-associated infections (HAIs).2,3 NHSN data collection, reporting, and analysis are organized into four components: Patient Safety, Healthcare Personnel Safety, Biovigilance, and Long-term Care, and use standardized methods and definitions in accordance with specific module protocols.4,5,6,7 Institutions may use modules singly or simultaneously, but once selected, they must be used for a minimum of one calendar month for the data to be included in CDC analyses. All infections are categorized using standard CDC definitions that include laboratory and clinical criteria.5-7 The DA Module within the Patient Safety Component may be used by facilities other than general acute care hospitals, including inpatient rehabilitation facilities (IRFs) and long term acute care hospitals (LTACHs). NHSN facilities contributing HAI surveillance data to this report did so voluntarily, in response to state mandatory reporting requirements or in compliance with the Centers for Medicare and Medicaid Services’ (CMS’s) Quality Reporting Programs.8,9 CDC aggregated these data into a single national database for 2012, consistent with the stated purposes of NHSN, which are to:
* Address correspondence to Margaret A. Dudeck, MPH, CPH, National Center for Emerging, Zoonotic, and Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE MS A-24, Atlanta, GA 30329. E-mail address: [email protected] (M.A. Dudeck). This report is public domain and can be copied freely.
Collect data from a sample of health care facilities in the United States to permit valid estimation of the magnitude of adverse events among patients and health care personnel. Collect data from a sample of health care facilities in the United States to permit valid estimation of the adherence to practices known to be associated with prevention of these adverse events. Analyze and report collected data to permit recognition of trends. Provide facilities with risk-adjusted metrics that can be used for inter-facility comparisons and local quality improvement activities. Assist facilities in developing surveillance and analysis methods that permit timely recognition of patient and health care worker safety problems and prompt intervention with appropriate measures. Conduct collaborative research studies with NHSN member facilities (eg, describe the epidemiology of emerging health care-associated infection [HAI] and pathogens, assess the importance of potential risk factors, further characterize HAI pathogens and their mechanisms of resistance, and evaluate alternative surveillance and prevention strategies). Comply with legal requirements e including but not limited to state or federal laws, regulations, or other requirements e for mandatory reporting of health care facility-specific adverse event, prevention practice adherence, and other public health data. Enable health care facilities to report HAI and prevention practice adherence data via NHSN to the U.S. Centers for Medicare and Medicaid Services (CMS) in fulfillment of CMS’s quality measurement reporting requirements for those data. Provide state departments of health with information that identifies the health care facilities in their state that participate in NHSN. Provide to state agencies, at their request, facility-specific, NHSN patient safety component and health care personnel safety
0196-6553/$00.00 - Published by Elsevier Inc. on behalf of the Association for Professionals in Infection Control and Epidemiology, Inc. http://dx.doi.org/10.1016/j.ajic.2013.09.002
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1149
Fig 1. Highlights from this report.
component adverse event and prevention practice adherence data for surveillance, prevention, or mandatory public reporting. Patient- and facility-specific data reported to CDC are kept confidential in accordance with sections 304, 306, and 308(d) of the Public Health Service Act (42 USC 242b, 242k, and 242m(d)).
days. For specialty care areas and oncology units, such as hematology/oncology and hematopoietic stem cell transplant locations, central line-days are split into those with only a permanent central line vs those with temporary central lines (with or without a permanent central line). In NICU locations, the device-days consist of the total number of central line-days (inclusive of umbilical catheters), or ventilator-days for each birth-weight category.
METHODS Data collection methods
Data analysis methods
For reporting to the DA Module, health care facility personnel responsible for infection prevention and patient safety may choose, with consideration of state mandates, federal reporting programs, and prevention initiatives, to collect data on central line-associated bloodstream infections (CLABSI), ventilator-associated pneumonias (VAP), or urinary catheter-associated urinary tract infections (CAUTI) that occur in patients staying in a patient care location such as a critical or intensive care unit (ICU), specialty care area, or inpatient ward. In NHSN, locations are further stratified according to patient population: adults, children, or neonates (in tables, pediatric and neonatal locations are so noted). In neonatal intensive care unit (NICU) locations (level III or level II/III), infection preventionists (IPs) collect data on CLABSI or VAP that occur in patients in each of five birth-weight categories (750 g, 751-1,000 g, 1,001 1,500 g, 1,501 - 2,500 g, and >2,500 g); data on CAUTI are not collected as part of the NHSN protocols in any NICU location. Corresponding location-specific denominator data consisting of patient-days and specific device-days are also collected by IPs or other trained personnel. In non-NICU locations, the device-days consist of the total number of central line-days, urinary catheter-days, or ventilator-
Compared to the previous report, five new locations d gastrointestinal ward, pediatric orthopedic ward, inpatient hospice ward, solid tumor ward, and pediatric inpatient rehabilitation facility e had sufficient data to be included in this report.1 Locations were further stratified by facility type, unit bed size and/or major teaching status to determine if pooled mean rates, medians, and empirical distributions significantly differed between two groups for all DA infections; if differences were present, the strata were retained for reporting. Comparisons of pooled mean rates were performed using Poisson regression. These comparisons could be influenced by potential outlier rates from locations with disproportionately large denominators. Therefore, greater weight was given to the results of nonparametric tests comparing the medians for location shift and empirical distributions for assessing differences across the range of reported rates. These nonparametric comparisons by definition require no validity assumptions and provide test results that are not subject to the potential weighting influence of high or low rates with large denominators. Comparisons of the pooled mean, median and percentile distribution were made if there were at least 50 locations contributing to one or more strata and at least
1150
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Table 1 NHSN facilities contributing data used in this report Hospital type Children’s Critical access General, including acute, trauma, and teaching Long-term acute care Military Oncology Orthopedic Psychiatric Rehabilitation Surgical Veterans’ Affairs Women’s Women’s and Children’s Total
N (%) 70 (1.6) 324 (7.3) 3,200 (72.0) 465 (10.5) 34 (0.8) 12 (0.3) 14 (0.3) 10 (0.2) 237 (5.3) 51 (1.1) 12 (0.3) 6 (0.1) 9 (0.2) 4,444
20 locations contributing to the percentile distribution in both strata. Existing strata were retained for adult combined medical/ surgical ICUs, medical ICUs, and surgical ICUs. The data for adult combined medical/surgical ICUs were split by medical school affiliation and unit bedsize, resulting in three groups: “major teaching,” “all others” with unit bedsize 15 beds, and “all others” with unit bedsize >15. The data for adult medical ICUs and adult surgical ICUs were split into two groups by teaching status. Hospitals self-identified their teaching hospital status through the annual NHSN facility survey. A major teaching hospital was defined as a hospital that has a program for medical students and post-graduate medical training. Locations within critical access hospitals (CAHs) were compared to their counterparts in all other acute care hospitals. The statistical evidence indicated that there was a significant difference in these strata and therefore, data from CAHs have been reported separate from all other location types. Adult hematology/oncology locations were also evaluated to assess importance of status as an oncology hospital, but differences were not significant and no new strata for this population were retained. Device utilization (DU) was calculated as a ratio of device-days to patient-days for each location type. As such, the DU of a location is one measure of the use of invasive devices and constitutes an extrinsic risk factor for health care-associated infection.10 DU may also serve as a marker for severity of illness of patients (ie more severely ill patients are more likely to require an invasive device) which is another reflection of the intrinsic susceptibility to infection. Data from at least 5 different reporting units of a given location type were used to determine pooled mean DA infection rates and DU ratios. Percentile distributions were determined if there were data from at least 20 different locations, excluding rates or DU ratios for locations that did not report at least 50 device-days or patient-days. Because of these requirements, the number of locations contributing data may vary among the tables.
RESULTS In 2012, 4,444 enrolled facilities reported at least one month of DA denominator data for some patient cohorts under surveillance. These 4,444 facilities were located in 53 states, territories, and the District of Columbia and were predominantly general acute care
hospitals (Table 1); 27% of all facilities that reported data were smaller organizations of 50 beds or less, comprised mostly of acute care hospitals that were not identified as critical access. Among LTACHs and IRFs, 59% and 86%, respectively, were categorized as physically free-standing from a hospital setting (Table 2). Where data volume was sufficient for this report, we tabulated DA infection rates and DU ratios for January through December 2012 (Tables 3-10). Data on the specific criteria used to report DA infections are provided in Tables 11-18. Tables 3-6 update and augment previously published DA rates and DU ratios by type of non-NICU locations.1 Based on results of statistical comparisons, data from CAHs are reported separately from all other acute care hospitals. These data are further stratified into combined critical care units and combined non-critical care units. Tables 7-10 update and augment the previously published DA rates and DU ratios by birth-weight category for NICU locations.1 Beginning in January 2012, CLABSI data in NICU locations were no longer collected according to central line type (ie, central line and umbilical catheter); therefore, CLABSI rates and DU ratios for NICUs are not stratified by line type in this report. Tables 11-18 provide data on select attributes of the DA infections for each location. For example, Tables 11, 12, 15 and 16 show the frequency and percent distribution of the specific sites of CLABSI and the criteria used for identifying these infections. Note that for these tables, criteria 2 and 3, which involve common commensals only, have been combined.
DISCUSSION This report summarizes the HAI data reported to the DA module of NHSN during 2012. Compared to the health care facility types for which HAI data were summarized in the last published report, in this report there is a slight increase in smaller hospitals, IRFs, and LTACHs.1 Based on the number of facilities reporting, overall contribution from all facility types to the device-associated module increased by 15% from the last report.1 This increase in reporting is largely attributable to health care facilities’ participation in CMS’s Quality Reporting Programs which require participants to use NHSN as the tool to report CLABSI data from all acute care hospital adult, pediatric, and neonatal ICUs (effective as of January 2011) and all LTACH locations, as well as CAUTI data from all acute care hospital adult and pediatric ICUs, and all LTACH and IRF locations (effective as of January 2012).8,9 While this growth impacted the volume of reporting in these designated settings, there is also an indication of increased participation in ward locations for CLABSI and CAUTI surveillance. Extensive analyses of the impact of facility type and medical school affiliation on all DA infection rates were performed for select locations. Medical school affiliation continues to be a significant factor for all three DA infection rates and/or percentile distributions in medical ICUs and surgical ICUs. All DA infection rate pooled means in this report continue to be higher in those locations stratified as major teaching compared to their non-major teaching counterparts. This suggests room for targeted prevention efforts in these settings that care for higher complexity patients. Additionally, medical school affiliation and bed size both continue to be significant factors in DA infection rates for medical/surgical ICUs. Note that while the CLABSI rates between unit bedsize strata in medical/surgical “all other” ICUs are equal (Table 3), the
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Table 2 Enrolled NHSN facilities contributing data used in this report by facility type and bedsize Bed size category 50 Facility type Acute care hospitals Major teaching Graduate teaching Undergraduate teaching Nonteaching Long term acute care hospitals Free-standing Within a hospital Inpatient rehabilitation facilities Free-standing Within a health care facility* Total
51-200
N (%) 802 16 33 16 737 274 104 170 102 82 20 1,178
N (%)
(18.0) (0.4) (0.7) (0.4) (16.6) (6.2) (2.3) (3.8) (2.3) (1.8) (0.5) (26.5)
1,596 99 202 63 1,232 181 161 20 131 118 13 1,908
(35.9) (2.2) (4.5) (1.4) (27.7) (4.1) (3.6) (0.5) (2.9) (2.6) (0.3) (42.9)
>500
201-500 N (%) 1,086 215 238 38 595 10 9 1 3 3 0 1,099
N (%)
(24.4) (4.8) (5.4) (0.8) (13.4) (0.2) (0.2) (0.0) (0.1) (0.1) (0.0) (24.7)
258 145 55 3 55 0 0 0 1 1 0 259
Total N (%)
(5.8) (3.3) (1.2) (0.1) (1.2) (0.0) (0.0) (0.0) (0.0) (0.0) (0.0) (5.8)
3,742 (84.2) 475 (10.7) 528 (11.9) 120 (2.7) 2,619 (58.9) 465 (10.5) 274 (6.2) 191 (4.3) 237 (5.3) 204 (4.6) 33 (0.7) 4,444
Major: Facility has a program for medical students and post-graduate medical training. Graduate: Facility has a program for post-graduate medical training (ie, residency and/or fellowships). Undergraduate: Facility has a program for medical students only. Free-standing/within a hospital or health care facility: Describes physical placement of LTACH or IRF and does not define financial or administrative relationship with other health care facility types. *Does not include inpatient rehabilitation facilities reporting to NHSN as locations within enrolled acute care hospitals. Table 3 Pooled means and key percentiles of the distribution of laboratory-confirmed central line associated BSI rates and central line utilization ratios, by type of location, DA module, 2012 Central line-associated BSI rate* Type of location Acute Care Hospitals Critical Care Burn Medical Major teaching Medical All other Medical cardiac Medical/surgical Major teaching Medical/surgical All other 15 beds Medical/surgical All other > 15 beds Neurologic Neurosurgical Pediatric cardiothoracic Pediatric medical Pediatric medical/surgical Pediatric surgical Prenatal Respiratory Surgical Major teaching Surgical All other Surgical cardiothoracic Trauma Step-Down Units Adult step-down (post-critical care) Step-down NICU (level II) Pediatric step-down (post-critical care) Inpatient Wards Acute stroke Antenatal Behavioral health/psychiatry Burn Gastrointestinal Genitourinary Geronotology Gynecology Jail Labor and delivery Labor, delivery, recovery, postpartum suite Medical
Percentile No. of locationsy
No. of CLABSI
Central line-days
Pooled mean
10%
25%
50% (median)
75%
90%
73 (72)
265
78,825
3.4
0.0
0.7
2.2
5.2
9.3
231 (230)
792
625,053
1.3
0.0
0.5
1.1
1.9
2.8
459 (433) 409 (403)
684 630
627,374 597,529
1.1 1.1
0.0 0.0
0.0 0.0
0.5 0.8
1.5 1.6
2.9 2.5
328 (324)
940
765,267
1.2
0.0
0.0
1.0
1.8
3.0
1,690 (1,562)
1,226
1,312,634
0.9
0.0
0.0
0.0
1.2
2.6
803 (801) 55 (54) 174 41 33 (24) 317 (293) 6 6 (3) 10
1,894 83 361 189 29 573 3 1 18
2,110,694 80,900 314,752 134,529 24,297 401,074 3,457 376 15,254
0.9 1.0 1.1 1.4 1.2 1.4 0.9 2.7 1.2
0.0 0.0 0.0 0.0 0.0 0.0
0.0 0.0 0.0 0.8 0.0 0.0
0.7 0.5 0.9 1.3 0.6 0.8
1.4 1.6 1.9 2.1 2.7 2.1
2.2 2.5 2.8 2.5 3.8 2.9
178
529
445,486
1.2
0.0
0.3
0.9
1.8
2.8
210 (203) 459 (457) 153
357 803 547
387,095 950,847 341,619
0.9 0.8 1.6
0.0 0.0 0.0
0.0 0.0 0.5
0.7 0.5 1.3
1.5 1.2 2.4
2.5 2.0 3.9
585 (570) 42 (20) 14
527 4 26
667,879 5,096 13,962
0.8 0.8 1.9
0.0 0.0
0.0 0.0
0.0 0.0
1.2 0.0
2.3 0.0
20 18 (6) 104 (31) 17 6 14 (12) 10 (9) 51 (28) 14 (12) 57 (2) 111 (16) 917 (877)
15 1 5 21 19 19 3 6 12 0 4 962
14,038 1,554 9,032 8,877 10,619 17,005 5,940 10,916 7,350 802 3,182 1,080,386
1.1 0.6 0.6 2.4 1.8 1.1 0.5 0.5 1.6 0.0 1.3 0.9
0.0
0.0
0.0
1.4
3.4
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
1.1
0.0
0.0
0.0
1.3
2.5
(continued on next page)
1152
M.A. Dudeck et al. / American Journal of Infection Control 41 (2013) 1148-66
Table 3 continued Central line-associated BSI rate* Type of location Medical/surgical Neurologic Neurosurgical Orthopedic Orthopedic trauma Pediatric medical Pediatric medical/surgical Pediatric orthopedic Pediatric rehabilitation - non-IRFz Pediatric surgical Postpartum Pulmonary Rehabilitation - non-IRFz Surgical Telemetry Vascular Surgery Well-Baby Nursery Chronic Care Unitsx Chronic care Inpatient hospice Ventilator dependent unit Critical Access Hospitals Critical care unitsjj Non-critical care units{ Long-Term Acute Care Hospitals{ Adult critical care Adult ward Inpatient Rehabilitation Facilities** Adult rehabilitation units - Freestanding Adult rehabilitation units - Within health care facility
Percentile No. of locationsy
No. of CLABSI
Central line-days
Pooled mean
10%
25%
50% (median)
75%
90%
1,592 54 44 78 26 48 226 1 8 15 2 69 4 452 241 21 0
1,938,992 64,719 54,802 172,241 22,588 49,399 212,654 2,034 4,418 15,668 3,647 66,228 15,786 555,766 277,559 37,652 486
0.8 0.8 0.8 0.5 1.2 1.0 1.1 0.5 1.8 1.0 0.5 1.0 0.3 0.8 0.9 0.6 0.0
0.0 0.0 0.0 0.0 0.0 0.0 0.0
0.0 0.0 0.0 0.0 0.0 0.0 0.0
0.0 0.0 0.0 0.0 0.4 0.0 0.0
1.1 1.4 0.8 0.0 1.6 1.1 1.1
2.2 2.6 2.2 1.7 2.1 2.3 2.3
0.0 0.0 0.0 0.0 0.0 0.0
0.0 0.0 0.0 0.0 0.0 0.0
0.0 0.7 0.0 0.3 0.0 0.0
0.0 1.3 0.0 1.4 1.3 1.3
0.0 2.7 0.0 2.8 2.7 1.9
24 5 7
18 0 15
24,932 3,089 13,193
0.7 0.0 1.1
0.0
0.0
0.0
0.9
1.8
153 (74) 181 (126)
10 21
17,942 37,932
0.6 0.6
0.0 0.0
0.0 0.0
0.0 0.0
0.0 0.0
0.0 0.0
63 574 (564)
147 1,967
90,703 1,879,822
1.6 1.0
0.0 0.0
0.0 0.0
1.1 0.8
2.6 1.6
4.4 2.4
69 (64) 323 (288)
17 86
44,818 133,910
0.4 0.6
0.0 0.0
0.0 0.0
0.0 0.0
0.0 0.0
1.0 2.4
No. of locationsy
Central line-days
Patient-days
2,048 64 63 274 21 52 286 10
(1,932) (63) (61) (247) (20) (47) (216) (3) 8 14 155 (23) 41 32 (26) 507 (482) 298 (293) 25 16 (3)
Central line utilization ratioyy Type of location Acute Care Hospitals Critical Care Burn Medical Major teaching Medical All other Medical cardiac Medical/surgical Major teaching Medical/surgical All other 15 beds Medical Surgical All other > 15 beds Neurologic Neurosurgical Pediatric cardiothoracic Pediatric medical Pediatric medical/surgical Pediatric surgical Prenatal Respiratory Surgical Major teaching Surgical All other Surgical cardiothoracic Trauma Step-Down Units Adult step-down (post-critical care) Step-down NICU (level II) Pediatric step-down (post-critical care) Inpatient Wards Acute stroke Antenatal Behavioral health/psychiatry Burn Gastrointestinal Genitourinary
Percentile Pooled mean
10%
25%
50% (median)
75%
90%
73
78,825
165,242
0.48
0.21
0.32
0.46
0.61
0.75
231
625,053
1,065,875
0.59
0.39
0.50
0.59
0.68
0.76
459 (454) 409
627,374 597,529
1,403,932 1,421,371
0.45 0.42
0.12 0.18
0.23 0.30
0.41 0.41
0.57 0.56
0.69 0.69
328 (327)
765,267
1,380,023
0.55
0.27
0.41
0.53
0.65
0.71
1,690 (1,669)
1,312,634
3,774,615
0.35
0.10
0.19
0.33
0.49
0.62
803 55 (54) 174 41 33 (29) 317 (313) 6 6 10
2,110,694 80,900 314,752 134,529 24,297 401,074 3,457 376 15,254
4,378,657 160,483 721,754 187,490 56,936 880,238 9,252 6,974 32,728
0.48 0.50 0.44 0.72 0.43 0.46 0.37 0.05 0.47
0.29 0.22 0.25 0.52 0.10 0.15
0.40 0.35 0.35 0.59 0.21 0.23
0.51 0.49 0.43 0.76 0.29 0.36
0.60 0.59 0.53 0.87 0.39 0.51
0.69 0.74 0.63 0.91 0.48 0.60
178
445,486
753,588
0.59
0.37
0.47
0.58
0.70
0.77
210 (208) 459 (458) 153
387,095 950,847 341,619
717,985 1,428,269 631,876
0.54 0.67 0.54
0.33 0.37 0.35
0.44 0.50 0.45
0.55 0.68 0.54
0.66 0.81 0.63
0.75 0.90 0.70
585 (583) 42 (40) 14
667,879 5,096 13,962
3,188,720 79,525 51,428
0.21 0.06 0.27
0.08 0.01
0.12 0.03
0.19 0.06
0.29 0.09
0.40 0.15
20 18 104 17 6 14
14,038 1,554 9,032 8,877 10,619 17,005
111,017 27,399 257,975 41,957 38,469 72,775
0.13 0.06 0.04 0.21 0.28 0.23
0.06
0.09
0.11
0.14
0.16
0.00
0.01
0.01
0.03
0.05
(continued on next page)
M.A. Dudeck et al. / American Journal of Infection Control 41 (2013) 1148-66
1153
Table 3 continued Central line utilization ratioyy Type of location Geronotology Gynecology Jail Labor and delivery Labor, delivery, recovery, postpartum suite Medical Medical/surgical Neurologic Neurosurgical Orthopedic Orthopedic Trauma Pediatric medical Pediatric medical/surgical Pediatric orthopedic Pediatric rehabilitation - non-IRFz Pediatric surgical Postpartum Pulmonary Rehabilitation - non-IRFz Surgical Telemetry Vascular surgery Well-Baby Nursery Chronic Care Unitsx Chronic care unit Inpatient hospice Ventilator dependent unit Critical Access Hospitals Critical care unitsjj Non-critical care units{ Long-Term Acute Care Hospitals# Adult critical care Adult ward Inpatient Rehabilitation Facilities** Adult rehabilitation units - Freestanding Adult rehabilitation units - Within health care facility
Percentile No. of locationsy
Central line-days
Patient-days
Pooled mean
10 51 (50) 14 57 (56) 111 (110) 917 (911) 2,048 (2,038) 64 63 274 21 52 286 (284) 10 8 14 155 41 32 507 (506) 298 25 16 (14)
5,940 10,916 7,350 802 3,182 1,080,386 1,938,992 64,719 54,802 172,241 22,588 49,399 212,654 2,034 4,418 15,668 3,647 66,228 15,786 555,766 277,559 37,652 486
51,878 124,952 46,237 53,708 147,766 6,325,631 13,323,221 460,682 400,128 1,629,594 149,270 234,474 1,142,975 12,684 24,829 70,738 318,836 290,991 122,348 3,336,490 2,111,059 178,330 11,649
0.11 0.09 0.16 0.01 0.02 0.17 0.15 0.14 0.14 0.11 0.15 0.21 0.19 0.16 0.18 0.22 0.01 0.23 0.13 0.17 0.13 0.21 0.04
24 (23) 5 7
24,932 3,089 13,193
104,024 10,670 41,749
153 (136) 181 (177)
17,942 37,932
63 574 (573) 69 323 (322)
10%
25%
50% (median)
75%
90%
0.01
0.02
0.04
0.08
0.14
0.00 0.00 0.06 0.05 0.06 0.06 0.02 0.03 0.04 0.02
0.01 0.01 0.09 0.08 0.09 0.08 0.05 0.10 0.08 0.05
0.01 0.01 0.15 0.12 0.14 0.14 0.08 0.15 0.16 0.10
0.03 0.03 0.21 0.17 0.18 0.18 0.13 0.17 0.26 0.22
0.06 0.06 0.30 0.26 0.21 0.22 0.17 0.21 0.39 0.34
0.00 0.10 0.03 0.05 0.05 0.09
0.00 0.14 0.06 0.09 0.09 0.11
0.01 0.22 0.11 0.14 0.13 0.19
0.02 0.31 0.18 0.21 0.17 0.27
0.04 0.38 0.31 0.27 0.23 0.40
0.24 0.29 0.32
0.04
0.09
0.17
0.33
0.61
113,098 415,592
0.16 0.09
0.06 0.03
0.10 0.04
0.17 0.07
0.23 0.10
0.34 0.16
90,703 1,879,822
147,465 3,069,199
0.62 0.61
0.53 0.30
0.66 0.52
0.78 0.66
0.88 0.76
0.93 0.86
44,818 133,910
578,554 1,394,340
0.08 0.10
0.02 0.04
0.04 0.06
0.06 0.08
0.10 0.12
0.15 0.16
BSI, bloodstream infection; CLABSI, central line-associated BSI; NICU, neonatal intensive care unit. Number of CLABSI 1; 000. * Number of central line days y The number in parentheses is the number of locations meeting minimum requirements for percentile distributions (ie, 50 device days for rate distributions, 50 patient days for device utilization ratios) if less than total number of locations. If this number is 15 beds Neurologic Neurosurgical Pediatric cardiothoracic Pediatric medical Pediatric medical/surgical Pediatric surgical Respiratory Surgical Major teaching Surgical All other Surgical cardiothoracic Trauma Specialty Care Areas/Oncology General hematology/oncology Hematopoietic stem cell transplant Pediatric general hematology/oncology Pediatric hematopoietic stem cell transplant Solid organ transplant Solid tumor Step-down Units Adult step-down (post-critical care) Pediatric step-down (post-critical care) Inpatient Wards Acute stroke Antenatal Behavioral health/psychiatry Burn Genitourinary Gerontology Gynecology Jail Labor and delivery Labor, delivery, recovery, postpartum suite Medical Medical/Surgical Neurologic Neurosurgical Orthopedic Orthopedic trauma Pediatric medical Pediatric medical/surgical Pediatric orthopedic Pediatric rehabilitation - non-IRFz Pediatric surgical
Percentile No. of locationsy
Urinary catheter-days
Patient days
73
82,039
163,298
0.50
0.24
0.35
0.48
0.64
0.84
230
741,268
1,061,826
0.70
0.53
0.64
0.73
0.79
0.85
460 (456) 405
852,627 703,734
1,401,026 1,393,767
0.61 0.50
0.32 0.29
0.50 0.42
0.64 0.54
0.74 0.66
0.82 0.76
328 (327)
935,001
1,371,681
0.68
0.46
0.58
0.69
0.77
0.83
1,688 (1,670)
2,032,215
3,800,961
0.53
0.31
0.45
0.60
0.72
0.79
797 55 173 32 30 (27) 297 (292) 5 9
2,766,887 118,556 489,391 28,823 10,389 166,710 1,346 19,324
4,338,434 157,449 713,836 129,344 49,809 775,828 3,792 32,296
0.64 0.75 0.69 0.22 0.21 0.21 0.35 0.60
0.46 0.48 0.46 0.07 0.05 0.08
0.59 0.64 0.61 0.16 0.09 0.13
0.70 0.76 0.72 0.20 0.13 0.19
0.77 0.85 0.80 0.30 0.21 0.26
0.82 0.88 0.86 0.36 0.34 0.32
176
558,102
745,658
0.75
0.55
0.67
0.77
0.84
0.89
209 (205) 456 (455) 153
491,868 939,044 490,351
708,482 1,417,609 631,132
0.69 0.66 0.78
0.52 0.41 0.60
0.64 0.55 0.71
0.75 0.70 0.80
0.82 0.80 0.86
0.88 0.89 0.93
148 (147) 42 24 5 16 6
119,248 21,134 3,252 277 22,667 25,785
812,884 192,836 113,041 8,384 94,290 78,482
0.15 0.11 0.03 0.03 0.24 0.33
0.07 0.03 0.01
0.10 0.05 0.01
0.14 0.08 0.02
0.20 0.16 0.03
0.28 0.23 0.08
470 (469) 12
615,962 970
2,480,340 37,889
0.25 0.03
0.11
0.17
0.25
0.37
0.50
17,456 2,234 11,605 6,061 11,409 7,489 29,614 3,372 28,435 63,794 882,392 2,038,073 78,211 61,879 356,156 31,586 4,188 31,738 2,086 245 5,846
77,769 33,101 318,371 35,863 65,152 60,604 170,866 37,316 168,958 411,335 5,552,794 11,501,523 376,137 315,157 1,389,082 132,749 102,201 654,343 11,202 6,965 48,474
0.22 0.07 0.04 0.17 0.18 0.12 0.17 0.09 0.17 0.16 0.16 0.18 0.21 0.20 0.26 0.24 0.04 0.05 0.19 0.04 0.12
0.00
0.01
0.02
0.04
0.06
0.05
0.11
0.15
0.23
0.38
0.01 0.05 0.07 0.09 0.08 0.10 0.11
0.06 0.09 0.11 0.12 0.14 0.15 0.17
0.11 0.13 0.15 0.17 0.19 0.19 0.25
0.21 0.18 0.20 0.22 0.24 0.24 0.33
0.35 0.29 0.26 0.29 0.34 0.35 0.43
0.00 0.01
0.01 0.01
0.02 0.03
0.04 0.07
0.10 0.12
15 15 118 16 12 11 59 (58) 11 95 (94) 167 (166) 813 (809) 1,825 (1,814) 56 48 249 (248) 17 33 (32) 209 (205) 5 5 12
(continued on next page)
M.A. Dudeck et al. / American Journal of Infection Control 41 (2013) 1148-66
1157
Table 5 continued Urinary catheter utilization ratioyy
Percentile No. of locationsy
Type of location Postpartum Pulmonary Rehabilitation - non-IRFz Surgical Telemetry Vascular surgery Well-baby nursery Chronic Care Unitsx Chronic care Chronic care rehabilitation unit Inpatient hospice Ventilator dependent unit Critical Access Hospitals Critical care unitsjj Non-critical care units{ Long-Term Acute Care Hospitals# Adult critical care Adult ward Inpatient Rehabilitation Facilities** Adult rehabilitation units - Freestanding Adult rehabilitation units - Within hospital Pediatric rehabilitation units - Within hospital
Urinary catheter-days
Patient days
Pooled mean
10%
25%
50% (median)
75%
90%
215 29 37 (36) 458 207 20 6 (4)
115,138 44,393 11,285 647,041 286,809 23,153 24
880,621 206,424 113,203 2,887,968 1,484,465 139,105 1,024
0.13 0.22 0.10 0.22 0.19 0.17 0.02
0.03 0.09 0.04 0.11 0.11 0.06
0.08 0.14 0.06 0.16 0.14 0.11
0.12 0.18 0.09 0.22 0.19 0.15
0.17 0.30 0.13 0.29 0.25 0.20
0.24 0.51 0.24 0.39 0.30 0.27
30 (27) 12 5 5
14,553 2,278 5,509 8,311
95,809 26,153 10,670 28,901
0.15 0.09 0.52 0.29
0.04
0.07
0.13
0.17
0.28
140 (129) 276 (239)
35,833 98,900
118,365 609,462
0.30 0.16
0.19 0.08
0.31 0.12
0.43 0.16
0.54 0.22
0.66 0.30
61 588 (587)
57,468 1,282,295
128,089 2,757,396
0.45 0.47
0.35 0.20
0.46 0.35
0.65 0.46
0.80 0.57
0.87 0.66
286 888 (887) 10
119,422 180,177 1,087
1,382,477 2,171,747 13,564
0.09 0.08 0.08
0.03 0.02
0.05 0.05
0.08 0.07
0.10 0.11
0.15 0.17
UTI, urinary tract infection; CAUTI, catheter-associated UTI. Number of CAUTI 1; 000. * Number of urinary catheter days y The number in parentheses is the number of locations meeting minimum requirements for percentile distributions (ie, 50 device days for rate distributions, 50 patient days for device utilization ratios) if less than total number of locations. If this number is 15 beds Neurologic Neurosurgical Pediatric cardiothoracic Pediatric medical Pediatric medical/surgical Pediatric surgical Respiratory Surgical Major teaching
Percentile No. of locationsy
No. of VAP
Ventilatoredays
Pooled mean
10%
25%
50% (median)
75%
90%
36 (34)
86
19,503
4.4
0.0
0.0
1.1
6.7
10.9
112 (111)
205
212,392
1.0
0.0
0.0
0.5
1.6
2.9
223 (197) 178 (170)
191 135
206,731 139,864
0.9 1.0
0.0 0.0
0.0 0.0
0.0 0.0
1.3 1.5
3.4 3.6
152 (145)
372
234,972
1.6
0.0
0.0
0.9
2.2
3.9
841 (660)
419
383,926
1.1
0.0
0.0
0.0
1.2
3.6
405 (400) 23 76 (74) 20 16 (9) 142 (132) 5 (4) 7
666 62 210 9 2 113 1 4
711,280 20,859 98,026 36,187 6,634 147,441 2,328 6,037
0.9 3.0 2.1 0.2 0.3 0.8 0.4 0.7
0.0 0.0 0.0 0.0
0.0 0.0 0.0 0.0
0.4 0.2 1.5 0.0
1.3 2.5 2.9 0.2
2.8 7.0 3.8 0.6
0.0
0.0
0.0
0.9
2.4
81 (80)
280
127,251
2.2
0.0
0.6
1.5
3.1
5.6
(continued on next page)
1158
M.A. Dudeck et al. / American Journal of Infection Control 41 (2013) 1148-66
Table 6 continued Ventilator-associated PNEU rate* Type of location Surgical All other Surgical cardiothoracic Trauma Specialty Care Areas/Oncology Hematopoietic stem cell transplant Step-Down Units Adult step-down (post-critical care) Pediatric step-down (post-critical care) Step-down NICU (level II) Inpatient Wards Medical Medical/surgical Pediatric medical Pediatric medical/surgical Pulmonary Surgical Telemetry Critical Access Hospitals Critical care unitsz Non-critical care unitsx Long-Term Acute Care Hospitalsjj Adult critical care Adult ward
Percentile No. of locationsy
No. of VAP
Ventilatoredays
Pooled mean
10%
25%
50% (median)
75%
90%
93 (88) 207 (203) 75 (74)
192 319 508
96,388 190,785 141,314
2.0 1.7 3.6
0.0 0.0 0.0
0.0 0.0 0.8
0.9 0.6 2.6
2.8 2.5 6.0
5.9 5.1 9.4
5
0
1,951
0.0
102 (82) 5 (4) 7 (1)
31 1 0
42,462 5,813 119
0.7 0.2 0.0
0.0
0.0
0.0
0.0
1.8
(22) (35) (5) (8) (8) (1) (5)
3 22 0 0 7 0 1
6,472 25,731 2,026 3,146 7,241 107 1,770
0.5 0.9 0.0 0.0 1.0 0.0 0.6
0.0 0.0
0.0 0.0
0.0 0.0
0.0 0.0
1.4 1.3
67 (14) 9 (1)
3 4
2,964 2,660
1.0 1.5
8 103
12,544 316,632
0.6 0.3
0.0
0.0
0.0
0.3
1.4
Pooled mean
10%
25%
50% (median)
75%
90%
39 64 6 11 9 8 10
18 (17) 195 (190)
{
Percentile
Ventilator utilization ratio Type of location
Acute Care Hospitals Critical Care Units Burn Medical Major teaching Medical All other Medical cardiac Medical/surgical Major teaching Medical/surgical All other 15 beds Medical/surgical All other >15 beds Neurologic Neurosurgical Pediatric cardiothoracic Pediatric medical Pediatric medical/surgical Pediatric surgical Respiratory Surgical Major teaching Surgical All other Surgical cardiothoracic Trauma Specialty Care Areas/Oncology Hematopoietic stem cell transplant Step-Down Units Adult step-down (post-critical care) Pediatric step-down (post-critical care) Step-down NICU (level II) Inpatient Wards Medical Medical/surgical Pediatric medical Pediatric medical/surgical Pulmonary Surgical Telemetry
No. of locationsy
Ventilatoredays
36
19,503
71,198
0.27
0.08
0.15
0.23
0.34
0.43
112
212,392
477,003
0.45
0.28
0.37
0.45
0.54
0.63
223 (220) 178 (177)
206,731 139,864
606,883 547,699
0.34 0.26
0.08 0.09
0.16 0.16
0.28 0.25
0.42 0.33
0.55 0.40
152 (150)
234,972
618,025
0.38
0.16
0.25
0.37
0.46
0.54
841 (815)
383,926
1,616,191
0.24
0.05
0.10
0.19
0.32
0.43
405 23 76 20 16 142 (141) 5 (4) 7
711,280 20,859 98,026 36,187 6,634 147,441 2,328 6,037
2,114,095 64,005 323,269 86,054 21,470 400,413 8,039 22,926
0.34 0.33 0.30 0.42 0.31 0.37 0.29 0.26
0.19 0.10 0.16 0.25
0.25 0.20 0.24 0.34
0.33 0.33 0.30 0.41
0.41 0.39 0.39 0.50
0.49 0.42 0.45 0.54
0.12
0.19
0.30
0.42
0.48
81
127,251
320,792
0.40
0.23
0.29
0.40
0.48
0.53
93 (92) 207 (206) 75
96,388 190,785 141,314
281,455 606,801 301,607
0.34 0.31 0.47
0.15 0.15 0.34
0.22 0.20 0.41
0.32 0.29 0.47
0.41 0.39 0.53
0.47 0.49 0.63
1,951
22,808
0.09
102 (101) 5 7 (6)
42,462 5,813 119
437,346 19,832 4,073
0.10 0.29 0.03
0.01
0.03
0.06
0.13
0.24
39 64 6 11 9 8 10
6,472 25,731 2,026 3,146 7,241 107 1,770
209,363 378,747 25,314 62,702 51,428 15,644 42,097
0.03 0.07 0.08 0.05 0.14 0.01 0.04
0.00 0.00
0.00 0.01
0.02 0.02
0.04 0.05
0.07 0.13
5
Patient-days
(continued on next page)
M.A. Dudeck et al. / American Journal of Infection Control 41 (2013) 1148-66
1159
Table 6 continued Ventilator utilization ratio{
Percentile No. of locationsy
Type of location Critical Access Hospitals Critical care unitsz Non-critical care unitsx Long-Term Acute Care Hospitalsjj Adult critical care Adult ward
Ventilatoredays
Patient-days
Pooled mean
10%
25%
50% (median)
75%
90%
0.01
0.04
0.07
0.12
0.16
0.07
0.12
0.19
0.29
0.39
67 (54) 9 (9)
2,964 2,660
30,983 12,632
0.10 0.21
18 (17) 195
12,544 316,632
41,665 1,474,536
0.30 0.21
VAP, ventilator-associated pneumonia. Number of VAP 1; 000. * Number of ventilator days y The number in parentheses is the number of locations meeting minimum requirements for percentile distributions (ie, 50 device days for rate distributions, 50 patient days for device utilization ratios) if less than total number of locations. If this number is 2,500 grams
380 401 418 415 422
(334) (339) (370) (338) (322)
No. of CLABSI
Central line-days
Pooled mean
10%
25%
50 % (median)
75%
90%
420 256 195 104 136
185,851 160,230 172,732 161,361 176,853
2.3 1.6 1.1 0.6 0.8
0 0 0 0 0
0 0 0 0 0
1.5 0 0 0 0
3.7 2.6 1.6 0 0.3
7.5 4.6 3.9 2.3 2.0
Central line utilization ratioz Birth-weight category
Percentile
No. of locationsy
750 grams 751-1,000 grams 1,001-1,500 grams 1,501-2,500 grams >2,500 grams
380 401 418 415 422
(346) (369) (407) (410) (412)
Central line-days
Patient-days
Pooled Mean
10%
25%
50% (median)
75%
90%
185,851 160,230 172,732 161,361 176,853
455,113 457,406 653,953 908,957 738,196
0.41 0.35 0.26 0.18 0.24
0.27 0.21 0.13 0.05 0.06
0.33 0.27 0.18 0.08 0.09
0.42 0.34 0.24 0.13 0.15
0.55 0.46 0.35 0.22 0.26
0.67 0.60 0.49 0.37 0.42
BSI, bloodstream infection; CLABSI, central line-associated BSI; NICU, neonatal intensive care unit. Number of CLABSI 1; 000. * Number of central line days y The number in parentheses is the number of locations meeting minimum requirements for percentile distributions (ie, 50 device days for rate distributions, 50 patient days for device utilization ratios) if less than total number of locations. If this number is 2,500 grams
377 443 524 555 555
(283) (312) (373) (351) (313)
No. of CLABSI
Central line-days
Pooled mean
10%
25%
50% (median)
75%
90%
300 197 115 67 68
118,042 101,014 123,617 109,035 112,147
2.5 2.0 0.9 0.6 0.6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
4.9 3.3 0 0 0
10.1 7.8 3.4 1.9 1.4
Central line utilization ratioz Birth-weight category 750 grams 751-1,000 grams 1,001-1,500 grams 1,501-2,500 grams >2,500 grams
Percentile
No. of locationsy 377 443 524 555 555
(311) (356) (466) (532) (528)
Central line-days
Patient-days
Pooled mean
10%
25%
50% (median)
75%
90%
118,042 101,014 123,617 109,035 112,147
310,004 304,330 484,544 756,073 614,939
0.38 0.33 0.26 0.14 0.18
0.23 0.19 0.11 0.04 0.05
0.33 0.27 0.17 0.06 0.07
0.45 0.36 0.25 0.10 0.11
0.57 0.47 0.35 0.17 0.19
0.75 0.61 0.49 0.28 0.29
BSI, bloodstream infection; CLABSI, central line-associated BSI; NICU, neonatal intensive care unit. Number of CLABSI 1; 000. * Number of central line days y The number in parentheses is the number of locations meeting minimum requirements for percentile distributions (ie, 50 device days for rate distributions, 50 patient days for device utilization ratios) if less than total number of locations. If this number is 2,500 grams
Percentile
No. of locationsy 157 163 167 165 167
(133) (123) (95) (83) (87)
No. of VAP
Ventilator-days
Pooled mean
10%
25%
50% (median)
75%
90%
97 47 14 4 10
73,987 39,689 22,701 20,945 30,305
1.3 1.2 0.6 0.2 0.3
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2.0 0 0 0 0
4.4 4.0 2.1 0 0
Ventilator utilization ratioz Birth-weight category 750 grams 751-1,000 grams 1,001-1,500 grams 1,501-2,500 grams >2,500 grams
Percentile No. of locationsy 157 163 167 165 167
(143) (149) (157) (163) (162)
Ventilator-days
Patient-days
Pooled mean
10%
25%
50% (median)
75%
90%
73,987 39,689 22,701 20,945 30,305
195,281 171,975 225,630 308,507 272,791
0.38 0.23 0.10 0.07 0.11
0.21 0.08 0.02 0.01 0.02
0.28 0.14 0.04 0.02 0.03
0.38 0.20 0.07 0.04 0.06
0.50 0.35 0.14 0.08 0.11
0.65 0.48 0.26 0.18 0.19
VAP, ventilator-associated pneumonia; NICU, neonatal intensive care unit. Number of VAP 1; 000. * Number of ventilator days y The number in parentheses is the number of locations meeting minimum requirements for percentile distributions (ie, 50 device days for rate distributions, 50 patient days for device utilization ratios) if less than total number of locations. If this number is 2,500 grams
Percentile
No. of locations 147 157 184 194 201
y
(110) (100) (75) (54) (58)
No. of VAP
Ventilator-days
Pooled mean
10%
25%
50% (median)
75%
90%
76 33 8 5 5
44,399 23,481 14,065 12,029 16,163
1.7 1.4 0.6 0.4 0.3
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2.4 0 0 0 0
5.8 5.6 0 0 0
Ventilator utilization ratioz Birth-weight category 750 grams 751-1,000 grams 1,001-1,500 grams 1,501-2,500 grams >2,500 grams
Percentile y
No. of locations 147 157 184 194 201
(121) (137) (166) (188) (189)
Ventilator-days
Patient-days
Pooled mean
10%
25%
50% (median)
75%
90%
44,399 23,481 14,065 12,029 16,163
117,397 106,652 151,764 246,360 194,888
0.38 0.22 0.09 0.05 0.08
0.25 0.09 0.03 0.01 0.02
0.30 0.16 0.05 0.02 0.02
0.43 0.22 0.08 0.03 0.05
0.53 0.33 0.14 0.05 0.08
0.71 0.45 0.24 0.09 0.13
VAP, ventilator-associated pneumonia; NICU, neonatal intensive care unit. Number of VAP 1; 000. * Number of ventilator days y The number in parentheses is the number of locations meeting minimum requirements for percentile distributions (ie, 50 device days for rate distributions, 50 patient days for device utilization ratios) if less than total number of locations. If this number is 15 beds Neurologic Neurosurgical
Criterion 1 n (%)
Criterion 2/3 n (%)
Total
251 (94.7)
14 (5.3)
265
692 (87.4)
100 (12.6)
792
560 (81.9) 487 (77.3)
124 (18.1) 143 (22.7)
684 630
803 (85.4)
137 (14.6)
940
996 (81.2)
230 (18.8)
1,226
1,542 (81.4) 63 (75.9) 275 (76.2)
352 (18.6) 20 (24.1) 86 (23.8)
1,894 83 361 (continued on next page)
M.A. Dudeck et al. / American Journal of Infection Control 41 (2013) 1148-66
1161
Table 11 continued LCBI Type of location Pediatric cardiothoracic Pediatric medical Pediatric medical/surgical Pediatric surgical Prenatal Respiratory Surgical Major teaching Surgical All other Surgical cardiothoracic Trauma Step-Down Units Adult step-down (post-critical care) Step-down NICU (level II) Pediatric step-down (post-critical care) Inpatient Wards Acute stroke Antenatal Behavioral health/psychiatry Burn Gastrointestinal Genitourinary Geronotology Gynecology Jail Labor and delivery Labor, delivery, recovery, postpartum suite Medical Medical/surgical Neurologic Neurosurgical Orthopedic Orthopedic trauma Pediatric medical Pediatric medical/surgical Pediatric orthopedic Pediatric rehabilitation - non-IRF* Pediatric surgical Postpartum Pulmonary Rehabilitation - non-IRF* Surgical Telemetry Vascular Surgery Well-Baby Nursery Chronic Care Unitsy Chronic care Inpatient hospice Ventilator dependent unit Critical Access Hospitals Critical care unitsz Non-critical care unitsx Long-Term Acute Care Hospitalsjj Adult critical care Adult ward Inpatient Rehabilitation Facilities{ Adult rehabilitation units - Freestanding Adult rehabilitation units - Within health care facility TOTAL
Criterion 1 n (%) 154 24 466 3 1 16
(81.5) (82.8) (81.3) (100.0) (100.0) (88.9)
Criterion 2/3 n (%)
Total
2 (11.1)
189 29 573 3 1 18
443 (83.7)
86 (16.3)
529
276 (77.3) 657 (81.8) 458 (83.7)
81 (22.7) 146 (18.2) 89 (16.3)
357 803 547
459 (87.1) 2 (50.0) 21 (80.8)
68 (12.9) 2 (50.0) 5 (19.2)
527 4 26
14 (93.3)
1 (6.7) 1 (100.0) 1 (80.0) 2 (9.5) 1 (5.3) 6 (31.6) 1 (33.3) 1 (16.7) 1 (8.3) 0 0 (0.0) 108 (11.2) 243 (15.3) 11 (20.4) 7 (15.9) 13 (16.7) 5 (19.2) 5 (10.4) 31 (13.7)
4 (80.0) 19 (90.5) 18 (94.7) 13 (68.4) 2 (66.7) 5 (83.3) 11 (91.7) 0 4 (100.0) 854 (88.8) 1,349 (84.7) 43 (79.6) 37 (84.1) 65 (83.3) 21 (80.8) 43 (89.6) 195 (86.3) 1 (100.0) 8 (100.0) 13 (86.7) 2 (100.0) 60 (87.0) 3 (75.0) 388 (85.8) 212 (88.0) 20 (95.2) 0
35 (18.5) 5 (17.2) 107 (18.7)
2 (13.3) 9 (13.0) 1 (25.0) 64 (14.2) 29 (12.0) 1 (4.8) 0
15 1 5 21 19 19 3 6 12 0 4 962 1,592 54 44 78 26 48 226 1 8 15 2 69 4 452 241 21 0
14 (77.8) 0 15 (100.0)
4 (22.2) 0
18 0 15
7 (70.0) 16 (76.2)
3 (30.0) 5 (23.8)
10 21
132 (89.8) 1,734 (88.2)
15 (10.2) 233 (11.8)
147 1,967
9 (10.5) 2,645 (15.8)
17 86 16,710
17 (100.0) 77 (89.5) 14,065 (84.2)
BSI, bloodstream infection; LCBI, laboratory-confirmed BSI.5 *Includes only in-hospital rehabilitation wards that are not defined as inpatient rehabilitation facilities (IRF) per the CMS Inpatient Rehabilitation Facility Quality Reporting Program. y Includes chronic care locations within the general acute care hospital setting. z Combines all critical care unit types within critical access hospitals. x Combines all units not identified as critical care (eg, inpatient wards, step-down units) within critical access hospitals. jj Includes free-standing long-term acute care hospitals and long-term acute care locations within the general acute care hospital setting. { Includes free-standing inpatient rehabilitation facilities and inpatient rehabilitation facilities within the acute care hospital setting, as defined by the CMS Inpatient Rehabilitation Facility Quality Reporting Program.
1162
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Table 12 Distribution of criteria for permanent and temporary central line-associated laboratory-confirmed BSI by location, 2012 LCBI Type of Location Permanent Central Line General hematology/oncology Hematopoietic stem cell transplant Pediatric general hematology/oncology Pediatric hematopoietic stem cell transplant Solid organ transplant Solid tumor Total Temporary Central Line General hematology/oncology Hematopoietic stem cell transplant Pediatric general hematology/oncology Pediatric hematopoietic stem cell transplant Solid organ transplant Solid tumor Total
Criterion 1 n (%)
Criterion 2/3 n (%)
Total
308 200 187 67 16 11 789
(76.6) (78.1) (72.8) (72.0) (80.0) (73.3) (75.6)
94 56 70 26 4 4 254
(23.4) (21.9) (27.2) (28.0) (20.0) (26.7) (24.4)
402 256 257 93 20 15 1,043
399 229 73 17 57 10 785
(81.3) (77.9) (77.7) (77.3) (89.1) (58.8) (79.9)
92 65 21 5 7 7 197
(18.7) (22.1) (22.3) (22.7) (10.9) (41.2) (20.1)
491 294 94 22 64 17 982
BSI, bloodstream infection; LCBI, laboratory-confirmed BSI.5
Table 13 Distribution of specific sites of urinary catheter-associated UTI by location, 2012 Type of location Acute Care Hospitals Critical care units Burn Medical Major teaching Medical All other Medical cardiac Medical/Surgical Major teaching Medical/Surgical All other, 15 beds Medical/Surgical All other, >15 beds Neurologic Neurosurgical Pediatric cardiothoracic Pediatric medical Pediatric medical/surgical Pediatric surgical Respiratory Surgical Major teaching Surgical All other Surgical cardiothoracic Trauma Specialty Care Areas/Oncology General hematology/oncology Hematopoietic stem cell transplant Pediatric general hematology/oncology Pediatric hematopoietic stem cell transplant Solid organ transplant Solid tumor Step-down Units Adult step-down (post-critical care) Pediatric step-down (post-critical care) Inpatient Wards Acute stroke Antenatal Behavioral health/psychiatry Burn Genitourinary Gerontology Gynecology Jail Labor and delivery Labor, delivery, recovery, postpartum suite
SUTI n (%)
ABUTI n (%)
Total
382 (99.5)
2 (0.5)
384
2,150 (98.6)
31 (1.4)
2,181
1,408 (97.9) 1,497 (98.7)
30 (2.1) 20 (1.3)
1,438 1,517
2,244 (98.4)
36 (1.6)
2,280
2,472 (98.1)
49 (1.9)
2,521
4,323 437 2,459 60 35 450 1 29
64 4 5 1
1 (3.3)
4,387 441 2,464 61 35 452 1 30
1,782 (99.1)
17 (0.9)
1,799
910 (99.1) 1,628 (98.2) 1,973 (99.1)
8 (0.9) 29 (1.8) 18 (0.9)
918 1,657 1,991
(98.4) (95.1) (100.0) (100.0) (94.6) (100.0)
4 (1.6) 2 (4.9)
257 41 9 1 37 58
1,120 (98.3) 1 (100.0)
19 (1.7)
1,139 1
1 (3.8)
26 2 32 32 11 8 26 6 15 30
253 39 9 1 35 58
25 2 31 30 11 8 25 5 15 30
(98.5) (99.1) (99.8) (98.4) (100.0) (99.6) (100.0) (96.7)
(96.2) (100.0) (96.9) (93.8) (100.0) (100.0) (96.2) (83.3) (100.0) (100.0)
(1.5) (0.9) (0.2) (1.6)
2 (0.4)
2 (5.4)
1 (3.1) 2 (6.3)
1 (3.8) 1 (16.7)
(continued on next page)
M.A. Dudeck et al. / American Journal of Infection Control 41 (2013) 1148-66
1163
Table 13 continued Type of location
SUTI n (%)
Medical Medical/Surgical Neurologic Neurosurgical Orthopedic Orthopedic trauma Pediatric medical Pediatric medical/surgical Pediatric orthopedic Pediatric rehabilitation - non-IRF* Pediatric surgical Postpartum Pulmonary Rehabilitation - non-IRF* Surgical Telemetry Vascular surgery Well-baby nursery Chronic Care Unitsy Chronic care Chronic care rehabilitation unit Inpatient hospice Ventilator dependent unit Critical Access Hospitals Critical care unitsz Non-critical care unitsx Long-Term Acute Care Hospitalsjj Adult critical care Adult ward Inpatient Rehabilitation Facilities{ Adult rehabilitation units - Freestanding Adult rehabilitation units - Within hospital Pediatric rehabilitation units - Within hospital TOTAL
ABUTI n (%)
Total
1,320 2,711 159 175 422 68 6 55 1 1 4 61 87 28 1,082 390 25
(99.0) (98.5) (100.0) (100.0) (99.3) (100.0) (100.0) (100.0) (100.0) (100.0) (100.0) (100.0) (98.9) (96.6) (98.5) (97.5) (100.0)
14 (1.0) 40 (1.5)
30 6 2 39
(96.8) (100.0) (100.0) (97.5)
1 (3.2)
1 (2.5)
31 6 2 40
25 (100.0) 167 (96.5)
6 (3.5)
25 173
3 (2.0) 47 (1.9)
148 2,537
2 (0.6) 9 (1.6)
347 569 2 36,849
3 (0.7)
1 1 17 10
145 (98.0) 2,490 (98.1) 345 560 2 36,344
1,334 2,751 159 175 425 68 6 55 1 1 4 61 88 29 1,099 400 25 0
(99.4) (98.4) (100.0) (98.6)
(1.1) (3.4) (1.5) (2.5)
505 (1.4)
UTI, urinary tract infection; SUTI, symptomatic UTI; ABUTI, asymptomatic bacteremic UTI.6 *Includes only in-hospital rehabilitation wards that are not defined as inpatient rehabilitation facilities (IRF) per the CMS Inpatient Rehabilitation Facility Quality Reporting Program. y Includes chronic care locations within the general acute care hospital setting. z Combines all critical care unit types within critical access hospitals. x Combines all units not identified as critical care (eg, inpatient wards, step-down units) within critical access hospitals. jj Includes free-standing long-term acute care hospitals and long-term acute care locations within the general acute care hospital setting. { Includes free-standing inpatient rehabilitation facilities and inpatient rehabilitation facilities within the acute care hospital setting, as defined by the CMS Inpatient Rehabilitation Facility Quality Reporting Program.
Table 14 Distribution of specific sites of ventilator-associated pneumonia by location, 2012 Type of location Acute Care Hospitals Critical Care Units Burn Medical Major teaching Medical All other Medical cardiac Medical/surgical Major teaching Medical/surgical All other 15 beds Medical/surgical All other >15 beds Neurologic Neurosurgical Pediatric cardiothoracic Pediatric medical Pediatric medical/surgical Pediatric surgical Respiratory Surgical Major teaching
PNU1 n (%)
PNU2 n (%)
PNU3 n (%)
Total
25
29.1%
61
70.9%
86
127
62.0%
74
36.1%
4
2.0%
205
119 88
62.3% 65.2%
65 46
34.0% 34.1%
7 1
3.7% 0.7%
191 135
208
55.9%
160
43.0%
4
1.1%
372
267
63.7%
138
32.9%
14
3.3%
419
454 24 114 6 1 80 1 4
68.2% 38.7% 54.3% 66.7% 50.0% 70.8% 100.0% 100.0%
201 37 95 2 1 28
30.2% 59.7% 45.2% 22.2% 50.0% 24.8%
11 1 1 1
1.7% 1.6% 0.5% 11.1%
5
4.4%
666 62 210 9 2 113 1 4
157
56.1%
122
43.6%
1
0.4%
280
(continued on next page)
1164
M.A. Dudeck et al. / American Journal of Infection Control 41 (2013) 1148-66
Table 14 continued Type of location
PNU1 n (%)
Surgical All other Surgical cardiothoracic Trauma Specialty Care Areas/Oncology Hematopoietic stem cell transplant Step-Down Units Adult step-down (post-critical care) Pediatric step-down (post-critical care) Step-down NICU (level II) Inpatient Wards Medical Medical/surgical Pediatric medical Pediatric medical/surgical Pulmonary Surgical Telemetry Critical Access Hospitals Critical care units* Non-critical care unitsy Long-Term Acute Care Hospitalsz Adult critical care Adult ward Total
89 194 232
PNU2 n (%) 46.4% 60.8% 45.7%
98 119 275
PNU3 n (%) 51.0% 37.3% 54.1%
5 6 1
Total 2.6% 1.9% 0.2%
192 319 508 0
26 1
83.9% 100.0%
5
16.1%
2 4
66.7% 18.2%
1 17
33.3% 77.3%
6
85.7%
1
14.3%
1
100.0%
3 2
100.0% 50.0%
1
7 78 2,320
87.5% 75.7% 58.6%
1 24 1,572
31 1 0 3 22 0 0 7 0 1
1
4.5%
25.0%
1
25.0%
3 4
12.5% 23.3% 39.7%
1 65
1.0% 1.6%
8 103 3,957
PNU1, clinically defined pneumonia; PNU2, pneumonia with specific laboratory findings; PNU3, pneumonia in immunocompromised patients.7 *Combines all critical care unit types within critical access hospitals. y Combines all units not identified as critical care (eg, inpatient wards, step-down units) within critical access hospitals. z Includes free-standing long-term acute care hospitals and long-term acute care locations within the general acute care hospital setting.
Table 15 Distribution of specific sites and criteria for central line-associated laboratoryconfirmed BSI among Level III NICUs by birthweight, 2012 LCBI
Birth-weight category
Birth-weight category
Criterion 1 n (%)
Criterion 2/3 n (%)
Total
750 grams 751-1,000 grams 1,001-1,500 grams 1,501-2,500 grams >2,500 grams Total
316 176 135 76 101 804
104 80 60 28 35 307
420 256 195 104 136 1,111
75.2% 68.8% 69.2% 73.1% 74.3% 72.4%
24.8% 31.3% 30.8% 26.9% 25.7% 27.6%
BSI, bloodstream infection; LCBI, laboratory-confirmed BSI.5
Table 16 Distribution of specific sites and criteria for central line-associated laboratoryconfirmed BSI among Level II/III NICUs by birthweight, 2012 LCBI Birth-weight category
Criterion 1 n (%)
Criterion 2/3 n (%)
Total
750 grams 751-1,000 grams 1,001-1,500 grams 1,501-2,500 grams >2,500 grams Total
211 127 73 49 43 503
89 70 42 18 25 244
300 197 115 67 68 747
70.3% 64.5% 63.5% 73.1% 63.2% 67.3%
Table 17 Distribution of specific sites of ventilator-associated pneumonia among Level III NICUs by birthweight, 2012
29.7% 35.5% 36.5% 26.9% 36.8% 32.7%
750 grams 751-1,000 grams 1,001-1,500 grams 1,501-2,500 grams >2,500 grams Total
PNU1 n (%) 60 30 10 1 7 108
61.9% 63.8% 71.4% 25.0% 70.0% 62.8%
PNU2 n (%)
PNU3 n (%)
Total
34 17 4 3 3 61
3
3.1%
3
1.7%
97 47 14 4 10 172
35.1% 36.2% 28.6% 75.0% 30.0% 35.5%
PNU1, clinically defined pneumonia; PNU2, pneumonia with specific laboratory findings; PNU3, pneumonia in immunocompromised patients.7
Table 18 Distribution of specific sites of ventilator-associated pneumonia among Level II/III NICUs by birthweight, 2012 Birth-weight category
PNU1 n (%)
PNU2 n (%)
PNU3 n (%)
Total
750 grams 751-1,000 grams 1,001-1,500 grams 1,501-2,500 grams > 2,500 grams Total
54 29 5 2 4 94
20 3 2 2 1 28
2 1 1 1
2.6% 3.0% 12.5% 20.0%
5
3.9%
76 33 8 5 5 127
71.1% 87.9% 62.5% 40.0% 80.0% 74.0%
26.3% 9.1% 25.0% 40.0% 20.0% 22.0%
PNU1, clinically defined pneumonia; PNU2, pneumonia with specific laboratory findings; PNU3, pneumonia in immunocompromised patients.7
BSI, bloodstream infection; LCBI, laboratory-confirmed BSI.5
(PNU1) which relies on the somewhat subjective interpretations of clinical findings. As diverse types of facilities continue to participate in NHSN, either voluntarily or by mandate, the need for careful scrutiny
of the data increases. NHSN will continue to assess how changing facility composition and changes in the proportion of data contributed by facility types impact the rates and their distributions so that the best possible risk-adjusted comparative data may be provided in future reports.
M.A. Dudeck et al. / American Journal of Infection Control 41 (2013) 1148-66
To improve the reliability of data reported to NHSN, several protocol changes were introduced in January 2013. The majority of these changes were with respect to timing and implementation of two-day rules to clarify infections that are health careassociated, association of device use to HAI, and attribution of HAI to an inpatient location after transfer or to a hospital after discharge. In addition, NHSN added criteria for mucosal barrier injury laboratory-confirmed bloodstream infections, which have not been removed or accounted for separately in this report. Finally, the VAP definition no longer applies to adult patients (ie, 18 years of age) and this definition has been replaced by ventilator-associated events (VAEs).11 We will carefully assess the potential impact of these changes on HAI incidence as these data are reported. For those who do not report to NHSN but would like to use these data for comparison, the information must first be collected from your hospital in accordance with the methods described for NHSN.5-7 Refer to Appendices A and B for further instructions. Appendix A discusses the calculation of infection rates and DU ratios for the DA Module. Appendix B gives a step-by-step method for interpretation of percentiles of infection rates or DU ratios. Although a high rate or ratio (>90th percentile) does not necessarily define a problem, it does suggest an area for further investigation. Similarly, a low rate or ratio (
