Tuesday, July 8, 2008

New York Acquired Infections Report... For Dummies

I've been following the progress of New York State's Hospital Acquired Infection reporting initiative since the law was first passed. NY was given a year to pilot the reporting, and to provide a public report in aggregate the first year, moving to hospital-specific reporting the next.

I've read the report, and while it's certainly a great move forward for transparency it's hardly easy to read. Weighing in at 115 glorious pages, it makes it hard to figure out exactly what it's saying. Therefore, I give you NY HAI For Dummies!

The report covers three topics: central line-associated blood stream infections in critical care unit patients, and surgical site infections associated with colon and coronary artery bypass graft procedures. CABG reports on both the chest incision and the secondary (leg) incision. Further, patients are given a risk factor ranging from zero to four, four implying plenty of risk for infection (long surgery time, dirty incision site etc.)

For each topic and risk factor, NY has an opportunity to be statistically significantly better, the same, or worse than (older) national rates provided by the CDC. One huge caveat: the "national rates" against which NY is compared are from data spanning 1992 to 2004, so I'm not sure they honestly comparable, but at this point in time it's all anyone's got.

Colon Procedure Surgical Site Infections

SSI Risk 0: 4.5% Same
SSI Risk 1: 6.3% Worse
SSI Risk 2: 7.6% Same
SSI Risk 3: 9.4% Same

1,082 reported infections of which MRSA (the "superbug") accounted for 110 cases or 10.2% and was the third most occurring organism.

Coronary Artery Bypass Graft with Chest and Donor Site Incisions

Leg SSI Risk 0: 0.0% Same
Leg SSI Risk 1: 0.8% Better
Leg SSI Risk 2: 1.6% Better
Leg SSI Risk 3: 0.0% Same

Chest SSI Risk 0: 0.0% Same
Chest SSI Risk 1: 2.2% Same
Chest SSI Risk 2: 3.2% Same
Chest SSI Risk 3: 5.3% Same

Coronary Artery Bypass Graft with Chest Incision Only

Chest SSI Risk 0: 20% (1 of 5 procedures) Same
Chest SSI Risk 1: 0.9% Better
Chest SSI Risk 2 & 3: 4.0% Same

503 total infections reported, of which MRSA accounted for 76 or 15.1%.

Central Line-Associated Blood Stream Infection (CLABSI) Rates

Coronary ICU: 2.2 Better
Cardiothoracic Surgical ICU: 2.0 Same
Medical ICU: 3.2 Same
Med Surg - Major Teaching: 2.4 Same
Med Surg - All others: 2.3 Same
Pediatric ICU: 4.0 Better
Neurosurgical ICU: 3.1 Same
Surgical ICU: 3.7 Worse

A central line infection rate is calculated by dividing the number of actual infections by the length in days all the lines are in and multiplying by 1,000. So if a patient has a central line inserted for 24 hours that's one "surgical line day".

Interestingly, when the report compares upstate NY to New York City, it stands out that NYC is the same across the board, whereas upstate stands out as being the offenders bringing the state average worse. I help out a little with the CLAB infection collaborative initiative run by UHF and GNYHA over on Jeny, so I know there's a bunch of hospitals more city than not who are actively working on reducing CLAB infections. I have no idea if that's attributable or not, but sure is interesting.

(Edit: on second reading I noticed on p.39 the author references the collaborative as a potential factor in the lower numbers.)

1,348 infections reported, MRSA counting 83, or 6.2%

That's the easy-to-read and way-too-simplified summary, there's a wealth more data in the report including CLAB bundle compliance and NICU numbers and much more, I urge you to download it. If nothing else, let's show the Department of Health we're interested in their reports.


Matt said...

Link to the report isn't working for me. Firefox thinks it's downloading something, but Acrobat disagrees. I'd be interested to see everything that NY is providing.

In Mo. we have this, which is pretty sweet: http://www.dhss.mo.gov/HAI/

My understanding is that the data available will be expanding. The end product is easy to read - complete Consumer Reports style - but I think the average person would have difficulty knowing what to look for. Also, I wish you could compare multiple measures at the same time.

Jaz said...

Hi Matt, the links were moved overnight, I've updated them both and you should be fine now. Let me know if not, I can just E-mail the report if you want.

Matt said...

Thanks, Jaz. I've got it now.

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