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Hospital Acquired Infections (HAIs) in South Carolina

2009 - HIDA Hospital Acquired Infections (HAI) Public Reports

This web page contains links to the following documents and reports:

 


Hospital Infections Disclosure Act (HIDA)
Hospital Acquired Infections Reports

Individual Hospital's HIDA HAI Reports
Individual Hospital Acquired Infections Report:  select on the name of the hospital as listed by hospital bed size category:

  • More than 500 beds (and teaching hospitals)
  • 201 to 500 beds
  • 51 to 200 beds
  • 50 beds or less 

Each report contains the following information:

  • Alphabetical order by the hospital name within each hospital bed size category.
  • Number of licensed general beds (excludes psychiatric and substance abuse beds).
  • Average daily census for general beds
  • Number of surgical procedures performed, number of infections, (SSI) rates for each reportable surgical procedures and separated by surgical risk category
  • Number of central line days, number of central line associated bloodstream infections (CLABSI), and CLABSI infection rates in defined “locations” (patient care units) within each hospital

Comparison Reports by HAIs

How are hospital HAIs compared?

Hospitals are not compared with other hospitals in South Carolina.  Each individual hospital’s infection rates for the reportable HAIs are compared with the historical experience in the standard population of all NHSN users in the United States.

In the Comparison reports, hospital SSI and CLABSI reports are compared using the Standardized Infection Ratio (SIR) which is a summary measure used to compare the HAI experience among one or more groups of patients to that of a standard population. It is the observed number of infections divided by the expected (predicted) number of infections. The term “expected” means that when looking at the national rate of infections you would expect (or predict) a certain number of infections.  “Expected”* is based on historical data for those procedures at the national level. It is, in effect, a national rate of infections found in the hospitals reporting to NHSN.

SIRs can be calculated based on the “pooled mean” or historic average for the standard population of NHSN users.  The pooled mean for this report is based on the most recent data and included in the following journal article: “National Healthcare Safety Network (NHSN) report: Data summary for 2006 through 2008, issued December 2009” published by the Association for Professionals in Infection Control and Epidemiology (APIC) found in the American Journal of Infection Control.

Each HAI Compare Table has a link to the Definition of Terms for Standardized Infection Ratio and Confidence Intervals and additional information about HAI reports.

 Comparison Tables contain the following information for each hospital listed:  

  • Name of hospital
  • Number of infections
  • Number of surgical procedures or central line days
  • The hospital’s statistically “expected” number of SSIs
  • Hospital’s SIR “observed / expected (predicted) Standardized Infection Ratio (SIR)
  • 95% Confidence Interval for each hospital’s SIR
  • Interpretation of the hospitals SIR
    • Not different = Statistically similar (not different) than the standard population
    • Lower = Statistically lower than the standard population
    • Higher = Statistically higher than the standard population


HAI Compare - Tables for HIDA Reporting Requirements:
December 1, 2008 – November 30, 2009

2009 Comparison Summary Data for Hospital HAIs: Standardized Infection Ratio (SIR) Report by Surgical Site Infections (SSI) Procedures and Central Line Locations

Introduction:  Surgical Site Infections

SSI rates are adjusted to take into account differences in patient risk factors for infection due to length of the surgery, type of surgical wound and the patient's physical condition. Many SSIs from these types of surgeries can be prevented by following defined prevention methods.

Surgical site infections (SSIs) are infections that:

  • are directly related to an operative procedure
  • occur in the part of the body where the operation took place
  • may be minor or serious
  • occur within 30 days if there is no implant or within one year if there is an implant.

SSI Reporting Changes:  DHEC, with the advice of the HIDA Advisory Committee, selected the surgical procedures for mandatory public reporting of SSIs from the National Healthcare Safety Network (NHSN) system. Over time, procedures have been added to or rotated off the reporting schedule.   

Beginning July 1, 2009, the following surgical procedures were rotated off the list of SSIs. Therefore only six months of data are provided in the 2009 Report:

    • Cholecystectomy/ cholecystotomy (CHOL)
    • Hysterectomy, vaginal (VHYS)
    • Spinal fusion, (FUSN)
  • Two surgical procedures (cholycystectomy and vaginal hysterectomy) were rotated off the list because the volume is very high and the infection rates are very low.  These reports were included in the previous annual report.
  • Spinal fusions were discontinued after six months of reporting. For every patient having this procedure, NHSN requires data to be entered into the system that are often not readily available in the patient records.  This situation makes spinal fusion reporting unsustainable with the current resources available in hospitals to enter the reports. These surgical procedures may be added back to the reporting requirements at a future date.  

Cardiac (Thoracic) Surgeries:

Heart Bypass (Coronary Artery Bypass Grafts):
Heart bypass or coronary artery bypass graft (CABG, pronounced cabbage) is a surgery used to bypass blocked heart arteries by creating new passages for blood to flow to the heart muscle. Arteries or veins from other parts of the body are used as grafts to create alternative blood-flow pathways.  There are two types of heart bypass surgeries and these are reported separately.  These are the grafts with chest and donor incisions (CABG), and the graft with chest incision only (CBGC).

Orthopedic Surgeries:
 
Total or Partial Hip Replacements:
Hip replacement is surgery for people with severe hip damage or pain related to chronic osteoarthritis, rheumatoid arthritis or other degenerative processes involving the hip joint. The surgical procedure for a hip replacement involves removing the damaged cartilage and bone from the hip joint and replacing them with new, man-made parts.

Total or Partial Knee Replacements:
Knee replacement surgery (arthroplasty) is an elective procedure for people with severe knee damage and pain related to osteoarthritis, rheumatoid arthritis, and traumatic arthritis. A total knee replacement involves removing the damaged cartilage and bone from the surface of the knee joint and replacing them with a man-made surface of metal and plastic. A partial knee replacement involves replacing only part of the knee joint.

Abdominal Surgeries:

Hysterectomy (abdominal) is the removal of the uterus through an abdominal incision.

Hysterectomy (vaginal) is the removal of the uterus through vaginal or perineal incision (2009 Report contains data from December 1, 2008 through June 30, 2009 when reporting was discontinued).

Cholecystectomy & cholecystotomy are gallbladder surgeries. (Cholecystectomy is the removal of the gallbladder and cholecystotomy is the making of an opening into the gallbladder, usually to remove a stone.)  (2009 Report contains data from December 1, 2008 through June 30, 2009 when reporting was discontinued.)

Colon surgery includes incisions, removal, and reconnection of the small and large bowel. It does not include rectal operations. (Reportable only by hospitals with 200 licensed beds or less.)  

Neurosurgical (Spine):
 
Spinal Fusion:
 Spinal fusion is the immobilization of the spinal column. This reporting requirement started December 1, 2008 and was discontinued June 30, 2009.  See explanation above for discontinuance.  


Reports: Surgical Site Infections

Surgical Site Infections (SSI) Reports for the following procedures, in all hospitals where these procedures are performed.  Some reports are divided into geographic regions because of the large number of hospitals performing the procedure.

Thoracic Surgical Procedures: (each contains one Table for all hospitals performing these procedures)

Orthopedic Surgical Procedures: (each contains one Table divided into three geographic regions)

Abdominal Surgical Procedures:  (each contains one Table divided into three geographic regions)

Spinal Fusions

Selected: SSI Summary Report


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Introduction: Central Line Associated Bloodstream Infections (CLABSI)

When a patient gets a bloodstream infection after having a central line put in (or, in the case of a newborn, an umbilical catheter) it’s considered a CLABSI.   A central line is an intravascular catheter (tube in a vein) that ends at or close to the heart or in one of the great vessels. An example of a great vessel is the aorta or superior vena cava. A central line can be used to infuse fluids or withdraw blood in patients. Central lines can be either temporary or permanent.

According to the CDC, an estimated 248,000 bloodstream infections occur in U.S. hospitals each year and many are CLABSIs. These bloodstream infections often lead to longer hospital stays, higher costs, and an increased risk of dying.  CLABSIs can often be prevented through proper insertion and care of the central line.

DHEC requires hospitals to report CLABSIs in selected patient units defined as NHSN  “Locations”. For these reports, the locations are combined by categories such as Critical Care and Inpatient Wards listed in the report tables below.  To calculate the infection rates, hospitals must also report the total number of “central line days” in each location for the reporting period.    

CLABSI Comparison reports will include only those locations with a pooled mean in the most recent NHSN Data Report.

CLABSI Reporting Changes: In September, 2009, all hospitals, regardless of size, began expanded CLABSI reporting to include all inpatient locations in the categories listed below.

Adult Critical Care
Pediatric Critical Care
Inpatient Specialty Care Areas
Inpatient Adult Wards
Inpatient Pediatric Wards
Step Down Units

For the added locations only three months of data are available, therefore they will not be included in the HIDA Report until the August 1, 2010 data report.

The CLABSI Summary Report provides the percentage of the microorganisms found in the blood cultures.  

Reports: Central Line Associated Bloodstream Infections (CLABSI) Locations:

Inpatient critical care units, also known as intensive care units- ICUs:

Inpatient Wards

Long Term Acute Care (LTAC)

Selected CLABSI Summary Report: 

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Report: Methicillin resistant Staphylococcus aureus (MRSA) bloodstream infections:

 


U.S. Hospital Compare (Dept. of Health and Human Services )

Hospital Compare

This website provides information on patient quality, including prevention and care of surgical site infections.  "Hospital Compare" was developed by the Centers for Medicare and Medicaid Services (CMS), an agency under the U.S. Department of Health and Human Services, and the Hospital Quality Alliance (HQA). "Hospital Compare" shows measures based on data from hospitals' patient records. The data is converted to reports that measure how well hospitals care for their patients.   Follow the instructions on the web site to locate specific hospitals in South Carolina.

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