Logan Reid
Hospital-acquired infections (HAIs) are a significant concern for healthcare facilities, and calculating infection rates is crucial for identifying problem areas and implementing preventive measures. HAIs can spread through various means, including contaminated hands, unclean equipment, airborne transmission, and administered blood. The CDC's National Healthcare Safety Network (NHSN) is the most widely used HAI tracking system in the US, providing data on infection rates and facilitating the identification of high-risk areas. The NHSN also enables healthcare facilities to monitor antimicrobial use, blood safety errors, and healthcare process measures. The calculation of hospital-acquired infection rates involves dividing the total number of infections by the total number of discharges (including deaths) and then multiplying the result by 100 to obtain the percentage. This metric helps hospitals assess their performance and develop strategies to minimize the occurrence of HAIs.
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Calculating HAI
Hospital-acquired infections (HAI) are infections spread within hospitals from one patient to another due to contaminated hands, unclean equipment, airborne transmission, administered blood, etc. The CDC's National Healthcare Safety Network (NHSN) is the most widely used HAI tracking system in the US. It provides data on infection rates and other important healthcare process measures, such as healthcare personnel influenza vaccine status and infection control adherence rates.
The following formula can be used to calculate HAI rates:
Hospital Infection Rate = (i / d) x 100
Where:
- I = Total Number of Hospital Infections
- D = Total Number of Discharges (Including Deaths)
For example, if a hospital has 32 total infections and 35 total discharges (including deaths), the hospital infection rate would be:
Hospital Infection Rate = (32 / 35) x 100 = 91.42%
It's important to note that this is a simplified model and that HAI calculations can be more complex in reality. For instance, the CDC's annual National and State Healthcare-Associated Infections Progress Report (HAI Progress Report) uses risk adjustment calculations and statistical hypothesis testing to compare infection rates over different years and across different facility types. This allows for a more nuanced understanding of HAI trends and helps identify areas for improvement in infection prevention and control.
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NHSN's role
The National Healthcare Safety Network (NHSN) is a program of the Centers for Disease Control and Prevention (CDC) and is the nation's most widely used healthcare-associated infection (HAI) tracking system. NHSN is a shared resource for HAI prevention and its data are used to generate CDC's annual HAI national and state progress reports.
NHSN provides facilities, states, regions, and the nation with data needed to identify problem areas, measure the progress of prevention efforts, and ultimately eliminate HAIs. NHSN also allows healthcare facilities to track blood safety errors and other important healthcare process measures such as healthcare personnel influenza vaccine status and infection control adherence rates.
NHSN recognizes that changes to CMS payment policies and changes in state and local reporting mandates may impact the number and characteristics of healthcare facilities participating in NHSN. The NHSN Team routinely reviews the data reported to NHSN and will contact facilities to resolve confirmed and suspected data quality concerns. These data quality activities, which include data analyses and facility outreach, enhance the quality of the HAI data used in preparing this report.
NHSN uses the standardized infection ratio (SIR) to track HAIs at a national, state, or local level over time. This measure compares the actual number of reported HAIs with the number that would be predicted, adjusting for the factors that are associated with differences in infection incidence. By calculating the SIR, the relevant and significant variables for each hospital are adjusted.
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Infection types
Hospital-acquired infections (HAI) are infections that patients get while or soon after receiving healthcare. They are also referred to as healthcare-associated infections, or nosocomial infections. HAIs are typically absent or incubating at admission and manifest 48 hours after admission to the hospital. They are spread within the hospital from one patient to another due to contaminated hands, unclean equipment, airborne transmission, administered blood, etc.
Nosocomial infections can cause severe pneumonia and infections of the urinary tract, bloodstream, and other parts of the body. Many types display antimicrobial resistance, which can complicate treatment. The most common nosocomial infections are of the urinary tract, surgical site, and various pneumonias. In the US, the most frequent types of hospital infections are catheter-associated urinary tract infection (32%), followed by surgical site infection (22%), and ventilator-associated pneumonia (15%). In 2012, the Health Protection Agency reported the prevalence rate of hospital-acquired infections in England was 6.4% in 2011, with respiratory tract, urinary tract, and surgical site infections the most common types of infections reported.
HAIs are monitored by agencies such as the National Healthcare Safety Network (NHSN) of the Center for Disease Control and Prevention (CDC). The NHSN is the nation's most widely used HAI infection-tracking system. It provides facilities, states, regions, and the nation with data needed to identify problem areas, measure the progress of prevention efforts, and ultimately eliminate HAIs.
Some common types of HAIs include:
- Central line-associated bloodstream infections (CLABSI)
- Catheter-associated urinary tract infections (CAUTI)
- Surgical site infections (SSI)
- Hospital-acquired Pneumonia (HAP)
- Ventilator-associated Pneumonia (VAP)
- Clostridium difficile infections
- Infections caused by Staphylococcus aureus (staph)
- Methicillin-resistant Staphylococcus aureus (MRSA) infections
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Data sources
The NHSN collects data from over 38,000 active hospitals, long-term care facilities, and other healthcare institutions. This data is used for national and state-level analyses, as well as targeted prevention initiatives. The NHSN also allows healthcare facilities to track antimicrobial use and resistance, blood safety errors, and other important healthcare process measures such as healthcare personnel influenza vaccine status and infection control adherence rates.
The CDC also utilizes the Emerging Infections Program Healthcare-Associated Infections – Community Interface (EIP HAIC) as a complementary HAI surveillance system. This system provides data on the incidence of HAIs in the community, helping to identify trends and emerging infections.
In addition to the CDC's surveillance systems, individual hospitals, long-term acute care hospitals (LTACHs), and inpatient rehabilitation facilities (IRFs) also report HAI data. This data is often available through the CDC's Healthcare-Associated Infection Data Reports website and the Antimicrobial Resistance and Patient Safety Portal.
The CDC's annual National and State Healthcare-Associated Infections (HAI) Progress Report provides a comprehensive summary of select HAIs across acute care hospitals, critical access hospitals, IRFs, and LTACHs. This report includes data on the number of infections, risk adjustments, and comparisons to national baselines and previous years' data.
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Standardised Infection Ratios
Standardized Infection Ratios (SIRs) are a crucial tool for monitoring and comparing infection rates in healthcare facilities, particularly in the context of surgical site infections. SIRs are calculated by dividing the observed number of infections by the predicted number of infections. The predicted number of infections is derived from procedure-specific risk models provided by the National Healthcare Safety Network (NHSN) in the United States or similar organisations in other countries, such as the Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre in Australia.
The SIR is an indirect method of standardization that has been widely adopted for risk-adjusted surgical site infection reporting in the US since 2009. One of its key advantages is that it provides a summary measure of a hospital's performance per procedure, allowing for an overall procedure-specific evaluation. This is in contrast to risk-stratified rates, which only enable comparisons within strata.
The calculation of SIRs involves specific statistical methods. The confidence interval is derived from the Poisson distribution. To calculate P values, a hypothesis test (z-test) is employed, but the data being compared must be normally distributed. When the sample size exceeds 30, normal distribution is typically achieved, and it can be confirmed through a minimum expected cell frequency greater than 1.0. In cases where the sample size is smaller than 30, Fisher's Exact Test, based on the hypergeometric distribution, is utilised. However, SIRs are usually not calculated for smaller sample sizes due to the minimum requirement for precision.
SIRs are essential for monitoring and evaluating infection rates in healthcare facilities. They provide a standardised metric that facilitates comparisons between hospitals and over time. By tracking SIRs, healthcare facilities can identify areas for improvement, implement preventive strategies, and significantly reduce infection rates. The ultimate goal is to achieve zero hospital-acquired infections, and SIRs play a pivotal role in guiding and assessing infection control efforts.
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Frequently asked questions
The formula for calculating HAI is: Hospital Infection Rate = (i / d) x 100. Where 'i' is the total number of hospital infections and 'd' is the total number of discharges (including deaths).
The HAI value gives you the percentage of patients who acquired an infection during their hospital stay. For example, an HAI of 91.42% means that out of every 100 patients discharged, 91.42 patients acquired an infection while receiving treatment.
The NHSN is the US CDC's HAI tracking system. It collects data on HAIs from various healthcare facilities, including acute care hospitals, long-term acute care hospitals, and inpatient rehabilitation facilities. This data is used to identify problem areas, measure the progress of prevention efforts, and eliminate HAIs. The NHSN also provides standardised infection ratios (SIRs) that allow for comparisons between observed and predicted infection rates.
