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STANDARDIZED INFECTION RATIO SIMPLIFIED Laurie Fish, RN, BSN, CIC Standardized Infection Ratio • The SIR is a summary measure used to compare the HAI experience among one or more groups of patients to that of a standard population. • Groups can be in various units of measure (unit, hospital, state or country) • The data in the group is aggregated into a summary measure and then compared to the standard population Definition of SIR The number of observed infections in an index group divided by the number of infections expected in that group, based on a standard population. This is the number of HAIs in your hospital This is the estimated number for your hospital based on standard population Observed (O) HAIs Expected (E) HAIs = SIR Standard Population Standard Population for CLABSI is 2006-2008 Standard Population for CAUTI is 2009 5/24/2017 4 How does my facilities performance compare? 5/24/2017 5 Making Comparisons Your expected is determined using the following formula: standard population rate/1000 X your device days= Expected Your actual (observed) number is then divided by your expected= SIR How is the CLABSI SIR calculated? The national rate of CLABSI for a teaching medical surgical unit is 2.1/1000 cath days Hospital A Data: Org id Location Summary Yr/Half Months Infcount Number expected 1001 8 ICU 2009H1 3 2 1.785 Central line days 850 SIR SIR P Value 1.12 0.532 7 95% Confidence Interval 0.199-3.527 The E for ICU = (2.1/1000) X 850 = 1.75 SIR = 2/1.785 = 1.12 Expected less than 1 If the expected is less that 1, a SIR will not be calculated. If the expected is less than 1 your denominator is too low to calculate a precise SIR How is SIR Calculated at hospital level? Type of ICU # of # of CLABSI central line days CLABSI Rate NHSN Rate p value Expected # of CLABSI Medical Cardiac 2 380 5.26 2.0 0.09 0.76 Medical 1 257 3.89 2.6 0.15 0.67 Med/Surgical 3 627 4.78 1.5 0.11 0.94 Neurosurgical 2 712 2.81 2.5 0.32 1.78 Total 8 1976 4.05 4.15 Overall CLABSI SIR= Observed/Expected= 8/4.15=1.93 Interpretation of the SIR • During the first 6 months of 2012, there was 1 CLABSI identified in our facility and we observed 2945 catheter days. • Based on the 2006-2008 data we expected 4.442 CLABSIs • This results in a SIR of 0.225 (almost 80% better than expected) • The p value and 95% confidence interval indicates the number of observed is not significantly lower that expected. Interpretation of statistical tests • p value: <0.05 is considered statistically significant • Confidence Interval: if the range between the 2 numbers does not contain 1 the value is considered statistically significant. SIR Value of 1 0.5-1.5 1.2-2.0 0.7-1.5 0.1-0.5 0.5-1.2 Risk Adjustment: CLABSI and CAUTI Population level risk adjustment: 1. Patient mix by type of unit location 2. Hospital affiliation with a medical school 3. Bed size for the patient care location Risk Adjustment for Surgical Site Infection Includes only deep and organ space and are detected through readmission to the same hospital • Colon: Age, ASA, duration, endoscope, medical school affiliation, bed size, wound class • Abdominal hysterectomy: Age, ASA, duration of procedure, hospital bed size The SIR is not…. 5/24/2017 14 Questions?