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Today’s Webinar will begin at 11 PST

Today’s Webinar will begin at 11 PST. 11/29/12. Do You Speak SIR? Using your SSI SIR data to drive improvement. November 29, 2012. Introduction. Please do not put your phone on hold; use the mute function or *6 Please type questions or comments into text box

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Today’s Webinar will begin at 11 PST

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  1. Today’s Webinar will begin at 11 PST 11/29/12

  2. Do You Speak SIR? Using your SSI SIR data to drive improvement November 29, 2012

  3. Introduction • Please do not put your phone on hold; use the mute function or *6 • Please type questions or comments into text box • If time permits, we will open up the phone lines at the conclusion of the presentation

  4. Using Data to Drive Improvement

  5. On Death, Dying & Data ACCEPTANCE DEPRESSION BARGAINING ANGER DENIAL

  6. Connie Cutler, RN, MS, CIC, FSHEA

  7. Main Line Health Bryn Mawr Hospital Lankenau Medical Center Paoli Hospital Riddle Hospital

  8. NHSN’s Definition of a SIR

  9. Standardized Infection Ratio Observed (by IP Surveillance) S I R = Expected (by NHSN)

  10. Standardized Infection Ratio Simple MATH (a fraction) Observed (# SSIs found through surveillance) Expected (# SSIs that NHSN predicted) • It’s all about comparison to the number 1 • SO, if Observed = Expected, result is 1 and that means SIR is equal to (same as) CDC’s National Healthcare Safety Network

  11. Standardized Infection Ratio • If surgery or surgeon is less than ONE, there are less SSIs than the comparative NHSN database • If higher than ONE, there are more SSIs than the comparative NHSN database • How much more? Depends on number… • 0.9 = 90% of expected OR 10% better than NHSN • 1.4 = 140% of expected or 40% worse than NHSN • 1.0 = 100% of expected or same as NHSN

  12. Numerators (infections) and Denominators (cases) for 6 procedures have been required by PA to be reported through the CDC’s National Healthcare Safety Network (NHSN). Colon Surgeries have been added for 2012. End of Quality Year Dashboard (April 2011-March 2012) 12

  13. 12 Months of SIRs Numerators (infections) and Denominators (cases) for 6 procedures have been required by PA to be reported through the CDC’s National Healthcare Safety Network (NHSN). Colon Surgeries have been added for 2012.

  14. New Dashboard

  15. Orthopedic Categories Laminectomy Knee Prosthesis Hip Prosthesis Neurosurgery Procedures Laminectomy Plastic Procedures Breast Implant Breast Lumpectomy Mastectomy Specialty Categories Esophageal Resection Kidney Transplant Lung Resection Pacemaker Pacemaker/ICD Insertion Infection Prevention is providing data on these 26 procedures Numbers of Surgeries with SIRs • Cardio-Thoracic Surgery Procedures • Cardiac Valve • CABG with one incision • CABG with two incisions • General Surgery Procedures • Appendectomy • Lap Cholecystectomy • Open Cholecystectomy • Lap Colectomy • Open Colectomy • Exploratory Abdominal Surgery • Vascular Bypass Surgery • Vascular Graft/Fistula/AV Shunt • OB/GYN Categories • Cesarean Section • Abdominal Hysterectomy • Vaginal Hysterectomy

  16. Goal: Zero SSIs • We have committed to • implementation of evidence-based “bundles” for all patients undergoing surgical procedures • special focus on cardiac and orthopedic • Feedback on SIR is provided to surgeons quarterly

  17. Accomplishments • Infection Prevention  system & division chiefs of surgical specialties • explain SIR • distribute surgeon-specific data • discuss best practices

  18. Accomplishments • Individual hospitals continue to address issues where their SIR is above NHSN‘s benchmarks (1.0, 0.75, 0.5 are our 3 goals)

  19. Risk-Stratification

  20. Surgeon-Specific SIR Report

  21. Two examples of SIRs

  22. Two examples of SIRs

  23. Total Hips/Knees SIRs for 3+ years Target Target

  24. Vicky Brinsko, Director IP Vanderbilt University

  25. Leaping Into Surgical SIR’s

  26. Moving to SIRs • Big Changes from CDC/NHSN and CMS • In Jan 2012, CMS requires reporting of SSIs from Colon Surgery (COLO) and Abdominal Hysterectomy (HYST) as part of their pay for performance program • Up until this point CDC via NHSN was providing benchmarks for “comparison” to a pooled mean • In January 2012, CDC switched to SIRs for SSIs

  27. Anticipating Change • At VUMC we knew this change was coming • We began preparing our surgeons for this change in late 2011 • Baby steps • Announced in November 2011 that VUMC easing in to SIRs for surgical infection data reporting

  28. Standardized Infection Ratio (SIR) Ratio of observed events to expected events Expected events = The expected number CDC calculates in NHSN SIR = 1  infection rate at benchmark SIR < 1  infection rate lower than benchmark SIR > 1  infection rate higher than benchmark

  29. Summary Data

  30. Are the Data Risk Stratified? Infect Control Hosp Epidemiol 2011;32(10):970-986

  31. Monthly Reports to Surgery • We provide monthly reports of surgical data to the Pod Leaders (see example) • We present these data as a summary in the Perioperative Surgical Enterprise meeting Fictional data used for illustration purposes

  32. New Reporting Metrics • In July (beginning of our fiscal year), we presented a tandem report • This report had the “old” graph they were used to seeing (without the CDC benchmark featured) Fictional data used for illustration purposes

  33. New SIR Addition • We included both the altered familiar graph and the new SIR graph with an explanation • Surgeons are visual and having both graphs in tandem was helpful

  34. Change is Good

  35. Amy Nichols, RN, MBA, CIC

  36. Using NHSN’s Standardized Infection Ratio The UCSF Experience Amy Nichols, RN, MBA, CIC Amy Nichols, RN, MBA, CIC Director Hospital Epidemiology and Infection Control November 2012

  37. What is the Standardized Infection Ratio? • Observed/Expected events • Expressed as decimal • Accompanied by significance statistics • Calculated by National Healthcare Safety Network database • Calculations are based upon the 2009 NHSN report (data from 2006-2008) • 2009 report reflects information reported from about 600 reporting hospitals • Now, NHSN has about 4500 reporting hospitals

  38. SIR at UCSF • Initially calculated quarterly for Surgical Site Infection (SSI) reports, now rolling monthly • Annually reported for Device-Related Infection (DRI) surveillance reports • Central Line-Associated Bloodstream Infections (CLABSI) • Catheter-Related Urinary Tract Infections (CAUTI) • Not reported for Ventilator-Associated Pneumonia (VAP)

  39. UCSF SSI SIR Display

  40. UCSF CLABSI SIR Display

  41. UCSF CAUTI SIR Display

  42. SIR-Based Strategy Implementation • SSI • Focus away from abdominal and transplant surgeries • Focus on procedures with SIR >1 • No procedures were significantly above expected • CLABSI • Reduction strategic work plan unchanged • No different than expected, but events still occur • Irreducible minimum achieved? • CAUTI • Reduction strategic work plan unchanged • Rates reducing

  43. Upcoming Beyond SCIP Events • Join us for a FREE Webinar • December 18, 2012 • 11:00 AM - 12:00 PM • Sue Barnes from Kaiser Permanente • SSI Prevention: How we are doing based on direct IP observations • www.cynosurehealth.org

  44. www.cynosurehealth.org

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