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Prevention of BSI and VAP Measuring Change in Outcomes Part I

Prevention of BSI and VAP Measuring Change in Outcomes Part I. Ted Speroff, PhD. NNIS Surveillance Data. Central line-associated BSI rate 5.0/1000 central line-days Ventilator-associated pneumonia rate 5.8/1000 ventilator-days The numerator is the number of events

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Prevention of BSI and VAP Measuring Change in Outcomes Part I

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  1. Prevention of BSI and VAPMeasuring Change in OutcomesPart I Ted Speroff, PhD

  2. NNIS Surveillance Data • Central line-associated BSI rate • 5.0/1000 central line-days • Ventilator-associated pneumonia rate • 5.8/1000 ventilator-days • The numerator is the number of events • Number of patients with infection or pneumonia • The denominator is the number of central-line or ventilator days, standardized to 1,000 • Census data in the ICU, all patients with lines or on ventilator • NNIS rate is calculated as number of BSI or VAP events (numerator) divided by observed number of line or vent days for the ICU (denominator) times 1,000

  3. Characteristics ofNNIS Rate Data • Requires aggregating data over a large sample • Takes time to accumulate data • Appropriate for Surveillance or Quality assurance • Appropriate for detecting a rate increase • Not appropriate for detecting a rate decrease unless sample is huge • Insufficient for Quality Improvement

  4. UCL Central Line is Mean LCL X-axis is Time Scale: days, weeks months Upper (UCL) and lower (LCL) control limits are usually 3 sigma units from the mean. A data point above the UCL or below the LCL is a significant change. There are additional control chart rules for detecting change. Statistical Process Control Charts • Used in QI to detect improvement (did it work?) • Chart:

  5. BSI Rates and Control Chart • Excel Tool • Naming and Saving the File • Entering Baseline Data • Setting the Baseline Period for the Control Chart • Editing Chart and Printing

  6. Name and Save the FileSave Often

  7. Rename the Template File

  8. HCAHospitalName_ICUName_ICUSafety_MonYr

  9. Spreadsheet is now calledMusic City_MICU_ICUSafety_Sep06

  10. Note the Tabs at the Bottom:4 WorksheetsBSI NNIS RateVAP NNIS Rate

  11. BSI NNIS Rate

  12. First Entry: Month/Year10/2004

  13. First Entry: CVC Days

  14. Collecting CVC Days

  15. First Entry: CVC-BSI Infections

  16. Continue Data Entry

  17. Data for Baseline Period Have Been EnteredNote: Data + Chart

  18. Set Baseline Period:Move Cursor to Cell F20

  19. Baseline goes from row 20 to 34Edit $D$50 to $D$34

  20. Move Cursor to Cell G3Edit the Text

  21. Text is a Reminder to You of the Baseline Period:the data for mean and control limits

  22. Chart: To Edit TitleMove Cursor on Title and Click

  23. Edit to your Hospital Nameand ICU Name

  24. Continue Data Entry:Only Baseline Data determine Mean and Control Limits

  25. Data Complete through 6/2006What do you see?

  26. End of Part IQuestions and Commentsso far?Continue to Part II

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