Healthcare-associated infections report, 2015 January 1 - 2016 December 31

Georgia Department of Public Health
Healthcare-Associated Infections Report
January 1, 2015 to December 31, 2016
March 2018

Contents Executive Summary .................................................................................................................................................................. i Key Findings............................................................................................................................................................................. ii Background ............................................................................................................................................................................. 1 Methods .................................................................................................................................................................................. 2 Results ..................................................................................................................................................................................... 4 Central Line-Associated Bloodstream Infections ..................................................................................................................... 6
CLABSI in Adult and Pediatric Intensive Care Units in Acute Care Hospitals.............................................. 7 CLABSI in Adult and Pediatric Wards in Acute Care Hospitals ................................................................... 8 CLABSI in Neonatal Intensive Care Units in Acute Care Hospitals ............................................................. 9 CLABSI in Long-Term Acute Care Hospitals ............................................................................................. 10 Catheter-Associated Urinary Tract Infections........................................................................................................................ 16 CAUTI in Adult and Pediatric Intensive Care Units in Acute Care Hospitals............................................. 17 CAUTI in Adult and Pediatric Wards in Acute Care Hospitals .................................................................. 18 CAUTI in Freestanding Inpatient Rehabilitation Facilities (IRF)................................................................ 19 CAUTI in Long-Term Acute Care Hospitals............................................................................................... 20 Surgical Site Infections .......................................................................................................................................................... 26 SSI following Colon Surgeries in Acute Care Hospitals............................................................................. 27 SSI following Abdominal Hysterectomies in Acute Care Hospitals .......................................................... 28 Methicillin-Resistant Staphylococcus aureus......................................................................................................................... 32 MRSA in Acute Care Hospitals ................................................................................................................. 33 MRSA in Freestanding Inpatient Rehabilitation Facilities ........................................................................ 33 MRSA in Long-Term Acute Care Hospitals ............................................................................................... 34 Clostridium difficile ................................................................................................................................................................ 35 CDI in Acute Care Hospitals ..................................................................................................................... 36 CDI in Freestanding Inpatient Rehabilitation Facilities ............................................................................ 36 CDI in Long-Term Acute Care Hospitals ................................................................................................... 37 Appendix ............................................................................................................................................................................... 38 Links for Further Information .................................................................................................................. 38 List of Acronyms ...................................................................................................................................... 38

List of Tables Table 1: Summary of HAI Data Submitted to NHSN, by Year, Georgia 2015-2016 ................................................................. iii Table 2: 2020 HHS HAI National Reduction Goals ................................................................................................................... 2 Table 3: Bed Size and Medical School Affiliation, Georgia 2015-2016..................................................................................... 4 Table 4: Number and Type of Locations Required to Report HAI Data, Georgia 2015-2016 ................................................... 5 Table 5: CLABSI SIR and SUR, by Facility Type, Location Type, and Year, Georgia 2015-2016 ............................................... 11 Table 6: Resistant Pathogen Phenotypes Identified from CLABSI in Adult and Pediatric ICU, Georgia 2015 and 2016......... 12 Table 7: Resistant Pathogen Phenotypes Identified from CLABSI in Adult and Pediatric Wards, Georgia 2015-2016........... 13 Table 8: Resistant Pathogen Phenotypes Identified from CLABSI in NICU, Georgia 2015-2016 ............................................ 14 Table 9: Resistant Pathogen Phenotypes Identified from CLABSI in LTACH, Georgia 2015-2016.......................................... 15 Table 10: CAUTI SIR, by Facility Type, Location Type, and Year, Georgia 2015-2016 ............................................................ 21 Table 11: Resistant Pathogen Phenotypes Identified from CAUTI in Adult and Pediatric ICU, Georgia 2015-2016 .............. 23 Table 12: Resistant Pathogen Phenotypes Identified from CAUTI in Adult and Pediatric Wards, Georgia 2015-2016.......... 24 Table 13: Resistant Pathogen Phenotypes Identified from CAUTI in LTACH, Georgia 2015-2016 ......................................... 25 Table 14: SSI SIR, by Procedure Type and Year, Georgia 2015-2016 ..................................................................................... 28 Table 15: Resistant Pathogen Phenotypes Identified from SSI COLO, Georgia 2015-2016.................................................... 30 Table 16: Resistant Pathogen Phenotypes Identified from SSI HYST, Georgia 2015-2016 .................................................... 31 Table 17: MRSA SIR, by Facility Type and Year, Georgia 2015-2016...................................................................................... 34 Table 18: CDI SIR, by Facility Type and Year, Georgia 2015-2016.......................................................................................... 37
List of Figures Figure 1: CLABSI SIR for ACH, by Location Type and Quarter, Georgia 2015-2016.................................................................. 6 Figure 2: CLABSI SIR for LTACH, by Quarter, Georgia 2015-2016 ............................................................................................ 6 Figure 3: Distribution of Pathogens Identified from CLABSI in Adult and Pediatric ICU, Georgia 2015-2016........................ 12 Figure 4: Distribution of Pathogens Identified from CLABSI in Adult and Pediatric Wards, Georgia 2015-2016 ................... 13 Figure 5: Distribution of Pathogens Identified from CLABSI in NICU, Georgia 2015-2016..................................................... 14 Figure 6: Distribution of Pathogens Identified from CLABSI in LTACH, Georgia 2015-2016 .................................................. 15 Figure 7: CAUTI SIR in ACH, by Location Type and Quarter, Georgia 2015-2016................................................................... 16 Figure 8: CAUTI SIR in LTACH and IRF, by Facility Type and Quarter, Georgia 2015-2016..................................................... 16 Figure 9: Distribution of Pathogens Identified from CAUTI in Adult and Pediatric ICU, Georgia 2015-2016 ......................... 22 Figure 10: Distribution of Pathogens Identified from CAUTI in Adult and Pediatric Wards, Georgia 2015-2016 .................. 24 Figure 11: Distribution of Pathogens Identified from CAUTI in LTACH, Georgia 2015-2016.................................................. 25 Figure 12: SSI SIR, by Procedure Type and Quarter, Georgia 2015-2016............................................................................... 26 Figure 13: Distribution of Pathogens Identified from SSI COLO, Georgia 2015-2016 ............................................................ 29 Figure 14: Distribution of Pathogens Identified from SSI HYST, Georgia 2015-2016 ............................................................. 31 Figure 15: MRSA SIR, by Facility Type and Quarter, Georgia 2015-2016 ............................................................................... 32 Figure 16: CDI SIR, by Facility Type and Quarter, Georgia 2015-2016 ................................................................................... 35

Executive Summary
Healthcare-associated infections (HAI) are a serious public health threat, affecting 1 in 32 hospital inpatients1 and causing up to $45 billion annually in direct hospital costs2. In 2013, the HAI reportable to the Centers for Medicaid and Medicare Services (CMS) Quality Reporting Program were made reportable to the Georgia Department of Public Health via the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN)--a secure, web-based HAI tracking system. This report provides aggregate Georgia HAI data, to compare state performance to national and state goals, and to measure progress over 2015 and 2016.
The HAI included in this report are: Central line-associated bloodstream infections (CLABSI) Catheter-associated urinary tract infections (CAUTI) Surgical site infections (SSI) following colon surgeries (COLO) Surgical site infections following abdominal hysterectomies (HYST) Laboratory-identified (LabID) methicillin-resistant Staphylococcus aureus (MRSA) found in the bloodstream Laboratory-identified Clostridium difficile in stool (CDI)
The facility and location types included in this report are: Acute Care Hospitals (ACH) o Adult and Pediatric Intensive Care Units (ICU) o Neonatal Intensive Care Units (NICU) o Adult and Pediatric Wards (Wards) Long-Term Acute Care Hospitals (LTACH) Inpatient Rehabilitation Facilities (IRF)
Performance is assessed using the standardized infection ratio (SIR). This metric is calculated by dividing the number of infections observed by the number of infections predicted. Lower SIR (< 1.0) indicate better performance. SIR goals are set by the United States Department of Health and Human Services (HHS). Progress made toward these goals is assessed using the number of infections needed to prevent (NNTP). NNTP at or below zero indicate the HHS SIR goal has been met or surpassed.
Device use is assessed using the standardized utilization ratio (SUR), which is calculated by dividing the number of device days observed by the number of device days predicted. Lower SUR (< 1.0) indicate lower than predicted device utilization, which may indicate reduced risk of device-associated HAI.
Pathogen distribution and antimicrobial susceptibility data are assessed to identify common pathogens for each HAI and to assess changes in the proportion of resistant pathogens.
1 Magill SS, Wilson LE, Thompson DL, Ray SM, Nadle J, Lynfield R, Janelle SJ, Kainer MA, Greissman S, Dumyati S, Beldavs ZG, Edwards JR. Reduction in the prevalence of healthcare-associated infections in U.S. acute care hospitals, 2015 versus 2011. Abstract presented at: National Trends in HAIs. IDWeek 2017; 2017 Oct 3-8; San Diego, CA. 2 Scott RD II. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. 2009. Retrieved from: http://www.cdc.gov/HAI/pdfs/hai/Scott_CostPaper.pdf. Accessed January 14, 2016.
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Key Findings
Improved Areas
The 2016 SIR was significantly lower than the 2015 national baseline SIR of 1.0 in the following areas: CDI in ACH was 12% lower CDI in IRF was 51% lower CDI in LTACH was 18% lower MRSA in LTACH was 55% lower
The 2020 HHS SIR Reduction Goals were met in the following areas: CAUTI in IRF with an SIR of 0.66 CDI in IRF with an SIR of 0.49 MRSA in LTACH with an SIR of 0.45
Improvement Needed
The 2016 SIR was significantly higher than the 2015 national baseline SIR of 1.0 in the following areas: CLABSI in ICU was 24% higher CLABSI in LTACH was 20% higher CAUTI in LTACH was 37% higher
Improvement Possible
The 2016 SIR was not significantly different from the 2015 national baseline SIR of 1.0 in the following areas: CLABSI in Wards and NICU CAUTI in ICU, Wards, and IRF SSI COLO and HYST MRSA in ACH and IRF
Table 1 summarizes HAI data submitted to the Georgia Department of Public Health for 2015 and 2016. The appendix includes links for additional information and a list of acronyms.
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Table 1: Summary of HAI Data Submitted to NHSN, by Year, Georgia 2015-2016
Indicates an SIR value that is significantly higher than the national baseline; Indicates an SIR value that is significantly lower than the national baseline; * indicates significance at the 0.05 level; . indicates no SIR or NNTP could be calculated
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Background
Healthcare-associated infections (HAI) are infections that develop during or soon after medical treatment for a separate medical condition. HAI can result from patients' own bacteria, be associated with surgery or invasive medical devices, or be due to exposure to bacteria, viruses, fungi, or spores transmitted from contaminated healthcare workers' hands, environmental surfaces, or medical equipment. Bacteria found in healthcare settings are often resistant to commonly prescribed antibiotics, making HAI more difficult to treat.
A 2015 survey of 143 acute care hospitals across the US found that on any given day, 1 in 32 inpatients had at least 1 HAI3. The direct cost of treating HAI ranges from $28.4 to $45 billion per year for US healthcare facilities. Preventing 20% of HAI could save up to $6.8 billion, and preventing 70% of HAI could save up to $31.5 billion per year4.
In January 2013, the HAI reportable to the Centers for Medicaid and Medicare Services' (CMS) Quality Reporting Program were added to the Georgia Department of Public Health (DPH) Notifiable Disease List. Facilities self-report data to DPH using the Centers for Disease Control and Prevention's (CDC's) National Healthcare Safety Network (NHSN), a secure, web-based HAI tracking system. Under Georgia law (O.C.G.A Sections 32-2-12 and 31-5-5), data submitted to DPH through NHSN remain confidential.
The HAI included in this report are: 1. Central line-associated bloodstream infections (CLABSI) 2. Catheter-associated urinary tract infections (CAUTI) 3. Surgical site infections (SSI) following colon surgeries (COLO) 4. Surgical site infections following abdominal hysterectomies (HYST) 5. Laboratory-identified (LabID) methicillin-resistant Staphylococcus aureus (MRSA) found in the bloodstream 6. Laboratory-identified Clostridium difficile in stool (CDI)
The facility and location types included in this report are: Acute Care Hospitals (ACH) o Adult and Pediatric Intensive Care Units (ICU) o Neonatal Intensive Care Units (NICU) o Adult and Pediatric Wards (Wards) Long-Term Acute Care Hospitals (LTACH) Inpatient Rehabilitation Facilities (IRF)
This report includes data from 123 facilities, including 102 ACH, 16 LTACH, and 5 IRF. Facilities reported up to 6 HAI, depending on (1) CMS reporting requirements and (2) applicability of the HAI measure. Any data that have been voluntarily reported by facility types or location types that are not required by CMS are not included.
3 Magill SS, Wilson LE, Thompson DL, Ray SM, Nadle J, Lynfield R, Janelle SJ, Kainer MA, Greissman S, Dumyati S, Beldavs ZG, Edwards JR. Reduction in the prevalence of healthcare-associated infections in U.S. acute care hospitals, 2015 versus 2011. Abstract presented at: National Trends in HAIs. IDWeek 2017; 2017 Oct 3-8; San Diego, CA. 4 Scott RD II. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. 2009. Retrieved from: http://www.cdc.gov/HAI/pdfs/hai/Scott_CostPaper.pdf. Accessed January 14, 2016.
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Methods

Infection data analyzed in this report were downloaded from NHSN on September 14, 2017.
SIR
The standardized infection ratio (SIR) is a summary measure that can be used to track HAI over time and can be calculated on a variety of levels, including unit, facility, state, and nation. The SIR compares the number of HAI observed to the number of HAI that was predicted.
The number of predicted HAI is calculated by risk-adjusted models created by CDC. Risk adjustment takes into account factors that may impact the number of HAI a facility reports, such as location type, number of beds, medical school affiliation, and facility type. The models were updated to be based on data submitted to NHSN in 2015, referred to as the "2015 rebaseline." When evaluating a facility's performance, the facility's SIR is compared to the national baseline SIR value 1.0 to determine if the facility is performing better, worse, or about the same as the nation in 2015.
Number of Observed Infections SIR = Number of Predicted Infections
When the SIR is calculated, there are three possible results:
The SIR is less than 1.0: there were fewer infections reported than predicted The SIR is equal to 1.0: there were as many infections reported as predicted The SIR is greater than 1.0: there were more infections reported than predicted

NNTP
HAI data are compared to the United States Health and Human Services (HHS) National Action Plan HAI reduction goals using the number of infections needed to prevent (NNTP) metric. The NNTP shows the number of infections that the state as a whole must prevent in one year to reach the 2020 HHS HAI national reduction goals [Table 2]. The NNTP is also referred to as the cumulative attributable difference (CAD) by CDC.

NNTP = Number of Observed Infections - (HHS Reduction Goal*Number of Predicted Infections)
The NNTP is part of the CDC's Targeted Assessment for Prevention strategy, which seeks to identify areas in need of targeted HAI prevention activities and quality improvement.
When the NNTP is calculated, there are three possible results:
The NNTP is less than 0: the SIR was lower (better) than the HHS reduction goal The NNTP is equal to 0: the SIR was the same as the HHS reduction goal The NNTP is greater than 0: the SIR was higher (worse) than the HHS reduction goal

Table 2: 2020 HHS HAI National Reduction Goals 2020 HAI Reduction Goal
Reduce by 25%, SIR goal = 0.75 Reduce by 30%, SIR goal = 0.70 Reduce by 50%, SIR goal = 0.50

Applicable HAI Types CAUTI CDI, COLO, HYST CLABSI, MRSA

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SUR
Use of invasive devices is a risk factor for the acquisition of HAI. The standardized utilization ratio (SUR) is a scalable measure that can be calculated on a variety of levels, including unit, facility, state, and nation. The SUR compares the number of device days observed to the number of device days that were predicted.
As with SIR, the number of predicted device days is calculated by risk-adjusted models created by CDC that account for factors such as location type, number of beds, medical school affiliation, and facility type. When evaluating a facility's performance, the facility's SUR is compared to the national baseline SUR value 1.0 to determine if the facility is performing better, worse, or about the same as the nation in 2015.
Number of Observed Device Days SUR = Number of Predicted Device Days When the SUR is calculated, there are three possible results:
The SUR is less than 1.0: there were fewer device days reported than predicted The SUR is equal to 1.0: there were as many device days reported as predicted The SUR is greater than 1.0: there were more device days reported than predicted
Pathogen Distribution
When an HAI is reported, up to three pathogens can be entered as causative agents. Antimicrobial susceptibility data are available for select species and phenotypes:
Carbapenem-resistant Enterobacteriaceae (CRE) Carbapenem-resistant Escherichia coli Carbapenem-resistant Enterobacter spp. Carbapenem-resistant Klebsiella pneumonia or K. oxytoca Carbapenem-non-susceptible (CarbNS) Acinetobacter spp. Carbapenem-non-susceptible Pseudomonas aeruginosa Extended-spectrum cephalosporin-resistant (ESC) Escherichia coli Extended-spectrum cephalosporin-resistant Klebsiella pneumonia or K. oxytoca Methicillin-resistant Staphylococcus aureus (MRSA) Multidrug-resistant (MDR) Pseudomonas aeruginosa Multidrug-resistant Acinetobacter spp. Vancomycin-resistant Enterococcus faecalis (VRE) Vancomycin-resistant Enterococcus faecium
When the same organism is entered with two different susceptibility patterns, the most resistant one is retained and the other deleted. When the same organism is listed as the cause of multiple simultaneous HAI (e.g., a CLABSI and a secondary bloodstream infection), the organism is only reported once.
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Results

Facility Characteristics
All 123 facilities completed the required NHSN facility survey in both 2015 and 2016. The surveys provided medical school affiliation and bed size, which are two factors included in the SIR risk adjustment performed by CDC for CLABSI, CAUTI, and LabID infections. A facility's medical school affiliation can be (1) major, meaning there is a program for medical students and post-graduate medical training; (2) graduate, meaning there is a program for post-graduate medical training; or (3) undergraduate, meaning there is a program for medical students only.

The majority of facilities in 2015 (99, 80.5%) and in 2016 (84, 68.3%) had no affiliation with a medical school. The most common type of medical school affiliation was major in both 2015 (10, 8.1%) and 2016 (17, 13.8%). The majority of facilities in 2015 (87, 70.7%) and in 2016 (86, 70.0%) had fewer than 200 beds [Table 3].

Table 3: Bed Size and Medical School Affiliation, Georgia 2015-2016 2015

Beds

Major

Graduate Undergraduate

25

0

0

1

26-49

1

0

0

50-199

1

2

2

200-499

2

2

3

500

6

4

0

Total (%)

10 (8.1)

8 (6.5)

6 (4.9)

2016

Beds

Major

Graduate Undergraduate

25

0

0

1

26-49

1

0

0

50-199

2

3

6

200-499

7

3

5

500

7

4

0

Total (%)

17 (13.8)

10 (8.1)

12 (9.8)

No Affiliation 6
23 51 15
4 99 (80.5)
No Affiliation 7
24 42
8 3 84 (68.3)

Total (%) 7 (5.7)
24 (19.5) 56 (45.5) 22 (17.9) 14 (11.4) 123 (100)
Total (%) 8 (6.5)
25 (20.3) 53 (43.1) 23 (18.7) 14 (11.4) 123 (100)

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Type of patient care location is another risk factor that can affect number of CLABSI and CAUTI reported by facilities, due to differences in patient acuity. During 2015 and 2016, intensive care units (ICU), select inpatient wards, long-term acute care (LTAC) locations, and inpatient rehabilitation facilities were required to report CLABSI and CAUTI.

The proportions of reporting location types were similar in 2015 and 2016, with the most common reporting locations as medical/surgical wards (~26%), medical wards (~18%), and medical/surgical ICU (~16%); [Table 4].

Table 4: Number and Type of Locations Required to Report HAI Data, Georgia 2015-2016

CDC-Designated Location Type

2015 n (%)

2016 n (%)

Medical/Surgical Ward

137 (25.6) 141 (26.0)

Medical Ward

97 (18.1) 101 (18.6)

Medical/Surgical ICU

87 (16.3) 84 (15.5)

Surgical Ward

51 (9.5) 52 (9.6)

Long-Term Acute Care Ward

24 (4.5) 24 (4.4)

Neonatal ICU (Level II/III)

22 (4.1) 21 (3.9)

Medical ICU

21 (3.9) 20 (3.7)

Surgical Cardiothoracic ICU

17 (3.2) 17 (3.1)

Medical Cardiac ICU

14 (2.6) 14 (2.6)

Pediatric Medical/Surgical Ward

14 (2.6) 14 (2.6)

Neonatal ICU (Level III)

13 (2.4) 15 (2.8)

Neurosurgical ICU

9 (1.7)

9 (1.7)

Surgical ICU

5 (0.9)

5 (0.9)

Inpatient Rehabilitation Facility

5 (0.9)

5 (0.9)

Neurologic ICU

4 (0.7)

5 (0.9)

Trauma ICU

4 (0.7)

4 (0.7)

Pediatric Medical/Surgical ICU

3 (0.6)

3 (0.6)

Pediatric Medical Ward

3 (0.6)

3 (0.6)

Burn ICU

2 (0.4)

2 (0.4)

Long-Term Acute Care ICU

2 (0.4)

2 (0.4)

Prenatal ICU

1 (0.2)

1 (0.2)

Total

535 (100) 542 (100)

The remainder of the report consists of five sections, one per HAI. In each section, the report summarizes trends for 20152016, highlights findings by facility and unit type, and follows with supporting tables and figures.

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Central Line-Associated Bloodstream Infections

Overview
A central line is a catheter that is inserted into a large vein and terminates at or near the heart in one of the great vessels. Central lines are used for infusing fluids or medications, withdrawing blood, or hemodynamic monitoring. When bacteria enter the bloodstream through the central line, bloodstream infections can occur.
Bloodstream infections meet the NHSN definition of a central line-associated bloodstream infection (CLABSI) when the central line is in place for at least 2 calendar days on the day the infection is recognized and is either still in place or was removed the day prior.
Overall CLABSI Key Findings CLABSI SIR from the first quarter of 2015 to the fourth quarter of 2016:
In ACH, adult and pediatric ICU increased from 1.06 to 1.18 In ACH, adult and pediatric wards decreased from 1.23 to 0.93 In ACH, NICU decreased from 1.64 to 0.97 [Figure 1] LTACH increased from 0.65 to 1.41 [Figure 2]

Figure 1: CLABSI SIR for ACH, by Location Type and Quarter, Georgia 2015-2016

ICU

Ward

NICU

Baseline (1.0)

2

HHS Goal (0.5)

1.5 1

SIR

0.5

0 2015Q1

2015Q2

2015Q3

2015Q4

2016Q1

2016Q2

2016Q3

Figure 2: CLABSI SIR for LTACH, by Quarter, Georgia 2015-2016

LTACH

Baseline (1.0)

2

HHS Goal (0.5)

2016Q4

1.5

SIR

1

0.5

0 2015Q1

2015Q2

2015Q3

2015Q4

2016Q1

2016Q2

2016Q3

2016Q4

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CLABSI in Adult and Pediatric Intensive Care Units in Acute Care Hospitals
Characteristics of Reporting Units In 2015, 89 ACH reported CLABSI from 167 adult and pediatric intensive care units (ICU); in 2016, 88 ACH reported from 164 ICU. SIR by Quarter The SIR increased from 1.06 in first quarter of 2015 to 1.18 in fourth quarter of 2016 [Figure 1]. SIR and NNTP by Year The 2015 SIR was 1.22 (95% CI 1.10, 1.35), meaning there were 22% more CLABSI than predicted. The 2015 SIR was not significantly different from the national baseline and a reduction of 209 CLABSI was needed to reach the HHS SIR goal of 0.50. The 2016 SIR was 1.24 (95% CI 1.12, 1.37), meaning there were 24% more CLABSI than predicted. The 2016 SIR was significantly higher than the national baseline and a reduction of 225 CLABSI was needed to reach the HHS SIR goal of 0.50 [Table 5]. There was no significant difference between the 2015 and 2016 SIR. SIR by CDC-Designated Location Type In 2015, compared to the national baseline, the SIR was significantly higher in burn, medical, and neurosurgical ICU and not significantly different in other reporting ICU. An SIR could not be calculated for prenatal ICU. In 2016, compared to the national baseline, the SIR was significantly higher in burn ICU and not significantly different in other reporting ICU. An SIR could not be calculated for prenatal ICU [Table 5]. Standardized Utilization Ratio In 2015, compared to the national baseline, the SUR was significantly higher in seven reporting ICU (burn, medical cardiac, surgical cardiothoracic, medical/surgical, pediatric medical/surgical, neurologic, and surgical ICU). The 2015 SUR was not significant in medical ICU and significantly lower in all other ICU types. In 2016, compared to the national baseline, the SUR remained higher in six reporting ICU (burn, medical cardiac, surgical cardiothoracic, medical/surgical, neurologic and surgical ICU) and significantly lower in all other ICU types [Table 5]. Pathogens Identified In 2015, 388 pathogens were isolated from the 355 reported CLABSI. The most commonly identified pathogens were Candida and other yeast species (27.3%), coagulase-negative Staphylococcus species (15.7%), and Enterococcus species (14.7%). Resistant phenotypes accounted for 8.5% of the identified pathogens. In 2016, 431 pathogens were isolated from the 375 reported CLABSI. The most commonly identified pathogens were Candida and other yeast species (27.1%), Enterococcus species (16.7%), and coagulase-negative Staphylococcus species (14.2%) [Figure 3]. Resistant phenotypes accounted for 13% of the identified pathogens [Table 6].
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CLABSI in Adult and Pediatric Wards in Acute Care Hospitals
Characteristics of Reporting Units In 2015, 97 ACH reported CLABSI from 302 adult and pediatric wards; in 2016, 97 ACH reported from 311 wards. SIR by Quarter The SIR decreased from 1.23 in the first quarter of 2015 to 0.93 in the fourth quarter of 2016 [Figure 1]. SIR and NNTP by Year The 2015 SIR was 1.09 (95% CI 1.10, 1.35), meaning there were 9% more CLABSI than predicted. The 2015 SIR was not significantly different from the national baseline and a reduction of 145 CLABSI was needed to reach the HHS SIR goal of 0.50. The 2016 SIR was 1.07 (95% CI 0.95, 1.21), meaning there were 7% more CLABSI than predicted. The 2016 SIR was not significantly different from the national baseline and a reduction of 149 infections was needed to reach the HHS SIR goal of 0.50 [Table 5]. There was no significant difference between the 2015 and 2016 SIR. SIR by CDC-Designated Location Type In 2015, compared to the national baseline, the SIR was significantly higher in medical wards and not significantly different in other reporting wards. An SIR could not be calculated for pediatric medical wards. In 2016, compared to the national baseline, the SIR was not significantly different in reporting wards. An SIR could not be calculated for pediatric medical wards [Table 5]. Standardized Utilization Ratio In 2015, compared to the national baseline, the SUR was significantly higher in medical, pediatric medical, and medical/surgical wards and not significantly different in other reporting wards. In 2016, compared to the national baseline SUR, the SUR was significantly higher in pediatric medical, pediatric medical/surgical, and surgical wards. The 2016 SUR was significantly lower in medical/surgical wards and not significantly different in medical wards [Table 5]. Pathogens Identified In 2015, 317 pathogens were isolated from the 267 reported CLABSI. The most commonly identified pathogens were Candida and other yeast species (23.7%), coagulase-negative Staphylococcus species (13.9%), and Enterococcus species (13.2%). Resistant phenotypes accounted for 14.1% of the identified pathogens. In 2016, 313 pathogens were isolated from the 278 reported CLABSI. The most commonly identified pathogens were Candida and other yeast species (24.3%), Staphylococcus aureus (16.0%), and Enterococcus species (13.4%) [Figure 4]. Resistant phenotypes accounted for 14.1% of the identified pathogens [Table 7].
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CLABSI in Neonatal Intensive Care Units in Acute Care Hospitals
Characteristics of Reporting Units In 2015, 32 ACH reported CLABSI from 35 neonatal intensive care units (NICU); in 2016, 31 ACH reported from 36 NICU. SIR by Quarter The SIR decreased from 1.64 in the first quarter of 2015 to 0.97 in the fourth quarter of 2016 [Figure 1]. SIR and NNTP by Year The 2015 SIR was 1.36 (95% CI 1.09, 1.67), meaning there were 36% more CLABSI than predicted. The 2015 SIR was significantly higher than the national baseline and a reduction of 54 CLABSI was needed to reach the HHS SIR goal of 0.50. The 2016 SIR was 1.12 (95% CI 0.88, 1.41), meaning there were 12% more CLABSI than predicted. The 2016 SIR was not significantly different from the national baseline and a reduction of 39 CLABSI was needed to reach the HHS SIR goal of 0.50 [Table 5]. There was no significant difference between the 2015 and 2016 SIR. SIR by CDC-Designated Location Type In 2015, compared to the national baseline, the SIR was significantly higher in Level III NICU and not significantly different in Level II/III NICU. In 2016, compared to the national baseline, the SIR was not significantly different in Level II/III and Level III NICU [Table 5]. Standardized Utilization Ratio In 2015, compared to the national baseline, the SUR was significantly higher in Level II/III NICU and significantly lower in Level III NICU. In 2016, compared to the national baseline, the SUR was significantly lower in both Level III NICU and Level II/III NICU [Table 5]. Pathogens Identified In 2015, 94 pathogens were isolated from the 85 reported CLABSI. The most commonly identified pathogens were Staphylococcus aureus (26.6%), coagulase-negative Staphylococcus species (13.8%), and Enterococcus species (13.8%). Resistant phenotypes accounted for 11.7% of the identified pathogens. In 2016, 80 pathogens were isolated from the 70 reported CLABSI. The most commonly identified pathogens were coagulase-negative Staphylococcus species (21.3%), Staphylococcus aureus (20.0%), and Candida and other yeast species (16.3%) [Figure 5]. Resistant phenotypes accounted for 5.0% of the identified pathogens [Table 8].
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CLABSI in Long-Term Acute Care Hospitals
Characteristics of Reporting Units In 2015 and 2016, 16 LTACH reported CLABSI from 26 long-term acute care units. SIR by Quarter The SIR increased from 0.65 in the first quarter of 2015 to 1.41 in the fourth quarter of 2016 [Figure 2]. SIR and NNTP by Year The 2015 SIR was 0.90 (95% CI 0.74, 1.08), meaning there were 10% fewer CLABSI than predicted. The 2015 SIR was not significantly different from the national baseline and a reduction of 48 infections was needed to reach the HHS SIR goal of 0.50. The 2016 SIR was 1.20 (95% CI 1.01, 1.42), meaning there were 20% more CLABSI than predicted. The 2016 SIR was not significantly different from the national baseline and a reduction of 76 infections was needed to reach the HHS SIR goal of 0.50 [Table 5]. There was a significant increase between the 2015 and 2016 SIR. SIR by CDC-Designated Location Type In 2015, compared to the national baseline, the SIR was significantly lower in long-term acute care ICU and not significantly different in long-term acute care wards. In 2016, compared to the national baseline, the SIR was significantly higher in long-term acute care wards and not significantly different in long-term acute care ICU [Table 5]. Standardized Utilization Ratio In both 2015 and 2016, compared to the national baseline, the SUR was significantly higher in long-term acute care ICU and wards [Table 5]. Pathogens Identified In 2015, 122 pathogens were isolated from the 108 reported CLABSI. The most commonly identified pathogens were Enterococcus species (19.7%), coagulase-negative Staphylococcus species (14.8%), Candida and other yeast (13.1%), and Klebsiella species (13.1%). Resistant phenotypes accounted for 26.2% of the identified pathogens. In 2016, 141 pathogens were isolated from the 130 reported CLABSI. The most commonly identified pathogens were Enterococcus species (26.2%), Candida and other yeast species (21.1%), coagulase-negative Staphylococcus species (11.3%), and Klebsiella species (11.3%) [Figure 6]. Resistant phenotypes accounted for 23.4% of the identified pathogens [Table 9].
Page | 10

Table 5: CLABSI SIR and SUR, by Facility Type, Location Type, and Year, Georgia 2015-2016

2015

2016

CDC-Designated Location Type

N

SIR &

NNTP

SUR &

N

SIR &

NNTP

SUR &

95% CI

95% CI

95% CI

95% CI

Acute Care Hospital Adult & Pediatric ICU Total
Burn ICU Medical Cardiac ICU Surgical Cardiothoracic ICU Medical ICU Medical/Surgical ICU

167 1.22 (1.10, 1.35) 2 1.48 (1.03, 2.06)
14 1.32 (0.90, 1.88) 17 1.28 (0.96, 1.67) 21 1.40 (1.01, 1.90) 87 1.07 (0.90, 1.26)

209 1.08 (1.08, 1.08) 164 1.24 (1.12, 1.37) 22 1.77 (1.73, 1.81) 2 3.04 (2.38, 3.83) 19 1.08 (1.06, 1.09) 14 1.16 (0.78, 1.66) 31 1.37 (1.35, 1.38) 17 0.91 (0.65, 1.24) 26 0.99 (0.97, 1.00) 20 0.96 (0.64, 1.38) 71 1.06 (1.05, 1.06) 84 1.12 (0.95, 1.31)

225 1.05 (1.05, 1.06) 57 1.76 (1.72, 1.80) 16 1.07 (1.05, 1.08) 18 1.29 (1.28, 1.30) 13 0.92 (0.91, 0.93) 79 1.05 (1.04, 1.05)

Pediatric Medical/Surgical ICU

3 0.69 (0.18, 1.89)

1 1.04 (1.01, 1.08) 3 1.65 (0.67, 3.44)

5 0.94 (0.90, 0.97)

Neurologic ICU

4 0.63 (0.26, 1.31)

2 1.09 (1.07, 1.11) 5 0.47 (0.17, 1.05)

0 1.05 (1.03, 1.07)

Neurosurgical ICU

9 1.83 (1.25, 2.60) 22 0.85 (0.84, 0.87) 9 1.31 (0.83, 1.96) 13 0.88 (0.86, 0.89)

Prenatal ICU Surgical ICU Trauma ICU

1

.

5 1.24 (0.71, 2.03)

4 1.24 (0.79, 1.87)

. 0.03 (0.02, 0.04) 9 1.12 (1.10, 1.14) 13 0.96 (0.94, 0.98)

1

.

5 1.46 (0.92, 2.21)

4 1.37 (0.87, 2.06)

. 0.02 (0.02, 0.03) 14 1.13 (1.11, 1.15) 14 0.88 (0.86, 0.90)

Acute Care Hospital Adult and Pediatric Ward Total

302 1.09 (0.97, 1.23) 145 1.06 (1.06, 1.07) 311 1.07 (0.95, 1.21) 149 1.05 (1.04, 1.05)

Medical Ward

97 1.25 (1.04, 1.49) 50 1.02 (1.01, 1.02) 101 0.90 (0.73, 1.10) 16 0.99 (0.98, 1.00)

Pediatric Medical Ward

3 0.00 (0.00, 2.88)

0 1.13 (1.12, 1.13) 3 0.00 (0.00, 2.16)

0 1.12 (1.11, 1.12)

Medical/Surgical Ward

137 0.99 (0.82, 1.19) 27 0.99 (0.96, 1.03) 141 1.13 (0.95, 1.34) 43 0.85 (0.82, 0.89)

Pediatric Medical/Surgical Ward

14

.

1 2.16 (2.05, 2.28) 14

.

0 1.42 (1.33, 1.51)

Surgical Ward

51 0.96 (0.74, 1.23) 14 1.01 (1.00, 1.02) 52 0.87 (0.66, 1.12)

8 1.03 (1.02, 1.04)

Acute Care Hospital Neonatal ICU Total

35 1.36 (1.09, 1.67) 54 1.00 (0.99, 1.01) 36 1.12 (0.88, 1.41) 39 0.89 (0.88, 0.90)

Neonatal ICU (Level II/III)

22 1.30 (0.91 ,1.81) 21 0.95 (0.94, 0.96) 21 1.20 (0.77 ,1.79) 13 0.92 (0.91, 0.93)

Neonatal ICU (Level III)

13 1.39 (1.05 ,1.81) 34 1.07 (1.06, 1.09) 15 1.09 (0.81 ,1.43) 26 0.83 (0.81, 0.84)

Long Term Acute Care Hospital Total 26 0.90 (0.74, 1.08) 48 1.20 (1.19, 1.20) 26 1.20 (1.01, 1.42) 76 1.10 (1.09, 1.10)

Long-Term Acute Care ICU

2 0.14 (0.01, 0.68)

0 1.58 (1.52, 1.64) 2 0.27 (0.01, 1.31)

0 1.46 (1.40, 1.53)

Long-Term Acute Care Ward

24 0.95 (0.78, 1.14) 51 1.19 (1.18, 1.19) 24 1.23 (1.04, 1.46) 77 1.09 (1.08, 1.10)

Indicates an SIR value that is significantly higher than the national baseline; Indicates an SIR value that is significantly lower than the national baseline; . Indicates no SIR, 95% CI, or NNTP could be calculated

Page | 11

Figure 3: Distribution of Pathogens Identified from CLABSI in Adult and Pediatric ICU, Georgia 2015-2016

CNS: Coagulase-negative Staphylococcus. Other pathogens: 5 or fewer of the following: Achromobacter Anaerococcus, Arthrobacter, Bacillus, Bacterioides, Bifidobacterium, Brevibacterium, Budvicia, Burkholderia, Citrobacter, Clostridium, Dialister, Eggerthella, Fusiformis, Fusobacterium, Lactobacillus, Morganella, other Staphylococcus species, Pantoea, Peptococcus, Peptostreptococcus, Proteus and Streptococcus; as well as pathogens identified as anaerobe, Boas-Oppler bacilli, CDC group, Gram-negative bacillus, and Gram-positive coccus.
Table 6: Resistant Pathogen Phenotypes Identified from CLABSI in Adult and Pediatric ICU, Georgia 2015 and 2016

Resistant Phenotype

2015

2016

N % of Total Pathogens N % of Total Pathogens

MRSA

11

2.8 22

5.1

VRE Enterococcus faecium

10

2.6 15

3.5

MDR Acinetobacter

3

0.8 1

0.2

MDR Pseudomonas aeruginosa 3

0.8 6

1.4

VRE Enterococcus faecalis

2

0.5 2

0.5

ESC Klebsiella spp.

2

0.5 9

2.1

ESC Escherichia coli

1

0.3 0

0

CRE Klebsiella spp.

1

0.3 1

0.2

Total

33

8.5 56

13.0

Page | 12

Figure 4: Distribution of Pathogens Identified from CLABSI in Adult and Pediatric Wards, Georgia 2015-2016

CNS: Coagulase-negative Staphylococcus. Other pathogens: 5 or fewer of the following: Achromobacter, Acinetobacter, Agrobacterium, Arthrobacter, Bacillus, Bacterioides, Branhamella, Burkholderia, Citrobacter, Corynebacterium, Fusobacterium, Kocuria, Lactobacillus, Leuconostoc, Micrococcus, Morganella, other Staphylococcus species, Serratia, and Streptococcus; as well as pathogens identified as CDC group, Gram-negative bacillus, and Gram-positive bacillus.

Table 7: Resistant Pathogen Phenotypes Identified from CLABSI in Adult and Pediatric Wards, Georgia 2015-2016

Resistant Phenotype

2015

2016

N % of Total Pathogens N % of Total Pathogens

MRSA

23

7.3 25

8.0

VRE Enterococcus faecium

8

2.5 6

1.9

ESC Klebsiella spp

4

1.3 3

1.0

ESC Escherichia coli

3

0.9 6

1.9

CRE Enterobacter spp

2

0.6 0

0

MDR Pseudomonas aeruginosa 2

0.6 2

0.6

VRE Enterococcus faecalis

1

0.3 1

0.3

CRE Klebsiella spp

1

0.3 0

0

MDR Acinetobacter spp

1

0.3 1

0.3

Total

45

14.1 44

14.1

Page | 13

Figure 5: Distribution of Pathogens Identified from CLABSI in NICU, Georgia 2015-2016

CNS: Coagulase-negative Staphylococcus. Other pathogens: 5 or fewer of the following: Acinetobacter, Enterobacter, Klebsiella, Proteus, Pseudomonas, other Staphylococcus species, Serratia, and Streptococcus; as well as pathogens identified as Gram-negative bacillus and Gram-positive coccus.

Table 8: Resistant Pathogen Phenotypes Identified from CLABSI in NICU, Georgia 2015-2016

Resistant Phenotype

2015 N % of Total Pathogens N

MRSA

10

10.6 2

CarbNS Pseudomonas aeruginosa 1

1.1 0

CRE Escherichia coli

0

0 1

ESC Escherichia coli

0

0 1

Total

11

11.7 4

2016 % of Total Pathogens
2.5 0
1.3 1.3 5.0

Page | 14

Figure 6: Distribution of Pathogens Identified from CLABSI in LTACH, Georgia 2015-2016

CNS: Coagulase-negative Staphylococcus. Other pathogens: 5 or fewer of the following: Acinetobacter, Bacterioides, Citrobacter, Enterobacter, Escherichia coli, Lactobacillus, other Staphylococcus species, Proteus, Serratia, and Streptococcus; as well as pathogens identified as: CDC group and Gram-negative bacillus.

Table 9: Resistant Pathogen Phenotypes Identified from CLABSI in LTACH, Georgia 2015-2016

Resistant Phenotype

2015

2016

N % of Total Pathogens N % of Total Pathogens

MRSA

11

9.0 3

2.1

VRE Enterococcus faecium

8

6.6 9

6.4

ESC Klebsiella spp

6

4.9 3

2.1

MDR Pseudomonas aeruginosa 2

1.6 3

2.1

VRE Enterococcus faecalis

2

1.6 4

2.8

ESC Escherichia coli

1

0.8 0

0

CRE Klebsiella spp

1

0.8 6

4.3

MDR Acinetobacter spp

1

0.8 0

0

CRE Enterobacter spp

0

0 5

3.5

Total

32

26.2 33

23.4

Page | 15

Catheter-Associated Urinary Tract Infections
Overview
An indwelling urinary catheter is a tube that is inserted into the bladder through the urethra and is connected to a drainage bag. When bacteria enter the bladder or kidneys through the urinary catheter, urinary tract infections can occur.
Urinary tract infections meet the NHSN definition of a catheter-associated urinary tract infection (CAUTI) when the catheter is in place for at least 2 calendar days on the day the infection is recognized and is either still in place or was removed the day prior.
Overall CAUTI Key Findings CAUTI SIR from the first quarter of 2015 to the fourth quarter of 2016:
In ACH, adult and pediatric ICU decreased from 1.21 to 0.84 In ACH, adult and pediatric wards decreased from 0.96 to 0.81 [Figure 7] IRF increased from 0 to 0.73. No SIR could be calculated for the fourth quarter of 2016 because there was less
than 1 infection predicted. LTACH increased from 1.24 to 1.55 [Figure 8]

Figure 7: CAUTI SIR in ACH, by Location Type and Quarter, Georgia 2015-2016

ICU

Ward

Baseline (1.0)

1.5

HHS Goal (0.75)

1

SIR

0.5

0 2015Q1

2015Q2

2015Q3

2015Q4

2016Q1

2016Q2

2016Q3

Figure 8: CAUTI SIR in LTACH and IRF, by Facility Type and Quarter, Georgia 2015-2016

IRF

LTACH

Baseline (1.0)

HHS Goal (0.75)

2.5

2

1.5

SIR

1

0.5

0 2015Q1

2015Q2

2015Q3

2015Q4

2016Q1

2016Q2

2016Q3

2016Q4 2016Q4

Page | 16

CAUTI in Adult and Pediatric Intensive Care Units in Acute Care Hospitals
Characteristics of Reporting Units In 2015, 89 ACH reported CAUTI from 167 adult and pediatric intensive care units (ICU); in 2016, 88 ACH reported from 164 ICU. SIR by Quarter The SIR decreased from 1.21 in the first quarter of 2015 to 0.84 in the fourth quarter of 2016 [Figure 7]. SIR and NNTP by Year The 2015 SIR was 1.18 (95% CI 1.08, 1.21), meaning there were 18% more CAUTI than predicted. The 2015 SIR was significantly higher than the national baseline and a reduction of 194 CAUTI was needed to reach the HHS SIR goal of 0.75. The 2016 SIR for was 1.01 (95% CI 0.93, 1.11), meaning there was 1% more CAUTI than predicted. The 2016 SIR was not significantly different from the national baseline and a reduction of 124 CAUTI was needed to reach the HHS SIR goal of 0.75 [Table 10]. There was no significant difference between the 2015 and 2016 SIR. SIR by CDC-Designated Location Type In 2015, compared to the national baseline, the SIR was significantly higher in medical/surgical and neurosurgical ICU and not significantly different in other reporting ICU. In 2016, compared to the national baseline, SIR was significantly higher in medical/surgical ICU and not significantly different in other reporting ICU [Table 10]. Standardized Utilization Ratio In 2015, compared to the national baseline, the SUR was significantly higher in seven reporting ICU (burn, surgical cardiothoracic, neurologic, neurosurgical, prenatal, surgical, and trauma ICU). The 2015 SUR was not significantly different in pediatric medical/surgical ICU and significantly lower in other reporting ICU. In 2016, compared to the national baseline, the SUR remained significantly higher in six reporting ICU (burn, neurologic, neurosurgical, prenatal, surgical, and trauma ICU). The 2016 SUR was not significantly different in surgical cardiothoracic ICU and significantly lower in other reporting ICU [Table 10]. Pathogens Identified In 2015, 579 pathogens were isolated from the 532 reported CAUTI. The most commonly identified pathogens were Escherichia coli (35.8%), Pseudomonas species (15.9%), and Klebsiella species (13.6%). Resistant phenotypes accounted for 9.7% of the identified pathogens. In 2016, 515 pathogens were isolated from the 474 reported CAUTI. The most commonly identified pathogens were Escherichia coli (32.5%), Enterococcus species (17.1%), and Klebsiella species (14.8%) [Figure 9]. Resistant phenotypes accounted for 14% of the identified pathogens [Table 11].
Page | 17

CAUTI in Adult and Pediatric Wards in Acute Care Hospitals
Characteristics of Reporting Units In 2015, 97 ACH reported CAUTI from 302 adult and pediatric wards; in 2016, 97 ACH reported from 311 wards. SIR by Quarter The SIR decreased from 0.96 in the first quarter of 2015 to 0.81 in the fourth quarter of 2016 [Figure 7].
SIR and NNTP by Year The 2015 SIR was 1.07 (95% CI 0.97, 1.20), meaning there were 7% more CAUTI than predicted. The 2015 SIR was not significantly different from the national baseline and a reduction of 89 CAUTI was needed to reach the HHS SIR goal of 0.75. The 2016 SIR was 0.98 (95% CI 0.87, 1.10), meaning there were 2% fewer CAUTI than predicted. The 2016 SIR was not significantly different from the national baseline and a reduction of 64 CAUTI was needed to reach the HHS SIR goal of 0.75 [Table 10]. There was no significant different between the 2015 and 2016 SIR. SIR by CDC-Designated Location Type In 2015, compared to the national baseline, the SIR was significantly higher in medical wards and not significantly different in other reporting wards. An SIR could not be calculated for pediatric medical/surgical wards. In 2016, compared to the national baseline, the SIR was not significantly different in reporting wards. An SIR could not be calculated for pediatric medical/surgical wards [Table 10]. Standardized Utilization Ratio In 2015, compared to the national baseline, the SUR was significantly higher in medical, pediatric medical, and medical/surgical wards and significantly lower in other reporting wards. In 2016, compared to the national baseline, the SUR was significantly higher in pediatric medical/surgical wards, not significantly different in pediatric medical wards, and significantly lower in other reporting wards [Table 10]. Pathogens Identified In 2015, 327 pathogens were isolated from the 295 reported CAUTI. The most commonly identified pathogens were Escherichia coli (32.7%), Enterococcus species (16.2%), and Pseudomonas species (13.8%). Resistant phenotypes accounted for 15.0% of the identified pathogens. In 2016, 297 pathogens were isolated from the 272 reported CAUTI. The most commonly identified pathogens were Escherichia coli (29.6%), Klebsiella species (13.5%), and Pseudomonas species (13.5%) [Figure 10]. Resistant phenotypes accounted for 13.8% of the identified pathogens [Table 12].
Page | 18

CAUTI in Freestanding Inpatient Rehabilitation Facilities (IRF)
Characteristics of Reporting Units In 2015 and 2016, 5 IRF reported CAUTI. SIR by Quarter The SIR increased from 0 in the first quarter of 2015 to 0.73 in the third quarter of 2016. An SIR could not be calculated for the fourth quarter of 2016 because there was less than one predicted infection [Figure 8]. SIR and NNTP by Year The 2015 SIR was 0.91 (95% CI 0.34, 2.03), meaning there were 9% fewer CAUTI than predicted. The 2015 SIR was not significantly different from the national baseline and a reduction of 1 infection was needed to reach the HHS SIR goal of 0.75. The 2016 SIR was 0.66 (95% CI 0.17, 1.79), meaning there were 34% fewer CAUTI than predicted. The 2016 SIR was not significantly different from the national baseline. The HHS SIR goal of 0.75 was reached [Table 10]. There was no significant difference between the 2015 and 2016 SIR. Standardized Utilization Ratio In both 2015 and 2016, compared to the national baseline, the SUR was significantly lower [Table 10]. Pathogens Identified In 2015, 5 pathogens were isolated from the 5 reported CAUTI and included Escherichia coli, Klebsiella species, and Enterococcus species. No resistant organisms were identified. In 2016, 3 pathogens were isolated from the 3 reported CAUTI and included Escherichia coli and Enterococcus species. No resistant organisms were identified.
Page | 19

CAUTI in Long-Term Acute Care Hospitals
Characteristics of Reporting Units In 2015 and 2016, 16 LTACH reported CLABSI from 26 long-term acute care units. SIR by Quarter The SIR increased from 1.24 in the first quarter of 2015 to 1.55 in the fourth quarter of 2016 [Figure 8]. SIR and NNTP by Year The 2015 SIR was 1.24 (95% CI 1.08, 1.42), meaning there were 24% more CAUTI than predicted. The 2015 SIR was significantly higher than the national baseline and a reduction of 79 CAUTI was needed to reach the HHS SIR goal of 0.75. The 2016 SIR was 1.37 (95% CI 1.19, 1.57), meaning there were 37% more CAUTI than predicted. The 2016 SIR was significantly higher than the national baseline and a reduction of 90 CAUTI was needed to reach the HHS SIR goal of 0.75 [Table 10]. There was no significant difference between the 2015 and 2016 SIR. SIR by CDC-Designated Location Type In 2015, compared to the national baseline, the SIR was significantly lower in long-term acute care ICU and not significantly different in long-term acute care wards. In 2016, compared to the national baseline, the SIR was significantly higher in long-term acute care wards and not significantly different in long-term acute care ICU [Table 10]. Standardized Utilization Ratio In both 2015 and 2016, compared to the national baseline, the SUR was significantly higher in both long-term acute care ICU and wards [Table 10]. Pathogens Identified In 2015, 216 pathogens were isolated from the 200 reported CAUTI. The most commonly identified pathogens were Pseudomonas species (30.1%), Escherichia coli (19.0%), and Klebsiella species (17.1%). Resistant phenotypes accounted for 28.2% of the identified pathogens. In 2016, 221 pathogens were isolated from the 199 reported CAUTI. The most commonly identified pathogens were Escherichia coli (24.9%), Pseudomonas species (23.1%), and Klebsiella species (20.4%) [Figure 11]. Resistant phenotypes accounted for 24.9% of the identified pathogens [Table 13].
Page | 20

Table 10: CAUTI SIR, by Facility Type, Location Type, and Year, Georgia 2015-2016 2015

2016

CDC-Designated Location Type

N

SIR &

NNTP

SUR &

N

SIR &

NNTP

SUR &

95% CI

95% CI

95% CI

95% CI

Acute Care Hospital Adult & Pediatric ICU Total
Burn ICU Medical Cardiac ICU Surgical Cardiothoracic ICU Medical ICU Medical/Surgical ICU Pediatric Medical/Surgical ICU Neurologic ICU Neurosurgical ICU Prenatal ICU Surgical ICU Trauma ICU Acute Care Hospital Adult and Pediatric Ward Total Medical Ward Pediatric Medical Ward Medical/Surgical Ward Pediatric Medical/Surgical Ward Surgical Ward Inpatient Rehabilitation Hospital Total

167 1.18 (1.08, 1.28) 2 0.76 (0.43, 1.25)
14 1.38 (0.96, 1.91) 17 1.13 (0.83, 1.51) 21 1.17 (0.85, 1.57) 87 1.29 (1.12, 1.47)
3 0.44 (0.02, 2.16) 4 0.99 (0.71, 1.35) 9 1.28 (1.03, 1.57) 1 0.77 (0.04, 3.81) 5 1.19 (0.79, 1.74) 4 0.97 (0.72, 1.28)

302 1.07 (0.96, 1.20)

97 1.25 (1.04, 1.49)

3 0.00 (0.00, 2.88)

137 0.99 (0.82, 1.19)

14

.

51 0.96 (0.74, 1.23)

5 0.91 (0.34, 2.03)

194 1.03 (1.03, 1.04) 164 1.01 (0.93, 1.11) 1 1.65 (1.61, 1.68) 14 1.22 (0.78, 1.82)
16 0.95 (0.93, 0.96) 17 0.75 (0.47, 1.14) 15 1.05 (1.04, 1.07) 20 0.71 (0.49, 1.01) 15 0.95 (0.94, 0.96) 3 0.93 (0.66, 1.29) 86 0.99 (0.99, 1.00) 84 1.25 (1.09, 1.43)
0 0.99 (0.93, 1.04) 5 2.60 (0.95, 5.76) 9 1.23 (1.21, 1.26) 9 1.00 (0.71, 1.36) 36 1.05 (1.03, 1.06) 2 0.94 (0.73, 1.20) 1 1.38 (1.29, 1.47) 1 0.00 (0.00, 1.98) 10 1.16 (1.14, 1.18) 5 0.76 (0.47, 1.15) 11 1.41 (1.39, 1.44) 4 0.79 (0.56, 1.09)

89 1.01 (1.01, 1.02) 311 50 1.05 (1.04, 1.06) 101
0 1.03 (1.03, 1.04) 3 27 0.92 (0.86, 0.98) 141
. 6.85 (6.56, 7.14) 14 50 0.91 (0.90, 0.91) 52
1 0.83 (0.80, 0.86) 5

0.98 (0.87, 1.10) 0.90 (0.73, 1.10) 0.00 (0.00, 2.16) 1.13 (0.95, 1.34)
. 0.87 (0.66, 1.12) 0.66 (0.17, 1.79)

124 1.02 (1.02, 1.02) 9 1.56 (1.52, 1.59) 1 0.96 (0.95, 0.97) 0 1.01 (1.00, 1.02) 7 0.91 (0.90, 0.92)
84 0.99 (0.99, 1.00) 4 0.89 (0.84, 0.94)
10 1.07 (1.05, 1.09) 13 1.07 (1.05, 1.08)
0 1.56 (1.47, 1.65) 1 1.23 (1.21, 1.24) 2 1.34 (1.31, 1.36)
64 0.96 (0.96, 0.97) 16 0.98 (0.97, 0.99)
0 0.99 (0.99, 1.00) 43 0.81 (0.76, 0.87)
. 7.20 (6.91, 7.50) 8 0.87 (0.87, 0.88) 0 0.72 (0.69, 0.74)

Long Term Acute Care Hospital Total

26 1.24 (1.08, 1.42) 79 1.20 (1.20, 1.21) 26 1.37 (1.19, 1.57) 90 1.16 (1.15, 1.17)

Long-Term Acute Care ICU

2 0.87 (0.01, 0.68)

2 1.58 (1.52, 1.64) 2 0.77 (0.01, 1.31)

1 1.46 (1.40, 1.53)

Long-Term Acute Care Ward

24 1.26 (0.78, 1.14) 78 1.19 (1.18, 1.19) 24 1.40 (1.04, 1.46) 90 1.09 (1.08, 1.10)

Indicates an SIR value that is significantly higher than the national baseline; Indicates an SIR value that is significantly lower than the national baseline; . Indicates no SIR, 95% CI,

or NNTP could be calculated

Page | 21

Figure 9: Distribution of Pathogens Identified from CAUTI in Adult and Pediatric ICU, Georgia 2015-2016
CNS: Coagulase-negative Staphylococcus. Other pathogens: 5 or fewer of the following: Achromobacter, Acinetobacter, Arthrobacter, Bacillus, Burkholderia, Candida and other yeast, Citrobacter, Corynebacterium, Micrococcus, Morganella, other Staphylococcus species, and Streptococcus; as well as pathogens identified as CDC group.
Page | 22

Table 11: Resistant Pathogen Phenotypes Identified from CAUTI in Adult and Pediatric ICU, Georgia 2015-2016

Resistant Phenotype

2015

2016

N % of Total Pathogens N % of Total Pathogens

MDR Pseudomonas aeruginosa

20

3.5 17

3.3

ESC Escherichia coli

14

2.4 14

2.7

MRSA

6

1.0 8

1.6

ESC Klebsiella spp

5

0.9 7

1.4

VRE Enterococcus faecium

5

0.9 17

3.3

CRE Klebsiella spp

3

0.5 2

0.4

MDR Acinetobacter spp

2

0.3 0

0

CarbNS Pseudomonas aeruginosa 1

0.2 5

1.0

CRE Escherichia coli

0

0 1

0.2

CRE Enterobacter spp

0

0 1

0.2

Total

56

9.7 72

14.0

Page | 23

Figure 10: Distribution of Pathogens Identified from CAUTI in Adult and Pediatric Wards, Georgia 2015-2016

CNS: Coagulase-negative Staphylococcus. Other pathogens: 5 or fewer of the following: Achromobacter, Acinetobacter, Aerococcus, Corynebacterium, Delftia, Morganella, Lactobacillus, Serratia, and Streptococcus; as well as pathogens identified as Gram-negative bacillus and CDC group.

Table 12: Resistant Pathogen Phenotypes Identified from CAUTI in Adult and Pediatric Wards, Georgia 2015-2016

Resistant Phenotype

2015

2016

N % of Total Pathogens N % of Total Pathogens

ESC Escherichia coli

15

4.6 14

4.7

MDR Pseudomonas aeruginosa

9

2.8 4

1.3

ESC Klebsiella spp

8

2.4 7

2.4

VRE Enterococcus faecium

8

2.4 4

1.3

MRSA

6

1.8 8

2.7

MDR Acinetobacter spp

1

0.3 1

0.3

CRE Enterobacter spp

1

0.3 1

0.3

CRE Escherichia coli

1

0.3 0

0

CRE Klebsiella spp

0

0 2

0.7

Total

49

15.0 41

13.8

Page | 24

Figure 11: Distribution of Pathogens Identified from CAUTI in LTACH, Georgia 2015-2016

CNS: Coagulase-negative Staphylococcus. Other pathogens: 5 or fewer of the following: Achromobacter, Acinetobacter, Citrobacter, Serratia, coagulase-negative Staphylococcus, Staphylococcus aureus, and Streptococcus, as well as pathogens identified as CDC group and Gram-positive bacillus.

Table 13: Resistant Pathogen Phenotypes Identified from CAUTI in LTACH, Georgia 2015-2016

Resistant Phenotype

2015

2016

N % of Total Pathogens N % of Total Pathogens

MDR Pseudomonas aeruginosa

21

9.7 15

6.8

ESC Klebsiella spp

12

5.6 8

3.6

VRE Enterococcus faecium

10

4.6 9

4.1

ESC Escherichia coli

7

3.2 10

4.5

CRE Klebsiella spp

3

1.4 3

1.4

CarbNS Pseudomonas aeruginosa 2

0.9 6

2.7

MRSA

2

0.9 0

0

CRE Enterobacter spp

1

0.5 2

0.9

MDR Acinetobacter spp

1

0.5 1

0.5

CarbNS Acinetobacter spp

1

0.5 0

0

CRE Escherichia coli

0

0 1

0.5

Total

60

27.4 55

24.9

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Surgical Site Infections

Overview
A surgical site infection is one that occurs after surgery and involves the skin, soft tissue, or other parts of the body that were incised, opened, or manipulated during the surgical procedure.
Overall SSI Key Findings SSI SIR from the first quarter of 2015 to the fourth quarter of 2016:
COLO decreased from 1.20 to 0.99 HYST decreased from 1.34 to 0.99 [Figure 12]

Figure 12: SSI SIR, by Procedure Type and Quarter, Georgia 2015-2016

COLO

HYST

Baseline (1.0)

1.5

HHS Goal (0.7)

1.25

1

SIR

0.75

0.5

0.25

0 2015Q1 2015Q2 2015Q3 2015Q4 2016Q1 2016Q2 2016Q3 2016Q4

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SSI following Colon Surgeries in Acute Care Hospitals
Characteristics of Reporting Units In 2015, 88 ACH reported SSI COLO; in 2016, 87 ACH reported. SIR by Quarter The SIR decreased from 1.20 in the first quarter of 2015 to 0.99 in the fourth quarter of 2016 [Figure 12]. SIR and NNTP by Year The 2015 SIR was 1.24 (95% CI 1.11, 1.39), meaning there were 24% more COLO SSI than predicted. The 2015 SIR was significantly higher than the national baseline and a reduction of 131 COLO SSI was needed to reach the HHS SIR goal of 0.70. The 2016 SIR was 1.01 (95% CI 0.89, 1.14), meaning there was 1% more COLO SSI than predicted. The 2016 SIR was not significantly different from the national baseline and a reduction of 80 COLO SSI was needed to reach the HHS SIR goal of 0.70 [Table 14]. There was a significant decrease between the 2015 and 2016 SIR. Pathogens Identified In 2015, 694 pathogens were isolated from the 300 reported SSI. The most commonly identified pathogens were Escherichia coli (20.5%), Enterococcus species (18.6%), and Klebsiella species (8.9%). Resistant phenotypes accounted for 9.8% of the identified pathogens. In 2016, 700 pathogens were isolated from the 260 reported SSI. The most commonly identified pathogens were Escherichia coli (23.0%), Enterococcus species (16.6%), and Bacterioides species (8%) [Figure 13]. Resistant phenotypes accounted for 10.7% of the identified pathogens [Table 15].
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SSI following Abdominal Hysterectomies in Acute Care Hospitals
Characteristics of Reporting Units In 2015, 86 ACH reported SSI HYST; in 2016, 82 ACH reported.
SIR by Quarter The SIR decreased from 1.34 in the first quarter of 2015 to 0.99 in the fourth quarter of 2016 [Figure 12].
SIR and NNTP by Year The 2015 SIR was 1.09 (95% CI 0.87, 1.33), meaning there were 9% more HYST SSI than predicted. The 2015 SIR was not significantly different from the national baseline and a reduction of 31 HYST SSI was needed to reach the HHS SIR goal of 0.70.
The 2016 SIR was 0.90 (95% CI 0.71, 1.13), meaning there were 10% fewer HYST SSI than predicted. The 2016 SIR was not significantly different from the national baseline and a reduction of 17 HYST SSI was needed to reach the HHS SIR goal of 0.70 [Table 14]. There was a significant decrease between the 2015 and 2016 SIR.
Pathogens Identified In 2015, 161 pathogens were isolated from the 86 reported SSI. The most commonly identified pathogens were Staphylococcus aureus (13.7%), Enterococcus species (12.4%), and Bacterioides species (11.8%). Resistant phenotypes accounted for 6.2% of the identified pathogens.
In 2016, 210 pathogens were isolated from the 72 reported SSI [Figure 14]. The most commonly identified pathogens were Staphylococcus aureus (15.7%), Escherichia coli (15.7%), and Enterococcus species (13.3%) [Table 16]. Resistant phenotypes accounted for 6.7% of the identified pathogens [Table 16].

Table 14: SSI SIR, by Procedure Type and Year, Georgia 2015-2016

2015

CDC-Designated Location Type N

SIR & 95% CI

NNTP N

SSI COLO

89 1.24 (1.11, 1.39) 131 87

SSI HYST

86 1.09 (0.87, 1.33) 31 82

Indicates an SIR value that is significantly higher than the national baseline

2016 SIR & 95% CI 1.01 (0.89, 1.14) 0.90 (0.71, 1.13)

NNTP
80 17

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Figure 13: Distribution of Pathogens Identified from SSI COLO, Georgia 2015-2016
CNS: Coagulase-negative Staphylococcus. Other pathogens: 5 or fewer of the following: Abiotrophia, Achromobacter, Acinetobacter, Actinobacterium, Actinomyces, Aeromonas, Alcaligenes, Anaerococcus, Bacillus, Clostridium, Corynebacterium, Diplococcus, Eggerthella, Falcivibrio, Finegoldia, Fusobacterium, Haemophilus, Kluyvera, Lactobacillus, Micrococcus, Micromonas, Morganella, Mycobacterium, Peptococcus, Peptostreptococcus, Prevotella, Serratia, and other Staphylococcus species; as well as pathogens identified as: Anaerobe, CDC group, Gram-positive coccus, Gramnegative bacillus, Gram-negative coccobacillus, and Gram-positive bacillus.
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Table 15: Resistant Pathogen Phenotypes Identified from SSI COLO, Georgia 2015-2016

Resistant Phenotype

2015

2016

N % of Total Pathogens N % of Total Pathogens

MRSA

25

3.6 32

4.6

VRE Enterococcus faecium

16

2.3 10

1.4

ESC Escherichia coli

15

2.2 21

3.0

MDR Pseudomonas spp

4

0.6 4

0.6

ESC Klebsiella spp

3

0.4 4

0.6

VRE Enterococcus faecalis

3

0.4 1

0.1

MDR Acinetobacter spp

1

0.1 0

0

CarbNS Pseudomonas spp

1

0.1 0

0

CRE Enterobacter spp

0

0 2

0.3

CRE Klebsiella spp

0

0 1

0.1

Total

68

9.8 75

10.7

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Figure 14: Distribution of Pathogens Identified from SSI HYST, Georgia 2015-2016

CNS: Coagulase-negative Staphylococcus. Other pathogens: 5 or fewer of the following: Achromobacter, Acinetobacter, Actinomyces, Anaerococcus, Arthrobacter, Bacillus, Bifidobacterium, Candida and other yeast species, Citrobacter, Corynebacterium, Enterobacter, Falcivibrio, Finegoldia, Morganella, Mycoplasma, other Staphylococcus species, and Peptococcus, Peptostreptococcus, Prevotella, and Serratia; as well as pathogens identified as: anaerobes, CDC group, Gram-negative bacillus, Gram-positive bacillus, and Gram-positive coccus.

Table 16: Resistant Pathogen Phenotypes Identified from SSI HYST, Georgia 2015-2016

Resistant Phenotype

2015

2016

N % of Total Pathogens N % of Total Pathogens

MRSA

8

5.0 13

6.2

MDR Pseudomonas spp

1

0.6 1

0.5

VRE Enterobacter faecium

1

0.6 0

0

Total

10

6.2 14

6.7

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Methicillin-Resistant Staphylococcus aureus

Overview
Methicillin-resistant Staphylococcus aureus (MRSA) is a type of Staphylococcus aureus that is resistant to several antibiotics. Staphylococcus aureus is commonly found on the skin or in the nose. It can be spread on contaminated medical equipment or by person-to-person contact. When these bacteria enter the bloodstream, they can cause bloodstream infections.
Blood cultures that test positive for MRSA by a recognized test meet the NHSN definition of laboratory-identified (LabID) MRSA. If the patient tests positive for MRSA on or after the third day of their inpatient hospital stay, it is considered hospital-acquired; otherwise it is considered community-acquired.
Overall MRSA Key Findings MRSA SIR from the first quarter of 2015 to the fourth quarter of 2016:
ACH decreased from 1.29 to 1.04 LTACH decreased from 0.33 to 0.29 [Figure 15]

No SIR could be calculated for IRF because there was less than 1 infection predicted for each quarter of 2015 and 2016.

Figure 15: MRSA SIR, by Facility Type and Quarter, Georgia 2015-2016

ACH

LTACH

Baseline (1.0)

HHS Goal (0.5)

1.5

1.25

1

SIR

0.75

0.5

0.25

0 2015Q1 2015Q2 2015Q3 2015Q4 2016Q1 2016Q2 2016Q3 2016Q4

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MRSA in Acute Care Hospitals
Characteristics of Reporting Units In 2015 and 2016, 102 ACH reported MRSA. SIR by Quarter The SIR decreased from 1.29 in the first quarter of 2015 to 1.04 in the fourth quarter of 2016 [Figure 15]. SIR and NNTP by Year The 2015 SIR was 1.25 (95% CI 1.12, 1.39), meaning there were 25% more MRSA than predicted. The 2015 SIR was significantly higher than the national baseline and a reduction of 198 MRSA was needed to reach the HHS SIR goal of 0.50. The 2016 SIR was 1.08 (95% CI 0.96, 1.21), meaning there were 8% more MRSA than predicted. The 2016 SIR was not significantly different from the national baseline and a reduction of 161 MRSA was needed to reach the HHS SIR goal of 0.5 [Table 17]. There was no significant difference between the 2015 and 2016 SIR.
MRSA in Freestanding Inpatient Rehabilitation Facilities
Characteristics of Reporting Units In 2015 and 2016, 5 IRF reported MRSA. SIR by Quarter There was less than one predicted infection for every quarter of 2015 and 2016; therefore, no SIR could be calculated. SIR and NNTP by Year In 2015 there was less than one predicted infection; therefore, no SIR could be calculated. The 2016 SIR for inpatient rehabilitation facilities was 0 (95% CI 0, 2.70), meaning there were no reported infections [Table 17].
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MRSA in Long-Term Acute Care Hospitals
Characteristics of Reporting Units In 2015, 15 LTACH reported MRSA; in 2016, 16 LTACH reported.
SIR by Quarter The SIR decreased from 0.33 in the first quarter of 2015 to 0.29 in the fourth quarter of 2016 [Figure 15].
SIR and NNTP by Year In 2015 the overall was 0.85 (95% CI 0.58, 1.21), meaning there were 15% fewer MRSA than predicted. The 2015 SIR was not significantly different from the national baseline and a reduction of 12 MRSA was needed to reach the HHS SIR goal of 0.50.
The 2016 SIR was 0.45 (95% CI 0.25, 0.75), meaning there were 55% fewer MRSA than predicted. The 2016 SIR was significantly lower than the national baseline. The HHS SIR goal of 0.5 was reached [Table 17]. There was a significant decrease between the 2015 and 2016 SIR.

Table 17: MRSA SIR, by Facility Type and Year, Georgia 2015-2016

2015

2016

CDC-Designated Location Type N

SIR & 95% CI

NNTP N

SIR & 95% CI

NNTP

Acute Care Hospital

102 1.25 (1.12, 1.39) 198 102 1.08 (0.96, 1.21) 161

Inpatient Rehabilitation Facility 5

.

. 5

0 (., 2.699)

.

Long-Term Acute Care Hospital 15 0.85 (0.58, 1.21) 12 16 0.45 (0.25, 0.78)

0

Indicates an SIR value that is significantly higher than the national baseline; Indicates an SIR value that is significantly lower than

the national baseline; . Indicates no SIR, 95% CI, or NNTP could be calculated

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Clostridium difficile

Overview
Clostridium difficile is a spore-forming bacteria that is commonly found in nature and commonly colonizes the human digestive system. Clostridium difficile can cause severe diarrhea, colitis, and other gastrointestinal illness. The spores of Clostridium difficile are spread via contaminated surfaces and hands.

Stool cultures that test positive for Clostridium difficile by a recognized test meet the NHSN definition of laboratoryidentified (LabID) Clostridium difficile infection (CDI). If the patient tests positive for CDI on or after the third day of their inpatient hospital stay, it is considered hospital-acquired; otherwise it is considered community-acquired.
Overall CDI Key Findings CDI SIR from the first quarter of 2015 to the fourth quarter of 2016:
ACH decreased from 0.93 to 0.82 IRF increased from 0.41 to 0.53 LTACH decreased from 0.91 to 0.77 [Figure 16]

Figure 16: CDI SIR, by Facility Type and Quarter, Georgia 2015-2016

ACH

IRF

LTACH

Baseline (1.0)

1.5

HHS Goal (0.7)

1.25

1

SIR

0.75

0.5

0.25

0 2015Q1

2015Q2

2015Q3

2015Q4

2016Q1

2016Q2

2016Q3

2016Q4

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CDI in Acute Care Hospitals
Characteristics of Reporting Units In 2015 and 2016, 102 ACH reported CDI. SIR by Quarter The SIR decreased from 0.93 in the first quarter of 2015 to 0.82 in the fourth quarter of 2016 [Figure 16]. SIR and NNTP by Year The 2015 SIR was 0.96 (95% CI 0.93, 0.99), meaning there were 4% fewer CDI than predicted. The 2015 SIR was significantly lower than the national baseline and a reduction of 749 CDI was needed to reach the HHS SIR goal of 0.70. The 2016 SIR was 0.88 (95% CI 0.85, 0.92), meaning there were 12% fewer CDI. The 2016 SIR was significantly lower than the national baseline and a reduction of 546 CDI was needed to reach the HHS SIR goal of 0.70 [Table 18]. There was a significant decrease between the 2015 and 2016 SIR.
CDI in Freestanding Inpatient Rehabilitation Facilities
Characteristics of Reporting Units In 2015 and 2016, 5 IRF reported CDI. SIR by Quarter The SIR increased from 0.41 in the first quarter of 2015 to 0.53 in the fourth quarter of 2016 [Figure 16]. SIR and NNTP by Year The 2015 SIR was 0.72 (95% CI 0.43, 1.15), meaning there were 18% fewer CDI than predicted. The 2015 SIR was not significantly different from the national baseline and a reduction of 1 CDI was needed to reach the HHS SIR goal of 0.70. The 2016 SIR was 0.49 (95% CI 0.27, 0.84), meaning there were 51% fewer CDI than predicted. The 2016 SIR was significantly lower than the national baseline. The HHS SIR goal of 0.70 was reached [Table 18]. There was no significant difference between the 2015 and 2016 SIR.
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CDI in Long-Term Acute Care Hospitals
Characteristics of Reporting Units In 2015, 15 LTACH reported CDI; in 2016, 16 LTACH reported.
SIR by Quarter The SIR decreased from 0.91 in the first quarter of 2015 to 0.77 in the fourth quarter of 2016 [Figure 16].
SIR and NNTP by Year The 2015 SIR was 0.91 (95% CI 0.79, 1.06), meaning there were 9% fewer CDI than predicted. The 2015 SIR was not significantly different from the national baseline and a reduction of 43 CDI was needed to reach the HHS SIR goal of 0.70.
The 2016 SIR was 0.82 (95% CI 0.70, 0.95), meaning there were 18% fewer CDI than predicted. The 2016 SIR was significantly lower than the national baseline and a reduction of 25 CDI was needed to reach the HHS SIR goal of 0.70 [Table 18]. There was no significant difference between the 2015 and 2016 SIR.

Table 18: CDI SIR, by Facility Type and Year, Georgia 2015-2016

2015

CDC-Designated Location Type N

SIR & 95% CI

NNTP N

Acute Care Hospital

102 0.96 (0.93, 0.99) 749 102

Inpatient Rehabilitation Facility 5 0.72 (0.43, 1.15)

1 5

Long-Term Acute Care Hospital 15 0.91 (0.79, 1.06) 43 16

Indicates an SIR value that is significantly lower than the national baseline

2016 SIR & 95% CI 0.88 (0.85, 0.92) 0.49 (0.27, 0.84) 0.82 (0.70, 0.95)

NNTP
546 0
25

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Appendix
Links for Further Information
About NHSN: https://www.cdc.gov/nhsn/about-nhsn/index.html CMS Reporting Requirements: https://www.cdc.gov/nhsn/pdfs/cms/cms-reporting-requirements.pdf NHSN SIR Guide: https://www.cdc.gov/nhsn/pdfs/ps-analysis-resources/nhsn-sir-guide.pdf NHSN SUR Guide: https://www.cdc.gov/nhsn/pdfs/ps-analysis-resources/nhsn-sur-guide-508.pdf NHSN Targeted Assessment for Prevention (TAP) Strategy: https://www.cdc.gov/hai/prevent/tap.html NHSN Protocols for Acute Care Hospitals: https://www.cdc.gov/nhsn/acute-care-hospital/index.html NHSN Protocols for Inpatient Rehabilitation Facilities: https://www.cdc.gov/nhsn/inpatient-rehab/index.html NHSN Protocols for Long-Term Acute Care Hospitals: https://www.cdc.gov/nhsn/ltach/index.html

List of Acronyms

ACH CAD CAUTI CDC CDI CLABSI CMS COLO DPH HAI HHS HSYT ICU IRF LabID LTACH MRSA NHSN NICU NNTP SIR SSI SUR TAP

Acute care hospital Cumulative attributable difference Catheter-associated urinary tract infection Centers for Disease Control and Prevention Clostridium difficile Central line-associated bloodstream infection Centers for Medicaid and Medicare Services Colon surgery Georgia Department of Public Health Healthcare-associated infections United States Department of Health and Human Resources Abdominal hysterectomy Intensive care unit Inpatient rehabilitation facility Laboratory identified Long-term acute care hospital Methicillin-resistant Staphylococcus aureus National Healthcare Safety Network Neonatal intensive care unit Number of infections needed to prevent Standardized infection ratio Surgical site infection Standardized utilization ratio Targeted assessment for prevention

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