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 DENIAL ANGER BARGAINING DEPRESSION ACCEPTANCE

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

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

8. NHSN’s Definition of a SIR 8

9. Standardized Infection Ratio S I R = Observed (by IP Surveillance) 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 10

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 11

12. 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)

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. 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 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

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 16

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 19

20. Surgeon-Specific SIR Report 20

21. Two examples of SIRs 21

22. Two examples of SIRs 22

26. 26 Target Total Hips/Knees SIRs for 3+ years

27. Vicky Brinsko, Director IP Vanderbilt University

28. Leaping Into Surgical SIR’s

29. 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

30. 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

31. 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

32. Overall SIR P-CARD SIR COLO SIRFUSN SIRKPRO SIRHPRO SIR P-VSHN SIR P-FUSN SIR REC SIRCRAN SIRVSHN SIRCBGC SIRCARD SIRVHYS SIRCSEC SIR Future Metrics CBGB SIRHYST SIR

33. Summary Data

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

35. 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

36. 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

37. 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

38. Change is Good

40. Amy Nichols, RN, MBA, CIC

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

42. 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 42

43. 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) 43

44. UCSF SSI SIR Display 44 CATEGORY# Procedures# SSIRateSIR*P-Value95% CI Abdominal Aortic Aneurysm2700.000.0000.24152.596 Appendectomy22231.350.7220.4034 0.149, 2.109 Biliary Surgery397235.790.5300.0005 0.336, 0.795

45. UCSF CLABSI SIR Display 45

46. UCSF CAUTI SIR Display 46

47. 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 47

49. 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

51. Thanks for joining us today