1. Prevention of BSI and VAP Measuring Change in Outcomes Part 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 of NNIS 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. Statistical Process Control Charts Used in QI to detect improvement (did it work?) Chart: Central Line is Mean UCL LCL 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. X-axis is Time Scale: days, weeks months

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

7. Name and Save the File Save Often

8. Rename the Template File

9. HCAHospitalName_ICUName_ ICUSafety_MonYr

10. Spreadsheet is now called Music City_MICU_ICUSafety_Sep06

11. Note the Tabs at the Bottom: 4 Worksheets BSI NNIS Rate VAP NNIS Rate

12. BSI NNIS Rate

13. First Entry: Month/Year 10/2004

14. First Entry: CVC Days

15. Collecting CVC Days

16. First Entry: CVC-BSI Infections

17. Continue Data Entry

18. Data for Baseline Period Have Been Entered Note: Data + Chart

19. Set Baseline Period: Move Cursor to Cell F20

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

21. Move Cursor to Cell G3 Edit the Text

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

23. Chart: To Edit Title Move Cursor on Title and Click

24. Edit to your Hospital Name and ICU Name

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

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

28. End of Part I Questions and Comments so far? Continue to Part II