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HAI-1 Data Details

HAI-1 Reduce central line-associated bloodstream infections (CLABSIs)

About the Data

Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

National Data Source
National Healthcare Safety Network (NHSN); Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (CDC/NCEZID)
Changed Since the Healthy People 2020 Launch
No
Measure
Standardized Infection Ratio (SIR) 
Baseline (Year)
1.00 (2006-2008)
Target
0.25
Target-Setting Method
Maintain consistency with national programs, regulations, policies, and laws.
Numerator
The observed number of central line-associated bloodstream infections
Denominator
The predicted number of central line-associated bloodstream infections
Data Collection Frequency
Annual
Comparable Healthy People 2010 Objective
Adapted from HP2010 objective
Methodology Notes

Bloodstream infections are usually serious infections that typically increase hospital stays, risk of mortality, and cost of care. An estimated 248,000 bloodstream infections occur in U.S. hospitals each year. It is believed that a large portion of these infections are associated with the presence of a central line, i.e., central vascular catheter. The target-setting method is consistent with the DHHS Action Plan to Prevent Healthcare-Associated Infections goals. The suggested goal is 75% reduction of HAI infections by year 2020.

The Healthy People 2010 data source [National Nosocomial Infections Surveillance System (NNIS), CDC] has been retained. However, this system has evolved and is now the National Healthcare Safety Network (NHSN). The system is national in scope and currently supports more than 2,000 hospitals across the country. As of March 2010, twenty-one of the fifty states require hospitals to report healthcare-associated infection data through NHSN.

The predicted number of CLABSI are obtained by multiplying the CLABSI incidence rates for the 2006-2008 (baseline) period by the corresponding central line-days by patient care location. These estimates are summed to obtain the total which is the denominator of this measure.

A three-year baseline was chosen to increase the precision of the single point estimate. There were few facilities (about 300) reporting in 2006; by 2008, the number of reporting facilities had doubled (about 600). Including all three years in the baseline increased the precision of the referent period. The number of reporting units varies by year depending on state mandates and/or federal policy. Because of CMS reporting incentives, the number of facilities reporting CLABSI related to this measure is likely to stabilize after 2012 when approximately 5,000 hospitals will be reporting some CLABSI data. However, the number of reporting hospitals may continue to vary year to year.

Caveats and Limitations
Over the past decade, CLABSI rates declined significantly in most, but not all, major Intensive Care Unit types in facilities reporting to CDC. CLABSI rates have been shown to decline when focused prevention efforts adhering to CDC's guidelines and recommendations have been adopted. In 2009, the Department released the DHHS Action Plan to Prevent Healthcare-Associated Infections. The DHHS Action Plan identified CLABSI as a priority for prevention with national 5-year prevention targets and metrics proposed.
Trend Issues
Data may not be representative of all U.S. hospitals. For each year of data collection, not all participating hospitals are represented.
Target Calculation Methods
The target is consistent with DHHS Action Plan to Prevent Healthcare-Associated Infections targets and goals.
Changes Between HP2010 and HP2020
The measure was revised and changed from rate per 1,000 days' use to Standardized infection ratio (SIR).

References

Additional resources about the objective.

  1. Burton DC, Edwards JR, Horan TC, Fridkin SK. Trends in Central Line-Associated Bloodstream Infections in Intensive Care Units-United States, 1997-2007. Abstract for SHEA 18th Annual Scientific Meeting.
  2. Healthcare Associated Infections
    http://www.hhs.gov/ophs/initiatives/hai/index.html
  3. Klevens RM, Edward JR, et al. Estimating health 2002. Public Health Reports 2007: 122:160-166.
  4. Muto C, Herbert C, West, Harrison E, Edwards, et al. Reduction in Central Line--Associated Bloodstream Infections Among Patients in Intensive Care Units --- Pennsylvania, April 2001--March 2005. MMWR. 2005. 54;1013-1016.