Reducing the incidence of healthcare-associated infections (HAIs) has been a major industry-wide focus lately. A recent report issued by the Leapfrog Group has highlighted that we still have a long way to go, as patients are still experiencing these serious infections too frequently. The report, titled Health Care-Associated Infections, is the first in a five-part series that analyzes current patient safety trends in the U.S. It focused on two common types of HAIs: catheter-associated urinary tract infection (CAUTI) and central line-associated bloodstream infection (CLABSI).
The Leapfrog Group used a specialized type of tool for comparing HAI rates by hospital and by state. You may not have heard of the standardized infection ratio (SIR) before, but it’s a good idea for nurses to familiarize themselves with the concept—particularly those who would like to work in infection prevention and control.
The SIR is a summary measure developed by the CDC to track HAIs at the hospital, regional, state, or national level over time. It compares the number of actual infections at those levels to a baseline number, which is the number of infections that can be expected in a standard population. This “standard population” comes from data reported to the National Healthcare Safety Network (NHSN). The SIR is adjusted for patients of varying risk—for example, hospitals with a burn center can be expected to see more infections among inpatients than hospitals without a burn center, because burn patients are at higher risk of infection than the “average” inpatient.
In simple terms: The SIR compares actual HAI rates of a target population to the average number of HAIs in a referent population, adjusted for risk. Here’s what you should understand:
- A SIR of 1.0 means the number of actual infections is equal to the national baseline (the number of “expected” infections).
- A SIR above 1.0 means the number of actual infections is higher than the national baseline (meaning we need to step up our infection control efforts).
- A SIR below 1.0 means the number of actual infections is lower than the national baseline (meaning infection control efforts are yielding results).
- The difference above or below 1.0 is the percentage by which the HAI rate exceeds or is lower than the national baseline.
The Leapfrog Group has set a target SIR of zero for CLABSI. According to its report, only 25 percent of hospitals met that goal. The good news is that 67 percent of hospitals had a SIR between zero and 1.0—meaning they are doing better than the national average in preventing central line-associated bloodstream infections, which are associated with increased mortality. And the bad news is, eight percent of hospitals had a SIR above 1.0.
For CAUTI, the most common type of HAI, the Leapfrog Group has set a target goal that the SIR is close to zero. Again, only 25 percent of hospitals met this standard.
In a press statement, the Leapfrog Group noted that:
Infection rates vary by state of residence, choice of hospital and metropolitan area – On average, New Hampshire had the safest hospitals, with 67 percent reporting a CLABSI rate of zero. Alternatively, Rhode Island and Maryland showed the most urgent need to improve, with no hospitals reporting a CLABSI rate of zero. What’s more, hospital infection rates vary significantly within communities. For example, one West Coast city had CLABSI rates range from zero to over five times the expected rate.
The report also called for more transparency in reporting HAI rates at the hospital level, and called for consumers to compare their local hospitals online before an elective admission. Nurses may also want to see how the facility they work at compares to the national average when it comes to HAIs—remember, many of the core measures for preventing CAUTI and CLABSI are nurse-directed interventions.
And if you’re interested in planning, implementing, and evaluating infection prevention and control measures, consider making this field your career specialty. As a first step, you can develop new skills and empower yourself with knowledge through an online RN to BSN/MSN degree with a specialization in infection control from American Sentinel University, an innovative, accredited provider of online nursing degrees.