Hospital‐Acquired Infections in New York State, 2015 Part 2: Technical Report 7 March 29, 2017 Table of Contents Introduction ................................................................................................................................................................ 3 Surgical Site Infections (SSIs) .................................................................................................................................. 5 Colon Surgical Site Infections ................................................................................................................................... 8 Coronary Artery Bypass Graft (CABG) Surgical Site Infections ............................................................................ 21 Hip Replacement/Revision Surgical Site Infections .............................................................................................. 30 Abdominal Hysterectomy Surgical Site Infections ................................................................................................ 38 Central Line‐Associated Bloodstream Infections (CLABSIs) ........................................................................... 52 Catheter‐Associated Urinary Tract Infections (CAUTIs) .................................................................................. 82 Infections from Clostridium difficile and Multidrug Resistant Organisms (MDROs) .................................. 84 Clostridium difficile Infections (CDI) ..................................................................................................................... 86 Carbapenem-resistant Enterobacteriaceae (CRE) Infections ................................................................................. 99 Other LabID MDROs ............................................................................................................................................ 113 Mortality related to CDI and MDROs ................................................................................................................... 115 MDRO Prevention Practices ................................................................................................................................. 117 Antimicrobial Stewardship ..................................................................................................................................... 118 Comparison of NYS HAI Rates with National HAI Rates.................................................................................. 121 HAI Prevention Projects ....................................................................................................................................... 122 Summary .................................................................................................................................................................. 126 Recommendations and Next Steps ......................................................................................................................... 127 Appendix 1: List of Abbreviations ....................................................................................................................... 129 Appendix 2: Glossary of Terms ........................................................................................................................... 131 Appendix 3: Methods ............................................................................................................................................ 137 Data Validation ................................................................................................................................................. 137 Risk Adjustment ............................................................................................................................................... 140 Attributable Mortality of CDI/MDROs ............................................................................................................ 142 Comparison of NYS and CMS HAI Reporting ................................................................................................. 143 Appendix 4: List of Hospitals by County ............................................................................................................ 144 Acknowledgements ............................................................................................................................................... 149 2 Introduction In accordance with Public Health Law 2819, New York State (NYS) has been tracking HAIs since 2007. This law was created to provide the public with fair, accurate, and reliable HAI data to compare hospital infection rates and to support quality improvement and infection prevention activities in hospitals. NYSDOH evaluates which HAI indicators should be reported annually with the help of a Technical Advisory Workgroup (TAW), a panel of experts in the prevention and reporting of HAIs. In 2007, hospitals were required to report central line-associated bloodstream infections (CLABSIs) in intensive care units (ICUs) and surgical site infections (SSIs) following colon and coronary artery bypass graft (CABG) surgeries. In 2008, hip replacement SSIs were added; in 2010, Clostridium difficile (CDI) infections were added; in 2012, abdominal hysterectomy SSIs were added; and in 2014, carbapenem-resistant Enterobacteriaceae (CRE) infections were added. In addition to reporting the HAI data mandated by NYS, hospitals enter data into NHSN for federal programs, regional collaboratives, and local surveillance. The Centers for Medicare and Medicaid Services (CMS) Hospital Inpatient Quality Reporting (IQR) Program provides higher reimbursement to hospitals that report certain types of HAI data, including catheter-associated urinary tract infections (CAUTIs) and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. In addition, the CMS Hospital Value-Based Purchasing Program provides incentive payments to hospitals based on how well they perform on certain HAI measures. NYS entered into a data use agreement (DUA) with CDC that allows NYS to see all NHSN data for surveillance or prevention purposes. The DUA implemented in May 2013 prohibits the use of the data for public reporting of facility-specific data or for regulatory action. More information about the DUA is available on the CDC website http://www.cdc.gov/hai/pdfs/stateplans/New- York_DUA.pdf. Table 1 summarizes the progression of NYS reporting requirements through 2015 and includes additional data visible through the DUA. 3 Table 1. Hospital-acquired infections reported by New York State hospitals, by year Type of Infection 2007 2008 2009 2010 2011 2012 2013 2014 2015 Central line-associated bloodstream infections in ICUs P1 Colon surgical site infections P1 Coronary artery bypass graft surgical site infections P1 Hip replacement surgical site infections Clostridium difficile infections P2 Abdominal hysterectomy surgical site infections Carbapenem-resistant Enterobacteriaceae infections P2 Central line-associated bloodstream infections in wards DUA DUA Catheter-associated urinary tract infections DUA DUA DUA Methicillin-resistant Staphylococcus aureus bacteremia DUA DUA DUA = full reporting (publish hospital-specific rates) P1= pilot reporting full year (do not publish hospital-specific rates) P2= pilot reporting half year from July (do not publish hospital-specific rates) DUA = Not required by New York, but reported for Centers for Medicare and Medicaid Services Inpatient Prospective Payment System and visible through data use agreement between CDC and NYS beginning May 2013. This report focuses on HAI rates in NYS hospitals in 2015. The detailed information is primarily intended for use by hospital Infection Preventionists (IPs), but it may also be used by others who want more detailed information than is available in “Part 1: Summary for Consumers”. CDC HAI surveillance definitions have changed over time so that it is no longer possible to accurately quantify progress since the onset of NYS reporting in 2007. CDC has declared that 2015 is the new “baseline” for assessment of trends in coming years (http://www.cdc.gov/nhsn/2015rebaseline/index.html). NYS will also consider 2015 to be a new baseline for assessment of trends until surveillance definitions change such that the comparisons are no longer valid, or until policy changes require a new baseline. Crude trend plots have been included in this report for transparency regarding how HAI counts in 2015 compared to counts in previous years, but the valid interpretation of these plots is limited by the degree of changes to the definitions. 4 Surgical Site Infections (SSIs) For each type of SSI, the following pages present detailed information on the severity (depth) of infections, the circumstance of detection (initial hospitalization, readmission, etc.), the microorganisms involved, and time trends. In addition, detailed plots show each individual hospital’s risk-adjusted infection rates compared to the state average. SSIs are categorized into three groups depending on the severity of the infection: Superficial Incisional SSI - This infection occurs in the area of the skin where the surgical incision was made. The patient may have pus draining from the incision or laboratory-identified pathogens from cultures of the incision. Deep Incisional SSI - This infection occurs beneath the incision in muscle tissue. Pus may drain from the incision, and patients may experience fever and pain. The