METHODS: Using information provided by S/T for the 2011 CDC SIR Report, S/T were divided into three strata: A) S/T conducting external validation (i.e., medical records audits), B) S/T assisting facilities with internal validation (i.e., data analysis to investigate and correct aberrancies), and C) S/T not conducting validation for 2011 CLABSI data. Overall SIRs and percentile distributions of facility-level SIRs within strata were calculated. Comparisons were made between strata in overall SIRs, median facility SIRs, and distribution of facility SIRs.
RESULTS: SIRs were calculated for the 3 S/T validation strata, including CLABSI data from all patient-care locations with baseline information, reported by 3468 facilities. Stratum A included 1175 facilities from thirteen states plus DC; stratum B included 780 facilities from 11 states; and stratum C included 1513 facilities from 26 states plus PR. CLABSI SIRs were higher for stratum A vs. stratum B (0.622 vs.0.578, p=0.0002) and stratum A vs. stratum C (0.622 vs. 0.567, p<0.0001), but not different for stratum B vs. stratum C (0.578 vs. 0.567, p=0.3585). The 2335 facilities with at least one predicted CLABSI (851 (72%) of stratum A facilities, 487 (62%) of stratum B facilities, and 997 (66%) of stratum C facilities) contributed to analyses of stratum-specific median SIR and SIR distribution. The median facility SIR was higher for stratum A vs. stratum C (0.503 vs. 0.418, p=0.0028) and stratum B vs. stratum C (0.500 vs. 0.418, p=0.0094). The stratum-specific distribution of facility SIRs was shifted toward higher SIRs for both stratum A (p=0.0142) and stratum B (p=0.0292) vs. stratum C.
CONCLUSIONS: In 2011, S/T CLABSI validation activities were associated with higher stratum-specific SIRs, median facility-level SIRs, and SIR distributions. Factors underlying this association may include increased completeness of reporting due to greater oversight and accountability. Monitoring of this association should continue and S/T validation should expand to maximize accountability, fairness, and data quality in all jurisdictions.