State CLABSI Validation Associated with Higher Standardized Infection Ratios in 2011

BACKGROUND: During 2011, 3472 facilities from 50 states, the District of Columbia (DC), and Puerto Rico (PR) reported central line-associated bloodstream infections (CLABSIs) to the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network.  As requested by states/territories (S/T), CDC includes notation indicating which S/T health departments have validated healthcare-associated infection data in its annual National and State Standardized Infection Ratio (SIR) Report. To evaluate for association between S/T validation activities and reporting, we used 2011 SIR report data to compare SIRs in S/T with varying extents of CLABSI validation.

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.