BACKGROUND: TAP strategy uses the Cumulative Attributable Difference (CAD) calculated from the Standardized Infection Ratio (SIR), determining the number of infections a given facility needs to avert to meet an infection reduction goal. It is has been applied to HAI data reported to NHSN from hospitals. This easily understood CAD target is much more motivating for healthcare providers than the SIR. CADs can be ranked, and this can be used to prioritize facilities for prevention program development and tracking. The Connecticut HAI Program is now piloting the use of TAP using a modified CAD calculation for outpatient hemodialysis centers.
METHODS: All 44 outpatient hemodialysis centers in Connecticut reported dialysis event (DE) data to NHSN in 2015. NHSN does not calculate the SIR for DE data; therefore, we could not use SIRs to calculate TAP. Because SIR is derived from infection rates, we modified the CAD calculation using rates. For this project, TAP were calculated from DE rates for BSI. The prevention goal was the statewide dialysis BSI rate. In 2015 all hemodialysis facilities in Connecticut reported catheter utilization (associated with higher BSI rates) and prevention process measure (PPM) data to NHSN. For PPM, facilities perform observations of infection control prevention by staff in the facilities and track adherence to proper practices.
RESULTS: Eight of 44 facilities (18%) had BSI CAD over 2.0. These facilities reported 63.6 excess infections over baseline, 24% of the 256 BSI reported from outpatient hemodialysis centers in the state that year. If the eight facilities all achieved the 2015 statewide rate, it would drop from 0.67/100 patient-months to 0.51, considerably below the most recent (2014) national rate (0.64). High CAD facilities had a higher rate of catheter access than other facilities, 18.3 vs. 17.3%, nearly statistically significant (p=0.52). Overall, three key PPM (hand hygiene observations, catheter and fistula care) were not significantly different between high CAD and other facilities. However, PPM varied among high CAD facilities: one facility, with a CAD of 17.1, contributing 26% of excess BSI in the state, had a very low percentage (36%) of adherent catheter care observations.
CONCLUSIONS: With modification, CAD can be used in facility types that are not currently using the SIR. Such analyses can be used to develop a TAP strategy for these facilities. Combing CAD rankings with prevention process metrics can be useful for planning focused interventions for high priority facilities to impact HAI outcomes.