CACI, Subcontractor to Leidos | Contractor for the National Healthcare Safety Network (NHSN), NCEZID, Division of Healthcare Quality Promotion (DHQP), Centers for Disease Control and Prevention, Atlanta, GA.
CACI, Subcontractor to Leidos | Contractor for the National Healthcare Safety Network (NHSN), NCEZID, Division of Healthcare Quality Promotion (DHQP), Centers for Disease Control and Prevention, Atlanta, GA.
Am J Infect Control. 2021 Nov;49(11):1423-1426. doi: 10.1016/j.ajic.2021.05.002. Epub 2021 Jul 28.
This case study is part of a series centered on the Centers for Disease Control and Prevention's National Healthcare Safety Network's (NHSN) health care-associated infection (HAI) surveillance definitions. This is the first analytic case study published in AJIC since the CDC/ NHSN updated its HAI risk adjustment models and rebaselined the standardized infection ratios (SIRs) in 2015. This case describes a scenario that Infection Preventionists (IPs) have encountered during their analysis of surgical site infection (SSI) surveillance data. The case study is intended to illustrate how specific models can impact the SIR results by highlighting differences in the criteria for NHSN's older and newer risk models: the original versions and the updated models introduced in 2015. Understanding these differences provides insight into how SSI SIR calculations differ between the older and newer NHSN baseline models. NHSN plans to produce another set of HAI risk adjustment models in the future, using newer HAI incidence and risk factor data. While the timetable for these changes remains to be determined, the statistical methods used to produce future models and SIR calculations will continue the precedents that NHSN has established. An online survey link is provided where participants may confidentially answer questions related to the case study and receive immediate feedback in the form of correct answers, explanations, rationales, and summary of teaching points. Details of the case study, answers, and explanations have been reviewed and approved by NHSN staff. We hope that participants take advantage of this educational offering and thereby gain a greater understanding of the NHSN's HAI data analysis. There are 2 baselines available for SSI standardized infection ration (SIRs) in the National Healthcare Safety Network (NHSN); one based on the 2006-2008 national aggregate data and another based on the 2015 data. Each of the 2 baselines has a different set of inclusion criteria for the SSI data, which impact the calculation of the SIR. In this case study, we focused on the impact of the inclusion of PATOS in the calculation of the 2006-2008 baseline SSI SIR and the exclusion of PATOS from the calculation of the 2015 baseline SSI SIR. In the 2006-2008 baseline SSI SIRs, PATOS events and the procedures to which they are linked are included in the calculation of the SSI SIR whereas in the 2015 baseline SSI SIRs, PATOS events and the procedures to which they are linked are excluded from the calculation of the SSI SIR. Meaning, if we control for all other inclusion criteria other than PATOS data for both baselines, we will notice differences in the number of observed events as well as the number of predicted infections for the 2 baselines. For details of the 2015 baseline and risk adjustment calculation, please review the NHSN Guide to the SIR referenced below. For details of the 2006-2008 baseline4 and risk adjustment, please see the SHEA paper "Improving Risk-Adjusted Measures of Surgical Site Infection for the National Healthcare Safety Network" by author Yi Mu.
本案例研究是围绕疾病控制与预防中心（CDC）国家医疗保健安全网络（NHSN）的医疗保健相关感染（HAI）监测定义展开的一系列研究之一。这是自 CDC/NHSN 于 2015 年更新其 HAI 风险调整模型并重新调整标准化感染比（SIR）以来，AJIC 发表的第一份分析性案例研究。本案例描述了感染预防人员（IP）在分析手术部位感染（SSI）监测数据时遇到的情况。本案例研究旨在说明特定模型如何通过突出 NHSN 新旧风险模型的标准的差异来影响 SIR 结果：原始版本和 2015 年引入的更新模型。了解这些差异可深入了解 NHSN 旧基线模型和新基线模型之间 SSI SIR 计算的差异。NHSN 计划未来使用新的 HAI 发病率和风险因素数据，生成另一组 HAI 风险调整模型。虽然这些变化的时间表仍有待确定，但用于生成未来模型和 SIR 计算的统计方法将继续沿用 NHSN 已经建立的先例。提供了一个在线调查链接，参与者可以在其中匿名回答与案例研究相关的问题，并以正确答案、解释、理由和教学要点摘要的形式立即获得反馈。案例研究的详细信息、答案和解释已由 NHSN 工作人员审查和批准。我们希望参与者利用这一教育机会，从而更好地了解 NHSN 的 HAI 数据分析。国家医疗保健安全网络（NHSN）有两个用于 SSI 标准化感染比（SIR）的基线；一个基于 2006-2008 年的国家综合数据，另一个基于 2015 年的数据。这两个基线中的每一个都有一套不同的 SSI 数据纳入标准，这些标准会影响 SIR 的计算。在本案例研究中，我们重点关注 PATOS 纳入 2006-2008 年基线 SSI SIR 计算和 PATOS 从 2015 年基线 SSI SIR 计算中排除对 SIR 的影响。在 2006-2008 年基线 SSI SIR 中，PATOS 事件及其相关的手术操作都包含在 SSI SIR 的计算中，而在 2015 年基线 SSI SIR 中，PATOS 事件及其相关的手术操作则从 SSI SIR 的计算中排除。这意味着，如果我们控制两个基线的所有其他纳入标准（除了 PATOS 数据），我们将注意到两个基线的观察到的事件数量和预测感染数量的差异。有关 2015 年基线和风险调整计算的详细信息，请参阅下面引用的 NHSN SIR 指南。有关 2006-2008 年基线 4 和风险调整的详细信息，请参阅作者 Yi Mu 的 SHEA 论文“为国家医疗保健安全网络改进手术部位感染的风险调整衡量指标”。
