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The case for a population standardized infection ratio (SIR): A metric that marries the device SIR to the standardized utilization ratio (SUR)

Published online by Cambridge University Press:  24 June 2019

Mohamad G. Fakih Open the ORCID record for Mohamad G. Fakih [Opens in a new window] ,
Ren-Huai Huang ,
Angelo Bufalino ,
Thomas Erlinger ,
Lisa Sturm ,
Ann Hendrich  and
Ziad Haydar
Mohamad G. Fakih*
Affiliation:
Care Excellence, Ascension Healthcare, St Louis, Missouri Wayne State University School of Medicine, Detroit, Michigan
Ren-Huai Huang
Affiliation:
Ascension Clinical Research Institute, St Louis, Missouri
Angelo Bufalino
Affiliation:
Ascension Clinical Research Institute, St Louis, Missouri
Thomas Erlinger
Affiliation:
Ascension Clinical Research Institute, St Louis, Missouri
Lisa Sturm
Affiliation:
Care Excellence, Ascension Healthcare, St Louis, Missouri
Ann Hendrich
Affiliation:
Care Excellence, Ascension Healthcare, St Louis, Missouri
Ziad Haydar
Affiliation:
Care Excellence, Ascension Healthcare, St Louis, Missouri
*
Author for correspondence: Mohamad G. Fakih, MD, MPH, Care Excellence, Ascension Healthcare, 4600 Edmundson Rd, St Louis, MO 63134. E-mail: Mohamad.Fakih@ascension.org
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Abstract

Background:

The device standardized infection ratio (SIR) is used to compare unit and hospital performance for different publicly reported infections. Interventions to reduce unnecessary device use may select a higher-risk population, leading to a paradoxical increase in SIR for some high-performing facilities. The standardized utilization ratio (SUR) adjusts for device use for different units and facilities.

Methods:

We calculated the device SIR (calculated based on actual device days) and population SIR (defined as Σ observed events divided by Σ predicted events based on predicted device days), adjusting for the facility SUR for both central-line–associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) in 84 hospitals from a single system for calendar years 2016 and 2017.

Results:

The central-line SUR was 1.02 for 801,172 central-line days, with a device SIR of 0.76 and a population SIR of 0.78, a 1.6% relative increase. On the other hand, the urinary catheter SUR was 0.90 for 757,504 urinary catheter days, with a device SIR of 0.84 and a population SIR of 0.76, a 10.0% relative decrease. The cumulative attributable difference for CAUTI to a target SIR of 1 was −135.4 for the device SIR compared to −203.66 for the population SIR, a 50.8% increase in prevented events.

Conclusion:

Population SIR accounts for predicted device utilization; thus, it is an attractive metric with which to address overall risk of infection or harm to a patient population. It also reduces the risk of selection bias that may impact the device SIR with interventions to reduce device use.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 9 , September 2019 , pp. 979 - 982
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION. The study was presented in part as abstract 2158 at ID Week 2018 on October 6, 2018, in San Francisco, California.

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