1. The Standardized Infection Ratio Linda R Greene, RN, MPS,CIC Rochester General Health System Rochester, NY linda.greene@rochestergeneral.org

2. Objectives Describe what the Standardized Infection Ratio (SIR) is and how it is calculated. Explain how to generate and interpret a report utilizing the SIR. Identify uses for the SIR in public reporting Explain the relationship between HAI rates and the SIR

3. Standardized Infection Ratio ( SIR) is a summary measure used to compare the HAI experience among one or more groups of patients to that of a standard population’s (e.g. NHSN) Indirect standardization method- Comparison to a referent population Standardized Infection Ratio Method

4. What is a standardized infection ratio (SIR)? The standardized infection ratio (SIR) is a summary measure used to track HAIs at a national, state, or local level over time The SIR adjusts for patients of varying risk within each facility It is a summary statistic widely used in public health In HAI data analysis, the SIR compares the actual number of HAIs reported with the baseline U.S. experience

5. I was just getting used to rates, why the SIR? More sensitive for low denominators Ability to combine data Useful for predicting state and national rates

6. OK, I’m no statistician what’s all this mumbo jumbo about? In simple terms- you are compared to the average of a referent population adjusted for risk. In this case it is a historical control. The SIR

7. Let’s take a closer look Hospital A : Type of ICUNumber of Infections Line daysMy rateNHSN Mean Med/ Surg18651.12.1 SICU0100002.8 CTICU210651.81.1 MICU210002.02.1

8. Turned into SIR How do we get the expected ? Type of ICUNumber of Infections Line daysMy rateNHSN Mean Med/ Surg18651.12.1 SICU0100002.8 CTICU29482.11.1 MICU210002.02.1 Med Surg 2.1 /1000 x 865= 0.95 SICU 2.8 /1000 X 1000= 2.8 CTICU 1.1/1000 X 848= 0.93 MICU 2.1 / 1000 X1000= 2.1

9. The SIR Type of ICUNumber of infections Number expected SIR Observed/ expected P VALUE Med/ Surg10.951.05 SICU02.8 0 CTICU20.932.1 MICU22.1 0.95 56.780.7 SIR is less than 1

10. Simply Put A SIR of 1.0 means the observed number of infections is equal to the number of expected infections. A SIR above 1.0 means that the infection rate is higher than that found in the "standard population." For HAI reports, the standard population comes from data reported by the hundreds of U.S. hospitals that use the NHSN system. The difference above 1.0 is the percentage by which the infection rate exceeds that of the standard population. A SIR below 1.0 means the infection rate is lower than that of the standard population. The difference below 1.0 is the percentage by which the infection rate is lower than that experienced by the standard population

12. Statistical Significance If the P value is less than.05 then your rates are different than the national average If the confidence level does not overlap 1, then your rates are different than the national average.

13. States with Mandatory HAI Laws

14. Conducting your own analysis

18. orgid=10330

20. Surgical SIR

22. Calculation Observed ( number of Infections) Expected (expected number of infections)

23. Surgery data vs. CLABSI Uses patient level data Logistic regression modeling Excludes superficial infections

24. Example

25. SSI SIR

26. Interpreting the SIR

27. The SIR PROSCONS Surgical risk adjustment is a significant improvement Risk adjustment still suboptimal – especially with CLABSI data Consistent with other types of data such as mortality Not designed to compare 1 institution to another- only to compare with national average Advantages with rare eventsPotential problems with ranking,etc Overall rates can cloud the big picture

28. Colon SSI per Month 2010- 2011 Using data Locally

29. 2010 SSI Expected and Observed SSI Number Of Infections

30. STILL FINALIZING DATA – MORE ANALYSIS TO GO

31. Questions ?