National Targets and Metrics

Monitoring Progress Toward Action Plan Goals: A Mid-Term Assessment

• Table: Summary of Progress Toward the Nine National Targets for Elimination of HAIs, 2011
• Central-line Associated Bloodstream Infections (CLABSI)
• Adherence to Central-line Insertion Practices (CLIP)
• Clostridium difficile (Hospitalizations)
• Clostridium difficile Infections
• Catheter-associated Urinary Tract Infections (CAUTI)
• MRSA invasive infections (population)
• MRSA Bacteremia (Hospital)
• Surgical Site Infections (SSI)
• Surgical Care Improvement Project (SCIP) Measures

The Federal Steering Committee for the Prevention of Health Care-Associated Infections intends to review on an annual basis progress toward achieving the nine targets in the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination.  The HAI Action Plan focuses on reducing the incidence of specific health care-associated infections and increasing adherence to specific sets of recommended prevention practices. Progress is steadily taking place. Below you will find a summary of the progress through October 2012:

• Marked improvement in infection rates for central line-associated bloodstream infections, health care-associated invasive methicillin-resistant Staphylococcus aureus (MRSA) infections, and surgical site infections, constituting timely progress toward the 5-year targets;
• Improvement in compliance with all five Surgical Care Improvement Project process measures to reduce the risk of surgical site infections;
• Leveling of hospitalizations with Clostridium difficile infection, but not a marked decrease. More work is needed to reduce the rate to meet the 2013 goal.

Table 1: Summary of Progress Toward the Nine National Targets for 
Elimination of Healthcare-Associated Infections, 2011

Summary of the Progress

The information below offers greater detail regarding the current progress toward the nine goals. It includes the baseline measure, the most current assessment, and additional notes on the measures and data. 

For more detailed reports on the data please go to the following pages:
CLABSI, CAUTI, and SSI Data
Clostridium difficile (Hospitalizations)
MRSA Invasive Infections (Population)

1. Central Line-Associated Bloodstream Infections (CLABSI)

2013 National Prevention Target: 50% reduction in CLABSI in intensive care unit (ICU) and ward-located patients or 0.50 Standardized Infection Ratio (SIR)

2011 Assessment (All inpatient locations in acute care hospitals, excluding long-term acute care facilities and rehabilitation facilities): 41% reduction or 0.59 SIR

2010 Assessment (All inpatient locations in acute care hospitals and excluding long-term acute care facilities and rehabilitation facilities): 32% reduction or 0.68 SIR

2010 Assessment (Non-Neonatal Intensive Care Units [NICUs] and wards): 33% reduction or 0.67 SIR*

2013 Projection: On track to meet target on schedule

*This data was originally posted in October 2011.  It was recalculated in April 2012 to account for more locations being used in the SIR calculation.  The 2009 and 2010 SIR were initially calculated using only non-NICU ICUs and wards.  The new methodology calculates the SIR using all inpatient locations in acute care hospitals and long-term acute care hospitals.

Data source: CDC’s National Healthcare Safety Network

2. Adherence to Central Line Insertion Practices (CLIP)

2013 National Prevention Target: 100% adherence

2011 Assessment: 95.7%; 3.8% increase from baseline*

2010 Assessment: 94.5%; 2.5% increase from baseline

2013 Projection: On track to meet target on schedule

Baseline Measurement (2009): 92.2% adherence

*Data for 2011 is through 9/1/2011

Central-line insertion practices, or CLIP, are a package, or “bundle”, of evidence-based practices shown to reduce bloodstream infections when practiced together at every insertion. The practices include 1) proper hand washing before insertion, 2) appropriate skin preparation with a recommended antiseptic prior to insertion, 3) ensuring the antiseptic was fully dry before insertion and 4) use of maximal sterile barriers during insertion, to include gloves, gown, cap, mask, and a full body drape on the patient. It should be noted that 95% of the baseline data are from California facilities.

Data source: CDC’s National Healthcare Safety Network

3. Clostridium difficile (hospitalizations)

2013 National Prevention Target: 30% reduction in hospitalizations with C. difficile

2012 Assessment Projection: 12.9 hospitalizations per 1,000 discharges; 11.2% increase from baseline

2011 Assessment Projection:  12.4 hospitalizations per 1,000 discharges; 6.9% increase from baseline

2013 Projection: The 2013 target is unlikely to be met on schedule

Baseline Measurement (2008): 11.6 hospitalizations with C. difficile per 1,000 discharges

Data source: AHRQ’s Healthcare Cost and Utilization Project

4. Clostridium difficile Infections

2013 National Prevention Target: 30% reduction in facility-wide health care facility-onset C. difficile or 0.70 SIR

2012 Assessment*: 1.28 SIR; 28% increase from baseline

Baseline Measurement: 2010-2011 is the baseline period

*These data from the first half of 2012 are incomplete and therefore only preliminary at this time.

Data source: CDC’s National Healthcare Safety Network

5. Catheter-Associated Urinary Tract Infections (CAUTI)

2013 National Prevention Target: 25% reduction in CAUTI in ICU and ward-located patients or 0.75 SIR

2011 Assessment (all inpatient locations in acute care hospitals, excluding NICUs, long term acute care facilities, and rehabilitation facilities):  7.0% reduction or 0.93 SIR

2010 Assessment (all inpatient locations, excluding NICUs and long-term acute care facilities and rehabilitation facilities): 6.0% reduction or 0.94 SIR

2010 Assessment (Non-NICU ICUs and wards in acute care hospitals): 7.0% reduction or 0.93 SIR*

2013 Projection: On track to meet target on schedule

*This data was originally posted in October 2011.  It was recalculated in April 2012 to reflect the addition of long-term care acute facilities to the SIR calculation.

^The data source changed its surveillance definition for CAUTI in January 2009, so the five-year target period has been extended from 2013 to 2014.

Data source: CDC’s National Healthcare Safety Network

6. MRSA Invasive Infections (Population)

2013 National Prevention Target: 50% reduction in the incidence of health care-associated invasive MRSA infections

2011 Assessment: 26.3% reduction; 20.06 infections per 100,000 persons

2010 Assessment: 19.7% reduction; 21.76 infections per 100,000 persons*
Baseline Measurement (2007-2008): 27.08 infections per 100,000 persons*

2013 Projection: On track to meet target on schedule

*The data source changed the methodology to more accurately reflect the data and now adjusts for sex and receipt of chronic dialysis, in addition to age and race, which were already included in the calculations.

Data source: CDC’s Emerging Infections Program Active Bacterial Core Surveillance

7. MRSA Bacteremia (Hospital)*

2013 National Prevention Target: 25% reduction in facility-wide health care facility-onset MRSA or 0.75 SIR

2012 Assessment: 5% reduction or 0.95 SIR

Baseline Measurement: 2010-2011 is the baseline period

* These data from the first half of 2012 are incomplete and therefore only preliminary at this time.

Due to a change in the data collection procedures in January 2010, the assessment period has been extended to December 2015, so that data are uniform for the entire period.

Data source: CDC’s National Healthcare Safety Network

8. Surgical Site Infections (SSI)

2013 National Prevention Target: 25% reduction in admission and readmission SSI or 0.75 SIR

2011 Assessment: 17% reduction or 0.83 SIR⁺

2010 Assessment: 8% reduction or 0.92 SIR*

2013 Projection: On track to meet target on schedule

⁺Reporting of deep incisional and organ/space SSIs attributable to 2011 continues through the end of calendar year 2012 per NHSN protocol requirements.  Measure will be final in early 2013.

*The data that was originally posted in October 2011 (10% reduction or 0.90 SIR) differs slightly from the revised number here due to additional facility reporting and adjustments made through evaluations and validation studies.

Data source: CDC’s National Healthcare Safety Network

9. Surgical Care Improvement Project (SCIP) Measures

2013 National Prevention Target: 95% adherence to process measures to prevent SSI. The measures include:

• SCIP Infection Measure 1: Antibiotics within 1 hour before incision or within 2 hours if vancomycin or quinolone is used;
• SCIP Infection Measure 2: Received prophylactic antibiotics consistent with recommendations;
• SCIP Infection Measure 3: Prophylactic antibiotics discontinued within 24 hours of surgery end time or 48 hours for cardiac surgery;
• SCIP Infection Measure 4: Controlled 6 am postoperative serum glucose for cardiac surgery patients;
• SCIP Infection Measure 6: Appropriate hair removal for surgery patients.

Baseline Measurement: 2006, 2007, 2008*

• SCIP Inf 1 – 83%, 87%, 91%
• SCIP Inf 2 – n/a, 92%, 95%
• SCIP Inf 3 – 74%, 80%, 87%
• SCIP Inf 4 – n/a, n/a, 89%
• SCIP Inf 6 – n/a, n/a, 97%

*SCIP Inf 4 and Inf 6 were not required for reporting until Q1 2008. The baseline data is based on approximately 3,650 hospitals reporting each quarter since mid-2006.

2011 Assessment:

•             SCIP Inf 1 – 98%

•             SCIP Inf 2 – 98%

•             SCIP Inf 3 – 97%

•             SCIP Inf 4 – 95%

•             SCIP Inf 6 – 100%

2010 Assessment:

•             SCIP Inf 1 – 97%

•             SCIP Inf 2 – 97%

•             SCIP Inf 3 – 95%

•             SCIP Inf 4 – 94%

•             SCIP Inf 6 – 100%

2013 Projection: On track to meet target on schedule

Data source: CMS Hospital Compare

Conclusion

Timely progress has been made toward most targets for which associated data are available. Although this progress is promising, continued efforts are needed to achieve the goals in the HAI Action Plan. In the case of Clostridium difficile, efforts must be enhanced and accelerated to achieve the target.