2023 Healthcare Associated Infections Annual Report


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About the Report

Healthcare-associated infections (HAIs) are infections patients can get while receiving medical treatment in a healthcare facility. Under state law (Sections 12 and 13 of Public Act No. 18-168), Connecticut healthcare facilities must report their incidence of certain healthcare associated infections (HAIs) to the Connecticut Department of Public Health (CT DPH). More information about Connecticut’s mandatory reporting can be found at the CT DPH HAI website.

Tracking and reporting of HAIs is an important quality improvement initiative for healthcare facilities. It can greatly improve the care patients receive and it allows facilities to have visibility on how well they are doing in preventing HAIs.

This report is meant to provide HAI information in an understandable way to enable readers to view facility-specific HAI performance, evaluate interventions to drive change within a facility, understand the state’s HAI performance as a whole, and to compare a facility’s HAI performance to others in the state and the rest of the country.

Patients and their family members can also use this information to ask healthcare providers questions when seeking or receiving medical treatment.

The following HAIs are described in this report:
  1. Central line-associated bloodstream infections (CLABSI)
  2. Catheter-associated urinary tract infections (CAUTI)
  3. Surgical site infections (SSI) following colon surgeries
  4. Surgical site infections (SSI) following abdominal hysterectomies
  5. Positive laboratory tests of methicillin-resistant Staphylococcus aureus (MRSA) bacteria found in the bloodstream
  6. Positive laboratory results with Clostridioides difficile (C. difficile)
  7. Dialysis events in hemodialysis centers. In this report data is presented on bloodstream infections (BSI), and local access site infections (LASI).

These measures do not represent all possible infections, but were selected by CMS and DPH to give an overview of how a healthcare facility is doing in preventing healthcare-associated infections. These infections are largely preventable when healthcare providers use infection prevention steps recommended by the Centers for Disease Control and Prevention (CDC) and by the Connecticut Department of Public Health (CT DPH).


Data Presented in this Report

The data presented in this report summarizes findings about healthcare associated infections in Connecticut’s healthcare facilities. The following types of facilities are included:

  • Acute care hospitals (ACH)
  • Long term acute care hospitals (LTACH)
  • Inpatient rehabilitation facilities (IRF)
  • Outpatient hemodialysis facilities (Dialysis)
Facility classification in this report,aligns with CMS designations and facility licensing.

In addition to being reported from the whole facility, HAI are also reported by “unit”, such as adult or pediatric ICUs or wards. Because levels of infections can vary between these different units, this more detailed information is important, as it can provide information more relevant for specific infection control measures.

Types of HAIs Presented in this Report
  • CLABSI: Central line-associated blood stream infections
  • CAUTI: Catheter-associated urinary tract infections
  • SSI: Surgical site infections (colon surgeries and abdominal hysterectomies)
  • MRSA: methicillin-resistant Staphylococcus aureus infections (bacteriain the bloodstream)
  • CDI: Clostridioides difficile infections

Not all infections are presented for each facility or each unit within the facility. This is either because they are not required to report the data to DPH, or because relevant procedures are not performed at that facility or unit.

See Appendix B for information about central lines, urinary catheters, and the HAIs discussed in this report. See Appendix C for more things to think about when it comes to choosing a healthcare facility, and Appendix D for things you can do to prevent infections.


Facilities' Performance

Facilities’ performance in HAI prevention is shown by comparing them to other facilities adjusting for their risk for HAIs to both the state and to the national baseline. Using the SIR, two values are reported: the number of observed infections, and the number of predicted infections, which is calculated by the CDC based on risk adjustment measures described earlier in this report.

In this report, we have reported whether a facility performed better or worse compared to other facilities in the state or nationally. In the summary tables, which show the SIR for each infection and facility, SIRs that are significantly better or worse are coded with an arrow indicator. A green down arrow beside an SIR value indicates the facility performed significantly better in that HAI compared to the national baseline. A red up arrow beside an SIR value indicates the facility performed significantly worse in that HAI compared to the national baseline. No arrow indicates that the facility performed about as expected compared to the national baseline or that the difference was not statistically significant.

For infection specific tables, a state and national comparison column is provided. Significantly better performance is indicated by a green down arrow, representing lower rates of infection. Significantly worse performance is indicated by a red up arrow. Performance that is within expectations based on the state or national baseline is indicated by an = symbol.

In some cases, the cells in the table for comparison are left empty. This is because in these facilities or units, the predicted number is than 1. This means the number or unit is too small to make a reliable conclusion about how the facility compares.

Frequently Asked Questions

Methods

The Standardized Infection Ratio (SIR)

The SIR is a summary measure that can be used to track HAIs over time and can be calculated on a variety of levels, including unit, facility, state, and nation. It adjusts for differences between healthcare facilities such as types of patients and procedures, as well as other factors such as the facility’s size and whether it is affiliated with a medical school. It compares the number of infections reported in a given time period to the number of infections that were predicted using data from a baseline time period. Lower SIRs indicate better performance.

When the SIR is calculated, there are three possible results:

  • The SIR is less than 1.0 – this indicates that there were fewer infections reported during the surveillance period than would have been predicted given the baseline data.
  • The SIR is equal to 1.0 – the value of 1 indicates that the numerator and denominator are equal. In this case, the number of infections reported during the surveillance period is the same as the number of infections predicted given the baseline data.
  • The SIR is less than 1.0 – this indicates that there were more infections reported during the surveillance period than would have been predicted given baseline data.
Rates

Local access site infections in outpatient hemodialysis centers one of the HAI measures, were calculated using rates rather than the SIR. An infection rate measures the number of new infections seen in a healthcare facility during a given time period for those patients at risk for infection.

A rate is calculated for each infection/event type (i.e., local access site infections (LASI) in dialysis) as the total number of infections or events reported during 2021, divided by the total number of days or months that patients were at risk for that infection or event.


Laboratory-Identified Event Analyses (LABID)

Clostridioides difficile infection (CDI) and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia LabID events rely on laboratory data. Patients do not have to meet clinical criteria for their events to be reported to NHSN, which allows for a much less labor-intensive means to track CDI and MRSA infections. LabID events that occurred more than three calendar days after admission are considered healthcare associated and counted. For more information on Lab ID events please see the extended methods section in Appendix A.


HAI Risk Adjustment

SIRs are adjusted for risk factors that may affect the number of infections reported by a healthcare facility, such as type of patient care location, bed size of a hospital, patient age, and other factors. The SIR is adjusted differently depending on the type of infection measured.  For a breakdown of the factors used to adjust SIR for each HAI infection please see the extended methods section in Appendix A.


Statistical Significance

The p-value and 95% confidence interval are statistical measures that describe the likelihood that what is observed might be explained by random chance. For HAIs and LabID events, the p-value and confidence interval show whether or not a facility’s SIR is significantly different from 1.0 (the value we would expect if the facility performed exactly the same as what was predicted based on the national data). If the p-value is less than or equal to 0.05, one can conclude that the number of observed infections is significantly different from the number of predicted infections (i.e., the facility’s SIR is significantly different from 1.0). If the p value is greater than 0.05, one should conclude that the number of observed infections in a facility is not significantly different from the number predicted (i.e., not significantly different than 1.0).

The 95% confidence interval is a range of values. One can have a high degree of confidence (in this case, 95%) that the true SIR lies within this range. The upper and lower limits are used to determine the significance and accuracy (or precision) of the SIR. For national comparison, if 1.0 falls within the confidence interval, then the SIR is not significant (i.e., the number of observed events is not significantly different from the number predicted). If 1.0 falls outside the confidence interval, then the SIR is significant. For state comparison, the statewide SIR is substituted for 1.0. When the SIR is zero, the lower bound of the 95% confidence interval cannot be calculated. However, for ease of interpretation, it can be considered zero.


Quality Assurance and Data Validation

As noted earlier, there may be differences in reporting practices and the efficacy of surveillance among healthcare facilities. For example, healthcare facilities with more infection control staff to count infections may be able to identify and report more infections compared to a healthcare facility with fewer infection control staff.

Reported data collected by NHSN in this report are self-reported by staff of healthcare facilities. The 2021 data have not been independently verified by public health staff through review of patient charts. However, DPH HAI Program staff check the data for outliers and unexpected results, and periodically checks in with facilities’ reporting staff to make sure the reported numbers are correct., including just before freezing the data for this report.


Other Data Caveats and Limitations

There may be small variations between results published by the CT DPH HAI Program and results published elsewhere (e.g., CMS Hospital Compare). This is expected and can be due for various reasons. Healthcare facilities have the ability to modify their data to update it in NHSN at any time once entered, and as such, results may appear to vary if other sources use different data collection periods or report cutoff dates than Connecticut’s reports. Alternatively, the same data may be analyzed and reported using slightly different criteria for analysis of reporting. For example, SSIs can be reported using different length of follow-up.

The CT DPH HAI Program does not calculate an SIR when the number of predicted infections is less than 1.0. In these situations, the SIR cannot be calculated in accordance with the threshold based on CDC recommendations. If the number is lower than the threshold, it means there is not enough data and the effect of chance is comparatively too great to judge the facility’s performance on this measure. In these situations, the comparison to the nation and the statewide SIR is left blank.

Statewide Trends

This section provides an overview of statewide trends in the standardized infection ratio (SIR) between 2016 and 2021. The Standardized Infection Ratio (SIR) is the primary measure to track healthcare associated infections by the Connecticut Department of Public Health. The ratio is the number of observed infections that occur in a given time divided by the number predicted.

A SIR less than 1.0 means that the state is performing better than predicted and a SIR above 1.0 means that the state is performing worse than predicted. Trend data, like these below, show that healthcare facilities in Connecticut have made significant progress in reducing HAIs in their facilities and any SIRs that are higher than the national goal (1.0) indicate the need for further assessment and enhanced prevention actions.

The year 2020 has been excluded from this analysis because the Centers for Medicaid and Medicare Services (CMS) who regulate facility reporting offered all facilities an exemption from reporting during the first year of the COVID-19 pandemic due to the high burden it placed on healthcare facilities. Statewide trends are presented by facility type: acute care hospitals, long term acute care hospitals, inpatient rehabilitation facilities, and dialysis facilities.

Summary Tables

The Standardized Infection Ratio (SIR) is the primary summary measure used by the National Healthcare Safety Network (NHSN) to track healthcare-associated infections (HAIs). SIR compares the actual number of HAIs reported to the number that would be predicted. It accounts for facility and/or patient-level factors that contribute to HAI risk within each facility.

An SIR greater than 1.0 indicates that more HAIs were observed than predicted; conversely, an SIR less than 1.0 indicates that fewer HAIs were observed than predicted. The tables below report the 2021 values for SIR across facilities for all infection categories reported to NHSN in 2021. Significant values are marked with a green down arrow or a red up arrow to indicate better or worse performance, respectively, compared to the national baseline.

Data by Facility and Infection Type

In the section below, infection specific tables are presented for each facility type. To see data by facility for a given infection type select an HAI infection from the dropdown menu.

Acute Care Hospital Data
Select an infection type from the dropdown menu to view the facility-specific data table for that infection.
Long Term Acute Care Hospital Data
Select an infection type from the dropdown menu to view the facility-specific data table for that infection.
Inpatient Rehabilitation Hospital Data
Select an infection type from the dropdown menu to view the facility-specific data table for that infection.
Outpatient Hemodialysis Data
Select an infection type from the dropdown menu to view the facility-specific data table for that infection.

Information for Healthcare Consumers

Invasive Devices

Sometimes patients have medical devices inserted into their bodies to provide necessary medical care. These devices are called “invasive devices” and patients with these devices have a higher chance of getting an infection. Here is what you need to know about invasive devices and what kinds of infections they can be associated with:

  • A central line is a tube placed in a large vein to allow access to the bloodstream and provide the patient with important medicine. A central line-associated bloodstream infection (CLABSI) can occur when bacteria or other germs travel along a central line and enter the blood. When not put in correctly or kept clean, central lines can become a pathway for germs to enter the body and cause serious infections in the blood.

  • A urinary catheter is a tube placed in the bladder to drain urine. A catheter-associated urinary tract infection (CAUTI) can occur when bacteria or other germs travel along a urinary catheter, resulting in an infection in the bladder or the kidney.

Surgical Site Infections (SSIs)

These happen after surgery in the part of the body where the surgery took place. These infections may involve only the skin or may be more serious and involve tissue under the skin or organs. SSIs sometimes take days or months after surgery to develop.

Symptoms may include:

  • fever
  • redness or pain around the surgical site
  • drainage of fluid from the wound

Methicillin-resistant Staphylococcus aureus (MRSA)

MRSA infections are caused by bacteria that are resistant to certain types of drugs. MRSA can cause skin or wound infections. Sometimes, MRSA can infect the blood and cause serious illness and even death. Bloodstream infections with MRSA are the kind of infection are shown in this report.

Clostridiodes difficile (C. difficile)

C. difficile is a type of bacteria that causes severe diarrhea and can be deadly. Infections most commonly occur in people who have recently taken antibiotics.