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 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 bloodstream infections
• CAUTI: Catheter-associated urinary tract infections
• SSI: Surgical site infections (colon surgeries and abdominal hysterectomies)
• MRSA: methicillin-resistant Staphylococcus aureus infections (bacteria in 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 less than 1. This means the number or unit is too small to make a reliable conclusion about how the facility compares.

Frequently Asked Questions

How do I read the report?

Answer: Using a measure called the standardized infection ratio (SIR), this report looks at the performance of healthcare facilities in this state by displaying the number of certain HAI types they reported in a given year. The SIR shows whether a healthcare facility had significantly more HAIs, fewer HAIs, or about the same number of HAIs compared to the number predicted for that healthcare facility based on national baseline data and state data.

What is the Standardized Infection Ratio?

Answer: 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 greater than 1.0 – this indicates that there were more infections reported during the surveillance period than would have been predicted given baseline data.

What do the numbers mean?

Answer: The number of infections alone will not show how well a healthcare facility is doing in preventing HAIs; more information and analysis is needed—that is what the SIR or rates provide. This report shows how healthcare facilities performed during a single year (2021) and compares each facility’s performance to the national baseline and to the statewide SIR. The statewide SIR or rates for a given year are specified in the data section of this report. For the purposes of comparison to the nation, the national baseline SIR is always 1.0.

Infection rates and SIRs are calculated using a numerator (number of infections) and a denominator (population at risk). Readers should evaluate the numerator and denominator as well as the SIR or rate in order to obtain an accurate picture of the facility’s infection experience. Larger facilities that see more patients or do more surgeries may have more infections compared to smaller facilities. Therefore, it is important not only to consider the number of infections for each facility, but to also look at size of the facility and the total number of procedures performed in that time period.

Although HAIs are a significant patient safety and public health concern, they are not the only available quality metric, and other quality measures should be considered in assessing the overall quality of care.

Where do the numbers come from?

Answer: Healthcare facility staff self-report their HAI data to the CDC and the DPH using a free, secure, web-based software system called the National Healthcare Safety Network (NHSN). CDC and the DPH HAI program provides training to hospital staff on the use of this system and provides guidance on how to track infections with standard methods.

Efforts are made through education and training to improve the standardization and understanding of NHSN surveillance guidelines, case definitions, other definitions relevant to risk adjustment and case classification, and case finding methods. However, there can be variability in interpretation of the case definitions and application of the reporting protocols, leading to differences in reporting practices among facilities. Furthermore, facilities with more resources and/or a robust HAI surveillance program may be able to identify and report more infections compared to a facility with fewer resources.

The SIR calculation compares the number of reported HAIs from a facility or unit (ward or ICU) to reports from similar facilities or units during a baseline period. The initial baselines for the various HAIs were developed at different times during 2006-2013. New baselines were developed in 2015; this process is called “rebaselining.” The SIRs in this report of 2021 HAI data in Connecticut use the 2015 baselines.

These reports cover data that were collected during 2021 and were downloaded from NHSN on December 28, 2022. Any changes made to the data after these dates are not reflected in this report. More information about NHSN can be found at CDC NHSN.

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.

• The SIR is less than 1.0 – fewer infections than predicted.
• The SIR is equal to 1.0 – the same number of infections as predicted.
• The SIR is greater than 1.0 – more infections than predicted.

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.

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.

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.

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.

Quality Assurance and Data Validation

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 check in with facilities’ reporting staff to make sure the reported numbers are correct.

Other Data Caveats and Limitations

There may be small variations between results published by the CT DPH HAI Program and results published elsewhere. This is expected and can occur for several reasons, including different data cutoff dates or analytical criteria.

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.

Statewide Trends

This section provides an overview of statewide trends in the standardized infection ratio (SIR) between 2016 and 2021.

Acute Care Hospitals (ACH)

The chart below shows SIR trends for acute care hospitals over the period 2016-2021.

Long Term Acute Care Hospitals (LTACH)

The chart below shows SIR trends for long term acute care hospitals over the period 2016-2021.

Inpatient Rehabilitation Facilities (IRF)

Content may be added here.

Outpatient Hemodialysis Facilities

Content may be added here.

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).

Acute Care Hospitals (ACH)

The table below shows the performance of acute care hospitals in all infection categories reported to NHSN for 2021.

Note: Because DataTables JavaScript is not included here, this will render as a standard HTML table. That is the safer option for Sitecore 2.0.

Data by Facility and Infection Type

In the section below, infection-specific tables are presented for each facility type.

Acute Care Hospital Data

• Central Line-Associated Bloodstream Infections (CLABSI)
• Catheter Associated Urinary Tract Infections (CAUTI)
• Colon Surgery Surgical Site Infections (SSI)
• Abdominal Hysterectomy Surgical Site Infections
• C. difficile events
• Methicillin-resistant Staphylococcus aureus (MRSA) events

Long Term Acute Care Hospital Data

• Central Line-Associated Bloodstream Infections (CLABSI)
• Catheter Associated Urinary Tract Infections (CAUTI)
• C. difficile events

Inpatient Rehabilitation Hospital Data

• Catheter Associated Urinary Tract Infections (CAUTI)
• C. difficile events

Outpatient Hemodialysis Data

• Bloodstream Infections
• Local Access Site Infections (LASI)

Information for Healthcare Consumers