The adjusted standardized infection ratio and cumulative attributable difference for central line-associated bloodstream infections and catheter-associated urinary tract infections in 2017, in Turkey

Abstract

Background: Standardized infection ratio (SIR) is a new measure used in surveillance of healthcare-associated infections, and cumulative attributable difference (CAD) is another new measure complementary to SIR. This study aims to calculate the SIR and the CAD for central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) at the national level in 2017. Material and Methods: Predicted number of CLABSI and CAUTI for the SIR and the CAD calculation was calculated by the formulas obtained from the negative binomial models using the national surveillance data in 2016 and the SIRs and CADs calculated for the data in 2017. Results: The average length of stay and hospital type are available in both models. While the CLABSI model has also ICU branch and number of hospital beds, the CAUTI model has catheter utilization ratio and the number of ICU beds. The standardized CLABSI ratio was 0.87 (95% CI:0.85-0.90) and the standardized CAUTI ratio was 0.84 (95% Cl:0.82-0.86). The CAD for CLABSI and CAUTI was 697.26 and 659.76, respectively. 59.4% of the ICUs reached 25% reduction target for CLABSI and the 67.8% of the ICUs for CAUTI. Conclusion: The SIRs and the CADs in this study proof that Turkey has achieved success in the implementation of infection control measures in the ICUs for CLABSI and CAUTI, however, this ought to be improved further. We hope that our findings shall be guiding and encouraging for other countries.

Keywords

• healthcare-associated infections,surveillance,standardized infection ratio,cumulative attributable diffrerence

Thanks

Acknowledgments: Thank you to all infection control nurses and physicians in all hospitals in Turkey for providing us this data.

References

1. 1. Refik Saydam Hygiene Centre, Ministry of Health, Republic of Turkey. Ulusal Hastane Enfeksiyonları Sürveyans Ağı (UHESA) Raporu Özet Veri, 2008-2009 (In Turkish).
2. 2. Turkish Public Health Institution of Turkey. Ulusal Hastane Enfeksiyonları Sürveyans Ağı Özet Raporu 2016 (In Turkish).
3. 3. General Directorate of Public Health, Ministry of Health, Republic of Turkey. Ulusal Sağlık Hizmeti İlişkili Enfeksiyonlar Sürveyans Ağı Özet Raporu 2017 (In Turkish).
4. 4. Centres for Disease Control and Prevention. The NHSN Standardized Infection Ratio (SIR): A Guide to the SIR.
5. 5. Wright M-O, Kharasch M, Beaumont JL, Peterson LR, Robicsek A. Reporting catheter-associated urinary tract infections: Denominator matters. Infect Control Hosp Epidemiol 2011; 32: 635-640.
6. 6. Saman DM, Kavanagh KT. Assessing the necessity of the standardized infection ratio for reporting central line-associated bloodstream infections. PLoS One 2013; 8: e79554.
7. 7. Centers for Disease Control and Prevention. Your guide to the standardized infection ratio (SIR). NHSN e-news: SIRs Special Edition. 2010: 1-14.
8. 8. Rioux C, Grandbastien B, Astagneau P. The standardized incidence ratio as a reliable tool for surgical site infection surveillance. Infect Control Hosp Epidemiol 2006; 27: 817-824.

9. 9. Soe MM, Gould CV, Pollock D Edwards J. Targeted Assessment for Prevention of Healthcare-Associated Infections: A New Prioritization Metric. Infect Control Hosp Epidemiol 2015; 36: 1379–1384.
10. 10. Infection Control Regulation of Inpatient Treatment Institutions. Official Gazette (Issue: 25903). (In Turkish).
11. 11. Öztürk R, Çetinkaya Şardan Y, Kurtoğlu D. Sağlıkta Dönüşüm Programı Hastane Enfeksiyonlarının Önlenmesi: Türkiye Deneyimi Eylül 2004 – Aralık 2010 (In Turkish).
12. 12. Centres for Disease Control and Prevention. 2011 National and State Healthcare-Associated Infections Standardized Infection Ratio Report.
13. 13. Lo E, Nicolle LE, Coffin SE, Gould C, Maragakis LL, Meddings J et, al. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infect Control Hospital Epidemiol 2014; 35: 464-479.
14. 14. Fakih MG, Greene MT, Kennedy EH, Meddings JA, Krein SL, Olmsted RN, et al. Introducing a population-based outcome measure to evaluate the effect of interventions to reduce catheter-associated urinary tract infection. Am J Infect Control 2012; 40: 359-364.
15. 15. Centres for Disease Control and Prevention. The NHSN Standardized Utilization Ratio (SUR): A Guide to the SUR.