Monday, November 8, 2010

1st Annual Illinois Conference on HAI: The SSI rates don't exist anymore edition

I ate all of the Illinois-shaped
chocolates. Sorry!
I had the pleasure of attending and speaking at the Illinois APIC conference this past Friday in Springfield, Illinois.  Lincoln was everywhere for some reason; I was expecting Homer or Bart statues...

The first speaker was Kathy Allen-Bridson, RN BSN CIC who is a Nurse Consultant at CDC's NHSN.  She gave an excellent talk describing how to apply NHSN definitions. She, Marc Wright (one of the conference organizers), Joan Hebden, Gloria Morrell and Teresa Horan have published a series of cases studies that aid IPs in the application of NHSN definitions of HAIs.  The first three of these have appeared in the June, September and October issues of APIC. (scroll down to the Special Article section)  I do think that these should be free to everyone and not require a membership or subscription, especially given the large role that CDC had in creating these vignettes.

As far as CLABSI definitions, there was some interesting discussion around Criterion 2 that requires the "same" skin contaminant from >2 blood cultures drawn <2 days apart. For the definition of same, NHSN suggests
that organisms are the same if they have the same antimicrobial sensitivities or only differ in susceptibility to ONE antibiotic.  Thus if they differ by 2 or more antibiotic susceptibilities then they are different and the BSI is not a CLABSI.  The interesting discussion came up around what to do with susceptibilities tested by the microbiology lab, but not reported.  Since some/many labs only report susceptibilities to clinicians for antibiotics on formulary or unrestricted antibiotics, should IPs go to the lab and search for susceptibility mismatch on antibiotics tested in the lab but not reported?  A show of hands suggested that 50% do the extra search and 50% don't.  This is something NHSN might want to address.

The second speaker was Maggie Dudeck MPH CPH, who is also with CDC's NHSN. She gave a really thorough talk on how to use NHSN for analysis and generate reports.  I found this very useful.  Additionally, she discussed that NHSN will no longer report SSI rates!  As of now, NHSN will only report SSI Standardized Infection Ratios (SIRs). You can read more about SSI SIRs here in the NSHN special edition newsletter.  Basically, SIRs are estimated by dividing reported SSI rates by expected infection rates estimated using a "to be published" logistic regression formula.  Thus, SIR>1 will suggest SSIs greater than expected and SIR<1 will suggest SSIs lower than expected.  This is pretty interesting, although as a patient and clinician, I would still want to see that actual rates. (FYI in CLABSI they will report rates and SIR, which I think is better)  In addition, if new information becomes available that might improve the SIR calculation, it is not clear how quickly that will be incorporated, if at all.

Overall, it was a great conference. I had a lot of fun speaking about "Reducing CLABSIs through Blood, Sweat and Tears, With a Happy Ending", interacting with the 200 or so IPs in attendance and eating all of the Illinois-shaped chocolates.  It was also fun to be recognized by a few people who read this blog. Thanks for saying hello!

1 comment:

  1. Nice post. Though the articles are not free, the case studies are and cases two and three can be found at the below sites. After you do the case study you get the answers as well.

    Case 2
    Case 3