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 Measures (SCIP)

The U.S. Department of Health and Human Services (HHS) Steering Committee for the Prevention of Healthcare-Associated Infections intends to review on an annual basis progress toward achieving the nine 5-year (end goal of December 31, 2013) goals or targets in the HHS Action Plan to Prevent Healthcare-Associated Infections for reducing the incidence of specific healthcare-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 2011:

• Marked improvement in infection rates for central line-associated bloodstream infections, healthcare-associated invasive methicillin-resistant Staphylococcus aureus (MRSA) infections, catheter-associated urinary tract 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.

For other measures, such as Clostridium difficile infections, 2009-2010 are the baseline years and data are still being collected and/or analyzed.

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 (fall 2011) progress toward the nine goals. It includes the baseline measure (as available), the current assessment (as available), and additional notes on the measures and data. 

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)

2010 Assessment:  33% reduction or 0.67 SIR
2009 Assessment: 18% reduction or 0.82 SIR

2013 Projection: On track to meet target on schedule

Data source: CDC’s National Healthcare Safety Network
The 2010 data reflect reports from over 2,200 facilities in 49 states and the District of Columbia; 51.9% were ICUs. Neonatal ICUs and wards are not included in these data. 

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 source: CDC’s National Healthcare Safety Network

*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.

3. Clostridium difficile (hospitalizations)

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

2011 Assessment Projection*:  11.9 hospitalizations per 1,000 discharges; 1.7% increase from baseline
2010 Assessment Projection*: 11.5 hospitalizations per 1,000 discharges; 1.7% decrease from baseline

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

Baseline Measurement (2008): 11.7 hospitalizations with C. difficile per 1,000 discharges

Data source: AHRQ’s Healthcare Cost and Utilization Project

*The 2010 projections were generated using 2010 inpatient data from states reporting early and time-series data forecasting software.

4. Clostridium difficile Infections

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

2011 Assessment: Data is not yet available

Baseline Measurement: 2009-2010 is the baseline period

Data source: CDC’s National Healthcare Safety Network

5. Catheter-associated Urinary Tract Tnfections (CAUTI)

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

2010 Assessment: 7.0% reduction or 0.93 SIR

2013 Projection: On track to meet target on schedule

Data source: CDC’s National Healthcare Safety Network

The data source changed its surveillance definition for CAUTI in January 2009, so the five year period has been extended from 2013 to 2014. The 2010 data has over 1,000 facilities reporting, with over 3600 locations, 40% were ICUs.

6. MRSA Invasive Infections (Population)

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

2010 Assessment: 18.2% reduction; 21.46 infections per 100,000 persons
2009 Assessment: 11.8% reduction; 23.14 infections per 100,000 persons

Baseline Measurement (2007-2008): 26.24 infections per 100,000 persons

2013 Projection: On track to meet target on schedule

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

7. MRSA Bacteremia (Hospital)

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

2010 Assessment: Data is not yet available

Baseline Measurement: 2009-2010 is the baseline period

Data source: CDC’s National Healthcare Safety Network

Baseline data are nationally representative. Because CDC changed its data collection procedures in January 2010, the assessment period has been extended to December 2015 so that data are uniform for the entire period.

8. Surgical Site Infections (SSI)

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

2010 Assessment: 10% reduction or 0.90 SIR
2009 Assessment: 2% reduction or 0.98 SIR

2013 Projection: On track to meet target on schedule

Data source: CDC’s National Healthcare Safety Network

9. Surgical Care Improvement Project Measures (SCIP)
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.

2009 Assessment:

• SCIP Inf 1 – 96%
• SCIP Inf 2 – 98%
• SCIP Inf 3 – 92%
• SCIP Inf 4 – 92%
• SCIP Inf 6 – 99%

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 Action Plan. In the case of hospitalizations with Clostridium difficile, efforts must be enhanced and accelerated to achieve the target.