Prevention of BSI and VAP Measuring Change in Outcomes Part I

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Prevention of BSI and VAPMeasuring Change in
OutcomesPart I

• Ted Speroff, PhD

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NNIS Surveillance Data

• Central line-associated BSI rate
• 5.0/1000 central line-days
• Ventilator-associated pneumonia rate
• 5.8/1000 ventilator-days
• The numerator is the number of events
• Number of patients with infection or pneumonia
• The denominator is the number of central-line or
  ventilator days, standardized to 1,000
• Census data in the ICU, all patients with lines
  or on ventilator
• NNIS rate is calculated as number of BSI or VAP
  events (numerator) divided by observed number of
  line or vent days for the ICU (denominator) times
  1,000

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Characteristics ofNNIS Rate Data

• Requires aggregating data over a large sample
• Takes time to accumulate data
• Appropriate for Surveillance or Quality assurance
• Appropriate for detecting a rate increase
• Not appropriate for detecting a rate decrease
  unless sample is huge
• Insufficient for Quality Improvement

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Statistical Process Control Charts

• Used in QI to detect improvement (did it work?)
• Chart

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BSI Rates and Control Chart

• Excel Tool
• Naming and Saving the File
• Entering Baseline Data
• Setting the Baseline Period for the Control Chart
• Editing Chart and Printing

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Name and Save the FileSave Often
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Rename the Template File
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HCAHospitalName_ICUName_ICUSafety_MonYr
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Spreadsheet is now calledMusic
City_MICU_ICUSafety_Sep06
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Note the Tabs at the Bottom4 WorksheetsBSI
NNIS RateVAP NNIS Rate
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BSI NNIS Rate
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First Entry Month/Year10/2004
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First Entry CVC Days
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Collecting CVC Days
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First Entry CVC-BSI Infections
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Continue Data Entry
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Data for Baseline Period Have Been EnteredNote
Data Chart
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Set Baseline PeriodMove Cursor to Cell F20
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Baseline goes from row 20 to 34Edit D50 to
D34
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Move Cursor to Cell G3Edit the Text
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Text is a Reminder to You of the Baseline
Periodthe data for mean and control limits
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Chart To Edit TitleMove Cursor on Title and
Click
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Edit to your Hospital Nameand ICU Name
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Continue Data EntryOnly Baseline Data determine
Mean and Control Limits
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Data Complete through 6/2006What do you see?
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End of Part IQuestions and Commentsso
far?Continue to Part II