Dan Bronson-Lowe, PhD, CIC
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1 Dan Bronson-Lowe, PhD, CIC Senior Clinical Manager Baxter Healthcare Corporation No conflicts of interest to disclose.
2
3 Clinic A Clinic B 20 vaccinated 5 vaccinated 100 total 5 total 20% vaccinated 100% vaccinated
4 Counts Ratios Proportions Rates Numerator Denominator x 10n Where: 10 0 = = = = 1, = 10,000 and so on
5 Number or rate of events/items/persons/etc. in group 1 Number or rate of events/items/persons/etc. in group 2 x 10 n A hospital with 420 inpatient beds has 3 IPs. 420 / 3 (x 1) = 140 inpatient beds per IP Ratio of inpatient beds to IPs is 140:1.
6 Number of events/persons with a particular characteristic Total number of events/persons (of which the numerator is a subset) x 10 n During 2015 a hospital had 50 CAUTIs, of which 18 were in male patients. 18 / 50 (x 100) = 36 CAUTIs in males per 100 CAUTIs = 36% of CAUTIs were in males
7 Number or rate of events during the time period Number or rate of events/items/persons/etc. at risk during the time period x 10 n A hospital with 80,000 admissions in 2014 had 120 cases of healthcare-acquired C. difficile infections in / 80,000 (x 1) = infection per admission per year 120 / 80,000 (x 10,000) = 15 infections per 10,000 admissions per year
8 1. Is it based on (Numerator/Denominator) x 10 n? No = Not a Ratio. Stop here. Yes = Ratio. Go to Question 2. Example A 24 patients Example B (Ratio) 16 males / 8 females = 2 males per female Example C 16 males/24 patients (x100) = 67% Example D (Ratio) 8 patients per day
9 2. Is the Numerator a subset of the Denominator? No = Not a Proportion. Go to Question 3. Yes = Proportion. Go to Question 3. Example B 16 males / 8 females = 2 males per female Example C 16 males/24 patients (x100) = 67% Example D 8 patients per day
10 3. Is time part of the Denominator? No = Not a Rate. Stop here. Yes = Rate. Stop here. Example B 16 males / 8 females = 2 males per female Example C 16 males/24 patients (x100) = 67% Example D 8 patients per day
11 Incidence Mortality or Cure Prevalence
12 Prevalence = Number of existing cases at a given point in time Total population at a given point in time Point Prevalence Specific point in time Period Prevalence Specific period in time
13 Prevalence = Number of isolation patients on Unit W on June 4th Total population on Unit W on June 4th
14 Patients on Isolation on Unit W - June 2015 Patient A B C D E F G H I J K L Day of the Month
15 Patient Presence on Unit W - June 2015 Patient A B C D E F G H I J K L Day of the Month
16 Prevalence = Number of isolation patients on Unit W on June 4th Total population on Unit W on June 4th Prevalence = 5 isolation patients 7 patients total = %
17 Prevalence = Number of isolation patients on Unit W in June Total population on Unit W in June
18 Patients on Isolation on Unit W - June 2015 Patient A B C D E F G H I J K L Day of the Month
19 Patient Presence on Unit W - June 2015 Patient A B C D E F G H I J K L Day of the Month
20 Prevalence = Number of isolation patients on Unit W in June Total population on Unit W in June Prevalence = 8 isolation patients 12 patients total = %
21 Incidence = Number of new cases during a given time period Total at-risk population (or time) observed Incidence Proportion Cumulative Incidence Person-based; uses people at risk Incidence Rate Incidence Density Time-based; uses time at risk
22 Incidence Proportion = Number of new cases during a given time period Total at-risk population observed
23 CAUTI Events on Unit Z - June 2015 Patient A B C D E F G H I J K L Day of the Month
24 Patient A B C D E F G H I J K L Foley Patient Catheter Presence Use on Unit Z -- June Day of the Month
25 Incidence Proportion = Incidence Proportion = Number of new cases during a given time period Total at-risk population observed 3 new CAUTIs in June 12 patients in June = %
26 Incidence Proportion = Incidence Proportion = Number of new cases during a given time period Total at-risk population observed 3 new CAUTIs in June 9 patients with urinary catheters in June = %
27 Foley Catheter Use on Unit Z - June 2015 Patient A B C D E F G H I J K L Day of the Month
28 Incidence Rate = Number of new cases during a given time period Total at-risk time observed
29 CAUTI Events on Unit Z - June 2015 Patient A B C D E F G H I J K L Day of the Month
30 Patient A B C D E F G H I J K L Foley Catheter Use on Unit Z - June Day of the Month Catheter- Days
31 Incidence Rate = Number of new cases during a given time period Total at-risk time observed Incidence Rate = 3 new CAUTIs in June 114 urinary catheter-days in June = CAUTIs per catheter-day = 26 CAUTIs per 1000 catheter-days
32 Attack Rate = Number of new cases during a given time period Total at-risk population observed Overall Attack Rate = 8 new cases of norovirus this week 420 in-patients = %
33 Attack Rate = Number of new cases during a given time period Total at-risk population observed Food-Specific Attack = Rate 7 new cases of norovirus this week (ate salad) 120 in-patients (ate salad) = %
34 Mortality Rate = Number of deaths Total at-risk population observed x10 n (per year) Crude Mortality Rate = 100 deaths 20,000 total population x1,000 (per year) = 5 deaths per 1,000 population per year
35 Mortality Rate = Number of deaths Total at-risk population observed x10 n (per year) Cause-Specific Mortality = Rate 2 tuberculosis deaths 20,000 total population x100,000 (per year) = 10 TB deaths per 100,000 population per year
36 Hospital A Hospital B 25 CAUTIs 11 CAUTIs 8000 catheter-days 8000 catheter-days 3.1 CAUTIs per 1,000 catheter-days 1.4 CAUTIs per 1,000 catheter-days
37 Hospital A Unit Number of CAUTIs Number of Catheter-Days CAUTI rate per 1,000 catheter-days Medical Rehab Total Hospital B Unit Number of CAUTIs Number of Catheter-Days CAUTI rate per 1,000 catheter-days Medical Rehab Total
38 Hospital A Hospital B Unit Number of CAUTIs Number of Catheter-Days CAUTI rate per 1,000 catheter-days ICU Medical Oncology Ortho Rehab Stepdown Surgical Telemetry Total Unit Number of CAUTIs Number of Catheter-Days CAUTI rate per 1,000 catheter-days ICU Medical Oncology Ortho Rehab Stepdown Surgical Telemetry Total
39 Direct Standardization Your Population Category-Specific Rates Standard Population Indirect Standardization Your Population Category-Specific Rates Standard Population
40 Hospital A Direct Standardization Unit Number of CAUTIs Number of Catheter-Days CAUTI rate per 1,000 catheter-days Medical Rehab Total Standard Hospital Unit Number of CAUTIs Number of Catheter-Days Medical 4000 Rehab 4000 Total 8000 CAUTI rate per 1,000 catheter-days
41 Hospital B Direct Standardization Unit Number of CAUTIs Number of Catheter-Days CAUTI rate per 1,000 catheter-days Medical Rehab Total Standard Hospital Unit Number of CAUTIs Number of Catheter-Days Medical 4000 Rehab 4000 Total 8000 CAUTI rate per 1,000 catheter-days
42 Hospital A Hospital B 25 CAUTIs 11 CAUTIs 8000 catheter-days 8000 catheter-days Crude Rate: 3.1 CAUTIs per 1,000 catheter-days Unit-Standardized Rate: 2.3 CAUTIs per 1,000 catheter-days Crude Rate: 1.4 CAUTIs per 1,000 catheter-days Unit-Standardized Rate: 2.3 CAUTIs per 1,000 catheter-days
43 Hospital A (Standardized) Indirect Standardization Unit Number of CAUTIs Number of Catheter-Days CAUTI rate per 1,000 catheter-days Medical Rehab Total Hospital B (Standard Population) Unit Number of CAUTIs Number of Catheter-Days CAUTI rate per 1,000 catheter-days Medical Rehab Total
44 Hospital A (Expected) Indirect Standardization Unit Number of CAUTIs Number of Catheter-Days CAUTI rate per 1,000 catheter-days Medical Rehab Total Hospital A (Observed) Unit Number of CAUTIs Number of Catheter-Days CAUTI rate per 1,000 catheter-days Medical Rehab Total
45 SIR = Observed number of infections Expected number of infections Better Same Worse SIR
46 Crude Rates Standardized Rates Category-Specific Rates
47
48 It is a truth universally acknowledged, that an infection preventionist in possession of a good dataset must be in want of an interpretation.
49 Sensitivity 100% Specificity 100% No HAI HAI
50 Disease No Disease Positive Test True Positive False Positive Total Positives Negative Test False Negative True Negative Total Negatives Total Diseased Total Disease-Free Total Population Number of True Positives Sensitivity = (x 100) Total Number of Diseased
51 Disease No Disease Positive Test True Positive False Positive Total Positives Negative Test False Negative True Negative Total Negatives Total Diseased Total Disease-Free Total Population Number of True Negatives Specificity = (x 100) Total Number Disease-Free
52 Disease No Disease Positive Test True Positive False Positive Total Positives Negative Test False Negative True Negative Total Negatives Total Diseased Total Disease-Free Total Population Number of True Positives PPV = (x 100) Total Number with Positive Tests
53 Disease No Disease Positive Test True Positive False Positive Total Positives Negative Test False Negative True Negative Total Negatives Total Diseased Total Disease-Free Total Population Number of True Negatives NPV = (x 100) Total Number with Negative Tests
54 Sensitivity: 80% Specificity: 91% Positive predictive value: 85% Negative predictive value: 87%
55 PPV = 8% PPV = 85%
56 NPV = 99% NPV = 87%
57
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