Blog Post

Which states have made the most—and least—progress on infections?

January 16, 2015

    Clare Rizer, The Daily Briefing

    On Wednesday, CDC officials released a report on how much U.S. hospitals have reduced the rate of hospital-acquired infections (HACs)—and how far they've come to meet benchmarks set by HHS in 2009.

    The report focused on six types of infections:

    • Catheter-associated urinary tract infections (CAUTIs);
    • Central-line associated bloodstream infections (CLABSIs)
    • Surgical-site infections (SSIs) for abdominal hysterectomies;
    • SSIs for colon surgery;
    • Hospital-acquired Clostridium difficile infections; and
    • Hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections.

    CDC found that 26 states performed better than the national average on at least two types of infections. But 19 states reported HAC rates worse than the national average on at least two of the six infection types studied, with eight of those states performing worse on at least three measures.

    So, how did your state fare?

    The Daily Briefing took a deeper look into the CDC data to determine which states are making the most progress in cutting various types of HAC rates—and which have struggled to make gains. 

    Click here to see our full coverage of CDC's latest report

    How the states fared

    We identified the three states that reduce the rates of four HACs—CLABSI, CAUTI, SSIs for hysterectomies, and SSIs for colon surgery—between 2012 and 2013:

    Maryland, which reported a:

    • 26% decline in the Standardized Infection Ratio (SIR) for CAUTIs;
    • 6% drop in the SIR for CLABSIs;
    • 44% reduction in the SIR for hysterectomy SSIs; and
    • 2% drop in the SIR for colon surgery SSIs.

    Mississippi, which reported a:

    • 10% decline in the SIR for CAUTIs;
    • 18% drop in the SIR for CLABSIs;
    • 36% decline in the SIR for hysterectomy SSIs; and
    • 1% drop in the SIR for colon surgery SSIs.

    South Carolina, which reported a:

    • 12% drop in the SIR for CAUTIs;
    • 7% decline in the SIR for CLABSIs;
    • 28% reduction in the SIR for hysterectomy SSIs; and
    • 10% decline in the SIR for colon surgery SSIs.

    Other states did not fare so well. The states that reported increased rates of all four infections were:

    Indiana, which reported a:

    • 16% increase in the SIR for CAUTIs;
    • 5% increase in the SIR for CLABSIs;
    • 61% increase in the SIR for hysterectomy SSIs; and
    • 2% increase in SSIs from colon surgery.

    Michigan, which reported a:

    • 25% increase in the SIR for CAUTIs;
    • 3% increase in the SIR for CLABSIs;
    • 15% increase in the SIR for hysterectomy SSIs; and
    • 21% increase in SSIs from colon surgery.

    North Carolina, which reported a:

    • 4% increase in the SIR for CAUTIs;
    • 4% increase in CLABSIs;
    • 33% increase in the SIR for hysterectomy SSIs; and
    • 18% increase in SSIs from colon surgery.

    Hospital-acquired conditions: The pay-for-performance game changer?

    Breaking it down by infection type

    We also took a closer look at state-level progress on specific types of infections in 2013.

    CAUTIs

    Hawaii and Puerto Rico were the only two states or territories that saw statistically significant declines in CAUTI rates from the 2012 state SIR, the 2013 national SIR, and the 2009 national baseline.  

    Meanwhile, Georgia and Michigan fared the worst in CAUTI reduction, with both states reporting an uptick in CAUTIs compared with the 2012 state SIR, the 2013 national SIR, and the 2009 national baseline. 

    CLABSIs

    States seemed to have more success reducing CLABSI rates than CAUTI rates, according to the CDC data. For instance, Alaska, Illinois, and Tennessee all saw reductions in CLABSIs, compared with the 2012 state SIR, the 2013 national SIR, and the 2009 national baseline.

    In addition, no state reported increases in SIR compared with the three baselines. Delaware was the only state to report higher infection rates when compared with the 2012 state SIR and the 2013 national SIR.

    SSIs for abdominal hysterectomies

    The majority of the data on SSIs from abdominal hysterectomies was not found to be statistically significant when compared with previously compiled data.

    The available data showed that Hawaii and Illinois reported steep declines in HAC rates compared with the 2012 state and 2013 national SIRs and the 2008 national baseline. New York was the only state to report increased SSI levels compared with the 2008 baseline and the 2012 state and 2013 national SIRs.  

    SSIs for colon surgeries

    New York also reported increased infection levels of SSIs during colon surgeries—up from similar data from the 2008 baseline and the 2012 state and 2013 national SIRs. Kansas and Massachusetts saw similar increases.

    The takeaway: Although hospitals have made progress on infections in the last four years, significant variation remains in different states and for different types of infections.

    Will you be penalized for infections?

    National or state-level trends are only so useful.

    Our new Hospital-Acquired Conditions Impact Assessment provides an early look at your organization's score, according to the most recent Hospital Compare data and the methodology described in CMS’s FY 2014 Final Inpatient Rule.

    GET YOUR ESTIMATE

    Please note the data we used from Hospital Compare is not the final data CMS will use to compute the penalties, so results will likely change a bit as we continue to update the analysis moving forward.

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