The NHSN Standardized Infection Ratio (Sir)

THE NHSN STANDARDIZED
INFECTION RATIO (SIR)

A Guide to the SIR
Updated February 2021. Please see Pages 25-29.
The Standardized Infection Ratio (SIR) is the primary summary measure used
by the National Healthcare Safety Network (NHSN) to track healthcare-
associated infections (HAIs). As NHSN grows, both in its user-base and
surveillance capability, the SIR continues to evolve. Highlighting the SIR and
changes resulting from an updated baseline, this document is intended to
serve both as guidance for those who are new to this metric as well as a useful
reference for more experienced infection prevention professionals.
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CORRECTIONS AND UPDATES AS OF FEBRUARY 2021
Recent changes to this document are listed here:
• Pages 25: Addition of Total VAE SIR model for Acute Care Hospitals (ACHs)
• Page 28: Addition of Infection-related Ventilator-Associated Complication (IVAC+) plus SIR

model for Acute Care Hospitals (ACHs)
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Table of Contents
Overview of the Standardized Infection Ratio (SIR) ______________________________ 4
Calculating the Number of Predicted Infections ___________________________________________ 5
Example: Logistic Regression Model (SSI)_________________________________________________ 5
Example: Negative Binomial Regression Model ____________________________________________ 8
Finding and Interpreting SIRs in NHSN _______________________________________ 11

How do I Interpret the SIRs? __________________________________________________________ 12
SIR Guide Supplement: Risk Adjustment Factors Included in the SIR, 2015 Baseline ___ 14
Introduction to the SIR Guide Supplement ______________________________________________ 14
CLABSI – Central Line-Associated Bloodstream Infection ___________________________________ 15
MBI-LCBI – Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infection ________________ 19
CAUTI – Catheter-Associated Urinary Tract Infection ______________________________________ 20
VAE – Ventilator-Associated Events ____________________________________________________ 24
a) Total VAE in Long-Term Acute Care Hospitals (LTACHs)_______________________________ 24
b) Infection-related Ventilator-Associated Complication (IVAC) Plus in LTACHs ______________ 24

c) Total VAE in Acute Care Hospitals (ACHs)__________________________________________ 25
d) Infection-related Ventilator-Associated Complication (IVAC) Plus in ACHs ________________ 28

SSI – Surgical Site Infections __________________________________________________________ 30
MRSA Bacteremia Laboratory-Identified Events __________________________________________ 40
Clostridioides difficile (CDI) Laboratory-Identified Events ___________________________________ 42
Using an Intercept-Only Model to Calculate the Number of Predicted Events ________ 45

Additional Resources_____________________________________________________ 46
ADDENDUM TO THE NHSN GUIDE TO THE SIR _________________________________ 48
Hospital Outpatient Department (HOPD) Procedure/SSI SIR Model ___________________________ 49
Outpatient Procedure Component Surgical Site Infections (OPC SSI) __________________________ 51
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Overview of the Standardized Infection Ratio (SIR)
What is the SIR?

The standardized infection ratio (SIR) is a summary measure used to track HAIs at a national, state, or local level
over time. The SIR adjusts for various facility and/or patient-level factors that contribute to HAI risk within each
facility. The method of calculating an SIR is similar to the method used to calculate the Standardized Mortality
Ratio (SMR), a summary statistic widely used in public health to analyze mortality data. In HAI data analysis, the
SIR compares the actual number of HAIs reported to the number that would be predicted, given the standard
population (i.e., NHSN baseline), adjusting for several risk factors that have been found to be significantly
associated with differences in infection incidence. In other words, an SIR greater than 1.0 indicates that more
HAIs were observed than predicted; conversely, an SIR less than 1.0 indicates that fewer HAIs were observed
than predicted. SIRs are currently calculated in NHSN for the following HAI types: central line-associated
bloodstream infections (CLABSI), mucosal barrier injury laboratory-confirmed bloodstream infections (MBI-LCBI),
catheter-associated urinary tract infections (CAUTI), surgical site infections (SSI), Clostridioides difficile infections
(CDI), methicillin-resistant Staphylococcus aureus bloodstream infections (MRSA), and ventilator-associated
events (VAE).
Why not rates?

In the past, NHSN has published annual HAI rates for device-associated infections. These rates, or pooled means,
were calculated using aggregate data reported to NHSN. The total number of infections was divided by the
applicable number of device days for that time period. However, a problem with strictly using pooled mean
rates is that they cannot reflect differences in risk between populations, and therefore lose comparability over
time and across entities. For example, calculating rates from two facilities serving entirely different patient
populations can lead to an unfair comparison. One solution to this problem is the stratification of pooled means,
as was done with location-stratified CLABSI and CAUTI pooled means. However, this method only allows for
comparison of rates within strata, and does not lend itself to calculating an overall performance metric for a
facility.
Instead, the SIR allows users to summarize data by more than a single stratum (e.g., location or procedure
category), adjusting for differences in the incidence of infection among the strata. For example, NHSN allows
users to obtain one CLABSI SIR for their facility, adjusting for all locations reported. Similarly, users can also
obtain one CLABSI SIR for all intensive care units in their facility.
Additionally, the SIR allows for a comparison to the national benchmark from a baseline time period, and can be
used to measure progress from a single point in time. In other words, the SIR permits comparisons between the
number of infections experienced by a facility, group, or state to the number of infections that were predicted
to have occurred based on national data (i.e., baseline data).
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How is the SIR calculated?
The SIR is calculated by dividing the number of observed infections by the number of predicted infections. The
number of predicted infections is calculated using multivariable regression models generated from nationally
aggregated data during a baseline time period. These models are applied to a facility’s denominator and risk
factor data to generate a predicted number of infections. Please refer to the SIR Guide Supplement at the end of
this document for more details regarding the models.
𝑂𝑏𝑠𝑒𝑟𝑣𝑒𝑑 (𝑂) 𝐻𝐴𝐼𝑠

𝑆𝐼𝑅 =
𝑃𝑟𝑒𝑑𝑖𝑐𝑡𝑒𝑑 (𝑃) 𝐻𝐴𝐼𝑠
In order to enforce a minimum precision criterion, SIRs are currently not calculated when the number of
predicted infections is less than 1.0. This rule was instituted to avoid the calculation and interpretation of
statistically imprecise SIRs, which typically have extreme values.
Calculating the Number of Predicted Infections

The number of predicted infections in NHSN is calculated based on the 2015 national HAI aggregate data and is
adjusted for each facility using variables found to be significant predictors of HAI incidence. NHSN uses either a
logistic regression model or a negative binomial regression model to perform this calculation. Logistic regression
models are used when there is an opportunity for a single outcome for each exposure (e.g., SSI following a
procedure). Negative binomial regression models are used when estimating incidence from a summarized
population (e.g., CLABSIs in a Medical ICU). Examples in applying each model type are provided below.
❖ Example: Logistic Regression Model (SSI)

The logistic regression model is the specific type of model used for surgical site infection risk adjustment. At a
high level, the model uses a set of fixed parameters (adjustment variables) to predict the log-odds of a surgical
site infection following an inpatient procedure. To obtain the total number of predicted SSIs, the following steps
are completed in NHSN:
1. Determine the log-odds for each procedure

2. Convert the log-odds into a probability, or risk of infection (𝑝̂ ), for each procedure
3. Sum the risk of infections across all procedures in a given timeframe
The sum of the risks from a set of procedures will amount to the total number of predicted infections for that
same set of procedures. Table 1 below shows the risk factors found to be significant for abdominal hysterectomy
(HYST) procedures (Complex 30-Day model) in NHSN. Note that each risk factor’s contribution to the SIR varies,
as represented by the parameter estimate for each factor. Parameter estimates describe the relationship
between the variable and the risk of SSI; positive parameter estimates indicate that the risk of SSI increases with
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increasing values of the variable. Negative parameter estimates indicate that the risk of SSI decreases with
increasing values of the variable.
Table 1. Risk Factors for SSI HYST: Complex 30-Day Model (2015 Baseline)
Factor Parameter Estimate P-value Variable Coding

Intercept -5.1801 - -
Diabetes 0.3247 <0.0001 Yes= 1
No= 0
ASA Score 0.4414 <0.0001 1= 1
2= 2
3= 3
4/5= 4
Body Mass Index (BMI) 0.1106 0.0090 ≥ 30= 1
< 30= 0
Patient Age -0.1501 <0.0001 Patient’s age/10
Oncology Hospital 0.5474 0.0005 Oncology hospital= 1
Non-oncology hospital= 0
The parameter estimates from Table 1 can be plugged into the following general logistic regression formula:
𝑙𝑜𝑔𝑖𝑡 (𝑝̂ ) = 𝛼 + 𝛽1 𝑋1 + 𝛽2 𝑋2 + ⋯ + 𝛽𝑖 𝑋𝑖 , where:

α = Intercept
βi = Parameter Estimate
Xi = Value of Risk Factor (Categorical variables= 1 if present, 0 if not present. Refer to
“Variable Coding” column in Table 1 above.)
i = Number of Predictors
The probability of SSI is calculated using the logistic regression model above, by utilizing the relationship
between the log-odds and the probability (risk). Let’s say we have a patient (Patient 1) who is 32 years old, has
diabetes, and a BMI score of 29. She had an ASA score of 2 and her procedure took place in an oncology
hospital. We can use the model above to plug in these values as shown below:
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𝑙𝑜𝑔𝑖𝑡 (𝑝̂ ) = −5.1801 + 0.3247(𝐷𝐼𝐴𝐵𝐸𝑇𝐸𝑆) + 0.4414(𝐴𝑆𝐴) + 0.1106(𝐵𝑀𝐼) − 0.1501(𝐴𝐺𝐸)
+ 0.5474(𝑂𝑁𝐶𝑂𝐿𝑂𝐺𝑌 𝐻𝑂𝑆𝑃𝐼𝑇𝐴𝐿)
𝑙𝑜𝑔𝑖𝑡 (𝑝̂ ) = −5.1801 + 0.3247(1) + 0.4414(2) + 0.1106(0) − 0.1501(3.2) + 0.5474(1) = -3.9055
The value -3.9055 is the log-odds of SSI for Patient 1. To convert this value into the risk of SSI (𝑝̂ ), we must use
the logit function below:
𝑒 𝑙𝑜𝑔𝑖𝑡(𝑝̂)
𝑝̂ =
1 + 𝑒 𝑙𝑜𝑔𝑖𝑡(𝑝̂)
𝑒 −3.9055
𝑝̂ =
1 + 𝑒 −3.9055
𝑝̂ = 0.020
Note that this can also be interpreted as a 2.0% risk of SSI for Patient 1. The probability of SSI is calculated for
each procedure and then summed across all procedures to give the total number of predicted SSIs for this
population. Table 2 provides a partial list of 100 hypothetical patients who have undergone this particular
procedure type and demonstrates how the total number of predicted SSIs is calculated.
Table 2. Risk Factors for 100 Patients Undergoing a HYST Procedure (Complex 30-Day model)
Patient Diabetes ASA score BMI Age Oncology Hospital SSI Identified? ̂)
Probability of SSI (𝒑
1 Y 2 29 32 Y 1 0.020
2 N 3 35 49 Y 0 0.019
3 N 5 20 51 Y 1 0.026
. . . . . . . .
. . . . . . . .
100 N 4 27 27 Y 0 0.037
TOTAL . . . . . 8 (observed SSIs) 6.750 (predicted SSIs)
Notice in the above table that the probability of SSI is different for each patient, given the risk factors present
during the reported procedure.
The SIR can now be calculated for those 100 procedures as follows:
𝑂𝑏𝑠𝑒𝑟𝑣𝑒𝑑 (𝑂) 𝐻𝐴𝐼𝑠 8

𝑆𝐼𝑅 = = = 1.190
𝑃𝑟𝑒𝑑𝑖𝑐𝑡𝑒𝑑 (𝑃) 𝐻𝐴𝐼𝑠 6.750
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❖ Example: Negative Binomial Regression Model
Negative binomial regression models are used to calculate the number of predicted events for CLABSI, MBI-LCBI,
CAUTI, VAE, MRSA bacteremia LabID, and C. difficile (CDI) LabID under the 2015 baseline. Below is a general
formula for a negative binomial regression model.
𝑙𝑜𝑔 (𝜆) = 𝛼 + 𝛽1 𝑋1 + 𝛽2 𝑋2 + ⋯ + 𝛽𝑖 𝑋𝑖 , where:

α = Intercept
βi = Parameter Estimate
Xi = Value of Risk Factor (Categorical variables: 1 if present, 0 if not present)
i = Number of Predictors
As an example, Table 3 below represents the negative binomial regression model used to calculate the number
of predicted healthcare facility-onset (HO) CDI LabID events in acute care hospitals under the 2015 baseline.
Table 3. Risk Factors Used in the Acute Care Hospital CDI LabID Event Model
Factor Parameter Estimate P-value
Intercept -8.9463 <0.0001
Inpatient community-onset (CO) admission prevalence rate 0.7339 <0.0001
CDI test type= EIA -0.1579 <0.0001
CDI test type= NAAT 0.1307 <0.0001
# ICU beds: ≥ 43 0.7465 <0.0001
# ICU beds: 20-42 0.7145 <0.0001
# ICU beds: 10-19 0.6261 <0.0001
# ICU beds: 5-9 0.4394 <0.0001
Oncology hospital (facility type = HOSP-ONC) 1.2420 <0.0001
General acute care hospital (facility type = HOSP-GEN) 0.3740 <0.0001
Total facility bed size 0.0003 <0.0001
CDI LabID surveillance in ED or 24-hour observation location(s) 0.1119 <0.0001
Teaching facility (major, graduate, or undergraduate) 0.0331 0.0028
The SIR for C. difficile LabID events in an acute care hospital is calculated on the facility-wide inpatient
(FacWideIN) level for each quarter. More information on the details of the LabID Event SIR calculations can be
found in the SIR Guide Supplement at the end of this document.
We can input the model details from Table 3 into the general negative binomial regression formula for CDI in
acute care hospitals:
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# predicted HO CDI =
For most variables shown in parentheses in the equation above, you would replace the variable name (and
therefore, multiply each parameter estimate) with a “1” or “0” depending on whether that factor is present in
your facility (Yes= “1”, No= “0”). The inpatient CO prevalence rate and total number of beds are continuous
variables and should be replaced with the actual values of the inpatient CO prevalence rate and total number of
beds. The last step in the equation is to multiply the resulting value by the appropriate HAI denominator (i.e.,
patient days for MRSA/CDI events, or device days for CLABSI/MBI/CAUTI/VAE). In this example, we multiply by
CDI patient days.
Note: in NHSN, “CDI patient days” refers to the patient days entered on Row 3 of the FacWideIN monthly
denominator forms, for an entire quarter. This value represents that total number of patient days from
all inpatient units within the facility, with the exception of NICUs, well-baby units, and CMS-certified
rehab and psych units.
Let’s walk through an example of calculating the number of predicted CDI events for an acute care hospital for
2015 Q1. The facility in our example has reported 5,000 CDI patient days and 5 healthcare facility-onset CDI
LabID events in 2015 Q1. After running the CDI rate tables in NHSN, the facility records that their 2015 Q1 CO
admission prevalence rate was 1.25 per 100 admissions. The facility was using a NAAT CDI test type, has 5 ICU
beds, is enrolled in NHSN as a children’s non-teaching hospital, and has 100 total beds. The facility has an
Emergency Department, and is thus reporting CDI data from this location per NHSN protocol.
In our example hospital, the completed formula looks like this:
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Because the facility was not using EIA test type, was not a general or oncology hospital, and was not a teaching
hospital, the associated parameters in the model were not met. Therefore, the parameter estimates for each of
those variables were multiplied by 0 and fell out of the equation.
To calculate the CDI LabID SIR, divide the number of observed HO CDI LabID events by the number of predicted
HO CID LabID events. In our example:
5 𝑜𝑏𝑠𝑒𝑟𝑣𝑒𝑑 𝐻𝑂 𝐶𝐷𝐼 𝐿𝑎𝑏𝐼𝐷 𝑒𝑣𝑒𝑛𝑡𝑠

𝑆𝐼𝑅 = = 1.506
3.321 𝑝𝑟𝑒𝑑𝑖𝑐𝑡𝑒𝑑 𝐻𝑂 𝐶𝐷𝐼 𝐿𝑎𝑏𝐼𝐷 𝑒𝑣𝑒𝑛𝑡𝑠
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Finding and Interpreting SIRs in NHSN
What SIR reports are available?

To run analysis reports in NHSN, users must first generate analysis data sets (Analysis > Generate Data Sets).
NHSN recommends users regenerate data sets after entering new data into the application or before creating
new reports. After data sets have been regenerated, users can select Analysis > Reports from the NHSN
homepage to view HAI-specific folders. The SIR reports located in the HAI-specific folders will be calculated using
the 2015 baselines and risk adjustment models. In addition, SIR reports are available that mirror the data
submitted to the Centers for Medicare & Medicaid Services (CMS) Quality Reporting Programs. These reports
can be found in the analysis folder titled “CMS Reports”.
SIRs can be generated for data through 2016 using the original NHSN baselines by running reports in the
“Baseline Set 1” reports folder. Data representing a later time period (i.e., starting in January 2017) can only be
analyzed in NHSN using the new 2015 rebaseline models. Year 2016 is the final year of data that can use the
original models to calculate SIRs. See Additional Resources for information about the original SIR baselines.
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Note: SIRs calculated under the original baseline cannot be directly compared to SIRs calculated under the
updated baseline. Additional information about NHSN Re-baseline can be found here :
https://www.cdc.gov/nhsn/pdfs/training/2017/Dudeck_March21.pdf;
https://www.cdc.gov/nhsn/pdfs/training/2017/Dudeck_March22.pdf.
How do I Interpret the SIRs?

SIR
• If the SIR > 1.0, then more HAIs were observed than predicted, based on the 2015 national aggregate
data.
• If the SIR < 1.0, then fewer HAIs were observed than predicted, based on the 2015 national aggregate
data.
• If the SIR= 1.0, then the same number of HAIs were observed as predicted, based on the 2015 national
aggregate data.
• Remember, the SIR is only calculated when the number of predicted infections is at least 1.0. When the
predicted number of infections is less than 1.0, facilities have a few options for reviewing and
interpreting HAI data in NHSN:
o A longer time period can be included in the SIR calculation in order to reach the threshold of 1.0
predicted infection.
o Infection rates can be used to track internal HAI incidence over time.
o Run the TAP Reports to review the CAD (cumulative attributable difference, which is the
difference between the number of observed infections and the number of predicted infections,
multiplied by the SIR goal). Information and guidance about running TAP reports can be found in
Additional Resources.
P-value
• In the context of the SIR, the p-value is a statistical measure that tells us whether the number of
observed infections is statistically significantly different than the number of predicted infections (i.e.,
whether the SIR is significantly different from 1.0). NHSN calculates p-values using a mid-P exact test.
• Given the typical cutoff value of 0.05, if the p-value ≤ 0.05, we can conclude that the number of
observed infections is statistically significantly different than the number of predicted infections.
• If the p-value > 0.05, then we can conclude that the number of observed infections is not statistically
significantly different than the number of predicted infections.
95% Confidence Interval

• The 95% confidence interval is a statistical range of values in which we have a high degree of confidence
that the true SIR lies.
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• If the confidence interval does not include the value of 1, then the SIR is significantly different than 1
(i.e., the number of observed infections is significantly different than the number of predicted
infections).
o Example: 95% confidence interval= (0.85, 0.92)
• If the confidence interval includes the value of 1, then the SIR is not significantly different than 1 (i.e.,
the number of observed infections is not significantly different than the number of predicted infections).
o Example: 95% confidence interval= (0.85, 1.24)
• If the SIR is 0.000 (i.e., the observed infection count is 0 and the number of predicted infections is ≥ 1.0),
then the lower bound of the 95% confidence interval will not be calculated.
As an example, let’s take a look at the CLABSI SIR output. Below is a table showing the overall CLABSI SIR for a
hospital during the first quarter of 2015.
• During the first quarter (January– March) of 2015 (“summaryYQ”), there were 5 CLABSIs identified in our
facility (“infCount”), and we observed a total of 1,850 central line days (“numcldays”) from the locations
under surveillance.
• Based on the NHSN 2015 baseline data, 2.365 CLABSIs were predicted (“numPred”) in our facility.
• This results in an SIR of 2.114 (5/2.365), signifying that during this time period, our facility identified
more CLABSIs than were predicted.
• Because the p-value (“SIR_pval”) is above the significance level of 0.05 and the 95% confidence interval
(“sir95ci”) includes the value of 1, we can conclude that our facility’s SIR is not statistically significant; in
other words, our facility did not observe a statistically significantly different number of CLABSIs than
predicted.
When analyzing these data as a Group user, an additional overall SIR will be calculated for all facilities in the
Group. More information about using the Group function in NHSN can be found here:
https://www.cdc.gov/nhsn/group-users/index.html.
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SIR Guide Supplement: Risk Adjustment Factors Included in the SIR
Calculations, 2015 Baseline
Introduction to the SIR Guide Supplement

The following pages contain information on the risk factors used in the calculation of the number of predicted
events for each HAI and facility type under the 2015 SIR baseline. This information is provided in order to aide in
the interpretation of the SIR calculations produced by NHSN. The tables displayed in this document list the
variables included in each risk adjustment model*, as well as parameter estimates and standard errors. Some
risk adjustment variables are broken into different levels, or categories (i.e., categorical variables), while other
variables are treated as continuous variables without any categorization. Standard errors reflect the precision of
the parameter estimate.
• Categorical variables:
Example: “medical school affiliation” in the CAUTI Acute Care Hospital model, page 20
Variables are categorized based on significant differences in HAI risk between the categories. Parameter
estimates reflect the nature of the relationship between the variable and the risk of HAI. In the case of
categorical variables, the risk of HAI in an individual category is compared to the risk of HAI in the “referent”
category. A positive parameter estimate indicates that the risk of HAI in that category (and therefore, the
number of predicted HAIs) is higher compared to the risk of HAI in the referent category. A negative parameter
estimate indicates that the HAI risk in that category is lower compared to the HAI risk in the “referent” category.
• Continuous variables:
Example: “facility bed size” in the CDI Acute Care Hospital model, page 38
Parameter estimates reflect the nature of the relationship between the variable and the risk of HAI (and
therefore, the number of predicted HAIs). For continuous variables, a positive parameter estimate indicates that
the risk of HAI increases as the variable increases, while negative parameter estimates indicate that the risk of
HAI decreases as the variable increases.
-----------------------------------------------------------------------------------------------------------------------------------------
*Exceptions:
Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infection (MBI-LCBI) data: The variables included in the MBI risk
adjustment model for acute care hospitals are shown on page 19. The MBI-LCBI SIR is not submitted to CMS under the
Hospital Inpatient Quality Reporting Program. Full model details including parameter estimates will be available in a
separate publication.
VAE and IVAC Plus data: Parameter estimates are shown only for Long-Term Acute Care Hospitals (LTACHs), which are
required to report these data under the CMS Long Term Care Hospital Quality Reporting Program. Full VAE and IVAC Plus
model details for additional facility types will be available in a separate publication.
SSI data: Parameter estimates are shown for colon (COLO) and abdominal hysterectomy (HYST) procedures under the
Complex 30-Day Model used for CMS Hospital Inpatient Quality Reporting Program. Full model details for all procedures
under the All SSI Model and the Complex A/R Model will be available in a separate publication.
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Risk Adjustment Factors Included in the SIR Calculation: 2015 Baseline
CLABSI – Central Line-Associated Bloodstream Infection
The number of predicted CLABSIs is calculated using a negative binomial regression model (see page 8 above for
more information). Inpatient locations that were previously excluded from the original baseline are now
included in the SIR under the 2015 baseline (e.g., Telemetry Ward, Mixed Acuity Ward). In cases when the
number of predicted events is less than 1.0, the SIR will not be calculated in NHSN. CLABSI events reported to
NHSN as mucosal barrier injury (MBI-LCBI), or with extracorporeal life support (ECMO), or a ventricular assist
device (VAD) (2019 events and alter) are excluded from the numerator of the CLABSI SIR.
The number of predicted CLABSIs calculated under the 2015 baseline is risk adjusted based on the following
variables found to be statistically significant predictors (risk adjustment updated August 2018):
Table 1. CLABSI in Acute Care Hospitals (non-NICU locations)

Parameter Parameter Estimate Standard Error P-value
Intercept -7.6325 0.0606 <0.0001
CDC Location Code: Adult Critical Care Units, Oncology
Critical Care Units
Medical Cardiac Critical Care
Surgical Cardiothoracic Critical Care
Medical Critical Care
Medical/Surgical Critical Care
Neurologic Critical Care
Neurosurgical Critical Care 0.3257 0.0435 <0.0001
Medical Oncology Critical Care
Medical/Surgical Oncology Critical Care
Pediatric Oncology Critical Care
Surgical Oncology Critical Care
Prenatal Critical Care
Respiratory Critical Care
Surgical Critical Care
CDC Location Code: Pediatric Critical Care
Pediatric Burn Critical Care
Pediatric Cardiothoracic Critical Care
Pediatric Medical/Surgical Critical Care
0.5695 0.0699 <0.0001
Pediatric Medical Critical Care
Pediatric Neurosurgical Critical Care
Pediatric Surgical Critical Care
Pediatric Trauma Critical Care
CDC Location Code: Burn Critical Care (Adult) 1.4269 0.1125 <0.0001
CDC Location Code: Trauma Critical Care (Adult) 0.6287 0.0835 <0.0001
CDC Location Code: Specialty Care Areas
Inpatient Dialysis
0.3766 0.1304 0.0039
Solid Organ Transplant (adult)
Solid Organ Transplant (pediatric)
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Table 1, continued. CLABSI in Acute Care Hospitals (non-NICU locations)
CDC Location Code: Step-down Units
Adult Step-down Unit
Oncology Step-down Unit 0.2155 0.0521 <0.0001
Pediatric Step-down Unit
Step-down Neonatal Nursery (Level II)
CDC Location Code: Select Adult Wards
Medical Ward
Medical/Surgical Ward
Neurology Ward 0.1797 0.0427 <0.0001
Neurosurgical Ward
Surgical Ward
Telemetry Ward
CDC Location Code: Oncology Wards
ONC General Hematology/Oncology Ward
ONC Pediatric General Hematology/Oncology Ward
ONC Leukemia Ward 0.3698 0.0550 <0.0001
ONC Leukemia/Lymphoma Ward
ONC Lymphoma Ward
ONC Solid Tumor Ward
CDC Location Code: Oncology Stem Cell Transplant
Wards
ONC Hematopoietic Stem Cell Transplant Ward (adult) 0.6876 0.0816 <0.0001
ONC Pediatric Hematopoietic Stem Cell Transplant Ward
CDC Location Code: Pediatric Wards & Nurseries

Pediatric Behavioral Health Ward
Pediatric Burn Ward
Pediatric Medical Ward
Pediatric Medical/Surgical Ward
Pediatric Neurosurgical Ward 0.1912 0.0704 0.0066
Well Baby Nursery (Level I)
Pediatric Neurology Ward
Pediatric Orthopedic Ward
Pediatric Rehabilitation Ward (non-CMS)
Pediatric Surgical Ward
CDC Location Code: All Other Wards
Adult Mixed Acuity
Mixed Age Mixed Acuity
Pediatric Mixed Acuity
Oncology Mixed Acuity
Antenatal Care Ward
Burn Ward REFERENT - -
Behavioral Health/Psych Ward
Adolescent Behavioral Health Ward
Ear/Nose/Throat Ward
Gastrointestinal Ward
Gerontology Ward
Genitourinary Ward
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Table 1, continued. CLABSI in Acute Care Hospitals (non-NICU locations)
Gynecology Ward REFERENT - -
Jail Unit (continued from
Labor and Delivery Ward previous page)
Labor, Delivery, Recovery, Postpartum Suite (LDRP)
Orthopedic Ward
Plastic Surgery Ward
Postpartum Ward
Pulmonary Ward
Rehabilitation Ward (non-CMS)
Stroke (Acute) Ward
Orthopedic Trauma Ward
Vascular Surgery Ward
Chronic Care Unit
Chronic Behavioral Health/Psychiatric Unit
Inpatient Hospice
Chronic Ventilator Dependent
Chronic Rehabilitation Unit
Facility bed size*: ≥ 224 beds 0.2571 0.0471 <0.0001
Facility bed size*: 94 - 223 beds 0.1160 0.0493 0.0187
Facility bed size*: ≤ 93 beds REFERENT - -
Medical school affiliation*: Major 0.2627 0.0211 <0.0001
Medical school affiliation*: Graduate 0.1494 0.0244 <0.0001
Medical school affiliation*:Undergraduate/Non-teaching REFERENT - -
Facility type: (based on NHSN enrollment) 0.1429 0.0526 0.0066
Children’s
Military
Veterans’ Affairs
Women’s
Women’s and Children’s
Facility type: (based on NHSN enrollment) REFERENT - -
General Acute Care
Oncology
Orthopedic
Psychiatric
Surgical
* Facility bed size and medical school affiliation are taken from the Annual Hospital Survey.
Table 2. CLABSI in Acute Care Hospitals (NICU locations)

Intercept -7.2573 0.0553 <0.0001
Birthweight A: ≤ 750 grams 1.2780 0.0745 <0.0001
Birthweight B: 751-1000 grams 0.9780 0.0791 <0.0001
Birthweight C: 1001-1500 grams 0.4579 0.0843 <0.0001
Birthweight D & E: 1501-2500 grams and > 2500 grams REFERENT - -
17 | P a g e
Table 3. CLABSI in Critical Access Hospitals (CAHs)
Intercept* -8.2066 0.1967 <0.0001
* None of the variables investigated were statistically significantly associated with CLABSIs in CAHs. The predicted number
of CLABSI events for CAHs is calculated using the 2015 national CAH CLABSI pooled mean (i.e., intercept-only model).
Table 4. CLABSI in Long-Term Acute Care Hospitals (LTACHs)

Intercept -7.8328 0.1307 <0.0001
Location Type: ICU 0.6716 0.1031 <0.0001
Location Type: Ward REFERENT - -
Facility bed size*: < 45 beds REFERENT - -
Average length of stay*: ≥ 28 days 0.1481 0.0708 0.0365
Average length of stay*: < 28 days REFERENT - -
Proportion of admissions on a ventilator*: ≥ 0.328 0.3907 0.0971 <0.0001
Proportion of admissions on a ventilator*: ≥ 0.125 and
0.2127 0.0859 0.0133
< 0.328
Proportion of admissions on a ventilator*: < 0.125 REFERENT - -
Proportion of admissions on hemodialysis*: ≥ 0.138 0.5785 0.1341 <0.0001
Proportion of admissions on hemodialysis*: ≥ 0.008 and
0.5090 0.1296 <0.0001
< 0.138
Proportion of admissions on hemodialysis*: < 0.008 REFERENT - -
* Facility bed size, average length of stay, and admission proportions are taken from the Annual LTACH Survey. Average
length of stay is calculated as: total # of annual patient days / total # of annual admissions.
Table 5. CLABSI in Inpatient Rehabilitation Facilities (IRFs): Free-standing Rehabilitation Hospitals and CMS-
Certified IRF Units Within a Hospital
Intercept -8.6717 0.3579 <0.001
Proportion of admissions with stroke*: ≥ 0.135 0.7707 0.3222 0.0168
Proportion of admissions with stroke*: < 0.135 REFERENT - -
Proportion of admissions in other non-specific diagnostic
0.4452 0.2051 0.0300
categories*: ≥ 0.197
Proportion of admissions in other non-specific diagnostic
REFERENT - -
categories*: < 0.197
* Admission proportions are taken from the Annual IRF Survey. “Other non-specific diagnostic categories” include all other
primary diagnoses not listed specifically on the Annual IRF Survey.
18 | P a g e
MBI-LCBI – Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infection
The number of predicted MBI-LCBIs is calculated using a negative binomial regression model (see page 8 above
for more information) and is only available for acute care hospitals. Only CLABSI events reported to NHSN as
mucosal barrier injury (MBI-LCBI) are included in the numerator of the MBI-LCBI SIR. In cases when the number
of predicted events is less than 1.0, the SIR will not be calculated in NHSN.
*Note: The variables included in the MBI risk adjustment model for acute care hospitals are shown below. The
MBI-LCBI SIR is not submitted to CMS under the Hospital Inpatient Quality Reporting Program. Full model details
including parameter estimates will be available in a separate publication.
The number of predicted MBI-LCBI events calculated under the 2015 baseline is risk adjusted based on the
following variables found to be statistically significant predictors:
Table 1. MBI-LCBI in Acute Care Hospitals

Facility Type Risk Factors
• CDC Location
Acute Care Hospitals • Facility bed size*
• Medical school affiliation*
* Facility bed size and medical school affiliation are taken from the Annual Hospital Survey.
19 | P a g e
CAUTI – Catheter-Associated Urinary Tract Infection
The number of predicted CAUTIs is calculated using a negative binomial regression model (see page 8 above for
more information). Previously excluded inpatient locations from the original baseline are included in the SIR
under the 2015 baseline (e.g., Telemetry Ward, Mixed Acuity Ward). In cases when the number of predicted
events is less than 1.0, the SIR will not be calculated in NHSN.
The number of predicted CAUTIs calculated under the 2015 baseline is risk adjusted based on the following
variables found to be statistically significant predictors (risk adjustment updated July 2017):
Table 1. CAUTI in Acute Care Hospitals

Intercept -10.2667 0.1618 <0.0001
CDC Location Code: Burn Critical Care 3.3318 0.1580 <0.0001
CDC Location Code: Cardiac Critical Care 2.5703 0.1301 <0.0001
CDC Location Code: Medical Critical Care 2.3834 0.1250 <0.0001
CDC Location Code: Neurologic Critical Care and
3.3675 0.1285 <0.0001
Neurosurgical Critical Care
CDC Location Code: Surgical Critical Care 2.7034 0.1270 <0.0001
CDC Location Code: Trauma Critical Care 3.1104 0.1344 <0.0001
CDC Location Code: Other Critical Care
Medical/Surgical Critical Care 2.3661 0.1214 <0.0001
CDC Location Code: Oncology Critical Care/Step-down
Oncology Medical Critical Care
Oncology Medical/Surgical Critical Care
Surgical Oncology Critical Care 2.2171 0.2239 <0.0001
Pediatric Oncology Critical Care
Oncology Mixed Acuity Unit
Oncology Step-Down Unit
CDC Location Code: Pediatric Cardiothoracic Critical Care 2.0965 0.2322 <0.0001
CDC Location Code: Other Pediatric Critical Care
Pediatric Burn Critical Care
Pediatric Medical/Surgical Critical Care
Pediatric Medical Critical Care 2.6419 0.1461 <0.0001
Pediatric Neurosurgical Critical Care
Pediatric Surgical Critical Care
Pediatric Trauma Critical Care
CDC Location Code: Mixed Acuity
Adult Mixed Acuity Unit
2.3378 0.1416 <0.0001
Pediatric Mixed Acuity Unit
Mixed Age Mixed Acuity Unit
CDC Location Code: Adult Step-down Unit 2.4800 0.1235 <0.0001
20 | P a g e
Table 1, continued. CAUTI in Acute Care Hospitals
CDC Location Code: Pediatric Step-down Unit
Neonatal Step-down Nursery (Level II) 2.3616 0.5351 <0.0001
Pediatric Step-down Unit
CDC Location Code: Solid Organ Transplant
Solid Organ Transplant SCA 2.3900 0.1979 <0.0001
Pediatric Solid Organ Transplant SCA
CDC Location Code: Adult Burn Ward 2.4564 0.3396 <0.0001
CDC Location Code: Behavioral/Psychiatric Ward 3.2503 0.2207 <0.0001
CDC Location Code: Pulmonary Ward 2.5024 0.1664 <0.0001
CDC Location Code: Rehabilitation Ward (non-CMS) 3.3578 0.2700 <0.0001
CDC Location Code: Neurology and Stroke
Neurologic Ward
2.8223 0.1314 <0.0001
Neurosurgical Ward
Stroke Ward
CDC Location Code: Orthopedic Ward
Orthopedic Ward 1.9992 0.1300 <0.0001
CDC Location Code: Other Wards
Inpatient Dialysis SCA
Gerontology Ward
2.3576 0.1216 <0.0001
Jail Unit
Medical Ward
Telemetry Ward
CDC Location Code: Other Wards
Ear, Nose, Throat Ward
Gastroenterology Ward
Genitourinary Ward
2.2532 0.1210 <0.0001
Medical/Surgical Ward
Surgical Ward
CDC Location Code: Hematology
General Hematology/Oncology Ward 2.6125 0.1315 <0.0001
Hematopoietic Stem Cell Transplant Ward
CDC Location Code: Pediatric Oncology
Pediatric Hematology/Oncology Ward 2.7077 0.2915 <0.0001
Pediatric Hematopoietic Stem Cell Transplant Ward
CDC Location Code: Adult Oncology Wards
Leukemia Ward
Lymphoma Ward 2.2253 0.2001 <0.0001
Leukemia/Lymphoma Ward
Solid Tumor Ward
CDC Location Code: Pediatric Wards
Adolescent Behavioral Ward
Pediatric Behavioral Ward 1.8899 0.1712 <0.0001
Pediatric Burn Ward
Pediatric Medical/Surgical Ward
21 | P a g e
Table 1, continued. CAUTI in Acute Care Hospitals
Pediatric Medical Ward
Pediatric Neurosurgical Ward
Pediatric Neurologic Ward
See
Pediatric Orthopedic Ward See above See above
Pediatric Rehabilitation Ward (non-IRF)
above
Pediatric Surgical Ward
Well-baby Nursery
CDC Location Code: Chronic Care
Chronic Care Unit
Chronic Behavioral Health/Psychiatric Unit
2.7695 0.1855 <0.0001
Chronic Rehabilitation Unit
Inpatient Hospice
Ventilator Dependent Unit
CDC Location Code: Labor and Delivery, Gynecology
Antenatal Ward
Gynecology Ward
REFERENT - -
Labor and Delivery Ward
Labor, Delivery, Postpartum Ward
Postpartum Ward
Medical school affiliation*: Major 0.3744 0.0195 <0.0001
Medical school affiliation*: Graduate 0.1313 0.0220 <0.0001
Medical school affiliation*:Undergraduate/Non-teaching REFERENT - -
Facility bed size*: 87-214 beds 0.2871 0.0445 <0.0001
Facility type: (based on NHSN enrollment)
General Acute Care Hospital
Military Hospital
0.3927 0.1069 0.0002
Psychiatric Hospital
Oncology Hospital
Veterans' Affairs Hospital
Facility type: Children's Hospital 0.4888 0.1556 0.0017
Facility type: (based on NHSN enrollment)
Orthopedic Hospital
Surgical Hospital REFERENT - -
Women's Hospital
Women's and Children's Hospital
* Medical school affiliation and facility bed size are taken from the Annual Hospital Survey.
Table 2. CAUTI in Critical Access Hospitals (CAHs)

Intercept -7.3337 0.0970 <0.0001
Medical school affiliation*: Undergraduate 1.3191 0.4744 0.0054
Medical school affiliation*: Major/Graduate/Non- REFERENT - -
teaching
* Medical school affiliation is taken from the Annual Hospital Survey.
22 | P a g e
Table 3. CAUTI in Long-Term Acute Care Hospitals (LTACHs)
Intercept -6.8683 0.0773 <0.0001
Average length of stay*: ≥ 29.33 days 0.5379 0.0837 <0.0001
Average length of stay*: 26.42 – 29.32 days 0.2779 0.0876 0.0015
Average length of stay*: ≤ 26.41 days REFERENT - -
Setting**: Freestanding 0.1700 0.0716 0.0176
Setting**: Within a Hospital REFERENT - -
Location Type: ICU 0.3153 0.1072 0.0033
Location Type: Ward REFERENT - -
* Average length of stay is taken from the Annual LTACH Survey. It is calculated as: total # of annual patient days / total # of
annual admissions.
** LTACH Setting (free-standing vs. within a hospital) is taken from the Annual LTACH Survey.
Table 4. CAUTI in Inpatient Rehabilitation Facilities (IRFs): Free-standing Rehabilitation Hospitals and CMS-
Intercept -6.8305 0.0848 <0.0001
Setting*: Within a Hospital 0.2897 0.0841 0.0006
Setting*: Freestanding REFERENT - -
Proportion of admissions with traumatic and non- 0.3603 0.0832 <0.0001
traumatic spinal cord dysfunction**: ≥ 0.05
Proportion of admissions with traumatic and non- REFERENT - -
traumatic spinal cord dysfunction**: < 0.05
Proportion of admissions with stroke**: ≥ 0.24 0.2750 0.0798 0.0006
Proportion of admissions with stroke**: < 0.24 REFERENT - -
* IRF Setting is taken from the Annual IRF Survey and NHSN enrollment/location mapping data. “Within a hospital” includes
CMS-certified IRF units mapped as locations within a hospital, as well as Rehabilitation hospitals enrolled as unique facilities
in NHSN in which the facility indicated “healthcare facility-based” on their annual IRF survey.
** Proportion of annual admissions with primary diagnoses are taken from the Annual IRF Survey and are calculated as: #
of admissions with the primary diagnosis (stroke, or traumatic/non-traumatic spinal cord dysfunction) / total # of annual
admissions.
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VAE – Ventilator-Associated Events
A. Total VAE in Long-Term Acute Care Hospitals (LTACHs)
The number of predicted VAE events is calculated using a negative binomial regression model (see page 8 above
for more information). Separate VAE SIRs are available for “Total VAE” and “IVAC Plus”. The “Total VAE” SIR
includes events identified as ventilator-associated condition (VAC), infection-related ventilator-associated
complication (IVAC), and possible ventilator-associated pneumonia (pVAP). In cases when the number of
predicted events is less than 1.0, the SIR will not be calculated in NHSN.
The number of predicted “Total VAE” events calculated under the 2015 baseline is risk adjusted based on the
following variables found to be statistically significant predictors of Total VAE incidence:
Table 1. Total VAE in Long-Term Acute Care Hospitals (LTACHs)

Intercept -8.3689 0.3361 <0.0001
†
Facility bed size : ≥ 32 beds 0.4645 0.1562 0.0030
†
Facility bed size : < 32 beds REFERENT - -
Proportion of admissions on hemodialysis*: > 0.11 -0.4098 0.1190 0.0006
Proportion of admissions on hemodialysis*: ≤ 0.11 REFERENT - -
Proportion of admissions on ventilator*: > 0.18 0.9313 0.1813 <0.0001
Proportion of admissions on ventilator*: ≤ 0.18 REFERENT - -
Location type: ICU 0.4118 0.1598 0.0099
Location type: Ward REFERENT - -
Average length of stay**: ≥ 25 days 1.0940 0.2602 <0.0001
Average length of stay**: < 25 days REFERENT - -
† Facility bed size is taken from the Annual LTACH Survey.
* Proportion of annual admissions on a ventilator (or hemodialysis) is taken from the Annual LTACH Survey. It is calculated
as: number of admissions on a ventilator (or hemodialysis) / total # of annual admissions.
**Average length of stay is taken from the Annual LTACH Survey. It is calculated as: # annual patient days/ # annual
admissions.
B. Infection-related Ventilator-Associated Complication (IVAC) Plus in Long-Term

Acute Care Hospitals (LTACHs)
for more information). Separate VAE SIRs are available for “Total VAE” and “IVAC Plus”. The “IVAC Plus” SIR
includes events identified as IVAC and possible ventilator-associated pneumonia (pVAP). In cases when the
number of predicted events is less than 1.0, the SIR will not be calculated in NHSN.
The number of predicted “IVAC Plus” events calculated under the 2015 baseline is risk adjusted based on the
following variables found to be statistically significant predictors of “IVAC Plus” incidence:
24 | P a g e
Table 1. IVAC Plus in Long-Term Acute Care Hospitals
<
Intercept -9.9593 0.5891
0.0001
Facility bed size†: ≥ 32 beds 1.1201 0.3633 0.0020
Facility bed size†: < 32 beds REFERENT - -
Proportion of admissions on a ventilator*: > 0.18 0.7130 0.3151 0.0236
Proportion of admissions on a ventilator*: ≤ 0.18 REFERENT - -
Average length of stay**: ≥ 25 days 0.8166 0.4157 0.0495
Average length of stay**: < 25 days REFERENT - -
† Facility bed size is taken from the Annual LTACH Survey.
* Proportion of annual admissions on a ventilator is taken from the Annual LTACH Survey. It is calculated as: number of
admissions on a ventilator / total # of annual admissions.
** Average length of stay is taken from the Annual LTACH Survey. It is calculated as: total # of annual patient days / total #
of annual admissions.
C. Total VAE in Acute Care Hospitals (ACHs)

for more information). Separate VAE SIRs are available for “Total VAE” and “IVAC Plus”. The “Total VAE” SIR
includes events identified as Ventilator-Associated Condition (VAC), Infection-related Ventilator-Associated
Complication (IVAC), and Possible Ventilator-Associated Pneumonia (PVAP). In cases when the number of
predicted events is less than 1.0, the SIR will not be calculated in NHSN.
The number of predicted “Total VAE” events calculated under the 2015 baseline is risk adjusted based on the
following variables found to be statistically significant predictors of Total VAE incidence:
Table 1. Total VAE in Acute Care Hospitals (ACHs)

Parameter Standard
Parameter Estimate Error P-value
Intercept -6.8748 0.1407 <0.0001
CDC Location Code: Adult Critical Care Units,
Oncology Critical Care Units
Oncology Surgical Critical Care
Oncology Medical-Surgical Critical Care 0.5009 0.1810 0.0057
CDC Location Code: Surgical Cardiothoracic Critical

Care 0.9418 0.0862 <.0001
CDC Location Code: Medical-Surgical Critical Care 1.0161 0.0822 <.0001
25 | P a g e
Parameter Standard
CDC Location Code: Adult Critical Care Units
Burn Critical Care
Medical Critical Care 1.1140 0.0820 <.0001
Neurologic Critical Care
CDC Location Code: Adult Mixed Acuity Unit
1.3225 0.1296 <.0001
CDC Location Code: Trauma Critical Care

1.4320 0.0882 <.0001
CDC Location Code: Step-down Units
0.4096 0.1060 0.0001
Oncology Step-down Unit
CDC Location Code: Wards, Solid Organ Transplant

Specialty Care Area
Antenatal Care Ward
Behavioral Health/Psychology Ward
Burn Ward
Ear, Nose, Throat Ward
Genitourinary Ward
Gerontology Ward
Gynecology Ward
Jail Unit
Labor, Delivery, Recovery, Postpartum Suite
Medical Ward
Medical-Surgical Ward REFERENT - -
Neurology Ward
Neurosurgical Ward
Oncology Leukemia Ward
Oncology Lymphoma Ward
Oncology Leukemia/Lymphoma Ward
Oncology Solid Tumor Ward
Oncology Hematopoietic Stem Cell Transplant
Ward
Oncology General Hematology-Oncology Ward
Ophthalmology Ward
Orthopedic Ward
Postpartum Ward
26 | P a g e
Parameter Standard
Pulmonary Ward
Rehabilitation Ward (within Hospital)
School Infirmary
Stroke (Acute) Ward
Surgical Ward
Telemetry Ward
Solid Organ Transplant Specialty Care Area
Facility bed size*: 85-129 beds 0.1591 0.0787 0.0433

Facility bed size*: 130-425 beds 0.2513 0.0679 0.0002
Facility bed size*: 426-526 beds 0.5123 0.0716 <.0001
Facility bed size*: ≥ 527 beds 0.6471 0.0706 <.0001
Medical School Affiliation*: Major 0.2905 0.0239 <.0001
Medical School Affiliation*:
0.1395 0.0240 <0.0001
Graduate/Undergraduate
Medical School Affiliation*: Non-teaching REFERENT - -
Facility Type (based on NHSN enrollment): GEN-VA
General Acute Care Hospital 0.2154 0.0987 0.0290
Veterans’ Affairs Hospital
Facility Type (based on NHSN enrollment): Other
Military Hospital
Psychiatry Hospital
Oncology Hospital
Orthopedic Hospital
Surgical Hospital REFERENT - -
Women’s Hospital
Women’s and Children’s Hospital
* Facility bed size and medical school affiliation are taken from the Annual ACH Survey
Table 2. Summary of Risk Factors in the Total VAE Model for Other Facility Types
Critical Access Hospitals (CAH) Intercept-only model*
Inpatient Rehabilitation Facilities (IRF) No SIR available^
* None of the variables investigated were statistically significantly associated with Total VAE in CAHs. These facilities will
have the predicted number of events calculated using the 2015 national pooled mean (i.e., intercept-only model).
^ Insufficient data were reported to NHSN. Therefore, SIRs are not available for Total VAE in IRFs.
27 | P a g e
D. Infection-related Ventilator-Associated Complication (IVAC) Plus in Acute Care
Hospitals (ACHs)
for more information). Separate VAE SIRs are available for “Total VAE” and “IVAC Plus”. The “IVAC Plus” SIR
includes events identified as IVAC and Possible Ventilator-Associated Pneumonia (PVAP). In cases when the
number of predicted events is less than 1.0, the SIR will not be calculated in NHSN.
The number of predicted “IVAC Plus” events calculated under the 2015 baseline is risk adjusted based on the
following variables found to be statistically significant predictors of “IVAC Plus” incidence:
Table 1. IVAC Plus in Acute Care Hospitals (ACHs)

Parameter
Parameter Estimate Standard Error P-value
Intercept -7.4627 0.0925 < 0.0001
CDC Location Code: Adult Critical Care Units
Burn Critical Care
Neurologic Critical Care 1.1747 0.0922 <.0001
CDC Location Code: Adult Critical Care Units, Oncology
Critical Care Units
Medical Critical Care
Medical-Surgical Critical Care
0.9092 0.0889 <.0001
Oncology Surgical Critical Care
Oncology Medical-Surgical Critical Care
CDC Location Code: Trauma Critical Care

1.5429 0.0984 <.0001
CDC Location Code: Adult Mixed Acuity Unit
1.2291 0.1779 <.0001
CDC Location Code: Wards, Specialty Care Areas, Step-
down Units
Antenatal Care Ward
Behavioral Health/Psychology Ward
Burn Ward
Ear, Nose, Throat Ward REFERENT - -
Genitourinary Ward
Gerontology Ward
Gynecology Ward
Jail Unit
28 | P a g e
Parameter
Parameter Estimate Standard Error P-value
Labor, Delivery, Recovery, Postpartum Suite
Medical Ward
Medical-Surgical Ward
Neurology Ward
Neurosurgical Ward
Oncology Leukemia Ward
Oncology Lymphoma Ward
Oncology Leukemia/Lymphoma Ward
Oncology Solid Tumor Ward
Oncology Hematopoietic Stem Cell Transplant Ward
Oncology General Hematology-Oncology Ward
Ophthalmology Ward
Orthopedic Ward
Postpartum Ward
Pulmonary Ward
Rehabilitation Ward (within Hospital)
School Infirmary
Stroke (Acute) Ward
Surgical Ward
Telemetry Ward
Solid Organ Transplant Specialty Care Area
Oncology Step-down Unit
Facility bed size*: >=527 beds 0.5079 0.0385 <.0001
Medical School Affiliation*: Major 0.3157 0.0354 <.0001
Medical School Affiliation*: Graduate/Undergraduate 0.1630 0.0362 <.0001
Medical School Affiliation*: Non-teaching REFERENT - -
* Facility bed size and medical school affiliation are taken from the Annual ACH Survey
Table 2. Summary of Risk Factors in the IVAC Plus Model for Other Facility Types
Critical Access Hospitals (CAH) No SIR Available^
Inpatient Rehabilitation Facilities (IRF) No SIR Available^
^ Insufficient data were reported to NHSN. Therefore, SIRs are not available for ‘IVAC Plus’ in CAHs or IRFs.
29 | P a g e
SSI – Surgical Site Infections
The number of predicted SSI events is calculated using a logistic regression model (see page 5 above for more
information). The SSI SIR is calculated for facilities who enroll in NHSN as acute care hospitals or critical access
hospitals. Under the 2015 SIR baseline, procedures and associated SSI events occurring in adult and pediatric
patients are modeled separately. There are three SSI SIR models available for inpatient adult procedures (and
associated SSIs) and two models available for inpatient pediatric procedures (and associated SSIs). Please see
Table 1 below for a summary of the SSI SIR models. Under the 2015 SIR baseline, procedures, regardless of
closure methods, are included in the SIR calculation, as long as the inclusion criteria listed below are met and
none of the exclusion criteria apply.
Table 1. Summary of SSI Models
SSI SIR Model Inclusion Criteria Patient Population
All SSI SIR Model • Includes only inpatient procedures • Procedures in
• Includes Superficial, Deep & Organ/Space SSIs adult patients
• Superficial & Deep Incisional SSIs limited to primary • Procedures in
incisional SSIs only pediatric patients
• Includes SSIs identified on admission, readmission & via
post-discharge surveillance
Complex • Includes only inpatient procedures • Procedures in
Admission/Readmission • Includes only Deep Incisional Primary SSIs & Organ/Space adult patients
(A/R) SSI Model SSIs • Procedures in
• Includes only SSIs identified on Admission/Readmission pediatric patients
to facility where procedure was performed
• Used for the annual CDC publication of national
benchmarks
Complex 30-Day SSI • Includes only in-plan, inpatient COLO and HYST • Procedures in
model (used for CMS procedures in adult patients (i.e., ≥ 18 years of age) adult patients
IPPS) • Includes only Deep Incisional Primary SSIs and
Organ/Space SSIs with an event date within 30 days of
the procedure
• Includes SSIs regardless of detection method
• Used only for CMS IPPS reporting and for public reporting
on Hospital Compare
Exclusion Criteria
In addition to the above inclusion criteria, there is also a list of exclusion criteria that applies to all the SSI SIR
models. This list is often referred to as the universal exclusion criteria. The list of exclusion criteria applies to
both procedures and the associated SSI events. Often the reason for excluding procedures and SSI events from
the SIR calculation is due to potential data quality issues. It is important that facilities review their data for
quality assurance and to determine the reason for exclusion from the SIR calculation.
Note: When a procedure is excluded from the denominator, the associated SSI event is excluded from the
numerator.
30 | P a g e
Table 2. Universal Procedure/SSI Event Exclusions
General Exclusions
Gender= ‘Other’
Outpatient procedures and resulting SSIs
Present at time of surgery (PATOS) is ‘Yes’
SSIs that are reported as superficial incisional secondary (SIS) or deep incisional secondary (DIS)
Exclusions due to potential data quality issues or outliers
Age at the time of procedure is greater than 109 years
Closure technique is missing
ASA score is missing
Gender is missing
Adult patients ≥ 18 years: if BMI is less than 12 or greater than 60*
Pediatric patients < 18 years: if BMI less than 10.49 or greater than 65.79**
Procedure duration less than 5 minutes
Procedure duration is greater than IQR5 (please see Table 4 in the SSI Section for more information)
Facility-level Exclusions
Data from ambulatory surgery centers (ASCs) and long-term acute care hospitals (LTACHs)
Medical affiliation is missing or medical affiliation is ‘Y’ and medical type is missing (from Annual Facility
Survey)
Number of beds is missing (from Annual Facility Survey)
*This BMI exclusion applies to all procedures on adult patients in all 3 SSI models (All SSI, Complex A/R, Complex 30-Day).
**This BMI exclusion applies to all procedures on pediatric patients, in both applicable SSI models (All SSI and Complex
A/R). CDC Growth Charts are used to assess BMI in pediatric patients, calculated using height, weight, age, and gender.
Additional clarification on the BMI exclusion rule for pediatric procedures: Although there are BMI thresholds for
procedures performed on pediatric patients (10.49-65.79), there is an additional level of consideration made for the
biological plausibility of a given BMI using the patient’s age and gender. After applying the BMI outlier exclusion rule, we
review the BMIs for the remaining pediatric procedures to determine if they are biologically plausible based on the
patient’s age and gender. So essentially, we take age and gender into consideration along with the calculated BMI. Only
procedures in which the patient’s BMI meets the inclusion rule (10.49-65.79), and in which the patient’s BMI is biologically
plausible based on age and gender, are included in the SIR. The determination of biologically plausible BMIs is made using
the macro available at this site: https://www.cdc.gov/nccdphp/dnpao/growthcharts/resources/sas.htm.
Predictive Risk Factors by SSI Models

The number of predicted events calculated under the 2015 baseline for SSI is risk adjusted based on the
following variables found to be statistically significant predictors of SSIs. The following tables (3a-3f) list the
factors included in each procedure-specific model, grouped by the three SSI models outlined above. In some
procedure-specific models, the interaction of age and gender is considered as a single factor. It is listed as age-
gender interaction. In cases when the number of predicted events is less than 1.0, the SIR will not be calculated
in NHSN.
Note: Parameter estimates are shown for colon (COLO) and abdominal hysterectomy (HYST) procedures under
the Complex 30-Day Model used for CMS Hospital Inpatient Quality Reporting Program. Full model details for all
procedures under the All SSI Model and the Complex A/R Model will be available in future resources.
31 | P a g e
Table 3a. Colon Procedures, Complex 30-Day Model
Intercept -3.6601 0.0678 <0.0001
Diabetes: Yes 0.0821 0.0303 0.0066
Diabetes: No REFERENT - -
ASA score: 1, 2, 3/4/5 0.3028 0.0237 <0.0001
Gender: Male 0.1036 0.0225 <0.0001
Gender: Female REFERENT - -
Age (Patient’s age/10) -0.1396 0.0075 <0.0001
BMI: ≥ 30 0.1259 0.0234 <0.0001
BMI: < 30 REFERENT - -
Closure technique: Other (non-Primary) 0.2383 0.0494 <0.0001
Closure technique: Primary REFERENT - -
Oncology Hospital: Yes 0.5437 0.0937 <0.0001
Oncology Hospital: No REFERENT - -
Table 3b. Abdominal Hysterectomy Procedures, Complex 30-Day Model

Intercept -5.1801 0.1057 < 0.0001
Diabetes: Yes 0.3247 0.0605 <0.0001
Diabetes: No REFERENT - -
ASA score: 1, 2, 3, 4/5 0.4414 0.0350 <0.0001
BMI: ≥ 30 0.1106 0.0423 0.0090
BMI: < 30 REFERENT - -
Age (Patient’s age/10) -0.1501 0.0180 <0.0001
Oncology Hospital: Yes 0.5474 0.1578 0.0005
Oncology Hospital: No REFERENT - -
Table 3c. Predictive Risk Factors from the All SSI Logistic Regression Model, Adults ≥ 18 years of age
NHSN Operative Procedure Risk Factor(s)-All SSI Model, Adults
AAA procedure duration
AMP anesthesia, wound class, hospital bed size*, age, procedure duration
APPY gender, wound class, hospital bed size*, closure, procedure duration, BMI
AVSD procedure duration
BILI gender, emergency, trauma, wound class, hospital bed size*, scope, age,
procedure duration
BRST ASA score, age, procedure duration, BMI
CARD emergency, medical school affiliation*, age, procedure duration, BMI
CABG gender, diabetes, trauma, medical school affiliation*, hospital bed size*, age,
procedure duration, BMI, age-gender interaction
32 | P a g e
Table 3c, Continued
NHSN Operative Procedure Risk Factor(s)-All SSI Model, Adults
CEA diabetes, wound class
CHOL diabetes, ASA score, wound class, scope, age, procedure duration
COLO diabetes, trauma, anesthesia, ASA score, wound class, medical school
affiliation*, hospital bed size*, scope, closure technique, age, procedure
duration, BMI
CRAN trauma, ASA score, age, procedure duration, BMI, wound class
CSEC diabetes, emergency, anesthesia, ASA score, wound class, medical school
affiliation*, hospital bed size*, age, procedure duration, BMI, duration of labor
FUSN gender, diabetes, emergency, trauma, ASA score, hospital bed size*,
procedure duration, BMI, spinal level, approach, medical school affiliation*
FX gender, diabetes, ASA score, wound class, closure technique, age, procedure
duration, BMI
GAST ASA score, wound class, scope, age, procedure duration, BMI
HER gender, ASA score, wound class, medical school affiliation*, hospital bed size*,
scope, age, procedure duration, BMI
HPRO diabetes, trauma, anesthesia, ASA score, wound class, hospital bed size*, age,
procedure duration, BMI, procedure type
HTP closure technique
HYST diabetes, ASA score, medical school affiliation*, hospital bed size*, scope, age,
procedure duration, BMI, oncology
KPRO gender, anesthesia, ASA score, wound class, medical school affiliation*, age,
procedure duration, BMI, procedure type
KTP wound class, age, procedure duration
LAM diabetes, ASA score, hospital bed size*, BMI, age
LTP age
NECK procedure duration
NEPH oncology
OVRY age, BMI, diabetes, medical school affiliation*, scope, wound class
PACE age
PRST medical school affiliation*, number of beds
PVBY BMI, diabetes, procedure duration, medical school affiliation*, wound class
REC ASA score, anesthesia, procedure duration, gender
RFUSN age, BMI, procedure duration, hospital bed size*
SB ASA score, emergency, trauma, medical school affiliation*, oncology
SPLE ASA score
THOR ASA score, procedure duration, oncology
THYR Intercept-only model‡
VHYS ASA score, medical school affiliation*, age, procedure duration, BMI
VSHN age
XLAP anesthesia, ASA score, procedure duration, emergency, gender, oncology,
scope
33 | P a g e
Table 3c Footnotes:
* These risk factors are taken from the Annual Facility Survey.
‡ None of the variables investigated were statistically significantly associated with SSI risk in these procedure categories. As
a result, the overall pooled mean will be used in the SIR calculation (i.e., intercept-only model).
Table 3d. Predictive Risk Factors from the Complex A/R SSI Logistic Regression, Adults ≥ 18 years of age
NHSN Operative Procedure Risk Factor(s) - Complex A/R SSI Model, Adults
AAA Intercept-only model‡
AMP anesthesia, wound class, hospital bed size*, age
APPY gender, wound class, hospital bed size*, procedure duration
AVSD Intercept-only model‡
BILI gender, emergency, trauma, hospital bed size*, scope, age, procedure duration
BRST ASA score, closure technique, age, duration, BMI
CARD emergency, medical school affiliation*, age, procedure duration, BMI
CABG gender, diabetes, ASA score, trauma, wound class, medical school affiliation*,
hospital bed size*, age, procedure duration, BMI, age-gender interaction
CEA wound class
CHOL gender, diabetes, ASA score, wound class, hospital bed size*, age, procedure
duration, age-gender interaction
COLO gender, diabetes, trauma, anesthesia, ASA score, wound class, hospital bed
size*, scope, closure technique, age, procedure duration, BMI
CRAN diabetes, trauma, ASA score, age, duration, wound class
CSEC emergency, ASA score, wound class, medical school affiliation*, hospital bed
size*, age, procedure duration, duration of labor
FUSN gender, diabetes, trauma, ASA score, medical school affiliation*, hospital bed
size*, procedure duration, BMI, spinal level, approach
FX gender, diabetes, ASA, wound class, closure, age, procedure duration, BMI
GAST wound class, scope, age, procedure duration, BMI
HER gender, ASA score, wound class, medical school affiliation*, hospital bed size*,
scope, age, procedure duration, BMI
HPRO diabetes, trauma, anesthesia, ASA score, wound class, medical school
affiliation*, hospital bed size*, age, procedure duration, BMI, procedure type
HTP Closure technique
HYST diabetes, ASA score, hospital bed size*, scope, age, procedure duration, BMI
KPRO gender, trauma, anesthesia, ASA score, wound class, medical school affiliation*,
hospital bed size*, age, procedure duration, BMI, procedure type
KTP procedure duration, diabetes, ASA score, hospital bed size*, BMI
LAM diabetes, ASA score, hospital bed size*, BMI
LTP age
NECK procedure duration
NEPH Intercept-only model‡
OVRY wound class
PACE age
PRST Intercept-only model‡
34 | P a g e
Table 3d, Continued
NHSN Operative Procedure Risk Factor(s) - Complex A/R SSI Model, Adults
PVBY BMI, diabetes, procedure duration, number of beds
REC ASA score, procedure duration, number of beds, oncology
RFUSN age, procedure duration, number of beds
SB gender, age, procedure duration, oncology
SPLE ASA score
THOR procedure duration, medical school affiliation*
VHYS medical school affiliation*
VSHN age
XLAP ASA score, closure technique, diabetes, procedure duration, emergency,
gender, scope, wound class, trauma
Table 3e. Predictive Risk Factors from the All SSI Logistic Regression Model, Pediatrics < 18 years of age
NHSN Operative Procedure Risk Factor(s) - All SSI SIR Model, Pediatrics
AAA Intercept-only model‡
AMP No SIR available^
APPY emergency, wound class, age, procedure duration
AVSD No SIR available^
BILI trauma
BRST No SIR available^
CARD, age ≥ 2 ASA score, BMI, age, diabetes, scope
CARD, age < 2 emergency, medical school affiliation*, procedure duration
CABG No SIR available^
CEA No SIR available^
CHOL Intercept-only model‡
COLO ASA score, medical school affiliation*, age, procedure duration, closure
technique, wound class
CRAN Intercept-only model‡
CSEC duration of labor
FUSN, age ≥ 2 ASA score, age, BMI, spinal level
FUSN, age < 2 No SIR available^
FX procedure duration, closure technique
GAST Intercept-only model‡
HER Intercept-only model‡
HPRO Intercept-only model‡
HTP No SIR available^
HYST hospital bed size*, procedure duration
35 | P a g e
Table 3e, Continued
KPRO Intercept-only model‡
KTP Intercept-only model‡
LAM age, procedure duration
LTP Intercept-only model‡
NECK No SIR available^
NEPH No SIR available^
OVRY Intercept-only model‡
PACE Intercept-only model‡
PRST No SIR available^
PVBY No SIR available^
REC Intercept-only model‡
RFUSN Intercept-only model‡
SB, age ≥ 2 BMI
SB, age < 2 scope, wound class
SPLE Intercept-only model‡
THOR age, trauma
THYR No SIR available^
VHYS No SIR available^
VSHN Intercept-only model‡
XLAP Intercept-only model‡
^ Insufficient data (i.e., < 50 procedures) were reported to NHSN. Therefore, SIRs are not available for these procedures.
Table 3f. Predictive Risk Factors from the Complex A/R SSI Logistic Regression, Pediatrics < 18 years of age
NHSN Operative Procedure Risk Factor(s) - Complex A/R SSI Model, Pediatrics
AAA No SIR available^
AMP No SIR available^
APPY hospital bed size*, procedure duration, wound class
AVSD No SIR available^
BILI trauma
BRST No SIR available^
CARD procedure duration, age
CABG No SIR available^
CEA No SIR available^
CHOL Intercept-only model‡
COLO Closure technique, wound class, age, trauma, procedure duration
CRAN, age > 2 BMI, anesthesia
36 | P a g e
Table 3f, Continued
NHSN Operative Procedure Risk Factor(s) - Complex A/R SSI Model, Pediatrics
CRAN, age < 2 Intercept-only model‡
CSEC duration of labor
FUSN, age > 2 ASA score, BMI
FUSN, age < 2 No SIR available^
FX procedure duration, closure technique
GAST No SIR available^
HER Intercept-only model‡
HPRO Intercept-only model‡
HTP No SIR available^
HYST Intercept-only model‡
KTP Intercept-only model‡
LAM Intercept-only model‡
LTP Intercept-only model‡
NECK No SIR available^
NEPH No SIR available^
OVRY No SIR available^
PACE No SIR available^
PRST No SIR available^
PVBY No SIR available^
REC Intercept-only model‡
RFUSN Intercept-only model‡
SB diabetes, wound class
SPLE No SIR available^
THOR trauma
THYR No SIR available^
VHYS No SIR available^
VSHN age
XLAP trauma
^ Insufficient data (i.e., < 50 procedures) were reported to NHSN. Therefore, SIRs are not available for these procedures.
37 | P a g e
Procedure Duration Outliers
The IQR5, also called the procedure duration cutoff point, is used as an indicator of an extreme outlier for
procedure durations when calculating the SSI SIRs. The IQR5 is calculated as five times the interquartile range
(Q1-Q3) above the 75th percentile. For example, if the interquartile range is 30 minutes, and the 75th percentile
is 100 minutes, the IQR5 would be calculated as: 100 + (30*5) = 250 minutes. Procedures with a duration greater
than the IQR5 were excluded from the baseline data and will be excluded from all SSI SIR calculations for your
facility.
Table 4. IQR5 Values, in Minutes, for NHSN Operative Procedures, Adult and Pediatric Patients
NHSN Operative Procedure IQR5 (in minutes) IQR5 (in hours and minutes)
Minutes Hours Minutes
AAA 1116 18 36
AMP 300 5 0
APPY 210 3 30
AVSD 471.5 7 51.5
BILI 1295 21 35
BRST 777 12 57
CARD 1001 16 41
CBGB 847 14 7
CBGC 847 14 7
CEA 376 6 16
CHOL 346 5 46
COLO 697 11 37
CRAN 904 15 4
CSEC 170 2 50
FUSN 874 14 34
FX 532 8 52
GAST 489 8 9
HER 521 8 41
HPRO 349 5 49
HTP 1355 22 35
HYST 547 9 7
KPRO 316 5 16
KTP 670 11 10
LAM 687 11 27
LTP 1243 20 43
NECK 1796 29 56
NEPH 774 12 54
OVRY 594 9 56
PACE 311 5 11
PRST 737 12 17
PVBY 850 14 10
REC 1136 18 56
RFUSN 1129 18 49
SB 856 14 16
SPLE 1073 17 53
38 | P a g e
THOR 721 12 1
THYR 506 8 26
VHYS 506 8 26
VSHN 378 6 18
XLAP 724 12 4
39 | P a g e
Methicillin-resistant Staphylococcus aureus (MRSA) Bacteremia Laboratory-Identified
Events
The number of predicted MRSA bacteremia LabID events is calculated using a negative binomial regression
model (see page 8 above for more information). For most settings, the MRSA bacteremia SIR is only calculated
on the facility-wide inpatient, or FacWideIN, level, and cannot be calculated for any individual location (note:
CMS-designated inpatient rehabilitation units within a hospital will receive a separate SIR). In cases when the
number of predicted events is less than 1.0, the SIR will not be calculated in NHSN. The SIRs for MRSA
bacteremia include only healthcare facility-onset (HO), non-duplicate MRSA blood LabID events in the
numerator. Information on which events are counted in the numerator of the MRSA bacteremia SIR can be
found here: http://www.cdc.gov/nhsn/pdfs/ps-analysis-resources/mrsacdi_tips.pdf.
The number of predicted events calculated under the 2015 baseline for MRSA bacteremia is risk adjusted based
on the following variables found to be statistically significant predictors of MRSA bacteremia incidence:
Notes for Acute Care Hospitals: MRSA LabID SIRs for acute care hospitals can only be calculated at the quarter-
level or higher. This is because two of the risk factors involving the community-onset prevalence rate require that
all community-onset data have been entered for an entire quarter. The quarter’s community-onset prevalence
rates, both inpatient and outpatient, are used to calculate the number of predicted events for the SIR.
Table 1. MRSA Bacteremia in Acute Care Hospitals

Intercept -11.3759 0.1167 <0.0001
Inpatient community-onset prevalence rate*: > 0.037 per
0.3650 0.0286 <0.0001
100 admissions
Inpatient community-onset prevalence rate*: ≤ 0.037 per
REFERENT - -
100 admissions
Average length of stay**: ≥ 5.1 days 0.2787 0.0343 <0.0001
Average length of stay**: 4.3-5.0 days 0.0955 0.0341 0.0050
Average length of stay**: 0-4.2 days REFERENT - -
Medical school affiliation‡: Major 0.2585 0.0334 <0.0001
Medical school affiliation‡: Graduate/undergraduate 0.1166 0.0345 0.0007
Medical school affiliation‡: Non-teaching REFERENT - -
Facility type: Oncology Hospital (HOSP-ONC) 1.1894 0.2085 <0.0001
Facility type: General Acute Care Hospital (HOSP-GEN) 0.4355 0.0897 <0.0001
Facility type: Other Specialty Hospital REFERENT - -
Number of ICU beds‡: ≥ 45 0.5650 0.0898 <0.0001
Number of ICU beds‡: 21-44 0.4599 0.0899 <0.0001
Number of ICU beds‡: 11-20 0.3394 0.0922 0.0002
Number of ICU beds‡: 0-6 REFERENT - -
40 | P a g e
Table 1, continued. MRSA Bacteremia in Acute Care Hospitals
Outpatient community-onset prevalence rate ED/24-hour
0.3476 0.0336 <0.0001
Observation Unit^: > 0.032 per 100 encounters
0.1048 0.0330 0.0015
Observation Unit^: > 0 and ≤ 0.032 per 100 encounters
Observation Unit^: 0 per 100 encounters, or no applicable REFERENT - -
locations
* Inpatient community-onset prevalence is calculated as the # of inpatient community-onset MRSA blood events, divided by
total admissions x 100. (i.e., MRSA_admPrevBldCount /numadms * 100).
** Average length of stay is taken from the Annual Hospital Survey. It is calculated as: total # of annual patient days / total #
of annual admissions.
‡ Medical school affiliation and number of ICU beds are taken from the Annual Hospital Survey.
^ Emergency department (ED)/24-hour observation unit prevalence rate combines MRSA bacteremia data from all EDs
and/or 24-hour observation units into a single, de-duplicated prevalence rate. This rate is calculated as the # of unique
community-onset MRSA blood events that occurred in an ED or 24-hour observation unit / total encounters * 100. (i.e.,
MRSA_EDOBSprevCount / numTotencounters * 100). NOTE: If you do not have an ED or 24-hour observation location that
meets the NHSN location definition and thus are not reporting MRSA bacteremia data from these locations, the number of
predicted events will be risk adjusted using the referent level of this variable.
Table 2. MRSA Bacteremia in Critical Access Hospitals (CAHs)

Intercept* -10.7795 0.2025 <0.0001
* MRSA LabID SIRs for CAHs can be calculated for any aggregate of time (month, quarter, half-year, or year). None of the
variables investigated were statistically significantly associated with healthcare facility-onset MRSA bacteremia in CAHs. The
predicted number of events for CAHs will be calculated using the 2015 national CAH MRSA bacteremia pooled mean (i.e.,
intercept-only model).
Table 3. MRSA Bacteremia in Long-Term Acute Care Hospitals (LTACHs)

Intercept* -9.3095 0.0936 <0.0001
Percent of admissions on ventilator** 0.0160 0.0027 <0.0001
* MRSA LabID SIRs for LTACHs can be calculated for any aggregate of time (month, quarter, half-year, or year).
** Percent of annual admissions on a ventilator is taken from the Annual LTACH Survey. It is calculated as: # admissions on
a ventilator / total # of annual admissions x 100 (i.e., numAdmvent /numAdmitsSurv * 100).
Table 4. MRSA Bacteremia in Inpatient Rehabilitation Hospitals (IRFs): Free-standing Rehabilitation Hospitals
and CMS-Certified IRF Units Within a Hospital
Intercept* -10.8703 0.0890 <0.0001
* MRSA LabID SIRs for IRFs can be calculated for any aggregate of time (month, quarter, half-year, or year). None of the
variables investigated were statistically significantly associated with healthcare facility-onset MRSA bacteremia in IRFs.
Free-standing IRFs and CMS-certified IRF units within a hospital will have the predicted number of events calculated using
the 2015 national IRF MRSA bacteremia pooled mean (i.e., intercept-only model).
41 | P a g e
Clostridioides difficile (CDI) Laboratory-Identified Events

The number of predicted CDI LabID events is calculated using a negative binomial regression model (see page 8
above for more information). For most settings, the CDI SIR is only calculated on the facility-wide inpatient, or
FacWideIN, level, and cannot be calculated for any individual location (note: CMS-designated inpatient
rehabilitation units within a hospital will receive a separate SIR). In cases when the number of predicted events
is less than 1.0, the SIR will not be calculated in NHSN. The FacWideIN SIRs for CDI include only incident,
healthcare facility-onset (HO), non-duplicate C. difficile LabID events in the numerator. Information on which
events are counted in the numerator of the FacWideIN and IRF Unit CDI SIR can be found here:
http://www.cdc.gov/nhsn/pdfs/ps-analysis-resources/mrsacdi_tips.pdf.
For all facility types, the CDI LabID SIR can only be calculated at the quarter-level or higher. Monthly SIRs cannot
be calculated due to certain risk factors used in each of the models that require complete data entry for a
quarter (e.g., CDI test type is reported on the FacWideIN and IRF unit’s MDRO denominator form on the 3rd
month of each quarter).
The number of predicted events calculated under the 2015 baseline for CDI is risk adjusted based on the
following variables found to be statistically significant predictors of CDI incidence:
Table 1. CDI in Acute Care Hospitals

Intercept -8.9463 0.0523 <0.0001
Inpatient community-onset prevalence rate* 0.7339 0.0181 <0.0001
+
CDI test type : EIA -0.1579 0.0246 <0.0001
+
CDI test type : NAAT 0.1307 0.0219 <0.0001
+
CDI test type : OTHER REFERENT - -
‡
Medical school affiliation : Major, graduate, or
undergraduate 0.0331 0.0111 0.0028
‡
Medical school affiliation : Non-teaching REFERENT - -
‡
Number of ICU beds : ≥ 43 0.7465 0.0412 <0.0001
‡
Number of ICU beds : 20- 42 0.7145 0.0395 <0.0001
‡
Number of ICU beds : 5-9 0.4394 0.0420 <0.0001
‡
Number of ICU beds : 0-4 REFERENT - -
Facility type: Oncology Hospital (HOSP-ONC) 1.2420 0.0765 <0.0001
Facility type: General Acute Care Hospital (HOSP-GEN) 0.3740 0.0342 <0.0001
Facility type: Other Specialty Hospital REFERENT - -
Facility bed size ‡
0.0003 0.0000 <0.0001
^
Reporting from ED or 24-hour observation unit : YES 0.1119 0.0179 <0.0001
Reporting from ED or 24-hour observation unit^: NO REFERENT - -
* Inpatient community-onset (CO) prevalence is calculated as the # of inpatient CO CDI events, divided by total admissions x
100 (i.e., cdif_admPrevCOCount /numCdifadms * 100). The prevalence rate for an entire quarter is used in the risk
42 | P a g e
Table 1 Footnotes continued:
adjustment. An SIR cannot be calculated for any quarter that has an outlier inpatient CO prevalence rate, defined as greater
than 2.6 CO events per 100 admissions.
+ CDI test type is reported on the FacWideIN MDRO denominator form on the 3rd month of each quarter.
-Starting in 2018 Q1, CDI test type is categorized as:

Nucleic acid amplification test (NAAT): This includes NAAT, GDH + NAAT, and GDH + EIA + NAAT.
Enzyme immunoassay (EIA) for toxin: This includes EIA for toxin, GDH antigen + EIA for toxin, and NAAT + EIA
Other: This includes all other CDI test types, including the selection of “Other” and associated free-text entry.
-Prior to 2018 Q1, CDI test type was categorized as: (refer to 2018 NHSN protocol changes for details)
Nucleic acid amplification test (NAAT): This includes NAAT, GDH + NAAT, GDH + EIA + NAAT, and NAAT + EIA.
Enzyme immunoassay (EIA) for toxin: This includes EIA for toxin, and GDH antigen + EIA for toxin.
‡ Medical school affiliation, number of ICU beds, and facility bed size are taken from the Annual Hospital Survey.
^ If your facility has a designated Emergency Department (ED) or 24-hour observation location meeting the standard NHSN
definitions, these locations should be mapped, included in your facility’s monthly reporting plan for LabID events, and have
appropriate outpatient LabID data reported to NHSN. If you do not have an ED or 24-hour observation location and thus are
not reporting CDI data from these locations, your hospital’s # predicted events will be risk adjusted using the referent value
for this variable.
Table 2. CDI in Critical Access Hospitals (CAHs)

Intercept -8.4180 0.0879 <0.0001
Inpatient community-onset prevalence rate*: > 0 0.7207 0.1108 <0.0001
Inpatient community-onset prevalence rate*: 0 REFERENT - -
* Inpatient community-onset (CO) prevalence rate is calculated as: # of inpatient CO CDI events, divided by total admissions
x 100. (i.e., cdif_admPrevCOCount / numCdifadms * 100). The prevalence rate for an entire quarter is used in the risk
adjustment.
Table 3. CDI in Long-Term Acute Care Hospitals (LTACHs)

Intercept -7.3345 0.0507 <0.0001
Inpatient community-onset prevalence rate*: > 0 0.3683 0.0493 <0.0001
Inpatient community-onset prevalence rate*: 0 REFERENT - -
Percent of admissions on a ventilator‡: ≥ 27.1% 0.3116 0.0478 <0.0001
Percent of admissions on a ventilator‡: ≥ 18% to < 27.1% 0.1463 0.0590 0.0131
Percent of admissions on a ventilator‡: < 18% REFERENT - -
CDI test type^: NAAT or OTHER 0.1607 0.0444 0.0003
CDI test type^: EIA REFERENT - -
Percent of single occupancy rooms+: ≤ 77% 0.0963 0.0425 0.0235
Percent of single occupancy rooms+: >77% REFERENT - -
* Inpatient community-onset prevalence is calculated as the # of inpatient community-onset CDI events, divided by total
admissions * 100. (i.e., cdif_admPrevCOCount / numCdifadms * 100). The prevalence rate for an entire quarter is used in
the risk adjustment.
‡ Percent of annual admissions on a ventilator is taken from the Annual LTACH Survey. It is calculated as: # admissions on a
ventilator / total # annual admissions x 100. (i.e., numAdmVent / numAdmitsSurv * 100).
43 | P a g e
Table 3 Footnotes continued:
^ CDI test type is reported on the FacWideIN MDRO denominator form on the 3 rd month of each quarter.
-Starting in 2018 Q1, CDI test type is categorized as:
Nucleic acid amplification test (NAAT) or Other: This includes NAAT, GDH + NAAT, GDH + EIA + NAAT, and all other
(non-EIA) CDI test types, including the selection of “Other” and associated free-text entry.
Enzyme immunoassay (EIA) for toxin: This includes EIA for toxin, GDH antigen + EIA for toxin, and NAAT + EIA.
Nucleic acid amplification test (NAAT) or Other: This includes NAAT, GDH + NAAT, GDH + EIA + NAAT, NAAT + EIA,
and all other (non-EIA) CDI test types, including the selection of “Other” and associated free-text entry.
+
Percent of beds located in single occupancy rooms is taken from the Annual LTACH Survey. It is calculated as: # of single
occupancy rooms / total number of beds x 100. (i.e., numSingOccRm / numbeds * 100).
Table 4. CDI in Inpatient Rehabilitation Facilities (IRFs): Free-standing Rehabilitation Hospitals and CMS-
Intercept -8.4475 0.0689 <0.0001
CDI test type^: NAAT 0.2921 0.0534 <0.0001
CDI test type^: OTHER 0.2163 0.0747 0.0038
^
CDI test type : EIA REFERENT - -
CMS-certified IRF Unit within a hospital 0.2188 0.0495 <0.0001
Free-standing HOSP-REHAB with reported community-
onset CDI events 0.4168 0.0803 <0.0001
Free-standing HOSP-REHAB with zero reported
community-onset CDI events REFERENT - -
Percent of admissions with orthopedic conditions*:
≤ 23.9% 0.2015 0.0427 <0.0001
Percent of admissions with orthopedic conditions*:
> 23.9% REFERENT - -
Percent of admissions with traumatic and non-traumatic
spinal cord dysfunction*: > 5.2% 0.1657 0.0437 0.0002
Percent of admissions with traumatic and non-traumatic
spinal cord dysfunction*: ≤ 5.2% REFERENT - -
Percent of admissions with stroke*: ≤ 23.8% 0.1965 0.0444 <0.0001
Percent of admissions with stroke*: > 23.8% REFERENT - -
^ CDI test type is reported on the FacWideIN or IRF Unit’s MDRO denominator form on the 3rd month of each quarter.
-Starting with 2018 Q1, CDI test type is categorized as:
Nucleic acid amplification test (NAAT): This includes NAAT, GDH + NAAT, and GDH + EIA + NAAT.
Enzyme immunoassay (EIA) for toxin: This includes EIA for toxin, GDH antigen + EIA for toxin, and NAAT + EIA.
Nucleic acid amplification test (NAAT): This includes NAAT, GDH + NAAT, GDH + EIA + NAAT, and NAAT + EIA.
^ Percent of annual admissions with primary diagnoses are taken from the Annual IRF Survey, and calculated as the # of
admissions with the primary diagnosis / total # of annual admissions x 100.
44 | P a g e
Using an Intercept-Only Model to Calculate the Number of Predicted Events
Example: MRSA Bacteremia LabID Event
Several regression models from the 2015 national baseline are “intercept-only models”. For example, none of
the investigated variables were found to have a significant association with the incidence of healthcare facility-
onset (HO) MRSA bacteremia in critical access hospitals or inpatient rehabilitation facilities. Therefore, the
number of predicted events is calculated by applying the following intercept-only formula:
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑃𝑟𝑒𝑑𝑖𝑐𝑡𝑒𝑑 𝐸𝑣𝑒𝑛𝑡𝑠 = exp(𝐼𝑛𝑡𝑒𝑟𝑐𝑒𝑝𝑡 𝑉𝑎𝑙𝑢𝑒) 𝑥 𝑃𝑎𝑡𝑖𝑒𝑛𝑡 𝐷𝑎𝑦𝑠
Let’s say a critical access hospital had 1,400 total patient days during a select time period. The number of
predicted events would be calculated as:
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑃𝑟𝑒𝑑𝑖𝑐𝑡𝑒𝑑 𝐸𝑣𝑒𝑛𝑡𝑠 = exp(−10.7795) 𝑥 1400
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑃𝑟𝑒𝑑𝑖𝑐𝑡𝑒𝑑 𝐸𝑣𝑒𝑛𝑡𝑠 = 0.029
Because the number of predicted events is less than 1.0, an SIR will not be calculated for this facility and time
period in NHSN.
45 | P a g e
Additional Resources
➢ Information about Transitioning to 2015 SIR Baselines:
NHSN Rebaseline webpage: https://www.cdc.gov/nhsn/2015rebaseline/
Introduction to the NHSN Re-baseline – March 2017

https://www.cdc.gov/nhsn/pdfs/training/2017/Dudeck_March21.pdf
The NHSN Re-Baseline: In Depth – March 2017

https://www.cdc.gov/nhsn/pdfs/training/2017/Dudeck_March22.pdf
➢ Original SIR Baselines for Acute Care Hospitals:
CLABSI (original baseline = 2006-2008): https://www.cdc.gov/nhsn/PDFs/dataStat/2009NHSNReport.pdf
CAUTI (original baseline = 2009): https://www.cdc.gov/nhsn/PDFs/NHSNReport_DataSummaryfor2009.pdf
SSI (original baseline = 2006-2008): https://www.cdc.gov/nhsn/PDFs/pscManual/SSI_ModelPaper.pdf
MRSA bacteremia and CDI LabID event (original baseline= 2010-2011):

https://www.cdc.gov/nhsn/pdfs/mrsa-cdi/riskadjustment-mrsa-cdi.pdf
December 2010 Special Edition NHSN Newsletter - Introduction to SIR (original baseline):
https://www.cdc.gov/nhsn/pdfs/newsletters/nhsn_nl_oct_2010se_final.pdf
➢ Original SIR Baselines for Long-term Acute Care Hospitals (LTACHs) and Inpatient
Rehabilitation Facilities (IRFs):
CLABSI/CAUTI in LTACHs, and CAUTI in IRFs (original baseline = 2013):

https://www.cdc.gov/nhsn/xls/reportdatatables/nhsn-2013-report.xlsx
➢ NHSN Analysis Trainings & Other Resources:
Analysis Resources, Trainings, and NHSN Data Dictionary:

https://www.cdc.gov/nhsn/ps-analysis-resources/index.html
Targeted Assessment for Prevention (TAP) General Information: https://www.cdc.gov/hai/prevent/tap.html
Quick Reference Guides: How to run and interpret NHSN reports (including SIR and TAP reports):
https://www.cdc.gov/nhsn/ps-analysis-resources/reference-guides.html
Troubleshooting CLABSI and CAUTI SIRs:

https://www.cdc.gov/nhsn/pdfs/ps-analysis-resources/clabsicauti_sirtroubleshooting.pdf
46 | P a g e
Troubleshooting SSI SIRs: https://www.cdc.gov/nhsn/pdfs/ps-analysis-resources/ssi-sir_tips.pdf
Troubleshooting MRSA and CDI LabID Event SIRs:

https://www.cdc.gov/nhsn/pdfs/ps-analysis-resources/mrsacdi_tips.pdf
Information related to SIRs used for the Centers for Medicare and Medicaid Services (CMS) Quality Reporting
Programs: https://www.cdc.gov/nhsn/cms/index.html
NHSN Annual Hospital Survey: https://www.cdc.gov/nhsn/forms/57.103_pshospsurv_blank.pdf

• Instructions for NHSN Annual Hospital Survey: https://www.cdc.gov/nhsn/forms/instr/57_103-toi.pdf
NHSN Annual LTACH Survey: https://www.cdc.gov/nhsn/forms/57.150_ltacfacsurv_blank.pdf

• Instructions for NHSN Annual LTACH Survey: https://www.cdc.gov/nhsn/forms/instr/toi-57.150-ltac.pdf
NHSN Annual IRF Survey: https://www.cdc.gov/nhsn/forms/57.151_rehabfacsurv_blank.pdf

• Instructions for NHSN Annual IRF Survey: https://www.cdc.gov/nhsn/forms/instr/toi-57.151-irf.pdf
NHSN Location Mapping: https://www.cdc.gov/nhsn/pdfs/pscmanual/15locationsdescriptions_current.pdf
Keys to Success with NHSN Data: https://www.cdc.gov/nhsn/ps-analysis-resources/keys-to-success.html
47 | P a g e
ADDENDUM TO THE NHSN GUIDE TO THE SIR
Hospital Outpatient Department (HOPD)

Outpatient Procedure Component (OPC)
48 | P a g e
Hospital Outpatient Department (HOPD) Procedure/SSI SIR Model
information). The SSI SIR is calculated for facilities who enroll in NHSN as acute care hospitals or critical access hospitals.
Under the 2015 SIR baseline, procedures and associated SSI events occurring in adult and pediatric patients are modeled
separately. There is only one SSI SIR Model available for the hospital outpatient procedures (and associated SSIs). Please
see Table 1 below for a summary of the SSI SIR model. Under the 2015 SIR baseline, procedures, regardless of closure
methods, are included in the SIR calculation, as long as the inclusion criteria listed below are met and none of the
exclusion criteria apply.
Table 1. Summary of SSI Models

SSI SIR Model Inclusion Criteria Patient Population
All SSI SIR Model • Includes only hospital outpatient procedures • Procedures in
• Superficial & Deep Incisional SSIs limited to primary • Procedures in
incisional SSIs only pediatric patients
• Includes SSIs identified on admission, readmission &
via post-discharge surveillance
Exclusion Criteria
The list of exclusion criteria is the same as those listed for the inpatient SSI –Surgical Site Infections-Hospital Inpatient
Procedures Models on page 27. The only difference is that, this model includes outpatient procedures and excludes
inpatient procedures.
Predictive Risk Factors for HOPD All SSI SIR Model

The number of predicted events calculated under the 2015 baseline for HOPD SSI is risk adjusted based on the following
variables found to be statistically significant predictors of SSIs. The following tables (2a and 2b) list the factors included
in each procedure category for adults and pediatrics.
Table 2a. Predictive Risk Factors from the hospital outpatient procedure department (HOPD) data: All SSI Logistic
Regression Model, Adults ≥ 18 years of age^
NHSN Operative Procedure Risk Factor(s) - All SSI SIR Model, Adults
APPY Intercept-only model‡
AVSD Medical school affiliation*, procedure duration
BRST Wound class, medical school affiliation*, procedure duration, BMI
CHOL Diabetes, hospital bed size*, procedure duration
COLO Procedure duration
FUSN Spinal level
FX Procedure duration
HER Gender, wound class, hospital bed size*, procedure duration, BMI
49 | P a g e
Table 2a, Continued^
HPRO Emergency, hospital bed size*, procedure duration
HYST Emergency, age, procedure duration, oncology hospital,
KPRO Medical school affiliation*, age
LAM Diabetes, medical school affiliation*, procedure duration
OVRY Intercept-only model‡
PACE Intercept-only model‡
VHYS Intercept-only model‡
XLAP age
^ SIRs are not available for procedure categories that had insufficient data (i.e., < 50 procedures and <1 SSI event) that were
reported to NHSN during the baseline period.
‡ None of the variables investigated were statistically significantly associated with SSI risk in these procedure categories.
As a result, the overall pooled mean will be used in the SIR calculation (i.e., intercept-only model).
Table 2b. Predictive Risk Factors from the hospital outpatient procedure department (HOPD) data: All SSI Logistic
Regression Model, Pediatrics <18 years of age*
FX Procedure duration
HER, (age >=2) BMI
* SIRs are not available for procedure categories that had insufficient data (i.e., < 50 procedures and <1 SSI event) that were
HOPD Procedure Duration Outliers

Please see table 4 on page 51.
50 | P a g e
Outpatient Procedure Component Surgical Site Infections (OPC SSI)
information). The OPC SSI SIR is calculated for facilities who enroll in NHSN as Ambulatory Surgery Centers (ASC). Under
the 2015 SIR baseline, procedures and associated SSI events occurring in adult outpatients are modeled separately in
this new component. There is one SIR model available for outpatient adult procedures (and associated SSIs). Please see
Table 1 below for a summary of the OPC SSI SIR model.
Table 1. Summary of OPC SSI Model

OPC SSI SIR Model Inclusion Criteria Patient Population
All SSI SIR Model • Includes only ambulatory surgery centers procedures • Procedures in
• Superficial & Deep Incisional SSIs limited to primary
incisional SSIs only
• Includes SSIs identified on active and passive surveillance
Exclusion Criteria
In addition to the above inclusion criteria, there is also a list of exclusion criteria that applies to the OPC All SSI SIR
model. Similar to the PSC, the list of exclusion criteria applies to both procedures and the associated SSI events. Often
the reason for excluding procedures and SSI events from the SIR calculation is due to potential data quality issues. It is
important that facilities review their data for quality assurance and to determine the reason for exclusion from the SIR
calculation.
Note: When a procedure is excluded from the denominator, the associated SSI event is excluded from the numerator.
Table 2. Procedure Exclusions specific to OPC

General Exclusions
Gender= ‘Other’
Inpatient and HOPD procedures and resulting SSIs
SSIs that are reported as superficial incisional secondary (SIS) or deep incisional secondary (DIS)
Exclusions due to potential data quality issues or outliers
Age at the time of procedure is greater than 109 years
Gender is missing
Adult patients ≥ 18 years: if BMI is less than 12 or greater than 60
Procedure duration less than 5 minutes
Procedure duration is greater than IQR5 (please see Table 4 in the OPC SSI Section for more information)
Predictive Risk Factors in OPC All SSI SIR Model

The number of predicted events, calculated under the 2015 baseline for SSI, is risk adjusted based on the following
variables found to be statistically significant predictors of SSIs. The following Table 3 lists the factors included in each
procedure with the OPC All SSI model SIR outlined above. Procedure categories that do not have an SIR available will be
revaluated in the future with baseline data to calculate an SIR. In cases when the number of predicted events is less than
1.0, the SIR will not be calculated in NHSN.
51 | P a g e
Table 3. Predictive Risk Factors from the OPC All SSI Logistic Regression Model, Adults ≥ 18 years of age*
BRST age, anesthesia, BMI
HER age, BMI, procedure duration
LAM Intercept-only model‡
*SIRs are not available for procedure categories that had insufficient data (i.e., < 1000 procedures and <1 SSI event) that were
‡ None of the variables investigated were statistically significantly associated with SSI risk in these procedure categories. As a result,
the overall pooled mean will be used in the SIR calculation (i.e., intercept-only model).
Procedure Duration Outliers

The IQR5, also called the procedure duration cutoff point, is used as an indicator of an extreme outlier for procedure
durations when calculating the SSI SIRs. The IQR5 is calculated as five times the interquartile range (Q1-Q3) above the
75th percentile. For example, if the interquartile range is 30 minutes, and the 75th percentile is 100 minutes, the IQR5
would be calculated as: 100 + (30*5) = 250 minutes. Procedures with a duration greater than the IQR5 were excluded
from the baseline data and will be excluded from all SSI SIR calculations for your facility. This list of procedure IQR5
apply to both the HOPD Procedure/SSI SIR and the OPC SIR Models.
Table 4. IQR5 Values, in Minutes, for NHSN Operative Procedures, Adult Outpatient Procedures
AMP 197 3 17
APPY 153 2 33
AVSD 308 5 8
BILI 300 5 0
BRST 355 5 5
CEA 477 7 57
CHOL 223 3 43
COLO 524 8 44
CSEC 166 2 46
FUSN 392 6 32
FX 326 5 26
GAST 326 5 26
HER 249 4 9
HPRO 255 4 15
HYST 452 7 32
KPRO 273 4 33
LAM 307 5 7
NECK 384 6 24
NEPH 296 4 46
OVRY 388 6 28
PACE 228 3 48
52 | P a g e
Table 4, Continued
PRST 340 5 40
PVBY 627 10 27
REC 228 3 48
RFUSN 542 9 2
SB 669 11 9
SPLE 604 10 4
THOR 414 6 54
THYR 334 8 26
VHYS 433 5 34
VSHN 244 4 4
XLAP 345 5 45
Outpatient Procedure Component Surgical Site Infections (OPC SSI)

ASC Surveillance for SSI Events: https://www.cdc.gov/nhsn/opc/ssi/index.html
53 | P a g e

The NHSN Standardized Infection Ratio (Sir)

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THE NHSN STANDARDIZED

INFECTION RATIO (SIR)

Recent changes to this document are listed here:

• Page 28: Addition of Infection-related Ventilator-Associated Complication (IVAC+) plus SIR

Finding and Interpreting SIRs in NHSN _______________________________________ 11

b) Infection-related Ventilator-Associated Complication (IVAC) Plus in LTACHs ______________ 24

d) Infection-related Ventilator-Associated Complication (IVAC) Plus in ACHs ________________ 28

Using an Intercept-Only Model to Calculate the Number of Predicted Events ________ 45

What is the SIR?

Why not rates?

𝑂𝑏𝑠𝑒𝑟𝑣𝑒𝑑 (𝑂) 𝐻𝐴𝐼𝑠

Calculating the Number of Predicted Infections

❖ Example: Logistic Regression Model (SSI)

1. Determine the log-odds for each procedure

Factor Parameter Estimate P-value Variable Coding

𝑙𝑜𝑔𝑖𝑡 (𝑝̂ ) = 𝛼 + 𝛽1 𝑋1 + 𝛽2 𝑋2 + ⋯ + 𝛽𝑖 𝑋𝑖 , where:

𝑙𝑜𝑔𝑖𝑡 (𝑝̂ ) = −5.1801 + 0.3247(1) + 0.4414(2) + 0.1106(0) − 0.1501(3.2) + 0.5474(1) = -3.9055

𝑂𝑏𝑠𝑒𝑟𝑣𝑒𝑑 (𝑂) 𝐻𝐴𝐼𝑠 8

𝑙𝑜𝑔 (𝜆) = 𝛼 + 𝛽1 𝑋1 + 𝛽2 𝑋2 + ⋯ + 𝛽𝑖 𝑋𝑖 , where:

In our example hospital, the completed formula looks like this:

5 𝑜𝑏𝑠𝑒𝑟𝑣𝑒𝑑 𝐻𝑂 𝐶𝐷𝐼 𝐿𝑎𝑏𝐼𝐷 𝑒𝑣𝑒𝑛𝑡𝑠

What SIR reports are available?

How do I Interpret the SIRs?

95% Confidence Interval

Introduction to the SIR Guide Supplement

Table 1. CLABSI in Acute Care Hospitals (non-NICU locations)

CDC Location Code: Pediatric Wards & Nurseries

Table 2. CLABSI in Acute Care Hospitals (NICU locations)

Parameter Parameter Estimate Standard Error P-value

Table 4. CLABSI in Long-Term Acute Care Hospitals (LTACHs)

Table 1. MBI-LCBI in Acute Care Hospitals

Table 1. CAUTI in Acute Care Hospitals

Table 2. CAUTI in Critical Access Hospitals (CAHs)

Table 1. Total VAE in Long-Term Acute Care Hospitals (LTACHs)

B. Infection-related Ventilator-Associated Complication (IVAC) Plus in Long-Term

C. Total VAE in Acute Care Hospitals (ACHs)

Table 1. Total VAE in Acute Care Hospitals (ACHs)

CDC Location Code: Surgical Cardiothoracic Critical

CDC Location Code: Medical-Surgical Critical Care 1.0161 0.0822 <.0001

CDC Location Code: Trauma Critical Care

CDC Location Code: Wards, Solid Organ Transplant

Facility bed size*: 85-129 beds 0.1591 0.0787 0.0433

Table 1. IVAC Plus in Acute Care Hospitals (ACHs)

CDC Location Code: Trauma Critical Care

Predictive Risk Factors by SSI Models

Table 3b. Abdominal Hysterectomy Procedures, Complex 30-Day Model

Table 1. MRSA Bacteremia in Acute Care Hospitals

Table 2. MRSA Bacteremia in Critical Access Hospitals (CAHs)

Table 3. MRSA Bacteremia in Long-Term Acute Care Hospitals (LTACHs)

Clostridioides difficile (CDI) Laboratory-Identified Events

Table 1. CDI in Acute Care Hospitals

-Starting in 2018 Q1, CDI test type is categorized as:

Table 2. CDI in Critical Access Hospitals (CAHs)

Table 3. CDI in Long-Term Acute Care Hospitals (LTACHs)

ventilator / total # annual admissions x 100. (i.e., numAdmVent / numAdmitsSurv * 100).

𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑃𝑟𝑒𝑑𝑖𝑐𝑡𝑒𝑑 𝐸𝑣𝑒𝑛𝑡𝑠 = exp(𝐼𝑛𝑡𝑒𝑟𝑐𝑒𝑝𝑡 𝑉𝑎𝑙𝑢𝑒) 𝑥 𝑃𝑎𝑡𝑖𝑒𝑛𝑡 𝐷𝑎𝑦𝑠

𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑃𝑟𝑒𝑑𝑖𝑐𝑡𝑒𝑑 𝐸𝑣𝑒𝑛𝑡𝑠 = exp(−10.7795) 𝑥 1400

𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑃𝑟𝑒𝑑𝑖𝑐𝑡𝑒𝑑 𝐸𝑣𝑒𝑛𝑡𝑠 = 0.029

➢ Information about Transitioning to 2015 SIR Baselines: