8004854536Am J Infect ControlAm J Infect ControlAmerican journal of infection control0196-65531527-329623538117462576410.1016/j.ajic.2013.01.002HHSPA731977ArticleNational Healthcare Safety Network (NHSN) Report, Data Summary for 2011, Device-associated ModuleDudeckMargaret A.MPH, CPHHoranTeresa C.MPHPetersonKelly D.BBAAllen-BridsonKatherineRN, BSN, MScPH, CICMorrellGloriaRN, MS, MSN, CICAnttilaAngelaRN, MSN, NPC, CICPollockDaniel A.MDEdwardsJonathan R.MStatDivision of Healthcare Quality Promotion, National Center for Emerging, Zoonotic, and Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, U.S. Department of Health and Human Services, Atlanta, Georgia211020154201329102015414286300Background

This report is a summary of Device-associated (DA) Module data collected by hospitals participating in the National Healthcare Safety Network (NHSN) for events occurring from January through December 2011 and reported to the Centers for Disease Control and Prevention (CDC) by August 1, 2012. This report updates previously published DA Module data from NHSN and provides contemporary comparative rates.1 This report complements other NHSN reports, including national and state-specific reports of standardized infection ratios (SIRs) for select healthcare-associated infections (HAIs).2,3,4

NHSN data collection, reporting, and analysis are organized into three components: Patient Safety, Healthcare Personnel Safety, and Biovigilance, and use standardized methods and definitions in accordance with specific module protocols.5,6,7 Institutions may use modules singly or simultaneously, but once selected, they must be used for a minimum of one calendar month for the data to be included in CDC analyses. All infections are categorized using standard CDC definitions that include laboratory and clinical criteria.7 The DA Module may be used by facilities other than hospitals, including outpatient dialysis centers. A report of data from this module for outpatient dialysis centers was published separately.8 NHSN facilities contributing HAI surveillance data to this report did so voluntarily, in response to state mandatory reporting requirements or in compliance with the Centers for Medicare and Medicaid Services’ (CMS) Hospital Inpatient Quality Reporting (IQR) Program. CDC aggregated these data into a single national database for 2011, consistent with the stated purposes of NHSN, which were to:

Collect data from a sample of healthcare facilities in the United States to permit valid estimation of the magnitude of adverse events among patients and healthcare personnel.

Collect data from a sample of healthcare facilities in the United States to permit valid estimation of the adherence to practices known to be associated with prevention of these adverse events.

Analyze and report collected data to permit recognition of trends.

Provide facilities with risk-adjusted metrics that can be used for inter-facility comparisons and local quality improvement activities.

Assist facilities in developing surveillance and analysis methods that permit timely recognition of patient and healthcare worker safety problems and prompt intervention with appropriate measures.

Conduct collaborative research studies with NHSN member facilities (e.g., describe the epidemiology of emerging healthcare-associated infection [HAI] and pathogens, assess the importance of potential risk factors, further characterize HAI pathogens and their mechanisms of resistance, and evaluate alternative surveillance and prevention strategies).

Comply with legal requirements – including but not limited to state or federal laws, regulations, or other requirements – for mandatory reporting of healthcare facility-specific adverse event, prevention practice adherence, and other public health data.

Enable healthcare facilities to report HAI and prevention practice adherence data via NHSN to the U.S. Centers for Medicare and Medicaid Services (CMS) in fulfillment of CMS’s quality measurement reporting requirements for those data.

Provide state departments of health with information that identifies the healthcare facilities in their state that participate in NHSN.

Provide to state agencies, at their request, facility-specific, NHSN patient safety component and healthcare personnel safety component adverse event and prevention practice adherence data for surveillance, prevention, or mandatory public reporting.

Patient- and facility-specific data reported to CDC are kept confidential in accordance with sections 304, 306, and 308(d) of the Public Health Service Act (42 USC 242b, 242k, and 242m(d)).

MethodsData Collection Methods

For reporting to the DA Module, healthcare facility personnel responsible for infection prevention and patient safety may choose, with consideration of state mandates, federal reporting programs, and prevention initiatives, to collect data on central line-associated primary bloodstream infections (CLABSI), ventilator-associated pneumonias (VAP), or urinary catheter-associated urinary tract infections (CAUTI) that occur in patients staying in a patient care location such as a critical or intensive care unit (ICU), specialty care area, or inpatient ward. In NHSN, locations are further stratified according to patient population: adults, children, or neonates (in tables, pediatric and neonatal locations are so noted). In neonatal intensive care unit (NICU) locations (level III or level II/III), infection preventionists (IPs) collect data on central line-associated and umbilical catheter-associated BSI or VAP that occur in patients in each of five birth-weight categories (≤750 g, 751–1000 g, 1001 – 1500 g, 1501 – 2500 g, and >2500 g); data on CAUTI are not collected as part of the NHSN protocols in any NICU location. Corresponding location-specific denominator data consisting of patient-days and specific device-days are also collected by IPs or other trained personnel.

In non-NICU locations, the device-days consist of the total number of central line-days, urinary catheter-days, or ventilator-days. For specialty care areas, such as hematology/oncology and hematopoietic stem cell transplant locations, central line days are split into those with only a permanent central line vs. those with temporary central lines (with or without a permanent central line). In NICU locations, the device-days consist of the total number of central line-days and umbilical catheter-days, or ventilator days for each birth-weight category.

Data Analysis Methods

Compared to the previous report, five new locations – pediatric surgical critical care, long term care rehabilitation unit, long term acute care critical care, long term acute care ward, and inpatient rehabilitation facility– had sufficient data to be included in this report.11

Locations were further stratified by unit bed size and/or major teaching status to determine if pooled mean rates, medians, and empirical distributions significantly differed between two groups for all DA infections; if differences were present, the strata were retained for reporting. Comparisons of pooled mean rates were performed using Poisson regression. These comparisons could be influenced by potential outlier rates from locations with disproportionately large denominators. Therefore, greater weight was given to the results of nonparametric tests comparing the medians for location shift and empirical distributions for assessing differences across the range of reported rates. These nonparametric comparisons by definition require no validity assumptions and provide test results that are not subject to the potential weighting influence of high or low rates with large denominators. Comparisons of the median and percentile distribution were made if there were at least 50 locations contributing to one or more strata and at least 20 locations contributing to the percentile distribution in both strata.

Existing strata were retained for adult combined medical/surgical ICUs, medical ICUs, and surgical ICUs. The data for adult combined medical/surgical ICUs were split by hospital type and unit bedsize, resulting in three groups: “major teaching,” “all others” with unit bedsize ≤15 beds, and “all others” with unit bedsize >15. The data for adult medical ICUs and adult surgical ICUs were split into two groups by teaching status. Facilities self-identified teaching status through an annual facility survey. Major teaching status was defined as a hospital that is an important part of the medical school teaching program in which the majority of medical students rotate through multiple clinical services. Adult bone marrow transplant and adult hematology/oncology locations were also evaluated to assess importance of status as an oncology hospital, but differences were not significant and no new strata were retained.

Device utilization (DU) was calculated as a ratio of device days to patient days for each location type. As such, the DU of a location is one measure of the use of invasive devices and constitutes an extrinsic risk factor for healthcare-associated infection.9 DU may also serve as a marker for severity of illness of patients (i.e. more severely ill patients are more likely to require an invasive device) which is another reflection of the intrinsic susceptibility to infection.

Data from at least 5 different reporting units of a given location type were used to determine pooled mean DA infection rates and DU ratios. Percentile distributions were determined if there were data from at least 20 different locations, excluding rates or DU ratios for locations that did not report at least 50 device-days or patient-days. Because of these requirements, the number of locations contributing data may vary among the tables.

Results

In 2011, 3,854 hospitals reported at least one month of DA denominator data for some patient cohorts under surveillance. These 3,854 hospitals were located in 53 states, territories, and the District of Columbia and were predominantly general acute care hospitals (Table 1); approximately two-thirds were smaller hospitals of 200 beds or less (65%), and only 10.9% were categorized as major teaching facilities (Table 2). Additionally, 60% of the hospitals included in this report are located in states with a mandate for reporting at least one type of DA infection to NHSN. Where data volume was sufficient for this report, we tabulated DA infection rates and DU ratios for January through December 2011 (Tables 3–10). Data on the specific criteria used to report DA infections are provided in Tables 11–18.

Tables 3–6 update and augment previously published DA rates and DU ratios by type of non-NICU locations.11 Beginning in 2012, long term acute care (LTAC) units were re-categorized by acuity level into critical care or ward designations; therefore, in order to align with current data reporting methods in this location type, LTAC data in this report have been categorized in the same manner. Additionally, data from inpatient rehabilitation facilities (IRFs), as defined by the Centers for Medicare and Medicaid Services (CMS), have been reported separately from non-IRF rehabilitation wards within acute care hospitals.

Tables 7–10 update and augment the previously published, DA rates and DU ratios by birth-weight category for NICU locations.1 Beginning in January 2012, CLABSI data in NICU locations are no longer collected according to central line type (i.e., central line and umbilical catheter); in order to align with the current reporting of these data, CLABSI rates and DU ratios for NICUs are not stratified by line type in this report.

Tables 11–18 provide data on select attributes of the DA infections for each location. For example, Tables 11, 12, 15 and 16 show the frequency and percent distribution of the specific sites of CLABSI and the criteria used for identifying these infections. Note that for these tables, criteria 2 and 3 have been combined.

Discussion

This report summarizes the HAI data reported to the DA module of NHSN during 2011. The data in this report continue to be restricted to a single year for several reasons. First, NHSN saw continued growth in participation due to state mandates and federal reporting programs and because of this, there were sufficient data reported in 2011 to support the analysis of a single year of data (e.g., considerable data contributing to the pooled means, most location types with >20 locations reporting), thus obviating the need to combine data with previous years. Second, analyzing one year of data removes the need to assess the influence of any large increase of new reporters in a single year of a multiyear summary measure. Finally, by restricting data to a single year, changes in HAI rates are more apparent and can highlight continued prevention efforts in different patient care areas. This strategy also fulfills the need for more timely publication of comparative rates.

The characteristics of hospitals reporting to NHSN are similar to those seen in the last published report, although this report demonstrates a slight increase in contribution from smaller hospitals.1 Based on the number of facilities reporting, overall contribution to the device-associated module increased by 56% from the last report.11 This increase in reporting is largely attributed to hospitals’ participation in the CMS Hospital Inpatient Quality Reporting Program which requires participants to use NHSN as the tool to report CLABSI data from all adult, pediatric, and neonatal ICUs beginning in January 2011. While much of this growth impacted the volume of CLABSI reporting in ICUs, there is an indication of increased participation in non-ICU locations for CLABSI reporting, as well as reporting for other HAIs in this module.

Extensive analyses of the impact of hospital type on all DA infection rates were performed for select ICU locations. Hospital type continues to be a significant factor for all three DA infection rates and percentile distributions in medical ICUs and surgical ICUs. Additionally, hospital type and bed size both continue to be significant factors in DA infection rates for medical/surgical ICUs. Note that while the CLABSI rates between unit bedsize strata in medical/surgical “all other” ICUs are equal (Table 3), the percentile distributions were shown to be significantly different as a result of nonparametric statistical tests. Therefore, this stratification by unit bedsize in “all other” medical/surgical ICUs was retained. Adult bone marrow transplant and adult hematology/oncology locations were not further stratified by hospital type (i.e., oncology hospital vs. all other acute care hospitals) as the results of the statistical tests indicated that the differences in the strata were not statistically significant. Beginning in 2013, oncology hospitals will be provided with fourteen oncology-specific CDC locations with which to identify for device-associated infection surveillance. As the volume of these data become sufficient, future analyses will continue to assess any potential differences in this specialized population.

Tables 11–18 were included to aid the reader in interpreting the DA infection rates data. One important use of these data is to better understthe distribution of DA infections by type of reporting criterion nationally. For example, approximately 82% of the CLABSIs from adult and pediatric ICU and inpatient wards were identified using the least subjective criterion (1) which attributes the CLABSI to a recognized pathogen; however, for NICUs, approximately two-thirds used this criterion, resulting in a greater percentage of CLABSIs in this population that were identified with common commensals. Similarly, the specific type of ventilator-associated pneumonia (VAP) most frequently reported, regardless of location, was the clinical criterion (PNU1) which relies on the somewhat subjective interpretations of clinical findings.

As more and diverse types of facilities participate in NHSN either voluntarily or by mandate, the need for careful scrutiny of the data increases. We will continue to assess how the changing composition of facilities and the changing proportion of data contributed by various types of facilities impact the rates and their distributions so that the best possible risk-adjusted comparative data may be provided in future reports.

To improve the reliability of data reported to NHSN, several protocol changes are set to occur in January 2013. The majority of these changes are with respect to timing and implementation of two-day rules to clarify infections that are healthcare-associated, association of device use to HAI, and attribution of HAI to an inpatient location after transfer or to a hospital after discharge. In addition, NHSN will add criteria for mucosal barrier injury laboratory-confirmed bloodstream infections. Finally, the VAP definition will no longer apply to adult patients (i.e., ≥ 18 years of age) and this definition will be replaced by ventilator-associated events (VAEs).10 We will carefully assess the potential impact of these changes on HAI incidence as these data are reported.

For those who do not report to NHSN but would like to use these data for comparison, the information must first be collected from your hospital in accordance with the methods described for NHSN.5,6,7 Refer to Appendices A and B for further instructions. Appendix A discusses the calculation of infection rates and DU ratios for the DA Module. Appendix B gives a step-by-step method for interpretation of percentiles of infection rates or DU ratios. Although a high rate or ratio (>90th percentile) does not necessarily define a problem, it does suggest an area for further investigation. Similarly, a low rate or ratio (<10th percentile) may be the result of inadequate infection detection.

Facilities should use the data in this report and their own data to guide local prevention strategies and other quality improvement efforts to reduce the occurrence of infections as much as possible. The data presented in this report can be used to prioritize prevention efforts in those patient care areas that are shown to have the highest incidence of DA infections and/or high device utilization. Facilities may also wish to set targets based on the percentile distributions provided in this report in an effort to strive for lower rates and greater prevention success. The authors are indebted to the NHSN participants for their ongoing efforts to monitor infections and improve patient safety. We also gratefully acknowledge our colleagues in the Division of Healthcare Quality Promotion who tirelessly support this unique public health network.

The findings and conclusions of the report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

DudeckMAHoranTCPetersonKDAllen-BridsonKMorrellGCPollockDAEdwardsJRNational Healthcare Safety Network (NHSN) report, data summary for 2010, device-associated moduleAm J Infect Control20113979881622133532Centers for Disease Control and PreventionState-specific HAI standardized infection ratio (SIR) reportJan-Jun2009Available from: http://www.cdc.gov/HAI/pdfs/stateplans/SIR_05_25_2010.pdf. Accessed October 25, 2012Centers for Disease Control and PreventionNational HAI standardized infection ratio (SIR) reportJul-Dec2009Available from: http://www.cdc.gov/HAI/pdfs/stateplans/SIR-2010_JunDec2009.pdf. Accessed October 25, 2012Centers for Disease Control and PreventionState-specific supplement to the national healthcare-associated infection standardized infection ratio (SIR) report: July 2009 through December 2009Available from: http://www.cdc.gov/HAI/pdfs/stateplans/state-specific-hai-sir-july-dec2009r.pdf. Accessed October 25, 2012Centers for Disease Control and PreventionOutline for healthcare-associated infection surveillanceAvailable from: http://www.cdc.gov/nhsn/PDFS/OutlineForHAISurveillance.pdf. Accessed October 25, 2012Centers for Disease Control and PreventionNHSN manual: patient safety component protocolsAvailable from: http://www.cdc.gov/nhsn/TOC_PSCManual.html. Accessed October 25, 2012Centers for Disease Control and PreventionSurveillance definition of healthcare-associated infection and criteria for specific types of infections in the acute care settingAvailable from: http://www.cdc.gov/nhsn/PDFs/pscManual/17pscNosInfDef_current.pdf. Accessed October 25, 2012KlevensRMEdwardsJRAndrusMLPetersonKDDudeckMAHoranTCthe NHSN participants in Outpatient Dialysis Surveillance. Dialysis Surveillance Report: National Healthcare Safety Network (NHSN)–Data Summary for 2006Seminars in Dialysis2008211242818251954JarvisWREdwardsJRCulverDHHughesJMHoranTEmoriTGNosocomial infection rates in adult and pediatric intensive care units in the United StatesAm J Med199191Suppl 3B185S91S1928163Centers for Disease Control and PreventionVentilator-associated eventsAvailable from: http://www.cdc.gov/nhsn/psc_da-vae.html. Accessed October 20, 2012

NHSN hospitals contributing data used in this report

Hospital typeN (%)
Children’s62 (1.6)
General, including acute, trauma, and teaching3,426 (88.9)
Long Term Acute Care192 (5.0)
Military25 (0.6)
Oncology10 (0.3)
Orthopedic13 (0.3)
Psychiatric10 (0.3)
Rehabilitation44 (1.1)
Surgical41 (1.1)
Veterans Affairs16 (0.4)
Women’s5 (0.1)
Women’s and Children’s10 (0.3)
Total3,854

NHSN hospitals contributing data used in this report by hospital type and bedsize

Hospital typeBed size categoryTotalN (%)
<= 200201–500501–1000> 1000
N (%)N (%)N (%)N (%)
Major teaching104 (2.7)185 (4.8)123 (3.2)9 (0.2)421 (10.9)
Graduate teaching125 (3.2)153 (4.0)35 (0.9)3 (0.1)316 (8.2)
Limited teaching193 (5.0)157 (4.1)30 (0.8)1 (0.0)381 (9.9)
Nonteaching2,085 (54.1)594 (15.4)55 (1.4)2 (0.0)2736 (71.0)
Total2,807 (65.0)1,089 (28.3)243 (6.3)15 (0.4)3,854

Major: Hospital is an important part of the teaching program of a medical school and the majority of medical students rotate through multiple clinical services.

Graduate: Hospital is used by the medical school for graduate training programs only; i.e., residency and/or fellowships.

Limited: Hospital is used in the medical school’s teaching program only to a limited extent.

Pooled means and key percentiles of the distribution of laboratory-confirmed central line-associated BSI rates and central line utilization ratios, by type of location, DA module, 2011

Central line-associated BSI rate*Percentile
Type of LocationNo. of locations+No. of CLABSICentral line-daysPooled mean10%25%50% (median)75%90%
Acute Care Hospitals
Critical Care
Burn71 (70)30180,4263.70.01.22.85.88.4
Medical-Major teaching198 (197)703563,5771.20.00.41.11.82.9
Medical-All other476 (451)769675,6201.10.00.00.51.62.9
Medical cardiac423 (415)673605,1871.10.00.00.81.72.8
Medical/surgical-Major teaching304 (300)937693,5701.40.00.01.11.93.1
Medical/surgical-All other ≤15 beds1,860 (1669)1,2461,416,5010.90.00.00.01.12.5
Medical/surgical-All other > 15 beds800 (795)1,9592,174,0550.90.00.20.71.42.2
Neurologic507676,5801.00.00.00.71.62.2
Neurosurgical166309300,0091.00.00.00.81.62.3
Pediatric cardiothoracic38180110,1271.60.01.11.62.12.7
Pediatric medical36 (29)3424,7771.40.00.00.01.62.7
Pediatric medical/surgical300 (281)717403,7281.80.00.01.32.64.1
Pediatric surgical6 (5)33,4730.9
Prenatal8 (3)03300.0
Respiratory10814,5240.6
Surgical-Major teaching161514435,0101.20.00.21.01.93.1
Surgical-All other218 (214)429419,6691.00.00.00.81.62.8
Surgical cardiothoracic457 (456)762934,2750.80.00.00.51.11.9
Trauma140511328,7131.60.00.51.32.43.3
Step-Down Units
Adult step-down (post-critical care)502 (493)588607,6811.00.00.00.01.22.5
Step-down NICU (level II)42 (20)85,3661.50.00.00.00.01.0
Pediatric step-down (post-critical care)11199,4302.0
Inpatient Wards
Acute stroke171012,7420.8
Antenatal11 (4)11,9880.5
Behavioral health/psychiatry94 (29)47,2530.60.00.00.00.00.2
Burn1556,4510.8
Genitourinary131920,6840.9
Geronotology9 (8)77,0501.0
Gynecology47 (26)713,1370.50.00.00.00.00.7
Jail17 (16)119,8751.1
Labor and delivery48 (7)09500.0
Labor, delivery, recovery, postpartum suite89 (14)13,2230.3
Medical770 (735)908963,9230.90.00.00.31.52.9
Medical/surgical1,892 (1,756)1,6061,844,3840.90.00.00.01.22.4
Neurologic49 (48)4456,5750.80.00.00.01.12.5
Neurosurgical57 (56)4759,9180.80.00.00.00.82.0
Orthopedic242 (213)98158,1310.60.00.00.00.81.6
Orthopedic trauma153218,9071.7
Pediatric medical47 (42)6250,4761.20.00.00.01.62.9
Pediatric medical/surgical241 (185)197170,5491.20.00.00.01.63.5
Pediatric rehabilitation‖876,7371.0
Pediatric surgical112116,2151.3
Postpartum128 (11)12,6480.4
Pulmonary315255,2300.90.00.00.71.42.3
Rehabilitation- non-IRF‖71 (65)1032,6170.30.00.00.00.01.4
Surgical444 (421)410506,0330.80.00.00.01.12.3
Telemetry225 (219)188219,8530.90.00.00.01.43.0
Vascular Surgery231435,3210.40.00.00.00.71.2
Well-Baby Nursery16 (5)26403.1
Inpatient Long Term Care§
Chronic care15 (13)511,3380.4
Ventilator dependent unit61910,8061.8
Long-Term Acute Care Hospitals‡
Adult critical care187638,8052.0
Adult ward229 (227)1,4311,205,2121.20.00.31.01.82.9
Inpatient Rehabilitation Facilities
Adult rehabilitation units-Freestanding77 (73)2351,9430.40.00.00.00.41.7
Adult rehabilitation units – Within hospital167 (162)4377,5850.60.00.00.00.02.5
Central line utilization ratio**Percentile
No. of locations+Central line-daysPatient-daysPooled mean10%25%50% (median)75%90%
Acute Care Hospitals
Critical Care
Burn71 (70)80,426172,9840.460.220.350.450.570.78
Medical-Major teaching198563,577913,5850.620.420.540.620.700.78
Medical-All other476 (471)675,6201,487,7170.450.130.250.430.580.71
Medical cardiac423 (422)605,1871,427,5750.420.190.290.420.560.68
Medical/surgical-Major teaching304 (303)693,5701,291,4010.540.260.420.550.660.74
Medical/surgical-All other ≤15 beds1,860 (1,822)1,416,5014,069,6140.350.100.180.330.500.63
Medical Surgical-All other > 15 beds8002,174,0554,420,5580.490.300.400.510.610.71
Neurologic5076,580152,0360.500.230.370.480.590.70
Neurosurgical166300,009683,5530.440.280.360.450.540.62
Pediatric cardiothoracic38110,127156,4660.700.480.610.730.860.91
Pediatric medical36 (34)24,77765,4280.380.070.150.250.440.53
Pediatric medical/surgical300 (295)403,728866,6850.470.140.250.390.530.61
Pediatric surgical63,4738,5160.41
Prenatal83307,4080.04
Respiratory1014,52430,7480.47
Surgical-Major teaching161435,010699,7830.620.410.520.600.720.80
Surgical-All other218 (215)419,669746,5000.560.370.460.560.680.77
Surgical cardiothoracic457934,2751,425,7110.660.400.500.670.810.91
Trauma140328,713601,4890.550.360.450.570.650.72
Step-Down Units
Adult step-down (post-critical care)502 (499)607,6812,949,6130.210.080.120.180.290.41
Step-down NICU (level II)42 (41)5,36652,9250.100.020.040.070.130.17
Pediatric step-down (post-critical care)119,43037,5740.25
Inpatient Wards
Acute stroke1712,74293,2950.14
Antenatal111,98842,6510.05
Behavioral health/psychiatry947,253228,5290.030.010.010.020.030.05
Burn156,45135,9060.18
Genitourinary1320,68485,8470.24
Geronotology97,05057,8190.12
Gynecology4713,137123,9170.110.010.010.040.130.29
Jail179,87555,2420.18
Labor and delivery48 (45)95044,5300.020.000.010.010.030.11
Labor, delivery, recovery, postpartum suite89 (88)3,223121,6340.030.000.010.020.030.04
Medical770 (766)963,9235,421,2650.180.060.100.150.220.32
Medical/surgical1,892 (1,888)1,844,38412,356,0810.150.040.070.120.180.25
Neurologic4956,575366,4170.150.070.110.130.190.25
Neurosurgical5759,918401,5910.150.070.090.150.200.25
Orthopedic242 (241)158,1311,478,9520.110.020.050.090.130.18
Orthopedic Trauma1518,907114,1470.17
Pediatric medical47 (46)50,476212,5410.240.030.090.180.310.37
Pediatric medical/surgical241 (239)170,549923,1480.180.030.040.110.230.32
Pediatric rehabilitation‖86,73732,9840.20
Pediatric surgical1116,21564,1530.25
Postpartum1282,648258,8070.010.000.000.010.010.03
Pulmonary3155,230233,4430.240.100.150.210.310.45
Rehabilitation – non-IRF‖7132,617302,4400.110.040.060.080.140.25
Surgical444 (440)506,0332,955,3380.170.050.090.150.210.27
Telemetry225 (223)219,8531,646,4130.130.060.090.130.170.22
Vascular surgery2335,321158,7290.220.090.140.190.310.45
Well-Baby Nursery1664015,2650.04
Inpatient Long Term Care§
Chronic care unit15 (13)11,33867,0780.17
Ventilator dependent unit610,80633,3900.32
Long-Term Acute Care Hospitals‡
Adult critical care1838,80569,2780.56
Adult ward2291,205,2121,901,5690.630.430.540.690.790.87
Inpatient Rehabilitation Facilities
Adult rehabilitation units – Freestanding7751,943694,6840.070.030.040.060.090.13
Adult rehabilitation units – Within hospital16777,585761,1550.100.040.060.080.130.18

BSI, bloodstream infection; CLABSI, central line-associated BSI; NICU, neonatal intensive care unit.

Number of CLABSINumber of central line-days×1000

Number of central line–daysNumber of patient-days

The number in parentheses is the number of locations meeting minimum requirements for percentile distributions (i.e., ≥50 device days for rate distributions, ≥50 patient days for device utilization ratios) if less than total number of locations. If this number is <20, percentile distributions are not calculated.

Includes free-standing long-term acute care hospitals and long-term acute care locations within the general acute care hospital setting.

Includes inpatient long term care locations within the general acute care hospital setting.

Includes only in-hospital rehabilitation wards that are not defined as inpatient rehabilitation facilities (IRF) per the CMS Inpatient Rehabilitation Facility Quality Reporting Program.

Includes free-standing inpatient rehabilitation facilities and inpatient rehabilitation facilities within the acute care hospital setting, as defined by the CMS Inpatient Rehabilitation Facility Quality Reporting Program.

Pooled means and key percentiles of the distribution of laboratory-confirmed permanent and temporary central line-associated BSI rates and central line utilization ratios, by type of speciality care area/oncology location, DA module, 2011

Permanent Central line-associated BSI rate *Percentile
Type of LocationNo. of locations+No. of PCLABSIPermanent Central line-daysPooled mean10%25%50% (median)75%90%
Specialty Care Area/Oncology
Hematopoietic stem cell transplant49 (48)285117,2642.40.00.91.93.85.3
General hematology/oncology163 (162)400295,2001.40.00.01.01.93.1
Pediatric hematopoietic stem cell transplant136730,5302.2
Pediatric general hematology/oncology40212127,4441.70.00.61.62.23.3
Solid organ transplant19 (15)2716,4481.6
Temporary Central line-associated BSI rate **Percentile
Type of LocationNo. of locations+No. of TCLABSITemporary Central line-daysPooled mean10%25%50% (median)75%90%
Specialty Care Area/Oncology
Hematopoietic stem cell transplant48 (47)20487,5072.30.00.91.83.24.7
General hematology/oncology170 (169)475243,1442.00.00.01.42.84.7
Pediatric hematopoietic stem cell transplant11 (8)115,1932.1
Pediatric general hematology/oncology41 (39)8437,8152.20.00.01.03.34.8
Solid organ transplant195834,7351.7
Permanent Central line utilization ratio #Percentile
Type of locationNo. of locations+Permanent Central line-daysPatient-daysPooled mean10%25%50% (median)75%90%
Specialty Care Area/Oncology
Hematopoietic stem cell transplant49117,264227,2820.520.160.280.500.670.81
General hematology/oncology163295,200984,0670.300.120.180.280.400.53
Pediatric hematopoietic stem cell transplant1330,53039,5710.77
Pediatric general hematology/oncology40127,444206,2840.620.340.440.590.790.84
Solid organ transplant19 (18)16,448101,1760.16
Temporary Central line utilization ratio ##Percentile
Type of locationNo. of locations+Temporary Central line-daysPatient-daysPooled mean10%25%50% (median)75%90%
Specialty Care Area/Oncology
Hematopoietic stem cell transplant4887,507210,1240.420.100.280.400.620.74
General hematology/oncology170243,1441,045,4500.230.080.140.210.320.44
Pediatric hematopoietic stem cell transplant115,19329,0990.18
Pediatric general hematology/oncology4137,815198,6570.190.050.070.130.310.41
Solid organ transplant1934,735111,5380.31

BSI, bloodstream infection; PCLABSI, permanent central line-associated BSI; TCLABSI, temporary central line-associated BSI

Number of PCLABSINumber of permanent central line−days×1000

Number of permanent central line−daysNumber of patient−days

Number of TCLABSINumber of temporary central line−days×1000

Number of temporary central line−daysNumber of patient−days

The number in parentheses is the number of locations meeting minimum requirements for percentile distributions (i.e., ≥50 device days for rate distributions, ≥50 patient days for device utilization ratios) if less than total number of locations. If this number is <20, percentile distributions are not calculated.

Pooled means and key percentiles of the distribution of urinary catheter-associated UTI rates and urinary catheter utilization ratios, by type of location, DA module, 2011

Urinary catheter-associated UTI rate *Percentile
Type of locationNo. of locations +No. of CAUTIUrinary catheter- daysPooled mean10%25%50% (median)75%90%
Acute Care Hospitals
Critical care units
Burn3814836,2224.10.00.02.85.28.6
Medical -Major teaching99739287,8802.60.00.72.03.45.0
Medical -All other212 (202)552350,5091.60.00.00.72.13.5
Medical cardiac211 (207)596301,8842.00.00.01.32.95.0
Medical/Surgical-Major teaching146 (145)827381,4162.20.00.11.62.84.5
Medical/Surgical-All other, ≤15 beds793 (748)921750,7951.20.00.00.01.63.5
Medical/Surgical-All other, >15 beds4051,6851,181,3011.40.00.41.12.13.1
Neurologic2111634,4223.40.01.52.54.96.6
Neurosurgical74812181,9864.50.01.83.85.58.1
Pediatric cardiothoracic10 (9)128,7641.4
Pediatric medical11 (10)51,7362.9
Pediatric medical/surgical129 (110)21770,6073.10.00.00.83.58.0
Prenatal6 (2)17811.3
Respiratory6117,8691.4
Surgical -Major teaching75552213,8452.60.41.22.13.55.1
Surgical -All other103 (102)366185,9672.00.00.11.32.54.4
Surgical cardiothoracic216 (213)560356,8421.60.00.01.02.23.4
Trauma75776230,6873.40.21.32.54.16.0
Specialty Care Areas/Oncology
Hematopoietic stem cell transplant31 (29)2815,2181.80.00.00.02.84.6
General hematology/oncology93 (91)16276,6702.10.00.51.93.14.7
Pediatric general hematology/oncology10 (7)41,2133.3
Solid organ transplant102112,3701.7
Step-down Units
Adult step-down (post-critical care)318 (313)764439,1421.70.00.01.32.74.5
Pediatric step-down (post-critical care)7 (5)37094.2
Inpatient Wards
Acute stroke112313,8251.7
Antenatal709710.0
Behavioral health/psychiatry91 (31)197,5172.50.00.00.00.28.1
Burn10 (9)112,2784.8
Genitourinary7168,1662.0
Gerontology9 (8)116,0521.8
Gynecology41 (36)1725,6050.70.00.00.00.02.2
Jail7 (4)42,3441.7
Labor and delivery53 (39)522,3500.20.00.00.00.00.1
Labor, delivery, recovery, postpartum suite118 (100)1637,7170.40.00.00.00.00.0
Medical577 (566)979646,9181.50.00.01.02.43.9
Medical/Surgical1,345 (1,292)1,9791,484,6641.30.00.00.82.03.5
Neurologic349544,5382.10.00.51.53.85.2
Neurosurgical3512651,8302.40.00.51.53.86.1
Orthopedic169 (166)308233,5421.30.00.00.82.03.8
Orthopedic trauma103217,8181.8
Pediatric medical/surgical141 (73)3827,0351.40.00.00.02.05.1
Pediatric medical27 (11)63,7031.6
Pediatric surgical7 (6)96,2931.4
Postpartum140 (133)3268,0270.50.00.00.00.01.7
Pulmonary226734,6771.90.00.31.13.03.8
Rehabilitation – non-IRF‖43 (40)4514,2103.20.00.00.04.310.1
Surgical313 (308)660437,4131.50.00.01.02.24.3
Telemetry90 (88)132114,5071.20.00.00.81.93.8
Vascular surgery101510,3961.4
Well-baby nursery8 (1)01260.0
Inpatient Long Term Care§
Chronic care16 (5)127,9451.5
Long-term care rehabilitation unit8182,5507.1
Long-Term Acute Care Hospitals‡
Adult critical care6174,7773.6
Adult ward166 (165)1,407652,1752.20.00.91.83.14.8
Inpatient Rehabilitation Facilities
Adult rehabilitation units – Freestanding82 (81)16454,7323.00.00.01.43.96.5
Adult rehabilitation units – Within hospital138 (126)14747,8693.10.00.01.15.29.0
Urinary catheter utilization ratio **Percentile
Type of locationNo. of locations +Urinary catheter- daysPatient daysPooled mean10%25%50% (median)75%90%
Acute Care Hospitals
Critical care units
Burn3836,22272,1390.500.340.380.450.640.76
Medical -Major teaching99287,880410,1230.700.560.650.740.800.85
Medical -All other212 (210)350,509570,6820.610.330.530.680.780.85
Medical cardiac211 (210)301,884597,7410.510.250.380.530.660.74
Medical/Surgical -Major teaching146 (145)381,416551,8550.690.490.620.740.800.83
Medical/Surgical -All other, ≤15 beds793 (766)750,7951,399,1380.540.310.460.610.730.81
Medical/Surgical -All other, >15 beds4051,181,3011,776,7930.660.490.600.710.780.84
Neurologic2134,42248,5490.710.320.560.730.820.84
Neurosurgical74181,986261,6820.700.540.610.710.790.85
Pediatric cardiothoracic108,76445,2810.19
Pediatric medical111,73614,0450.12
Pediatric medical/surgical129 (126)70,607311,9740.230.070.120.200.260.32
Prenatal67817,9260.10
Respiratory67,86917,3880.45
Surgical -Major teaching75213,845282,2210.760.580.700.770.830.88
Surgical -All other103 (102)185,967261,3570.710.450.640.750.810.89
Surgical cardiothoracic216 (215)356,842530,1540.670.410.550.690.820.88
Trauma75230,687292,8090.790.620.740.800.870.94
Specialty Care Areas/Oncology
Hematopoietic stem cell transplant3115,218135,7760.110.040.050.070.150.24
General hematology/oncology93 (92)76,670492,7320.160.070.090.150.210.30
Pediatric general hematology/oncology101,21349,5410.02
Solid organ transplant1012,37061,7820.20
Step-down Units
Adult step-down (post-critical care)318439,1421,708,2560.260.120.170.250.370.52
Pediatric step-down (post critical care)770921,4270.03
Inpatient Wards
Acute stroke1113,82540,0590.35
Antenatal79719,2570.10
Behavioral health/psychiatry917,517216,3430.030.000.010.020.040.07
Burn102,27815,6920.15
Genitourinary78,16648,0610.17
Gerontology96,05248,7320.12
Gynecology4125,605124,1660.210.070.120.200.290.47
Jail72,34424,2490.10
Labor and delivery5322,350101,2210.220.020.060.130.200.44
Labor, delivery, recovery, postpartum suite118 (116)37,717243,4610.150.060.100.130.190.28
Medical577 (574)646,9183,758,6650.170.080.120.170.220.30
Medical/Surgical1,345 (1,335)1,484,6647,712,9510.190.100.130.180.240.31
Neurologic3444,538213,6950.210.090.150.200.240.36
Neurosurgical3551,830229,3330.230.100.170.210.320.50
Orthopedic169233,542869,2250.270.130.200.270.340.44
Orthopedic trauma1017,81876,4510.23
Pediatric medical/surgical141 (138)27,035382,3380.070.010.010.040.080.15
Pediatric medical27 (26)3,70381,7120.050.010.010.010.030.16
Pediatric surgical76,29339,9980.16
Postpartum14068,027519,2190.130.030.080.130.190.29
Pulmonary2234,677154,6040.220.090.160.190.230.50
Rehabilitation – non-IRF‖4314,210166,0120.090.030.050.070.130.16
Surgical313 (311)437,4131,875,8900.230.120.170.230.300.40
Telemetry90 (89)114,507548,6510.210.100.150.210.250.31
Vascular surgery1010,39665,1920.16
Well-baby nursery8 (7)1262,1490.06
Inpatient Long Term Care§
Chronic care16 (13)7,94541,5410.19
Long-term care rehabilitation unit82,55038,7410.07
Long-Term Acute Care Hospitals‡
Adult critical care64,77711,8060.40
Adult ward166652,1751,258,8010.520.310.430.510.620.71
Inpatient Rehabilitation Facilities
Adult rehabilitation units – Freestanding8254,732700,4140.080.030.050.070.090.13
Adult rehabilitation units – Within hospital13847,869521,2380.090.030.050.080.120.16

UTI, urinary trach infection; CAUTI, catheter-associated UTI.

Number of CAUTINumber of urinary catheter−days×1000

Number of urinary catheter−daysNumber of patient−days

The number in parentheses is the number of locations meeting minimum requirements for percentile distributions (i.e., ≥50 device days for rate distributions, ≥50 patient days for device utilization ratios) if less than total number of locations. If this number is <20, percentile distributions are not calculated.

Includes free-standing long-term acute care hospitals and long-term acute care locations within the general acute care hospital setting.

Includes inpatient long term care locations within the general acute care hospital setting.

Includes only in-hospital rehabilitation wards that are not defined as inpatient rehabilitation facilities (IRF) per the CMS Inpatient Rehabilitation Facility Quality Reporting Program.

Includes free-standing inpatient rehabilitation facilities and inpatient rehabilitation facilities within the acute care hospital setting, as defined by the CMS Inpatient Rehabilitation Facility Quality Reporting Program.

Pooled means and key percentiles of the distribution of ventilator-associated PNEU rates and ventilator utilization ratios, by type of location, DA module, 2011

Ventilator-associated PNEU rate *Percentile
Type of locationNo. of locations +No. of VAPVentilator -daysPooled mean10%25%50% (median)75%90%
Acute Care Hospitals
Critical Care Units
Burn31 (30)8817,8444.90.00.04.28.812.5
Medical -Major teaching89188174,4121.10.00.00.71.83.0
Medical -All other156 (141)152156,1911.00.00.00.01.03.0
Medical cardiac161 (152)138128,3691.10.00.00.01.33.8
Medical/surgical -Major teaching123 (118)461215,2142.10.00.01.02.35.4
Medical/surgical -All other ≤15 beds597 (482)296267,2721.10.00.00.01.24.3
Medical/surgical -All other >15 beds317 (315)527509,4921.00.00.00.61.62.8
Neurologic196417,6563.6
Neurosurgical66 (65)16170,8942.30.00.00.73.05.9
Pediatric cardiothoracic151228,7560.4
Pediatric medical1167,3850.8
Pediatric medical/surgical121 (112)146135,5851.10.00.00.01.43.2
Respiratory603,9840.0
Surgical -Major teaching70290122,4722.40.00.61.73.56.4
Surgical -All other83 (81)16582,3632.00.00.00.12.84.7
Surgical cardiothoracic168 (164)268154,2341.70.00.00.62.45.3
Trauma56499106,8574.70.00.93.17.513.5
Specialty Care Areas/Oncology
Hematopoietic stem cell transplant5 (4)01,1180.0
Step-Down Units
Adult step-down (post-critical care)73 (59)4138,5721.10.00.00.01.03.7
Step-down NICU (level II)6 (0)0930.0
Inpatient Wards
Medical34 (21)18,3160.10.00.00.00.00.0
Medical/surgical53 (32)1723,3490.70.00.00.00.72.3
Neurosurgical513,1780.3
Pediatric medical6 (5)02,7070.0
Pediatric medical/surgical10 (8)02,6090.0
Pulmonary7(5)65,8401.0
Telemetry5 (3)11,2450.8
Long-Term Acute Care Hospitals‡
Adult critical care624,3140.5
Adult ward144 (139)114249,3300.50.00.00.00.61.2
Ventilator utilization ratio **Percentile
Type of locationNo. of locations +Ventilator -daysPatient-daysPooled mean10%25%50% (median)75%90%
Acute Care Hospitals
Critical Care Units
Burn3117,84466,5700.270.100.160.240.300.42
Medical -Major teaching89174,412381,5570.460.290.380.470.570.65
Medical -All other156 (153)156,191444,8930.350.090.190.320.470.56
Medical cardiac161 (160)128,369461,1480.280.100.170.250.350.43
Medical/surgical -Major teaching123 (122)215,214522,4590.410.160.260.390.490.59
Medical/surgical -All other ≤15 beds597 (582)267,2721,118,3630.240.050.110.210.320.44
Medical/surgical -All other >15 beds317 (316)509,4921,473,5810.350.180.260.350.440.51
Neurologic1917,65648,8220.36
Neurosurgical6670,894236,5540.300.140.240.290.380.45
Pediatric cardiothoracic1528,75664,4060.45
Pediatric medical117,38522,3460.33
Pediatric medical/surgical121135,585339,4070.400.130.200.340.440.52
Respiratory63,98411,3660.35
Surgical -Major teaching70122,472292,5170.420.200.300.400.500.57
Surgical -All other83 (82)82,363238,0480.350.150.230.310.450.52
Surgical cardiothoracic168154,234462,7330.330.160.220.310.410.51
Trauma56106,857225,6540.470.360.420.480.550.64
Specialty Care Areas/Oncology
Hematopoietic stem cell transplant51,11819,4800.06
Step-Down Units
Adult step-down (post-critical care)7338,572346,4180.110.010.030.080.130.31
Step-down NICU (level II)6934,7060.02
Inpatient Wards
Medical348,316168,1270.050.000.010.020.040.07
Medical/surgical5323,349319,6380.070.000.010.030.070.19
Neurosurgical53,17828,5570.11
Pediatric medical62,70730,6200.09
Pediatric medical/surgical102,60952,8680.05
Pulmonary75,84035,2690.17
Telemetry51,24520,6850.06
Long-Term Acute Care Hospitals‡
Adult critical care64,31411,8060.37
Adult ward144249,3301,129,8320.220.070.120.200.290.40

VAP, ventilator-associated pneumonia.

Number of VAPNumber of ventilator−days×1000

Number of ventilator−daysNumber of patient−days

The number in parentheses is the number of locations meeting minimum requirements for percentile distributions (i.e., ≥50 device days for rate distributions, ≥50 patient days for device utilization ratios) if less than total number of locations. If this number is <20, percentile distributions are not calculated.

Includes free-standing long-term acute care hospitals and long-term acute care locations within the general acute care hospital setting.

Pooled means and key percentiles of the distribution of central line-associated BSI rates and central line utilization ratios for level III NICUs, DA module, 2011

Central line-associated BSI rate *Percentile
Birth-weight categoryNo. of locations +No. of CLABSICentral line-daysPooled mean10%25%50% (median)75%90%
≤ 750 grams385 (342)500196,6592.50.00.01.64.37.8
751–1000 grams405 (351)339168,9382.00.00.00.33.26.3
1001–1500 grams412 (368)244186,0991.30.00.00.01.94.5
1501–2500 grams408 (348)150163,3390.90.00.00.00.72.7
> 2500 grams413 (331)154181,0910.90.00.00.00.32.1
Central line utilization ratio **Percentile
Birth-weight categoryNo. of locations +Central line-daysPatient-daysPooled Mean10%25%50% (median)75%90%
≤ 750 grams385 (351)196,659452,3090.430.290.370.450.570.72
751–1000 grams405 (370)168,938456,3490.370.230.300.380.470.65
1001–1500 grams412 (405)186,099654,1870.280.140.200.270.380.52
1501–2500 grams408 (405)163,339885,0950.180.050.080.140.220.43
> 2500 grams413 (406)181,091713,2460.250.060.100.170.300.45

BSI, bloodstream infection; CLABSI, central line-associated BSI; NICU, neonatal intensive care unit.

Number of CLABSINumber of central line−days×1000

Number of central line−daysNumber of patient−days

The number in parentheses is the number of locations meeting minimum requirements for percentile distributions (i.e., ≥50 device days for rate distributions, ≥50 patient days for device utilization ratios) if less than total number of locations. If this number is <20, percentile distributions are not calculated.

Pooled means and key percentiles of the distribution of central line-associated BSI rates and central line utilization ratios for level II/III NICUs, DA module, 2011

Central line-associated BSI rate *Percentile
Birth-weight categoryNo. of locations +No. of CLABSICentral line-daysPooled mean10%25%50% (median)75%90%
≤ 750 grams364 (265)295110,1722.70.00.00.04.48.6
751–1000 grams412 (296)193101,6451.90.00.00.03.26.9
1001–1500 grams486 (363)147126,8191.20.00.00.01.54.4
1501–2500 grams520 (355)87117,5300.70.00.00.00.02.3
> 2500 grams525 (315)77109,7300.70.00.00.00.01.9
Central line utilization ratio **Percentile
Birth-weight categoryNo. of locations +Central line-daysPatient-daysPooled mean10%25%50% (median)75%90%
≤ 750 grams364 (288)110,172266,4790.410.280.350.480.630.78
751–1000 grams412 (335)101,645264,9040.380.220.300.390.510.65
1001–1500 grams486 (438)126,819460,0140.280.120.180.270.370.51
1501–2500 grams520 (495)117,530740,2790.160.040.070.120.190.32
> 2500 grams525 (494)109,730555,5990.200.050.080.120.220.32

BSI, bloodstream infection; CLABSI, central line-associated BSI; NICU, neonatal intensive care unit.

Number of CLABSINumber of central line−days×1000

Number of central line−daysNumber of patient−days

The number in parentheses is the number of locations meeting minimum requirements for percentile distributions (i.e., ≥50 device days for rate distributions, ≥50 patient days for device utilization ratios) if less than total number of locations. If this number is <20, percentile distributions are not calculated.

Pooled means and key percentiles of the distribution of ventilator-associated PNEU rates and ventilator utilization ratios for level III NICUs, DA module, 2011

Ventilator-associated PNEU rate *Percentile
Birth-weight categoryNo. of locations +No. of VAPVentilator- daysPooled mean10%25%50% (median)75%90%
≤ 750 grams127 (112)8957,1331.60.00.00.02.26.9
751–1000 grams125 (104)4732,5011.40.00.00.00.94.4
1001–1500 grams130 (88)2019,9741.00.00.00.00.02.9
1501–2500 grams129 (69)917,2500.50.00.00.00.00.1
> 2500 grams128 (72)629,1020.20.00.00.00.00.0
Ventilator utilization ratio**Percentile
Birth-weight categoryNo. of locations +Ventilator- daysPatient-daysPooled mean10%25%50% (median)75%90%
≤ 750 grams127 (118)57,133147,9320.390.220.300.430.550.66
751–1000 grams125 (118)32,501145,5200.220.070.130.220.340.48
1001–1500 grams130 (127)19,974185,3670.110.020.050.080.160.28
1501–2500 grams129 (128)17,250253,2590.070.010.020.040.090.19
> 2500 grams12829,102230,0770.130.020.030.070.140.23

VAP, ventilator-associated pneumonia; NICU, neonatal intensive care unit.

Number of VAPNumber of ventilator−days×1000

Number of ventilator−daysNumber of patient−days

The number in parentheses is the number of locations meeting minimum requirements for percentile distributions (i.e., ≥50 device days for rate distributions, ≥50 patient days for device utilization ratios) if less than total number of locations. If this number is <20, percentile distributions are not calculated.

Pooled means and key percentiles of the distribution of ventilator-associated PNEU rates and ventilator utilization ratios for level II/III NICUs, DA module, 2011

Ventilator-associated PNEU rate *Percentile
Birth-weight categoryNo. of locations +No. of VAPVentilator- daysPooled mean10%25%50% (median)75%90%
≤ 750 grams99 (69)4927,1901.80.00.00.02.85.9
751–1000 grams105 (66)2114,6851.40.00.00.00.09.7
1001–1500 grams118 (52)78,4640.80.00.00.00.01.5
1501–2500 grams131 (43)78,5900.80.00.00.00.03.8
> 2500 grams136 (44)210,7370.20.00.00.00.00.0
Ventilator utilization ratio **Percentile
Birth-weight categoryNo. of locations +Ventilator- daysPatient-daysPooled mean10%25%50% (median)75%90%
≤ 750 grams99 (80)27,19073,4630.370.210.270.390.530.65
751–1000 grams105 (87)14,68567,7930.220.090.140.220.330.45
1001–1500 grams118 (101)8,464102,6600.080.020.040.070.120.20
1501–2500 grams131 (127)8,590167,4650.050.010.020.030.050.11
> 2500 grams136 (125)10,737123,7700.090.020.030.040.080.15

VAP, ventilator-associated pneumonia; NICU, neonatal intensive care unit.

Number of VAPNumber of ventilator−days×1000

Number of ventilator−daysNumber of patient−days

The number in parentheses is the number of locations meeting minimum requirements for percentile distributions (i.e., ≥50 device days for rate distributions, ≥50 patient days for device utilization ratios) if less than total number of locations. If this number is <20, percentile distributions are not calculated.

Distribution of criteria for central line-associated laboratory-confirmed BSI by location, 2011

LCBI
Type of LocationCriterion 1n (%)Criterion 2/3n (%)Total
Acute Care Hospitals
Critical Care
Burn28193.4%206.6%301
Medical -Major teaching60586.1%9813.9%703
Medical -All other62080.6%14919.4%769
Medical cardiac54280.5%13119.5%673
Medical/surgical -Major teaching78383.6%15416.4%937
Medical/surgical -All other ≤15 beds1,00380.5%24319.5%1,246
Medical/surgical -All other > 15 beds1,54078.6%41921.4%1,959
Neurologic5572.4%2127.6%76
Neurosurgical22071.2%8928.8%309
Pediatric cardiothoracic14379.4%3720.6%180
Pediatric medical3294.1%25.9%34
Pediatric medical/surgical56779.1%15020.9%717
Pediatric surgical3100.0%00.0%3
Respiratory8100.0%00.0%8
Surgical -Major teaching40679.0%10821.0%514
Surgical -All other36083.9%6916.1%429
Surgical cardiothoracic64184.1%12115.9%762
Trauma43785.5%7414.5%511
Step-Down Units
Adult step-down (post-critical care)48682.7%10217.3%588
Step-down NICU (level II)450.0%450.0%8
Pediatric step-down (post-critical care)1789.5%210.5%19
Inpatient Wards
Acute stroke880.0%220.0%10
Antenatal00.0%1100.0%1
Behavioral health/psychiatry4100.0%00.0%4
Burn5100.0%00.0%5
Genitourinary1473.7%526.3%19
Geronotology7100.0%00.0%7
Gynecology685.7%114.3%7
Jail1090.9%19.1%11
Labor, delivery, recovery, postpartum suite1100.0%00.0%1
Medical76484.1%14415.9%908
Medical/surgical1,34783.9%25916.1%1,606
Neurologic3886.4%613.6%44
Neurosurgical3778.7%1021.3%47
Orthopedic7273.5%2626.5%98
Orthopedic trauma2784.4%515.6%32
Pediatric medical5487.1%812.9%62
Pediatric medical/surgical16081.2%3718.8%197
Pediatric rehabilitation – non-IRF‖7100.0%7
Pediatric surgical2095.2%14.8%21
Postpartum1100.0%00.0%1
Pulmonary4586.5%713.5%52
Rehabilitation – non-IRF‖990.0%110.0%10
Surgical33581.7%7518.3%410
Telemetry16386.7%2513.3%188
Vascular Surgery1392.9%17.1%14
Well-Baby Nursery150.0%150.0%2
Inpatient Long Term Care§
Chronic care5100.0%00.0%5
Ventilator dependent unit1684.2%315.8%19
Long-Term Acute Care Hospitals‡
Adult critical care6889.5%810.5%76
Adult ward1,20484.1%22715.9%1,431
Inpatient Rehabilitation Facilities
Adult rehabilitation units – Freestanding2191.3%28.7%23
Adult rehabilitation units – Within hospital3888.4%511.6%43
TOTAL13,25382.5%2,85417.8%16,064

BSI, bloodstream infection; LCBI, laboratory-confirmed BSI.7

Includes free-standing long-term acute care hospitals and long-term acute care locations within the general acute care hospital setting.

Includes inpatient long term care locations within the general acute care hospital setting.

Includes only in-hospital rehabilitation wards that are not defined as inpatient rehabilitation facilities (IRF) per the CMS Inpatient Rehabilitation Facility Quality Reporting Program.

Includes free-standing inpatient rehabilitation facilities and inpatient rehabilitation facilities within the acute care hospital setting, as defined by the CMS Inpatient Rehabilitation Facility Quality Reporting Program.

Distribution of criteria for permanent and temporary central line-associated laboratory-confirmed BSI by location, 2011

LCBI
Type of LocationCriterion 1n (%)Criterion 2/3n (%)Total
Permanent Central Line
Hematopoietic stem cell transplant21976.8%6623.2%285
General hematology/oncology30776.8%9323.3%400
Pediatric hematopoietic stem cell transplant5582.1%1217.9%67
Pediatric general hematology/oncology17582.5%3717.5%212
Solid organ transplant2488.9%311.1%27
Total78078.7%21121.3%991
Temporary Central Line
Hematopoietic stem cell transplant16480.4%4019.6%204
General hematology/oncology38781.5%8818.5%475
Pediatric hematopoietic stem cell transplant981.8%218.2%11
Pediatric general hematology/oncology6982.1%1517.9%84
Solid organ transplant4781.0%1119.0%58
Total67681.3%15618.8%832

BSI, bloodstream infection; LCBI, laboratory-confirmed BSI.7

Distribution of specific sites of urinary catheter-associated UTI by location, 2011

Type of locationSUTI n (%)ABUTI n (%)Total
Acute Care Hospitals
Critical care units
Burn14799.3%10.7%148
Medical -Major teaching72898.5%111.5%739
Medical -All other54198.0%112.0%552
Medical cardiac58898.7%81.3%596
Medical/Surgical -Major teaching81698.7%111.3%827
Medical/Surgical -All other, ≤15 beds90197.8%202.2%921
Medical/Surgical -All other, >15 beds1,65298.0%332.0%1,685
Neurologic11599.1%10.9%116
Neurosurgical81099.8%20.2%812
Pediatric cardiothoracic12100.0%12
Pediatric medical5100.0%5
Pediatric medical/surgical21297.7%52.3%217
Prenatal1100.0%1
Respiratory11100.0%11
Surgical -Major teaching54899.3%40.7%552
Surgical -All other35697.3%102.7%366
Surgical cardiothoracic55198.4%91.6%560
Trauma77199.4%50.6%776
Specialty Care Areas/Oncology
Hematopoietic stem cell transplant28100.0%28
General hematology/oncology15998.1%31.9%162
Pediatric general hematology/oncology4100.0%4
Solid organ transplant21100.0%21
Step-down Units
Adult step-down (post-critical care)74998.0%152.0%764
Pediatric step-down (post-critical care)3100.0%3
Inpatient Wards
Acute stroke2295.7%14.3%23
Behavioral health/psychiatry19100.0%19
Burn11100.0%11
Genitourinary16100.0%16
Gerontology11100.0%11
Gynecology17100.0%17
Jail4100.0%4
Labor and delivery5100.0%5
Labor, delivery, recovery, postpartum suite1593.8%16.3%16
Medical96198.2%181.8%979
Medical/Surgical1,95999.0%201.0%1,979
Neurologic95100.0%95
Neurosurgical126100.0%126
Orthopedic30699.4%20.6%308
Orthopedic trauma32100.0%32
Pediatric medical/surgical38100.0%38
Pediatric medical6100.0%6
Pediatric surgical9100.0%9
Postpartum32100.0%32
Pulmonary6495.5%34.5%67
Rehabilitation – non-IRF‖4497.8%12.2%45
Surgical65499.1%60.9%660
Telemetry13199.2%10.8%132
Vascular surgery15100.0%15
Inpatient Long Term Care§
Chronic care12100.0%12
Long-term care rehabilitation unit18100.0%18
Long Term Acute Care Hospitals‡
Adult critical care17100.0%17
Adult ward1,39198.9%151.1%1,406
Inpatient Rehabilitation Facilities
Adult rehabilitation units – Freestanding164100.0%164
Adult rehabilitation units – Within hospital14397.3%42.7%147
TOTAL16,06698.7%2171.3%16,283

UTI, urinary tract infection; SUTI, symptomatic UTI; ABUTI, asymptomatic bacteremic UTI.7

Includes free-standing long-term acute care hospitals and long-term acute care locations within the general acute care hospital setting.

Includes inpatient long term care locations within the general acute care hospital setting.

Includes only in-hospital rehabilitation wards that are not defined as inpatient rehabilitation facilities (IRF) per the CMS Inpatient Rehabilitation Facility Quality Reporting Program.

Includes free-standing inpatient rehabilitation facilities and inpatient rehabilitation facilities within the acute care hospital setting, as defined by the CMS Inpatient Rehabilitation Facility Quality Reporting Program.

Distribution of specific sites of ventilator-associated pneumonia by location, 2011

Type of locationPNU1 n (%)PNU2 n (%)PNU3 n (%)Total
Acute Care Hospitals
Critical Care
Burn3742.0%5158.0%88
Medical -Major teaching11762.2%6836.2%31.6%188
Medical -All other12481.6%2818.4%152
Medical cardiac7655.1%6244.9%138
Medical/surgical -Major teaching21346.2%24553.1%30.7%461
Medical/surgical -All other ≤15 beds21472.3%7525.3%72.4%296
Medical/surgical -All other >15 beds30958.6%20438.7%142.7%527
Neurologic1929.7%4570.3%64
Neurosurgical7949.1%8150.3%10.6%161
Pediatric cardiothoracic975.0%325.0%12
Pediatric medical6100.0%6
Pediatric medical/surgical11176.0%3423.3%10.7%146
Surgical -Major teaching14249.0%13847.6%103.4%290
Surgical -All other8048.5%8249.7%31.8%165
Surgical cardiothoracic15457.5%10739.9%72.6%268
Trauma24448.9%25150.3%40.8%499
Step-Down Units
Adult step-down (post-critical care)3585.4%614.6%41
Inpatient Wards
Medical1100.0%1
Medical/surgical529.4%1270.6%17
Neurosurgical1100.0%1
Pulmonary6100.0%6
Telemetry1100.0%1
Long-Term Acute Care Hospitals‡
Adult critical care150.0%150.0%2
Adult ward8271.9%3228.1%114
Total2,06056.5%1,53042.0%541.5%3,644

PNU1, clinically defined pneumonia; PNU2, pneumonia with specific laboratory findings; PNU3, pneumonia in immunocompromised patients.7

Includes free-standing long-term acute care hospitals and long-term acute care locations within the general acute care hospital setting.

Distribution of specific sites and criteria for central line-associated laboratory-confirmed BSI among Level III NICUs by birthweight, 2011

LCBI
Birth-weight categoryCriterion 1 n (%)Criterion 2/3 n (%)Total
≤ 750 grams34669.2%15430.8%500
750–1000 grams21663.7%12336.3%339
1001–1500 grams15663.9%8836.1%244
1501–2500 grams10670.7%4429.3%150
> 2500 grams11876.6%3623.4%154
Total94267.9%44532.1%1387

BSI, bloodstream infection; LCBI, laboratory-confirmed BSI.7

Distribution of specific sites and criteria for central line-associated laboratory-confirmed BSI among Level II/III NICUs by birthweight, 2011

LCBI
Birth-weight categoryCriterion 1 n (%)Criterion 2/3 n (%)Total
≤ 750 grams19465.8%10134.2%295
750–1000 grams11961.7%7438.3%193
1001–1500 grams8658.5%6141.5%147
1501–2500 grams5563.2%3236.8%87
> 2500 grams5064.9%2735.1%77
Total50463.1%29536.9%799

BSI, bloodstream infection; LCBI, laboratory-confirmed BSI.7

Distribution of specific sites of ventilator-associated pneumonia among Level III NICUs by birthweight, 2011

Birth-weight categoryPNU1 n (%)PNU2 n (%)PNU3 n (%)Total
≤ 750 grams6269.7%2629.2%11.1%89
750–1000 grams2961.7%1736.2%12.1%47
1001–1500 grams1575.0%525.0%20
1501–2500 grams666.7%333.3%9
> 2500 grams6100.0%6
Total11869.0%5129.8%21.2%171

PNU1, clinically defined pneumonia; PNU2, pneumonia with specific laboratory findings; PNU3, pneumonia in immunocompromised patients.7

Distribution of specific sites of ventilator-associated pneumonia among Level II/III NICUs by birthweight, 2011

Birth-weight categoryPNU1n (%)PNU2n (%)PNU3n (%)Total
≤ 750 grams3775.5%714.3%510.2%49
750–1000 grams1466.7%523.8%29.5%21
1001–1500 grams685.7%114.3%7
1501–2500 grams7100.0%7
> 2500 grams2100.0%2
Total6676.7%1315.1%78.1%86

PNU1, clinically defined pneumonia; PNU2, pneumonia with specific laboratory findings; PNU3, pneumonia in immunocompromised patients.7