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The Florida Department of Health works to protect, promote, and improve the health of all people in Florida through integrated state, county, and community efforts.
National Healthcare Safety Network (NHSN)
Florida HealthDisease Control
On September 2015, the Florida Department of Health (FDOH) established a Data Use Agreement with the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN), a national healthcare-associated infection (HAI) surveillance system. Data entered into NHSN and accessed by FDOH is protected and confidential and shared in aggregate. FDOH epidemiologists assure the data quality, send feedback reports, and provide technical support to facilities on the use of NHSN.
Florida does not have any HAI reporting requirements, but acute care hospitals, outpatient hemodialysis facilities, long-term acute care hospitals, and inpatient rehabilitation facilities participating in quality improvement programs with the Centers for Medicare and Medicaid Services (CMS) are required to report HAI data in NHSN. HAI data are reported to CMS quarterly to align with CMS reporting requirements.
Annual reports including data on trends in HAIs throughout the state are posted to the FDOH website. The reports describe a summary of select HAIs across acute care hospitals providing state-level data about HAI incidence throughout the year. The FDOH HAI Prevention Program monitors these reports and offers consultation and assistance to facilities with higher-than-expected infection rates. For more information on these consultations contact HAI_Program@FLHealth.gov.
Health Care-Associated Infections Trends Over Time for Acute Care Hospitals in Florida, 2018 to Half 2 2022Data source: CDC HAI Progress Report
State SIR Comparison to HHS SIR Goal for Florida Acute Care Hospitals
State SIR Comparison to 2021 Q1 2023 National SIR
Data source: CDC HAI Progress Report
Note: Data from the U.S. Department of Veterans Affairs (VA)/Military Hospitals are not included due to provisions under Florida’s NHSN Data Use Agreement. All data are provisional and subject to change.
The National Healthcare Safety Network (NHSN) is the nation’s most widely used healthcare-associated infection surveillance system. NHSN is designed and maintained by the Centers for Disease Control and Prevention (CDC).
Surveillance tools for enrolled facilities (CDC) – click on your healthcare setting type to access NHSN protocols and resources specific to that setting (i.e., acute care hospital, ambulatory surgery center, inpatient rehabilitation facility, long-term acute care facility, long-term care facility, or outpatient dialysis facility)
- Resources for Users New to NHSN– enrollment and set-up training
- NHSN Educational Roadmaps– guided tour of the NHSN training materials to provide a solid foundation for NHSN
HAI Checklists (CDC) – tools to assist Infection Preventionists when determining if an infection meets HAI criteria for NHSN reporting
Frequently Asked Questions (CDC) – FAQs for all HAI surveillance events
Healthcare facilities collect and report data on healthcare-associated infections (HAIs) to NHSN using standardized definitions. HAI data are used for a variety of purposes, which may include, satisfying reporting mandates, comparing infection rates between and within healthcare facilities, providing consumers with information, guiding policies and procedures, evaluating the effectiveness of interventions, and conducting research.
Surveillance data can be categorized into Process Measures or Outcome Measures.
Measures adherence to recommended practices that may affect outcomes.
Process measures have a 100% target adherence rate and are a more direct measure of quality and outcome. These measures apply to a variety of healthcare settings and often reflect promotion of evidence-based best practices to improve patient outcomes or quality of care.
Examples: Hand hygiene compliance rate, adherence to cleaning catheter hubs and injection ports before access, percentage of environmental cleanings completed appropriately.
Measures actual results.
Outcome measures have variable goals and often require risk adjustment. These measures allow you to see whether changes are leading to improvement such as reducing and preventing HAIs. These measures may not be collected in all healthcare settings and may not involve direct care or provider accountability.
Example: CLABSI, CAUTI, and SSI SIRs
Standardized Infection Ratio (SIR)
Purpose: The primary summary measure used by NHSN to track healthcare-associated infections at a national, state, or facility level over time.
Calculation: number of observed infections / number of predicted infections.
- If SIR > 1.0, more infections were observed than predicted.
- If SIR > 1.0, less infections were observed than predicted.
- If SIR = 1.0, the same number of infections were observed as predicted.
Standardized Utilization Ratio (SUR)
Purpose: A risk-adjusted measure used to compare device utilization at the national, state, or facility level by tracking central line, urinary catheter, and ventilator use.
Calculation: number of observed device days / number of predicted device days.
- If the SUR < 1.0, fewer device days were reported than predicted.
- If the SUR = 1.0, the same number of device days were observed as predicted.
- If the SUR > 1.0, more device days were observed than predicted.
- The SUR is designed to be a high-level indicator of device use and should not be used to draw conclusions around whether devices are overused or underused.
- The SUR should be used in conjunction with the SIR.
Cumulative Attributable Difference (CAD)
Purpose: A risk-adjusted measure that indicated the number of infections that must be prevented within a group, facility, or unit to achieve an HAI reduction goal
Calculation: (number of observed infections) — (number of predicted infections*SIRgoal)
- A positive CAD is the number of excess infections a facility would have needed to prevent to achieve an HAI reduction goal during a specified time.
- A negative CAD means the facility has reached or surpassed the HAI reduction goal.
- Usually presented as a whole number.
Standard Antimicrobial Administration Ratio (SAAR)
Purpose: A standardized metric of antimicrobial use for specified patient care locations.
Calculation: number of observed antimicrobial days / number of predicted antimicrobial days.
- If the SAAR>1.0, more antimicrobial used was observed than predicted.
- If the SAAR <1.0, less antimicrobial use was observed than predicted.
- If the SAAR = 1.0, the same antimicrobial use was observed as predicted.
- A SAAR is not a definitive measure of appropriateness or judiciousness of antimicrobial use, and any SAAR value may warrant additional investigation.