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Prevention of BSI and VAP Measuring Change in Outcomes Part I. Ted Speroff, PhD. NNIS Surveillance Data. Central line-associated BSI rate 5.0/1000 central line-days Ventilator-associated pneumonia rate 5.8/1000 ventilator-days The numerator is the number of events - PowerPoint PPT Presentation
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Prevention of BSI and VAPMeasuring Change in Outcomes
Part ITed Speroff, PhD
NNIS Surveillance Data
• Central line-associated BSI rate– 5.0/1000 central line-days
• Ventilator-associated pneumonia rate– 5.8/1000 ventilator-days
• The numerator is the number of events– Number of patients with infection or pneumonia
• The denominator is the number of central-line or ventilator days, standardized to 1,000– Census data in the ICU, all patients with lines or on ventilator
• NNIS rate is calculated as number of BSI or VAP events (numerator) divided by observed number of line or vent days for the ICU (denominator) times 1,000
Characteristics ofNNIS Rate Data
• Requires aggregating data over a large sample
• Takes time to accumulate data• Appropriate for Surveillance or Quality
assurance• Appropriate for detecting a rate increase• Not appropriate for detecting a rate
decrease unless sample is huge• Insufficient for Quality Improvement
Statistical Process Control Charts• Used in QI to detect improvement (did it
work?)
• Chart:
Central Line is Mean
UCL
LCL
Upper (UCL) and lower (LCL) control limits are usually 3 sigma units from the mean. A data point above the UCL or below the LCL is a significant change. There are additional control chart rules for detecting change.
X-axis is Time Scale: days, weeks months
BSI Rates and Control Chart
• Excel Tool
• Naming and Saving the File
• Entering Baseline Data
• Setting the Baseline Period for the Control Chart
• Editing Chart and Printing
Name and Save the FileSave Often
Rename the Template File
HCAHospitalName_ICUName_ICUSafety_MonYr
Spreadsheet is now calledMusic City_MICU_ICUSafety_Sep06
Note the Tabs at the Bottom:4 WorksheetsBSI NNIS RateVAP NNIS Rate
BSI NNIS Rate
First Entry: Month/Year10/2004
First Entry: CVC Days
Collecting CVC Days
First Entry: CVC-BSI Infections
Continue Data Entry
Data for Baseline Period Have Been EnteredNote: Data + Chart
Set Baseline Period:Move Cursor to Cell F20
Baseline goes from row 20 to 34Edit $D$50 to $D$34
Move Cursor to Cell G3Edit the Text
Text is a Reminder to You of the Baseline Period:
the data for mean and control limits
Chart: To Edit TitleMove Cursor on Title and Click
Edit to your Hospital Nameand ICU Name
Continue Data Entry:Only Baseline Data determine
Mean and Control Limits
Data Complete through 6/2006What do you see?
End of Part I
Questions and Commentsso far?
Continue to Part II