Under the South Carolina Hospital Infection Disclosure Act (HIDA), DHEC publishes public reports of Healthcare-Associated Infection (HAI) data from acute care, long term acute care and inpatient rehabilitation facilities. This is to notify the consumers of this report that from October 2016 onwards the following changes have been made to this report:

1. Two reports will be published:
   1. A consumer friendly HAI report that presents data in a high-level summary form and uses plain language making the interpretation of HAI data easy for consumers. The consumer report is intended to provide sufficient, facility-specific HAI performance information to enable consumers to make informed decisions when selecting healthcare from the available options.
   2. A technical report tailored for healthcare providers and those with HAI subject matter expertise and/or epidemiologic methods. The purpose of the technical report is to provide detailed HAI information in an understandable way to enable healthcare providers and public health professionals to view facility-specific HAI performance, understand the state's HAI performance as a whole, and/or to compare a facility's HAI experience to that of the rest of the country.
2. In the past, the facility-specific HIDA report included infection rates for different HAIs such as Central Line-Associated Bloodstream Infections (CLABSIs), Surgical Site Infections (SSIs), Methicillin-Resistant Staphylococcus aureus (MRSA) & Clostridium difficile Infections (CDIs). The new report will use Standardized Infection Ratio (SIR) as the HAI metric.

   Rationale:

   Using infection rates does not allow fair comparison of healthcare facilities because rates do not account for differences in patient populations in terms of illness severity and other factors that may affect the risk of developing HAIs. For example, a hospital that performs a large number of complex procedures on very sick patients would be expected to have a higher infection rate than a hospital that performs more routine procedures on healthier patients. Therefore, before comparing the infection rates of hospitals, it is important to adjust for the number and proportion of high- and low-risk patients by using risk adjustment methods. Different risk adjustment methods are used for different types of HAIs.

Standardized Infection Ratio (SIR)

The SIR is a summary measure that can be used to track HAIs over time and can be calculated on a variety of levels, including unit, facility, state, and nation. It adjusts for differences between healthcare facilities such as types of patients and procedures, as well as other factors that may affect the risk of developing HAIs.

The SIR is calculated by dividing the number of observed infections by the number of statistically predicted infections based on the National Healthcare Safety Network (NHSN) standard population and appropriate patient and facility-level risk adjustment:

• A SIR of 1.0 means the observed number of infections is equal to the number of predicted infections
• A SIR greater than 1.0 means there were more infections than predicted. For example, if a facility has a CLABSI SIR=1.5, they experienced 50% more CLABSIs than predicted.
• A SIR less than 1.0 means there were fewer infections than predicted. For example, if a facility has a CLABSI SIR=0.8, they experienced 20% fewer CLABSIs than predicted.

Example to illustrate how to read Hospital-Specific SIR

Hospital A has 30% more infections than predicted during the surveillance period.
Hospital B has 50% fewer infections than predicted during the surveillance period.