823 - How to Compare standardized Healthcare-associated Infection (HAI) Rates? Benchmark 2D and 3D

Background: External benchmarking involves comparing standardized data on HAI rates in one hospital or healthcare facility in relation to others. Here we present two epidemiological graphical tools, 2D and 3D benchmarks, which summarize the efficiency in preventing main infections in a Medical/Surgical Intensive Care Unit (MSICU).

Methods: The 3D benchmark graph considers the incidence density rate of ventilator-associated pneumonias (VAP cases per 1,000 ventilator-days) as the X-Axis, the incidence density rate of central line-associated primary bloodstream infections (CLABSI cases per 1,000 central line-days) as the Y-Axis, and the incidence density rate of urinary catheter-associated urinary tract infections (CAUTI per 1,000 urinary catheter-days) as the Z-Axis. Efficiency in preventing infection (e) considers the zero rate to be 100% efficient (e=100%) and the highest available benchmark rate to be “zero” efficiency (RMax: e=0%). From this definition, the efficiency of any MSICU (0% ≤ e ≤ 100%) is obtained using a linear interpolation function, from the rate observed in the MSICU under evaluation (Rx): e = 100x(RMax – Rx)/RMax. If Rx > RMax, then RMax = Rx. The 3D benchmark is build by calculating the preventing infection (e) for each infection (VAP, CLABSI, and CAUTI) for all benchmarks and for the MSICU under evaluation. In the 3D Benchmark, three control volumes are created: “Infection Control Urgency” volume, “Infection Control Excellence” volume, “Infection Prevention Opportunity” volume. Benchmark 2D considers only the VAP density rate as X-Axis, and the CLABSI density rate as Y-Axis. In this graph, five control regions are created: 1=excellence in the control of VAP+CLABSI; 2=excellence in VAP control and opportunity for CLABSI prevention; 3=excellence in CLABSI control and opportunity to prevent VAP; 4=opportunity to prevent VAP+CLABSI; 5=urgency in infection control.

Results: Graph parameters were based on NHSN data from the device-associated module, NOIS Project, Anahp, CQH, and GVIMS/GGTES/ANVISA (Brazilian benchmarks), and El-Saed et al. benchmarks. We applied the 2D/3D benchmarks to several Brazilian ICUs.2D benchmark for the MSICUs from Lifecenter Hospital, Brazil, Jan-Dez/2019: UCO & UTI 19 =excellence in CLABSI control and opportunity to prevent VAP; UTI 20=excellence in VAP control and opportunity for CLABSI prevention; UTI 18=opportunity to prevent VAP+CLABSI.
3D benchmark for the MSICUs from Lifecenter Hospital, Brazil, Jan-Dez/2019
2D benchmark for the MSICUs from Vera Cruz Hospital, Brazil, Jan-Dez/2019: CTI 3.o Andar =excellence in the control of VAP+CLABSI; CTI 1.o Andar=excellence in VAP control and opportunity for CLABSI prevention.


Conclusion: 2D and 3D benchmarks are easy to understand and summarize the efficiency in prevention the mains infections of MSICU.