Taking advantage of public reporting: An infection composite score to assist evaluating hospital performance for infection prevention efforts.

Background: The standardized infection ratio (SIR) evaluates individual publicly reported health care-associated infections, but it may not assess overall performance.

Methods: We piloted an infection composite score (ICS) in 82 hospitals of a single health system. The ICS is a combined score for central line-associated bloodstream infections, catheter-associated urinary tract infections, colon and abdominal hysterectomy surgical site infections, and hospital-onset methicillin-resistant Staphylococcus aureus bacteremia and Clostridium difficile infections. Individual facility ICSs were calculated by normalizing each of the 6 SIR events to the system SIR for baseline and performance periods (ICS and ICS, respectively). A hospital ICS reflected its baseline performance compared with system baseline, whereas a ICS provided information of its outcome changes compared with system baseline.

Results: Both the ICS (baseline 2013) and ICS (performance 2014) were calculated for 63 hospitals (reporting at least 4 of the 6 event types). The ICS improved in 36 of 63 (57.1%) hospitals in 2014 when compared with the ICS in 2013. The ICS 2013 median was 0.96 (range, 0.13-2.94) versus the 2014 ICS median of 0.92 (range, 0-6.55). Variation was more evident in hospitals with ≤100 beds. The system performance score (ICS) in 2014 was 0.95, a 5% improvement compared with 2013.

Conclusions: The proposed ICS may help large health systems and state hospital associations better evaluate key infectious outcomes, comparing them with historic and concurrent performance of peers.