National Targets and Metrics

In October 2016, the U.S. Department of Health and Human Services (HHS) announced new targets for the national acute care hospital metrics for the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination (HAI Action Plan). The targets use data from calendar year 2015 as a baseline — and they replace the previous targets that expired in December 2013. These target goals for reduction of health care-associated infections (HAIs) are ambitious but achievable.

The measures will track population-based harm from HAIs at the national level. These measures address the following goals from the HAI Action Plan:

The initial set of acute care hospital targets and metrics included a measure on Surgical Care Improvement Project (SCIP) processes. That measure is no longer part of the HAI Action Plan because these processes are now widely accepted as standards of practice.

Table 1: 2013 Targets and Progress Made by 2014

Measure (and data source)

Original target for 2013 (from 2009 baseline)

Progress made by 2014

CLABSI (NHSN1)

50% reduction

50% reduction

CAUTI (NHSN)

25% reduction

No change

Invasive MRSA (NHSN/EIP)

50% reduction

36% reduction

Facility-onset MRSA (NHSN)

25% reduction

13% reduction

CDI (NHSN)

30% reduction

8% reduction

SSI (NHSN)

25% reduction

18% reduction

Clostridium difficile hospitalizations (HCUP2)

30% reduction

18% increase

Table 2: New Targets

Measure (and data source)

2020 Target (from 2015 baseline)

CLABSI (NHSN)

50% reduction

CAUTI (NHSN)

25% reduction

Invasive MRSA (NHSN/EIP)

50% reduction

Facility-onset MRSA (NHSN)

50% reduction

CDI (NHSN)

30% reduction

SSI (NHSN)

30% reduction

Clostridium difficile hospitalizations (HCUP)

30% reduction

As indicated in the table above, the new targets start from a new baseline — and, in some cases, are more aggressive than the previous targets.

Progress in reducing HAIs will be tracked using a standardized infection ratio (SIR). The SIR compares the actual number of HAIs to the predicted number of infections. The predicted number is a risk-adjusted estimate that is determined using national baseline data.

Antibiotic Stewardship

Antibiotic overuse has contributed to the growing problem of C. difficile infection and antibiotic resistance. Although progress has been made, more work is needed to address Clostridium difficile infection and CAUTI. In response to this challenge, the Agency for Healthcare Research and Quality (AHRQ), the Centers for Disease Control and Prevention (CDC), and the Centers for Medicare & Medicaid Services (CMS) have developed initiatives for antibiotic stewardship.

1 NHSN: The National Healthcare Safety Network, of the Centers for Disease Control and Prevention (CDC), is the nation’s most widely used health care-associated infection tracking system. Since 2009, infection data has been reported to the NHSN to track the national progress of the reduction of HAIs.

2 HCUP: AHRQ’s Healthcare Cost and Utilization Project is the nation’s most comprehensive source of hospital data. HCUP data is used to track hospitalizations due to Clostridium difficile.

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