Hospital-Acquired Infections

in New York State, 2018

Part 2: Technical Report

7

November 2019
Table of Contents
Introduction .................................................................................................................................................................3

Surgical Site Infections (SSIs) ..................................................................................................................................5

Colon Surgical Site Infections...................................................................................................................................6
Coronary Artery Bypass Graft (CABG) Surgical Site Infections ............................................................................ 14
Hip Replacement/Revision Surgical Site Infections .............................................................................................. 23
Abdominal Hysterectomy Surgical Site Infections .................................................................................................. 31

Central Line-Associated Bloodstream Infections (CLABSIs) ........................................................................... 39

Catheter-Associated Urinary Tract Infections (CAUTIs) .................................................................................. 64

Infections from Clostridioides difficile and Multidrug Resistant Organisms (MDROs)............................... 67

Clostridioides difficile Infections (CDI) .................................................................................................................. 69
Carbapenem-resistant Enterobacteriaceae (CRE) Infections ............................................................................... 83
Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections ........................................................ 99
Candida auris infections ....................................................................................................................................... 101
Mortality related to CDI and MDROs................................................................................................................... 108
MDRO Prevention Practices ................................................................................................................................. 109

Antimicrobial Stewardship and Use ...................................................................................................................... 110

Comparison of NYS HAI Rates with National HAI Rates ................................................................................... 115

Infection Prevention Resources .............................................................................................................................. 117

HAI Prevention Projects ....................................................................................................................................... 124

Summary .................................................................................................................................................................. 126

Recommendations and Next Steps ......................................................................................................................... 128

Appendix 1: List of Abbreviations ....................................................................................................................... 129

Appendix 2: Glossary of Terms ........................................................................................................................... 131

Appendix 3: Methods ............................................................................................................................................ 137

Data Validation ................................................................................................................................................. 137
Risk Adjustment ............................................................................................................................................... 140
Attributable Mortality of CDI/MDROs ............................................................................................................ 143
Comparison of NYS and CMS HAI Reporting ................................................................................................. 144

Appendix 4: List of Hospitals by County ............................................................................................................ 147

Acknowledgements ............................................................................................................................................... 152

References ................................................................................................................................................................ 153

 Introduction
In accordance with Public Health Law 2819, New York State (NYS) has been tracking hospital-
acquired infections (HAIs) since 2007. This law was created to provide the public with fair,
accurate, and reliable HAI data to compare hospital infection rates and to support quality
improvement and infection prevention activities in hospitals.

The NYS Department of Health (NYSDOH) evaluates which HAI indicators should be reported
annually with the help of a Technical Advisory Workgroup (TAW), a panel of experts in the
prevention and reporting of HAIs. In addition to reporting the HAI data mandated by NYS,
hospitals enter data into NHSN for federal programs (e.g. Centers for Medicare and Medicaid
Services [CMS]), regional collaboratives, and local surveillance. NYSDOH can access this other
data (i.e. data not mandated by NYS) through a data use agreement (DUA) with the Centers for
Disease Control and Prevention (CDC). The DUA specifies that DOH may only use this other
data for surveillance or prevention purposes, not for public reporting of facility-specific data or
for regulatory action. NYSDOH does not audit this data. The data are only reported in
aggregate. More information about the DUA is available on the CDC website at
https://www.cdc.gov/hai/pdfs/stateplans/New-York_DUA.pdf.

Table 1 summarizes the progression of NYS reporting requirements through 2018 and includes
additional data visible through the DUA.

Table 1. Hospital-acquired infections reported by New York State hospitals, by year

Type of Infection 2010- 2015-
2007 2008 2009 2012 2013 2014
2011 2018
Central line-associated bloodstream infections in ICUs P1       
Colon surgical site infections P1       
Coronary artery bypass graft surgical site infections P1       
Hip replacement surgical site infections       
Clostridioides difficile infections P2     
Abdominal hysterectomy surgical site infections    
Carbapenem-resistant Enterobacteriaceae infections P2  
Central line-associated bloodstream infections in wards DUA DUA 
Catheter-associated urinary tract infections DUA DUA DUA
Methicillin-resistant Staphylococcus aureus bacteremia DUA DUA DUA
 = full reporting (publish hospital-specific rates)
P1 = pilot reporting full year (do not publish hospital-specific rates)
P2 = pilot reporting half year from July (do not publish hospital-specific rates)
DUA = Not required by New York, but reported for Centers for Medicare and Medicaid Services
programs and visible through data use agreement between CDC and NYS beginning May 2013.

3
This report focuses on HAI rates in NYS hospitals in 2018. The detailed information is
primarily intended for use by hospital infection preventionists (IPs), but it may also be used by
others who want more detailed information than is available in “Part 1: Summary for
Consumers”.

Because of substantive changes to HAI surveillance definitions that occurred between 2007 and
2015, state and federal agencies designated 2015 as the “baseline” for assessment of trends. This
baseline will be used until surveillance definitions change such that the comparisons are no
longer valid, or until policy changes require a new baseline. This report will assess trends
between 2015 and 2018. For information on HAI rates prior to 2015, please see the 2015 NYS
HAI Report.

4
Surgical Site Infections (SSIs)
For each type of SSI, the following pages present detailed information on the severity (depth) of
infections, the circumstance of detection (initial hospitalization, readmission, etc.), the
microorganisms involved, and time trends. In addition, detailed plots show each individual
hospital’s risk-adjusted infection rates compared to the state average.

SSIs are categorized into three groups depending on the severity of the infection:
• Superficial Incisional SSI - This infection occurs in the area of the skin where the
surgical incision was made. The patient may have pus draining from the incision or
laboratory-identified pathogens from cultures of the incision.
• Deep Incisional SSI - This infection occurs beneath the incision in muscle tissue. Pus
may drain from the incision, and patients may experience fever and pain. The incision
may reopen on its own, or a surgeon may reopen the wound.
• Organ or Space SSI - This type of infection occurs in body organs or the space between
organs. Pus may collect in an abscess below the muscles, resulting in inflammation and
pain.

Hospital IPs use a wide variety of surveillance methods to identify SSIs. Some routinely review
all procedures for SSIs, while others review a subset of procedures that are flagged based on data
mining systems, wound culture reports, readmission, return to surgery, and discharge coding.
IPs review the selected procedures using many data sources, including lab reports, operative
reports, physician dictated operative notes, progress notes, discharge notes, history and physical
examination documentation, return to surgery, radiology reports, infectious disease
consultations, intraoperative reports, outpatient/emergency room visits, documentation of vital
signs, antibiotic prescriptions, and coding summary sheets.

SSIs may be detected on the original hospital admission, readmission to the same hospital,
readmission to a different hospital, or only in outpatient settings (post-discharge surveillance and
not readmitted, [PDS]). The ability to identify SSIs among patients seen by physicians in
outpatient settings varies among hospitals. PDS infections are excluded from hospital-specific
comparisons in this report so as not to penalize facilities with the best surveillance systems.

If there is evidence of clinical infection or abscess at the time a surgical procedure is performed,
any resulting SSI will be designated as “present at time of surgery” (PATOS). The number of
PATOS SSIs are summarized for each type of procedure. Because PATOS SSIs are more
difficult to prevent, these SSIs and procedures are excluded from the final hospital risk-adjusted
rates.

5
Colon Surgical Site Infections
In 2018, 160 hospitals reported a total of 1,139 colon SSIs out of 19,732 procedures, a rate of 5.8
infections per 100 procedures. NYSDOH excludes some of these SSIs and procedures from SSI
rates before evaluating time trends and comparing hospital performance, as described below.

Of the 1,139 infections, 253 (22%) were classified as PATOS. The PATOS SSIs were
predominantly (87%) Organ/Space. At completion of the surgery 77% were primarily closed.
PATOS SSIs/procedures were excluded from the final SSI rate because these infections are more
difficult to prevent. However, to encourage hospitals to continue to implement prevention
efforts for these types of procedures, the number of excluded PATOS are listed in the hospital-
specific colon SSI rate plots at the end of the section.

Of the remaining 886 infections, 42% were superficial, 8% were deep, and 51% were
organ/space (Table 2). Most of the SSIs (58%) were detected during the initial hospitalization;
29% were identified upon readmission to the same hospital; 4% involved readmission to another
hospital; and 10% were detected using post-discharge surveillance and not readmitted. The
majority of the PDS infections were superficial. Detection of SSIs in outpatient locations is
labor intensive and is not standardized across hospitals; therefore, the NYSDOH did not include
these 88 PDS infections in the final SSI rate so as not to penalize facilities with the best
surveillance systems.

Table 2. Method of detection of colon surgical site infection by depth of infection,

New York State 2018

When Detected
Extent Post-
(Row%) Discharge
(Column%) Readmitted to Readmitted Surveillance
Initial the Same to Another Not
Hospitalization Hospital Hospital Readmitted Total
Superficial Incisional 182 86 14 87 369
(49.3%) (23.3%) (3.8%) (23.6%) (41.6%)
(35.5%) (33.9%) (45.2%) (98.9%)
Deep Incisional 40 25 2 1 68
(58.8%) (36.8%) (2.9%) (1.5%) (7.7%)
(7.8%) (9.8%) (6.5%) (1.1%)
Organ/Space 291 143 15 0 449
(64.8%) (31.8%) (3.3%) (0.0%) (50.7%)
(56.7%) (56.3%) (48.4%) (0.0%)
Total 513 254 31 88 886
(57.9%) (28.7%) (3.5%) (9.9%)
New York State data reported as of June 27, 2019. Excludes infections present at time of surgery.

6
Trends in colon SSI rates after deleting PATOS and PDS infections are show in Figure 1.
Between 2015 and 2018, the colon surgical site infection rate declined 27%, from 5.63 infections
per 100 procedures in 2015, to 4.10 infections per 100 procedures in 2018.

Figure 1. Trend in colon surgical site infection rates, New York State 2015-2018
Excluding infections present at time of surgery or detected in outpatient settings without readmission

# # # Infection Rate
Year Hospitals Infections Procedures (95% Confidence Interval)
2015 160 1,047 18,611 5.63 (5.30, 5.97)
2016 161 994 19,910 4.99 (4.69, 5.30)
2017 162 881 19,594 4.50 (4.21, 4.80)
2018 160 798 19,479 4.10 (3.82, 4.38)
New York State data reported as of June 27, 2019. Infection rate is the number of infections divided by the
number of procedures, multiplied by 100.

7
The most common microorganisms associated with colon SSIs were Enterococci and
Escherichia coli (Table 3).

Table 3. Microorganisms identified in colon surgical site infections,

New York State 2018

Number of Percent of
Microorganism Isolates Infections
Enterococci 378 33.2
(VRE) (85) (7.5)
Escherichia coli 322 28.3
(CRE-E. coli) (3) (0.3)
Yeast 112 9.8
(Candida auris) (1) (0.1)
Staphylococcus aureus 98 8.6
(MRSA) (58) (5.1)
Bacteroides spp. 94 8.3
Klebsiella spp. 89 7.8
(CRE-Klebsiella) (4) (0.4)
Pseudomonas spp. 88 7.7
Streptococci 74 6.5
Enterobacter spp. 60 5.3
(CRE-Enterobacter) (8) (0.7)
Coagulase negative staphylococci 59 5.2
Proteus spp. 31 2.7
Clostridium spp. 21 1.8
Morganella morganii 18 1.6
Citrobacter spp. 14 1.2
Prevotella spp. 12 1.1
Lactobacilli 7 0.6
Actinomyces spp. 5 0.4
Corynebacteria 5 0.4
Stenotrophomonas spp. 5 0.4
Acinetobacter spp. 4 0.4
(MDR-Acinetobacter) (3) (0.3)
Other 42 3.7
New York State data reported as of June 27, 2019. Out of 1,139 infections, no
microorganisms identified for 242 (21%) infections. VRE: vancomycin-resistant
enterococci; CRE: carbapenem-resistant Enterobacteriaceae; MRSA: methicillin-
resistant Staphylococcus aureus; MDR: multidrug resistant; spp: multiple species

8
Risk-Adjustment for Colon SSIs
The following risk factors were associated with these SSIs and included in the risk-adjustment
model:

• For each increase in American Society of Anesthesiologists (ASA) score (1, 2, 3/4/5), a
measure of systemic disease, patients were 1.4 times more likely to develop an SSI.
• Procedures that used traditional surgical incisions were 1.7 times more likely to result in
SSI than procedures performed entirely with a laparoscopic instrument.
• Obese patients (with body mass index [BMI] greater than 30) were 1.3 times more likely
to develop an SSI than patients with BMI less than or equal to 30.
• Procedures with duration greater than four hours were 1.9 times more likely to result in
SSI than procedures less than two hours. Procedures with duration between two and four
hours were 1.2 times more likely to result in SSI than procedures less than two hours.
• Patients who experienced trauma (i.e. a blunt or penetrating injury) prior to the procedure
were 1.5 times more likely to develop an SSI than other patients.

Hospital-Specific Colon SSI Rates

Hospital-specific colon SSI rates are provided in Figure 2. Of the 132 hospitals that reported
more than twenty procedures, five hospitals (4%) had colon SSI rates that were statistically
higher than the state average. All five hospitals will submit improvement plans following the
NYSDOH HAI Reporting Program’s Policy for Facilities with Consecutive Years of High HAI
Rates. Six hospitals (5%) had rates that were statistically lower than the state average. One
hospital (Roswell Park) was significantly high for 3 consecutive years, and one hospital (Vassar
Brothers Medical Center) was significantly low for 3 consecutive years.

9
 Figure 2. Colon surgical site infection rates, New York 2018 (page 1 of 4)

Data reported as of June 27, 2019. ┇State Average. ●Risk-adjusted Infection rate. ▬^^Significantly higher than state average.
▬**Significantly lower than state average. ▬Average. > Upper confidence limit exceeds graph area. NA: less than 20 procedures.
SSI: surgical site infections, Procs: procedures. Rates are per 100 procedures. Adjusted using ASA score, obesity, duration, trauma, and
endoscope. Excludes SSIs present at time of surgery and non-readmitted cases identified using post discharge surveillance.

10
 Figure 2. Colon surgical site infection rates, New York 2018 (page 2 of 4)

Data reported as of June 27, 2019. ┇State Average. ●Risk-adjusted Infection rate. ▬^^Significantly higher than state average.
▬**Significantly lower than state average. ▬Average. > Upper confidence limit exceeds graph area. NA: less than 20 procedures.
SSI: surgical site infections, Procs: procedures. Rates are per 100 procedures. Adjusted using ASA score, obesity, duration, trauma, and
endoscope. Excludes SSIs present at time of surgery and non-readmitted cases identified using post discharge surveillance.

11
 Figure 2. Colon surgical site infection rates, New York 2018 (page 3 of 4)

Data reported as of June 27, 2019. ┇State Average. ●Risk-adjusted Infection rate. ▬^^Significantly higher than state average.
▬**Significantly lower than state average. ▬Average. > Upper confidence limit exceeds graph area. NA: less than 20 procedures.
SSI: surgical site infections, Procs: procedures. Rates are per 100 procedures. Adjusted using ASA score, obesity, duration, trauma, and
endoscope. Excludes SSIs present at time of surgery and non-readmitted cases identified using post discharge surveillance.

12
 Figure 2. Colon surgical site infection rates, New York 2018 (page 4 of 4)

Data reported as of June 27, 2019. ┇State Average. ●Risk-adjusted Infection rate. ▬^^Significantly higher than state average.
▬**Significantly lower than state average. ▬Average. > Upper confidence limit exceeds graph area. NA: less than 20 procedures.
SSI: surgical site infections, Procs: procedures. Rates are per 100 procedures. Adjusted using ASA score, obesity, duration, trauma, and
endoscope. Excludes SSIs present at time of surgery and non-readmitted cases identified using post discharge surveillance.

13
Coronary Artery Bypass Graft (CABG) Surgical Site
Infections
CABG surgery usually involves two surgical sites: a chest incision and a separate site to harvest
“donor” vessels. Because infections can occur at either incision site the SSI rates are presented
separately.

CABG Chest Infections

In 2018, 37 hospitals reported a total of 159 CABG chest surgical site infections out of 10,540
procedures, a rate of 1.5 infections per 100 procedures. NYSDOH excludes some of these SSIs
and procedures from SSI rates before evaluating time trends and comparing hospital
performance, as described below.

Of the 159 infections, none were classified as PATOS, and 38% were superficial, 33% were
deep, and 30% were organ/space (Table 4). Most of the SSIs (70%) were detected upon
readmission to the same hospital; 16% were identified during the initial hospitalization; 7%
involved readmission to another hospital; and 7% were detected using PDS and not readmitted.
Detection of SSIs in outpatient locations is labor intensive and is not standardized across
hospitals; therefore, the NYSDOH did not include these 11 PDS infections in the final SSI rate
so as not to penalize facilities with the best surveillance systems.

Table 4. Method of detection of coronary artery bypass graft chest-site surgical site
infection by depth of infection, New York State 2018

When Detected
Extent Post-
(Row%) Discharge
(Column%) Readmitted to Readmitted Surveillance
Initial the Same to Another Not
Hospitalization Hospital Hospital Readmitted Total
Superficial Incisional 10 34 5 11 60
(16.7%) (56.7%) (8.3%) (18.3%) (37.7%)
(38.5%) (30.6%) (45.5%) (100.0%)
Deep Incisional 9 39 4 0 52
(17.3%) (75.0%) (7.7%) (0%) (32.7%)
(34.6%) (35.1%) (36.4%) (0%)
Organ/Space 7 38 2 0 47
(14.9%) (80.9%) (4.3%) (0%) (29.6%)
(26.9%) (34.2%) (18.2%) (0%)
Total 26 111 11 11 159
(16.4%) (69.8%) (6.9%) (6.9%)
New York State data reported as of June 27, 2019. Excludes infections present at time of surgery.

14
Trends in CABG chest SSI rates after deleting PATOS and PDS infections are shown in Figure
3. Between 2015 and 2018, the total number of CABG chest SSIs declined 23%, with 1.83
infections per 100 procedures in 2015, and 1.40 infections per 100 procedures in 2018.

Figure 3. Trend in coronary artery bypass graph chest site surgical site infection rates, New
York State 2015-2018
Excluding infections present at time of surgery or detected in outpatient settings without readmission

2
Infection Rate

Mean 95% Confidence Interval

0

2015 2016 2017 2018

Year

# # # Infection Rate
Year Hospitals Infections Procedures (95% Confidence Interval)
2015 38 196 10,735 1.83 (1.58, 2.10)
2016 37 172 11,040 1.56 (1.34, 1.81)
2017 36 167 10,849 1.54 (1.32, 1.79)
2018 37 148 10,540 1.40 (1.19, 1.65)
New York State data reported as of June 27, 2019.
Infection rate is the number of infections divided by the number of procedures, multiplied by 100.

15
In NYS, the most common microorganisms associated with CABG chest SSIs were
Staphylococcus aureus and coagulase-negative staphylococci (Table 5).

Table 5. Microorganisms identified in coronary artery bypass graft chest site infections,
New York State 2018
Number
of Percent of
Microorganism Isolates Infections
Staphylococcus aureus 56 35.2
(MRSA) (21) (13.2)
Coagulase negative staphylococci 28 17.6
Pseudomonas spp. 16 10.1
Serratia spp. 12 7.5
Enterobacter spp. 9 5.7
Escherichia coli 9 5.7
Klebsiella spp. 9 5.7
Proteus spp. 5 3.1
Enterococci 4 2.5
Acinetobacter spp. 2 1.3
(MDR-Acinetobacter) (1) (0.6)
Other 19 11.9
New York State data reported as of June 27, 2019. Out of 159 infections. No
microorganisms identified for 30 (19%) infections. MRSA: methicillin-resistant
Staphylococcus aureus; MDR: multidrug resistant

Risk Adjustment for CABG Chest SSIs

Certain patient and procedure-specific risk factors increased the risk of developing a chest SSI
following CABG surgery. In 2018, the following risk factors were associated with SSIs and
were included in the risk-adjustment:

• Patients with diabetes were 2.3 times more likely to develop an SSI than patients without
diabetes.
• Obese patients (with body mass index [BMI] greater than or equal to 30) were 1.4 times
more likely to develop an SSI than patients with BMI less than 30.
• Females were 2.1 times more likely to develop an SSI than males.
• Patients who experienced trauma (i.e. a blunt or penetrating injury) prior to the procedure
were 3.3 times more likely to develop an SSI than other patients.

16
Hospital-Specific CABG Chest SSI Rates

Hospital-specific CABG chest SSI rates are provided in Figure 4. In 2018, of the 36 reporting
hospitals, two (6%) had a CABG chest SSI rate that was statistically higher than the state
average. These hospitals will submit improvement plans following the NYSDOH HAI
Reporting Program’s Policy for Facilities with Consecutive Years of High HAI Rates.
Three hospitals (8%) were statistically lower than the state average. No hospitals were flagged
high or low for more than two consecutive years.

17
Figure 4. Coronary artery bypass graft chest site infection rates, New York 2018

Data reported as of June 27, 2019. ┇State Average. ●Risk-adjusted Infection rate. ▬^^Significantly higher than state average.
▬**Significantly lower than state average. ▬Average. > Upper confidence limit exceeds graph area. NA: less than 20 procedures.
SSI: surgical site infections, Procs: procedures. Rates are per 100 procedures. Adjusted using diabetes, obesity, gender, and trauma.
Excludes SSIs present at time of surgery (PATOS) and non-readmitted cases identified using post discharge surveillance (PDS).

18
CABG Donor Site Infections

In 2018, 36 hospitals reported a total of 35 CABG donor site infections out of 9,410 procedures,
a rate of 0.37 infections per 100 procedures. None of the infections were classified as PATOS.

Of the 35 infections, 83% were superficial, and 17% were deep (Table 6). Most of the SSIs
(77%) were detected upon readmission to the same hospital; 9% were identified during the initial
hospitalization; 6% involved readmission to another hospital; and 9% were detected using PDS
and not readmitted. Detection of SSIs in outpatient locations is labor intensive and is not
standardized across hospitals; therefore, the NYSDOH did not include these 3 PDS infections in
the final SSI rate so as not to penalize facilities with the best surveillance systems.

Table 6. Method of detection for coronary artery bypass graft donor site infection by depth
of infection, New York State 2018

When Detected
Extent Readmitted to Readmitted Post-Discharge
(Row%) Initial the Same to Another Surveillance Not
(Column%) Hospitalization Hospital Hospital Readmitted Total
Superficial Incisional 3 22 1 3 29
(10.3%) (75.9%) (3.4%) (10.3%) (82.9%)
(100.0%) (81.5%) (50.0%) (100.0%)
Deep Incisional 0 5 1 0 6
(0.0%) (83.3%) (16.7%) (0%) (17.1%)
(0.0%) (18.5%) (50.0%) (0%)
Total 3 27 2 3 35
(8.6%) (77.1%) (5.7%) (8.6%)
New York State data reported as of June 27, 2019. Excludes infections present at time of surgery.

Trends in CABG SSI rates are shown in Figure 5. Between 2015 and 2018, the total number of
CABG donor site infection rate decreased 33%, from 0.51 infections per 100 procedures in 2015,
to 0.34 infections per 100 procedures in 2018.

19
Figure 5. Trend in coronary artery bypass graft donor site surgical site infection rates, New
York State 2015-2018
Excluding infections present at time of surgery or detected in outpatient settings without readmission

# # # Infection Rate
Year Hospitals Infections Procedures (95% Confidence Interval)
2015 38 49 9,558 0.51 (0.38, 0.68)
2016 37 33 9,801 0.34 (0.23, 0.47)
2017 36 47 9,559 0.49 (0.36, 0.65)
2018 36 32 9,410 0.34 (0.23, 0.48)
New York State data reported as of June 27, 2019.
Infection rate is the number of infections divided by the number of procedures, multiplied by 100.

Klebsiella spp., Escherichia coli, and Staphylococcus aureus were the most common
microorganisms associated with CABG donor site SSIs. (Table 7).

20
Table 7. Microorganisms identified in coronary artery bypass graft donor site infections,
New York State 2018

Number
of Percent of
Microorganism Isolates Infections
Klebsiella spp. 7 20.0
Escherichia coli 6 17.1
Staphylococcus aureus 6 17.1
(MRSA) (1) (2.9)
Pseudomonas spp. 5 14.3
Enterococci 2 5.7
Enterobacter spp. 1 2.9
Other 12 34.3
New York State data reported as of June 27, 2019. Out of 35 infections. No
microorganisms identified for 9 (26%) infections. MRSA: methicillin-resistant
Staphylococcus aureus; spp: multiples species.

Risk Adjustment for CABG Donor Site SSIs

Certain patient and procedure-specific factors increased the risk of developing a donor site SSI
following CABG surgery. In 2018, after excluding SSIs identified using PDS that did not result
in hospitalization, the following risk factors were associated with SSI. These variables were
used to risk-adjust hospital-specific rates:
• Obese patients (with BMI at least 30) were 2.1 times more likely to develop an SSI than
patients with BMI less than 30.
• Patients with diabetes were 2.0 times more likely to develop an SSI than patients without
diabetes.

Hospital-Specific CABG Donor Site SSI rates

Hospital-specific CABG donor site SSI rates are provided in Figure 6. In 2018, no hospitals
were flagged for having a significantly high or low rate.

21
Figure 6. Coronary artery bypass graft donor site infection rates, New York 2018

Data reported as of June 27, 2019. ┇State Average. ●Risk-adjusted Infection rate. ▬^^Significantly higher than state average.
▬**Significantly lower than state average. ▬Average. > Upper confidence limit exceeds graph area. NA: less than 20 procedures.
SSI: surgical site infections, Procs: procedures. Rates are per 100 procedures. Adjusted using obesity and diabetes. Excludes SSIs
present at time of surgery (PATOS) and post discharge surveillance non–readmitted cases (PDS).

22
Hip Replacement/Revision Surgical Site Infections
In 2018, 154 hospitals reported a total of 372 hip replacement/revision surgical site infections out
of 35,252 procedures, a rate of 1.1 infections per 100 procedures. NYSDOH excludes some of
these SSIs and procedures from SSI rates before evaluating time trends and comparing hospital
performance, as described below.

Of the 372 infections, 11 were classified as PATOS and excluded from further analysis, because
PATOS infections are more difficult to prevent.

Of the remaining 361 infections, 30% were superficial, 27% were deep, and 43% were
organ/space (Table 8). Most of the SSIs (82%) were detected upon readmission to the same
hospital; 4% were identified during the initial hospitalization; 8% involved readmission to
another hospital; and 6% were detected using PDS and not readmitted. The majority (61%) of
the PDS infections were superficial. Detection of SSIs in outpatient locations is labor intensive
and is not standardized across hospitals; therefore, the NYSDOH did not include these 23 PDS
infections in the final SSI rate so as not to penalize facilities with the best surveillance systems.

Table 8. Method of detection of hip surgical site infection by depth of infection,

New York State 2018

When Detected
Extent Post-
(Row%) Discharge
(Column%) Readmitted to Readmitted Surveillance
Initial the Same to Another Not
Hospitalization Hospital Hospital Readmitted Total
Superficial Incisional 6 77 10 14 107
(5.6%) (72.0%) (9.3%) (13.1%) (29.6%)
(46.2%) (25.9%) (35.7%) (60.9%)
Deep Incisional 4 79 5 9 97
(4.1%) (81.4%) (5.2%) (9.3%) (26.9%)
(30.8%) (26.6%) (17.9%) (39.1%)
Organ/Space 3 141 13 0 157
(1.9%) (89.8) (8.3%) (0%) (43.5%)
(23.1%) (47.5%) (46.4%) (0 %)
Total 13 297 28 23 361
(3.6%) (82.3%) (7.8%) (6.4%)
New York State data reported as of June 27, 2019. Excludes infections present at time of surgery.

23
Trends in hip SSI rates after deleting PATOS and PDS infections are shown in Figure 7.
Between 2015 and 2018, the total number of hip surgical site infections remained the same, at
0.96 infections per 100 procedures.

Figure 7. Trend in hip surgical site infection rates, New York State 2015-2018
Excluding infections present at time of surgery or detected in outpatient settings without readmission

# # # Infection Rate
Year Hospitals Infections Procedures (95% Confidence Interval)
2015 158 318 33,294 0.955 (0.85, 1.07)
2016 157 267 33,811 0.790 (0.70, 0.89)
2017 157 317 34,883 0.909 (0.81, 1.01)
2018 154 338 35,241 0.959 (0.86, 1.07)
New York State Data reported as of June 27, 2019.
Infection rate is the number of infections divided by the number of procedures, multiplied by 100.

24
Microorganisms Associated with Hip SSIs

The most common microorganism associated with hip SSIs was Staphylococcus aureus (Table
9).

Table 9. Microorganisms identified in hip replacement surgical site infections,

New York State 2018

Number
of Percent of
Microorganism Isolates Infections
Staphylococcus aureus 160 43.0
(MRSA) (63) (16.9)
Coagulase negative staphylococci 55 14.8
Enterococci 37 9.9
(VRE) (4) (1.1)
Pseudomonas spp. 34 9.1
Escherichia coli 27 7.3
Streptococci 27 7.3
Enterobacter spp. 15 4.0
Proteus spp. 14 3.8
Klebsiella spp. 13 3.5
(CRE-Klebsiella) (1) (0.3)
Serratia spp. 13 3.5
Corynebacteria 11 3.0
Yeast 5 1.3
Acinetobacter spp. 3 0.8
(MDR-Acinetobacter) (1) (0.3)
Other 24 6.5
New York State data reported as of June 27, 2019. Out of 372 infections. No
microorganisms identified for 30 (8%) infections. CRE: carbapenem-resistant
Enterobacteriaceae; VRE: vancomycin-resistant enterococci; MRSA: methicillin-
resistant Staphylococcus aureus; MDR: multidrug resistant; spp: multiple species.

25
Risk Adjustment for Hip Surgical Site Infections

Certain patient and procedure-specific factors increased the risk of developing an SSI following
hip surgery. In 2018, after excluding SSIs identified using PDS that did not result in
hospitalization, and SSIs that were PATOS, the following risk factors were associated with SSIs.
These variables were used to risk-adjust hospital-specific rates.
• Patients with severe systemic disease (ASA score of 3, 4, or 5) were 1.7 times more
likely to develop an SSI than healthier patients (ASA score of 1 or 2).
• The risk of SSI varied by type of hip procedure. Compared to total and resurfacing
primary hip replacement procedures, partial primary procedures were 1.5 times more
likely to result in an SSI, revisions with no prior infection at the joint were 3.9 times
more likely to result in an SSI, and revisions with prior infection at the joint were 4.0
times more likely to result in an SSI.
• Very obese patients (with BMI greater than or equal to 40) were 3.0 times more likely to
develop an SSI, and obese patients (with BMI between 30 and 39) were 1.6 times more
likely to develop an SSI than patients with BMI less than 30.

Hospital-Specific Hip SSI Rates

Hospital-specific hip SSI rates are provided in Figure 8. Of the 141 hospitals that reported more
than twenty hip procedures in 2018, three hospitals (2%) had hip SSI rates that were statistically
higher than the state average. These hospitals will submit improvement plans following the
NYSDOH HAI Reporting Program’s Policy for Facilities with Consecutive Years of High HAI
Rates. Two hospitals (1%) had an SSI rate significantly lower than the state average; Hospital
for Special Surgery was significantly lower in each of the past eleven years (2008-2018).

26
 Figure 8. Hip replacement surgical site infection rates, New York 2018 (page 1 of 4)

Data reported as of June 27, 2019. ┇State Average. ●Risk-adjusted Infection rate. ▬^^Significantly higher than state average.
▬**Significantly lower than state average. ▬Average. > Upper confidence limit exceeds graph area. NA: less than 20 procedures.
SSI: surgical site infections, Procs: procedures. Rates are per 100 procedures. Adjusted using ASA score, procedure type, and obesity.
Excludes SSIs present at time of surgery and non-readmitted cases identified using post discharge surveillance.

27
 Figure 8. Hip replacement surgical site infection rates, New York 2018 (page 2 of 4)

Data reported as of June 27, 2019. ┇State Average. ●Risk-adjusted Infection rate. ▬^^Significantly higher than state average.
▬**Significantly lower than state average. ▬Average. > Upper confidence limit exceeds graph area. NA: less than 20 procedures.
SSI: surgical site infections, Procs: procedures. Rates are per 100 procedures. Adjusted using ASA score, procedure type, and obesity.
Excludes SSIs present at time of surgery and non-readmitted cases identified using post discharge surveillance.

28
 Figure 8. Hip replacement surgical site infection rates, New York 2018 (page 3 of 4)

Data reported as of June 27, 2019. ┇State Average. ●Risk-adjusted Infection rate. ▬^^Significantly higher than state average.
▬**Significantly lower than state average. ▬Average. > Upper confidence limit exceeds graph area. NA: less than 20 procedures.
SSI: surgical site infections, Procs: procedures. Rates are per 100 procedures. Adjusted using ASA score, procedure type, and obesity.
Excludes SSIs present at time of surgery and non-readmitted cases identified using post discharge surveillance.

29
 Figure 8. Hip replacement surgical site infection rates, New York 2018 (page 4 of 4)

Data reported as of June 27, 2019. ┇State Average. ●Risk-adjusted Infection rate. ▬^^Significantly higher than state average.
▬**Significantly lower than state average. ▬Average. > Upper confidence limit exceeds graph area. NA: less than 20 procedures.
SSI: surgical site infections, Procs: procedures. Rates are per 100 procedures. Adjusted using ASA score, procedure type, and obesity.
Excludes SSIs present at time of surgery and non-readmitted cases identified using post discharge surveillance.

30
Abdominal Hysterectomy Surgical Site Infections
In 2018, 149 hospitals reported a total of 267 hysterectomy surgical site infections out of 16,806
procedures, a rate of 1.6 infections per 100 procedures. NYSDOH excludes some of these SSIs
and procedures from SSI rates before evaluating time trends and comparing hospital
performance, as described below.

Of the 267 infections, three were classified as PATOS. PATOS SSIs/procedures were excluded
from the final SSI rate because these infections are more difficult to prevent. Of the remaining
264 infections, 49% were superficial, 8% were deep, and 42% were organ/space (Table 10).
Most of the SSIs (52%) were detected upon readmission to the same hospital; 11% were
identified during the initial hospitalization; 7% involved readmission to another hospital; and
30% were detected using post-discharge surveillance and not readmitted. Most (90%) of the
PDS infections were superficial. Detection of SSIs in outpatient locations is labor intensive and
is not standardized across hospitals; therefore, the NYSDOH did not include these 78 PDS
infections in the final SSI rate so as not to penalize facilities with the best surveillance systems.

Table 10. Method of detection of hysterectomy surgical site infection by depth of infection,
New York State 2018

When Detected
Extent Post-
(Row%) Discharge
(Column%) Readmitted to Readmitted Surveillance
Initial the Same to Another Not
Hospitalization Hospital Hospital Readmitted Total
Superficial Incisional 10 43 7 70 130
(7.7%) (33.1%) (5.4%) (53.8%) (49.2%)
(34.5%) (31.2%) (36.8%) (89.7%)
Deep Incisional 4 10 4 4 22
(18.2%) (45.5%) (18.2%) (18.2%) (8.3%)
(13.8%) (7.2%) (21.1%) (5.1%)
Organ/Space 15 85 8 4 112
(13.4%) (75.9%) (7.1%) (3.6%) (42.4%)
(51.7%) (61.6%) (42.1%) (5.1%)
Total 29 138 19 78 264
(11.0%) (52.3%) (7.2%) (29.6%)
New York State data reported as of June 27, 2019. Excludes infections present at time of surgery.

31
Trends in hysterectomy SSI rates after deleting PATOS and PDS infections are shown in Figure
9. Between 2015 and 2018 the total number of hysterectomy surgical site infections decreased
10%, from 1.23 infections per 100 procedures in 2015, to 1.11 infections per 100 procedures in
2018.

Figure 9. Trend in hysterectomy surgical site infection rates, New York State 2015-2018
Excluding infections present at time of surgery or detected in outpatient settings without readmission

# # # Infection Rate
Year Hospitals Infections Procedures (95% Confidence Interval)
2015 151 237 19,216 1.23 (1.08, 1.40)
2016 148 210 18,325 1.15 (1.00, 1.31)
2017 149 208 16,934 1.23 (1.07, 1.41)
2018 149 186 16,803 1.11 (0.95, 1.28)
New York State data reported as of June 27, 2019.
Infection rate is the number of infections divided by the number of procedures, multiplied by 100.

32
Microorganisms Associated with Hysterectomy SSIs

The most common microorganisms associated with hysterectomy SSIs were Enterococci and E.
coli (Table 11).

Table 11. Microorganisms identified in hysterectomy surgical site infections,

New York State 2018

Number
of Percent of
Microorganism Isolates Infections
Enterococci 45 16.9
(VRE) (2) (0.7)
Escherichia coli 44 16.5
Staphylococcus aureus 33 12.4
(MRSA) (10) (3.7)
Streptococci 33 12.4
Coagulase negative staphylococci 30 11.2
Bacteroides spp. 22 8.2
Klebsiella spp. 18 6.7
(CRE) (2) (0.7)
Proteus spp. 15 5.6
Pseudomonas spp. 12 4.5
Enterobacter spp. 11 4.1
Yeast 9 3.4
Citrobacter spp. 7 2.6
Corynebacterium spp. 7 2.6
Prevotella spp. 7 2.6
Other 24 9.0
New York State data reported as of June 27, 2019. Out of 267 infections. No
microorganisms identified for 72 (27%) infections. CRE: carbapenem-resistant
Enterobacteriaceae; MRSA: methicillin-resistant Staphylococcus aureus; VRE:
vancomycin-resistant enterococci; spp: multiple species

33
Risk Adjustment for Hysterectomy Surgical Site Infections

Certain patient and procedure-specific factors increased the risk of developing an SSI following
abdominal hysterectomy. In 2017, after excluding SSIs identified using PDS that did not result
in hospitalization and SSIs that were PATOS, the following risk factors were associated with
SSIs. These variables were used to risk-adjust hospital-specific rates.
• For each unit increase in ASA score (1, 2, 3, 4/5), a measure of systemic disease, patients
were 1.5 times more likely to develop an SSI.
• Procedures that involved traditional surgical incisions were 2.2 times more likely to result
in SSI than procedures performed entirely with a laparoscopic instrument.
• Patients with diabetes were 1.6 times more likely to develop an SSI than patients without
diabetes.
• Obese patients (with body mass index [BMI] greater than 30) were 2.0 times more likely
to develop an SSI than patients with BMI less than or equal to 30.
• Procedures with duration greater than three hours were 1.8 times more likely to result in
SSI than procedures less than three hours.

Hospital-Specific Hysterectomy SSI Rates

Hospital-specific hysterectomy SSI rates are provided in Figure 10. Of the 109 hospitals that
reported more than twenty procedures in 2018, four hospitals (4%) had a hysterectomy SSI rate
that was statistically higher than the state average. These four hospitals will submit
improvement plans following the NYSDOH HAI Reporting Program’s Policy for Facilities with
Consecutive Years of High HAI Rates. One hospital (1%) had an SSI rate that was significantly
lower than the state average. No hospitals were flagged high or low for more than two
consecutive years.

34
Figure 10. Abdominal hysterectomy surgical site infection rates, New York 2018 (page 1 of 4)

Data reported as of June 27, 2019. ┇State Average. ●Risk-adjusted Infection rate. ▬^^Significantly higher than state average.
▬**Significantly lower than state average. ▬Average. > Upper confidence limit exceeds graph area. NA: less than 20 procedures.
SSI: surgical site infections, Procs: procedures. Rates are per 100 procedures. Adjusted using ASA score, duration, diabetes, obesity, and
endoscope. Excludes SSIs present at time of surgery (PATOS) and non-readmitted cases identified using post discharge surveillance (PDS).

35
Figure 10. Abdominal hysterectomy surgical site infection rates, New York 2018 (page 2 of 4)

Data reported as of June 27, 2019. ┇State Average. ●Risk-adjusted Infection rate. ▬^^Significantly higher than state average.
▬**Significantly lower than state average. ▬Average. > Upper confidence limit exceeds graph area. NA: less than 20 procedures.
SSI: surgical site infections, Procs: procedures. Rates are per 100 procedures. Adjusted using ASA score, duration, diabetes, obesity, and
endoscope. Excludes SSIs present at time of surgery (PATOS) and non-readmitted cases identified using post discharge surveillance (PDS).

36
Figure 10. Abdominal hysterectomy surgical site infection rates, New York 2018 (page 3 of 4)

Data reported as of June 27, 2019. ┇State Average. ●Risk-adjusted Infection rate. ▬^^Significantly higher than state average.
▬**Significantly lower than state average. ▬Average. > Upper confidence limit exceeds graph area. NA: less than 20 procedures.
SSI: surgical site infections, Procs: procedures. Rates are per 100 procedures. Adjusted using ASA score, duration, diabetes, obesity, and
endoscope. Excludes SSIs present at time of surgery (PATOS) and non-readmitted cases identified using post discharge surveillance (PDS).

37
Figure 10. Abdominal hysterectomy surgical site infection rates, New York 2018 (page 4 of 4)

Data reported as of June 27, 2019. ┇State Average. ●Risk-adjusted Infection rate. ▬^^Significantly higher than state average.
▬**Significantly lower than state average. ▬Average. > Upper confidence limit exceeds graph area. NA: less than 20 procedures.
SSI: surgical site infections, Procs: procedures. Rates are per 100 procedures. Adjusted using ASA score, duration, diabetes, obesity, and
endoscope. Excludes SSIs present at time of surgery (PATOS) and non-readmitted cases identified using post discharge surveillance (PDS).

38
Central Line-Associated Bloodstream
Infections (CLABSIs)
In 2018, a total of 1,051 CLABSIs were associated with 1,294,898 days of central line use, for an
overall rate of 0.81 infections per 1,000 central line days in selected ICUs and wards.

In addition, a total of 81 mucosal barrier injury (MBI)-CLABSIs were reported. An MBI-

CLABSI is a type of CLABSI that can occur in cancer patients who have had stem cell
transplants or other patients with certain blood disorders. In these patients, BSIs are more likely
the result of organisms that enter the bloodstream from the gut, rather than organisms that enter
the bloodstream from the central line. HAI CLABSI surveillance is intended to capture BSIs that
are associated with the central line itself, so MBI-CLABSIs were excluded from CLABSI rates
beginning in 2015.

In 2018, NHSN began identifying and excluding from CLABSI rates BSIs occurring in patients
with ventricular assist devices (VAD) and/or extracorporeal membrane oxygenation (ECMO)
because patients who have these devices are at an increased risk of acquiring a BSI independent
of the presence of a central line. In 2018, 16 hospitals reported 30 ECMO BSIs, 22 VAD BSIs,
and 2 ECMO and VAD BSIs. This definition change resulted in a 5% decrease in the overall
CLABSI rate, and a 55% decrease in the rate in cardiothoracic ICUs, where ECMO and VAD are
most frequently used.

The 2015-2018 CLABSI, MBI, ECMO, VAD, and device utilization data are summarized by
location type in Figure 11. Including VAD and ECMO as CLABSIs for consistency in
definitions over time, the CLABSI rate steadily declined 24%, from 1.123 infections per 1,000
central line days in 2015, to 0.853 infections per 1,000 central line days in 2018.

39
 Figure 11. Central line-associated bloodstream infection (CLABSI) rates, New York State
2015-2018

CLABSI
# CLABSI Rate CLABSI Rate
excluding excluding # including Device
# ECMO/VAD # Central Line ECMO/VAD ECMO/ ECMO/VAD all Utilization
Year Hospitals starting 2018 Days starting 2018 # MBI VAD years # Patient Days ratio

Cardiothoracic ICU
2015 33 64 79,156 0.809 1 NA 0.809 112,709 70.2
2016 32 65 79,411 0.819 1 NA 0.819 111,186 71.4
2017 31 44 78,437 0.561 0 NA 0.561 114,241 68.7
2018 31 26 81,749 0.318 0 32 0.709 117,028 69.9

Coronary ICU
2015 39 48 45,986 1.044 0 NA 1.044 120,051 38.3
2016 35 64 42,059 1.522 0 NA 1.522 112,528 37.4
2017 34 55 37,965 1.449 0 NA 1.449 111,092 34.2
2018 35 44 37,294 1.180 0 0 1.180 108,899 34.2

Medical ICU

40
 CLABSI
# CLABSI Rate CLABSI Rate
excluding excluding # including Device
# ECMO/VAD # Central Line ECMO/VAD ECMO/ ECMO/VAD all Utilization
Year Hospitals starting 2018 Days starting 2018 # MBI VAD years # Patient Days ratio
2015 55 153 121,410 1.260 10 NA 1.260 251,564 48.3
2016 61 127 132,405 0.959 10 NA 0.959 275,727 48.0
2017 62 117 126,843 0.922 13 NA 0.922 275,285 46.1
2018 60 100 120,323 0.831 9 2 0.848 267,524 45.0

Medical Surgical ICU

2015 100 130 134,545 0.966 2 NA 0.966 317,598 42.4
2016 95 97 119,493 0.812 2 NA 0.812 293,048 40.8
2017 100 94 120,747 0.778 9 NA 0.778 293,092 41.2
2018 98 97 120,454 0.805 9 3 0.830 297,710 40.5

Neurosurgical ICU
2015 12 16 17,781 0.900 0 NA 0.900 49,593 35.9
2016 12 14 18,588 0.753 0 NA 0.753 51,259 36.3
2017 13 15 18,093 0.829 0 NA 0.829 51,992 34.8
2018 13 16 17,118 0.935 0 0 0.935 54,100 31.6

Pediatric ICU
2015 28 52 33,541 1.550 1 NA 1.550 90,551 37.0
2016 28 46 32,813 1.402 0 NA 1.402 93,349 35.2
2017 28 50 34,947 1.431 3 NA 1.431 97,260 35.9
2018 28 39 32,645 1.195 6 9 1.470 98,097 33.3

Surgical ICU
2015 41 81 76,345 1.061 0 NA 1.061 156,625 48.7
2016 41 81 74,301 1.090 0 NA 1.090 158,236 47.0
2017 41 72 69,621 1.034 2 NA 1.034 156,813 44.4
2018 38 52 66,880 0.778 2 2 0.807 150,198 44.5

---Subtotal Adult/Pediatric ICUs---

2015 156 544 508,764 1.069 14 NA 1.069 1,098,691 46.3
2016 158 494 499,070 0.990 13 NA 0.990 1,095,333 45.6
2017 160 447 486,653 0.919 27 NA 0.919 1,099,775 44.3
2018 159 374 476,463 0.785 26 48 0.886 1,093,556 43.6

Neonatal ICU Level II/III

2015 12 8 4,580 1.747 0 NA 1.747 42,092 10.9
2016 12 8 4,593 1.742 0 NA 1.742 39,549 11.6
2017 13 11 4,372 2.516 0 NA 2.516 38,285 11.4
2018 12 5 4,223 1.184 0 0 1.184 37,922 11.1

Neonatal ICU Level III

2015 24 23 17,000 1.353 0 NA 1.353 112,246 15.1

41
 CLABSI
# CLABSI Rate CLABSI Rate
excluding excluding # including Device
# ECMO/VAD # Central Line ECMO/VAD ECMO/ ECMO/VAD all Utilization
Year Hospitals starting 2018 Days starting 2018 # MBI VAD years # Patient Days ratio
2016 24 19 15,635 1.215 0 NA 1.215 106,830 14.6
2017 24 11 16,063 0.685 0 NA 0.685 111,163 14.4
2018 24 11 15,136 0.727 0 0 0.727 106,736 14.2

Neonatal ICU Regional Perinatal Center

2015 17 63 60,702 1.038 0 NA 1.038 233,570 26.0
2016 17 48 60,254 0.797 1 NA 0.797 240,354 25.1
2017 17 74 62,341 1.187 0 NA 1.187 250,151 24.9
2018 17 44 60,972 0.722 1 0 0.722 254,881 23.9

---Subtotal Neonatal ICUs---

2015 53 94 82,282 1.142 0 NA 1.142 387,908 21.2
2016 53 75 80,482 0.932 1 NA 0.932 386,733 20.8
2017 54 96 82,776 1.160 0 NA 1.160 399,599 20.7
2018 53 60 80,331 0.747 1 0 0.747 399,539 20.1

Medical Surgical Ward

2015 136 356 315,134 1.130 17 NA 1.130 2,812,762 11.2
2016 136 311 297,571 1.045 14 NA 1.045 2,764,558 10.8
2017 132 224 264,816 0.846 12 NA 0.846 2,652,695 10.0
2018 134 198 257,923 0.768 6 0 0.768 2,643,272 9.8

Medical Ward
2015 85 338 294,669 1.147 19 NA 1.147 2,338,541 12.6
2016 83 333 292,615 1.138 17 NA 1.138 2,379,097 12.3
2017 88 293 289,799 1.011 32 NA 1.011 2,398,442 12.1
2018 90 263 279,454 0.941 29 4 0.955 2,518,708 11.1

Pediatric ward
2015 54 41 34,275 1.196 12 NA 1.196 267,238 12.8
2016 55 38 34,287 1.108 16 NA 1.108 272,971 12.6
2017 54 40 36,134 1.107 23 NA 1.107 291,593 12.4
2018 53 34 39,220 0.867 15 0 0.867 298,120 13.2

Step down unit

2015 55 99 67,484 1.467 1 NA 1.467 359,515 18.8
2016 55 68 65,829 1.033 0 NA 1.033 366,761 17.9
2017 59 51 60,786 0.839 1 NA 0.839 367,760 16.5
2018 67 39 61,860 0.630 2 0 0.630 382,365 16.2

Surgical Ward
2015 71 118 113,102 1.043 1 NA 1.043 913,475 12.4
2016 72 85 109,071 0.779 0 NA 0.779 906,607 12.0

42
 CLABSI
# CLABSI Rate CLABSI Rate
excluding excluding # including Device
# ECMO/VAD # Central Line ECMO/VAD ECMO/ ECMO/VAD all Utilization
Year Hospitals starting 2018 Days starting 2018 # MBI VAD years # Patient Days ratio
2017 73 80 104,985 0.762 2 NA 0.762 917,616 11.4
2018 76 83 99,647 0.833 2 2 0.853 913,147 10.9

---Subtotal Adult/Pediatric Wards---

2015 167 952 824,664 1.154 50 NA 1.154 6,691,531 12.3
2016 170 835 799,373 1.045 47 NA 1.045 6,689,994 11.9
2017 170 688 756,520 0.909 70 NA 0.909 6,628,106 11.4
2018 167 617 738,104 0.836 54 6 0.844 6,755,612 10.9

------------Grand Total------------
2015 167 1,590 1,415,710 1.123 64 NA 1.123 8,178,130 17.3
2016 170 1,404 1,378,925 1.018 61 NA 1.018 8,172,060 16.9
2017 172 1,231 1,325,949 0.928 97 NA 0.928 8,127,480 16.3
2018 170 1,051 1,294,898 0.812 81 54 0.853 8,248,707 15.7
New York State data as of June 27, 2019. CLABSI rates are per 1,000 central line days. Device utilization = 100*
central line days/patient days. MBI = mucosal barrier injury (excluded from all counts starting in 2015); ICU =
intensive care unit; VAD = ventricular assist devices; ECMO = extracorporeal membrane oxygenation. Beginning
in 2017, ICU data from the two cancer hospitals: Memorial Sloan Kettering Cancer Center and Roswell Park Cancer
Institute were added to this table.

43
Microorganisms Associated with CLABSIs

The distribution of microorganisms associated with CLABSIs is presented by location in Tables

12 and 13. Yeast was the most common organism in adult and pediatric ICUs and wards. Other
common infecting organisms included Enterococci and Staphylococcus aureus. The most
common organism in neonatal ICUs was Staphylococcus aureus.

Table 12. Microorganisms identified in central line-associated bloodstream infections, adult

and pediatric intensive care units and wards, New York State 2018

Number
of Percent of
Microorganism Isolates Infections
Yeast 298 26.5
(Candida auris) (12) (1.1)
Enterococci 223 19.8
(VRE) (107) (9.5)
Staphylococcus aureus 159 14.1
(MRSA) (61) (5.4)
Coagulase negative staphylococci 127 11.3
Klebsiella spp. 108 9.6
(CRE-Klebsiella) (12) (1.1)
Escherichia coli 57 5.1
(CRE-E. coli) (1) (0.1)
Enterobacter spp. 45 4.0
(CRE-Enterobacter) (3) (0.3)
Pseudomonas spp. 44 3.9
Serratia spp. 29 2.6
Acinetobacter spp. 20 1.8
(MDR-Acinetobacter) (5) (0.4)
Streptococci 18 1.6
Proteus spp. 16 1.4
Citrobacter spp. 10 0.9
Bacteroides spp. 9 0.8
Lactobacillus spp. 9 0.8
Stenotrophomonas spp. 8 0.7
Bacilli 7 0.6
Other 56 5.0
New York State data reported as of June 27, 2019. Out of 1,071 infections (includes mucosal
barrier injury infections; excludes bloodstream infections associated with extracorporeal
membrane oxygenation and ventricular assist devices). VRE: vancomycin-resistant enterococci;
CRE: carbapenem-resistant Enterobacteriaceae; MRSA: methicillin-resistant Staphylococcus
aureus; MDR: multi-drug resistant; spp: multiple species.

44
Table 13. Microorganisms associated with central line-associated bloodstream infections,
neonatal intensive care units, New York State 2018

Number
of Percent of
Microorganism Isolates Infections
Staphylococcus aureus 18 29.5
(MRSA) (5) (8.2)
Coagulase negative staphylococci 13 21.3
Enterococci 9 14.8
Yeast 9 14.8
Escherichia coli 4 6.6
Klebsiella spp. 4 6.6
Enterobacter spp. 4 6.6
Other 6 9.8
New York State data reported as of June 27, 2019. Out of 61 infections (includes mucosal
barrier injury infections). MRSA: methicillin-resistant Staphylococcus aureus; spp: multiple
species.

45
Risk Factors for CLABSIs

Hospitals do not collect patient-specific risk factors for CLABSIs; NHSN requires reporting of
only the total number of patient days and total number of central line days per month within each
hospital location. CLABSI rates are stratified by type of location. For CLABSIs in neonatal
intensive care units (NICUs), the data are collected by birth weight group because lower birth
weight babies are more susceptible to CLABSIs than higher birth weight babies. No risk
adjustment is performed by birthweight group in Level II/III facilities due to the small number of
CLABSI. In Level III NICUs, babies weighing less than 1001 grams were 5.0 times more likely
to develop a CLABSI than babies weighing more than 1000 grams. In Regional Perinatal
Centers (RPCs), for the first time since the HAI program began in 2007, there was no difference
in CLABSI rates between babies weighing more or less than 1000 grams.

Hospital-Specific, Location-Specific CLABSI Rates

Within NYS, hospital-specific CLABSI rates were compared to the state average by hospital
location type. The CLABSI rates in Table 14 (ICUs) and Table 15 (wards) help hospital IPs
target their CLABSI reduction efforts to specific locations. Overall, twenty-four high flags will
be addressed in CLABSI improvement plans by the eighteen affected hospitals.

46
Table 14. Central line-associated bloodstream infection rates by intensive care unit type, New York State 2018

Cardiothoracic Medical Surgical

Coronary ICU ICU Medical ICU ICU Surgical ICU Neurosurgical ICU Pediatric ICU Neonatal ICU

CLABSI/ CLABSI/ CLABSI/ CLABSI/ CLABSI/ CLABSI/ CLABSI/ NICU CLABSI/ Adj
Hospital CLDays Rate CLDays Rate CLDays Rate CLDays Rate CLDays Rate CLDays Rate CLDays Rate level CLDays rate

State average rate 1.18 0.32 0.83 0.81 0.78 0.93 1.19 RPC 0.72/L3 0.73/L23 1.18

Adirondack Medical 1/230 4.3

Albany Med Ctr 2/1926 1.0 0/3057 0.0 0/3332 0.0 4/4671 0.9 0/1485 0.0 RPC 3/2834 1.1
Albany Memorial 0/201 0.0
Alice Hyde Med Ctr NA NA
Arnot Ogden Med Ctr 2/2002 1.0 Lev 3 1/1322 1.0
Auburn Memorial 1/367 2.7
Bellevue Hospital 1/1817 0.6 0/749 0.0 2/1407 1.4 8/1591 ^ 5.0 0/248 0.0 0/85 0.0 RPC 5/2079 ^ 2.4
Bon Secours 1/240 4.2
BronxCare 0/821 0.0 2/3841 0.5 NA NA Lev 3 1/475 1.5
Brookdale Hospital 2/566 3.5 3/2216 1.4 3/1104 2.7 NA NA Lev 3 0/426 0.0
Brooklyn Hosp Ctr 0/1113 0.0 0/2928 0.0 0/184 0.0 Lev 3 0/1381 0.0
Brooks Memorial 2/318 6.3
Buffalo General 0/3476 0.0 5/7070 0.7 0/2666 0.0 2/2274 0.9
Canton-Potsdam 0/287 0.0
Catskill Regional 0/441 0.0
Cayuga Medical Ctr 0/667 0.0
Champlain Valley 0/1550 0.0
Claxton-Hepburn 0/480 0.0
Clifton Springs 0/256 0.0
Cohens Childrens 2/2309 0.9 RPC 0/5585 * 0.0
Columbia Memorial 3/642 ^ 4.7
Coney Island Hosp 0/522 0.0 4/2368 1.7 1/1305 0.8
Corning Hospital 0/286 0.0
Cortland Reg Med 0/460 0.0
Crouse Hospital 1/1490 0.7 RPC 6/4487 1.3
East. Niag. Lockport 1/183 5.5
Eastern Long Island NA NA
Ellis Hospital 2/5334 0.4
Elmhurst Hospital 1/452 2.2 2/1126 1.8 3/909 3.3 Lev 2/3 1/435 2.3
Erie County Med Ctr 4/2540 1.6
FF Thompson 0/729 0.0

47
Table 14. Central line-associated bloodstream infection rates by intensive care unit type, New York State 2018

Cardiothoracic Medical Surgical

Coronary ICU ICU Medical ICU ICU Surgical ICU Neurosurgical ICU Pediatric ICU Neonatal ICU

CLABSI/ CLABSI/ CLABSI/ CLABSI/ CLABSI/ CLABSI/ CLABSI/ NICU CLABSI/ Adj
Hospital CLDays Rate CLDays Rate CLDays Rate CLDays Rate CLDays Rate CLDays Rate CLDays Rate level CLDays rate

State average rate 1.18 0.32 0.83 0.81 0.78 0.93 1.19 RPC 0.72/L3 0.73/L23 1.18

Faxton St. Lukes 2/2147 0.9

Flushing Hospital 2/1082 1.8 0/215 0.0 Lev 3 0/774 0.0
Geneva General 0/704 0.0
Glen Cove Hospital 1/394 2.5
Glens Falls Hospital 0/1278 0.0
Good Samar. Suffern 0/663 0.0 2/1493 1.3 0/565 0.0
Good Samar. W Islip 0/1196 0.0 1/2447 0.4 1/2116 0.5 0/248 0.0 0/84 0.0 Lev 3 0/947 0.0
Harlem Hospital 0/373 0.0 1/2152 0.5 NA NA Lev 3 0/708 0.0
HealthAlli Broadway 0/826 0.0
HealthAlli MarysAve NA NA
Highland Hospital 2/1742 1.1
Hosp for Spec Surg 0/124 0.0
Huntington Hospital 0/275 0.0 0/473 0.0
Interfaith Med Ctr 0/1584 0.0
JT Mather Hospital 0/2489 0.0
Jacobi Med Ctr 2/723 2.8 0/1251 0.0 1/722 1.4 NA NA Lev 3 3/1142 2.5
Jamaica Hospital 4/1559 2.6 1/1057 0.9 Lev 3 0/559 0.0
Jones Memorial 0/212 0.0
Kenmore Mercy 0/890 0.0
Kings County Hosp 1/741 1.3 2/1099 1.8 3/858 3.5 3/533 ^ 5.6 NA NA Lev 2/3 1/710 1.4
Kingsbrook Jewish MC 6/2474 ^ 2.4
LIJ at Forest Hills 0/1840 0.0
LIJ at Valley Stream 0/570 0.0
Lenox Hill Hospital 2/756 2.6 0/2589 0.0 2/1668 1.2 0/1752 0.0 Lev 2/3 0/930 0.0
Lincoln Med Ctr 0/753 0.0 3/1861 1.6 0/680 0.0 Lev 3 0/484 0.0
Long Isl Jewish(LIJ) 0/394 0.0 2/1193 1.7 0/567 0.0 0/1335 0.0
Long Isl. Community 1/675 1.5 2/781 2.6 0/774 0.0
Maimonides Med Ctr 2/1290 1.6 2/2783 0.7 1/2220 0.5 0/1631 0.0 1/513 1.9 RPC 0/1979 0.0
Mary Imogene Bassett 3/3057 1.0
Massena Memorial NA NA
Memor SloanKettering 10/4979 ^ 2.0 5/1187 ^ 4.2

48
Table 14. Central line-associated bloodstream infection rates by intensive care unit type, New York State 2018

Cardiothoracic Medical Surgical

Coronary ICU ICU Medical ICU ICU Surgical ICU Neurosurgical ICU Pediatric ICU Neonatal ICU

CLABSI/ CLABSI/ CLABSI/ CLABSI/ CLABSI/ CLABSI/ CLABSI/ NICU CLABSI/ Adj
Hospital CLDays Rate CLDays Rate CLDays Rate CLDays Rate CLDays Rate CLDays Rate CLDays Rate level CLDays rate

State average rate 1.18 0.32 0.83 0.81 0.78 0.93 1.19 RPC 0.72/L3 0.73/L23 1.18

Mercy Hosp Buffalo 0/700 0.0 0/1759 0.0 0/3539 0.0

Mercy Med Ctr 0/1191 0.0 Lev 3 0/187 0.0
Metropolitan Hosp 0/1094 0.0 Lev 2/3 0/347 0.0
MidHudson Reg of WMC 1/929 1.1
Millard Fill. Suburb 0/3399 0.0
Montefiore-Einstein 2/2976 0.7 3/2953 1.0 RPC 3/1944 1.5
Montefiore-Moses 3/1975 1.5 5/3185 ^ 1.6 3/3453 0.9 3/2397 1.3 2/2648 0.8
Montefiore-Mt Vernon 3/425 ^ 7.1
Montefiore-NewRochl 2/1096 1.8 Lev 3 NA NA
Montefiore-Nyack 1/918 1.1 0/559 0.0
Montefiore-Wakefield 2/2204 0.9 Lev 2/3 1/327 3.1
Mount St. Marys 0/643 0.0
Mt Sinai 0/1064 0.0 3/5463 0.5 3/2582 1.2 2/2265 0.9 1/926 1.1 2/1778 1.1 RPC 3/3109 1.0
Mt Sinai Beth Israel 0/364 0.0 1/1971 0.5
Mt Sinai Brooklyn 0/1119 0.0
Mt Sinai Queens 0/1217 0.0
Mt Sinai St Lukes 1/726 1.4 1/1699 0.6 1/1368 0.7 2/591 3.4
Mt Sinai West 1/1104 0.9 0/325 0.0 Lev 3 0/1054 0.0
NY Community Hosp 0/680 0.0
NYP-Allen 0/894 0.0
NYP-Brklyn Methodist 2/684 2.9 0/1450 0.0 0/3984 * 0.0 0/95 0.0 Lev 3 0/1341 0.0
NYP-Columbia 8/5828 1.4 2/6949 0.3 6/5114 1.2 3/3012 1.0 1/2608 0.4
NYP-Hudson Valley 0/745 0.0 Lev 2/3 NA NA
NYP-Lawrence 0/1387 0.0
NYP-Lower Manhattan 1/2258 0.4
NYP-Morgan Stanley 16/7856 2.0 RPC 8/6902 1.2
NYP-Queens 0/761 0.0 0/751 0.0 0/1322 0.0 0/881 0.0 Lev 3 0/256 0.0
NYP-Weill Cornell 5/3394 1.5 0/4766 0.0 1/2948 0.3 5/3459 1.4 2/1493 1.3 3/2343 1.3 RPC 4/4451 0.9
NYU Langone Brooklyn 1/703 1.4 0/752 0.0 Lev 2/3 0/73 0.0
NYU Orthopedic Hosp
NYU Tisch 0/492 0.0 0/2122 0.0 0/1817 0.0 3/2189 1.4 3/343 ^ 8.7 1/3271 0.3 RPC 1/2839 0.4

49
Table 14. Central line-associated bloodstream infection rates by intensive care unit type, New York State 2018

Cardiothoracic Medical Surgical

Coronary ICU ICU Medical ICU ICU Surgical ICU Neurosurgical ICU Pediatric ICU Neonatal ICU

CLABSI/ CLABSI/ CLABSI/ CLABSI/ CLABSI/ CLABSI/ CLABSI/ NICU CLABSI/ Adj
Hospital CLDays Rate CLDays Rate CLDays Rate CLDays Rate CLDays Rate CLDays Rate CLDays Rate level CLDays rate

State average rate 1.18 0.32 0.83 0.81 0.78 0.93 1.19 RPC 0.72/L3 0.73/L23 1.18

NYU Winthrop 5/2450 2.0 2/4153 0.5 1/935 1.1 0/493 0.0 RPC 1/1836 0.5
Nassau University 0/533 0.0 0/1344 0.0 0/340 0.0 NA NA Lev 3 1/451 2.8
Nathan Littauer 0/650 0.0
Newark Wayne 2/1036 1.9
Niagara Falls 2/709 2.8
North Central Bronx 0/254 0.0
North Shore 3/1730 1.7 3/5711 0.5 2/2505 0.8 1/2072 0.5 1/1330 0.8 RPC 0/2134 0.0
Northern Dutchess 0/498 0.0
Northern Westchester 2/546 3.7 Lev 3 0/59 0.0
Noyes Memorial 0/275 0.0
Oishei Childrens 0/1107 0.0 RPC 2/5499 0.4
Olean General 1/801 1.2
Oneida Healthcare 0/173 0.0
Orange Regional 6/1665 ^ 3.6
Oswego Hospital 0/225 0.0
Our Lady of Lourdes 0/883 0.0
Peconic Bay Medical 0/1055 0.0
Phelps Memorial 0/737 0.0
Plainview Hospital 5/1244 ^ 4.0
Putnam Hospital 0/568 0.0
Queens Hospital 1/1831 0.5 Lev 3 1/362 2.0
Richmond Univ MC 0/111 0.0 2/2091 1.0 0/1192 0.0 NA NA Lev 3 1/872 1.0
Rochester General 0/3604 0.0 4/3784 1.1 0/2274 0.0
Rome Memorial 1/401 2.5
Roswell Park 5/2427 2.1
SUNY Downstate MedCr 1/302 3.3 0/1058 0.0 1/1456 0.7 0/80 0.0 RPC 0/750 0.0
Samaritan- Troy 3/2464 1.2
Samaritan- Watertown 0/871 0.0
Saratoga Hospital 1/688 1.5
Sisters of Charity 1/1394 0.7 Lev 3 1/934 1.0
Sisters- St Joseph 0/627 0.0

50
Table 14. Central line-associated bloodstream infection rates by intensive care unit type, New York State 2018

Cardiothoracic Medical Surgical

Coronary ICU ICU Medical ICU ICU Surgical ICU Neurosurgical ICU Pediatric ICU Neonatal ICU

CLABSI/ CLABSI/ CLABSI/ CLABSI/ CLABSI/ CLABSI/ CLABSI/ NICU CLABSI/ Adj
Hospital CLDays Rate CLDays Rate CLDays Rate CLDays Rate CLDays Rate CLDays Rate CLDays Rate level CLDays rate

State average rate 1.18 0.32 0.83 0.81 0.78 0.93 1.19 RPC 0.72/L3 0.73/L23 1.18

South Nassau Comm. 7/4161 1.7

Southside 2/1220 1.6 0/787 0.0 0/1049 0.0
St Anthony 0/122 0.0
St Barnabas 1/882 1.1 0/553 0.0 Lev 2/3 0/327 0.0
St Catherine Siena 1/667 1.5 0/721 0.0
St Charles Hospital 0/733 0.0
St Elizabeth Medical 1/1147 0.9 2/1991 1.0
St Francis- Roslyn 1/5139 0.2 0/2249 0.0 0/2018 0.0
St Johns Episcopal 1/779 1.3 0/852 0.0
St Johns Riverside 0/1072 0.0
St Joseph- Bethpage 0/1304 0.0
St Josephs- Syracuse 0/3426 0.0 0/4005 * 0.0 Lev 2/3 0/126 0.0
St Josephs- Yonkers 1/688 1.5
St Lukes Cornwall 0/1876 0.0
St Marys Amsterdam 1/225 4.4
St Peters Hospital 0/426 0.0 0/1884 0.0 0/3017 0.0 Lev 3 1/474 2.3
Staten Island U N 0/1515 0.0 0/4710 * 0.0 NA NA Lev 3 0/315 0.0
Staten Island U S 0/1102 0.0
StonyBrkSouthampton 1/429 2.3
StonyBrookUniv 0/932 0.0 0/2014 0.0 0/2331 0.0 1/1926 0.5 0/286 0.0 RPC 0/2241 0.0
Strong Memorial 1/4296 0.2 1/2789 0.4 2/2501 0.8 4/4150 1.0 RPC 6/7399 0.8
Syosset Hospital 0/835 0.0
UHS Binghamton 0/237 0.0
UHS Chenango Memor 1/50 20.0
UHS Wilson 4/1715 2.3 1/1832 0.5 Lev 2/3 1/133 7.5
UPMC Chautauqua WCA 5/1392 ^ 3.6
United Memorial 0/371 0.0
Unity Hosp Rochester 1/3618 0.3
Univ Hosp SUNY Upst 1/2588 0.4 4/6915 0.6 2/3364 0.6 2/3142 0.6 0/1133 0.0
Upst. Community Gen 2/920 2.2
Vassar Brothers 0/1180 0.0 3/4000 0.8 Lev 2/3 1/463 2.2

51
Table 14. Central line-associated bloodstream infection rates by intensive care unit type, New York State 2018

Cardiothoracic Medical Surgical

Coronary ICU ICU Medical ICU ICU Surgical ICU Neurosurgical ICU Pediatric ICU Neonatal ICU

CLABSI/ CLABSI/ CLABSI/ CLABSI/ CLABSI/ CLABSI/ CLABSI/ NICU CLABSI/ Adj
Hospital CLDays Rate CLDays Rate CLDays Rate CLDays Rate CLDays Rate CLDays Rate CLDays Rate level CLDays rate

State average rate 1.18 0.32 0.83 0.81 0.78 0.93 1.19 RPC 0.72/L3 0.73/L23 1.18

Westchester Medical 1/1406 0.7 1/4558 0.2 4/2768 1.4 1/1592 0.6 0/2713 0.0 3/1384 2.2 RPC 2/4904 0.4
White Plains Hosp 1/2334 0.4 Lev 3 0/151 0.0
Woodhull Med Ctr 3/1231 2.4 Lev 2/3 0/344 0.0
Wyckoff Heights 3/1315 2.3 Lev 3 1/449 2.2
Wyoming County Comm. NA NA
New York State data reported as of June 27, 2019. ▬ Significantly higher than state average. ▬Significantly lower than state average. ▬Same as state average.
Rates are per 1000 central line days (CLDAYS). Excludes Mucosal Barrier Injury (MBI)-CLABSIs and bloodstream infections associated with use of extracorporeal membrane
oxygenation and ventricular assist devices.

52
Table 15. Central line-associated bloodstream infection rates by ward type, New York State 2018

Medical Wards Medical Surgical Wards Surgical Wards Step Down Units Pediatric Wards

CLABSI/ CLABSI/ CLABSI/ CLABSI/ CLABSI/

Hospital CLDays Rate CLDays Rate CLDays Rate CLDays Rate CLDays Rate

State average rate 0.94 0.77 0.83 0.63 0.87

AO Fox Memorial 0/95 0.0 0/503 0.0 0/364 0.0

Adirondack Medical 0/522 0.0
Albany Med Ctr 16/14916 1.1 1/1728 0.6 2/5003 0.4 1/1018 1.0 0/2590 0.0
Albany Memorial 0/497 0.0 NA NA 0/182 0.0
Alice Hyde Med Ctr 1/268 3.7
Arnot Ogden Med Ctr 1/2871 0.3
Auburn Memorial 0/510 0.0 0/241 0.0
Bellevue Hospital 14/5745 ^ 2.4 0/592 0.0 4/816 ^ 4.9 0/104 0.0
Bertrand Chaffee NA NA
Blythedale Childrens 3/2839 1.1
Bon Secours 0/296 0.0 NA NA
BronxCare 8/4832 1.7 5/3629 1.4 1/411 2.4 NA NA
Brookdale Hospital 6/3160 1.9 1/583 1.7 2/96 ^20.8 NA NA
Brooklyn Hosp Ctr 1/3561 0.3 1/2919 0.3 0/3887 0.0 0/239 0.0
Brooks Memorial 0/325 0.0
Buffalo General 2/2944 0.7 2/3309 0.6 1/1624 0.6 5/5215 1.0
Canton-Potsdam NA NA 0/1579 0.0
Catskill Regional 1/274 3.6 1/120 8.3
Cayuga Medical Ctr 1/1353 0.7 NA NA
Champlain Valley 2/3067 0.7 0/1400 0.0 NA NA
Claxton-Hepburn 3/1658 1.8
Clifton Springs 0/901 0.0
Cobleskill Regional 0/146 0.0
Cohens Childrens 2/2005 1.0
Columbia Memorial 0/578 0.0 1/1244 0.8
Coney Island Hosp 2/4153 0.5 0/56 0.0 0/1016 0.0 0/353 0.0 NA NA
Corning Hospital 1/342 2.9 0/364 0.0
Cortland Reg Med 0/293 0.0 0/394 0.0
Crouse Hospital 8/6161 1.3
East. Niag. Lockport 1/168 6.0
Eastern Long Island 0/59 0.0
Ellis Hospital 0/3686 * 0.0 0/110 0.0 0/750 0.0 0/304 0.0

53
Table 15. Central line-associated bloodstream infection rates by ward type, New York State 2018

Medical Wards Medical Surgical Wards Surgical Wards Step Down Units Pediatric Wards

CLABSI/ CLABSI/ CLABSI/ CLABSI/ CLABSI/

Hospital CLDays Rate CLDays Rate CLDays Rate CLDays Rate CLDays Rate

State average rate 0.94 0.77 0.83 0.63 0.87

Elmhurst Hospital 2/1843 1.1 5/1301 ^ 3.8 2/1158 1.7 NA NA

Erie County Med Ctr 16/12059 1.3
FF Thompson 0/1266 0.0 1/325 3.1
Faxton St. Lukes 2/1989 1.0 0/979 0.0 3/2009 1.5 NA NA
Flushing Hospital 2/2177 0.9 NA NA
Geneva General 0/486 0.0 0/476 0.0 0/223 0.0
Glen Cove Hospital 0/257 0.0 NA NA
Glens Falls Hospital 0/1408 0.0 1/1177 0.8 0/639 0.0 NA NA
Good Samar. Suffern 2/3314 0.6 0/1054 0.0
Good Samar. W Islip 1/4102 0.2 0/1479 0.0 NA NA 1/133 7.5
Harlem Hospital 1/1498 0.7 1/1357 0.7 0/61 0.0
HealthAlli Broadway 1/2142 0.5 0/477 0.0 0/419 0.0
HealthAlli MarysAve 0/280 0.0
Highland Hospital 3/4435 0.7 0/1879 0.0 0/1390 0.0
Hosp for Spec Surg 0/2250 0.0 0/202 0.0 NA NA
Huntington Hospital 0/316 0.0 0/588 0.0 0/129 0.0 NA NA
Interfaith Med Ctr 1/2536 0.4 NA NA
Ira Davenport NA NA
JT Mather Hospital 2/3050 0.7 1/788 1.3 1/2189 0.5
Jacobi Med Ctr 3/2587 1.2 0/1117 0.0 1/283 3.5 0/170 0.0 NA NA
Jamaica Hospital 5/2816 1.8 1/378 2.6 0/384 0.0 NA NA
Jones Memorial 0/587 0.0
Kenmore Mercy 0/2172 0.0 NA NA
Kings County Hosp 1/2864 0.3 1/2913 0.3 0/596 0.0 NA NA
Kingsbrook Jewish MC 12/4082 ^ 2.9 1/620 1.6
LIJ at Forest Hills 4/2146 1.9 NA NA 0/193 0.0
LIJ at Valley Stream 2/1363 1.5 NA NA NA NA
Lenox Hill Hospital 4/2763 1.4 0/228 0.0 0/988 0.0 2/1310 1.5
Lincoln Med Ctr 1/1292 0.8 0/1052 0.0 2/1824 1.1 NA NA
Long Isl Jewish(LIJ) 3/6139 0.5 0/1796 0.0 2/1927 1.0 NA NA
Long Isl. Community 3/1689 1.8 1/763 1.3
Maimonides Med Ctr 6/6228 1.0 2/1122 1.8 1/1023 1.0 1/571 1.8

54
Table 15. Central line-associated bloodstream infection rates by ward type, New York State 2018

Medical Wards Medical Surgical Wards Surgical Wards Step Down Units Pediatric Wards

CLABSI/ CLABSI/ CLABSI/ CLABSI/ CLABSI/

Hospital CLDays Rate CLDays Rate CLDays Rate CLDays Rate CLDays Rate

State average rate 0.94 0.77 0.83 0.63 0.87

Mary Imogene Bassett 0/1313 0.0 2/1012 2.0 3/2249 1.3 1/1064 0.9
Massena Memorial 0/107 0.0 NA NA
Mercy Hosp Buffalo 0/355 0.0 2/5437 0.4 1/1066 0.9 0/817 0.0
Mercy Med Ctr 1/1155 0.9 0/207 0.0 1/535 1.9
Metropolitan Hosp 1/687 1.5 0/307 0.0 NA NA
MidHudson Reg of WMC 4/1542 2.6 0/503 0.0
Millard Fill. Suburb 2/7320 0.3
Montefiore-Einstein 9/6101 1.5 4/3007 1.3
Montefiore-Moses 14/15894 0.9 1/746 1.3 9/4481 ^ 2.0 3/4792 0.6
Montefiore-Mt Vernon 0/469 0.0 0/140 0.0
Montefiore-NewRochl 0/474 0.0 1/401 2.5 2/509 3.9
Montefiore-Nyack 1/1884 0.5 2/786 2.5 0/232 0.0
Montefiore-Wakefield 6/3530 1.7 0/316 0.0
Mount St. Marys 0/2195 0.0
Mt Sinai 12/7682 1.6 9/3030 ^ 3.0 5/3508 1.4 1/754 1.3 3/1382 2.2
Mt Sinai Beth Israel 2/2320 0.9 0/389 0.0 0/675 0.0 0/146 0.0
Mt Sinai Brooklyn 2/2657 0.8 2/394 5.1 NA NA
Mt Sinai Queens 3/2006 1.5 0/836 0.0
Mt Sinai St Lukes 2/2726 0.7 0/449 0.0 0/864 0.0
Mt Sinai West 0/1777 0.0
NY Community Hosp 0/257 0.0 0/525 0.0
NY Eye&Ear Mt Sinai NA NA
NYP-Allen 1/1680 0.6 0/737 0.0
NYP-Brklyn Methodist 2/2073 1.0 3/5121 0.6 1/1143 0.9 0/572 0.0 0/743 0.0
NYP-Columbia 20/12902 ^ 1.6 3/6954 0.4 6/4508 1.3
NYP-Hudson Valley 1/1441 0.7 0/293 0.0
NYP-Lawrence 2/3662 0.5 NA NA
NYP-Lower Manhattan 0/1903 0.0
NYP-Morgan Stanley 12/7812 1.5
NYP-Queens 2/5171 0.4 1/1167 0.9 0/104 0.0 NA NA
NYP-Weill Cornell 14/8445 1.7 14/4665 ^ 3.0 2/3824 0.5 1/412 2.4 1/1477 0.7
NYU Langone Brooklyn 1/1633 0.6 0/826 0.0 1/613 1.6 0/874 0.0 NA NA

55
Table 15. Central line-associated bloodstream infection rates by ward type, New York State 2018

Medical Wards Medical Surgical Wards Surgical Wards Step Down Units Pediatric Wards

CLABSI/ CLABSI/ CLABSI/ CLABSI/ CLABSI/

Hospital CLDays Rate CLDays Rate CLDays Rate CLDays Rate CLDays Rate

State average rate 0.94 0.77 0.83 0.63 0.87

NYU Orthopedic Hosp 0/176 0.0

NYU Tisch 3/3287 0.9 0/1249 0.0 2/4336 0.5 1/2969 0.3 1/2452 0.4
NYU Winthrop 7/10333 0.7 1/1314 0.8 2/978 2.0 0/714 0.0
Nassau University 1/1369 0.7 1/323 3.1 0/63 0.0 NA NA
Nathan Littauer 0/762 0.0
Newark Wayne 0/1472 0.0
Niagara Falls 1/873 1.1 0/445 0.0
North Central Bronx 0/370 0.0 0/86 0.0
North Shore 4/5374 0.7 2/2548 0.8 1/4889 0.2 NA NA
Northern Dutchess 0/271 0.0 1/899 1.1
Northern Westchester 1/1862 0.5 0/354 0.0 NA NA NA NA
Noyes Memorial 0/539 0.0
Oishei Childrens 2/1840 1.1
Olean General 1/1901 0.5 1/366 2.7
Oneida Healthcare 1/545 1.8
Orange Regional 1/2790 0.4 0/455 0.0
Oswego Hospital 0/581 0.0
Our Lady of Lourdes 0/3183 0.0 0/179 0.0 1/1211 0.8 NA NA
Peconic Bay Medical 1/2240 0.4 0/215 0.0
Phelps Memorial 2/792 2.5 0/384 0.0 NA NA
Plainview Hospital 1/1727 0.6 NA NA 0/155 0.0 NA NA
Putnam Hospital 0/1174 0.0
Queens Hospital 1/1671 0.6 0/1022 0.0 1/197 5.1 0/381 0.0
Richmond Univ MC 1/1270 0.8 0/430 0.0
Rochester General 10/7501 1.3 0/4438 * 0.0 6/3736 1.6
Rome Memorial 1/235 4.3 1/339 2.9
SUNY Downstate MedCr 0/1100 0.0 3/3322 0.9 2/1094 1.8 0/239 0.0
Samaritan- Troy NA NA 1/2908 0.3 0/863 0.0
Samaritan- Watertown 0/77 0.0 3/2758 1.1
Saratoga Hospital 1/3142 0.3 NA NA
Sisters of Charity 3/2742 1.1 3/2007 1.5 1/1390 0.7
Sisters- St Joseph 2/1773 1.1 1/353 2.8

56
Table 15. Central line-associated bloodstream infection rates by ward type, New York State 2018

Medical Wards Medical Surgical Wards Surgical Wards Step Down Units Pediatric Wards

CLABSI/ CLABSI/ CLABSI/ CLABSI/ CLABSI/

Hospital CLDays Rate CLDays Rate CLDays Rate CLDays Rate CLDays Rate

State average rate 0.94 0.77 0.83 0.63 0.87

South Nassau Comm. 6/7997 0.8 4/4241 0.9 0/51 0.0

Southside 0/330 0.0 6/3574 1.7 0/624 0.0 NA NA
St Anthony 1/214 4.7
St Barnabas 0/1166 0.0 0/371 0.0
St Catherine Siena 1/2826 0.4 0/371 0.0
St Charles Hospital 0/759 0.0
St Elizabeth Medical 4/2820 1.4 1/1830 0.5
St Francis- Roslyn 2/6642 0.3 0/1384 0.0
St James Mercy 0/196 0.0
St Johns Dobbs Ferry NA NA
St Johns Episcopal 11/2810 ^ 3.9 NA NA
St Johns Riverside 0/1111 0.0 0/646 0.0
St Joseph- Bethpage 0/813 0.0 0/289 0.0
St Josephs- Elmira NA NA
St Josephs- Syracuse 0/10180 * 0.0
St Josephs- Yonkers 1/531 1.9 0/141 0.0 NA NA
St Lukes Cornwall 0/2215 0.0
St Marys Amsterdam 0/545 0.0 0/489 0.0 0/563 0.0
St Peters Hospital 6/11142 0.5 1/6115 0.2 0/2687 0.0
Staten Island U N 3/3336 0.9 1/995 1.0 NA NA 0/185 0.0
Staten Island U S 1/825 1.2
StonyBrkSouthampton 4/1316 ^ 3.0
StonyBrookUniv 8/4524 1.8 5/7310 0.7 2/449 4.5 0/722 0.0
Strong Memorial 14/15141 0.9 6/8545 0.7 1/392 2.6 1/4101 0.2
Sunnyview Rehab Hosp 0/85 0.0
Syosset Hospital 0/320 0.0 NA NA NA NA
UHS Binghamton 0/1116 0.0
UHS Chenango Memor 0/166 0.0
UHS Wilson 0/68 0.0 9/8045 1.1 0/485 0.0
UPMC Chautauqua WCA 1/973 1.0 1/953 1.0
United Memorial 0/717 0.0 0/181 0.0
Unity Hosp Rochester 1/11195 * 0.1

57
Table 15. Central line-associated bloodstream infection rates by ward type, New York State 2018

Medical Wards Medical Surgical Wards Surgical Wards Step Down Units Pediatric Wards

CLABSI/ CLABSI/ CLABSI/ CLABSI/ CLABSI/

Hospital CLDays Rate CLDays Rate CLDays Rate CLDays Rate CLDays Rate

State average rate 0.94 0.77 0.83 0.63 0.87

Univ Hosp SUNY Upst 2/10394 * 0.2 1/4125 0.2 0/1352 0.0 2/1187 1.7
Upst. Community Gen 1/931 1.1 0/1157 0.0
Vassar Brothers 2/3685 0.5 0/545 0.0 0/1967 0.0 0/65 0.0
Westchester Medical 3/2784 1.1 4/5909 0.7 0/2497 0.0 1/5441 0.2 2/2519 0.8
White Plains Hosp 1/3861 0.3 0/1906 0.0
Woodhull Med Ctr 2/2058 1.0 0/263 0.0 0/588 0.0 NA NA
Wyckoff Heights 5/3750 1.3 0/89 0.0 NA NA
New York State data reported as of June 27, 2019. ▬ Significantly higher than state average. ▬Significantly lower than state average. ▬Same as state average.
Rates are per 1000 central line days (CLDAYS). Excludes Mucosal Barrier Injury (MBI)-CLABSIs and bloodstream infections associated with use of extracorporeal
membrane oxygenation and ventricular assist devices.

58
Hospital-Specific, CLABSI Standardized Infection Ratios

The standardized infection ratio (SIR) is a summary measure used to compare infection data
from one population to data from a “standard” population. When calculating hospital-specific
SIRs in NYS reports, the standard population is NYS data in the same calendar year. The
CLABSI SIR is calculated by dividing the total observed number of CLABSIs across all
reportable locations in the hospital by the statistically predicted number of CLABSIs in each
location. CLABSI SIRs combine results across the eight different types of ICUs and five types
of wards to show the average performance of each hospital for CLABSIs.

• An SIR of 1.0 means the observed number of infections is equal to the number of
predicted infections.
• An SIR above 1.0 means that the infection rate is higher than that found in the standard
population. The difference above 1.0 is the percentage by which the infection rate
exceeds that of the standard population. For example, a hospital SIR of 1.12 indicates that
the hospital performed 12% worse than the state average. If the SIR is significantly
higher than 1, the result is highlighted in red.
• An SIR below 1.0 means that the infection rate is lower than that of the standard
population. The difference below 1.0 is the percentage by which the infection rate is
lower than that experienced by the standard population. For example, a hospital SIR of
0.85 indicates that the hospital performed 15% better than the state average. If the SIR is
significantly lower than 1, the result is highlighted in blue.

Figure 12 provides hospital-specific CLABSI SIRs for each hospital. Thirteen hospitals (8%)
had high SIR flags in 2018; two (Kingsbrook Jewish and Mount Sinai) were high for three
consecutive years. These hospitals will submit improvement plans following the NYSDOH HAI
Reporting Program’s Policy for Facilities with Consecutive Years of High HAI Rates. Twelve
hospitals (7%) had low SIR flags; St. Peters Hospital and Unity Hospital of Rochester were low
for four consecutive years, and Good Samaritan Medical Center (Islip) and St. Francis Hospital,
the Heart Center were low for three consecutive years.

59
Figure 12. Central line-associated bloodstream infection standardized infection ratios for intensive care units
and medical/surgical/stepdown wards: New York 2018 (page 1 of 4)

Data reported as of June 27, 2019. ┇State Average. ●SIR. ▬^^Significantly higher than state average.
▬**Significantly lower than state average. ▬Average. > Upper confidence limit exceeds graph area. NA: less than 50 central line days.
Predicted based on NYS 2018 average, adjusting for location and birthweight. Excludes mucosal barrier injury CLABSI and bloodstream
infections associated with use of extracorporeal membrane oxygenation and ventricular assist devices.

60
 Figure 12. Central line-associated bloodstream infection standardized infection ratios for intensive care
units and medical/surgical/stepdown wards: New York 2018 (page 2 of 4)

Data reported as of June 27, 2019. ┇State Average. ●SIR. ▬^^Significantly higher than state average.
▬**Significantly lower than state average. ▬Average. > Upper confidence limit exceeds graph area. NA: less than 50 central line days.
Predicted based on NYS 2018 average, adjusting for location and birthweight. Excludes mucosal barrier injury CLABSI and bloodstream
infections associated with use of extracorporeal membrane oxygenation and ventricular assist devices.

61
 Figure 12. Central line-associated bloodstream infection standardized infection ratios for intensive care
units and medical/surgical/stepdown wards: New York 2018 (page 3 of 4)

Data reported as of June 27, 2019. ┇State Average. ●SIR. ▬^^Significantly higher than state average.
▬**Significantly lower than state average. ▬Average. > Upper confidence limit exceeds graph area. NA: less than 50 central line days.
Predicted based on NYS 2018 average, adjusting for location and birthweight. Excludes mucosal barrier injury CLABSI and bloodstream
infections associated with use of extracorporeal membrane oxygenation and ventricular assist devices.

62
 Figure 12. Central line-associated bloodstream infection standardized infection ratios for intensive care
units and medical/surgical/stepdown wards: New York 2018 (page 4 of 4)

Data reported as of June 27, 2019. ┇State Average. ●SIR. ▬^^Significantly higher than state average.
▬**Significantly lower than state average. ▬Average. > Upper confidence limit exceeds graph area. NA: less than 50 central line days.
Predicted based on NYS 2018 average, adjusting for location and birthweight. Excludes mucosal barrier injury CLABSI and bloodstream
infections associated with use of extracorporeal membrane oxygenation and ventricular assist devices.
63
Catheter-Associated Urinary Tract Infections
(CAUTIs)

In order to determine if a patient has a healthcare-associated CAUTI, the CDC developed

surveillance definitions based on catheter usage, symptoms, and laboratory results. These
definitions are used by all facilities entering data into NHSN. Hospitals track the number of
CAUTIs, the number of urinary catheter days, and the number of patient days per month.

While CAUTI reporting is not required by NYSDOH, the data are available via the CDC-NYS
DUA. This DUA prohibits NYSDOH from publishing hospital-specific rates. NYSDOH does
not audit this data.

Between 2015 and 2018, the CAUTI rate declined 25%, from 1.30 infections per 1,000 catheter
days in 2015, to 1.04 infections per 1,000 catheter days in 2018. The decline was greater in
ICUs (26%) than in wards (14%). Catheter utilization decreased from 55% to 48% in ICUs, and
from 13% to 10% in wards (Figure 13).

64
Figure 13. Catheter-associated urinary tract infection and device utilization rates, New
York State 2015-2018

# Catheter Catheter
associated associated
urinary # Urinary urinary Device
# tract catheter tract # Patient utilization
year Location Hospitals infections days infection days rate

2015 Intensive Care Unit 157 901 641,269 1.41 1,160,365 55.3
2016 Intensive Care Unit 160 855 621,562 1.38 1,156,335 53.8
2017 Intensive Care Unit 160 763 581,732 1.31 1,149,734 50.6
2018 Intensive Care Unit 159 576 555,875 1.04 1,146,854 48.5
2015 Medical and Surgical Ward 167 987 811,105 1.22 6,322,223 12.8
2016 Medical and Surgical Ward 171 908 756,457 1.20 6,315,241 12.0
2017 Medical and Surgical Ward 169 800 702,450 1.14 6,207,829 11.3
2018 Medical and Surgical Ward 166 699 668,618 1.05 6,342,782 10.5
2015 TOTAL 169 1,888 1,452,374 1.30 7,482,588 19.4
2016 TOTAL 173 1,763 1,378,019 1.28 7,471,576 18.4
2017 TOTAL 171 1,563 1,284,182 1.22 7,357,563 17.5
2018 TOTAL 169 1,275 1,224,493 1.04 7,489,636 16.3
1
Infection rate is the number of infections divided by the number of catheter days, multiplied by 1,000.
2
Device utilization is the number of catheter days divided by the number of patient days.
Data reported as of May 16, 2019.

65
Microorganisms Associated with CAUTIs

The most common microorganism identified in CAUTIs in intensive care units and wards was E.
coli. (Table 16).

Table 16. Microorganisms identified in catheter-associated urinary tract infections, New

York State 2018

Number of Percent of
Microorganism Isolates Infections
Escherichia coli 447 35.1
(CRE-E. coli) (2) (0.2)
Enterococci 251 19.7
(VRE) (66) (5.2)
Pseudomonas spp. 213 16.7
Klebsiella spp. 207 16.2
(CRE-Klebsiella) (19) (1.5)
Enterobacter spp. 82 6.4
(CRE-Enterobacter) (2) (0.2)
Proteus spp. 77 6.0
Coagulase negative staphylococci 33 2.6
Citrobacter spp. 31 2.4
Staphylococcus aureus 28 2.2
(MRSA) (15) (1.2)
Morganella morganii 13 1.0
Acinetobacter spp. 11 0.9
(MDR-Acinetobacter) (4) (0.3)
Serratia spp. 11 0.9
Providencia spp. 10 0.8
Other 27 2.1
New York State data reported as of May 16, 2019. Out of 1,275 infections.
CRE: carbapenem-resistant Enterobacteriaceae;
MDR: multidrug resistant; MRSA: methicillin-resistant Staphylococcus aureus;
VRE: vancomycin-resistant Enterococci; spp: multiple species

66
Infections from Clostridioides difficile and
Multidrug Resistant Organisms (MDROs)

NYS requires hospitals to track Clostridioides difficile infections (CDI) and carbapenem-
resistant Enterobacteriaceae (CRE) infections. CMS programs require hospitals to report
methicillin-resistant Staphylococcus aureus (MRSA). Candida auris is an emerging healthcare-
associated fungal pathogen that causes infections reportable to NYS and the local health
department.

CDI, CRE, and MRSA are reported following NHSN’s “Laboratory-Identified (LabID) Event
Reporting” protocol (http://www.cdc.gov/nhsn/pdfs/pscmanual/12pscmdro_cdadcurrent.pdf).
The LabID surveillance method is a simple approach where cases are identified based on
laboratory testing and hospital admission and discharge data, rather than by clinical chart review.
Only specimens collected for clinical purposes are included (i.e. this excludes active surveillance
testing on asymptomatic patients).

LabID numerator data (e.g. admission date and specimen date) and denominator data (e.g.
number of outpatient encounters, inpatient admissions and patient days) are reported based on
the location of the specimen collection. Because CMS reporting programs are specific to certain
types of locations, hospitals’ inpatient areas are split for NHSN reporting purposes when they
have specific Centers for Medicaid and Medicare Services certification numbers. The NHSN
reporting areas are:

• Outpatient (OP)
o Emergency department (ED)
o Observation units (OBS) – Location used to evaluate whether patients require an inpatient
stay. Decision is typically made within 24 hours.
• Inpatient rehabilitation facilities or units (IRF) - These units care for patients following traumatic
physical injuries (e.g. joint replacement surgery), neurological problems (e.g. stroke, traumatic brain
injury and spinal cord injury), and cardiopulmonary illness (e.g. ventilator weaning).
• Inpatient psychiatric facilities or units (IPF) - These units cover multiple behavioral health issues
including mental illness and alcohol/drug addiction. If the units don’t have a separate CMS certification
number from the hospital, they are reported as FWI.
• Facility-wide inpatient (FWI) – all inpatient areas excluding IRF and IPFs. For CDI reporting, well
baby nurseries and neonatal ICUs are also excluded from surveillance because babies may carry
Clostridioides difficile naturally.

This report will summarize FWI and OP areas only.

67
LabID cases are categorized based on when the specimen is collected in relation to the
admission date. In this report,

• Cases termed “outpatient” are cases in which the positive stool sample was obtained in
the ED/OBS unit and the patient was not admitted the same calendar day.

• Cases termed “admission prevalent” are cases in which the positive stool sample was
obtained during the first three days of the patient’s inpatient stay. (This includes cases
identified in the ED/OBS and admitted the same day for CRE and CDI.)

o Cases termed “community onset - possibly my hospital (CO-PMH)” are

admission prevalent cases in which the patient was discharged as an inpatient
from the same hospital within the previous 4 weeks.

o Cases termed “community onset - not my hospital (CO-NMH)” are admission

prevalent cases in which the patient was not discharged from the same hospital
within the previous 4 weeks.

• Cases termed “hospital-onset (HO)” are cases in which the positive stool sample was
obtained on day four or later during the hospital stay.

These definitions are slightly different than the ones used in CDC/CMS reports. Admission date
is optional in NHSN for ED/OBS reports; however, between 2015 and 2018 NYS required
hospitals to enter the admission date if it occurred on the same calendar day as the specimen date
for CDI and CRE (to match the 2014 surveillance definition, and because these infected patients
increase the risk of transmission in the inpatient area). In the situation where a CDI or CRE
specimen is obtained in ED/OBS and the patient is admitted the same day, the case is counted in
the admission prevalence rate by NYS, and in the outpatient rate by NHSN; for other MDROs,
the specimens are counted in the outpatient rate because NYS did not direct hospitals to enter the
admission date for these pathogens.

68
Clostridioides difficile Infections (CDI)
In 2018, 15,310 CDI events were reported by acute care hospitals: 14% were identified in
ED/OBS units among patients who were not admitted the same day, 11% were identified in
ED/OBS units among patients who were admitted the same day, 40% were identified in the FWI
areas during the first three days of hospitalization, and 34% were identified in the FWI areas
after the first three days of inpatient stay (Figure 14).

Figure 14. Clostridioides difficile onset, New York State, 2018

6162
6000
5268
Number of infections

4000

2199
2000 1681

0
outpatient (not admitted outpatient admission inpatient admission inpatient hospital onset
same day) prevalent (admitted same prevalent (specimen on (specimen on day 4+)
day) day 1,2,3)

Location and day of specimen collection

Data reported as of June 18, 2019. Includes recurrent cases. Excludes inpatient rehabilitation and inpatient
psychiatric facilities. Specimens identified in the outpatient setting and admitted the next day are counted as
outpatient.

69
Laboratory Testing for CDI

Several CDI laboratory testing methods are available. The methods vary in sensitivity (ability to
detect a true positive), specificity (ability to detect a true negative), timeliness, and cost. Testing
methods may have an impact on observed CDI rates, with an increased number of cases detected
with a change to a more sensitive test method (i.e. nucleic acid amplification tests (NAAT)).

In 2018 NHSN changed the protocol for hospitals using multi-step testing algorithms, requiring
them to report the results of the final CDI test that is placed in the patient’s medical record. This
impacted the risk adjustment method for the “NAAT plus enzyme immunoassay (EIA), if
NAAT-positive” test. In 2017, two hospitals used this method, which was considered a sensitive
test because NAAT-positive/EIA negative cases were reported. In 2018, six hospitals reported
using that algorithm, which is now considered a less sensitive test because NAAT-positive/EIA
negative cases are not reported. Table 17 summarizes the testing methods reported by hospitals
in December 2018.

Table 17. C. difficile test method, New York State Hospitals, December 2018
Test method More or less Number
sensitive (%) of
hospitals
Enzyme immunoassay (EIA) for toxin less 10 (6%)
Glutamate dehydrogenase (GDH) antigen plus EIA for toxin less 9 (5%)
(2-step algorithm)
Nucleic acid amplification tests (NAAT) plus EIA, if NAAT- less 6 (3%)
positive (2-step algorithm)
GDH plus EIA for toxin, followed by NAAT for discrepant more 41 (23%)
results
GDH plus NAAT (2-step algorithm) more 7 (4%)
NAAT more 102 (58%)

The percentage of patient days surveilled using more sensitive tests has not changed much
between 2016 and 2018 (Figure 15).

70
Figure 15. Percent of patient days using sensitive laboratory test method for C. difficile,
New York State 2015-2018

100 91 92
91
86

80
% sensitive test

60

40

20

0
2015 2016 2017 2018
Year

Data reported as of June 18, 2019.

71
Admission Prevalence
The admission prevalence rate describes the percentage of patients admitted to hospitals with
CDIs. In 2018, there were 7,827 of these cases out of 2,158,053 admissions, for a rate of 0.36%
(Figure 16). This was a decrease of 27% compared to 2015.

Figure 16. Trend in C. difficile admission prevalence rate, New York State 2015-2018

% Discharged
from Same
# Admission Hospital in
# Prevalent Admission Previous 28
Year Hospitals Infections # Admissions Prevalence Rate Days
2015 175 10,454 2,106,161 0.496 25%
2016 178 9,173 2,113,844 0.434 24%
2017 177 8,278 2,166,855 0.382 25%
2018 175 7,827 2,158,053 0.363 25%
Data reported as of June 18, 2019. Excludes inpatient rehabilitation and inpatient psychiatric facilities.
Rate is number of nonduplicate CDI events per patient per month identified <3 days after admission to the facility
per 100 admissions. Includes cases identified in the emergency room if admitted the same day.

72
Hospital onset CDI rates

The longer a person stays in the hospital, the higher the total risk of acquiring an infection in the
hospital, so the HO incidence rate is reported using a denominator of patient days. The HO rate
is defined as the number of incident events identified more than three days after hospital
admission, per 10,000 patient days, where an incident event is the first event for that patient in
the same hospital or one that has been obtained more than 8 weeks after the most recent event for
that patient in the same hospital. The HO rate was 4.84 per 10,000 patient days in 2018 (Figure
17), a decrease of 35% compared to 2015.

Figure 17. Trend in Clostridioides difficile hospital onset rates, New York State 2015-2018
8

6
Incidence rate

0 Rate 95% Confidence Interval

2015 2016 2017 2018

Year

#
Hospital Onset # Hospital Onset
Year # Hospitals Infections Patient Days Rate
2015 175 7,870 10,590,347 7.43
2016 178 6,933 10,525,449 6.59
2017 177 5,449 10,471,466 5.20
2018 175 5,057 10,449,466 4.84
Data reported as of June 18, 2019. Excludes inpatient rehabilitation and inpatient psychiatric facilities.
Rate is number of incident CDI events identified >3 days after admission to the facility per 10,000 patient days.

73
Risk Adjustment

The following risk factors were associated with FWI HO CDI rates and included in the risk
adjustment (negative binomial regression) model.

• Laboratory test method – Testing method was obtained from quarterly NHSN rate tables
and expressed as the fraction of the year that a more sensitive test was used. Consistent
with results from previous NYS reports, the HO rate for hospitals performing more
sensitive tests was set to 1.5 times higher than hospitals performing less sensitive tests.

• Hospital CO-NMH prevalence rate – As the CO-NMH rate increased from 0 to 1 case per
100 admissions, the HO rate increased by a factor of 3.6.

• Hospital bed size, as reported in 2018 NHSN survey – The HO rate at hospitals with 100
to 424 beds was 1.3 times higher than the rate at hospitals with less than 100 beds, and
the HO rate at hospitals with greater than 424 beds was 1.7 times higher than the rate at
hospitals with less than 100 beds.

• Percent of patient days in adult intensive care units – This was calculated by dividing the
number of adult ICU patient days (from the CLABSI summary data) by the number of
CDI patient days (from the MDRO summary data). As percent ICU days increased 10%,
the HO rate increased by a factor of 1.2.

Hospital-specific FWI HO CDI rates are summarized in Figure 18. Fifteen specialty hospitals
(e.g. children’s, maternity, orthopedic/surgical, oncology, long term acute care, and freestanding
rehabilitation) were excluded from the risk adjustment model because there was insufficient data
to compare the hospital rates, and one very small hospital was excluded due to an outlying CO-
NMH prevalence rate. The remaining 159 hospitals contributed 4,690 HO CDIs among
9,870,269 patient days, for an average HO rate of 4.75 per 10,000 patient days.

Hospitals were flagged as having adjusted rates significantly higher or lower than the state
average if the 99% confidence interval excluded the state average HO rate. In 2018, 13 out of
159 hospitals (7%) were flagged with adjusted rates significantly higher than the state average;
NYP-Columbia and NYP-Weill Cornell were flagged high for four consecutive years, and
Montefiore Moses was flagged high for three consecutive years. The 13 hospitals will submit
improvement plans following the NYSDOH HAI Reporting Program’s Policy for Facilities with
Consecutive Years of High HAI Rates. Thirteen hospitals (7%) were flagged significantly lower
than average. Mount Sinai West, Mount Sinai Beth Israel, and St. Barnabas Hospital were
significantly lower than average for the last three consecutive years.

74
Figure 18. Hospital onset facility-wide inpatient C. difficile rates, New York State 2018 (Page 1 of 7)

Data reported as of June 18, 2019. ┇State Average. ●Risk-adjusted Infection rate. ▬^Significantly higher than state average. ▬**Significantly lower than state average.
▬ Average. > Upper confidence limit exceeds graph area. Test method: N = less sensitive test (e.g. enzyme immunoassay), S = more sensitive test (e.g. nucleic acid amplification
test). OP: Outpatient not admitted, CO-NMH: community onset-not my hospital, CO-PMH: community onset-possibly my hospital, HO: hospital onset, HO rate is per 10,000 patient
days. HO rate adjusted using test method, CO-NMH rate, percent intensive care unit days, and number of beds. Rehabilitation and behavioral health units excluded.

75
Figure 18. Hospital onset facility-wide inpatient C. difficile rates, New York State 2018 (Page 2 of 7)

Data reported as of June 18, 2019. ┇State Average. ●Risk-adjusted Infection rate. ▬^Significantly higher than state average. ▬**Significantly lower than state average.
▬ Average. > Upper confidence limit exceeds graph area. Test method: N = less sensitive test (e.g. enzyme immunoassay), S = more sensitive test (e.g. nucleic acid amplification
test). OP: Outpatient not admitted, CO-NMH: community onset-not my hospital, CO-PMH: community onset-possibly my hospital, HO: hospital onset, HO rate is per 10,000 patient
days. HO rate adjusted using test method, CO-NMH rate, percent intensive care unit days, and number of beds. Rehabilitation and behavioral health units excluded.
76
Figure 18. Hospital onset facility-wide inpatient C. difficile rates, New York State 2018 (Page 3 of 7)

Data reported as of June 18, 2019. ┇State Average. ●Risk-adjusted Infection rate. ▬^Significantly higher than state average. ▬**Significantly lower than state average.
▬ Average. > Upper confidence limit exceeds graph area. Test method: N = less sensitive test (e.g. enzyme immunoassay), S = more sensitive test (e.g. nucleic acid amplification
test). OP: Outpatient not admitted, CO-NMH: community onset-not my hospital, CO-PMH: community onset-possibly my hospital, HO: hospital onset, HO rate is per 10,000 patient
days. HO rate adjusted using test method, CO-NMH rate, percent intensive care unit days, and number of beds. Rehabilitation and behavioral health units excluded.
77
Figure 18. Hospital onset facility-wide inpatient C. difficile rates, New York State 2018 (Page 4 of 7)

Data reported as of June 18, 2019. ┇State Average. ●Risk-adjusted Infection rate. ▬^Significantly higher than state average. ▬**Significantly lower than state average.
▬ Average. > Upper confidence limit exceeds graph area. Test method: N = less sensitive test (e.g. enzyme immunoassay), S = more sensitive test (e.g. nucleic acid amplification test).
OP: Outpatient not admitted, CO-NMH: community onset-not my hospital, CO-PMH: community onset-possibly my hospital, HO: hospital onset, HO rate is per 10,000 patient days. HO
rate adjusted using test method, CO-NMH rate, percent intensive care unit days, and number of beds. Rehabilitation and behavioral health units excluded.
78
Figure 18. Hospital onset facility-wide inpatient C. difficile rates, New York State 2018 (Page 5 of 7)

Data reported as of June 18, 2019. ┇State Average. ●Risk-adjusted Infection rate. ▬^Significantly higher than state average. ▬**Significantly lower than state average.
▬ Average. > Upper confidence limit exceeds graph area. Test method: N = less sensitive test (e.g. enzyme immunoassay), S = more sensitive test (e.g. nucleic acid amplification
test). OP: Outpatient not admitted, CO-NMH: community onset-not my hospital, CO-PMH: community onset-possibly my hospital, HO: hospital onset, HO rate is per 10,000 patient
days. HO rate adjusted using test method, CO-NMH rate, percent intensive care unit days, and number of beds. Rehabilitation and behavioral health units excluded.

79
Figure 18. Hospital onset facility-wide inpatient C. difficile rates, New York State 2018 (Page 6 of 7)

Data reported as of June 18, 2019. ┇State Average. ●Risk-adjusted Infection rate. ▬^Significantly higher than state average. ▬**Significantly lower than state average.
▬ Average. > Upper confidence limit exceeds graph area. Test method: N = less sensitive test (e.g. enzyme immunoassay), S = more sensitive test (e.g. nucleic acid amplification test).
OP: Outpatient not admitted, CO-NMH: community onset-not my hospital, CO-PMH: community onset-possibly my hospital, HO: hospital onset, HO rate is per 10,000 patient days. HO
rate adjusted using test method, CO-NMH rate, percent intensive care unit days, and number of beds. Rehabilitation and behavioral health units excluded.
80
Figure 18. Hospital onset facility-wide inpatient C. difficile rates, New York State 2018 (Page 7 of 7)

Data reported as of June 18, 2019. ┇State Average. ●Risk-adjusted Infection rate. ▬^Significantly higher than state average. ▬**Significantly lower than state average.
▬ Average. > Upper confidence limit exceeds graph area. Test method: N = less sensitive test (e.g. enzyme immunoassay), S = more sensitive test (e.g. nucleic acid amplification test).
OP: Outpatient not admitted, CO-NMH: community onset-not my hospital, CO-PMH: community onset-possibly my hospital, HO: hospital onset, HO rate is per 10,000 patient days. HO
rate adjusted using test method, CO-NMH rate, percent intensive care unit days, and number of beds. Rehabilitation and behavioral health units excluded.

81
Figure 19 shows the FWI CDI overall patient prevalence rate by county (or merged county for
those with few or no hospitals). In contrast to CRE (see maps in CRE section), the prevalence of
CDI is low in New York City (NYC), and varies in the upstate area.

Figure 19. Facility-wide inpatient Clostridioides difficile prevalence rates, New York State
2018

Data reported as of June 18, 2019. Excludes specialty hospitals, inpatient rehabilitation facilities, and inpatient psychiatric
facilities. Specimens identified in the outpatient setting and admitted the next day are not included. The number of cases reported
in hospitals performing less sensitive tests was multiplied by 1.5 to approximate the number of cases expected if a more sensitive
test was used.

82
Carbapenem-resistant Enterobacteriaceae (CRE) Infections
The NHSN LabID CRE surveillance definition is:

Any Escherichia coli, Klebsiella oxytoca, Klebsiella pneumoniae, or Enterobacter spp.

testing resistant to imipenem, meropenem, doripenem, or ertapenem by standard
susceptibility testing methods (i.e., minimum inhibitory concentrations of ≥4 mcg/mL for
doripenem, imipenem and meropenem or ≥2 mcg/mL for ertapenem) OR by production of a
carbapenemase demonstrated using a recognized test.

In 2018, 2,640 CRE cases were reported: 13% were identified in ED/OBS units among patients
who were not admitted the same day, 17% were identified in ED/OBS units among patients who
were admitted the same day, 24% were identified in the FWI area during the first three days of
hospitalization, and 46% were identified in the FWI area after the first three days of inpatient
stay (Figure 20).

Figure 20. Carbapenem-resistant Enterobacteriaceae infection onset, NYS 2018

Data reported as of June 18, 2019. Excludes inpatient rehabilitation and inpatient psychiatric facilities. Specimens identified in
the outpatient setting and admitted the next day are counted as outpatient.

83
Among community onset cases, the most common specimen site was by far the urinary tract;
among hospital onset cases, there was an increase in the proportion of respiratory specimens in
2018 (Figure 21).

Figure 21. Carbapenem-resistant Enterobacteriaceae by specimen site, NYS 2015-2018

Data reported as of June 18, 2019

84
The admission prevalence rate describes the percentage of patients admitted to hospitals with
CRE. In 2018, there were 1,033 of these cases out of 2,376,700 admissions, for a rate of 0.435
infections per 1,000 admissions. The overall admission prevalence rate decreased 33% between
2015 and 2018. The bloodstream infection (BSI) rate decreased 24% over the same time period;
there was an increase between 2017 and 2018 that was not statistically significant (Figure 22).

Figure 22. Facility-wide inpatient carbapenem-resistant Enterobacteriaceae admission

prevalence infection rates, New York State 2015-2018

Bloodstream All-Specimen
Infection Admission
# Bloodstream # Total Admission Prevalence
Year infections Infections # Admissions Prevalence Rate Rate
2015 145 1,519 2,329,051 0.0623 0.652
2016 125 1,459 2,328,690 0.0537 0.627
2017 92 1,084 2,379,788 0.0387 0.456
2018 113 1,033 2,376,700 0.0475 0.435
Data reported as of June 18, 2019. Bloodstream Infection Admission Prevalence Rate = number of unique (no others
in previous 14 days) blood source infections per patient per month identified ≤ 3 days after admission to the hospital
/ Number of patient admissions to the hospital x 1000. All Specimen Admission Prevalence Rate = number of first
infections per patient per month identified ≤ 3 days after admission to the hospital / Number of patient admissions to
the hospital x 1000. Includes cases identified in the emergency room if admitted the same day. Excludes inpatient
rehabilitation and inpatient psychiatric locations.

85
The longer a person stays in the hospital, the higher the total risk of acquiring an infection in the
hospital, so the incidence rates are reported using a denominator of patient days. The BSI
incidence rate decreased 34% between 2015 and 2018, and the all-specimen incidence rate
significantly decreased 32% between 2015 and 2018 (Figure 23). The 2018 all-specimen
incidence rate was six times higher than the BSI incidence rate.

Figure 23. Facility-wide inpatient carbapenem-resistant Enterobacteriaceae infection

incidence rates, New York State 2015-2018

Bloodstream
# Infection All Specimen
Bloodstream # Total # Patient Incidence Infection/Colonization
Year Infections Infections Days Rate Incidence Rate
2015 231 1,324 11,466,593 0.201 1.155
2016 248 1,311 11,397,102 0.218 1.150
2017 208 1,057 11,355,798 0.183 0.931
2018 150 885 11,330,490 0.132 0.781
Data reported as of June 18, 2019. Bloodstream Infection Incidence Rate = Number of all unique (no others in
previous 14 days) blood source infections per patient per month identified > 3 days after admission to the hospital /
Number of patient days x 10,000. All Specimen Infection/Colonization Incidence Rate = Number of first events per
patient among those with no event with this specific organism type reported in a previous month at this hospital, and
identified > 3 days after admission to the hospital / Number of patient days x 10,000. Excludes inpatient
rehabilitation and inpatient psychiatric locations.

86
Overall patient prevalence includes both admission prevalent and hospital onset cases. Overall
patient prevalence rates by year and species are summarized in Figure 24. Between 2015 and
2018, the prevalence of Klebsiella decreased 46%, the prevalence of Enterobacter spp. decreased
1%, and the prevalence of E. coli increased 14%. A small percentage (3%) of patients harbored
more than one type of organism.

Figure 24. Trends in overall patient prevalence carbapenem-resistant Enterobacteriaceae

infection rates by species, NYS 2015-2018

Klebsiella oxytoca
Year and pneumoniae Enterobacter spp. E. coli Total
2015 1.104 0.199 0.102 1.405
2016 1.037 0.208 0.126 1.372
2017 0.736 0.212 0.112 1.061
2018 0.600 0.197 0.116 0.913
Data reported as of June 18, 2019. Inpatient rehab and pychiatric facility data excluded. Overall patient prevalence
rate is the number of first LabID Events per patient per month (e.g. admission prevalent or hospital onset) / Number
of patient admissions to the hospital x 1000

87
Figures 25 (a,b,c) show the FWI CRE patient prevalence rate by species and county (or merged
county for those with few or no hospitals). FWI CRE-Klebsiella and CRE-E. coli patient
prevalence rates are highest in the New York City area. CRE-Enterobacter rates showed some
spikes in western and northern NYS. Note that all maps were made to show areas with zero
reported cases in the darkest shade of blue, followed by five equal ranges; if the CRE-
Enterobacter and CRE-E. coli maps used the same scale as the CRE-Klebsiella map, they would
be entirely in the three shades of blue.

Figure 25 a-c. Facility-wide inpatient carbapenem-resistant Enterobacteriaceae patient

prevalence rates, New York State 2018

(a) CRE-Klebsiella overall patient prevalence rate 2018

88
 (b) CRE-Enterobacter overall patient prevalence rate 2018

(c) CRE-E. coli overall patient prevalence rate 2018

Data reported as of June 18, 2019. Small counties have been merged.

89
Laboratory Testing Methods

Breakpoints for determining whether an organism is susceptible, intermediate, or resistant to an

antibiotic are published by the Clinical Laboratory Standards Institute (CLSI). However, the
CLSI breakpoints are updated more frequently than they can be adopted by manufacturers of
susceptibility testing systems because of additional approvals required by the Food and Drug
Administration. According to the 2018 NHSN survey, 91% of facilities used the newer more
sensitive (CLSI M22 or M23 standard) breakpoints in 2018, while 9% continued to use the old
breakpoints. The facilities using the older breakpoints may follow screening algorithms that
incorporate additional testing to approximate the newer breakpoints.

Identification of carbapenemases (enzymes that bacteria produce that destroy carbapenem

antibiotics), can also be used to meet the CRE LabID definition. On the 2018 NHSN survey,
47% of facilities reported that their labs perform a special test for carbapenemase production.
However, based on the list of 2018 CRE infections reported to NHSN, approximately 17% of
specimens were tested for the presence of a carbapenemase. This was most commonly done
using the Modified Hodge Test. Among those tested, a carbapenemase was identified 69% of
the time.

Facilities using the older breakpoints or not detecting carbapenemases may be undercounting
CRE, and testing differences may reduce the comparability of CRE rates between facilities.

There may also be variation in the extent to which facilities identify and perform susceptibility
testing of non-sterile specimens. Laboratory identification of CRE can be achieved through
several methods, all of which have benefits and drawbacks. There is no standardization for which
method should be used in individual health care facility laboratories. As such, hospital-specific
CRE rates, particularly in non-blood specimens, may vary based on testing methods.

Hospital-specific CRE rates

The primary HAI indicator of interest for evaluating hospital performance is the hospital onset
BSI rate, because 1) blood specimens are more consistently screened by laboratories across the
state; 2) bloodstream infections are very serious and more likely reflect clinical disease than CRE
detected from nonsterile body sites such as wounds 1. The prevalence of CRE among patients
newly admitted to facilities is also reported because this burden of admission prevalent cases is
related to the risk of spread within the facility.

Hospitals should review their HO BSI rates in relation to their admission prevalence rates as
shown in Figure 26, e.g. hospitals with high HO rates and low admission prevalence rates should
examine whether they are testing patients promptly (days 1-3) and if their cases were clustered.

90
With respect to interpreting the all-site rates, note there are variations in the types of specimens
reported among hospitals, e.g. some hospitals have reported a very large proportion of urinary
tract infections/colonizations, others reported a very large proportion of skin or respiratory
infections/colonizations. The hospital- and region-specific admission prevalence rate, bed size,
and percent intensive care unit patient days do not strongly predict the HO BSI rate; therefore,
risk-adjusted rates are not presented. More research is needed on CRE risk adjustment to
balance the importance of accuracy and fairly comparing rates with the need for having a
measure to identify hospitals with higher than predicted rates for public health assistance and
quality improvement programs.

Hospitals should continue to evaluate their infection prevention and control practices in relation
to CDC recommendations. Challenges include imperfect compliance with handwashing, delays
and/or variations in implementing contact precautions and appropriately cohorting patients,
delays in discontinuing devices when they are no longer needed, and lack of established
protocols to screen epidemiologically linked contacts and perform active surveillance testing in
high-risk areas. In addition, the pressures of broad-spectrum antibiotic usage along with the
interdependence of acute and long-term care facilities in the spread and transmission of CRE2
and challenges promptly communicating infection control issues at the time of inter-facility
transfer compound the complexity of CRE containment and prevention.

91
 Figure 26. Hospital carbapenem-resistant Enterobacteriaceae infection rates, NYS 2018 (Page 1 of 7)

Data reported as of June 18, 2019. Facility-wide inpatient only, rehab and behavioral health units excluded
HO-All: hospital onset CRE incidence rate all sites per 10,000 patient days and 95% confidence interval (state average = 0.8)
HO-BSI: hospital onset CRE blood incidence rate per 10,000 patient days and 95% confidence interval (state average = 0.1)
All-Admprev: all body site CRE admissions prevalence rate per 1,000 admissions and 95% confidence interval (state average = 0.4)
92
 Figure 26. Hospital carbapenem-resistant Enterobacteriaceae infection rates, NYS 2018 (Page 2 of 7)

Data reported as of June 18, 2019. Facility-wide inpatient only, rehab and behavioral health units excluded
HO-All: hospital onset CRE incidence rate all sites per 10,000 patient days and 95% confidence interval (state average = 0.8)
HO-BSI: hospital onset CRE blood incidence rate per 10,000 patient days and 95% confidence interval (state average = 0.1)
All-Admprev: all body site CRE admissions prevalence rate per 1,000 admissions and 95% confidence interval (state average = 0.4)

93
 Figure 26. Hospital carbapenem-resistant Enterobacteriaceae infection rates, NYS 2018 (Page 3 of 7)

Data reported as of June 18, 2019. Facility-wide inpatient only, rehab and behavioral health units excluded
HO-All: hospital onset CRE incidence rate all sites per 10,000 patient days and 95% confidence interval (state average = 0.8)
HO-BSI: hospital onset CRE blood incidence rate per 10,000 patient days and 95% confidence interval (state average = 0.1)
All-Admprev: all body site CRE admissions prevalence rate per 1,000 admissions and 95% confidence interval (state average = 0.4)

94
 Figure 26. Hospital carbapenem-resistant Enterobacteriaceae infection rates, NYS 2018 (Page 4 of 7)

Data reported as of June 18, 2019. Facility-wide inpatient only, rehab and behavioral health units excluded
HO-All: hospital onset CRE incidence rate all sites per 10,000 patient days and 95% confidence interval (state average = 0.8)
HO-BSI: hospital onset CRE blood incidence rate per 10,000 patient days and 95% confidence interval (state average = 0.1)
All-Admprev: all body site CRE admissions prevalence rate per 1,000 admissions and 95% confidence interval (state average = 0.4)

95
 Figure 26. Hospital carbapenem-resistant Enterobacteriaceae infection rates, NYS 2018 (Page 5 of 7)

Data reported as of June 18, 2019. Facility-wide inpatient only, rehab and behavioral health units excluded
HO-All: hospital onset CRE incidence rate all sites per 10,000 patient days and 95% confidence interval (state average = 0.8)
HO-BSI: hospital onset CRE blood incidence rate per 10,000 patient days and 95% confidence interval (state average = 0.1)
All-Admprev: all body site CRE admissions prevalence rate per 1,000 admissions and 95% confidence interval (state average = 0.4)

96
 Figure 26. Hospital carbapenem-resistant Enterobacteriaceae infection rates, NYS 2018 (Page 6 of 7)

Data reported as of June 18, 2019. Facility-wide inpatient only, rehab and behavioral health units excluded
HO-All: hospital onset CRE incidence rate all sites per 10,000 patient days and 95% confidence interval (state average = 0.8)
HO-BSI: hospital onset CRE blood incidence rate per 10,000 patient days and 95% confidence interval (state average = 0.1)
All-Admprev: all body site CRE admissions prevalence rate per 1,000 admissions and 95% confidence interval (state average = 0.4)

97
 Figure 26. Hospital carbapenem-resistant Enterobacteriaceae infection rates, NYS 2018 (Page 7 of 7)

Data reported as of June 18, 2019. Facility-wide inpatient only, rehab and behavioral health units excluded
HO-All: hospital onset CRE incidence rate all sites per 10,000 patient days and 95% confidence interval (state average = 0.8)
HO-BSI: hospital onset CRE blood incidence rate per 10,000 patient days and 95% confidence interval (state average = 0.1)
All-Admprev: all body site CRE admissions prevalence rate per 1,000 admissions and 95% confidence interval (state average = 0.4)

98
 Methicillin-resistant Staphylococcus aureus (MRSA)
bloodstream infections

Staphylococcus aureus is a common type of bacteria found on the skin or in the nose of many
healthy individuals. When Staphylococcus aureus is resistant to the antibiotics oxacillin,
cefoxitin, or methicillin, it is called MRSA. In 2018, 173 hospitals reported MRSA BSIs for
participation in CMS incentive programs. MRSA is not a NYSDOH indicator. NYSDOH does
not audit the data, and the DUA specifies that MRSA rates cannot be published by hospital.

Between 2015 and 2018, the admission prevalence MRSA BSI rate decreased 28% and the
hospital onset MRSA rate decreased 17% (Figure 27).

Figure 27. MRSA bloodstream infections, New York State 2015-2018

Admission
# # Prevalence Hospital Onset
Emergency Admission Rate # Hospital Incidence Rate
# Dept. Prevalent # (per 1,000 Onset (per 10,000 patient
Year Hosp Infections Infections Admissions admissions) Infections # Patient Days days)
2015 174 1,464 1,459 2,325,035 0.628 777 11,410,301 0.681
2016 177 1,921 1,154 2,330,860 0.495 718 11,369,649 0.632
2017 175 2,083 1,059 2,358,724 0.449 695 11,222,935 0.619
2018 173 2,253 1,078 2,375,972 0.453 661 11,225,000 0.589
Facility-wide inpatient data reported as of May 16, 2019

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Figure 28 shows the FWI MRSA patient prevalence rate by county (or merged county for those
with few or no hospitals).

Figure 28. Facility-wide inpatient MRSA bloodstream infection patient prevalence rates,
New York State 2018

Facility-wide inpatient data reported as of May 16, 2019. Small counties were merged.

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Candida auris infections
Candida auris (C. auris) is a globally emerging, multidrug-resistant yeast that has caused
healthcare-associated outbreaks of invasive infections with high mortality. CDC issued a clinical
alert to US healthcare facilities in June 2016 requesting notification of C. auris cases. Following
the CDC alert, NYSDOH issued advisories, presented webinars, and provided other
communications to relay information about C auris identification, prevention, and control to
NYS healthcare facilities, clinicians, and laboratories.

Epidemiologic and laboratory evidence continue to show that C. auris has been transmitted
within healthcare facilities in New York City and the surrounding Metropolitan area of NYS. In
over two years of investigation, case counts have increased, and the New York City/Metropolitan
area is one of the areas in the United States where the most C. auris cases have been detected; C.
auris may already be endemic in healthcare facilities in some of the most impacted localities.

To curb further spread of C. auris, NYS developed a special team to handle C. auris activity in
the region. Working with senior staff in both regional and central offices, this team has been
investigating cases of C. auris. Activities include conducting on-site investigations; reviewing
patient charts; developing lists of close contacts of confirmed cases; providing infection control
education and recommendations to facilities experiencing C. auris; collecting laboratory
specimens from patients/residents and environmental surfaces in facilities; monitoring to ensure
facility compliance with infection control recommendations; and implementing training
programs on infection prevention issues, including training for hospitals, nursing homes, and
health care facilities, focusing on MDR fungi and general infection control; and providing
guidance on environmental cleaning.

An admission screening pilot program was implemented and found to be effective as a means for
early case detection. Admission screening recommendations are planned, depending on the
success of ongoing efforts to increase laboratory capacity for rapid detection of C. auris. These
recommendations will be in addition to current CDC recommendations and will be tailored for
the NYS situation.

This section summarizes the laboratory test results confirmed by Wadsworth Center, NYS’s
public health laboratory. Clinical cases are defined as persons with a positive C. auris culture
from specimens collected to diagnose or treat disease in the normal course of care.
Screening/surveillance cases are defined as persons without symptoms of infection but with a
positive C. auris culture from specimens collected from point prevalence surveys, admission
screening, and contact tracing. Some surveillance cases later developed clinical illness and so are
also counted as surveillance-to-clinical cases. For example, if an asymptomatic person was
identified as a surveillance case in 2017 then develops clinical illness in 2018, he is counted both
as a 2017 surveillance case and as a surveillance-to-clinical case in 2018. For consistency, if a

101
person is identified as a surveillance case in 2018 and develops clinical illness later in 2018, she
is counted as both a surveillance case and as a surveillance-to-clinical case in 2018.

In 2018 there were 254 surveillance cases, 132 clinical cases, and 26 clinical cases that were also
previously counted as surveillance cases (Figure 29). Eighty-one patients had bloodstream
infections. The average patient age was 69 (range 21 to 100 years).

Figure 29. Candida auris cases, New York State facilities 2016-18

# surveillance to # total
year # clinical cases clinical # surveillance cases
2016 26 0 11 37
2017 93 6 129 228
2018 132 26 254 412

Samples reported as of July 11, 2019. First positive per person per specimen type (clinical/surveillance). Includes
cases identified in hospitals, nursing homes, and other facility types.

Clinical and surveillance cases are mapped by county of diagnosis in Figure 30. Cases were
concentrated in Brooklyn.

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Figure 30. Number of patients colonized or infected with Candida auris, New York State
2018
a) Clinical cases

b) Surveillance cases

Samples reported as of July 11, 2019. First positive per person per specimen type (clinical/surveillance). Includes
cases identified in hospitals and LTCFs.

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C. auris has been found in health care facilities throughout the New York City metropolitan area.
It is not a problem particular to any one facility but rather a challenge for all facilities in the
region, regardless of whether C. auris has thus far been identified there. When a hospital or
LTCF cares for patients or residents whose positive colonization status is known, NYS personnel
work with the facility to institute the appropriate infection control measures and, in certain
situations, to conduct point prevalence surveys to detect other colonized patients and residents.
Because of these activities, transmission is less likely to occur when a person’s positive
colonization status is known.

Between January 1, 2016 and June 28, 2019, 64 hospitals, 1 long term acute care hospital, 103
LTCFs, and 3 hospices were known to have cared for a person infected, colonized, or possibly
colonized with C. auris (Tables 18 and 19). There are several caveats to the use of this
information:

• Facilities are included if they cared for one or more patients with known C. auris
infection or colonization or if a person with C. auris infection or colonization had been
cared for in the facility within 90 days before diagnosis. Facilities caring for patients
within 90 days before diagnosis are included because people can be colonized for weeks,
months, or longer before an infection occurs or before colonization is detected. However,
this might result in a facility being included on this list even though the patient in
question was not yet colonized while in that facility. Conversely, it also might result in a
facility not being included on this list if it cared for a colonized patient more than 90 days
before the colonization was detected.
• Surveillance for C. auris cases in NYS is likely incomplete because cases are found in
many health care facilities throughout the New York City metropolitan area and because
of the resource-intensive nature of patient tracking. Therefore, it is likely that there are
facilities which have cared for affected patients but which are not included on the lists
below.
• Inclusion on these lists of impacted facilities does not necessarily imply that the facility is
currently caring for any patients or residents with C. auris. For example, the lists include
facilities that had patients more than a year ago and are not known to have cared for
patients with C. auris since then. It is not possible to determine the date a colonized or
infected patient was last present in a facility. This, along with the fact that affected
persons are frequently transferred to and from different facilities, also accounts for the
fact that the number of affected persons in each facility cannot be provided.
• Inclusion on these lists of impacted facilities does not necessarily imply that the patient or
resident acquired C. auris at that facility. Persons who are colonized or infected with C.
auris tend to have multiple serious medical problems and frequent admissions and
transfers to different hospitals or LTCFs. Because a person can be asymptomatically

104
 colonized for an indeterminate period, it is not usually possible to determine where C.
auris was acquired.
• Some hospitals on the list of impacted facilities are large institutions, often with discrete
wings and sections or multiple buildings. Having cared for one or more patients with C.
auris in one area might not result in an increased risk for patients cared for in other areas.
• LTCFs, by regulation, can only accept residents for whom they can provide an
appropriate care plan. LTCFs which decline admissions of residents with known C. auris
infection or colonization are less likely to be included on the list, although they might be
caring for colonized residents whose colonization has not yet been detected.

For all of these reasons, these lists of affected facilities should not be used by consumers to
decide where to seek care, and inclusion on the lists does not relate to quality of care.
Consumers interested in information about quality of care should refer to the NYS HAI report
“Summary for Consumers” or CMS’s Hospital Compare website for hospital information and
CMS’s Nursing Home Compare website for LTCFs.

The lists below can be used to get a sense for how widespread C. auris is in a community. All
facilities in highly affected communities might care for patients or residents who are colonized or
infected with C. auris, whether known or unknown. This illustrates the need for careful and
thorough routine infection control, including environmental cleaning and disinfection, in every
health care facility.

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Table 18. Hospitals that Have Cared for Persons with Candida auris Infection or Colonization, as of 6/28/2019
Hospital Name ID Hospital Name ID Hospital Name ID
New York County (Manhattan) Kings County (Brooklyn) Richmond County (Staten Island)
Bellevue Hospital Center 1438 Brookdale Hospital Medical Center 1286 Richmond University Medical Center 1738
Harlem Hospital Center 1445 Brooklyn Hospital Center - Downtown Campus 1288 Staten Island University Hosp - North 1740
Henry J. Carter Specialty Hospital 1486 Calvary Hospital Inc (Brooklyn campus) 1175 Staten Island University Hosp - South 1737
Lenox Hill Hospital 1450 Coney Island Hospital 1294 Westchester County
Memorial Hospital for Cancer and Allied Diseases 1453 Interfaith Medical Center 1309 SJRH - St Johns Division 1097
Metropolitan Hospital Center 1454 Kings County Hospital Center 1301 Westchester Medical Center 1139
Mount Sinai Beth Israel 1439 Kingsbrook Jewish Medical Center 1315 Rockland County
Mount Sinai Hospital 1456 Maimonides Medical Center 1305 Good Samaritan Hospital of Suffern 0779
Mount Sinai West 1466 Mount Sinai Brooklyn 1324 Helen Hayes Hospital 0775
New York Presbyterian Hospital - Allen Hospital 3975 New York Community Hospital of Brooklyn, Inc 1293 Montefiore Nyack 0776
New York Presbyterian Hospital - Columbia Presbyterian Center 1464 NewYork-Presbyterian Brooklyn Methodist Hospital 1306 Nassau County
New York Presbyterian Hospital - New York Weill Cornell Center 1458 NYU Langone Hospital-Brooklyn 1304 North Shore University Hospital 0541
New York-Presbyterian/Lower Manhattan Hospital 1437 University Hospital of Brooklyn 1320 Glen Cove Hospital 0490
NYU Langone Hospitals 1463 Woodhull Medical & Mental Health Center 1692 Mount Sinai South Nassau 0527
NYU Langone Orthopedic Hospital 1446 Wyckoff Heights Medical Center 1318 NYU Winthrop Hospital 0511
Queens County (Queens) Bronx County (Bronx) Suffolk County
Elmhurst Hospital Center 1626 BronxCare Hospital Center (Concourse) 1178 Huntington Hospital 0913
Flushing Hospital Medical Center 1628 Calvary Hospital Inc (Bronx campus) 1175 Southside Hospital 0924
Jamaica Hospital Medical Center 1629 Lincoln Medical and Mental Health Center 1172 University Hospital 0245
Long Island Jewish Forest Hills 1638 Montefiore Med Center - Jack D Weiler Hosp of A Einstein College Div 3058 Orange County
Long Island Jewish Medical Center 1630 Montefiore Medical Center - Henry and Lucy Moses Div 1169 Orange Regional Medical Center 0699
Mount Sinai Hospital - Mount Sinai Hospital of Queens 1639 Montefiore Medical Center - Wakefield Hospital 1168 Dutchess County
NewYork-Presbyterian/Queens 1637 SBH Health System 1176 Vassar Brothers Medical Center 0181
Queens Hospital Center 1633 Albany County
St Johns Episcopal Hospital So Shore 1635 Albany Medical Center Hospital 0001
Monroe County
Rochester General Hospital 0411

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Table 19. Long-term Care Facilities and Hospices that Have Cared for Persons with Candida auris Infection or Colonization, as of
6/28/2019
LTCF Name ID LTCF or Hospice Name ID LTCF Name ID
New York County (Manhattan) Kings County (Brooklyn) Bronx County (Bronx)
Isabella Geriatric Center Inc 1569 Atrium Center for Rehabilitation and Nursing 1430 BronxCare Special Care Center 4501
Amsterdam Nursing Home Corp (1992) 1605 Bedford Center for Nursing and Rehabilitation 1409 Bainbridge Nursing & Rehabilitation Center 1227
Mary Manning Walsh Nursing Home Co Inc 1571 Bensonhurst Center for Rehabilitation and Healthcare 1406 Bronx Gardens Rehabilitation and Nursing Center 4887
Terence Cardinal Cooke Health Care Center 3089 Boro Park Center for Rehabilitation and Healthcare 1403 Concourse Rehabilitation and Nursing Center, Inc 1253
The New Jewish Home, Manhattan 1603 Brooklyn Center for Rehabilitation and Residential Health Care 1395 Fieldston Lodge Care Center 1233
The Riverside 1370 Brooklyn Gardens Nursing & Rehabilitation Center 7069 Grand Manor Nursing & Rehabilitation Center 0856
Pelham Parkway Nursing Care and Rehabilitation Facility
1368
Queens County (Queens) Brooklyn United Methodist Church Home LLC 1245
Beacon Rehabilitation and Nursing Center 1736 Brooklyn-Queens Nursing Home 0277 Split Rock Rehabilitation and Health Care Center 1243
Bridge View Nursing Home 1673 Bushwick Center for Rehabilitation and Health Care 4037 Wayne Center for Nursing & Rehabilitation 1257
Brookhaven Rehabilitation & Health Care Center LLC 1703 Caton Park Rehabilitation and Nursing Center, LLC 1380 Richmond County (Staten Island)
Cliffside Rehabilitation & Residential Health Care Center 1676 Cobble Hill Health Center, Inc 1381 Clove Lakes Health Care and Rehabilitation Center, Inc 1750
Dry Harbor Nursing Home 1705 Concord Nursing and Rehabilitation Center 1404 New Vanderbilt Rehabilitation and Care Center, Inc 1752
Richmond Center for Rehabilitation and Specialty 4823
Fairview Nursing Care Center Inc 1678 Crown Heights Center for Nursing and Rehabilitation 1407 Healthcare
Franklin Center for Rehabilitation and Nursing 1708 Ditmas Park Care Center 1576 Silver Lake Specialized Rehabilitation and Care Center 1753
Haven Manor Health Care Center, LLC 3256 Downtown Brooklyn Nursing & Rehabilitation Center 1408 Staten Island Care Center 1756
Highland Care Center 1711 Four Seasons Nursing and Rehabilitation Center 3227 Westchester County
Holliswood Center for Rehabilitation and Healthcare 1712 Hamilton Park Nursing and Rehabilitation Center 4285 Adira at Riverside Rehabilitation and Nursing 6250
Long Island Care Center Inc 1685 Haym Solomon Home for the Aged 1361 Schaffer Extended Care Center 1081
Meadow Park Rehabilitation and Health Care Center LLC 1687 Hopkins Center for Rehabilitation and Healthcare 5546 Tarrytown Hall Care Center 1115
Midway Nursing Home 1704 King David Center for Nursing and Rehabilitation 1364 Rockland County
Oceanview Nursing & Rehabilitation Center, LLC 1688 Linden Center for Nursing and Rehabilitation 7665 Friedwald Center for Rehabilitation and Nursing, LLC 0787
Lutheran Augustana Center for Extended Care & Rehabilitation Northern Manor Geriatric Center Inc 0784
Park Nursing Home 1689 (closed) 1372
Park Terrace Care Center 1698 Menorah Home & Hospital for Aged & Infirm 2539 Northern Riverview Health Care Center, Inc 0774
Parker Jewish Institute for Health Care & Rehab 1671 New Carlton Rehab and Nursing Center, LLC 1379 Nyack Ridge Rehab & Nursing Center 0786
Peninsula Nursing and Rehabilitation Center 1672 Oxford Nursing Home 1391 Pine Valley Center for Rehabilitation and Nursing 0778
Promenade Rehabilitation and Health Care Center 1690 Palm Gardens Center for Nursing and Rehabilitation 1392 Nassau County
Queens Nassau Rehabilitation and Nursing Center 1702 Rutland Nursing Home, Inc. 1316 Excel at Woodbury for Rehabilitation and Nursing, LLC 0559
Regal Heights Rehabilitation and Health Care Center 7875 Saints Joachim & Anne Nursing and Rehabilitation Center 4418 Fulton Commons Care Center Inc 6312
Resort Nursing Home 1694 Schulman and Schachne Institute for Nursing and Rehabilitation 1376 Meadowbrook Care Center, Inc 6009
Rockaway Care Center 1666 Sea Crest Nursing and Rehabilitation Center 1401 Nassau Rehabilitation & Nursing Center 5710
Silvercrest 4407 Seagate Rehabilitation and Nursing Center 1373 South Shore Rehabilitation and Nursing Center 0504
The Grand Rehabilitation and Nursing at Queens 1675 Shore View Nursing & Rehabilitation Center 1399 Sunharbor Manor 0548
The Pavilion at Queens for Rehabilitation & Nursing 7298 Spring Creek Rehabilitation & Nursing Care Center 1400 The Five Towns Premier Rehabilitation & Nursing Center 0539
Union Plaza Care Center 6037 The Chateau at Brooklyn Rehabilitation and Nursing Center 1383 The Grand Rehabilitation and Nursing at South Point 0564
West Lawrence Care Center, LLC 1726 The Heritage Rehabilitation and Health Care Center 1393 Townhouse Center for Rehabilitation & Nursing 6050
Woodcrest Rehabilitation & Residential Health Care Center.,
LLC 1700 The Phoenix Rehabilitation and Nursing Center 1405 Suffolk County
Kings County (Brooklyn) Hospices Medford Multicare Center for Living 6462
Hospice of New York (Brooklyn Hospital inpatient unit) 7234
MJHS Hospice and Palliative Care, Inc. (Boro Park branch) 4039
MJHS Hospice and Palliative Care, Inc. (Menorah branch, closed) 4039

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Mortality related to CDI and MDROs
NHSN does not collect data on mortality associated with CDI or MDROs. However, by applying
information published in the scientific literature to the NYS population, it is possible to estimate the
number of deaths associated with these infections in NYS.

The attributable mortality rate is the death rate among a group of people with the infection minus the
death rate among a similar (matched) group of people without the infection. The attributable death
rates for five types of infections are summarized in Table 20. More details on the derivation of these
rates are provided in Appendix 2.

To estimate how many deaths were attributable to these infections in NYS, the attributable mortality
rate derived from the scientific literature was multiplied by the total number of reported infections.
Only bloodstream infections were counted for CRE. The number of deaths caused by C. auris could
not be calculated because of lack of attributable mortality data. Based on this analysis, CDI resulted in
the largest number of deaths; even though the attributable death rate is relatively low, the number of
people with CDI is very large. The total number of estimated deaths from CDI, MRSA, and CRE
(1,224), greatly exceeds the number of deaths due to other well-known infections such as acquired
immune deficiency syndrome (AIDS, 547), influenza (152), and tuberculosis (29) reported in NYS in
2016. 3

Table 20. New York State hospital mortality estimates, 2018

% # Cases # Hospital # Deaths # Deaths

1
Infection Attributable Total3 Onset Total from
Deaths2 Cases Hospital
Onset
Cases
Clostridioides difficile 6% 13,109 5,057 787 303
MRSA BSI 20% 1,739 661 348 132
CRE BSI 34% 263 150 89 51
Total 15,111 5,868 1,224 486
NHSN facility-wide inpatient data downloaded 6/18/2019 for CRE and CDI, 5/16/2019 for MRSA. BSI = bloodstream
infection. 1 CDI and CRE data were deduplicated to one infection per person, MRSA data did not contain unique identifiers
and may contain duplicates. 2 Based on estimations from scientific literature, see Appendix 2. 3 Total cases = community
and hospital onset.

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MDRO Prevention Practices

NHSN requires all facilities to submit an annual survey. Table 21 summarizes the self-reported 2018
survey results related to MDRO prevention practices.

Table 21. MDRO Prevention Practice Survey, New York State Hospitals 2018

Patients infected or colonized with MRSA are routinely placed on contact

precautions?
No 15%
Yes, all infected or colonized 59%
Yes, only all infected 19%
Yes, only those with high risk 7%
Patients infected or colonized with CRE are routinely placed on contact
precautions?
No 0%
Yes, all infected or colonized 98%
Yes, only all infected 1%
Yes, only those with high risk 2%
Facility routinely performs screening cultures for CRE? 8%
Facility routinely performs screening cultures for MRSA in non-NICU 27%
settings (e.g. on pre-operative patients to prevent SSI, or on high risk
patients)
Facility routinely performs screening cultures for MRSA in patients 20%
admitted to NICUs
Facility routinely uses chlorhexidine bathing to prevent transmission of 75%
MDROs?
Facility routinely uses a combination of topical chlorhexidine and 20%
intranasal mupirocin to prevent transmission of MRSA? (Note: this does
not include the use of these agents in preoperative patients or dialysis
patients.)
National Healthcare Safety Network Surveys, downloaded May 20, 2019. All 175 hospitals responded.

Although 98% of facilities responded that they put colonized and/or infected patients on contact
precautions, this data should be interpreted cautiously, especially in areas of high CRE prevalence and
incidence. The implementation of “Contact Precautions”, i.e., the donning of personal protective
equipment (PPE - gowns, gloves, and in some cases masks), has many variations between facilities and
even within facilities. Some policies require all persons, i.e. healthcare workers and visitors, who enter
a contact isolation room to don PPE; others exclude visitors from wearing PPE.

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 Antimicrobial Stewardship and Use
Appropriate use of antibiotics is a recognized element of global efforts to combat antimicrobial
resistance. In 2018, 90% of NYS hospitals reported meeting all seven elements of the CDC Core
Elements of Antimicrobial Stewardship Programs 4 (Table 22). The CDC Core Elements identify
common elements among successful programs. However, flexibility to tailor ASPs to local needs is
important. As ASPs mature, hospitals should continually evaluate ASPs using both process and
outcome measures to ensure programs are implemented with fidelity and are effective. No single
measure is available to compare program performance between healthcare facilities.

Table 22. Antimicrobial stewardship practices in NYS hospitals, 2018 survey

CDC Core Elements of antimicrobial stewardship program % met
1. Hospital Leadership Commitment* 100%
Formal statement of support for antibiotic stewardship (e.g. a written policy or statement approved by board) 97.1%
Hospital leadership communicates to staff about stewardship activities 88.0%
Hospital leadership provides opportunities for staff training and development 74.3%
Hospital leadership allocates information technology resources 81.1%
Committee responsible for antibiotic stewardship 94.9%
Physician leader has antibiotic stewardship responsibilities in job description/contract 49.7%
Pharmacist leader has antibiotic stewardship responsibilities in job description/contract 49.7%
2. Accountability 98.9%
A leader is responsible for program outcomes of stewardship activities. 98.9%
3. Drug Expertise* 98.9%
Antibiotic stewardship outcomes are lead/co-lead by pharmacist 74.3%
Lead/co-lead is not pharmacist, but at least one pharmacist is responsible for improving antibiotic use 24.6%
4. Action (Implementing recommended interventions)* 99.4%
Require documentation of indication for antibiotic orders 67.4%
Require documentation of duration for antibiotic orders 42.3%
Review antibiotics 48-72 hours after initial order (i.e. antibiotic time-out) 52.0%
Stewardship team provides prospective audit and feedback to treatment team 75.4%
Require prior authorization before restricted antibiotics can be dispensed 61.7%
Providers have access to facility- or region-specific treatment guidelines or recommendations for commonly 94.3%
encountered infections
Target select diagnoses for active interventions to optimize antibiotic use 73.7%
5. Tracking* 99.4%
Formal procedure or required documentation of indication for antibiotic orders and our stewardship team 78.8%
monitors adherence to that policy or formal procedure
Providers have access to facility- or region-specific treatment guidelines or recommendations for commonly 70.9%
encountered infections and our stewardship team monitors adherence to those guidelines or
recommendations
Stewardship team monitors antibiotic resistance patterns (either facility- or region-specific) 91.9%
Stewardship team monitors antibiotic use in days of therapy (DOT) per 1000 patient days or days present 77.7%
Stewardship team monitors antibiotic use in defined daily doses (DDT) per 1000 patient days 22.9%
Stewardship team monitors antibiotic expenditures 55.4%
6. Reporting* 97.7%
Stewardship team provides prospective audit and feedback to treatment team (also counted as an action) 75.4%

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 Stewardship team provides facility/unit/service-specific reports on antibiotics with prescribers 54.5%
Stewardship team provides updates to facility leadership on antibiotic use and stewardship efforts 93.7%
Stewardship team provides outcomes for antibiotic stewardship interventions to staff 64.0%
7. Education* 92.0%
Stewardship program provides education to prescribers on improving antibiotic prescribing 82.9%
Stewardship program provides education to nurses on improving antibiotic prescribing 59.4%
Stewardship program provides education to pharmacists on improving antibiotic prescribing 84.0%
Total**: Met all 7 Core Elements above 90.3%
Annual survey data downloaded from National Healthcare Safety Network on June 25, 2019. 100% of 175 hospitals responded.
* A core element is met when a facility answers “Yes” to at least one survey question within that core element category.
** All seven core elements are met if a facility has “Yes” for ALL seven core elements (bolded rows).

Between 2015 and 2018, the percent of NYS hospitals meeting all 7 core stewardship elements
increased from 59% to 90% (Figure 31).

Figure 31. Trend in percent of New York hospitals that met all 7 core stewardship elements

Annual survey data downloaded from National Healthcare Safety Network on June 25, 2019.

Measuring antimicrobial use

Measuring the impact of ASPs may be accomplished several ways, including measuring antimicrobial
use, appropriate selection, patient outcomes, adverse events, or expenditures. 5,6,7 NYSDOH strongly
recommends that hospitals measure antimicrobial use using the NHSN established definition for Days
of Therapy (DOT) per 1,000 patient days to establish baseline data and identify opportunities for
targeted interventions. Almost 78% of hospitals reported using DOT per 1000 patient days or days
present to track antibiotic use as part of an ASP. Between 2015 and 2018, the number NYS of
hospitals that submitted AU data to NHSN increased from 13 to 50 (29%) (Figure 32). These data are
visible to NYSDOH via the CDC-NYS DUA, but the DUA prohibits NYSDOH from publishing
hospital-specific data.
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Figure 32. Number of hospitals reporting antimicrobial use data to the National Healthcare
Safety Network, New York State 2015-2018

In 2018, NYS hospitals reported an average antimicrobial usage rate of 561 DOT per 1,000 days
present in adult medical, medical-surgical, and surgical ICUs and wards, step down units, and
oncology units. DOT are the number of days for which any amount of a specific antimicrobial was
administered to a patient in a specific location. Days present are the number of days in which a patient
spent any time in a location, and are always greater than the total number of patient days reported in
the rest of this report.

NHSN provides a metric called the standardized antimicrobial administration ratio (SAAR) that
compares the observed DOT to the predicted DOT in the referent population (voluntary reporters in
United States, 2017) after adjusting for patient care location. The 2018 NYS SAAR of 0.91 (Table 23)
indicates that NYS antimicrobial use data was 9% lower than antimicrobial use in the 2017 referent
population. The SAAR alone is not a definitive measure of the appropriateness of antimicrobial use,
but suggests areas for further evaluation by stewardship programs. Trends are not shown because the
group of participating hospitals changed over time.

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Table 23. Antimicrobial usage and standardized antimicrobial administration ratio (SAAR) in
NYS hospitals in 2018, adult medical, medical-surgical, and surgical ICUs and wards, step
down units, and oncology units
Antimicrobial Antimicrobial Antimicrobial SAAR
days days use per 1,000 compared
observed predicted days present to United
States 2017

1
All antibacterial agents 1,728,610 1,905,033 561.3 0.91
2
Broad spectrum antibacterial agents 491,036 468,254 159.4 1.05
predominantly used for hospital-onset infections
3
Broad spectrum antibacterial agents 348,377 434,088 113.1 0.80
predominantly used for community-acquired
infections
4
Antibacterial agents predominantly used for 264,820 303,100 86.0 0.87
resistant Gram-positive infections (e.g., MRSA)
5
Narrow spectrum beta-lactam agents 255,522 271,765 83.0 0.94
6
Antibacterial agents posing the highest risk for 435,024 536,098 141.2 0.81
CDI
7
Antifungal agents predominantly used for 67,636 73,989 22.0 0.91
invasive candidiasis
National Healthcare Safety Network data reported as of June 25, 2019.
1 excluding delafloxacin, meropenem/vaborbactam, piperacillin, ticarcillin/clavulanate
2 amikacin (IV only), aztreonam (IV only), cefepime, ceftazidime, doripenem, gentamicin (IV only), imipenem/cilastatin, meropenem,

piperacillin/tazobactam, tobramycin (IV only)

3 cefaclor, cefdinir, cefixime, cefotaxime, cefpodoxime, cefprozil, ceftriaxone, ciprofloxacin, cefuroxime, ertapenem, gemifloxacin,

levofloxacin, moxifloxacin
4 ceftaroline, dalbavancin, daptomycin, linezolid, oritavancin, quinupristin/dalfopristin, tedizolid, telavancin, vancomycin (IV only)
5 amoxicillin, amoxicillin/clavulanate, ampicillin, ampicillin/sulbactam, cefadroxil, cefazolin, cefotetan, cefoxitin, cephalexin,

dicloxacillin, nafcillin, oxacillin, penicillin G, penicillin V

6 cefdinir, cefepime, cefixime, cefotaxime, cefpodoxime, ceftazidime, ceftriaxone, ciprofloxacin, clindamycin,

gemifloxacin, levofloxacin, moxifloxacin

7 anidulafungin, caspofungin, fluconazole, micafungin

From 2017 to 2018, NYSDOH used a portion of funding received via the CDC Epidemiology and
Laboratory Capacity (ELC) Cooperative Agreement to support hospitals to improve the uptake of
AUR reporting. Using a competitive award process, nine contracts were awarded to hospitals or
hospital systems to implement or make significant progress toward reporting into the AUR module.
One facility did not complete the project. The majority of participants used funds to meet NHSN
reporting requirements through the use of third-party health information technology vendors.

Measurement of antibiotic use and evaluation and intervention to ensure appropriate use are important
in healthcare, including hospitals, long term care, and ambulatory/outpatient care settings. 8, 9
Guidelines and numerous training programs are available through federal and state partners, as well as
professional associations. Efforts across healthcare settings to use antibiotics appropriately will
contribute to public health goals to reduce antimicrobial resistance.

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Patients should understand and be educated on the consequences of inappropriate antibiotic use.
Antibiotics are life-saving medications when used appropriately; misuse of antibiotics can cause
harm. Consequences of using antibiotics when they are not needed can include antibiotic resistant
infections that are difficult to treat, altering the bacteria in the gut thereby increasing the risk of
infection with Clostridioides difficile, and experiencing adverse reactions (e.g. allergic reactions or
diarrhea) to the medication 10. CDC’s Be Antibiotics Aware campaign contains patient-centered
education to address patient concerns and provide information about appropriate use of antibiotics.

114
Comparison of NYS HAI Rates with National HAI
Rates
Approximate comparisons of concurrent state and national HAI rates are available in annual progress
reports published by CDC 11. Figure 33 summarizes data from the 2015, 2016, and 2017 CDC reports.

Figure 33. Trends in New York State and National Standardized Infection Ratios

2017 New York 2017 National

Type of Hospital-Acquired Infection SIR^ SIR^
Central-line associated bloodstream infections (CLABSIs)* 0.900 0.814
Catheter-associated urinary tract infections (CAUTI) 1.022 0.880
Colon surgical site infections (SSIs)* 0.973 0.906
Abdominal hysterectomy SSIs* 1.026 0.890
MRSA bacteremia 0.990 0.862
Clostridium difficile infections (CDI)* 0.755 0.804
Source of data: CDC. 2015, 2016, and 2017 National and State Healthcare-associated Infection Data Reports.
^ Standardized Infection Ratio is compared to national 2015 baseline
* Data audited by New York State

Figure 33 shows that HAI rates in NYS are higher than national rates, with the exception of CDI. The
rate of change in NYS between 2015 and 2017 was similar to the rate of change nationally for

115
CLABSI, CAUTI, CDI, and hysterectomy SSIs. NYS improved faster than the Nation for colon SSIs,
and slower for MRSA.

The intensity of the auditing performed by NYSDOH exceeds the intensity of auditing performed by
other states and CMS in terms of the number of hospitals audited, the number of records audited in
each hospital, and the methods used to efficiently target the records most likely to have errors. The
data validation process is likely to increase HAI rates because missed infections are identified and
entered into the NHSN, and training efforts increase the skills of the hospital IPs, leading to better
identification of HAIs. Additionally, the presence of a validation process in a state might encourage
increased care and thoroughness in reporting, which might result in higher pre-audit HAI rates. States
with data validation programs might appear to have higher rates because of their validation efforts,
because they truly have a higher rate, or both.

116
Infection Prevention Resources
NYSDOH conducts a biennial survey to measure hospital infection prevention staffing levels.
Information is obtained on the number of IPs; their educational background and certification; infection
control program support services; activities and responsibilities of infection prevention and control
program staff; and time dedicated to various activities. This section summarizes the highlights of the
2018 survey. A total of 175 hospitals (100%) responded to the survey.

NYS IPs reported having an average of ten years of experience in infection prevention. Fifty-five
percent of IPs were board certified (CIC ®), and 78% were members of the Association for
Professionals in Infection Control (APIC). IPs spent most of their time (36%) on infection
surveillance. The rest of their time was spent on department rounds (12%), daily isolation issues (8%),
quality/performance improvement (8%), administrative/policy and procedure development (7%),
environment/construction rounds (6%), infection prevention for hospital affiliated outpatient areas
(5%), employee/occupational health (4%), emergency preparedness (4%), staff education/central
sterile processing/risk management/community education (8%), and other issues (1%).

IP staffing levels are typically calculated as the number of acute care beds (i.e. patients) for which one
full-time equivalent (FTE) IP is responsible. In this report, we present that measure (# inpatients per
IP), along with another measure (# total patients per IP) that is a weighted aggregate of patients in
acute and non-acute settings (i.e. long-term care centers, dialysis centers, ambulatory surgery centers,
ambulatory surgery clinics, private physician practices, and EDs). In 2018, the average FTE IP in
NYS was responsible for 89 inpatients and 228 total patients per day. These results are similar to those
reported in the 2016 survey (Figure 34).

Figure 34. Patients per one full time equivalent Infection Preventionist in NYS, 2016-2018

117
Figure 35 summarizes the IP staffing levels by hospital. Hospitals in the lowest 15th percentile using
either infection prevention staffing measure are graphed in red. Facilities with low IP resources are
encouraged to review the responsibilities of their IPs to ensure that staffing levels are appropriate. The
review should take into consideration the range of the clinical programs, the risks of the patient
population, the scope of the duties covered by the IPs, and the availability of support staff and
information technology to assist with surveillance functions and reporting requirements. For example,
ambulatory outpatient clinics vary in size (larger clinics require more resources than smaller clinics)
and infection risk (e.g. endoscopy and dental clinics, which require high level disinfection, require
more IP oversite than radiology and chemical dependency clinics).

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Figure 35. Infection Preventionist Personnel Resources in NYS Hospitals, 2018 (page 1 of 5)
# # # Total In- and # # Total
FTE Inpatie nts O ut patie nts Inpatie nts Patie nts (Inpatie nt and O utpatie nt)
Hospital IPs pe r day pe r day pe r FTE IP pe r FTE IP
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

AO Fox Memorial 1.3 22 236 17 182

Adirondack Medical 0.9 27 358 30 398
Albany Med Ctr 6.0 614 1,460 102 243
Albany Memorial 1.0 31 87 31 87
Alice Hyde Med Ctr 1.0 20 166 20 166
Arnot Ogden Med Ctr 2.5 146 476 58 190
Auburn Memorial 1.0 59 79 59 79
Bellevue Ellis 0.2 33 33 165 165
Bellevue Hospital 5.8 573 1,644 99 283
Bertrand Chaffee 0.9 12 32 13 36
Blythedale Childrens 0.8 78 90 98 113
Bon Secours 0.2 42 83 210 415
BronxCare 3.0 321 842 107 281
Brookdale Hospital 3.0 252 445 85 151
Brooklyn Hosp Ctr 3.0 265 448 88 149
Brooks Memorial 1.0 21 40 21 40
Buffalo General 5.0 408 733 82 147
Burdett Care Center 0.1 12 12 120 120
Calvary Hospital 0.8 213 223 284 297
Canton Potsdam 2.0 54 473 27 237
Catskill Regional 1.0 60 135 60 135
Cayuga Medical Ctr 1.0 87 320 87 320
Champlain Valley 2.5 153 390 61 156
Claxton Hepburn 1.0 59 262 59 262
Clifton Springs 1.2 51 128 43 107
Cobleskill Regional 0.9 13 279 14 310
Cohens Childrens 1.5 204 314 136 209
Columbia Memorial 1.9 89 330 47 174
Coney Island Hosp 3.8 289 650 76 171
Corning Hospital 0.5 42 172 84 344
Cortland Reg Med 1.0 40 143 40 143
Crouse Hospital 3.0 283 553 94 184
DeGraff Memorial 0.5 4 30 8 60
East Niag Lockport 0.5 74 188 148 376
Eastern Long Island 1.0 51 57 51 57

FTE = Full Time Equivalent; IP = Infection Preventionist; # Inpatients per day = # facility-wide inpatient days / 365 + # inpatient
rehabilitation facility patient days / 365 + # inpatient psychiatric facility patient days / 365; # Total in- and out-patients per day
= # inpatients per day + intensive care unit patients per day (note: also counted as inpatients) + 0.5 * long term care beds + 50 * dialysis
centers + 50 * ambulatory surgery centers + 10 * ambulatory surgery clinics + 5 * private physician practices + 0.2 * emergency
department visits per day; Vertical reference lines indicate 15th percentiles (126 inpatients, 373 total patients per FTE IP);
█ hospital staffing levels among the lowest 15th percent in the state; █ hospital staffing resources are not low.
119
Figure 35. Infection Preventionist Personnel Resources in NYS Hospitals, 2018 (page 2 of 5)
# # # Total In- and # # Total
FTE Inpatie nts O ut patie nts Inpatie nts Patie nts (Inpatie nt and O utpatie nt)
Hospital IPs pe r day pe r day pe r FTE IP pe r FTE IP
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Ellis Hospital 3.4 217 639 64 188

Elmhurst Hospital 4.7 382 831 82 179
Erie County Med Ctr 3.7 424 750 115 203
FF Thompson 0.4 69 359 173 898
Faxton St Lukes 3.5 185 670 53 191
Flushing Hospital 2.6 197 744 77 292
Geneva General 0.9 45 210 50 233
Glen Cove Hospital 1.0 95 125 95 125
Glens Falls Hospital 1.5 183 498 126 343
Good Samar Suffern 1.6 140 316 88 198
Good Samar W Islip 4.0 352 498 88 125
Harlem Hospital 2.8 210 628 76 228
HealthAlli Broadway 1.1 72 98 65 89
HealthAlli MarysAve 0.1 59 59 590 590
Henry J Carter 2.0 134 216 67 108
Highland Hospital 2.9 255 423 88 146
Hosp for Spec Surg 3.7 127 158 35 43
Huntington Hospital 2.9 217 375 75 129
Interfaith Med Ctr 3.0 183 276 61 92
Ira Davenport 0.5 2 67 4 134
JT Mather Hospital 3.8 194 321 52 86
Jacobi Med Ctr 5.0 358 1,091 72 218
Jamaica Hospital 4.0 280 374 70 94
Jones Memorial 0.5 22 127 44 254
Kenmore Mercy 0.4 105 164 263 410
Kings County Hosp 4.7 433 1,446 93 311
Kingsbrook Jewish MC 2.5 186 586 74 234
LIJ at Forest Hills 2.0 204 259 102 130
LIJ at Valley Stream 1.5 124 163 83 109
Lenox Hill Hospital 5.0 362 597 72 119
Lincoln Med Ctr 3.3 277 572 85 176
Long Isl Community 2.5 208 377 83 151
Long Isl Jewish(LIJ) 4.8 548 777 115 164
Maimonides Med Ctr 3.0 616 1,010 205 337
Mary Imogene Bassett 5.0 146 1,019 29 204

FTE = Full Time Equivalent; IP = Infection Preventionist; # Inpatients per day = # facility-wide inpatient days / 365 + # inpatient
rehabilitation facility patient days / 365 + # inpatient psychiatric facility patient days / 365; # Total in- and out-patients per day
= # inpatients per day + intensive care unit patients per day (note: also counted as inpatients) + 0.5 * long term care beds + 50 * dialysis
centers + 50 * ambulatory surgery centers + 10 * ambulatory surgery clinics + 5 * private physician practices + 0.2 * emergency
department visits per day; Vertical reference lines indicate 15th percentiles (126 inpatients, 373 total patients per FTE IP);
█ hospital staffing levels among the lowest 15th percent in the state; █ hospital staffing resources are not low.

120
Figure 35. Infection Preventionist Personnel Resources in NYS Hospitals, 2018 (page 3 of 5)
# # # Total In- and # # Total
FTE Inpatie nts O ut patie nts Inpatie nts Patie nts (Inpatie nt and O utpatie nt)
Hospital IPs pe r day pe r day pe r FTE IP pe r FTE IP
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Massena Memorial 0.5 22 142 44 284

Memor SloanKettering 5.4 446 4,558 82 841
Mercy Hosp Buffalo 3.2 296 605 93 189
Mercy Med Ctr 2.0 190 253 95 127
Metropolitan Hosp 3.0 194 670 65 223
MidHudson Reg of WMC 1.1 119 230 113 219
Millard Fill Suburb 2.0 191 225 96 113
Montefiore Einstein 1.3 441 762 339 586
Montefiore Moses 4.8 749 1,493 156 311
Montefiore Mt Vernon 1.0 58 72 58 72
Montefiore NewRochl 0.8 93 177 113 216
Montefiore Nyack 0.6 177 239 305 412
Montefiore Wakefield 2.3 238 571 103 248
Mount St Marys 1.0 91 180 91 180
Mt Sinai 8.0 922 2,121 115 265
Mt Sinai Beth Israel 3.0 252 1,119 84 373
Mt Sinai Brooklyn 2.0 165 206 83 103
Mt Sinai Queens 2.0 144 336 72 168
Mt Sinai St Lukes 1.8 268 723 153 413
Mt Sinai West 2.0 321 718 161 359
NY Community Hosp 1.0 98 116 98 116
NY Eye&Ear Mt Sinai 1.0 3 178 3 178
NYP Allen 1.0 171 254 171 254
NYP Brklyn Methodist 4.8 550 722 115 150
NYP Columbia 5.0 623 1,197 125 239
NYP Hudson Valley 1.9 93 174 49 92
NYP Lawrence 1.7 159 228 94 134
NYP Lower Manhattan 1.0 150 290 150 290
NYP Morgan Stanley 3.0 273 723 91 241
NYP Queens 4.4 450 811 102 184
NYP Weill Cornell 6.0 757 1,497 126 250
NYU Langone Brooklyn 2.3 291 353 129 157
NYU Orthopedic Hosp 1.2 90 92 78 80
NYU Tisch 5.2 508 3,957 99 768
NYU Winthrop 5.9 484 1,361 82 230

FTE = Full Time Equivalent; IP = Infection Preventionist; # Inpatients per day = # facility-wide inpatient days / 365 + # inpatient
rehabilitation facility patient days / 365 + # inpatient psychiatric facility patient days / 365; # Total in- and out-patients per day
= # inpatients per day + intensive care unit patients per day (note: also counted as inpatients) + 0.5 * long term care beds + 50 * dialysis
centers + 50 * ambulatory surgery centers + 10 * ambulatory surgery clinics + 5 * private physician practices + 0.2 * emergency
department visits per day; Vertical reference lines indicate 15th percentiles (126 inpatients, 373 total patients per FTE IP);
█ hospital staffing levels among the lowest 15th percent in the state; █ hospital staffing resources are not low.

121
Figure 35. Infection Preventionist Personnel Resources in NYS Hospitals, 2018 (page 4 of 5)
# # # Total In- and # # Total
FTE Inpatie nts O ut patie nts Inpatie nts Patie nts (Inpatie nt and O utpatie nt)
Hospital IPs pe r day pe r day pe r FTE IP pe r FTE IP
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Nassau University 3.7 344 705 93 191

Nathan Littauer 1.0 23 302 23 302
Newark Wayne 1.2 67 114 56 95
Niagara Falls 0.9 62 165 69 183
North Central Bronx 2.0 132 914 66 457
North Shore 6.4 772 1,080 121 169
Northern Dutchess 1.0 63 80 63 80
Northern Westchester 2.0 108 170 54 85
Noyes Memorial 0.5 25 231 50 462
Oishei Childrens 1.7 165 503 97 296
Olean General 1.0 87 418 87 418
Oneida Healthcare 2.3 28 269 12 117
Orange Regional 3.9 329 1,205 84 309
Oswego Hospital 0.8 38 325 48 406
Our Lady of Lourdes 1.0 121 541 121 541
Peconic Bay Medical 1.0 101 129 101 129
Phelps Memorial 2.0 138 259 69 130
Plainview Hospital 1.5 106 132 71 88
Putnam Hospital 1.0 70 89 70 89
Queens Hospital 4.0 206 1,149 52 291
Richmond Univ MC 2.0 231 416 116 208
Rochester General 3.2 488 2,303 153 720
Rome Memorial 1.0 47 155 47 155
Roswell Park 3.0 110 418 37 139
SUNY Downstate MedCr 4.0 194 531 49 133
Samaritan Troy 2.0 136 338 68 169
Samaritan Watertown 1.8 142 714 81 408
Saratoga Hospital 2.1 155 395 76 193
Sisters St Joseph 1.2 53 73 44 61
Sisters of Charity 1.2 182 273 152 228
South Nassau Comm 3.0 321 539 107 180
Southside 3.0 280 345 93 115
St Anthony 0.2 21 90 105 450
St Barnabas 3.0 221 400 74 133
St Catherine Siena 2.0 181 310 93 159

FTE = Full Time Equivalent; IP = Infection Preventionist; # Inpatients per day = # facility-wide inpatient days / 365 + # inpatient
rehabilitation facility patient days / 365 + # inpatient psychiatric facility patient days / 365; # Total in- and out-patients per day
= # inpatients per day + intensive care unit patients per day (note: also counted as inpatients) + 0.5 * long term care beds + 50 * dialysis
centers + 50 * ambulatory surgery centers + 10 * ambulatory surgery clinics + 5 * private physician practices + 0.2 * emergency
department visits per day; Vertical reference lines indicate 15th percentiles (126 inpatients, 373 total patients per FTE IP);
█ hospital staffing levels among the lowest 15th percent in the state; █ hospital staffing resources are not low.

122
Figure 35. Infection Preventionist Personnel Resources in NYS Hospitals, 2018 (page 5 of 5)

# # # Total In- and # # Total

FTE Inpatie nts O ut patie nts Inpatie nts Patie nts (Inpatie nt and O utpatie nt)
Hospital IPs pe r day pe r day pe r FTE IP pe r FTE IP
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

St Charles Hospital 2.0 177 202 89 101

St Elizabeth Medical 3.5 141 530 40 151
St Francis Roslyn 3.0 261 340 87 113
St James Mercy 0.1 8 34 80 340
St Johns Dobbs Ferry 0.1 8 73 80 730
St Johns Episcopal 2.0 158 218 79 109
St Johns Riverside 0.8 138 261 173 326
St Joseph Bethpage 1.5 79 104 53 69
St Josephs Elmira 0.4 53 327 143 884
St Josephs Syracuse 3.0 341 1,141 114 380
St Josephs Yonkers 1.0 95 229 95 229
St Lukes Cornwall 1.0 133 195 133 195
St Marys Amsterdam 1.3 86 188 69 150
St Peters Hospital 2.6 340 403 131 155
Staten Island U N 5.5 450 976 82 178
Staten Island U S 1.0 144 280 144 280
StonyBrkSouthampton 1.0 55 213 55 213
StonyBrookUniv 6.0 557 1,094 93 182
Strong Memorial 7.0 825 2,068 118 295
Sunnyview Rehab Hosp 0.6 89 89 148 148
Syosset Hospital 1.0 53 138 53 138
UHS Binghamton 0.5 123 195 246 390
UHS Chenango Memor 1.0 12 147 13 155
UHS Wilson 2.1 201 1,004 98 490
UPMC Chautauqua WCA 1.0 82 165 82 165
United Memorial 1.2 38 319 32 266
Unity Hosp Rochester 3.2 240 852 75 266
Univ Hosp SUNY Upst 4.5 390 1,333 87 296
Upst Community Gen 1.1 115 223 105 203
Vassar Brothers 2.6 294 686 113 264
Westchester Medical 5.2 565 1,002 109 193
White Plains Hosp 2.5 244 452 98 181
Woodhull Med Ctr 3.0 228 1,222 76 407
Wyckoff Heights 2.0 161 925 81 463
Wyoming County Comm 0.5 28 38 56 76

FTE = Full Time Equivalent; IP = Infection Preventionist; # Inpatients per day = # facility-wide inpatient days / 365 + # inpatient
rehabilitation facility patient days / 365 + # inpatient psychiatric facility patient days / 365; # Total in- and out-patients per day
= # inpatients per day + intensive care unit patients per day (note: also counted as inpatients) + 0.5 * long term care beds + 50 * dialysis
centers + 50 * ambulatory surgery centers + 10 * ambulatory surgery clinics + 5 * private physician practices + 0.2 * emergency
department visits per day; Vertical reference lines indicate 15th percentiles (126 inpatients, 373 total patients per FTE IP);
█ hospital staffing levels among the lowest 15th percent in the state; █ hospital staffing resources are not low.

123
HAI Prevention Projects
CDC Funded HAI Prevention Projects
ELC for Infectious Diseases Grant (Aug 2014-July 2019)

New York State Long Term Care Antimicrobial Stewardship Collaborative Project

DOH continued its efforts to improve antibiotic use and implement antibiotic stewardship
programs in NYS LTCFs with a project that used the CDC document The Core Elements of
Antibiotic Stewardship for Nursing Homes as a framework, with a focus on appropriate antibiotic
use for urinary tract infections (UTI). Between May 1, 2017 and April 30, 2018, a group of
LTCFs participated in educational webinars, completed surveys on facility antibiotic stewardship
policies and practices, and provided monthly tracking data on antibiotic starts and urine cultures
collected related to UTI. The percent of facilities with at least one or more core element of an
antibiotic stewardship program implemented increased. During the latter half of 2018, DOH
planned a follow up 6-month quality improvement project focusing on re-assessing treatment
(24-72 hours after antibiotic start) of residents with acute respiratory illness (ARI). Project
activities include data collection to track the frequency of re-assessment and of treatment or
diagnosis change post re-assessment, as well as educational webinars on topics related to ARI
and antibiotic stewardship.

Multidrug-Resistant Organisms such as Carbapenem-resistant Enterobacteriaceae (CRE)

The mandated reporting of LabID CRE events in NYS hospitals has demonstrated that a wide
variability exists in the incidence and prevalence of these organisms across NYS. In addition,
CDC’s creation of the Antimicrobial Resistance Laboratory Network (ARLN) and the increased
testing of resistant isolates performed by Wadsworth Center Laboratory as one of CDC’s seven
regional antimicrobial resistance testing sites have further revealed that the burden of
antimicrobial resistance in our communities may be greater than previously estimated and
include resistant gene-encoded plasmids that, up to this point, were thought to be rare in NYS.

Current ARLN testing is focused on identifying carbapenemase-producing CRE (CP-CRE).

Statewide, results indicate that roughly 65% of submitted CRE isolates are CP-CRE, and of these
Klebsiella pneumoniae carbapenemase is found most often as the mechanism of resistance.
However, New Delhi metallo-β-lactamase and oxacillinase-48-type carbapenemases are also
being identified in increasing numbers of CP-CRE isolates. These data highlight the urgent need
to intensify efforts to combat the spread of carbapenem-resistant and other multidrug-resistant
organisms before the AR problem becomes insurmountable.

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Educational Efforts to Promote Appropriate Antibiotic Use: Get Smart

In 2018, NYSDOH expanded its initial analysis of Medicaid claims data (targeting geographic
counties with high “avoidable” rates of antibiotic prescribing for adults with upper respiratory
tract infections) by one more year to include 2010 to 2016 and by extending its analysis to
include broad vs. narrow-spectrum antibiotic prescribing and prescribing per enrollee.
NYSDOH’s distilled Adult/Pediatric Antibiotic Prescribing Guidelines in both electronic and
hard-copy pocket versions (including dosage and duration) were popular, with uptake of over
12,000 of the pocket versions in 2018. The guidelines were adapted by at least one other state
health department and a healthcare system and were included in the order sets for another
healthcare system. The guidelines were also featured in a national webinar for urgent care
providers. NYSDOH amplified its antibiotic stewardship outreach in collaboration with the New
York State Association of County Health Officials (NYSACHO) by offering a webinar on
antibiotic stewardship academic detailing for public health nurses; a public health nurse toolkit
on antibiotic stewardship is in development. Outreach to schools was furthered through sharing
of educational materials with individual school systems and school health educators from the
NYS Association of Health, Physical Education, Recreation and Dance educators (NYS
AHPERD). A presentation was made to the Evidence-Based Medicine class at Albany Medical
College for 2nd year medical students. NYSDOH collaborated with the NYS Dental Association
and the NYSDOH Division of Medical and Dental Directors (Office of Health Insurance
Programs) to further outreach of the antibiotic stewardship message in dental settings. Upon
request, NYSDOH expanded its translations of CDC’s “viral prescription pad” from 10 to 13
non-English languages spoken by patients in NYS, including Bengali, Nepali, and French.

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 Summary
Table 24 summarizes the total number of each type of HAI for NYS in 2018. The table is sorted
from most common to least common.

Table 24. Inpatient infections reported by New York State hospitals in 2018
Type of infection Number Rate
Hospital onset Clostridioides difficile infections (CDIs) 5,057 4.8/10,000 patient days
Surgical site infections (SSIs) following
Colon surgeryB 798 4.1/100 procedures
N
Hip replacement or revision surgery 338 1.0/100 procedures
B
Abdominal hysterectomy surgery 186 1.1/100 procedures
N
Coronary artery bypass graft (CABG) - chest site 148 1.4/100 procedures
N
CABG - donor site 32 0.3/100 procedures
Catheter-associated urinary tract infections (CAUTIs)
in intensive care units, and medical/surgical wards 1,275 1.0/1,000 catheter days
Central line-associated bloodstream infections (CLABSIs)
in intensive care units and medical and surgical wardsB
1,051 0.8/1,000 line days
and step down unitsN
Hospital onset methicillin-resistant Staphylococcus aureus
661 0.59/10,000 patient days
(MRSA) bloodstream infectionsC
Hospital onset carbapenem-resistant Klebsiella, E. coli, and
Enterobacter (CRE) bloodstream infectionsN 150 0.13/10,000 patient days
N = required by NYS, C = required by Centers for Medicare and Medicaid Services (CMS; these data are accessible
through a data use agreement but cannot be used for public reporting or regulatory action), B = required by both
NYS and CMS. CDI, CRE, and MRSA events are from facility-wide inpatient location only. SSI/CLABSI data
reported as of 6/27/2019; CDI/CRE reported as of 6/18/2019; CAUTI and MRSA data reported as of 5/16/2019.
Data from inpatient rehabilitation and psychiatric facilities were excluded. SSI data exclude infections present at
time of surgery or detected in outpatient settings without readmission. CLABSI data exclude mucosal barrier injury,
ventricular assist device, and extracorporeal membrane oxygenation-associated BSI.

Table 25 summarizes the rates of improvement, number of prevented infections, and direct cost
savings associated with the NYS indicators, sorted by cost savings. The greatest improvement
has been seen in CDIs, with a 35% decrease in incidence. Cost savings are estimated with a
range because HAIs vary in severity, and studies upon which estimates are based differ
somewhat in their cost estimates. Between 2015 and 2018, 7,622 infections were prevented
because of reductions in HAI rates; this was related to a cost savings of $91.5 to $178.3 million.

Table 25 also compares NYS progress to National and State Prevention Goals. NYS has met the
2019 CDI and CRE goals, is on track to reach the 2019 goal for colon SSI and CABG chest SSI,
and is off track for the remaining indicators.

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 Table 25. Cost savings associated with change in HAI rates between 2015 and 2018
2018 Improvement Direct Cost Savings
National/State Since 2015 # (in millions)
2015-2019 (Compared to Prevented
Type of Infection Prevention Goal 2019 Goal) Infections Min Max
Hospital onset
improved 35%
Clostridioides difficile 30% 5,930 $62.9 $89.5
(met goal)
infections (CDI)
improved 27%
Colon surgery SSIs 30% 645 $12.7 $37.0
(on track)
Central line-associated
improved 24%
bloodstream infections 50% 752 $9.1 $36.3
(off track)
(CLABSIs)
Hip replacement or improved 0%
30% 71 $1.4 $4.1
revision surgery SSIs (off track)
Coronary artery bypass improved 23%
30% 105 $2.1 $6.0
graft chest SSIs (on track)
Abdominal hysterectomy improved 10%
30% 38 $0.7 $2.2
surgery SSIs (off track)
Hospital onset
carbapenem-resistant improved 34%
25% 81 $2.6 $3.2
Enterobacteriaceae (CRE) (met goal)
bloodstream infections
Total 7,622 $91.5 $178.3
Cost ranges for CDI, SSI, and CLABSI are from Scott RD. The direct medical costs of healthcare-associated infections
in U.S. hospitals and the benefits of prevention. CDC, Division of Healthcare Quality Promotion, Atlanta GA, March
2009. Report CS200891-A. Cost ranges for CRE are from Bartsch SM et. al. Potential economic burden of
carbapenem-resistant Enterobacteriaceae (CRE) in the United States. Clin Microbiol Infect. 2017; 48:e9-48.e16.
All costs converted to 2016 dollars based on the Consumer Price Index for Hospital Inpatient Services.
Cells are shaded yellow if 2019 prevention goal was met, green if on track to meet 2019 prevention goal, and pink if not
on track.

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Recommendations and Next Steps

NYSDOH will continue to monitor and report HAI rates to encourage continued reduction in
HAIs. Following the NYSDOH HAI Program’s policy on hospitals that have significantly high
rates (available at
http://www.health.ny.gov/statistics/facilities/hospital/hospital_acquired_infections/), NYSDOH
will continue to work with hospitals that are underperforming to ensure that they implement
effective improvement plans and show progress in decreasing rates. NYSDOH will also
continue to notify hospitals of current issues in surveillance and infection prevention practices
through email communication and webinars.

NYSDOH will continue to work with the HAI TAW to seek guidance on the selection of
reporting indicators, methods of risk adjustment, presentation of hospital-identified data, and
overall planning for the reduction in HAIs in NYS.

NYSDOH will continue to conduct medical record audits to verify appropriate use of
surveillance definitions and accurate reporting by hospitals. Valid data are important for the
analysis of HAI rates within the state, as well as for the analysis of NYS rates in comparison
with other states’ rates.

Efforts to combat the spread of CRE and Candida auris (and other MDROs) in NYS healthcare
facilities will continue. NYSDOH will continue to visit hospitals and LTCFs to evaluate and
discuss infection surveillance and prevention practices, barriers to implementation, antibiotic
stewardship activities, and other strategies intended to reduce facility incidence rates, and to
provide assistance as needed.

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Appendix 1: List of Abbreviations
AIDS – Acquired immune deficiency syndrome
ARLN – Antimicrobial Resistance Laboratory Network
ASA – American Society of Anesthesiologists’ classification of physical status
ASP – Antimicrobial stewardship program
AUR – Antimicrobial use and resistance
BMI – Body mass index
BSI – Bloodstream infection
CABG – Coronary artery bypass graft surgery
CAUTI – Catheter-associated urinary tract infection
CDC – Centers for Disease Control and Prevention
CDI – Clostridioides difficile infection
C. auris – Candida auris
C. difficile – Clostridioides difficile
CI – Confidence interval
CLABSI – Central line-associated bloodstream infection
CLSI - Clinical Laboratory Standards Institute
CMS – Centers for Medicare and Medicaid Services
CO – Community onset
CO-NMH – Community onset-not my hospital
CO-PMH – Community onset-possibly my hospital
CP-CRE - Carbapenemase-producing - Carbapenem-resistant Enterobacteriaceae
CRE – Carbapenem-resistant Enterobacteriaceae
DOH – Department of Health
DUA – Data use agreement
ECMO – Extracorporeal membrane oxygenation
ED – Emergency department
EIA – Enzyme immunoassay
ELC – Epidemiology and Laboratory Capacity
FWI – Facility-wide inpatient
HAI – Hospital-acquired infection
HO – Hospital onset
ICU – Intensive care unit
IP – Infection preventionist
IPF – Inpatient psychiatric facility
IRF – Inpatient rehabilitation facility
LabID – Laboratory identified
LTCF – Long term care facility
MBI – Mucosal barrier injury
MDR – Multidrug resistant
MDRO – Multidrug resistant organism
MRSA – Methicillin-resistant Staphylococcus aureus
NAAT – Nucleic acid amplification test
NICU – Neonatal intensive care unit

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NHSN – National Healthcare Safety Network
NYC – New York City
NYS – New York State
NYSDOH – New York State Department of Health
OBS – Observation unit
OP – Outpatient
PATOS – Present at time of surgery
PDS – Post-discharge surveillance
PPE – Personal protective equipment
RPC – Regional Perinatal Center
SAAR – Standardized antimicrobial administration ratio
SIR – Standardized infection ratio
SPARCS – Statewide Planning and Research Cooperative System
spp – Species (plural)
SSI – Surgical site infection
TAW – Technical Advisory Workgroup
UTI – Urinary tract infection
VAD – Ventricular assist device
VRE – Vancomycin-resistant Enterococci

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Appendix 2: Glossary of Terms
ASA score: This is a scale used by the anesthesiologist to classify the patient’s physical
condition prior to surgery. It uses the American Society of Anesthesiologist (ASA)
Classification of Physical Status. It is one of the factors that help determine a patient’s risk of
possibly developing a SSI. Here is the ASA scale:
1 - Normally healthy patient
2 - Patient with mild systemic disease
3 - Patient with severe systemic disease
4 - Patient with an incapacitating systemic disease that is a constant threat to life
5 -A patient who is not expected to survive with or without the operation.

Admission prevalence rate: The percent of patients that are admitted to the hospital already
carrying an infection. This is calculated as the number of admission prevalent cases divided by
the number of admissions.

Birth weight categories: Birth weight refers to the weight of the infant at the time of birth.
Infants remain in their birth weight category even if they gain weight. Birth weight category is
important because the lower the birth weight, the higher the risk of developing an infection.

Body mass index (BMI): BMI is a measure of the relationship between a person’s weight and
their height. It is calculated with the following formula: kg/m2.
Catheter-associated urinary tract infection (CAUTI): A CAUTI is an infection of the bladder
or kidneys associated with the use of a urinary catheter. Hospitalized patients may have a
urinary catheter, a thin tube inserted into the bladder through the urethra, to drain urine when
they cannot urinate on their own.
Carbapenem: There are four carbapenem antibiotics: ertapenem, meropenem, doripenem, and
imipenem. Carbapenems are considered antibiotics of near last resort by medical professionals.
Carbapenem-resistant Enterobacteriaceae (CRE): Bacteria in the Enterobacteriaceae family
that are resistant to carbapenems are called CRE.
Central line: A central line is a long thin tube that is placed into a large vein, usually in the
neck, chest, arm, groin or umbilical cord. The tube is threaded through this vein until it reaches a
large vein near the heart. A central line is used to give fluids or medication, withdraw blood, and
monitor the patient’s condition.
Central line-associated bloodstream infection (CLABSI): A bloodstream infection can occur
when microorganisms travel around and through a central line or umbilical catheter and then
enter the blood.
Central line-associated bloodstream infection (CLABSI) rate: To get this rate, divide the total
number of central line-associated bloodstream infections by the number of central line days. That
result is then multiplied by 1,000. Lower rates are better.

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Central line days (device days): This is the total number of days a central line is used. A
daily count of patients with a central line in place is performed at the same time each day. Each
patient with one or more central lines at the time the daily count is performed is counted as one
central line day.

Clostridioides difficile: A bacterium that naturally resides in the bowels of some people without
symptoms of infection but which can cause infections in some situations. Overgrowth of C.
difficile in the bowel sometimes occurs after a patient takes antibiotics, which can kill good
bacteria in the bowel. Sometimes people become infected with C. difficile from touching their
mouth after coming in contact with contaminated environmental surfaces or patient care items.
Symptoms range from mild to severe diarrhea; in some instances, death can occur.

Colon surgery: Colon surgery is a procedure performed on the lower part of the digestive tract
also known as the large intestine or colon.

Community onset (CO): Documented infection occurring within 3 days of hospital admission.

Community onset - not my hospital (CO-NMH): Documented infection occurring within 3

days of hospital admission and more than 4 weeks after discharge from the same hospital.

Community onset – possibly my hospital (CO-PMH): Documented infection occurring within

three days of readmission to the same hospital when a discharge from the same hospital occurred
within the last four weeks.

Confidence interval (CI): The confidence interval is the range around a measurement that
conveys how precise the measurement is. A 95% CI means that we can be 95% confident that
the true measurement falls within the interval. If hospital A reports 1 infection out of 20
procedures (i.e. 5%, with 95% CI: 0% to 25%), and hospital B reports 10 infections out of 200
procedures (i.e. 5% with 95% CI: 2% to 9%), we can see that both hospitals have the same rate,
but we are less confident that the rate is truly 5% at hospital A because it was based on only 1
infection.

Coronary artery bypass graft (CABG) surgery: A treatment for heart disease in which a vein
or artery from another part of the body is used to create an alternate path for blood to flow to the
heart, bypassing a blocked artery.

Deep incisional SSI: A surgical site infection that involves the deep soft tissues (e.g., fascial and
muscle layers) of the incision and meets the NHSN criteria as described in the NHSN Patient
Safety Manual.

Device utilization ratio: This ratio is obtained by dividing the number of device days by the
number of patient days. It is calculated for central line utilization and urinary catheter
utilization.

Diabetes: A disease in which the body does not produce or properly use insulin. Insulin is
needed to control the amount of sugar normally released into the blood.

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Donor incision site for coronary artery bypass graft (CABG): CABG surgery with a chest
incision and donor site incisions (donor sites include the patient’s leg or arm) from which a blood
vessel is removed to create a new path for blood to flow to the heart. CABG surgical incision site
infections involving the donor incision site are reported separately from CABG surgical chest
incision site infections.

Duration: The duration of an operation is the time between skin incision and stitching or
stapling the skin closed. In the NHSN protocol, if a person has another operation through the
same incision within 24 hours of the end of the original procedure, only one procedure is entered
into NHSN and the total duration of the procedure is assigned as the sum of the two durations.
Infection risk tends to increase with duration of surgery.

Higher than state average: The risk adjusted rate for each hospital is compared to the state
average to determine if it is significantly higher or lower than the state average. A rate is
significantly higher than the state average if the confidence interval around the risk adjusted rate
falls entirely above the state average.

Hip replacement surgery: Hip replacement surgery involves removing damaged cartilage and
bone from the hip joint and replacing them with new, man-made parts.

Hospital-acquired infection (HAI): A hospital acquired infection is an infection that occurs in a

patient as a result of being in a hospital setting after having medical or surgical treatments.

Hospital Onset (HO): Documented infection occurring after the third day of hospital admission.

Hysterectomy: The surgical removal of a woman’s uterus.

Infection control/prevention processes: These are routine measures to prevent infections that
can be used in all healthcare settings. Some hospitals make the processes mandatory. Examples
include:
• Complete and thorough hand washing.
• Use of personal protective equipment such as gloves, gowns, and/or masks when caring
for patients in selected situations to prevent the spread of infections.
• Use of an infection prevention checklist when putting central lines in patients. The list
reminds healthcare workers to clean their hands thoroughly; clean the patient’s skin
before insertion with the right type of skin cleanser; wear the recommended sterile gown,
gloves and mask; and place sterile barriers around the insertion site, etc.
• Monitoring to ensure that employees, doctors and visitors are following the proper
infection prevention procedures.

Infection preventionist (IP): Health professional that has special training in infection
prevention and monitoring.

Intensive care unit (ICU): Intensive care units are hospital units that provide intensive
observation and treatment for patients (adult, pediatric, or newborn) either suffering from, or at

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risk of developing life-threatening problems. ICUs are described by the types of patients cared
for. Many hospitals care for patients with both medical and surgical conditions in a combined
medical/surgical ICU, while others have separate ICUs for medical, surgical and other specialties
based on the patient care services provided by the hospital.

Lower than state average: The risk adjusted rate for each hospital is compared to the state
average to determine if it is significantly higher or lower than the state average. A rate is
significantly lower than the state average if the confidence interval around the risk adjusted rate
falls entirely below the state average.

Methicillin-resistant Staphylococcus aureus (MRSA): Staphylococcus aureus (SA) is a

common bacterium normally found on the skin or in the nose of 20 to 30 percent of healthy
individuals. When SA is resistant to the antibiotics oxacillin, cefoxitin, or methicillin, it is
defined as MRSA for surveillance purposes.
National Healthcare Safety Network (NHSN): This is a secure, internet-based national data
reporting system that NYS hospitals must use to report HAIs. The NHSN is managed by the
CDC’s Division of Healthcare Quality Promotion.

Neonatal intensive care units: Patient care units that provide care to newborns.
• Level II/III Units: provide care to newborns at Level II (moderate risk) and Level III
(requiring increasingly complex care).
• Level III Units: provide highly specialized care to newborns with serious illness,
including premature birth and low birth weight.
• Regional Perinatal Centers (RPC): Level IV units, providing all the services and
expertise required by the most acutely sick or at-risk pregnant women and newborns.
RPCs provide or coordinate maternal-fetal and newborn transfers of high-risk patients
from their affiliate hospitals to the RPC and are responsible for support, education,
consultation and improvements in the quality of care in the affiliate hospitals within their
region.

Obesity: Obesity is a condition in which a person has too much body fat that can lower the
likelihood of good health. It is commonly defined as a body mass index (BMI) of 30 kg/m2 or
higher.

Organ/space SSI: A surgical site infection that involves a part of the body, excluding the skin
incision, fascia, or muscle layers, that is opened or manipulated during the operative procedure.

Patient day: Patient days are the number of hospitalizations multiplied by the length of stay of
each hospitalization. One patient hospitalized for 6 days will contribute 6 patient days to the
hospital total, as will two patients each hospitalized for 3 days.

Post discharge surveillance: This is the process IPs use to seek out infections after patients
have been discharged from the hospital. It includes screening a variety of data sources, including
re-admissions, emergency department visits and/or contacting the patient’s doctor.

Raw rate: Raw rates are not adjusted to account for differences in the patient populations.

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 • Bloodstream infections: Raw rate is the number of infections (the numerator) divided
by the number of line days (the denominator) then multiplied by 1000 to give the
number of infections per 1000 line days.
• Surgical site infections: Raw rate is the number of infections (the numerator) divided by
the number of procedures (the denominator) then multiplied by 100 to give the number of
infections per 100 operative procedures.
• Admission Prevalent infection: Raw rate is the number of infections (the numerator)
divided by the number of admissions (the denominator) then multiplied by 100 to give
the number of infections per 100 admissions.
• Hospital onset infection: Raw rate is the number of infections (the numerator) divided
by the number of patient days (the denominator) then multiplied by 10,000 to give the
number of infections per 10,000 patient days.

Risk adjustment: Risk adjustment accounts for differences in patient populations and allows
hospitals to be compared. 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.

Risk-adjusted rate: The risk-adjusted rate is based on a comparison of the actual (observed) rate
and the rate that would be predicted if, statewide, the patients had the same distribution of risk
factors as the hospital.

SPARCS: The Statewide Planning and Research Cooperative System (SPARCS) is a

comprehensive data reporting system established in 1979 as a result of cooperation between the
health care industry and government. Initially created to collect information on discharges from
hospitals, SPARCS currently collects patient level detail on patient characteristics, diagnoses and
treatments, services, and charges for every hospital discharge, ambulatory surgery procedure and
emergency department admission in NYS.

Standardized infection ratio (SIR): The SIR compares infection rates in a smaller population
with infection rates in a larger standard population, after adjusting for risk factors that might
affect the chance of developing an infection. In this report, the SIR is most often used to
compare each hospital’s rate to the NYS standard. Sometimes the SIR is also used to compare
NYS to the National standard. In both cases, the SIR is calculated by dividing the actual number
of infections in the smaller group by the number of infections that would be statistically
predicted if the standard population had the same risk distribution as the observed population.
• An SIR of 1.0 means the observed number of infections is equal to the number of predicted
infections.
• An SIR above 1.0 means that the infection rate is higher than that found in the standard
population. The difference above 1.0 is the percentage by which the infection rate exceeds
that of the standard population. For example, a hospital SIR of 1.12 indicates that the
hospital performed 12% worse than the state average.
• An SIR below 1.0 means that the infection rate is lower than that of the standard population.
The difference below 1.0 is the percentage by which the infection rate is lower than that
experienced by the standard population. For example, a hospital SIR of 0.85 indicates that
the hospital performed 15% better than the state average.

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Superficial incisional SSI: A surgical site infection that involves only skin and soft tissue
layers of the incision and meets NHSN criteria as described in the NHSN Patient Safety
Protocol.

Surgical site infection (SSI): An infection that occurs after the operation in the part of the body
where the surgery took place (incision).

Validation: A way of making sure the HAI data reported to NYS are complete and
accurate. Complete reporting of HAIs, total numbers of surgical procedures performed, central
line days, and patient information to assign risk scores must all be validated. The accuracy of
reporting is evaluated by visiting hospitals and reviewing patient records. The purpose of the
validation visits is to:
• Assess the accuracy and quality of the data submitted to NYS.
• Provide hospitals with information to help them use the data to improve and decrease
HAIs.
• Provide education to the IPs and other hospital employees and doctors, to improve
reporting accuracy and quality.
• Look for unreported HAIs.
• Make recommendations for improving data accuracy and/or patient care quality issues.

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Appendix 3: Methods
For more details on the HAI surveillance protocols used to collect this data, please see the NHSN
website at http://www.cdc.gov/nhsn/. This section of the report focuses on NYS-specific
methods and provides additional information helpful for interpreting the results.

Data Validation

Data reported to the NHSN are validated by the NYSDOH using several methods.

Point of entry checks - The NHSN is a web-based data reporting and analysis program that
includes validation routines for many data elements, reducing common data entry errors.
Hospitals can view, edit, and analyze their data at any time.

Monthly checks for internal consistency – Every other month, NYS HAI staff download the data
from the NHSN and run it through a computerized data validation code. Data that are missing,
unusual, inconsistent, or duplicate are identified and investigated through email or telephone
communication with hospital staff. Hospitals are given the opportunity to verify and/or correct
the data.

Audits – Audits of a sample of medical records are conducted by the NYSDOH to assess
compliance with reporting requirements. In addition, the purposes of the audit are to enhance the
reliability and consistency of applying the surveillance definitions; evaluate the adequacy of
surveillance methods to detect infections; and evaluate intervention strategies designed to reduce
or eliminate specific infections. Audits have been an important component of the NYSDOH
program since its inception in 2007, and have been conducted continuously through the years.
Figure 36 summarizes the percentage of hospitals audited each year. A hospital was more likely
to be audited in a given year if it had significantly high or low rates in the previous year, was not
audited the previous year, performed poorly during the previous audit, or hired new hospital
staff.

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Figure 36. Percent of hospitals audited each year, New York State

For CLABSI audits, staff reviewed the medical records of patients identified as having a positive
blood culture during a specified time period. For CDI and CRE audits, staff reviewed a
laboratory list of positive laboratory reports during a specified time period. For SSI audits, staff
reviewed a targeted selection of medical records to efficiently identify under reporting.
Specifically, the SPARCS database was used to preferentially select patients with an infection
reported to the SPARCS billing database but not NHSN.

The 2018 audit results will be summarized in the next annual report. In 2017, NYSDOH staff
reviewed 6,945 records and agreed with the hospital-reported infection status 96% of the time.
Disagreements were discussed with the IPs and corrected in NHSN. Table 26 summarizes the
number of inconsistencies in reporting infections out of the total number of qualified records
reviewed. The number of unqualified records (e.g. bloodstream infections with no central lines
(for CLABSI auditing) and procedures that should not have been reported (for SSI auditing)) that
underwent partial review are not included in the summary. Hospitals are more likely to under
report than over report infections. The overall agreement rates for this sample should not be
used to infer the overall agreement for NYS data because 1) hospitals were not randomly
selected for audit 2) the sample of records within each hospital was not random.

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Table 26. Brief summary of 2017 HAI audit

Hospital Hospital Hospital Hospital

# Said HAI Said HAI Said HAI Said HAI
Qualified1 = Y; = Y; = N; = N;
Type of Records Auditor Auditor Auditor Auditor Overall %
Infection Reviewed Agreed Disagreed Agreed Disagreed Agreement
Colon SSI 788 118 5 609 56 92.3 %
CABG SSI 170 27 1 139 3 97.6 %
Hyst SSI 702 49 0 641 12 98.3 %
Hip SSI 780 71 1 702 6 99.1 %
CLABSI 859 143 3 686 27 96.5 %
CDI 2,697 2,611 14 0 72 96.8 %
CRE 949 883 3 0 63 93.0 %
Total 6,945 3,902 27 2,777 239 96.2 %
The 2017 audit was conducted between October 2017 and June 2018, and predominantly covered 2017 data.
SSI = surgical site infection; CLABSI = central line associated bloodstream infection; CDI = Clostridioides difficile
infection; CRE = carbapenem resistant Enterobacteriaceae.
1
Unqualified records are not shown; these included patients with no central lines (for CLABSI auditing) and
procedures that should not have been reported (for SSI auditing).

Cross-checks for completeness and accuracy in reporting - NYS HAI staff match the NHSN
colon, hip, hysterectomy, CDI, and CRE data to the Statewide Planning and Research
Cooperative System (SPARCS) database. SPARCS is an administrative billing database that
contains details on patient diagnoses and treatments, services, and charges for every hospital
discharge in NYS.

Thresholds for Reporting Hospital-Specific Infection Rates

This report contains data from 175 hospitals reporting complete data for 2018. Hospitals that
perform very few procedures or have ICUs with very few patients with central lines have
infection rates that fluctuate greatly over time. This is because even a few cases of infection will
yield a numerically high rate in the rate calculation when the denominator is small. To assure a
fair and representative set of data, the NYSDOH adopted minimum thresholds.
• For surgical site infections there must be a minimum of 20 patients undergoing a surgical
procedure.
• For CLABSIs there must be a minimum of 50 central line days. Central line days are the
total number of days central lines are used for each patient in a location over a given
period of time.
• For CDI and CRE there must be a minimum of 50 patient days.

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NYSDOH tracks hospital performance over time. Hospitals flagged high or low for at least
three consecutive years (i.e. 2016, 2017, 2018) are specifically named in this report.

Risk Adjustment
Risk adjustment is a statistical technique that allows hospitals to be more fairly compared. The
adjustment takes into account the differences in patient populations related to severity of illness
and other factors that may affect the risk of developing an HAI. A hospital that performs many
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 proportion of high and
low risk patients.

Risk-adjusted infection rates for SSIs in each hospital were calculated using a two-step method.
First, all the data for the state were pooled to develop a logistic regression model predicting the
risk of infection based on patient-specific risk factors. Second, that model was used to calculate
the predicted number of infections for each hospital. The observed infection rate was then
divided by the hospital’s predicted infection rate. If the resulting ratio is larger than one, the
hospital has a higher infection rate than expected based on its patient mix. If it is smaller than
one, the hospital has a lower infection rate than expected from its patient mix. For each hospital,
the ratio is then multiplied by the overall statewide infection rate to obtain the hospital’s risk-
adjusted rate. This method of risk adjustment is called “indirect adjustment.” Hospitals with
risk-adjusted rates significantly higher or lower than the state average were identified using 95%
confidence intervals for all indicators except CDI, for which a 99% CI was used. All data
analyses were performed using SAS version 9.4 (SAS Institute, Cary NC). Figure 37 provides
an example of how to interpret the hospital-specific SSI and CLABSI infection rate tables.

140
Figure 37. How to read hospital-specific SSI and CLABSI infection rate

Hospital A had an adjusted infection rate very similar to the state average. The grey bar (95%
confidence interval) goes over the dotted line representing the state average, indicating no
statistical difference in the rates.

Hospital B has an adjusted infection rate that is significantly higher than the state average,
because the red bar is entirely to the right (representing higher rates) of the dotted line.

Hospital C had zero infections, but this was not considered to be statistically lower than the state
average because the grey bar goes over the dotted line. All hospitals that observed zero
infections get a *, because they do deserve acknowledgement for achieving zero infections.

Hospital D had the highest infection rate, but this was not statistically higher than the state
average.

Hospital E - The data are not shown because the hospital performed fewer than 20 procedures,
and therefore the rates are not stable enough to be reported.

Hospital F had an adjusted infection rate that is statistically lower than the state average, because
the blue bar is entirely to the left (representing lower rates) of the dotted line

141
In the 2015, 2016, and 2017 NYS HAI reports, we summarized the SSI results for colon, hip,
CABG, and hysterectomy procedures into the SSI SIR, which described the average
performance for each hospital across the colon, hip, CABG, and hysterectomy procedures that
they performed. For example, if a hospital performed significantly better than average for colon
SSIs, and significantly worse than average for hip SSIs, the hospital SSI SIR indicator would be
average (1.0). If a hospital performed somewhat worse than average for colon, hip, and
hysterectomy SSIs, even without indicator-specific flags, the SSI SIR might flag the hospital as
significantly worse than average overall because the confidence interval decreases when all the
procedures are combined.

The advantages of the SIR are that it summarizes several risk-adjusted rates into one number,
may be useful to identify issues at small hospitals with insufficient data in any one indicator to
receive a statistical flag, and may be useful when the same infection prevention strategies impact
all SSI rates. The disadvantages are that one cannot tell which indicator is a problem without
drilling down to the indicator-specific adjusted rates, and some prevention strategies or bundles
are not procedure- or location- specific. In particular, hospitals that were flagged with a high SSI
SIRs and no indicator-specific SIRs found it difficult to write improvement plans. In conclusion,
after discussing the SSI SIR with the TAW, we decided to remove the SSI SIR from the 2018
report.

142
Attributable Mortality of CDI/MDROs

Attributable mortality rates were calculated using the data in Table 27. The attributable
mortality rate for each indicator was calculated as the average attributable mortality rate over the
relevant journal articles, weighted by the number of MDROs considered in each analysis.

Table 27. Attributable mortality estimates from literature review

% % Attributable
#
MDRO Reference Deaths Deaths Mortality
MDROs
MDROs Controls %
Dodek 2013 12 227 29 27 2.0
Gravel 2009 13 1430 N/A N/A 5.7
Kenneally 2007 14 278 36.7 30.6 6.1
Loo 2005 15 1703 N/A N/A 6.9
Pepin 2005 16 161 23 7 16.0
CDI
Tabak 2013 17 255 11.8 7.3 4.5
Dubberke 2008 18 353 36 30.3 5.7
Hensgens 2013 19 317 14.8 5.4 9.4
Barbut 2017 20 482 9 5 4.0
Weighted average 6
Borer 2009 21 32 71.9 21.9 50.0
Mouloudi 2014 22 37 NA NA 27.0
CRE
Gallagher 2014 23 43 45 18 27
Weighted average 34
Harbarth 1998 24 39 36 28 8.0
MRSA DeKraker 2011 25 242 30.6 8.4 22.2
Weighted average 20

143
Comparison of NYS and CMS HAI Reporting

In addition to the indicators required by NYS law, hospitals are encouraged by the Centers for
Medicaid and Medicare Services (CMS) to report HAI data. The CMS Hospital Inpatient
Quality Reporting Program offers financial incentives to hospitals that report HAI data and
publishes the nationwide data on the Hospital Compare website
(http://www.hospitalcompare.hhs.gov). The CMS website compares hospital-specific CLABSI,
CAUTI, colon SSI, hysterectomy SSI, MRSA bloodstream infection, and CDI infection rates to
national benchmarks.

The HAI rates reported by NYS and CMS may differ.

The first important difference is the peer group to which each hospital is compared.

• In the NYS 2018 report, each hospital’s 2018 data is compared to 2018 data reported by
other hospitals in NYS.

• In CMS Hospital Compare, each hospital’s 2018 data is compared to 2015 data reported
by other hospitals in the United States.

In general, NYS hospital Standardized Infection Ratios (SIRs) tend to be higher than CMS SIRs
for two reasons.

• HAI rates decrease over time as infection prevention practices improve; the NYS
benchmark is expected to decrease over time (but the average SIR is always 1.0 because
comparison is in the same year), while the CMS benchmark remains the same (SIRs
decrease over time).

• NYS HAI data are audited more than data from other states. Auditing is likely to
increase HAI rates because missed infections are identified and entered into the National
Healthcare Surveillance Network (NHSN), and training efforts lead to better
identification of HAIs.

We also note that by comparing data within the same year, NYS ensures that the same protocol is
followed for identification of a hospital’s data and the data to which it is compared. There were
some changes to CLABSI surveillance definitions in 2018.

Finally, the statistical models used to predict HAI rates in NYS and CMS models are slightly
different. These differences are described in Table 28. For HAI rates published on Hospital
Compare we show the CMS model, and for HAI rates not published on Hospital Compare, we
show a model available through the NHSN application that hospitals may or may not use for
internal benchmarking. 26

144
 Each approach has advantages and disadvantages and may be implemented for different
purposes. NYS assesses hospital-specific performance each year, while CMS and NHSN
measure improvement over time. NYS often avoids using hospital-level risk adjustment
variables (e.g. teaching hospital vs. not) because these are effects we are interested in measuring,
while NHSN may include these variables to increase the homogeneity of the groups under
comparison. NYS includes superficial infections (except those identified from post-discharge
surveillance) because they have been found to be similar to deeper infections in terms of
infectious etiologies and length of stay, while CMS focuses on deeper infections because they
may be reported more consistently across facilities 27.
Table 28. Comparison of New York State and Centers for Medicare and Medicaid Services (CMS)
Methods for 2018 Hospital-Acquired Infection Reports

Indicator Report Exclusions Risk Adjustment

Mucosal barrier injury-,
extracorporeal membrane In adult/pediatric units, CLABSI rates are compared
within each CDC location independently. In
oxygenation-, or ventricular assist
NYS NICUs, CLABSI rates are compared by level (RPC,
device- associated bloodstream Level 3, Level 2/3) and birthweight group. Hospital
infections; neurologic, burn, trauma, compared to NYS 2018 average.
CLABSI and respiratory ICUs
In adult/pediatric units, negative binomial
regression model with location type, facility bed
Mucosal barrier injury CLABSIs; step
CMS size, medical school affiliation, and facility type. In
down units
NICUs, only birthweight group. Hospital compared
to National 2015 average.
SSIs detected by post discharge
ASA, duration, BMI, trauma, laparoscope. Hospital
NYS surveillance (PDS) or present at time
compared to NYS 2018 average.
of surgery (PATOS)
Colon SSI
Diabetes, ASA, gender, age, BMI, closure
Complex 30-day SSI model: age<18,
CMS technique, oncology hospital. Hospital compared to
superficial SSIs, PATOS, outliers
National 2015 average.
Diabetes, ASA, BMI, duration, laparoscope.
NYS PDS, PATOS
Hysterectomy Hospital compared to NYS 2018 average.
SSI Complex 30-day SSI model: age<18, Diabetes, ASA, BMI, age, cancer hospital. Hospital
CMS
superficial SSIs, PATOS, outliers compared to National 2015 average.
ASA, BMI, procedure type. Hospital compared to
NYS PDS, PATOS
NYS 2018 average.
Adults: Diabetes, trauma, anesthesia, ASA, wound
Hip SSI Complex admission/readmission class, medical school affiliation, hospital bed size,
NHSN model: superficial SSIs, PDS, age, duration, BMI, procedure type. Children:
PATOS, outliers intercept only. Hospital compared to National 2015
average.
Diabetes, BMI, gender, trauma. Hospital compared
NYS PDS, PATOS
to NYS 2018 average.
CABG chest Diabetes, gender, ASA, trauma, wound class,
SSI Complex admission/readmission
medical school affiliation, hospital bed size, age
NHSN model: superficial SSIs, PDS, PATOS,
duration, BMI, age-gender interaction. Hospital
outliers, children.
compared to National 2015 average.

145
 BMI, diabetes. Hospital compared to NYS 2018
CABG donor NYS PDS, PATOS
average.
SSI
NHSN No model No model
CDI test type, CO admission prevalence rate
Outlier community onset (CO) (including patients tested in ED and admitted same
NYS
prevalence rate day), hospital bed size, % patient days in adult
ICUs. Hospital compared to NYS 2018 average.
Clostridium Hospitals: CDI test type, CO admission prevalence
difficile rate, medical school affiliation, number of ICU
beds, facility type, facility bed size, reporting from
CMS Outlier CO prevalence rate
ED. LTACHs: CDI test type, CO rate, % ventilator,
% single occupancy. Hospital compared to
National 2015 average.

146
Appendix 4: List of Hospitals by County
Table 29 lists the hospitals individually identified in this report. Additional information on the
hospitals can be obtained from the NYSDOH Hospital Profile at
https://profiles.health.ny.gov/hospital/.

Table 29. List of hospitals included in this report

County PFI CMS ID Hospital Name

Albany 0001 330013 Albany Med Ctr

0004 330003 Albany Memorial

0005 330057 St Peters Hospital

Allegany 0039 330096 Jones Memorial

Bronx 1169 330059 Montefiore-Moses

1178 330009 BronxCare

1176 330399 St Barnabas

1186 330385 North Central Bronx

1165 330127 Jacobi Med Ctr

1168 330059 Montefiore-Wakefield

1172 330080 Lincoln Med Ctr

3058 330059 Montefiore-Einstein

1175 332006 Calvary Hospital

Broome 0058 330394 UHS Wilson

0043 330011 Our Lady of Lourdes

0042 330394 UHS Binghamton

Cattaraugus 0066 330103 Olean General

Cayuga 0085 330235 Auburn Memorial

Chautauqua 0103 330239 UPMC Chautauqua WCA

0098 330229 Brooks Memorial

Chemung 0116 330090 Arnot Ogden Med Ctr

0118 330090 St Josephs- Elmira

Chenango 0128 330033 UHS Chenango Memor

Clinton 0135 330250 Champlain Valley

Columbia 0146 330094 Columbia Memorial

Cortland 0158 330175 Cortland Reg Med

Dutchess 0192 330049 Northern Dutchess

0180 330067 MidHudson Reg of WMC

0181 330023 Vassar Brothers

147
 County PFI CMS ID Hospital Name

Erie 0280 330111 Bertrand Chaffee

0292 330078 Sisters- St Joseph

0213 330279 Mercy Hosp Buffalo

0267 330102 Kenmore Mercy

0218 330078 Sisters of Charity

0207 330005 Buffalo General

3067 330005 Millard Fill. Suburb

0208 330005 Oishei Childrens

0210 330219 Erie County Med Ctr

0216 330354 Roswell Park

Franklin 0324 330079 Adirondack Medical

0325 330084 Alice Hyde Med Ctr

Fulton 0330 330276 Nathan Littauer

Genesee 0339 330073 United Memorial

Jefferson 0367 330157 Samaritan- Watertown

Kings 1320 330350 SUNY Downstate MedCr

1324 330169 Mt Sinai Brooklyn

1301 330202 Kings County Hosp

1306 330236 NYP-Brklyn Methodist

1305 330194 Maimonides Med Ctr

1294 330196 Coney Island Hosp

1315 330201 Kingsbrook Jewish MC

1304 330306 NYU Langone Brooklyn

1318 330221 Wyckoff Heights

1692 330396 Woodhull Med Ctr

1286 330233 Brookdale Hospital

1288 330056 Brooklyn Hosp Ctr

1309 330397 Interfaith Med Ctr

1293 330019 NY Community Hosp

Livingston 0393 330238 Noyes Memorial

Madison 0397 330115 Oneida Healthcare

Monroe 0411 330125 Rochester General

0413 330285 Strong Memorial

0409 330164 Highland Hospital

0471 330226 Unity Hosp Rochester

Montgomery 0484 330047 St Marys Amsterdam

148
 County PFI CMS ID Hospital Name

Nassau 0528 330027 Nassau University

0550 330106 Syosset Hospital

0552 330331 Plainview Hospital

0490 330181 Glen Cove Hospital

0518 330372 LIJ at Valley Stream

0541 330106 North Shore

0551 330332 St Joseph- Bethpage

0527 330198 South Nassau Comm.

0563 330182 St Francis- Roslyn

0511 330167 NYU Winthrop

0513 330259 Mercy Med Ctr

New York 1438 330204 Bellevue Hospital

1439 330169 Mt Sinai Beth Israel

1454 330199 Metropolitan Hosp

1469 330046 Mt Sinai St Lukes

1466 330046 Mt Sinai West

1450 330119 Lenox Hill Hospital

1437 330064 NYP-Lower Manhattan

1456 330024 Mt Sinai

1463 330214 NYU Tisch

1453 330154 Memor SloanKettering

1464 330101 NYP-Columbia

3975 330101 NYP-Allen

1464 330101 NYP-Morgan Stanley

1458 330101 NYP-Weill Cornell

1445 330240 Harlem Hospital

1446 330214 NYU Orthopedic Hosp

1447 330270 Hosp for Spec Surg

1486 332008 Henry J. Carter

1460 330100 NY Eye&Ear Mt Sinai

Niagara 0583 330188 Mount St. Marys

0565 330163 East. Niag. Lockport

0574 330065 Niagara Falls

0581 330005 DeGraff Memorial

Oneida 0598 330245 St Elizabeth Medical

0599 330044 Faxton St. Lukes

0589 330215 Rome Memorial

Onondaga 0636 330203 Crouse Hospital

0635 330241 Univ Hosp SUNY Upst

0628 330241 Upst. Community Gen

0630 330140 St Josephs- Syracuse

149
 County PFI CMS ID Hospital Name

Ontario 0678 330074 FF Thompson

0676 330265 Clifton Springs

0671 330058 Geneva General

Orange 0699 330126 Orange Regional

0694 330264 St Lukes Cornwall

0708 330135 Bon Secours

0704 330205 St Anthony

Oswego 0727 330218 Oswego Hospital

Otsego 0746 330136 Mary Imogene Bassett

0739 330085 AO Fox Memorial

Putnam 0752 330273 Putnam Hospital

Queens 1633 330231 Queens Hospital

1635 330395 St Johns Episcopal

1638 330353 LIJ at Forest Hills

1630 330195 Long Isl Jewish(LIJ)

1629 330014 Jamaica Hospital

1628 330193 Flushing Hospital

1639 330024 Mt Sinai Queens

1637 330055 NYP-Queens

1626 330128 Elmhurst Hospital

3376 330195 Cohens Childrens

Rensselaer 0756 330180 Samaritan- Troy

9250 330409 Burdett Care Center

Richmond 1740 330160 Staten Island U N

1738 330028 Richmond Univ MC

1737 330160 Staten Island U S

Rockland 0779 330158 Good Samar. Suffern

0776 330104 Montefiore-Nyack

Saratoga 0818 330222 Saratoga Hospital

Schenectady 0829 330153 Ellis Hospital

0831 330406 Sunnyview Rehab Hosp

0848 330153 Bellevue Ellis

Schoharie 0851 330268 Cobleskill Regional

St.Lawrence 0798 330211 Claxton-Hepburn

0815 330197 Canton-Potsdam

0804 330223 Massena Memorial

Steuben 0873 330144 Ira Davenport

0870 330151 St James Mercy

0866 330277 Corning Hospital

150
 County PFI CMS ID Hospital Name

Suffolk 0885 330141 Long Isl. Community

0938 330107 Peconic Bay Medical

0891 330088 Eastern Long Island

0925 330286 Good Samar. W Islip

0943 330401 St Catherine Siena

0896 330246 St Charles Hospital

0924 330043 Southside

0889 330340 StonyBrkSouthampton

0245 330393 StonyBrookUniv

0913 330045 Huntington Hospital

0895 330185 JT Mather Hospital

Sullivan 0971 330386 Catskill Regional

Tompkins 0977 330307 Cayuga Medical Ctr

Ulster 0989 330224 HealthAlli MarysAve

0990 330004 HealthAlli Broadway

Warren 1005 330191 Glens Falls Hospital

Wayne 1028 330030 Newark Wayne

Westchester 1045 330304 White Plains Hosp

1139 330234 Westchester Medical

1129 330261 Phelps Memorial

1117 330162 Northern Westchester

1039 330267 NYP-Hudson Valley

1097 330208 St Johns Riverside

1061 330086 Montefiore-Mt Vernon

1098 330006 St Josephs- Yonkers

1122 330061 NYP-Lawrence

1072 330184 Montefiore-NewRochl

1138 333301 Blythedale Childrens

1124 330208 St Johns Dobbs Ferry

Wyoming 1153 330008 Wyoming County Comm.

151
Acknowledgements
New York State Department of Health Staff
Director, Bureau of Healthcare-Associated Infections – Emily Lutterloh, MD, MPH
Director, Data Analysis Unit, Bureau of HAIs – Valerie Haley, PhD
Clinical Director HAI Reporting Pgm and Western Region HAI Prog Rep – Peggy Hazamy, RN, BSN, CIC, FAPIC (retired)
Metropolitan Area HAI Reporting Program Representative – Marie Tsivitis, MPH, CIC, FAPIC
Central Region HAI Reporting Program Representative – Robin Knab, CLT, M(ASCP)CM, CIC
Metropolitan Area HAI Reporting Program Representative – Antonella Eramo, MS, CIC
Capital Region HAI Reporting Program Representative – Martha Luzinas, MT(ASCP)SM
Data Analyst – Boldtsetseg Tserenpuntsag, DrPH
Data Analyst – Jiankun Kuang, MS
Antimicrobial Resistance/CRE Coordinator – Rosalie Giardina, MT(ASCP), CIC
Research Scientist – Sarah Kogut, MPH, CIC
Research Scientist – Monica Quinn, RN, MS, CIC
Research Scientist – Coralie Bucher, MPH
Health Communications Specialist – Mary Beth Wenger
State HAI Plan Coordinator – Karyn Langguth McCloskey
Health Program Administrator – Sallie Ann Avery

Technical Advisory Workgroup

Physicians
Maria Basile, MD, John T. Mather Hospital (2015-current)
John Crane, MD, Erie County Medical Center (2012-current)
Paul Graman, MD, Strong Memorial Hospital (2006-current)
Mini Kamboj, MD, Memorial Sloan-Kettering Cancer Center (2015-current)
Belinda Ostrowsky, MD, Montefiore Medical Center (2017-2018)
Gopi Patel, MD, Mount Sinai Hospital (2017-current)
Lisa Saiman, MD, MPH, Columbia University Medical Center (2008-current)
Javaid Waleed, MD, Mt. Sinai Health System (2017-2018)
Krystina Woods, MD, Mt. Sinai West (2018-current)
Infection Preventionists
Susan Bayh-Martino, RN MBA, Broadlawn Manor Nursing and Rehabilitation Center (2015-current)
Heather Bernard, DNP, RN, CIC, St. Elizabeth’s & Faxton St. Luke’s Hospitals (2017-current)
Terry Hammill, RN, ICP, Oswego Health (2015-current)
Mary Ann Haran, RN, CIC, Long Island Jewish Medical Center (2017-current)
Charlene Ludlow, RN, MHA, CIC, Erie County Medical Center (2008-current)
Veronica Mataprasad, MT, MPH, CIC, Northwell Health-Lenox Hill Hospital (2017-current)
Judith Medefindt, RN, CIC, NYU Lutheran Medical Center (2017-current)
Jennifer Ryan, MSN, RN, CIC, St. Peter’s Hospital (2017-2018)
Michelle Vignari, RN, CIC Director IP, FF Thompson Health (2017-current)
Gina DiMonica, RN, MSN, CIC, St. Francis Hospital (2018-current)
Consumer: Dale Ann Micalizzi, Task Force for Global Health (2017-current)
Preparedness Representatives:
Shannon Ethier, NSYDOH Office of Health Emerg. Prep. (2015-current)
Mary Foote, MD, MPH, New York City Department of Health (2015-current)
Healthcare Organization Representatives
Joy Cesareo, RN, MS, CIC, NYC Health & Hospitals Corporation (2017-current)
Ellen Lee, MD, NYC Department of Health and Mental Hygiene (2015-current)
Rodolfo Simons, Jr., New York State New York State APIC Coordinating Council (2017-current)
Zeynep Sumer, MS, Greater New York Hospital Association (2009–current)
Sarah Duvall, MPH, Healthcare Association of New York State (2018-current)

152
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