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Hospital Performance: Healthcare-associated Staphylococcus aureus bloodstream infections in 2011–12

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Key findings

In 2011–2012, 1,725 cases of healthcare-associated S. aureus bloodstream infection were reported by the 352 public hospitals covered in this report. This represents over 99% of all cases of this infection reported nationally (Figure 1a and Figure 1b).

Bigger hospitals report more patient infections

People with healthcare-associated S. aureus bloodstream infection are most often detected and reported by the largest hospitals.

All major hospitals reported at least one case of S. aureus bloodstream infection. Major hospitals accounted for 82% of all reported cases and 64% of all patient bed days monitored.

Among large hospitals, 31 of the 39 hospitals reported at least one case. Large hospitals accounted for 6% of all reported cases and 10% of all patient bed days monitored.

Nearly half (41) of hospitals in the medium hospital peer group reported at least one case. Medium hospitals accounted for 5% of all reported cases and 9% of all patient bed days monitored.

Only 14 of the 79 small hospitals reported at least one case. Small hospitals accounted for 2% of all reported cases and 4% of all patient bed days monitored.

Of the remaining 77 cases, 68 were reported in hospitals in the ‘specialist women’s and children’s’ hospital peer group and nine in the ‘other’ hospital peer group. These two groups each accounted for 5% of all patient bed days monitored.

Hospitals with more vulnerable patients report more infections

People with healthcare-associated S. aureus bloodstream infection were more often reported by hospitals with more vulnerable patients.

Major hospitals with:

  • More vulnerable patients reported 60% (1046) of all cases in 2011–12 and accounted for 41% of patient bed days monitored
  • Fewer vulnerable patients reported 22% (381) of all cases in 2011–12 and accounted for 23% of patient bed days monitored.

Large hospitals with:

  • More vulnerable patients reported 4% (73) of all cases in 2011–12 and accounted for 4% of patient bed days monitored
  • Fewer vulnerable patients reported 2% (40) of all cases in 2011–12 and accounted for 6% of patient bed days monitored.

Medium hospitals with:

  • More vulnerable patients reported 3% (55) of all cases in 2011–12 and accounted for 4% of patient bed days monitored
  • Fewer vulnerable patients reported 2% (30) of all cases in 2011–12 and accounted for 5% of patient bed days monitored.

Small hospitals with:

  • More vulnerable patients reported 1% (13) of all cases in 2011–12 and accounted for 2% of patient bed days monitored
  • Fewer vulnerable patients reported 1% (10) of all cases in 2011–12 and accounted for 2% of patient bed days monitored.

The number of cases of S. aureus healthcare-associated bloodstream infection per 10,000 patient bed days, or the rates of infection, are higher in peer groups with more vulnerable patients compared to those with fewer vulnerable patients (Figure 1a and Figure 1b).

Major hospitals with:

  • More vulnerable patients have an average rate of infection of 1.38 cases per 10,000 patient bed days
  • Fewer vulnerable patients have an average rate of infection of 0.90 cases per 10,000 patient bed days.

Large hospitals with:

  • More vulnerable patients have an average rate of infection of 1.01 cases per 10,000 patient bed days
  • Fewer vulnerable patients have an average rate of infection of 0.33 cases per 10,000 patient bed days.

Medium hospitals with:

  • More vulnerable patients have an average rate of infection of 0.71 cases per 10,000 patient bed days
  • Fewer vulnerable patients have an average rate of infection of 0.35 cases per 10,000 patient bed days.

Small hospitals with:

  • More vulnerable patients have an average rate of infection of 0.34 cases per 10,000 patient bed days
  • Fewer vulnerable patients have an average rate of infection of 0.23 cases per 10,000 patient bed days.

Infection rates differ markedly between similar hospitals

There is noticeable variation between hospitals in terms of the proportions of patients with healthcare-associated S. aureus bloodstream infection, even after accounting for hospital size, service provision and patient vulnerability.

In major hospitals, the rate of healthcare-associated S. aureus bloodstream infection in 2011–12 ranged from:

  • 0.47 to 2.15 per 10,000 patient bed days for hospitals with more vulnerable patients
  • 0.17 to 2.59 per 10,000 patient bed days for hospitals with fewer vulnerable patients.

Among major hospitals with more vulnerable patients, there are two hospitals with 10 cases or fewer, and rates as low as about 0.5 cases per 10,000 patient bed days. There are five hospitals with more than 30 cases and rates more than 2.0 cases per 10,000 patient bed days (Figure 1a).

Among major hospitals with fewer vulnerable patients, there are hospitals with 10 cases or fewer, and rates as low as about 0.17 cases per 10,000 patient bed days. There is a hospital with more than 30 cases and a rate of 2.59 cases per 10,000 patient bed days (Figure 1a).

This four-fold and 15-fold difference in rates of infection for major hospitals with more or fewer vulnerable patients, respectively, may represent an opportunity to improve the prevention of healthcare-associated S. aureus bloodstream infection.

In large hospitals, the rate of healthcare-associated S. aureus bloodstream infection ranged from:

  • 0 to 2.30 per 10,000 patient bed days for hospitals with more vulnerable patients
  • 0 to 1.11 per 10,000 patient bed days for hospitals with fewer vulnerable patients.

Among large hospitals with more vulnerable patients, there are two hospitals with 10 cases or fewer, and rates as low as about 0.16 cases per 10,000 patient bed days. There are two hospitals with between 11 and 30 cases and rates of more than 2.0 cases per 10,000 patient bed days (Figure 1a).

This 10-fold difference in rates of infection may represent an opportunity to improve the prevention of healthcare-associated S. aureus infection.

In medium hospitals, the rate of healthcare-associated S. aureus bloodstream infection ranged from:

  • 0 to 2.01 per 10,000 patient bed days for hospitals with more vulnerable patients
  • 0 to 2.95 per 10,000 patient bed days for hospitals with fewer vulnerable patients.

In small hospitals, the rate of healthcare-associated S. aureus bloodstream infection ranged from:

  • 0 to 2.38 per 10,000 patient bed days for hospitals with more vulnerable patients
  • 0 to 1.50 per 10,000 patient bed days for hospitals with fewer vulnerable patients.
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