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

Published:September 16, 2016DOI:


      • An infection composite score of the 6 publicly reported health care–associated infections is proposed.
      • The infection composite score adjusts the individual standardized infection ratios into a group performance.
      • The infection composite score may help evaluate general performance of hospitals in preventing infection.
      • Large systems, state health departments and hospital associations, and quality improvement networks may use the infection composite score to help them identify hospitals that require further support to reduce infection.


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


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


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


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

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Dudeck M.A.
        • Edwards J.R.
        • Allen-Bridson K.
        • Gross C.
        • Malpiedi P.J.
        • Peterson K.D.
        • et al.
        National Healthcare Safety Network report, data summary for 2013, Device-associated Module.
        Am J Infect Control. 2015; 43: 206-221
        • Centers for Disease Control and Prevention
        Your guide to the standardized infection ratio (SIR).
        NHSN e-news. 2010: 1-14 (SIRs Special Edition; Available from) (Accessed August 29, 2016)
        • Centers for Medicare and Medicaid Services (CMS), HHS.
        Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and Fiscal Year 2014 rates; quality reporting requirements for specific providers; hospital conditions of participation; payment policies related to patient status. Final rules.
        Fed Regist. 2013; 78: 50495-51040
        • Centers for Medicare & Medicaid Services (CMS)
        Hospital-acquired conditions.
        (Available from) (Accessed July 4, 2015)
        • Saman D.M.
        • Kavanagh K.T.
        • Abusalem S.K.
        Redefining the standardized infection ratio to aid in consumer value purchasing.
        J Patient Saf. 2013; 9: 55-58
        • Gould C.V.
        • Edwards J.R.
        • Cohen J.
        • Bamberg W.M.
        • Clark L.A.
        • Farley M.M.
        • et al.
        Effect of nucleic acid amplification testing on population-based incidence rates of Clostridium difficile infection.
        Clin Infect Dis. 2013; 57: 1304-1307
        • Jacobs R.
        • Goddard M.
        • Smith P.C.
        How robust are hospital ranks based on composite performance measures?.
        Med Care. 2005; 43: 1177-1184
        • Dimick J.B.
        • Staiger D.O.
        • Osborne N.H.
        • Nicholas L.H.
        • Birkmeyer J.D.
        Composite measures for rating hospital quality with major surgery.
        Health Serv Res. 2012; 47: 1861-1879