New Leapfrog Analysis Looks at HAI Rates

By Matt Phillion

A new analysis from Leapfrog has found a steady downward trajectory for HAIs since COVID-19—but while these improvements are encouraging, there’s still more work to be done with transparent reporting and patient empowerment to get to zero-lives-lost from preventable infections.

Of note from the fall 2024 Safety Grade release:

• MRSA and CAUTI rates are now lower than they were pre-pandemic (2019), equating to almost 400 lives saved per year.
• CLASBI rates have seen a slight increase since 2019, equating to almost 200 lives lost per year.

How the HAI metrics works: Hospitals report infection data to federal entities using the CDC’s National Healthcare Safety Network (NHSN), the leading HAI-tracking system. Hospitals that report to the Leapfrog Hospital Survey have the option to share this data directly with Leapfrog through the NHSN. This data, alongside publicly reported data from the CDC, is used to assign Safety Grades. Leapfrog uses Standardized Infection Ratios (SIR) to understand performance for the three key HAIs mentioned above. SIRS represent the number of observed infections divided by the number of predicted infections. A SIR score of 1, for example, indicates that a given hospital had exactly the number of infections that were expected based on their volume of patients, hospitals characteristics, and community prevalence in a one-year reporting period. A SIR greater than 1 means the hospital had more infections than expected when following standard HAI prevention protocols.

“While many organizations are focused solely on infection prevention, Leapfrog is focused on patient safety as a whole, with our goal being to collect and publicly report the most up to date information from hospitals. Our Safety Grade Program compares every hospital across the country using important patient safety metrics,” says Alex Campione, program analyst for the Leapfrog Group. “We weren’t surprised when there was an uptick in 2020 given the stress on the American healthcare system but we were surprised when that uptick was sustained.”

This was a cause for some worry, Campione said: How were hospitals going to react?

“It seemed like decades of progress in infection control were being challenged at that time,” says Campione.

But the numbers we’re seeing now are promising.

“We’re seeing a return not only to pre-pandemic levels, but the best rates we’ve seen in the last 10 years. Things are looking a lot more promising,” she says.

Part of this improvement can be attributed to public pressure to do better, Campione notes.

“We started reporting on it in 2022 or early 2023 and realized internally that there was a problem and it would take a concerted effort,” she says. “How do you balance these infection prevention strategies alongside COVID prevention strategies?”

The numbers were a bit of a surprise, Campione notes. One might expect with COVID prevention strategies in place—fewer visitors, serious PPE use, better hand hygiene compliance—that things might head in the right direction.

“First, we have to acknowledge that the downtick was related to COVID: the peaks corresponded with surges in COVID or a new variant,” says Campione. “It was very obviously related to this. There were changes to hospital practice, such as the length of time providers were spending with patients.”

There were also longer hospital stays in general, which means that the devices associated with HAIs like catheters were being used more. And ultimately the acuity levels and comorbidities of the patients themselves played into the overall impact.

There’s always a risk when a foreign object is inserted in the body, but expert guidelines exist to prevent infections associated with catheters, central lines, and so on. But some of these guidelines fell to the wayside in the face of a national pandemic and the numbers showed the impact of that.

“We know what works with infection prevention, but it’s the commitment to doing so,” says Campione.

Where things are going well

Hospitals have done an incredible job of getting back to those pre-pandemic levels and doing even better than before, Campione notes.

“It’s a commitment to those basic guidelines,” she says. “We see it in hand hygiene as well—more hospitals are achieving the standards for hand hygiene than ever before. It’s getting back to basics, realizing there was a problem, and having proper surveillance. If you’re not measuring how you’re doing, you don’t know there’s a problem.”

Meanwhile, one challenge impacts infection prevention as much as it impacts everywhere else in healthcare: the continued staffing shortage the industry faces.

“COVID really shined a light on where we were lacking: proper staffing, proper training, and knowing that there is always the chance for another health emergency,” says Campione. “A huge part of preparing for that is making sure organizations are staffed at appropriate numbers and with appropriate credentials.”

Theres’s also a greater need to involve patients and their families and caregivers, Campione explains.

“Prevention is an everyone problem,” she says. “Proper training for hospital staff is key, but so is awareness among patients and their families. They’re the first ones who would notice something is off—a fever, sensitivity to touch, generally not feeling well. They’re able to catch some of these infections early, and general awareness around HAIs, the signs around them, can help make that happen.”

The Leapfrog Safety Grade website offers tools and education in this area as well as the ability to see how hospitals across the country are performing in terms of HAIs.

Looking ahead

We’ve seen improvements in HAI prevention, but are these current numbers sustainable?

“I think so,” says Campione. “We just can’t take our progress for granted. That’s what we saw during COVID. The big thing I’d be worried about is healthcare system resilience in the case of another emergency, ensuring you have proper staffing, and that people are trained and not burned out.”

Leapfrog also offers analyses of basic metrics about nurse-to-patient ratios or percentage of nurses with a BSN.

“We’re doing what we can to capture that data. It’s important for hospitals to monitor these metrics as well and to have benchmarks, specific to their geography, resources, and other factors,” says Campione. “Our survey is a great tool for benchmarking their programs not just from year to year but to other hospitals.”

Ultimately, it comes down to hospital leadership as to what is done with this information, what steps or improvements to prioritize, and so on.

“Is patient safety at the top of the priority list? We at Leapfrog feel it’s the most important thing a hospital can do,” says Campione.

But change and improvement goes beyond just hospital leadership or even hospital staff, she says.

“I’d like to see patients more engaged in their care and holding hospitals accountable,” says Campione. “We have a lot of experts who care deeply about addressing HAIs, but many patients may not even know that their infection was related to a hospital stay. It’s really important going forward to provide greater patient advocacy and ensure they feel empowered to look for the signs of infection.”

Overall, the industry is in a better place than they were during the heart of the pandemic or even before.

“Generally, we at Leapfrog are happy with the work hospitals have put in over the past few years,” says Campione. “We’ve seen them not only get back to pre-pandemic levels but improve on other measures as well—areas like risks of falls and other patient safety indicators. The Safety Grade is one of many ratings programs, but it’s a very important one because the emphasis is on patient safety. HAIs are common, one in 31 patients each day contract an HAI, so we’re pleased to see hospitals have put in the work to make them less common.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.