This dataset shows the incidence rates of hospital onset (HO) methicillin-resistant Staphylococcus aureus bloodstream infections (MRSA BSI) reported by California free-standing acute care hospitals, rehabilitation acute care hospitals and rehabilitation units, and long-term acute care hospitals with their own Centers for Medicare and Medicaid Services certification number (CCN). MRSA BSI cases are classified as HO when a positive blood sample is obtained on day four or later during a hospital stay, from a patient with no prior positive blood culture within the preceding two weeks.
1) Acute Care Hospitals: Critical access acute care hospital (CAH; defined as certain facilities that participate in Medicare and that are designated by states through a protocol)
2) Rehabilitation (REHABs) acute hospitals are hospitals with inpatient wards for evaluation and restoration of function to patients who have lost function due to acute or chronic pain, musculoskeletal problems, stroke, or catastrophic events resulting in complete or partial paralysis. These hospitals were self-identified through National Healthcare Safety Network (NHSN).
3) Long-term acute care hospitals (LTACs) are defined by the Centers for Medicare and Medicaid Services as providing care to patients with medically complex conditions requiring an average length of stay greater than 25 days.
Acute Care Hospitals Methods: The HO MRSA BSI SIR, which adjusts for significant risk factors, is calculated by comparing the number of MRSA BSI that occurred (or were observed) in the hospital to the number that would be predicted based on the national referent MRSA BSI rate data. Risk factors found to be significant in predicting HO MRSA BSI incidence include hospital bed size, affiliation with a medical school, and the community burden of MRSA BSI as observed in patients admitted to the hospital. Adjusting for these factors provides for a more accurate comparison of hospitals’ infections. For more precise comparisons, NHSN only calculates a SIR when at least one HO MRSA BSI is predicted, which is determined by patient volume and other factors predictive of acquiring MRSA BSI. However, we calculated the SIR for such hospitals with HO MRSA BSI predicted less than one if the number of HO MRSA BSI predicted was ≥ 0.2. For each hospital with a MRSA BSI SIR, we performed a statistical analysis to determine if the observed number of infections was significantly different than the predicted number. Based on our statistical analysis we labeled each hospital’s MRSA BSI SIR as indicating:
• No Different - no difference in number of observed and predicted infections,
• Higher - high or more infections than predicted, or
• Lower - low or fewer infections than predicted
REHABs and LTACs Methods: The HO MRSA BSI rate is calculated by dividing the number of cases by the total number of patient days; the rate is then reported per 10,000 patient days. The MRSA BSI rates in this data release are not risk adjusted because there are no such methods available at this time for REHABs and LTACs. In addition to patient-based risk factors, the unadjusted REHAB and LTACs MRSA BSI rates herein are also affected by facility bed size, community prevalence rate, clinical and infection control practices, and/or surveillance methods. While stratifying MRSA BSI rates by hospital type may make rates more comparable, it cannot control for all factors that can affect MRSA BSI rates. Therefore, comparisons between hospitals within REHABs should still be made with caution. That is, differences in rates within this hospital type can represent other factors besides differences in infection and transmission prevention practices.
To link the CDPH facility IDs with those from other Departments, like OSHPD, please reference the "Licensed Facility Cross-Walk" Open Data table at https://data.chhs.ca.gov/dataset/licensed-facility-crosswalk.
Health and Safety Code section 1288.55(a)(1) requires general acute care hospitals to report to the California Department of Public Health (CDPH) all cases of MRSA BSI identified in their facilities. The data are submitted by California hospitals to the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN). For more information on data collection processes and methods, please see the "MRSA and VRE BSI Technical Notes" of the healthcare-associated infections (HAI) report on: https://www.cdph.ca.gov/Programs/CHCQ/HAI/Pages/HAIProgramHome.aspx.
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