Frequently Asked Questions

Why was this web site developed?
What does this web site contain?
How can this web site be useful to me?
Why were these infections and procedures selected ?
How do I use this web site?
How do I interpret the tables?
Where do the data come from?
Why can't I find a particular hospital or ambulatory surgical center?
Are the surgical site infection data adjusted for risk level?
How can I keep from getting a healthcare-associated infection?
Why are hospitals reporting head of bed (HOB) elevation rates instead of actual ventilator-associated pneumonia (VAP) rates?
What is head-of-bed (HOB) elevation and why is it being monitored and reported?
Why are central line-associated bloodstream (CLAB) infections and surgical site infections (SSIs) reported as ( ), ( ), or ( ), while head of bed (HOB) elevation data are reported numerically?
Why aren’t such infections as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) or Clostridium difficle reported on this site ?
What are the reporting criteria for facilities?

Why was this web site developed?
The Missouri legislature passed Senate Bill 1279, which establishes the "Missouri Nosocomial Infection Reporting Act of 2004" which seeks to decrease the incidence of infections within healthcare facilities in Missouri. It requires hospitals and ambulatory surgery centers to report specific healthcare-associated infections (HAIs) to the Missouri Department of Health and Senior Services (DHSS). This law also requires DHSS to report this information to the public, which led to the development of this website.

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What does this web site contain?
This site provides two ways of viewing data related to acquiring infections in hospitals and ambulatory surgery centers (ASC)-- facility comparison tables and profile tables. The facility comparison tables allow you to select a region of the state and view the data for all the reporting facilities in that region. The profile tables allow you to select an individual hospital or ASC to see all the data for that facility. Each type of table indicates whether the facility was higher or lower than selected comparison groups. Types of data currently available are central line-associated bloodstream (CLAB) infection data and surgical site infection (SSI) data. 

How can this web site be useful to me?
Healthcare-associated infections can be very serious, increasing the cost, lengthing your recovery time, and even threatening your life. This site can provide helpful information as you select a facility for your healthcare. Of course, the advice of your physician, the experience of the hospital or surgery center staff, and other factors unique to your situation are also critical for your decision-making.

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Why were these infections and procedures selected?
These infections are tracked by the Centers for Disease Control and Prevention (CDC). They tend to be reported by many types of facilities, and are good indicators of other types of facility infections. Also, there is scientific consensus on how they are defined, identified and counted. Additionally, there are widely accepted methods that a facility can use to reduce the frequency of these infections.

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How do I use this web site?
Background information and definitions of terms can be viewed by selecting the relevant links in the left bar margin. The data tables can be viewed by clicking on Infection Reporting Data. This will take you to a Main Page, where you will be guided through three or four simple steps to create either hospital comparison tables or individual hospital profile tables.

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How do I interpret the tables?
The facility comparison and profile tables are patterned after other consumer-related reports in that they use shaded circles to relate the performance of the facility to a standard or reference group. The shaded circles indicate whether the facility's infection rates are similar to ( ), higher than ( ), or lower than ( ) each reference group rate, according to statistical tests.

The infection rates table displays the number of infections and the infection rate for a given facility. Rates for the reference groups are also shown. Note: A facility's rate may appear higher or lower than a reference group rate without being significantly different from that rate; users should focus their attention on the facility comparison and profile tables.

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Where do the data come from?
The data on central lines and procedures and the associated infections are carefully collected on a daily basis by each reporting facility. They are transmitted electronically to the department each month, where they are prepared for this web site. Prior to their appearing on this web site, the facilities review the data for accuracy. They can also comment on the data, and these comments can be viewed in the tables.

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Why can't I find a particular hospital or ambulatory surgery center?
If the facility of interest does not appear in any of the four regions or the profile list, it is probably because it was not required to submit data for the specific infection-reporting category you selected to view. Hospitals that had less than fifty (50) central line-days per year in a given intensive care unit (ICU) were not required to report for that ICU. Similarly, hospitals and ambulatory surgery centers that performed less than twenty (20) procedures per year were not required to report for that surgical procedure. This is because infection rates based on too few central line-days or procedures would not be reliable or meaningful.  In addition, facilities that have at least 100 ventilator- days for all ICUs combined, are asked to voluntarily report the number of patients with their head-of-bed elevated to at least 30 degrees.

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Are the surgical site infection data adjusted for risk level?
Yes, the results in the comparison tables and profiles reflect the results of statistical tests that take into account the risk level of the surgery. These tests compare each facility to either national data and/or to data for all facilities that report to the department. Also, data for each facility are reported by risk level in the "Data" section of the tables.

See left bar margin to link to additional information and definitions, or click here to begin viewing data.

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How can I keep from getting a healthcare-associated infection?
  1. Clean your hands with soap and warm water and rub well for 15 seconds:
    • Before touching or eating food
    • After using the bathroom, taking out trash, changing a diaper
    • After visiting someone who is ill
    • After playing with a pet
  1. Make sure health care providers clean their hands or wear gloves.
    • Doctors, nurses, dentists and other health care providers come into contact with lots of bacteria and viruses. So before they treat you, ask them if they’ve cleaned their hands.
    • Don’t be afraid to ask them if they should wear gloves when performing tasks such as taking blood, touching wounds, or examining your mouth or private parts.
  1. Cover your mouth and nose.
    • When you sneeze or cough, the germs can travel 3 feet or more!
    • Use a tissue and clean your hands after coughing or sneezing.
    • No tissue? Cover your mouth and nose with the bend of your elbow. If you use your hands – clean them right away.
  1. If you are sick, avoid close contact with others.
    • Stay home
    • Don’t shake hands or touch others
    • When you go for treatment, call ahead and let them know you are ill.
  1. Get shots to avoid disease and fight the spread of infection.
    • Make sure that your vaccinations are current—even for adults. Check with your doctor about shots you may need. Vaccinations are available to prevent many diseases.

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Why are hospitals reporting head of bed (HOB) elevation rates instead of actual ventilator-associated pneumonia (VAP) rates?
Criteria used to diagnose VAPs are varied and not consistent among hospitals; therefore, it would be difficult to compare hospitals fairly using these data. However, there are process measures that are proven to be successful in preventing VAPs. The one measure that has the greatest individual impact on VAP prevention is HOB elevation, which is why this measure was chosen.

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What is head-of-bed (HOB) elevation and why is it being monitored and reported?
Patients on a ventilator have a high risk of getting pneumonia. One of the ways to help prevent patients from getting pneumonia is to raise the HOB to at least a 30-degree angle. The goal is for healthcare facilities to keep beds at the proper angle for 100 percent of patients on ventilators. Hospitals are currently voluntarily reporting to the DHSS the number of patients on a ventilator and the number of these patients who have the HOB at 30-degrees or greater. The DHSS then calculates the rates of HOB elevation and posts them on this web site.

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Why are central line-associated bloodstream (CLAB) infections and surgical site infections (SSIs) reported as ( ), ( ), or ( ), while head of bed (HOB) elevation data are reported numerically? CLAB and SSI data are related to actual infections and are analyzed using risk stratification and other statistical methods so the public can make fair comparisons among facilities. HOB elevation data are not related to actual infections – HOB is a process measure that has been proven to prevent ventilator-associated pneumonia (VAP). The goal is to have the ventilated patient’s HOB elevated 100 percent of the time (when appropriate). Therefore, it was decided to report the percentage of time the HOB was elevated, as an indicator of the hospital’s performance.

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Why aren’t such infections as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) or Clostridium difficle reported on this site ?
Information is reported to the Department of Health and Senior Services (DHSS) regarding antibiotic resistance trends. Rates of specific infections caused by antibiotic resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and Clostridium difficle, are not collected for the purpose of public reporting. The infections and measures that are reported were selected based on a number of criteria. The infections had to be serious, likely to occur and be detected in facilities regardless of their size, identifiable as being related to hospital care as opposed to being contracted in the community, and be fairly indicative of the level of infection control in the facility. Additionally, the resources of the facilities and the DHSS had to be taken into consideration: Facilities could not feasibly report every infection and the DHSS would not have been able to accommodate this volume of data.

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What are the reporting criteria for facilities?
Hospitals that had less than fifty (50) central line-days per year in a given intensive care unit (ICU) are not required to report for that ICU. Similarly, hospitals and ambulatory surgery centers that performed less than twenty (20) procedures per year are not required to report for that surgical procedure. This is because infection rates based on too few central line-days or procedures would not be reliable or meaningful.  In addition, facilities that have at least 100 ventilator- days for all ICUs combined, are asked to voluntarily report the number of patients with their head-of-bed elevated to at least 30 degrees.