Background: Interventions to reduce unnecessary device use may select a higher-risk population, leading to a paradoxical increase in SIR for some high-performing facilities. The standardized utilization ratio (SUR) adjusts for device use for different units and facilities. We evaluated the performance of a population SIR (pSIR) metric compared to device SIR (dSIR) in the situations of increased, decreased, and no change in SUR for a large system. Methods: We evaluated hospitals that had a reduction, increase, and no substantial change (±5% relative change) in their SUR in FY2019 (July 2018–June 2019) compared to baseline FY2017 (July 2016–June 2017). The dSIR (defined as Σ observed events divided by Σ predicted events based on actual device days) and pSIR (defined as Σ observed events divided by Σ predicted events based on predicted device days). We calculated the cumulative attributable difference (CAD) for catheter-associated urinary tract infections (CAUTIs) for the same facilities based on dSIR and pSIR. Results: Overall, the system SUR dropped from 0.92 in 2017 to 0.85 in 2019 (7.3% decrease). Of the 48 hospitals included, 25 (52%) exhibited a drop, 13 (27%) exhibited an increase, and 10 (21%) had no change in SUR during 2019. For hospitals in which SUR decreased, the dSIR decreased by 15.9% from 0.88 to 0.74, and the pSIR decreased by 32.3% from 0.85 to 0.58 (Table 1). In 2019, the CAD for CAUTI to a target SIR of 1 was 133 for the dSIR compared to 181 for the pSIR, and 36% more events were avoided. Conclusions: The traditional SIR (dSIR) underestimated improvements in infection rates compared to the pSIR because it failed to account for reduced device utilization associated with infection prevention interventions. The pSIR accounts for overall risk of infection associated with device exposure in a population and better reflects the efficacy of prevention efforts compared to dSIR. The pSIR should be considered in situations in which interventions have led to substantial reductions in device use. Funding: None Disclosures: None

The learnability of center-embedded recursive structures has attracted much attention (Corballis, 2007; Friederici, 2004; Rey, Perruchet, & Fagot, 2012). However, most of the previous studies adopted the artificial grammar learning paradigm (Reber, 1967) and did not apply natural language stimuli. Rather, they applied synthetic meaningless training materials, which hardly represent the richness and complexity of natural language. Accordingly, in the current study, we attempt to tighten the link between artificial language learning and natural language acquisition in the auditory modality, by enriching our learning environment with phonological cues that occur in natural, spoken information; in particular, Chinese tones. In a grammaticality judgment task, we examined the syntactical processing by participants from different language backgrounds. Through the cross-language comparison between Chinese and Dutch native speakers, we aim to test the influence of language-specific phonological cues on processing complex linguistic structures. The results showed that tones had a more beneficial learning effect for Chinese than for Dutch participants. In other words, when participants learned a new language, they were likely to bring their own language routines implicitly from the familiar native language into processing the unfamiliar one.