Mandatory reporting of healthcare-associated infections: A long way to go

Abstract

BACKGROUND: In 2004, the Pennsylvania Health Care Cost Containment Council (PHC4) mandated that acute care hospitals in Pennsylvania report all healthcare-associated infections (HAIs) in hospitalized patients. The goal of PHC4 is to reduce the cost and improve the quality of healthcare through public reporting of healthcare outcomes, including HAIs. PHC4 requires the use of CDC definitions of HAI but does not specify a methodology to obtain this data. PHC4 utilizes both administrative and active surveillance data sources supplied by hospitals to assess the quality of HAI data submitted. Preliminary reports from PHC4 revealed significant discrepancies between data from these two sources. Objective: To determine the concordance between HAIs in hospitalized patients identified using administrative data to HAIs identified by active surveillance conducted by infection control professionals (ICPs). METHODS: This retrospective study was performed at a large children's hospital that conducts active surveillance of high-risk patient units. Using selected ICD-9 billing codes in predetermined positions on hospital discharge reports, PHC4 classifies four types of presumed HAI: 1) surgical site infections, 2) ventilator-associated pneumonia, 3) catheter-associated urinary tract infections, and 4) central line–associated bloodstream infections (CLABSIs). We compared HAIs identified by active surveillance to HAIs identified by PHC4 from hospital administrative data. Discrepancies were resolved by further chart review by ICPs. RESULTS: Active surveillance of targeted units over 9 months in 2004 identified 239 HAIs; administrative data identified 943 patients with presumed HAIs during the same period. 131 infections identified by active surveillance were not captured from administrative data; 842 presumed HAIs captured from administrative data were not identified by active surveillance. Upon further review, we found that 70% of HAIs identified by active surveillance alone were CLABSIs. We are conducting an audit of randomly selected records to resolve discrepancies and identify sources of error in this reporting mechanism. CONCLUSIONS: Public reporting of adverse healthcare events might reduce costs and improve patient outcomes. However, additional study is needed to define the optimal strategy for conducting surveillance for HAIs so that accurate and meaningful data are available to consumers.