Korean National Healthcare-associated Infections Surveillance Research Articles

A Validation Study of Surveillance Data: Focus on the Korean National Healthcare-associated Infections Surveillance System (KONIS), Intensive Care Unit Module

A Validation Study of Surveillance Data: Focus on the Korean National Healthcare-associated Infections Surveillance System (KONIS), Intensive Care Unit Module

2470. A Survey of the Collection of Denominator Data in the Korean National Healthcare-associated Infections Surveillance System (KONIS), Intensive Care Unit Module

Abstract Background National surveillance data should be validated to identify data quality issues. While denominator data can have a significant effect on the healthcare-associated infection (HAI) rate, they are relatively overlooked compared to numerator data. The Korean National Healthcare-associated Infections Surveillance System (KONIS) has been conducting data validation, and this study analyzed the current status of, and problems with, collecting denominator data for the first time. Methods The web-based cross-sectional survey was conducted on January 6, 2023 on 183 infection control nurses from 127 hospitals, among a total of 275 participating hospitals in the KONIS ICU module. The questionnaire was delivered using the QR code method and answered online by participants via SurveyMonkey®. The survey examined denominator data collection methods, such as patient days and device days of central lines and urinary catheters. The knowledge of the types of central lines and urinary catheters for KONIS reporting and the responses to case questions about specific situations related to the calculation of device days, were also evaluated. Results The respective proportions of manual vs. electronic methods for counting denominator data were 10.4% vs. 81.4% for patient days, 22.4% vs. 67.8% for central line days, and 23.5% vs. 69.4% for urinary catheter days. About 27.3%, 29.5%, and 31.1% of respondents reported periodically checking the accuracy of patient days, central line days, and urinary catheter days data, respectively. Infection control nurses were responsible for collecting the majority (66.1%) of the denominator data and entering them into the Web-based Report and Analysis Program (88.0%). The survey results indicated that the rate of accurately understanding and responding to the case questions on device days for central lines ranged from 24.6% to 78.7%, while for urinary catheters, it ranged from 27.3% to 92.3%. Conclusion To maintain the reliability of the national HAI surveillance data, it is important to collect accurate denominator data, in addition to numerator data. This study has identified several areas where improvements in denominator data collection methods are needed. Continuing education on the definition of denominator data and accurate data collection methods is crucial. Disclosures All Authors: No reported disclosures

External and internal validation of healthcare-associated infection data collected by the Korean National healthcare-associated Infections Surveillance System (KONIS)

This study analyzed the validity of healthcare-associated infection (HAI) data of the Korean National healthcare-associated Infections Surveillance System. The validation process consisted of external (EV) and internal (IV) validation phases. Of the 193 hospitals that participated from July 2016 through June 2017, EV was performed for 10 hospitals that were selected based on the HAI rate percentile. The EV team reviewed 295 medical records for 60 HAIs and 235 non-HAI control patients. IV was performed for both the 10 EV hospitals and 11 other participating hospitals that did not report any HAIs. In the EV, the diagnosis of urinary tract infections had a sensitivity of 72.0% and a specificity of 99.3%. The respective sensitivities of bloodstream infection and pneumonia were 63.2% and 70.6%; the respective specificities were 98.8% and 99.6%. The agreement (ĸ) between the EV and IV for 10 hospitals was 0.754 for urinary tract infections and 0.674 for bloodstream infections (P<.001, respectively). Additionally, IV found additional cases among 11 zero-report hospitals. This study demonstrates the need for ongoing validation and continuous training to maintain the accuracy of nationwide surveillance data. IV should be considered a validation method to supplement EV.

A Survey of the Collection of Denominator Data in the Korean National Healthcare-associated Infections Surveillance System, Intensive Care Unit Module

Je Eun Song, Gang-Bok Oh, Young Hwa Choi, Sung Ran Kim, Su Ha Han, So-Yeon Yoo, Hyeon Mi Yoo, Ji-youn Choi, Myoung Jin Shin, Yee Gyung Kwak. Korean J healthc assoc Infect Control Prev 2023;28:78-84. https://doi.org/10.14192/kjicp.2023.28.1.78

Korean National Healthcare-associated Infections Surveillance System, Intensive Care Unit Module Report: Summary of Data from July 2020 through June 2021

Eun Jin Kim, Yee Gyung Kwak, Sun Hee Kwak, Su Hui Ko, Oh Mee Kweon, Eu Suk Kim, Jin Hwa Kim, Tae Hyong Kim, Taek Soo Kim, Hee-Won Moon, Sun Hee Park, Jin Young Ahn, So-Yeon Yoo, Hyeon Mi Yoo, Sang-Oh Lee, Yu-Mi Lee, Nan-Hyoung Cho, Young Hwa Choi, Pyoeng Gyun Choe, Ki Ho Hong, Mi Suk Lee, Korean National Healthcare-associated Infections Surveillance System (KONIS) ICU module. Korean J healthc assoc Infect Control Prev 2023;28:64-77. https://doi.org/10.14192/kjicp.2023.28.1.64

Impact of COVID-19 pandemic on healthcare-associated infections at intensive care units in South Korea: data from the Korean National Healthcare-Associated Infections Surveillance System (KONIS)

The coronavirus disease 2019 (COVID-19) pandemic has influenced hospital infection control practices. To evaluate the impact of the COVID-19 pandemic on healthcare-associated infections (HAIs) in intensive care units (ICUs). A retrospective analysis using data from the Korean National Healthcare-Associated Infections Surveillance System was conducted. Comparisons between incidence rates and micro-organism distributions of bloodstream infection (BSI), central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (VAP) before and during the COVID-19 pandemic were performed according to hospital size. The incidence rate of BSI significantly decreased during the COVID-19 pandemic compared to the pre-COVID-19 period (1.38 vs 1.23 per 10,000 patient-days, relative change -11.5%; P < 0.001). The incidence rate of VAP (1.03 vs 0.81 per 1000 device-days, relative change -21.4%; P < 0.001) significantly decreased during the COVID-19 pandemic compared to the pre-COVID-19 period, whereas rates of CLABSI (2.30 vs 2.23 per 1000 device-days; P= 0.19) and CAUTI (1.26 vs 1.26 per 1000 device-days; P= 0.99) were similar between the two periods. The rates of BSI and CLABSI significantly increased during the COVID-19 pandemic compared to the pre-COVID-19 period in large-sized hospitals, whereas these rates significantly decreased in small-to-medium-sized hospitals. The rates of CAUTI and VAP significantly decreased in small-sized hospitals. There were no significant changing trends in the rates of multidrug-resistant pathogens isolated from patients with HAI between the two periods. The incidence rates of BSI and VAP in ICUs decreased during the COVID-19 pandemic compared to the pre-COVID-19 period. This decrease was mainly seen in small-to-medium-sized hospitals.

2041. Impact of Coronavirus Disease 2019 pandemic on healthcare-associated infections at intensive care unit in South Korea: Data from Korean National Healthcare-associated Infections Surveillance System (KONIS)

Abstract Background Coronavirus Disease 2019 (COVID-19) pandemic has influenced hospital infection control practices. We evaluated the impact of the COVID-19 pandemic on healthcare-associated infections (HAIs) in the intensive care unit. Methods We conducted a retrospective analysis using data from the Korean National Healthcare-Associated Infections Surveillance System (KONIS). KONIS has conducted nationwide prospective surveillance of HAIs in intensive care units. Comparisons of incidence rates of bloodstream infection (BSI), central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (VAP) before (Jan 2018-Dec 2019) and during the COVID-19 pandemic (Jan 2020-Jun 2021) were performed according to hospital size. The microorganism distributions in BSI, urinary tract infection, and pneumonia were compared between the period before and during the COVID-19 pandemic. Results The incidence rate of BSI significantly decreased during the COVID-19 pandemic than in the pre-COVID-19 period (1.38 vs. 1.19 per 10,000 patient-days; P &amp;lt; 0.001) [Table 1]. Incidence rates of CLABSI (2.30 vs. 2.17 per 1,000 device-days; P = 0.03) and VAP (1.03 vs. 0.81 per 1,000 device-days; P &amp;lt; 0.001) decreased significantly during the COVID-19 pandemic than in the pre-COVID-19 period, whereas that rate of CAUTI was similar between the two periods. The annual trends of incidence rate of CLABSI and VAP also has decreased (Figure 1). According to the hospital size, the incidence rate per 1,000 device-days of CLABSI significantly decreased during the COVID-19 pandemic than in the pre-COVID-19 period in small to medium-sized hospitals (300-699 beds). The incidence rate per 1,000 device-days of VAP significantly decreased only in small-sized hospitals (200-449 beds). The microorganism distributions in HAIs did not change significantly. Conclusion The incidence rates of CLABSI and VAP decreased during the COVID-19 pandemic than in the pre-COVID-19 period, which was attributable to the changes in small to medium-sized hospitals. Disclosures All Authors: No reported disclosures.

Korean National Healthcare-associated Infections Surveillance System, Intensive Care Unit Module Report: Summary of Data from July 2019 through June 2020

Eun Jin Kim, Yee Gyung Kwak, Sun Hee Kwak, Su Hui Ko, Oh Mee Kweon, Eu Suk Kim, Jin Hwa Kim, Tae Hyong Kim, Taek Soo Kim, Hee-Won Moon, Sun Hee Park, Jin Young Ahn, So-Yeon Yoo, Hyeon Mi Yoo, Sang-Oh Lee, Nan-Hyoung Cho, Pyoeng Gyun Choe, Ki Ho Hong, Yu-Mi Lee, Mi Suk Lee. Korean J healthc assoc Infect Control Prev 2021;26:115-28. https://doi.org/10.14192/kjicp.2021.26.2.115

Korean National Healthcare-associated Infections Surveillance System, Intensive Care Unit Module Report: Summary of Data from July 2018 to June 2019

Eun Jin Kim, Yee Gyung Kwak, Sun Hee Kwak, Su Hui Ko, Jin Hwa Kim, Eu Suk Kim, Tae Hyong Kim, Seong Yeol Ryu, Hee-Won Moon, Sun Hee Park, Jin Young Ahn, So-Yeon Yoo, Hyeon Mi Yoo, Na Ra Yun, Mi Suk Lee, Sang-Oh Lee, Nan-hyoung Cho, Ji-youn Choi, Ki Ho Hong, Young Hwa Choi, Mi-Na Kim. Korean J healthc assoc Infect Control Prev 2020;25:115-27. https://doi.org/10.14192/kjicp.2020.25.2.115

Trends in the Epidemiology of Candidemia in Intensive Care Units From 2006 to 2017: Results From the Korean National Healthcare-Associated Infections Surveillance System.

Candidemia is an important healthcare-associated infection (HAI) in intensive care units (ICUs). However, limited research has been conducted on candidemia in the Republic of Korea. We aimed to analyze the secular trends in the incidence and distribution of candidemia in ICUs over 12-years using data from the Korean National Healthcare-Associated Infections Surveillance System (KONIS). KONIS was established in 2006 and has performed prospective surveillance of HAIs including bloodstream infections (BSIs) in ICUs. We evaluated the trends in the distribution of causative pathogens and the incidence of candidemia. From 2006 to 2017, 2,248 candidemia cases occurred in 9,184,264 patient-days (PDs). The pooled mean incidence rates of candidemia significantly decreased from 3.05 cases/10,000 PDs in 2006 to 2.5 cases/10,000 PDs in 2017 (P = 0.001). Nevertheless, the proportion of candidemia gradually increased from 15.2% in 2006 to 16.6% in 2017 (P = 0.001). The most frequent causative pathogen of BSIs from 2006 to 2012 was Staphylococcus aureus; however, Candida spp. emerged as the most frequent causative pathogen since 2013. C. albicans (39.9%) was the most common among Candida spp. causing BSIs, followed by Candida tropicalis (20.2%) and Candida parapsilosis (18.2%). The proportion of candidemia caused by C. glabrata significantly increased from 8.9% in 2006 to 17.9% in 2017 (P < 0.001). There was no significant change in the distribution of Candida spp. by year (P = 0.285). The most common source of BSIs was central lines associated BSI (92.5%). There was a significant increase in the proportion of candidemia by year in hospitals with organ transplant wards (from 18.9% in 2006 to 21.1% in 2017, P = 0.003), hospitals with <500 beds (from 2.7% in 2006 to 13.6% in 2017, P < 0.001), and surgical ICUs (from 16.2% in 2006 to 21.7% in 2017, P = 0.003). The proportion of candidemia has increased in Korea, especially in hospitals with <500 beds and surgical ICUs. Thus, appropriate infection control programs are needed.

Pilot Survey for National Point Prevalence Study of Healthcare-Associated Infections in Acute-Care Hospitals in South Korea

Background: The Korean National Healthcare-Associated Infections Surveillance System (KONIS) was established to conduct nationwide surveillance of device-associated healthcare-associated infections (HAIs) and surgical site infections annually in 2006. However, no surveillance on overall HAIs has been conducted. Objective: We conducted a point-prevalence survey of total HAIs to estimate the incidence rate of HAIs in acute-care hospitals in South Korea. Methods: We defined HAIs according to KONIS and NHSN criteria. In total, 29 acute-care hospitals including 9 tertiary-care hospitals (TCHs) and 20 secondary-care hospitals (SCHs) were recruited as representing the population of every metropolitan city and province in South Korea. Patients who stayed at the hospitals on August 1, 2018, were randomly selected: 100 for SCHs and 200 for TCHs. Their medical records were retrospectively reviewed for HAIs according to the NHSN criteria by the infection control nurses (ICNs) from each hospital. A web-based data collection and analysis program was developed, and participating ICNs were educated in a 1-day training course with pre- and postevaluations. They received continuous feedback of input data and questions through the web-based system during the study. To generate estimates of the incidence rate of HAIs, we converted prevalence to incidence using the formula of Rhame and Sudderth. Results: Of 4,296 patients, 133 had ≥1 HAI (3.1%). In total, 141 HAIs were identified: gastrointestinal infections (n = 30, 21.3%), bloodstream infections (n = 30, 21.3%), pneumonia (n = 29, 20.6%), urinary tract infection (n =26, 18.4%). Among the gastrointestinal infections, C. difficile infections were the most common (17.7%). Device-associated infections accounted for 34.8% of all HAIs. The overall incidence of HAIs in TCHs was 4.39%, which was a higher incidence than SCHs (3.76%). Intensive care units had 12.6% of HAIs, whereas general wards had 3.4%. HAI incidences were 5.7%, 2.8%, and 2.3%, respectively, for each of the medical wards, surgical wards, and pediatric wards. The 3 most common pathogens were Escherichia coli, Acinetobacter baumannii, and Enterococcus faecium. Conclusions: The prevalence of HAI in Korea is lower than in most Western countries. The HAI burden of Clostridium difficile infection is surprisingly high, which calls for prompt control at the national level. To obtain national-level data on HAI burdens, ongoing surveillance is needed.Funding: NoneDisclosures: None

National hospital quality measures for surgical site infections in South Korea: a survey among 20 expert physicians

BackgroundSurgical site infection (SSI) is recognized as an important quality indicator for patient safety. In Korea, the use of prophylactic antibiotics for surgery is conducted as a national quality measures related to SSI prevention. The objective of the present study was to investigate physicians’ perceptions of hospital quality measures for SSI as well as identify obstacles that might hinder its implementation in South Korea.MethodOnline-based questionnaires were administered twice. Twenty physician experts who were members of the Healthcare Review and Assessment Committee that was constituted for the “Assessment of prophylactic use of antibiotics for surgery” participated in the study. The first survey comprised open-ended questions that were designed to elicit the physician who could hinder the implementation of SSI indicators. The second survey, which was developed on the basis of the initial survey’s results, consisted of 10 closed-ended questions about the feasibility of objective perception and the need for subjectivity, with regard to SSI.ResultsFrom among the 20 physicians, we collected data from 16 respondents in the first survey (response rate of 80%) and 15 respondents in the second survey (response rate of 75%).Thirty-one percent of the respondents supported hospital SSI evaluations, and 69% expressed objections. The obstacles that were perceived as being able to hinder hospital SSI evaluations pertained to difficulties in collecting data, unavailability of information, possibility of underreporting, and redundancy of the inquiry undertaken by the Korean National Healthcare-associated Infections Surveillance System-SSI. Physician experts provide significantly higher ratings for the clinical indicator, rate of readmission due to SSI, both in terms of feasibility and need, when evaluating the results of SSI prevention in hospitals.ConclusionThe results of this study show that physicians perceive the need for QI development of hospital SSI measurements to prevent nation-wide SSIs in Korea. However, the feasibility of hospital SSI measurements is low. To develop QIs of hospital SSIs using health insurance claims data, it is necessary to develop a methodology for claims data-based surveillance systems and a data collection system in order to increase the sensitivity and validity of post-operative SSI detection.

Birth Story of KONIS (Korean National Healthcare-associated Infections Surveillance System), How to Improve Tomorrow

Birth Story of KONIS (Korean National Healthcare-associated Infections Surveillance System), How to Improve Tomorrow

The Incidences of Catheter Colonization and Central Line-Associated Bloodstream Infection According to Tegaderm vs. Chlorhexidine Gluconate (CHG)-Tegaderm Dressing

In spite of the recent application of a general infection control method, central line-associated infections is still relatively high in Korea. Central line bundle with Chlorhexidine gluconate (CHG) tegaderm dressing was reported to be effective in reducing catheter colonization and central line-associated bloodstream infections (CLABSI). Therefore, this study aimed to examine the incidences of catheter colonization occurrence and CLABSI while using Tegaderm vs. CHG Tegaderm dressings. We used a descriptive design. 400 patients who had central venous catheters were selected from four hospitals in the Korean National Healthcare-associated Infections Surveillance System. Of all subjects, 200 used Tegaderm™ (Tegaderm group), and the remaining 200 used CHG Tegaderm (CHG Tegaderm group) dressing at the catheter insertion site. Data were analyzed using the χ² test or Fisher's exact test, t-test, and logistic regression analysis using SPSS WIN 21.0. In the Tegaderm and CHG Tegaderm groups, CLABSI incidences were 5.89 and 1.79 per 1,000 catheter-days, catheter colonization incidences were 3.93 and 1.43 per 1,000 catheter-days, and central line bundle compliance rates were 26.0% and 49.0%, respectively. Catheter colonization risk factors were 'reinsertion after failure' and 'Tegaderm dressing' at the central line insertion site. CLABSI risk factors were 'incomplete performance of 7 central line bundle items' and 'Tegaderm dressing' at the central line insertion site. A further prospective study is needed to examine the effects of central line bundle with CHG Tegaderm dressing, avoiding central line reinsertion after failure, and improving the bundle compliance in reducing catheter colonization and CLABSI.

2476. External and Internal Validation of the Healthcare-associated Infection Data in the Korean National Healthcare-associated Infectious Surveillance System (KONIS)

BackgroundNational surveillance data should be validated to identify data quality issues. This study tested the validity of healthcare-associated infection (HAI) data in the Korean National Healthcare-associated Infections Surveillance System (KONIS), intensive care unit (ICU) module.MethodsThe validation process consisted of external (EV) and internal (IV) validation phases. For the 10 hospitals that were selected based on the HAI rate, among the 193 participating hospitals between July 2016 and June 2017, both EV and IV were performed. For the EV, the validation team reviewed 295 medical records of 60 patients with reported HAIs, including 20 urinary tract infections (UTIs), 27 bloodstream infections (BSIs), and 13 cases of pneumonia (PNEU), and 235 patients with no reported HAI during 1-day visits conducted in November and December 2017. The reviewer’s diagnosis of HAI was regarded as the reference standard. IV was conducted by the staff of each hospital and evaluated whether UTI or BSI were present. Primary IV was performed for 279 patients who were subject to EV. Secondary IV was performed on 203 patients in another 11 selected participating hospitals that did not report HAIs to KONIS during the 1-year study period.ResultsIn the EV, the diagnosis of UTI in the participating hospitals had a sensitivity of 72.0% and specificity of 99.3%. The sensitivity of BSI and PNEU was 63.2% and 70.6%, respectively, and specificity was 98.8% and 99.6%. The agreement (kappa) between the EV and primary IV was significant, with κ = 0.754 for UTI and κ = 0.674 for BSI. The results of the secondary IV showed that the hospitals that had no reports of HAI had few hospital beds and performed few blood or urine culture tests. In the secondary IV, eight UTIs and three BSIs were newly diagnosed in three hospitals, respectively. The reasons for not reporting the HAIs were presumed to be a lack of understanding of the surveillance standards and fear of the disadvantages of disclosing the HAI.ConclusionThis study shows the need for ongoing validation and continuous training of surveillance personnel to maintain the accuracy of surveillance data. We also confirmed that IV can be used as an alternative monitoring method to examine validity and accuracy.Disclosures All authors: No reported disclosures.

Ten-year surveillance of central line–associated bloodstream infections in South Korea: Surveillance not enough, action needed

Central line-associated bloodstream infections (CLABSIs) are preventable health care-associated infections that can lead to increased mortality. Therefore, we investigated trends in CLABSI rates, and the factors associated with changing trends over a 10-year period using the Korean National Healthcare-associated Infections Surveillance System (KONIS). We investigated annual CLABSI rates from 2006 to 2015 in 190 KONIS-participating intensive care units (ICUs) from 107 participating hospitals. We collected data associated with hospital and ICU characteristics and analyzed trends using generalized autoregressive moving average models. The CLABSI pooled mean rate decreased from 3.40 in 2006 to 2.20 in 2015 (per 1,000 catheter-days). The trend analysis also showed a significant decreasing trend in CLABSI rates in unadjusted models (annual increase, -0.137; P < .001). After adjusting for hospital and ICU characteristics, significant decreasing trends were identified (annual increase, -0.109; P < .001). However, there were no significant changes in subgroups with non-university-affiliated hospitals, hospitals in metropolitan areas near Seoul, small hospitals (300-699 beds), or surgical ICUs. In South Korea, CLABSI rates have shown significant reductions in the past 10 years with participation in the KONIS. However, CLABSI rates may be reduced by encouraging more hospitals to participate in the KONIS and by improved policy support for hospitals lacking infection control resources.

Korean National Healthcare-associated Infections Surveillance System, Intensive Care Unit Module Report: Summary of Data from July 2017 through June 2018

Korean National Healthcare-associated Infections Surveillance System, Intensive Care Unit Module Report: Summary of Data from July 2017 through June 2018

Korean National Healthcare-associated Infections Surveillance System, Intensive Care Unit Module Report: Summary of Data from July 2016 through June 2017

Korean National Healthcare-associated Infections Surveillance System, Intensive Care Unit Module Report: Summary of Data from July 2016 through June 2017

Trends in device utilization ratios in intensive care units over 10-year period in South Korea: device utilization ratio as a new aspect of surveillance

Device-associated infection (DAI) is an important issue related to patient safety. It is important to reduce unnecessary device utilization in order to decrease DAI rates. To investigate the time trend of device utilization ratios (DURs) of voluntarily participating hospitals, collected over a 10-year period through the Korean National Healthcare-associated Infections Surveillance System (KONIS). DURs from 2006 to 2015 in 190 intensive care units (ICUs) participating in KONIS were included in this study. DURs were calculated as the ratio of device-days to patient-days. The pooled incidences of DAIs and DURs were calculated for each year of participation, and the year-wise trends were analysed. Year-wise ventilator utilization ratio (V-DUR) increased significantly from 0.40 to 0.41 (F=6.27, P<0.01), urinary catheter utilization ratio (U-DUR) increased non-significantly from 0.83 to 0.84 (F=1.66, P=0.10), and C-line utilization ratio (CL-DUR) decreased non-significantly from 0.55 to 0.51 (F=1.62, P=0.11). In the subgroup analysis, 'medical ICU' (F=2.79, P<0.01) and 'hospital with >900 beds' (F=3.07, P<0.01) were associated with the significant increase in V-DUR. In Korea, V-DUR showed a significant, year-wise increasing trend. The trends for U-DUR and CL-DUR showed no significant decrease. Efforts are required to ensure the reduction of DURs.

Validation of the Korean National Healthcare-associated Infections Surveillance System (KONIS): an intensive care unit module report

National surveillance data should be validated to identify methodological problems within the surveillance programme and data quality issues. To test the validity of healthcare-associated infection (HAI) rate data from the Korean National Healthcare-associated Infections Surveillance System (KONIS). Records from intensive care units of 12 (14.8%) of 81 participating hospitals for January-March 2014 were examined. The validation team reviewed 406 medical records of 110 patients with 114 reported HAIs - including 34 urinary tract infections (UTIs), 57 bloodstream infections (BSIs) and 23 cases of pneumonia (PNEU) - and 296 patients with no reported HAIs during one-day visits conducted in August and September 2014. The reviewers' diagnosis of HAI was regarded as the reference standard; in ambiguous cases, the KONIS Steering Committee confirmed the diagnosis of HAI. Sensitivity values for UTIs, BSIs and PNEU were 85.3%, 74.0% and 66.7%, and specificity values were 98.7%, 99.1% and 98.7%, respectively. Positive predictive values were 85.3%, 94.7% and 78.3%, and negative predictive values were 98.7%, 94.6% and 97.7%, respectively. Sensitivity for PNEU was lower than that for UTIs and BSIs. The hospitals participating in KONIS infrequently reported conditions that were not HAIs. Sensitivity for BSIs was lower in this study than in KONIS validation studies conducted in 2008 and 2010. KONIS data are generally reliable; however, sensitivity for BSIs exhibited a decrease. This study shows the need for ongoing validation and continuous training of surveillance personnel to maintain the accuracy of surveillance data.