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Public reporting of health care-associated infections

Health Factors: Quality of Care
Decision Makers: Local Government State Government Federal Government Healthcare Professionals & Advocates
Evidence Rating: Expert Opinion
Population Reach: 50-99% of WI's population
Impact on Disparities: No impact on disparities likely

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Description

Public reporting of health care-associated or hospital-acquired infection (HAI) rates allows patients and providers to compare the quality of infection prevention across health care facilities (Talbot 2013). Hospitals typically collect such data using the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) process; the requirements of state mandates vary (Herzig 2015, Makary 2013, Reagan 2012, Aswani 2011). Nationally, as of 2016, many HAI rates appear to be decreasing (CDC-HAIs).

Expected Beneficial Outcomes

Reduced health care-associated infections (HAIs)
Increased infection prevention efforts
Improved health outcomes

Evidence of Effectiveness

Public reporting of health care-associated infection (HAI) rates is a suggested strategy to reduce patient infections and increase infection prevention efforts (CDC-HICPAC, ASTHO-CDC 2011, CWF-Leape 2010). Available evidence suggests that public reporting may increase implementation of protocols to prevent central-line associated bloodstream infections (CLABSIs), and lower CLABSI rates among extremely low birthweight babies in neonatal intensive care units (Zachariah 2014) and patients in adult ICUs (Liu 2016). An Ontario-based study suggests that public reporting may reduce Clostridium dificile (C. dificile) infection rates (Daneman 2012). However, additional evidence is needed to confirm effects (McKibben 2006).

Many providers use National Healthcare Safety Network (NHSN) criteria to report HAIs, but classify infections differently (Siegel 2014, Mayer 2012). Given non-standardization, underreporting of HAIs appears more likely than overreporting (Hazamy 2013). Experts suggest standardizing data monitoring, reporting, and submission requirements across states (Makary 2013, ASTHO-CDC 2011, Aswani 2011) and between state and federal laws (Stone 2015).

External review of infection reporting can improve reporting accuracy (Hazamy 2013, Oh 2012). Experts suggest review processes be conducted by independent parties (Talbot 2013) and that reporting account for patient baseline risk (CWF-Leape 2010). 

Implementation

United States

As of 2016, 34 states and the District of Columbia require hospitals to report health care-associated infection (HAI) data to the National Healthcare Safety Network (NHSN) (CDC-State HAI). As of 2013, 35 states, the District of Columbia, and Puerto Rico have laws that require HAI data submission; most require reporting of central-line associated bloodstream infections (CLABSIs) in adult ICUs and approximately half require reporting of methicillin-resistant Staphylococcus aureus (Herzig 2015). Twenty states required clostridium difficile infection reporting, either under state law or through federal Centers for Medicare & Medicaid Services’ (CMS) reporting requirements (Reagan 2015). Many hospitals also participate in the Agency for Healthcare Research and Quality (AHRQ) Comprehensive Unit-based Safety Program (CUSP), or interstate or regional initiatives (Zachariah 2014).

Consumers can get more information on HAI rates at specific locations through Medicare’s Hospital Compare tool (CMS-Hospital compare) and Leapfrog (Leapfrog-HAIs).

Wisconsin

Wisconsin regularly receives Epidemiology and Laboratory Capacity for Infection Diseases funding for HAI detection and response infrastructure and related activities. Wisconsin does not require hospitals to publicly report HAI rates (CDC-State HAI).

Implementation Resources

ASTHO-HAI - Association of State and Territorial Health Officials (ASTHO). Healthcare-associated infections (HAI): Healthcare and Infection Control Gateway. Accessed on March 15, 2017
CDC-HAI legal - Centers for Disease Control and Prevention (CDC). Public health law program: Healthcare-associated infections (HAI). Accessed on March 16, 2017
Talbot 2013 - Talbot TR, Bratzler DW, Carrico RM, et al. Public reporting of health care- Associated surveillance data: Recommendations from the healthcare infection control practices advisory committee. Annals of Health Law. 2013;159(9):631-636. Accessed on January 25, 2016
US DHHS-HAI Action plan - US Department of Health and Human Services (US DHHS). National Action Plan to Prevent Health Care-Associated (HAI) Infections: Road Map to Elimination. Accessed on March 15, 2017

Citations - Description

Aswani 2011* - Aswani MS, Reagan J, Jin L, Pronovost PJ, Goeschel C. Variation in public reporting of central line-associated bloodstream infections by state. American Journal of Medical Quality. 2011;26(5):387-395. Accessed on March 15, 2017
CDC-HAIs - Centers for Disease Control and Prevention (CDC). Healthcare-associated infections: HAI data and statistics. Accessed on March 15, 2017
Herzig 2015 - Herzig CTA, Reagan J, Pogorzelska-Maziarz M, Srinath D, Stone PW. State-mandated reporting of health care-associated infections in the United States: Trends over time. American Journal of Medical Quality. 2015;30(5):417-424. Accessed on March 15, 2017
Makary 2013* - Makary MA, Aswani MS, Ibrahim AM, et al. Variation in surgical site infection monitoring and reporting by state. Journal for Healthcare Quality. 2013;35(2):41-46. Accessed on March 15, 2017
Reagan 2012* - Reagan J, Hacker C. Laws pertaining to healthcare-associated infections: A review of 3 legal requirements. Infection Control & Hospital Epidemiology. 2012;33(1):75-80. Accessed on March 15, 2017
Talbot 2013 - Talbot TR, Bratzler DW, Carrico RM, et al. Public reporting of health care- Associated surveillance data: Recommendations from the healthcare infection control practices advisory committee. Annals of Health Law. 2013;159(9):631-636. Accessed on January 25, 2016

Citations - Evidence

ASTHO-CDC 2011 - Association of State and Territorial Health Officials (ASTHO), Centers for Disease Control and Prevention (CDC). Eliminating healthcare associated infections: State policy options. Arlington, VA: Association of State and Territorial Health Officials (ASTHO); 2011. Accessed on March 15, 2017
Aswani 2011* - Aswani MS, Reagan J, Jin L, Pronovost PJ, Goeschel C. Variation in public reporting of central line-associated bloodstream infections by state. American Journal of Medical Quality. 2011;26(5):387-395. Accessed on March 15, 2017
CDC-HICPAC - The Centers for Disease Control and Prevention (CDC). Guidance on public reporting of healthcare-associated infections: Recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC). Accessed on January 25, 2016
CWF-Leape 2010 - Leape LL. Transparency and public reporting are essential for a safe health care system. New York: The Commonwealth Fund (CWF); 2010. Accessed on January 25, 2016
Daneman 2012 - Daneman N, Stukel TA, Ma X, Vermeulen M, Guttmann A. Reduction in Clostridium difficile infection rates after mandatory hospital public reporting: Findings from a longitudinal cohort study in Canada. PLoS Medicine. 2012;9(7):e1001268. Accessed on January 25, 2016
Hazamy 2013* - Hazamy PA, Van Antwerpen C, Tserenpuntsag B, et al. Trends in validity of central line-associated bloodstream infection surveillance data, New York State, 2007-2010. American Journal of Infection Control. 2013;41(12):1200-4. Accessed on January 25, 2016
Liu 2016* - Liu H, Herzig CTA, Dick AW, et al. Impact of state reporting laws on central line-associated bloodstream infection rates in U.S. adult intensive care units. Health Services Research. 2016:1-20. Accessed on March 15, 2017
Makary 2013* - Makary MA, Aswani MS, Ibrahim AM, et al. Variation in surgical site infection monitoring and reporting by state. Journal for Healthcare Quality. 2013;35(2):41-46. Accessed on March 15, 2017
Mayer 2012 - Mayer J, Greene T, Howell J, et al. Agreement in classifying bloodstream infections among multiple reviewers conducting surveillance. Clinical Infectious Diseases. 2012;55(3):364-70. Accessed on January 25, 2016
McKibben 2006 - McKibben L, Fowler G, Horan T, Brennan PJ. Ensuring rational public reporting systems for health care-associated infections: Systematic literature review and evaluation recommendations. American Journal of Infection Control. 2006;34(3):142-49. Accessed on January 25, 2016
Oh 2012 - Oh JY, Cunningham MC, Beldavs ZG, et al. Statewide validation of hospital-reported central line-associated bloodstream infections: Oregon, 2009. Infection Control and Hospital Epidemiology. 2012;33(5):439-45. Accessed on January 25, 2016
Siegel 2014 - Siegel S, Kahn KL. Regional interventions to eliminate healthcare-associated infections. Medical Care. 2014;52(2 Suppl 1):S46-53. Accessed on January 25, 2016
Stone 2015 - Stone PW, Pogorzelska-Maziarz M, Reagan J, et al. Impact of laws aimed at healthcare-associated infection reduction: A qualitative study. BMJ Quality & Safety. 2015;24(10):637-644. Accessed on March 15, 2017
Talbot 2013 - Talbot TR, Bratzler DW, Carrico RM, et al. Public reporting of health care- Associated surveillance data: Recommendations from the healthcare infection control practices advisory committee. Annals of Health Law. 2013;159(9):631-636. Accessed on January 25, 2016
Zachariah 2014* - Zachariah P, Reagan J, Furuya EY, et al. The association of state legal mandates for data submission of central line-associated bloodstream infections in neonatal intensive care units with process and outcome measures. Infection Control and Hospital Epidemiology. 2014:35(9);1133-39. Accessed on January 25, 2016

Citations - Implementation

CDC-State HAI - Centers for Disease Control and Prevention (CDC). State-based HAI prevention: State-based HAI prevention activities. Accessed on January 25, 2016
CMS-Hospital compare - Centers for Medicare & Medicaid Services (CMS). Hospital compare. Accessed on January 25, 2016
Herzig 2015 - Herzig CTA, Reagan J, Pogorzelska-Maziarz M, Srinath D, Stone PW. State-mandated reporting of health care-associated infections in the United States: Trends over time. American Journal of Medical Quality. 2015;30(5):417-424. Accessed on March 15, 2017
Leapfrog-HAIs - The Leapfrog Group. Hospital-Acquired Infections (HAIs). Accessed on March 15, 2017
Reagan 2015 - Reagan J, Herzig CTA, Pogorzelska-Maziarz M, et al. State law mandates for reporting of healthcare-associated Clostridium difficile infections in hospitals. Infection Control & Hospital Epidemiology. 2015;36(3):350-352. Accessed on March 15, 2017
Zachariah 2014* - Zachariah P, Reagan J, Furuya EY, et al. The association of state legal mandates for data submission of central line-associated bloodstream infections in neonatal intensive care units with process and outcome measures. Infection Control and Hospital Epidemiology. 2014:35(9);1133-39. Accessed on January 25, 2016

Page Last Updated

March 15, 2017

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