Public reporting of health care-associated infections
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 facilities1. 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 vary2, 3, 4, 5. Nationally, as of 2016, many HAI rates appear to be decreasing6.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Reduced health care-associated infections (HAIs)
Increased infection prevention efforts
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Improved health outcomes
What does the research say about effectiveness?
Public reporting of health care-associated infection (HAI) rates is a suggested strategy to reduce patient infections and increase infection prevention efforts7, 8, 9. 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 units10 and patients in adult ICUs11. An Ontario-based study suggests that public reporting may reduce Clostridium dificile (C. dificile) infection rates12. However, additional evidence is needed to confirm effects13.
Many providers use National Healthcare Safety Network (NHSN) criteria to report HAIs, but classify infections differently14, 15. Given non-standardization, underreporting of HAIs appears more likely than overreporting16. Experts suggest standardizing data monitoring, reporting, and submission requirements across states3, 5, 8 and between state and federal laws17.
External review of infection reporting can improve reporting accuracy16, 18. Experts suggest review processes be conducted by independent parties1 and that reporting account for patient baseline risk9.
Implementation Examples
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)19. 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 aureus2. Twenty states required clostridium difficile infection reporting, either under state law or through federal Centers for Medicare & Medicaid Services’ (CMS) reporting requirements20. Many hospitals also participate in the Agency for Healthcare Research and Quality (AHRQ) Comprehensive Unit-based Safety Program (CUSP), or interstate or regional initiatives10.
Consumers can get more information on HAI rates at specific locations through Medicare’s Hospital Compare tool21 and Leapfrog22.
Implementation Resources
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.
ASTHO-HAI - Association of State and Territorial Health Officials (ASTHO). Healthcare-associated infections (HAI): Healthcare and Infection Control Gateway.
CDC-HAI legal - Centers for Disease Control and Prevention (CDC). Public health law program: Healthcare-associated infections (HAI).
US DHHS-HAI Action plan - U.S. Department of Health and Human Services (U.S. DHHS). National Action Plan to Prevent Health Care-Associated (HAI) Infections: Road Map to Elimination.
Footnotes
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1 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.
2 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.
3 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.
4 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.
5 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.
6 CDC-HAIs - Centers for Disease Control and Prevention (CDC). Healthcare-associated infections: HAI data and statistics.
7 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).
8 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.
9 CWF-Leape 2010 - Leape LL. Transparency and public reporting are essential for a safe health care system. New York: The Commonwealth Fund (CWF); 2010.
10 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.
11 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.
12 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.
13 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.
14 Siegel 2014 - Siegel S, Kahn KL. Regional interventions to eliminate healthcare-associated infections. Medical Care. 2014;52(2 Suppl 1):S46-53.
15 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.
16 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.
17 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.
18 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.
19 CDC-State HAI - Centers for Disease Control and Prevention (CDC). State-based HAI prevention: State-based HAI prevention activities.
20 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.
21 CMS-Hospital compare - Centers for Medicare & Medicaid Services (CMS). Hospital compare.
22 Leapfrog-HAIs - The Leapfrog Group. Hospital-Acquired Infections (HAIs).
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