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 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, , , ). Nationally, as of 2016, many HAI rates appear to be decreasing (CDC-HAIs).

Expected Beneficial Outcomes (Rated)

  • Reduced health care-associated infections (HAIs)

  • Increased infection prevention efforts

Other Potential Beneficial Outcomes

  • 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 () and patients in adult ICUs (). 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 (). Experts suggest standardizing data monitoring, reporting, and submission requirements across states (, ASTHO-CDC 2011, ) and between state and federal laws (Stone 2015).

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

Impact on Disparities

No impact on disparities likely

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) (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 ().

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

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.

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.

CDC-HAI legal - Centers for Disease Control and Prevention (CDC). Public health law program: Healthcare-associated infections (HAI).

ASTHO-HAI - Association of State and Territorial Health Officials (ASTHO). Healthcare-associated infections (HAI): Healthcare and Infection Control Gateway.

Citations - Evidence

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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.

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).

CWF-Leape 2010 - Leape LL. Transparency and public reporting are essential for a safe health care system. New York: The Commonwealth Fund (CWF); 2010.

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.

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.

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.

Siegel 2014 - Siegel S, Kahn KL. Regional interventions to eliminate healthcare-associated infections. Medical Care. 2014;52(2 Suppl 1):S46-53.

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.

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.

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.

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.

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.

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.

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.

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.

Citations - Implementation Examples

* Journal subscription may be required for access.

CMS-Hospital compare - Centers for Medicare & Medicaid Services (CMS). Hospital compare.

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.

CDC-State HAI - Centers for Disease Control and Prevention (CDC). State-based HAI prevention: State-based HAI prevention activities.

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.

Leapfrog-HAIs - The Leapfrog Group. Hospital-Acquired Infections (HAIs).

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.

Date Last Updated

Mar 15, 2017