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SHEA: Time for national HAI reporting standard
'National standard [could] ensure validated data'
The report recently released by Consumer Reports (CR) on infection rates in health care facilities highlights the importance of transparent public reporting, but a national system is needed to replace the variety of state approaches, the Society for Healthcare Epidemiology of America (SHEA) said in a statement.
SHEA supports public reporting as part of a comprehensive strategy to eliminate health care-associated infections. Such data should stimulate immediate and sustained action by health care facilities to improve adherence to evidence-based prevention practices — the basis for checklists, innovative prevention programs, and other strategies — that can yield measurable improvements and indeed, elimination of HAIs, the Society reported.
"As leaders in the field of infection prevention and control, SHEA members are deeply committed to the need for establishing a national standard of reporting for HAIs," SHEA said.
In 2006, SHEA, the Infectious Diseases Society of America (IDSA), and the Association for Professionals in Infection Control and Epidemiology (APIC) jointly published model legislation and a toolkit outlining recommendations for design of public reporting programs at the state level. These recommendations focused on creating standardized definitions of health care-associated infections, ensuring validated data and supporting the use of the Centers for Disease Control and Prevention's National Health Safety Network (NHSN) as a backbone for surveillance and public reporting. The NHSN is a surveillance system that allows HAI data to be tracked, analyzed, and shared to maximize prevention efforts. Currently, 28 states have implemented public reporting laws, 21 of which utilize NHSN for their reporting requirements
"We are pleased that nearly half of the states have adopted laws similar to this model," SHEA said. "However, SHEA believes it is time for a national standard that can ensure validated data and comparisons that accurately portray infection rates across geographic and health status-based risk categories. Such attention must be paid to ensure that patients and health care facilities have comparable information and that the focus remains on continuous improvement at each facility. A national standard will give all of us involved in the delivery of patient care — including the patient themselves — data for action that drives our progress toward elimination of HAIs."
CR embraces suggestion
CR initially resisted federal reporting laws — favoring states as "laboratories" to find the best methods — but now that so many states are reporting data to the NHSN, the framework for a national system is in place, says Lisa McGiffert, director of Consumers Union's Safe Patient Project.
"That has been a really nice evolution of addressing this problem," she says. "The CDC will have a lot of better information of what is happening out there. We definitely support a national system now, and it definitely should be through NHSN. We have learned that there is quite a bit of support at the federal level for a national reporting system, and we will continue to work on making that happen."
Indeed, the CDC stressed in a statement issued in light of the CR report that "public reporting of infection rates are an important component of eradication efforts." Research shows that when health care facilities are aware of their infection issues and implement concrete strategies to prevent them, rates of certain hospital infections can be decreased by more than 70%, the CDC stated.
"Eliminating health care-associated infections is a top priority for CDC," said Denise Cardo, MD, director of the CDC's Division of Healthcare Quality Promotion. "The tracking and reporting of health care-associated infections is an important step toward health care transparency. Infection data can give health care facilities, patients, and public health agencies the knowledge needed to design and implement prevention strategies that protect patients and save lives."
HAIs are not only a problem for individual health care facilities — they represent a public health issue that requires many people and organizations to work together in a comprehensive effort to attack these "largely preventable" infections, the agency said. As a result, the CDC is working with partners and states to implement infection prevention tools and increase their use of the agency's NHSN.
However, there are some troubling questions about the rapid expansion of NHSN and its dramatically emerging role in a national infection rate reporting system, cautions William Jarvis, MD, a former leading CDC hospital outbreak investigator who is now a private epidemiology consultant for Jason and Jarvis Associates in Hilton Head, SC.
The current NHSN is based on the old CDC National Nosocomial Infection Surveillance (NNIS) system, which was comprised of a few hundred hospitals rather than the 2,000-plus that are now reporting to NHSN as required by their state laws. Yet even IPs voluntarily participating in the NNIS system out of a desire to provide benchmarks and improve quality still had some problems matching definitions to infections, he notes.
"Those were highly interested people who really cared about the quality of the data," Jarvis says. "Now we have majority of hospitals reporting [to NHSN] solely because they have to. What is there level of interest in making sure they have high-quality data that is validated? And will CDC do to ensure it is validated data? Is it just garbage in and garbage out?"