Bad data? IP groups reject fed HAI report

'An outdated and incomplete picture of HAIs'

Faced with a critical federal report on the lack of progress against healthcare associated infections, the nation's leading infection prevention groups find themselves in the thankless position of having to challenge the methodology of the report without appearing to be in denial about HAIs.

The Agency for Healthcare Research and Quality's recently issued National Healthcare Quality Report found that HAIs "are one of the most serious patient safety concerns. It is unfortunate that HAI rates are not declining. Of all the measures in the NHQR measure set, the one worsening at the fastest rate is postoperative sepsis. The two process measures related to HAIs tracked in the NHQR, both covering timely receipt of prophylactic antibiotics for surgery, are improving steadily. However, HAI outcome measures are lagging."

Moreover, a subsequent column by Carolyn M. Clancy, MD, AHRQ director, personalized the issue by noting that her father had been colonized but not infected with methicillin-resistant Staphylococcus aureus (MRSA).

"You shouldn't have to worry about getting sick because of an infection you may pick up when you're getting treated in a hospital or other health care setting," she wrote in a column posted on AHRQ website. "Unfortunately, you have reason to be concerned. ...[The AHRQ report] found that we've made very little progress in eliminating most kinds of HAIs in older patients. The reports show that blood infections after surgery and infections from urinary catheters inserted after surgery continue to be a problem. For younger patients, other data show some improvement, but much more work needs to be done."

Refuting the AHRQ conclusions in a statement were the Association for Professionals in Infection Control and Epidemiology (APIC); the Society for Healthcare Epidemiology of America (SHEA); and the Infectious Diseases Society of America (ISDA)."The [AHRQ report] released data that presents an outdated and incomplete picture of HAIs in our healthcare system," they argued. "This report confirms the critical need for a national standard for defining and reporting HAIs that ensures validated data that accurately portray infection rates across different geographic regions and categories of risk. Without such a standard, patients and healthcare facilities lack comparable information on rates of infection that can inform their decision-making and improve the quality of care."

The joint letter by APIC, SHEA and ISDA also made the following points:

  • "We are concerned that any report coming from a government agency based solely on the use of administrative data, commonly referred to as billing/coding data, paints an inaccurate picture of healthcare-associated infections for the public. Multiple studies have concluded that administrative coding data appears to be a poor tool for accurately identifying infections. This may create greater confusion among consumers."
  • "Innovative research is taking place in academic and practice centers across the country and globally. Epidemiologists and infection preventionists are identifying and implementing quality and performance measurement systems to support the goal of HAI elimination, providing meaningful data for providers, state health departments, and consumers that can be readily implemented. Our patients require that we work together toward this critical goal."

The AHRQ report and Clancy's column can both be found at: http://www.ahrq.gov/