HICPAC draft recommendations may guide state, national laws

ICPs, experts should be included in lawmaking

A draft guidance document by the Centers for Disease Control and Prevention’s Healthcare Infection Control Practices Advisory Committee (HICPAC) includes the following executive summary and four overarching recommendations.

Executive Summary: Presently, there is insufficient evidence on the merits and limitations of a hospital-acquired infection (HAI) public reporting system. Therefore, HICPAC has not recommended for or against mandatory public reporting of HAI rates. However, to assist those who will be implementing such reporting systems, HICPAC has developed the following recommendations that are based on established principles for public health and HAI reporting systems. The recommendations are intended for policy-makers, program planners, consumer advocacy organizations, and others tasked with designing and implementing public reporting systems for HAIs. These recommendations provide operational guidance for creation of statewide public HAI reporting systems, but do not include model legislation. HICPAC will update these recommendations as more research and experience become available.

Recommendations

HICPAC proposes four overarching recommendations regarding the mandatory public reporting of HAIs. These recommendations are intended to guide policy-makers in the creation of statewide reporting systems for health care facilities in their jurisdictions:

I. Use established public health surveillance methods when designing and implementing mandatory HAI reporting systems (see II, III). This process involves:

A. Selection of appropriate process and outcome measures to monitor.

B. Selection of appropriate patient populations to monitor.

C. Use of standardized case-finding methods and data validity checks.

D. Provision of adequate support and resources.

E. Production of useful and accessible reports to stakeholders.

Hospital discharge diagnostic codes should not be used as the primary data source for HAI public reporting systems.

II. Include people with expertise in the prevention and control of HAIs in the planning and oversight of HAI public reporting systems.

III. Choose appropriate process and outcome measures based on facility type and phase in measures gradually to allow time for facilities to adapt and to permit ongoing evaluation of data validity. States can select from the following measures as appropriate for hospitals or long-term care facilities in their jurisdictions:

A. Three process measures are appropriate for hospitals and long-term care facilities participating in a mandatory HAI reporting system:

1. Central line insertion practices — with the goal of targeting intensive care unit (ICU)-specific central line-associated, laboratory-confirmed primary bloodstream infections — can be measured by all hospitals that have the type of ICUs selected for monitoring (e.g., medical or surgical).

2. Surgical antimicrobial prophylaxis — with the goal of targeting surgical site infection (SSI) rates — can be measured by all hospitals that conduct the surgical operations selected for monitoring.

3. Influenza vaccination coverage rates for health care personnel and patients/residents can be measured by all hospitals and long-term care facilities. For example:

  • Coverage rates for health care personnel can be measured in all hospitals and long-term care facilities.
  • Coverage rates for high-risk patients can be measured in all hospitals.
  • Coverage rates for all residents can be measured in all long-term care facilities.

B. Two outcome measures are appropriate for some hospitals participating in a mandatory HAI reporting system. These hospitals are those in which the frequency of the HAI is sufficient to achieve statistically stable rates. To foster performance improvement, the HAI rate to be reported should be coupled with a measure of adherence to the prevention practice known to lower the rate. For example, hospitals in states where reporting of SSIs is mandated should monitor and report adherence to recommended standards for surgical prophylaxis (see IIIA2).

IV. Provide regular and confidential feedback of performance data to health care providers prior to public release. This practice may encourage low performers to implement targeted prevention activities and increase the acceptability of public reporting systems within the health care system.