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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

PA says reporting law cuts HAIs: Skeptics left at the station

In 2003, when Pennsylvania was first in the vanguard of states enacting laws requiring public reporting of health care associated infections (HAIs), there was considerable concern and consternation within the infection control community. I was skeptical myself, questioning whether such laws — however well intentioned — create disincentives to aggressively pursue and report all infections.

The thinking was that rates may go down, but is it because reporting laws spur higher quality care or because they discourage full reporting of all HAIs? We’ve heard the anecdotal stories of arguments within the hospital walls about whether a given case meets the definition of an HAI. The stakes are higher now, and there are so many infections coming in from the community. Could there be a chilling effect on HAI surveillance?

Still, with all due homage to healthy skepticism, I’m starting to wonder if mandating HAI rate reporting is indeed a path to improved quality. In any case, it became a reality in so many states so quickly, that our academic arguments were left like baggage on the station platform as the train departed.

Now Pennsylvania, the state that started it all, has released a report detailing impressive HAI reductions as the results of its legislative requirements, which in 2007 included an additional provision requiring health care facilities to develop internal infection control plans based on evidence-based practices. This was apparently an answer to the criticism that such reporting laws create “data graveyards” that inspire little real change. Key findings summarized in the Pennsylvania report include:

  • Hospitals have reduced catheter-associated urinary tract infections by 26%, central line-associated bloodstream infections by 44%, and ventilator-associated pneumonia by 27%.
  • Central line-associated bloodstream infection rates are below the national average.
  • Hospitals reduced HAIs overall by 12.5%.