PH+Reporting+User+Story+-+Healthcare-Associated+Infections

include component="page" wikiName="siframework" page="PHRI Header" =User Story: Healthcare-Associated Infection Reporting=

Contact Info:
David Birnbaum, PhD, MPH (david.birnbaum@doh.wa.gov) -- Program Manager, HAI Program, Division of Epidemiology, Health Statistics and Public Health Laboratories, Washington State Department of Health Marion Kainer, MD, MPH, FRACP (marion.kainer@tn.gov) -- Director, Healthcare Associated Infections and Antimicrobial Resistance Program, Tennessee Department of Health

Date Received:
11/18/2011

Every month, over 4,000 hospitals across the United States send details of their healthcare-associated infection (HAI) cases along with information about exposure to related devices and procedures, in order to satisfy state and federal laws and regulations as well as guide their own patient safety initiatives. They report this information to the National Healthcare Safety Network (NHSN), which is operated by the Centers for Disease Control and Prevention (CDC). CDC maintains the secure NHSN data system along with rules of conduct, surveillance definitions for the various types of HAI, educational modules on HAI reporting, and guidelines on HAI prevention. This reporting network enables hospitals to compare their own HAI infection rates with the performance of similar facilities as a quality benchmark. State health departments and federal agencies capable of protecting confidential data in accord with NHSN’s privacy, security and business process standards also are able to gain access to NHSN data through rights conferred by hospitals, which enables state and federal programs to prepare facility-specific risk-adjusted or risk-stratified HAI rate summaries for public information. Without that access, state health departments would not be able to fulfill their legislated HAI program responsibilities. All of the related professional associations have endorsed the use of NHSN in this manner as the preferred “gold standard” for HAI reporting and comparisons (APIC, see support letter at @http://www.apic.org/Content/NavigationMenu/GovernmentAdvocacy/PublicPolicyLibrary/Comments_on_Meaningful_Use_Stage_2.pdf; CSTE, see Position Statement #11-SI-05 at @http://www.cste.org; SHEA, see support letter at @http://www.shea-online.org/Portals/0/SHEA%20_comments_Meaningful_use_and_EMR_FINAL_%28022511%29.pdf).

The data needed to complete an NHSN record is contained in different parts of a patient medical record. Accreditation standards require hospitals to have an infection control program run by a suitably qualified infection control professional or preventionist (ICP/IP). That individual has access to all parts of all patient records. Historically, ICPs/IPs have read and abstracted patient information manually, then entered data manually to the CDC’s secure data network since it began in 1970. That long ago, participation was voluntary and the amount of information required was smaller. In recent years, mandatory public reporting legislation caused enormous increases in the number of hospitals required to report; at the same time, evolving sophistication in hospital epidemiology led to need for more and more data elements in order to enable meaningful comparisons. Today, hospitals face new requirements to report surgical site infections that cannot be done reliably by manual means alone. Among the 90% of American hospitals now participating in NHSN, a vanguard of several hundred have already moved from manually filling in data entry screens one record at a time. Some have accomplished this “electronic reporting” by automating the extraction of data from their own information systems into an ASCII format “flat file” that can be uploaded to NHSN. Another 280 already have taken the next step, and an additional 244 are in the process, of connecting their own health information systems to the NHSN system via HL7 CDA messaging to automate the data exchange. Information content and exchange technical reference standards documentation for hospitals and information system producers has been available from CDC over the past two years to promote development of this electronic data interchange capability, starting with acute-care hospitals and now scaling up for other facility types (e.g. dialysis, extended care, ambulatory surgery, etc.).

Additional documentation is available from the National Quality Forum website (http://www.qualityforum.org/QPS) concerning existing HAI reporting measures:
 * #0138 - Urinary catheter-associated urinary tract infection for intensive care unit (ICU) patients;
 * #0139 Central line catheter-associated blood stream infection rate for ICU and high-risk nursery (HRN) patients;
 * #0299 Surgical Site Infection Rate;
 * and updated versions intended for the NQF Patient Safety Measures program:
 * PSM-001-10 National Healthcare Safety Network (NHSN) Central-line-associated Bloodstream Infection (CLABSI) Outcome Measure;
 * PSM-003-10 National Healthcare Safety Network (NHSN) Catheter-associated Urinary Tract Infection (CAUTI) Outcome;
 * PSM-007-10 American College of Surgeons (ACS) – Centers for Disease Control and Prevention (CDC) Harmonized Procedure Specific SSI Outcome Measure.

The Centers for Medicare and Medicaid Services (CMS) has designated NHSN as the source through which these measure will be reportable under its latest Inpatient Prospective Payment System rules.

Supporting Files:

 * **Description** || **File** ||

Comments:
Please comment on this User Story using the "Discussion" tab at the top of the screen.

include component="page" wikiName="siframework" page="space.template.inc_contentleft_end"