Public Reporting of Healthcare Associated Infections: Ready for Primetime?

Recently the Virginia Department of Health released its first report on healthcare associated infections. In 2005, the Virginia General Assembly passed a bill mandating public reporting of infections, but deferred to the Board of Health to determine which infections were to be selected for reporting. Subsequently, the Board of Health determined that central line associated infections (CLABSIs) in adult ICUs were to be reported. The bill also mandated that hospitals report their infections through the National Healthcare Safety Network (NSHN), which standardized the methodology of surveillance and the case definitions. APIC-Virginia played a major role in shaping the legislation and in preparing infection control practitioners throughout the state for data collection. Simulated cases were prepared for practice sessions since some ICPs had not performed surveillance and some were not familiar with CDC methodology. These sessions were enlightening—a fair amount of variability in applying the definitions was uncovered and even experienced ICPs disagreed on some of the cases. In Virginia, as in many other states, public reporting is an unfunded mandate. Therefore, there currently is no funding available to validate the data hospitals are reporting to CDC.

In the Virginia report each hospital’s individual ICU CLABSI rates for July through December 2008 are rolled up into a composite rate. This was done because some hospitals have a single combined medical-surgical ICU, while others have multiple specialized units, such as burn and neurosurgery. While it gives a better overall picture of the situation at each hospital, the downside is that the rates cannot be compared to CDC benchmarks.

There are many unanswered questions regarding publicly reported HAI data in addition to validity. How can the data be risk adjusted so that hospitals that care for the sickest patients are not penalized? Will consumers use the data to choose their venue of care? And even if they want to change hospitals based on the data provided, are they able to given the control exerted by third party payers? Will hospitals with high rates attempt to game the system to make their rates appear lower? Will public reporting increase inappropriate antibiotic use?

Despite the difficulties, the principles that underlie public reporting, transparency and accountability, are so vital to maintaining trust with our patients that the onus is on us in healthcare epidemiology to continue to improve our methods so that validity can be maximized.