Public reporting of HAIs: Getting it right

The October issue of American Journal of Infection Control has an important commentary on public reporting of healthcare associated infections (HAIs). The authors, who include Don Goldmann, stress the need for reliability and validity in publicly reported metrics, two important concepts that have been largely ignored by many states that have mandated public reporting. They call on the CDC to develop online clinical vignettes which could be completed by ICPs in order to assess the accuracy of case ascertainment. This is a great idea and should be a relatively easy way to begin the process of improving validity. While the CDC HAI case definitions appear straightforward when simply read, in the context of application in real time numerous questions arise. My ICPs not uncommonly ask me to review cases where ambiguities preclude their ability to decide whether the patient's clinical picture meets the definition of an HAI. Moreover, in preparing ICPs for mandated reporting in Virginia, we developed case vignettes for training and testing, and found wide discrepanices in the application of definitions, even among ICPs who were epxerienced in NHSN methodology. Hopefully, funding to states from the American Recovery and Reinvestment Act will be used for training of ICPs to improve case ascertainment, as well as to establish programs to assess validity of data submitted by hospitals.