Mandatory reporting of HAIs: A work in progress
The December issue of American Journal of Infection Control, has a paper looking at validation of central line associated bloodstream infection (CLABSI) reporting in Connecticut, where all 30 acute care hospitals are required to report CLABSIs from 1 ICU via the National Healthcare Safety Network (NHSN). All positive blood cultures for the fourth quarter of 2008 for these ICUs were reviewed by a trained nurse microbiologist (the gold standard for the study) and compared to locally collected data. A total of 770 blood cultures were reviewed and the validator detected 48 CLABSI cases.
The validity parameters were as follows:
The validity parameters were as follows:
- Sensitivity 48%
- Specificity 99%
- Positive predictive value 85%
- Negative predictive value 94%
So, as you might suspect even before seeing these data, the major problem with mandatory reporting programs is a failure to adequately detect cases. Keep that in mind when you read through Consumer Reports honor roll of US hospitals that reported no CLABSIs! While I continue to believe that mandatory reporting is the right thing to do, much work is still needed to produce valid data.
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