There must be a pony in here somewhere...

Before mandatory reporting and pay-for-performance, and before zero became the only acceptable infection rate, it was OK to have somewhat subjective, imperfect definitions for healthcare associated infections. No longer!

Never fear…HICPAC has working groups now grappling with three different definitions: for CLABSI, VAP and SSI (full disclosure: I’m a member of these working groups). Here are just a few desired attributes of any newly-modified HAI definition:

• Must have excellent performance characteristics (most importantly, nearly 100% specificity) when compared with gold standards (note: gold standards do not yet exist).
• Must consist of only objective measures that can be collected by all NHSN participating hospitals, and that are amenable to electronic reporting and easy validation.
• Must demonstrate excellent concordance with clinical definitions of infection, so as not to lose credibility with frontline clinicians (note: because of the subjectivity of clinical definitions, this attribute is not consistent with the attribute above).
• Must not be subject to “gaming”, even by the most creative hospitals (note: even supposedly “objective” measures, like culture and antibiotic use data, are subject to practice changes in response to pressure to reduce HAI rates).
• Must not result in public or political perception that modifications were made in an attempt to lower HAI rates (i.e. “define our way to zero”).

So, keeping these in mind, feel free to submit any suggested changes to current definitions, in the comments section!