Infection Data Audit is Essential to HAI Public Reporting


Findings from the New York State Department of Health reveal the benefits of an audit process to validate healthcare-associated infection (HAI) data.

Findings from the New York State Department of Health reveal the benefits of an audit process to validate healthcare-associated infection (HAI) data. Results of New Yorks validation process were presented at the 37th Annual Conference and International Meeting of the Association for Professionals in Infection Control and Epidemiology (APIC).

New York, along with a growing number of U.S. states, has laws mandating that hospitals report certain types of HAIs to the state health department via the Centers for Disease Control and Prevention (CDC)'s HAI monitoring system, the National Healthcare Safety Network (NHSN). In 2008, as the mandated reporting for hip surgical site infections began, the New York State Department of Health (DOH) developed an audit process to assess the accuracy and completeness of the data being reported. New York State is the first state to validate HAI data. After reviewing data from 151 hospitals, auditors found that a number of state facilities were making reporting errors that could affect the risk-adjusted rate for HAIs.

To analyze the validity of the states NHSN reporting data, the New York DOH audits all mandated infection indicators. The presentation at the APIC conference provided the results of audits involving hip replacement surgery and related surgical site infections. Hip replacements are a common procedure with a relatively low risk of infection and are included in New Yorks reporting mandate.

Peggy Ann Hazamy, RN, BSN, CIC, a research scientist at the New York DOHs HAI Reporting Program, worked with a team of auditors comparing patients medical records to the information reported to NHSN in 2008. Auditors found a high level of reporting accuracy on whether or not surgical site infections developed in each case. However, though facilities accurately reported infections, some made reporting errors concerning other aspects of cases, some of which had the potential to affect hospital comparisons and the accuracy of New Yorks HAI report to the public.

For example, the CDC defines a procedures duration as the time between the surgical incisions opening and closing. Some facilities were including time spent administering anesthesia when reporting the duration of the procedure. As duration of the procedure is part of the calculation of risk for acquiring an HAI, facilities that inaccurately reported an increased duration were also potentially inflating the perceived risk of infection. Reporting errors concerning duration were the most common errors that affected infection risk, with 10 percent of hospital records found to be inconsistent with NHSN reported data.

"Our results demonstrate the critical need for a validation process," said Hazamy. "One of the most important issues in public reporting of healthcare-associated infection rates is ensuring that the data are reliable and accurate. Our validation process increases public confidence in the data. In general, HAI reporting errors were rare, and in the errors we did find, lack of familiarity with CDC definitions was typically the cause. The states hospitals were already quite accurate in their reporting, but through the validation process, we were able to assist infection preventionists with knowledge and skills that could fill the remaining knowledge gaps."

A key component of the New York DOHs audit was providing immediate feedback to hospital staff on best practices for surveillance and reporting, as well as follow-up letters to facility CEOs with recommendations for maintaining accurate reporting. Validated data is an effective means of measuring the progress of HAI prevention.

"New Yorks experience with validation is significant to infection preventionists, government agencies, and the ongoing discussion on mandated public reporting," said APIC President Cathryn Murphy, RN, PhD, CIC. "As the U.S. and other countries continue to expand mandated HAI reporting, it is essential that proper methods and resources are available to validate the data."

Hazamy presented a poster on the methods and findings from New York States audit at APICs 2010 Annual Conference.

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