Healthcare-Associated Infections (HAIs): Reporting and Validating Data across the

Nation

Tyler Whittington

Texas Information

Health and Safety Code, Chapter 98– SSIs related to 10 procedures and CLABSI

Required to review reporting activities to ensure data are valid

Currently: 390 licensed Ambulatory Surgical Centers and 512 licensed hospitals in Texas

Goal of Report

Compile a comprehensive source of state-specific information related to HAI reporting and data validation– Qualitative surveys were chosen as the method to

extract this information

Methods Basic understand of HAI reporting

– “First State-Specific Healthcare-Associated Infections Summary Data Report”

Compiled a list of preliminary questions to learn about other state mandates for HAI reporting

Conference calls with subject matter experts– Rachel Stricof– Mary Andrus– Becky Heinsohn and Karen Vallejo

Subject Matter Experts: Take Home Points

Both numerator and denominator data are extremely important for calculating infection rates

It is imperative to understand the processes that facilities use to capture data

Central line days are one of the most inconsistently measured and reported components used to determine SIRs

Despite creating a sample size determination for auditing records the bottom line is how many records can be audited in a given day

Administrative databases can be very valuable to provide monthly checks on data

State-Specific HAI Information

Taken from the CDC: http://www.cdc.gov/hai/stateplans/required-to-report-hai-NHSN.html

Compiled the following information into tables: – Contact information– Reporting status– Reporting indicators– Facilities required to report

Reporting Survey

1. Do you currently audit HAI reporting in your state?2. If you do audit, may we contact you again later to discuss more specifics

about this proposed audit methodology?3. Do you plan to audit any of the reported HAI data in the next six months?4. May we contact you again later to discuss more specifics about this

proposed audit methodology?5. If you do not plan to audit in the next six months, what led you to this

decision?6. If you are not auditing due to lack of resources, what resources would

you need (e.g. more FTEs, staff with infection prevention experience, travel funds, etc.)?

7. How many FTEs do you currently have to implement mandatory reporting?

8. Did your state ever attempt to create a method for auditing facilities to validate reported data?

Reporting Survey Results

Currently auditing HAI

data

Plan to audit HAI data in the next 6

months

No immediate plan to audit HAI

data

New Jersey Ohio, District of Columbia, Montana, Nevada, Alabama,

and Illinois

Rhode Island, Delaware, West

Virginia and Arkansas

Reporting Survey Results

Rhode Island, Delaware, West Virginia and Arkansas: all pointed to limited resources as the reason behind the lack of an auditing plan– There is a need for improved funding and

increased staff

Auditing Survey

1. How do you select facilities to be audited?2. How do you select procedures to be audited?3. How do you select medical records to be audited?4. What is the timing cycle of the audit (Do you visit every

facility every year, every three years, variable depending on findings)?

5. What is the ratio of auditors to facilities?6. Is the audit performed blinded?7. What is the actual number of charts you review per as

many units of time as they can tell you (e.g. per visit, per facility, per day, per year…)?

8. What are the error rates that you have found for specific variables?

Auditing Survey Results

Connecticut, Maryland, and Washington: CLABSIs

New York and South Carolina: CLABSIs and SSIs– NY: SSIs for hip, colon, and CABG procedures– SC: SSIs for hip, knee, CABG, and hysterectomy

procedures in all facilities. Colon and abdominal hysterectomies in facilities with <200 beds

Pennsylvania: CLABSIs and CAUTIs

Auditing CLABSIs: Connecticut

One auditor reviews all positive blood cultures from every facility reporting CLABSIs to NHSN (~30)

Blinded audit: all medical record reviews occur from January 1st – April 30th

For 2008 audit: 35-day time period with 770 positive blood cultures and 476 septic events

Auditing CLABSIs: Maryland

Contracted with APIC

Five auditors complete blinded medical record reviews in all facilities reporting CLABSIs to NHSN (~45)

Review 5 charts in ICUs in the top and bottom 11 (25th percentile) facilities of their ranking list (based on CLABSI rates) and 4 charts in all other ICUs

Audit study time period: July 1, 2008 to June 30, 2009– Charts audits completed from December 9, 2009 – January 8, 2010

Auditing CLABSIs: New York

Complete medical record reviews for at least 90% of the facilities reporting CLABSIs to NHSN (~200)

– Facilities with high rates of HAI and low rates of HAI are given priority for their audit

Six auditors divided into regions of the state– 5 auditors each responsible for 35-39 facilities– 1 auditor responsible for 9 facilities in the capital region

Auditing CLABSIs: New York

Each facility submits: – Line list of NHSN CLABSIs– Laboratory list of positive ICU blood cultures

Randomly select patient records from the most recent ICU positive blood cultures

Currently, they select a total of 20 records to audit

Auditing CLABSIs: Pennsylvania

Contracted with APIC: 4 CIC IP auditors

12 facilities are selected to validate their CLABSI data

8 records are selected at each facility and auditor is blind to results

Auditing CLABSIs: South Carolina

Two auditors to review records in 60/75 facilities required to report

No specific methodology for selecting records to review– Attempt to review between 20 and 30 records at

each facility

Auditing CLABSIs: Washington

Annual internal validation performed by all (62) facilities required to report

– External validation done by state health department depending on results

Currently has two auditors to complete external validation External Validation:

– Select 40 records from most recent positive blood culture list– List of all CLABSI records (based on discharge data) within same

time period– Review both lists and note if any record meets NHSN definition of

CLABSI– Compare the lists to check for discrepancies

Auditing SSIs: New York

Treat each SSI indicator as a separate audit (hip, colon, CABG)

– 9-18 medical records selected for each procedure (depending on volume of procedures done)

Case-control format– Cases: taken from NHSN– Controls:

Hip and colon surgeries from NY State Wide Planning and Research Cooperative System (SPARCS) not in NHSN

CABG surgeries from the Cardiac Surgical Reporting System (CSRS) that do not appear in NHSN

Auditing SSIs: South Carolina

Hip, knee, CABG and abdominal hysterectomies in all hospitals and colon surgeries for facilities with less than 200 beds

Stratified random method to select records to audit

Review roughly 20-30 charts per facility– Variable depending on size of facility and volume of

procedures performed

Common Error Rates

Connecticut: improper understanding of CLABSI rules– minimum time period, patient transfer, and two or

more blood cultures drawn on separate occasion rule

Common Error Rates

NY and SC: wound class, procedure duration, ASA score, and improper classification of surgeries as clean versus clean-contaminated

Conclusion

Lessons can be learned from other states and their validation programs

However, Texas has drastically larger numbers of facilities without increased funding

It is vital for Texas to create an efficient validation plan– Think long-term goals with limited funding

Questions?