title: First year of mandatory reporting of healthcare-associated infections, Pennsylvania: an infection control-chart abstractor collaboration.
abstract: BACKGROUND
  In 2004, the Commonwealth of Pennsylvania mandated hospitals to report healthcare-associated infections (HAIs). The increased workload led our Infection Control staff to collaborate with Atlas, a group of chart abstractors.
  
  
  OBJECTIVE
  The objective of this study was to assess our first year of experience with mandatory reporting of HAIs--specifically, to assess Atlas' contribution to surveillance.
  
  
  METHODS
  Cases were selected if they had 1 or more of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes designated by Pennsylvania as a possible HAI. After training by the Infection Control staff, Atlas applied National Nosocomial Infection Surveillance (NNIS) system case definitions for catheter-associated urinary tract infections (UTIs) and surgical site infections (SSIs), and they applied NNIS chest imaging criteria to eliminate cases that were not ventilator-associated pneumonia (VAP). To assess Atlas' performance, Infection Control staff conducted a parallel review.
  
  
  RESULTS
  For discharges from the hospital during the fourth quarter of 2004, a total of 410 UTIs, 59 SSIs, and 56 VAPs were identified on the basis of state-designated ICD-9-CM codes; review by Atlas/Infection Control determined that 15%, 15%, and 16% of cases met case definitions, respectively. Of cases reviewed by both Infection Control and Atlas, 87% of the assessments made by Atlas were correct for UTI, and 96% were correct for SSI. For VAP, Infection Control concluded that 39% of cases could be ruled out on the basis of chest imaging criteria; Atlas correctly dismissed these 12 cases but incorrectly dismissed an additional 6 (error, 19%). Surveillance was not timely: 1-2 months elapsed between the time of HAI onset and the earliest case review.
  
  
  CONCLUSIONS
  With ongoing training by Infection Control, Atlas successfully demonstrated a role in retrospective HAI surveillance. However, despite a major effort to comply with mandates, time lags and other design limitations rendered the data of low utility for Infection Control. States that are planning HAI-reporting programs should standardize an efficient surveillance methodology that yields data capable of guiding interventions to prevent HAI.
authors.affiliation: Division of Infectious Diseases, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA. kjulian@psu.edu
authors.forename: Kathleen G
authors.initials: KG
authors.lastname: Julian
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Brumbach
authors.forename: Michelle K
authors.initials: MK
authors.lastname: Chicora
authors.forename: Carol
authors.initials: C
authors.lastname: Houlihan
authors.forename: Anna M
authors.initials: AM
authors.lastname: Riddle
authors.forename: Teanna
authors.initials: T
authors.lastname: Umberger
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Whitener
mesh_terms: D002404:Catheterization / Q000009:adverse effects; D003141:Communicable Diseases / Q000145:classification / Q000453:epidemiology*; D003428:Cross Infection / Q000145:classification / Q000453:epidemiology*; D006801:Humans; D038801:International Classification of Diseases; D019221:Mandatory Reporting; D010414:Pennsylvania / Q000453:epidemiology; D011014:Pneumonia / Q000145:classification / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods*; D013530:Surgical Wound Infection / Q000145:classification / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000145:classification / Q000453:epidemiology