First year of mandatory reporting of healthcare-associated infections, Pennsylvania: an infection control-chart abstractor collaboration.
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.
Julian
Kathleen G
KG
Division of Infectious Diseases, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA. kjulian@psu.edu
Brumbach
Arlene M
AM
Chicora
Michelle K
MK
Houlihan
Carol
C
Riddle
Anna M
AM
Umberger
Teanna
T
Whitener
Cynthia J
CJ
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