Health­care-as­so­ci­ated in­fec­tions down in first state-by-state re­port

CDC: In­fec­tion rates drop, but progress still un­clear

Modern Healthcare - - Editorial - Mau­reen McKin­ney

THE WEEK IN HEALTH­CARE

New fig­ures from Cen­ters for Dis­ease Con­trol and Pre­ven­tion sug­gest hos­pi­tals are gain­ing sig­nif­i­cant ground in their ef­forts to lower the rates of health­care-as­so­ci­ated in­fec­tions. Ac­cord­ing to the CDC’s first state-spe­cific re­port on HAIs, re­leased May 27, the num­ber of cen­tral line-as­so­ci­ated blood­stream in­fec­tions dropped 18% dur­ing the first six months of 2009 when com­pared with rates from the three pre­vi­ous years.

The CDC ar­rived at that num­ber us­ing data from its Na­tional Health­care Safety Net­work, a sur­veil­lance and pre­ven­tion pro­gram that uses hos­pi­tal-re­ported data to track rates of HAIs across the coun­try. Among the 1,538 hos­pi­tals that re­ported in­fec­tion data to the NHSN dur­ing the first half of 2009, there were 4,615 ob­served cen­tral line-as­so­ci­ated blood- stream in­fec­tions com­pared with the nearly 5,619 pre­dicted for that time pe­riod.

The find­ings are en­cour­ag­ing and em­pha­size the im­por­tance of cur­rent im­prove­ment ini­tia­tives, said Ar­jun Srini­vasan, as­so­ci­ate di­rec­tor for health­care-as­so­ci­ated in­fec­tion pre­ven­tion pro­grams at the CDC’s Di­vi­sion of Health­care Qual­ity Pro­mo­tion. But the real test of progress will come with fu­ture NHSN re­ports, which will be re­leased ev­ery six months, he added.

In ad­di­tion to pro­vid­ing over­all rates of cen­tral line in­fec­tions for the coun­try, the CDC was also able to as­sess the in­di­vid­ual per­for­mance of the 17 states that man­date NHSN re­port­ing for all of their hos­pi­tals. Us­ing data re­ported dur­ing pre­vi­ous years, the agency as­signed each of the states a stan­dard­ized in­fec­tion ra­tio, which com­pares the ac­tual num­ber of in­fec­tions with base­line na­tional num­bers.

For in­stance, Ok­la­homa’s 48 re­port­ing fa­cil­i­ties ob­served 59 cen­tral line-as­so­ci­ated blood­stream in­fec­tions, 50% less than the pre­dicted num­ber of 119, for a stan­dard­ized in­fec­tion ra­tio of 0.50 (ac­tual in­fec­tions com­pared with ex­pected in­fec­tions). Eleven of the 17 states had stan­dard­ized in­fec­tion ra­tios that were sig­nif­i­cantly less than 1.0, mean­ing they had lower in­fec­tion rates than ex­pected based on the na­tional av­er­age.

The data from the CDC re­port is par­tic­u­larly mean­ing­ful, ex­perts say, be­cause the safety net­work uses stan­dard­ized HAI def­i­ni­tions and data-col­lec­tion meth­ods that are gov­erned by rig­or­ous pro­to­cols. Sev­eral re­cent re­ports on health­care-as­so­ci­ated in­fec­tions, in­clud­ing the Agency for Health­care Re­search and Qual­ity’s Na­tional Health­care Qual­ity Re­port, re­leased in April, have re­lied on ad­min­is­tra­tive cod­ing and billing data to draw their con­clu­sions, (April 26, p. 7).

By con­trast, the NHSN was de­signed ex­pressly for the pur­pose of mon­i­tor­ing HAIs, and re­quires spe­cial­ized staff and ad­her­ence to guide­lines, said Neil Fish­man, pres­i­dent of the So­ci­ety for Health­care Epi­demi­ol­ogy of Amer­ica and di­rec­tor of the depart­ment of health­care epi­demi­ol­ogy and in­fec­tion con­trol for the Uni­ver­sity of Penn­syl­va­nia Health Sys-

Srini­vasan finds the de­crease in in­fec­tions promis­ing.

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