CDC offers guide to states on reporting infection rates

The Centers for Disease Control & Prevention recently released detailed recommendations to state health departments that are considering mandatory public reporting of healthcare-associated infections (HAIs). "HAIs are a major public health problem in the United States," said Patrick Brennan, M.D., chairman of the CDC's Healthcare Infection Control Practices Advisory Committee (HICPAC), which wrote the document.

CDC said states considering public reporting of HAIs should:

"With regard to surgical site infections, health-system R.Ph.s play an important role in establishing standards within an organization and monitoring the appropriate drug use within established parameters," said Brennan in a recent teleconference announcing the HICPAC recommendations. The purpose of the guidelines is to reduce the number of surgical site infections, which currently occur about 500,000 a year. The document is entitled "Guidance on Public Reporting of Healthcare-Associated Infections."

HAIs-including surgical site infections-account for about two million infections, 90,000 deaths, and $4.5 billion in excess healthcare costs a year, according to the CDC. Since 1970, a group of U.S. hospitals, now about 300, have voluntarily and confidentially reported their HAI rates to the CDC. A HICPAC official said there is not yet enough evidence to determine whether mandatory public reporting of HAIs would reduce infection rates. But the committee recommends that states that implement public reporting strive to gather meaningful data and use nationally recommended infection control measures.

Since 2003, four states-Florida, Illinois, Missouri, and Pennsylvania-have enacted legislation that requires healthcare organizations to publicly disclose HAI rates. According to the CDC, 30 more states are considering similar legislation.

"I believe public reporting of HAIs can make clear problems that might not otherwise come to the attention of a health system," said Donald R. Jones, M.S., R.Ph., system director of pharmacy care at Temple University Health System in Philadelphia, which has been reporting HAIs to the state since January 2004. "Although health-system R.Ph.s are not directly involved in the reporting process, we use the information gathered to examine [regional HAI] trends. We communicate with each other, across systems, to determine what to watch for and how we can improve what we do."

"Our document is a guide to best practices," said Brennan. Our intended audience is the policy makers, program planners, and consumer advocacy organizations that are planning and implementing the public reporting systems for HAIs. We advocate specifying goals, objectives, and priorities in developing these systems; the selection of measurable outcomes; and the use of established methods," he said.

Pharmacists should be part of the creation of a multidisciplinary advisory panel of professionals with expertise in prevention and control of HAIs in the planning and oversight of public reporting systems. "We believe there are many stakeholders in these processes," said Brennan.

Appropriate process and outcome measures should be adopted, based on facility type. The indicators should be phased in, maximizing their usefulness to consumers and their acceptability to providers, said Brennan. Three process measures and two outcome measures were recommended. The process measures include the practices used to insert central venous catheters that can lead to bloodstream infections, antimicrobial prophylaxis for surgical procedures, and influenza vaccination coverage for healthcare workers and patients. The outcome measures include central line-associated, laboratory-confirmed bloodstream infections and surgical site infections.

HICPAC recommends regular and confidential feedback to healthcare providers. "Feedback provides knowledge," said Jones. "The real danger lies in not having the data needed to identify [HAI] trends."

The guidance document is available at http://www.cdc.gov/ncidod/hip/PublicReportingGuide.pdf.