Pennsylvania adopts mandatory HAI reporting

Hospitals and nursing homes now have to report infections to state health authorities within 24 hours. Hospitals will also have to report to the National Healthcare Safety Network at the Centers for Disease Control & Prevention.

Wait and see

The public reporting of HAIs is a complex issue, said Kasey Thompson, Pharm.D., director of patient safety for ASHP. First, it needs to be clear that patients are not coming into the hospital already infected. Second, it should be clear that an HAI was preventable. "The theory is that public reporting improves performance," he said. "But . . . risk adjustment is a crucial part of any meaningful reporting system."

The legislation went through a lot of changes before it was finalized in July, primarily because of Hospital & Healthsystem Association of Pennsylvania concerns that smaller hospitals couldn't afford the mandated reporting system. But the concerns were eased when the new federal infection-reporting network, which standardizes electronic reporting by hospitals, was created. "The uniformity of that system could help reduce costs," said Paula Bussard, senior VP of policy and regulatory services, for the association.

According to Consumers Union, 19 states have mandatory HAI reporting laws. Two more require that data be available but do not require rate reports. Two states have confidential reporting, and one state has a voluntary reporting law. Of the remaining states, as of May, all except Arizona, Montana, North Dakota, and Wyoming are considering such legislation.

Pennsylvania law

Pennsylvania's new legislation is among the most comprehensive, and is one of the few to offer potential incentive payments for reduced infection rates. It is unique in that it is the only state law requiring nursing homes to report such infections.

Many of the state's larger hospitals will be required by 2009 to install an electronic monitoring system that checks lab, pharmacy, and radiology reports on individual patients for signs of infection. According to Bussard, about one-third of Pennsylvania's 174 general hospitals already have such systems, including all the larger hospitals.

Hospitals without such systems will, by 2009, have to show that they lack the financial and technological resources to make such a program feasible, or do not have infection-prone patients. But all of the state's hospital, outpatient surgery centers, and nursing homes will have to develop an internal infection control system that meets the standards developed by the state's Department of Health. And by 2010, the state will establish infection rate benchmarks for individual facilities.

The Pennsylvania Patient Safety Authority will issue advisories on how to improve infection control, and the Pennsylvania Health Care Cost Containment Council will publish reports on infection rates and treatment costs.

Although the Centers for Medicare & Medicaid Services does not mandate reporting of HAI incidents or incident rates, the agency announced in August that it will no longer pay for treatment costs associated with catheter-related HAIs. CMS has conducted a voluntary HAI reporting program for several years as part of its National Voluntary Hospital Reporting Initiative.