306. Validation of Hospital Healthcare-Associated Infections (HAI) Reporting via the National Healthcare Safety Network (NHSN) with a Focus on Improving Case-Finding, California 2014
Session: Poster Abstract Session: HAI: Epidemiology
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • HAI Poster 2 of 5 IDWeek Valid Sam H-S 9.16.15.pdf (458.7 kB)
  • Background:

    Since 2010, California hospitals have been required to report HAI to the California Department of Public Health (CDPH) via NSHN.  From 2013-2015 the CDPH HAI Program implemented a three-year plan to validate reported HAI data; 2014 validation focused on case-finding.  

    Methods:

    In 2014, the CDPH HAI Program conducted onsite visits to validate reporting of colon surgical site infections (SSI), central line associated bloodstream infections (CLABSI), C. difficile infections (CDI), and methicillin-resistant S. aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) bloodstream infections (BSI). Validators reviewed up to 20 randomly selected infections of each type using a chart abstraction tool and identified whether HAIs had been reported to NHSN. Sensitivity calculations and significance tests were conducted, and adjusted rate ratios were calculated using negative binomial regression models.

    Results:

    The HAI Program visited 234 of 254 (92%) eligible large volume hospitals, including 22 long-term acute care (LTAC) hospitals. Participants were representative of all hospitals with respect to bed size, patient days, hospital type (e.g. teaching, LTAC), and region.  Case-finding/reporting sensitivity for each infection type are reported in Table 1. One hundred seventy (73%) hospitals missed at least one infection. Although no significant differences in overall sensitivity were observed between hospitals by facility type and patient days, we did observe statistically significant differences among 8 regions (Figure 1). After controlling for bed size and facility type, hospitals in the Inland Empire region (n=26) demonstrated higher rates of missing HAIs than other hospitals (RR: 1.75 95% CI: 1.07-2.87).

    Conclusion:

    Hospitals were better able to correctly identify and report CDI and MRSA/VRE BSI than SSI and CLABSI. Some geographic variation in sensitivity was observed, indicating that surveillance practices may vary by region. These findings will allow the HAI Program to target poor performing hospitals for focused surveillance education and repeat validation visits in 2015.

    Table 1

    Infection

    Infections

    Reported/

    Total Identified

    Sensitivity (%)

    SSI

    204/295

    69%

    CLABSI

    299/416

    72%

    CDI

    3480/3765

    92%

    MRSA/VRE BSI

    1271/1436

    89%

    Figure 1

    Sam Horwich-Scholefield, MPH, Vicki Keller, RN, MSN, PHN, Neely Kazerouni, DrPH, MPH and Lynn Janssen, MS, CIC, CHCQ, Healthcare Associated Infections Program, California Department of Public Health, Richmond, CA

    Disclosures:

    S. Horwich-Scholefield, None

    V. Keller, None

    N. Kazerouni, None

    L. Janssen, None

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