First year of mandatory reporting of healthcare-associated infections, Pennsylvania: An infection control-chart abstractor collaboration

Kathleen G. Julian, Arlene M. Brumbach, Michelle K. Chicora, Carol Houlihan, Anna M. Riddle, Teanna Umberger, Cynthia J. Whitener

Research output: Contribution to journalReview articlepeer-review

30 Scopus citations


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. DESIGN. 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.

Original languageEnglish (US)
Pages (from-to)926-930
Number of pages5
JournalInfection Control and Hospital Epidemiology
Issue number9
StatePublished - Sep 2006

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases


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