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

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

Research output: Contribution to journalReview article

29 Citations (Scopus)

Abstract

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
Volume27
Issue number9
DOIs
StatePublished - Sep 1 2006

Fingerprint

Mandatory Reporting
Atlases
Infection Control
Cross Infection
Surgical Wound Infection
Urinary Tract Infections
Ventilator-Associated Pneumonia
International Classification of Diseases
Thorax
Catheter-Related Infections
Workload

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Julian, Kathleen ; Brumbach, Arlene M. ; Chicora, Michelle K. ; Houlihan, Carol ; Riddle, Anna M. ; Umberger, Teanna ; Whitener, Cynthia. / First year of mandatory reporting of healthcare-associated infections, Pennsylvania : An infection control-chart abstractor collaboration. In: Infection Control and Hospital Epidemiology. 2006 ; Vol. 27, No. 9. pp. 926-930.
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abstract = "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.",
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First year of mandatory reporting of healthcare-associated infections, Pennsylvania : An infection control-chart abstractor collaboration. / Julian, Kathleen; Brumbach, Arlene M.; Chicora, Michelle K.; Houlihan, Carol; Riddle, Anna M.; Umberger, Teanna; Whitener, Cynthia.

In: Infection Control and Hospital Epidemiology, Vol. 27, No. 9, 01.09.2006, p. 926-930.

Research output: Contribution to journalReview article

TY - JOUR

T1 - First year of mandatory reporting of healthcare-associated infections, Pennsylvania

T2 - An infection control-chart abstractor collaboration

AU - Julian, Kathleen

AU - Brumbach, Arlene M.

AU - Chicora, Michelle K.

AU - Houlihan, Carol

AU - Riddle, Anna M.

AU - Umberger, Teanna

AU - Whitener, Cynthia

PY - 2006/9/1

Y1 - 2006/9/1

N2 - 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.

AB - 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.

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