Professional organizations consider public reporting of health care–acquired infections

January 2006

Over the last two years, both lay media and professional journals have argued the case for and against the reporting of hospital-specific rates of health care–related infections to the public.

Originating with several stories of highly inflammatory (and frequently oversimplified “exposes” of such infections) appearing in newspapers, such as the Chicago Tribune, lay media and political leaders have urged that the public has the right to know the infection risks they may confront as unforeseen consequences of hospital admission. These highly publicized “nightmare” stories have led august groups such as Consumers Union to propose legislation in several states to mandate such reporting both to a governmental authority (usually but not exclusively the state health department) and thence to the public on a variety of health care–related infections. Persistent lobbing by advocates for individuals who have reportedly experienced such infections has resulted in the passage of public reporting legislation in a number of states, including Florida, Illinois, Missouri, Nevada, New York, Pennsylvania and Virginia. Many other states have considered, pended or, in some cases, rejected the notion of both centralized and public reporting of health care–associated infections.

What is the science behind such reporting? What evidence can be drawn from previous experiments with public reporting of health care complications? Last year, to provide this background, the CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC) published a comprehensive review of such experiences and, without endorsing or rejecting such efforts, proposed guidelines for states considering public reporting legislation. In so doing, the HICPAC recommended a combination of both process measures (such as the timing of perioperative prophylactic antibiotics) and outcome measures (such as catheter-associated bloodstream infections).

More recently, professional organizations, such as the Association of Professionals in Infection Control and Epidemiology (APIC) and SHEA, have cautiously endorsed the concepts outlined in the HICPAC document, while noting both the difficulty of universally monitoring health care–associated infections, the inherent problems with risk-adjustment of such data and the dangers of trying to compare different institutions with a varying patient mix.

However, the subtleties of issues, such as risk stratification, patient mix and outcomes vs. process indicators, are just a jumble of words to patients, their organized advocates and their public representatives who perceive the qualms and caveats enunciated by the HICPAC, APIC and SHEA as stalling to avoid pulling back the curtain on health care–related infections. And, to a certain extent, they are correct. As academic specialists, have we become so entrapped in our own language and search for universally applicable definitions and surveillance methodology that we are incapable of moving forward toward a more rational system of data monitoring and data sharing that enable health care facilities to define reasonable benchmarks and goals for improvement? Does the public really understand or care about our mutual angst?

One favorable outcome of the ongoing debate over public reporting may be an accelerated drive to deal affirmatively with these difficult methodological issues. The CDC has recently expanded and consolidated its venerable reporting systems — the National Nosocomial Infection Surveillance System, the Dialysis Surveillance Network and the National Surveillance System for Healthcare Workers — into a single reporting system: the National Healthcare Safety Network, which may prove to be the most effective vehicle yet designed for a uniform system of statewide or nationwide health care–associated infection reporting.

Similarly, the National Quality Forum has announced its intention to convene several forces representing health care experts, consumers and payers to consider the development of standards for uniform definitions, surveillance and reporting of health care–associated infections. Existing voluntary and government-supported initiatives have already been implemented to reduce health care–related infections. For example, the Institution for Healthcare Improvement’s “Save 100,000 Lives” Campaign has engaged U.S. hospitals in a commitment to improve patient care and prevent avoidable deaths. In 2003, the Centers for Medicare and Medicaid Services initiated the Surgical Care Improvement Project, whose goal is to reduce the incidence of surgical complications by 25% by the year 2010.

Like it or not, we are on our way to some form of enhanced public availability of data regarding health care–associated infections. We had better take the opportunity now to make the system as good as we can. Vox populi, vox Dei!

For more information:

• McKibbin L, Horan T, Tokars JI, et al. Guidance on public reporting of healthcare-associated infections: recommendations of the Healthcare Infection Control Practices Advisory Committee. Am J Infect Control. 2005;33:217-226.
• Wong ES, Rupp ME, Mermel L, et al. Public disclosure of healthcare-associated infections: the role of the Society for Epidemiology of America. Infect Control Hosp Epidemiol. 2005;26:210-212.
• Association for Professionals in Infection Control and Epidemiology. APIC position on mandatory public reporting of healthcare-associated infections [APIC Web site]. March 14, 2005. Available at: www.apic.org/AM/Template.cfm?Section=Position_Papers1&Template=/CM/ContentDisplay.cfm&ContentFileID=2240. Accessed Dec. 29, 2005.