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Guidance on Public Reporting of Healthcare-Associated Infections: Recommendations of the Healthcare Infection Control Practices Advisory Committee

Guidance on Public Reporting of Healthcare-Associated Infections: Recommendations of the HICPAC [PDF 150 KB]

Table 2. Recommended outcome measures for a mandatory public reporting system on health care–associated infections

Events Measures Rationale for inclusion Potential limitations
Central line–associated laboratory-confirmed primary bloodstream infection (CLA-LCBI)* Numerator: Number of CLA-LCBI Overall, an infrequent event but one that is associated with substantial cost, morbidity, and mortality LCBI* can be challenging to diagnose since the definition includes criteria that are difficult to interpret (eg, single-positive blood cultures from skin commensal organisms may not represent true infections). To offset this limitation, a system could include only those CLA-LCBI identified by criterion 1, which will result in smaller numerators and therefore will require longer periods of time for sufficient data accumulation for rates to become stable/meaningful.
  Denominator: Number of central-line days in each population at risk, expressed per 1,000 Reliable laboratory test available for identification (ie, positive blood culture) Standard definition of central line* requires knowing where the tip of the line terminates, which is not always documented and can therefore lead to misclassification of lines
  Populations at risk: Patients with central lines cared for in different types of intensive care units (ICUs)* Prevention guidelines exist6 and insertion processes can be monitored concurrently  
  Risk stratification: By type of ICU Sensitivity*: 85%; predictive value positive (PVP)*: 75%15  
  Frequency of monitoring: 12 months per year for ICU with ≤5 beds; 6 months per year for ICU with >5 beds    
  Frequency of rate calculation: Monthly (or quarterly for small ICUs) for internal hospital quality improvement purposes    
  Frequency of rate reporting: Annually using all the data to calculate the rate    
Surgical site infection (SSI)*  Numerator: Number of SSI for each specific type of operation*  Low frequency event but one that is associated with substantial cost, morbidity, and mortality  Rates dependent on surveillance intensity, especially completeness of post-discharge surveillance (50% become evident after discharge and may not be detected) 
  Denominator: Total number of each specific type of operation, expressed per 100  Prevention guidelines exist10 and certain important prevention processes can be monitored concurrently  SSI definitions include a ‘‘physician diagnosis'' criterion, which reduces objectivity 
  Risk stratification: Focus on high-volume operations and stratify by type of operation and National Nosocomial Infections Surveillance (NNIS) SSI risk index*  Sensitivity*: 67%; PVP*: 73%15   
  Alternate risk adjustment: For low-volume operations, adjust for risk by using the standardized infection ratio*     

*See Glossary (Appendix 1).

 
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