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