First year of mandatory reporting of Healthcare-Associated infections, pennsylvania: An infection control-chart abstractor collaboration

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 ( ICD9- 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.