Nosocomial infections, or infections acquired by patients during hospitalization, have long been of concern to healthcare providers. The rise of antibiotic-resistant infections in hospitals, however, has resulted in pushes for compulsory reporting and control measures.
As such, several states, including New York, Tennessee, and Vermont, among others, have passed legislation mandating the reporting of healthcare-associated infection rates. Other states are in the process of considering similar laws.
New York passed mandatory reporting legislation of healthcare-associated infections in July 2005. To help shoulder the burden, the New York Department of Health has directed hospitals to use the Atlanta-based Centers for Disease Control and Prevention's (CDC) National Healthcare Safety Network (NHSN). And New York is not the only state to do so. Approximately half the states with mandatory reporting are using NHSN.
NHSN, deployed in 2005, is the joining of three existing infection control systems created by CDC's Division of Healthcare Quality Promotion — the National Nosocomial Infection Surveillance System, the Dialysis Surveillance Network and the National Surveillance System for Healthcare Workers — into a single, Web-based reporting and analysis platform.
The union of these applications allows hospitals to use the same system for the surveillance of both patients and healthcare workers in a facility, creates increased abilities to import data from legacy systems, and allows individualized data analysis. James Tolson, technical project manager of NHSN, says, "We currently have 402 active facility members and another 50 or so in the process of enrolling." Some of those are New York hospitals, with approximately 80 percent of that state's facilities now using NHSN.
Data pushes quality control measures
Linda Greene, infection control manager of the Via Health Rochester General Hospital in Rochester, N.Y., was pleased by the Department of Health's decision to use NHSN. Greene has been using the National Nosocomial Infection Surveillance System since 1997 and is happy with the newer NHSN. "It is so important to have a system in place that uses all of the standard definitions, correctly risk adjusts and uses appropriate denominator data. NHSN really handles surveillance the way it should be done."
Since implementing the system at Via Health, Greene says the organization has made reductions in nosocomial infection rates, including a record run of 11 months without a blood-stream infection. She credits the system's data analysis capabilities with the hospital's achievements, not only with helping her to create useful quality improvement measures but also to help persuade staff members of their importance. "The data we were able to pull from the system gave us a great deal of credibility with personnel that we hadn't been able to convince before."
From volunteer to mandatory
Current users have shown successes, but will those who aren't as familiar with NHSN be as happy with the Department of Health's push? Teresa Horan, NHSN's program manager, is optimistic.
"We're different from some of the other mandatory systems in that we started on a strictly volunteer basis," says Horan. "We built NHSN based on user feedback from the National Nosocomial Infection Surveillance System, and we've developed a good product that is useful and provides users with the analysis tools that they need."
Furthermore, NHSN was designed to expand for accommodation of new modules as needed. For example, it is expected that a project which provides specific antimicrobial use and resistance e-surveillance capabilities will fall under the NHSN umbrella in the future.
Greene believes that other facilities will also see the benefit of using NHSN for their reporting. "The more robust your quality program, the more you need to have the information necessary to drive improvements at your fingertips. NHSN provides that. Let's face it, information is power, and if you don't have it, you're just shooting in the dark."
Kayt Sukel is a freelance writer based in Germany.