Mandatory Public Reporting of Hospital Acquired Infections (MPRHAI): Recommendations of the Tennessee Study Group to the Tennessee Legislature

ISSUE: About 2 million Americans acquire healthcare associated infections annually; one third of these infections are considered preventable. Various consumersʹ groups have highlighted these facts urging legislators to pass legislation mandating public reporting of hospital-acquired infections (HAI). Since 2002, six states have enacted legislation that requires health care organizations to publicly disclose HAI. To date, there are six additional states (including Tennessee) that have required a study of such legislation and many other states with pending legislation. PROJECT: To describe the underlying rationale and recommendations made by Tennesseeʹs study group on MPRHAI. The study group included infection control professionals and hospital epidemiologists from large and small hospitals; urban and rural. It reviewed reporting requirements for the State of Tennessee, impacts and effect of MPRHAI legislation in other states, quality improvement initiatives from multiple organizations, and guidelines from the Healthcare Infection Control Practices Advisory Committee (HICPAC). Emphasis was placed on collection of actionable, verifiable data. RESULTS: The study group found no evidence for or against using MPRHAI to reduce HAI. It recognized that consumers want this information available publicly and that data must be displayed in a way that consumers will be able to comprehend. It recommended that any action taken by the Tennessee legislature be in conjunction with current national reporting initiatives and sufficient resources be allocated to implement a meaningful reporting system. The study group recommended: a) All healthcare institutions be included except: critical access hospitals or hospitals with an average daily census of <25. b) Public reporting of 1) outcome measures: laboratory confirmed central-line associated blood stream infections in intensive care unit patients, using National Healthcare Safety Network definitions, methodology and software [NHSN]; 2) process measures: antibiotic timing (surgical care improvement project [SCIP] using Centers for Medicare and Medicaid Services (CMS) definitions, methodology and data collection instruments. c) All hospitals performing coronary-artery bypass graft surgery report infection rates to the State, using NHSN. d) Adding to “rules” governing healthcare facilities: 1) influenza vaccination of healthcare staff (or declination) by December; 2) central line insertion checklist, and 3) handhygiene monitoring. e) Modifying interpretive rules on adverse-event reporting. LESSONS LEARNED: A combination of process and outcome measures and modification of rules was recommended.