Mandatory reporting of healthcare-associated infections (HAIs) is a focus for many organizations, including the Association for Professionals in Infection Control and Epidemiology (APIC), the Centers for Medicare and Medicaid Services (CMS), the Healthcare Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control (CDC) and several consumer, patient safety and quality improvement groups. Interest in mandatory reporting is based on the impact of HAIs in contributing to patient mortality and excess healthcare costs. According to the CDC, HAIs account for 90,000 deaths annually and boost costs of care by $4.5 billion.1

Hospitals routinely track infection rates and administer prevention programs, but these infection surveillance activities are most likely to be performed for selected procedures or to track a subset of the most common infections. Total infection rates for institutions often are not calculated or, if they are available, may not be determined in a manner that allows for comparison by institution. A primary concern of many organizations is that hospital infection data generally are used only internally and therefore are not publicly available. Although many healthcare organizations have long histories of improving the practice of infection control in hospitals, the mandatory reporting issue is particularly influenced by consumer groups. The publication in 1999 of the Institute of Medicine’s report titled, To Err is Human: Building a Safer Health System, highlighted the cost in lives and healthcare expenditures due to medical errors.2 This, in turn, led to consumer advocacy designed to educate consumers and hold healthcare organizations accountable for care. The Consumers Union, the publisher of Consumer Reports, has been especially influential and has even created a campaign targeted toward reducing HAIs. Their website, StopHospitalInfections.org, provides information designed to educate consumers and provide news updates about infection control efforts at the state and national levels.3 Information provided on this site is distributed to mainstream television and print media, increasing consumer awareness of infection risks, hospital practices and reporting processes.

In an effort to address consumer concerns and improve accountability and standardization, the state legislatures of Florida, Illinois, Missouri and Pennsylvania have adopted mandatory reporting procedures at the state-wide level. Additional legislation is pending in most other states. (For information about the status of mandatory reporting legislation by state, visit the APIC website at www.apic.org.)4 Although the states’ efforts to require reporting are helpful first steps, requirements differ by state, and there are no national requirements or standards for collecting infection rate data.

HICPAC recommendations:
A summary
In late February, HICPAC released a document that was designed to provide guidance for policymakers developing mandatory HAI public reporting systems.1 This document, titled, Guidance on Public Reporting of Healthcare-Associated Infections, includes recommendations to help reporting organizations collect meaningful infection control data by using nationally recognized infection control measures. The guidance document is based on established principles for public health and HAI reporting systems and aims to enable decision-makers, including consumers, to have the data necessary to make informed decisions about healthcare practices and institutions. Recommendations in the HICPAC guidance document have been endorsed by APIC, the Council of State and Territorial Epidemiologists and the Society for Healthcare Epidemiology of America (SHEA).

Conclusion
The HICPAC guidance document provides a useful framework for policymakers and others who are involved in developing infection reporting systems. Nevertheless, the details of which process and outcome measure to use, how to collect and analyze data and how to report results will continue to be developed either privately or at the state legislative level unless national standards are eventually developed. It is inevitable, therefore, that significant differences in reporting standards will continue. Currently, organizations such as APIC can play a vital role in encouraging additional conversation among infection control professionals about the reporting process. As new systems are put into place, it is critical to candidly evaluate failures as well as successes and to encourage sharing of both process methodology and overall results. Collecting useful, comparable infection rate data will take time. Ongoing oversight from organizations that can collect information from various reporting organizations can be extraordinarily useful. HPN