Thomas R. Talbot, MD, MPH; Dale W. Bratzler, DO, MPH; Ruth M. Carrico, PhD, RN; Daniel J. Diekema, MD; Mary K. Hayden, MD; Susan S. Huang, MD, MPH; Deborah S. Yokoe, MD, MPH; Neil O. Fishman, MD; for the Healthcare Infection Control Practices Advisory Committee
Disclaimer: The findings in this report are those of the authors and do necessarily represent the official position of the Centers for Disease Control and Prevention or the Department of Health and Human Services.
Acknowledgment: The authors thank the other advisory and liaison members of HICPAC for their thoughtful discussion and insight on this topic and white paper.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-1120.
Requests for Single Reprints: Thomas R. Talbot, MD, MPH, Vanderbilt University Medical Center, A2200 Medical Center North, 1161 21st Avenue South, Nashville, TN 37232; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Talbot: Vanderbilt University Medical Center, A2200 Medical Center North, 1161 21st Avenue South, Nashville, TN 37232.
Dr. Bratzler: OU Physicians Executive Office, Oklahoma University Health Sciences Center, 1200 North Children's Avenue, Suite 3200, Oklahoma City, OK 73104.
Dr. Carrico: Division of Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 120, Louisville, KY 40202.
Dr. Diekema: University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242.
Dr. Hayden: Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612.
Dr. Huang: Division of Infectious Diseases, University of California, Irvine, 101 The City Drive, City Tower, Suite 400, ZC 4081, Orange, CA 92868.
Dr. Yokoe: Brigham and Women's Hospital, Channing Laboratory, 181 Longwood Avenue, Boston, MA 02115.
Dr. Fishman: University of Pennsylvania, One Convention Avenue, Penn Tower, Suite 101, Philadelphia, PA 19104.
Author Contributions: Conception and design: T.R. Talbot, D.W. Bratzler, R.M. Carrico, D.J. Diekema, N.O. Fishman.
Analysis and interpretation of the data: T.R. Talbot, M.K. Hayden, N.O. Fishman.
Drafting of the article: T.R. Talbot, D.S. Yokoe, N.O. Fishman.
Critical revision of the article for important intellectual content: T.R. Talbot, D.W. Bratzler, R.M. Carrico, D.J. Diekema, M.K. Hayden, S.S. Huang, D.S. Yokoe, N.O. Fishman.
Final approval of the article: T.R. Talbot, D.W. Bratzler, R.M. Carrico, D.J. Diekema, M.K. Hayden, S.S. Huang, D.S. Yokoe, N.O. Fishman.
Administrative, technical, or logistic support: T.R. Talbot.
Collection and assembly of data: T.R. Talbot, R.M. Carrico.
Health care–associated infection (HAI) rates are used as measures of a health care facility's quality of patient care. Recently, these outcomes have been used to publicly rank quality efforts and determine facility reimbursement. The value of comparing HAI rates among health care facilities is limited by many factors inherent to HAI surveillance, and incentives that reward low HAI rates can lead to unintended consequences that can compromise medical care surveillance efforts, such as the use of clinical adjudication panels to veto events that meet HAI surveillance definitions.
The Healthcare Infection Control Practices Advisory Committee, a federal advisory committee that provides advice and guidance to the Centers for Disease Control and Prevention (CDC) and the Secretary of the Department of Health and Human Services about strategies for surveillance, prevention, and control of HAIs, assessed the challenges associated with using HAI surveillance data for external quality reporting, including the unintended consequences of clinician veto and clinical adjudication panels. Discussions with stakeholder liaisons and committee members were then used to formulate recommended standards for the use of HAI surveillance data for external facility assessment to ensure valid comparisons and to provide as level a playing field as possible.
The final recommendations advocate for consistent, objective, and independent application of CDC HAI definitions with concomitant validation of HAIs and surveillance processes. The use of clinician veto and adjudication is discouraged.
Table 1. Timeline of Key Events in CDC HAI Surveillance
Table 2. Examples of Clinician Veto of an NHSN-Defined HAI Surveillance Event
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Thomas R. Talbot, Dale W. Bratzler, Ruth M. Carrico, Daniel J. Diekema, Mary K. Hayden, Susan S. Huang, et al. Public Reporting of Health Care–Associated Surveillance Data: Recommendations From the Healthcare Infection Control Practices Advisory Committee. Ann Intern Med. 2013;159:631–635. doi: 10.7326/0003-4819-159-9-201311050-00011
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Published: Ann Intern Med. 2013;159(9):631-635.
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