Massachusetts Healthcare-Associated Infections Prevention and Control

Dates: 2006-2012

State: Massachusetts

Client(s): Massachusetts Department of Public Health (DPH)

Services: Health Care & Public Health Planning, Applied Research & Evaluation, Training & Technical Assistance, Health Systems Transformation

Technical Expertise: State and Local Public Health, Patient Safety


The importance of healthcare-associated infections (HAIs) as a cause of preventable illness and death has been recognized increasingly in recent years, and several states have initiated public reporting of individual hospital rates. The use of hospital-specific performance data to stimulate improved quality of care and enhance consumer choice is a controversial area. Several states have initiated mandatory public reporting of HAI rates in the past few years. To determine the Massachusetts approach, the Department of Public Health and the Betsy Lehman Center for Patient Safety and Medical Error Reduction selected JSI to coordinate a new statewide Infection Prevention and Control Program in late 2006.

At the completion of the advisory and research process, JSI coordinated the production of a comprehensive set of recommendations for the state [Read the report: Prevention and Control of Healthcare-Associated Infections in Massachusetts] that address prevention best-practices and an approach to making selected HAI data publicly available. Regulatory changes called for hospitals to report selected HAIs through the National Healthcare Safety Network (NHSN). JSI trained hospitals on the use of the reporting system and provided technical support to the rollout of statewide mandatory reporting.

Following the start of mandatory HAI reporting on July 1, 2008, the JSI team's unique role has been to design and lead NHSN data validation. With the innovative and comprehensive methodology JSI designed, in-depth case-finding and medical record reviews have been conducted in 70 acute care hospitals in the Commonwealth. During these visits, JSI has provided substantial technical assistance in application of the complex NHSN case definitions. Discrepancies between the audit team's findings and the hospital's infection prevention interpretations have been explored and adjudicated with input from CDC as needed. The overall system-level analysis is underway to summarize the extent and sources of under-reporting for surgical site infections (SSIs) and central line associated blood stream infections (CLABSIs). JSI was invited to present its methodology to CDC's national conference for state HAI coordinators in October 2011, in recognition of its unique technical expertise in HAI validation.