New Hampshire Hospital Associated Infections Validation

Dates: 2011

State: New Hampshire

Client(s): NH DHHS Division of Public Health Services

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

Technical Expertise: Patient Safety, State and Local Public Health

As in many other states, reporting of specific healthcare associated infection (HAI) measures through NHSN has been required in New Hampshire since 2009. However the value of these data in determining quality of care and informing consumer choices cannot be assured without confirming the accuracy of the reported information. JSI was contracted by the State of NH Department of Public Health Services to carry out an in-depth data validation process to assess and improve the quality of National Healthcare Safety Network (NHSN) data reported by the 26 acute care hospitals in New Hampshire.

JSI has been a national leader and innovator in this technical area, developing a comprehensive method for HAI case finding and data verification to identify possible missed cases of surgical site infections (SSI) and central line associated bloodstream infections (CLASBI). Using a combination of administrative and laboratory data, cases are selected for audit and JSI's team of specially trained clinicians, epidemiologists and researchers conducts hospital visits and detailed medical record reviews. The audit team applies the complex NHSN definitions to each case and compares their determinations to those of the hospital infection prevention team. Discrepancies are discussed and adjudicated after the visit; areas in need of further standardization and interpretation are identified and addressed in subsequent training and support materials.

With the completion of this contract, JSI has trained the program staff of the NH HAI Program in the validation process and provided individual hospital feedback and technical assistance on NHSN reporting statewide. The validation findings increased the overall number of reported infections by 21%, from 244 to 295 at the system level. A number of other technical complexities and errors were identified regarding the process of data collection for NHSN that will be addressed and monitored going forward. Feedback from the individual hospital staff was generally positive with many finding the detailed case validation process and discussion of definitions to be a helpful educational opportunity. The learning effect from this comprehensive audit is expected to improve future data consistency and enhance the value of the public HAI reports.