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Public Reporting of Healthcare Associated Infections – Part 1 of 2

Posted on by CDC's Safe Healthcare Blog
 Dr. Daniel Pollock
Dr. Daniel Pollock

Dr. Daniel Pollock
Head of CDC’s National Healthcare Safety Network

A colleague began a recent presentation by asking the audience, “How many of you have had a colonoscopy?

The majority of participants raised their hands.

Then he asked, “How many of you assumed that the instruments used during your procedure were truly clean?

All raised their hands again.

Then, he asked, “How would you feel if you found out two weeks, or even a year later, that you may have contracted a severe illness because the tools used were contaminated?


No one expects that receiving healthcare will make them sicker instead of well. ‪

Healthcare-associated infections (HAIs) are a significant concern that affects all types of patients in all kinds of settings including hospitals, surgery centers, dialysis clinics, community clinics, long-term care facilities and more. While we know that the financial cost and, more importantly, the emotional and physical toll of these infections is huge, HAIs were historically accepted as part of routine care. Certainly, not many people outside of the medical and public health communities knew much about what we now know are largely preventable infections.

‪In recent years, however, there has been a momentum building to incorporate more accountability, transparency, and patient empowerment into our healthcare system. With that movement came interest in having HAIs reported publicly, a stance that CDC supports. In fact, we published a statement on the topic in February 2010. Several states have laws that mandate public disclosure of infection rates and certain healthcare facilities, and we expect that trend to expand quickly. In addition, CDC began this year publishing state specific HAI information, and we will report again this fall and include more infection types and all states.

Public reporting of HAIs has had many intended and unintended consequences. In addition to providing increased transparency, infection prevention professionals are telling us that they are getting more support for their prevention efforts. Intense focus on HAI prevention has patients asking about infection rates and other safe healthcare issues. We’ve also heard that some healthcare professionals are not in favor of this type of reporting.

‪What is your take on public reporting? How has it been handled in your organization? What impact has it had?

Posted on by CDC's Safe Healthcare Blog

8 comments on “Public Reporting of Healthcare Associated Infections – Part 1 of 2”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    Michael, in my review of hundreds of dialysis facility survey reports, as well as having observed some hospital-connected versus small or large dialysis providers, I found no real significant difference in the deficiencies cited, to recall.

    Dr. Jacobs, AGREE. As I have observed, in numerous dialysis facilities and hospitals, the average time that staff wash their hands with soap and water was between 3 and 7 seconds.

    Let’s get back to the basics and increase the unit level supervision, whether in the dialysis setting or hospital setting.

    Roberta Mikles BA RN
    uncompensated Dialysis Facility and Hospital Patient Advocate

    You are right on target regarding sharing the information in a way that it is easy to understand. The HAI data is going to be presented in a way that it will be easier to understand so that people at all reading levels can use the information for their personal use. Thanks again! Anne

    After reading your article and the comments on it, I come down on support for public reporting of healthcare associated infections. I believe there is a critical need for this information to be reported as an important vehicle for improving medical services delivery. I also understand the comments on HAIs and dialysis centers and I think HAI control at these centers depends on the quality of the management and the training of the staff. I probably would chhose a center that was either in a major hospital or that was closely associated with a hospital rather than a small storefront type facility. I know of storefront dialysis centers located in strip malls here in town. These centers are small, fit in a regular size single store space, and are set in among the different fast food restaurents and such. The cost to use such centers maybe less than one in a hospital facility but the chances of getting HAIs are also probably greater. I also think this data on HAIs is important for the public to know and for hospital and facility administrators to know so informed choices can be made. But I also know the health literacy for the average adult is very low and so presenting the HAI data must be done in a way that someone not very health literate can still look at it and get meaning from it and understandit. To do otherwise would mean the information would not get to many people who need it–the patients and potential patients. Reading about this issue and its impact on facilities has got me thinking and wondering if there is a similar program that looks at contracting HAIs through the medical equipment used on ambulances and paramedic units. Best wishes, Michael E. Bailey.

    When is the CDC going to directly support the best evidence way of sanitizing your hands as promulgated by the World Health Organization and prominently featured in the Joint Commission ‘s 2009 historic monnograph on hand hygiene adherence?
    Science clearly shows that producing clean safe infection free hands via handwashing involves correct preliminaries. Sleeves rolled up 2-3″ above the wrists.
    Rings off , watch off, or slide 1/2 way up forearm.
    Wet hands thoroughly, put on enough antibacterial soap to thickly lather front and back of hands and wrists. Scrub viorously five rubs each section, You are lifting germs and spores into the detergent layer of the soap and that takes vigor.
    ***The Scientific scrub steps are 7.*** See the Joint Commission monograph and the WHO monograph. It takes 30- to 35 seconds to throughly complete this check list.. This a check list step process that is NOT time limited. However if you are addicted to singing Happy Birthday , do it three times.
    If you allow your subconscious mind to give your hands a good 35 second scrub without following the 7 step check list ,you leave infectious deadly germs on your hands that can harm the health professional and kill/disable our patients. Where are they?-thumbs/webs fingertips and wrists. Wrists count. Germy sleeves should be rolled up out of harms way. I contend HAI won’t drop substantially until we
    adopt what every other advanced nation in the world is promulgating re hand hygiene. I am calling on the CDC to adopt the scientific RIGHT WAY at the Right Time program of the World Health Organization. The CDC is still officially at 20 seconds since Nov 09 even though science clearly shows safw handwashing is not time based. Lets insist on the 7 steps that requires 35 sec srub time Isn’t 15 more seconds using a seven step check list worth doing? It alone can save 50,000 American lives in my opinion.
    Three of these steps everyone does already. We can all learn 4 more procedural memory steps. Keep your conscience clean and your hands mean.
    Kill E Coli, MRSA and C Diff, not Bill, Jane, Mary and Cliff.

    Hello Dan, I fought hard to pass public reporting in Colorado . At the time I thought it would change everything after four years of implementation this is my take:

    Good Changes
    1. Hospital CEO’s read our reports and are much more aware of their facilities infection rates
    2. Hospital CEO’s are putting some pressure on IP’s and other staff to improve rates.
    3. Small rural Hospitals are able to show their extremely low rates to consumers
    4. Long Term Care Facilities, ASC’s, and Dialysis Centers are beginning to report and are beefing up their infection control programs.

    Unintended Consequences
    1. Reporting has taken valuable IP’s off the patient floors and put them behind computers doing a lot more data entry. This hurts Infection Prevention efforts.
    2. Focus has become for all hospitals to look the same via risk adjustment.
    3. Facilities with excellent rates are met with suspicion instead of praise

    Major Disappointments
    1. Not many consumers read our reports. Data is very complex and time consuming to wade through
    2. CEO’s while concerned have not released the purse strings to hire more IP’s and really devote major resources to this problem.
    3. The total percentage of infection making it into your NHSN remains extremely small (less than 5%)

    We have a long way to go before public reporting will really be the means to drive rates down but every journey begins with a plan and a first step. Some states have plans and Colorado has taken the first step.

    Isaac Newton said that an object at rest remains at rest until an external force is applied. Progress on reducing hospital-acquired infections has occurred only because people who have been seriously affected by infections, and their surviving family members, have joined together to advocate for public reporting. Congratulations to the CDC for moving foward on public reporting.

    The author led national quality and safety initiatives at the Robert Wood Johnson Foundation for 16 years and is the author of The Treatment Trap: How the Overuse of Medical Care is Wrecking Your Health and What You Can Do to Prevent It.

    The following link is about a hospital in Escondido and Poway (San Diego), Calif, where recently 3400 patients received letters that they might have been exposed to an infection due to instruments not being adequately cleaned. ttp:// ..

    As a dialysis patient safety advocate, having reviewed hundreds of dialysis facility survey (inspection) reports, I continue to be shocked that the most basic of infection control practices are not implemented. Infection has been the number two killer of dialysis patients for well over ten years. So what is the problem? Why can’t staff implement safe practices? It is my opinion, in dialysis facilities, that staff are not thoroughly trained with understanding of negative outcomes, not only for patients, but for themselves and their families. Additionally, I do not believe there is sufficient unit-level supervision to ensure correct practices are being implemented. Infection control remains the most cited deficiency in this setting. It is my opinion that ALL dialysis facilities should be mandated to report their infectiondata to NHSN.
    Several years ago I was shocked to see only a handful of facilities that voluntarily participated in the NHSN program.

    I support public reporting of infection data ONLY if the data is accurate, data is presented to consumers so that there is full understanding and that consumers are educated in order to use the information for their well being. If data is not accurate, standardized, etc., there are too many potential problems not only for patients, but for providers, as well. Having been a charter member of a Patient & Family Advisory Council for a large metropolitan hospital, I am aware of the attention that infection control has received and hope that all hospitals are doing same.

    Roberta Mikles, BA RN
    (uncompensated) Patient Safety Advocate
    San Diego, CA

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