GAO Report: Health-Care-Associated Infections in Hospitals

An Overview of State Reporting Programs and Individual Hospital Initiatives to Reduce Certain Infections

Governmental initiatives to reduce HAIs involve a complicated mix of federal and state activities. The federal government, and in particular its lead agency for HAIs, CDC, have over the last few decades evolved a role that involves certain discrete activities. These include the development of guidelines that assess and recommend specific clinical practices for reducing HAIs. They also include the development and promulgation of procedures and definitions that enable ICPs to determine in a systematic and consistent way which patients have HAIs, and to measure their HAI rates over time. In addition, CDC has initiated and maintained data collection programs, such as NHSN, that provide a mechanism that hospitals can use to both collect information on their own HAIs and compare their experience with that of other hospitals using the same set of clinical definitions and data collection procedures. CDC provides these services to participating hospitals free of charge, and by law protects the confidentiality of the data that hospitals submit.

Meanwhile, at least 23 states have taken initiatives that seek to use comparable information about HAIs for a quite different purpose—informing consumers about the relative performance of specific hospitals. As the states have set up these programs, and confronted the challenges of implementing them with limited resources, many have found compelling advantages in drawing on CDC’s procedures and data collection systems. CDC protocols for identifying HAIs are widely respected for their clinical sophistication, and are well known to the ICPs in individual hospitals who will most likely be the ones to report the data. NHSN not only incorporates those widely accepted definitions and procedures, it is also available at no cost to the hospitals that use it. Thus many states have chosen to implement their public reporting programs by mandating that hospitals in their states enroll in NHSN. Although CDC itself may not publicly release HAI data on individual hospitals enrolled in NHSN, hospitals can give access to the state agencies to view and analyze their data using the group feature of NHSN. The state agencies can then use those data for their public reporting programs.

Complete Report