Validation of surgical site infection surveillance data in colon procedures reported to the Connecticut Department of Public Health.

A validation study of 692 patients undergoing colon surgery during the fourth quarter of 2012 identified 102 surgical site infections, of which 34% were not reported to the National Healthcare Safety Network. Possible reasons for underreporting included the misinterpretation of the National Healthcare Safety Network surgical site infection definition and variations in case-finding methods. Colon procedure denominator data were also reviewed to determine inaccuracies. Error rates were highest for implant presence (34%), endoscope use (32%), and procedure duration (33%).

Validation of the surveillance and reporting of central line-associated bloodstream infection denominator data.

BACKGROUND: While the main focus of validating central line-associated infections (CLABIs) has been applying strict definitions to identify cases, assessing the denominator counts has received less attention. This study evaluates the accuracy of the reporting of CLABSI denominator patient-day (PD) and central line-day (CLD) counts to the National Healthcare Safety Network (NHSN) system in one state. METHODS: The Connecticut Department of Public Health (CT DPH) performed a blinded retrospective chart review on the collection of CLABSI PD and CLD on 9 selected days during the fourth quarter of 2009 from 23 acute care hospitals. RESULTS: Overall, 1,988 intensive care unit patient charts were reviewed. Comparison of hospital and CT DPH counts identified over-reporting by 300 PD (17.2%) and 200 CLD (21.7%) with 17 hospitals (74%) collecting data manually. PD manual collection methods were more accurate than electronic methods (P < .01). For CLD, there was no significant difference in collection method (P > .05). Wednesday PD counts were more accurate than Monday (P < .05) or Saturday (P < .05). For CLD counts, there was no significant difference among the 3 days (P > .05). CONCLUSION: Our results provide some evidence for the prerequisite internal validation of denominator data by hospitals before reporting to the national surveillance system.

Validation of the surveillance and reporting of central line-associated bloodstream infection data to a state health department.

BACKGROUND: The primary goal of health care-associated infection reporting is to identify and measure progress towards achieving the irreducible minimum number of infections. Assessing the accuracy of reporting data using independent validation is critical to this goal. In January 2008, all 30 acute care hospitals in Connecticut began mandatory reporting of central line-associated bloodstream infections (CLABSI) to the National Healthcare Safety Network (NHSN) system. METHODS: A state nurse epidemiologist performed a blinded retrospective chart review for NHSN-reported CLABSI based on positive blood cultures from October to December 2008. RESULTS: Of 476 septic events, 48 met the NHSN CLABSI definition, of which 23 (48%) had been reported to NHSN. Concordance of non-CLABSI events was 99% sensitive. Components of the case definition that were a source of misinterpretation included the following: NHSN surveillance definition of primary and secondary bacteremia (45%), CLABSI rules (19%), CLABSI terms (10%), and differentiation between laboratory-confirmed bloodstream criterion 1 (recognized pathogen) and criterion 2 (skin contaminant) (13%). CONCLUSION: The validation study identified >50% underreporting of CLABSI, most related to misinterpretation of components of the NHSN definition. Continued validation and training will be needed in Connecticut to improve completeness of reported health care-associated infection data and to assure that publicly reported data are valid.