Evaluation of the Healthcare-Associated Hepatitis Surveillance System in New York State

BACKGROUND: Healthcare-associated hepatitis is an emerging public health problem. The recent shift in healthcare delivery to outpatient settings with limited oversight and infection control resources has made surveillance critical. In New York State (NYS) all laboratory confirmed cases of hepatitis are reported via electronic surveillance systems. The Bureau of Healthcare-Associated Infections (BHAI) uses this information to track and investigate potential transmission in healthcare facilities. This study evaluates the New York Healthcare-Associated Hepatitis Surveillance System (NY-HAHSS) and provides recommendations to improve its future use. 

METHODS: Evaluation was conducted using CDC Guidelines for Evaluating Public Health Surveillance Systems. Data on NYS cases of healthcare-associated hepatitis B and hepatitis C were extracted from the Electronic Clinical Laboratory Reporting System (ECLRS) and paired with an investigation timeline in NY-HAHSS. To evaluate timeliness, median times between three points (diagnosis date, BHAI notification date, investigation completion date) within NY-HAHSS were calculated for 2011−2012. Wilcoxon rank-sum tests were performed to determine significance. Stakeholders from NYS Department of Health were interviewed to evaluate the simplicity and usefulness of NY-HAHSS.

RESULTS: Compared to 2011, median time was shorter for all intervals in 2012. Median time between diagnosis date and BHAI notification date in 2012 (37 days, N=14) was significantly lower than in 2011 (98 days, N=19, p=0.03). No significant differences were found for either median time between BHAI notification date and investigation completion date in 2012 (73 days, N=13) compared to 2011 (89 days, N=19, p=0.82) or median time between diagnosis date and investigation completion date in 2012 (110 days, N=13) compared to 2011 (187 days, N=19, p=0.123). Seven stakeholders were interviewed about NY-HAHSS. Regarding simplicity, four of seven stakeholders (57%) were dissatisfied. The laborious data collection process, inadequate coordination with local health departments, and manual tracking of investigations were cited as areas in need of improvement. All stakeholders found NY-HAHSS to be useful. 

CONCLUSIONS: From 2011−2012, NY-HAHSS demonstrated a marked improvement in timeliness. Greater collaboration with Bureau of Communicable Disease Control and weekly verification of NYS healthcare-associated hepatitis cases might explain this difference. Furthermore, evaluation of NY-HAHSS revealed it was useful for investigating potential healthcare exposures, managing outbreaks, and monitoring trends in hepatitis in NYS. In the future, efforts should be made to improve the simplicity of NY-HAHSS. Creating a formal database for NY-HAHSS and training additional BHAI employees to manage it would streamline the data collection process and enhance the data analysis capabilities of NY-HAHSS.