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Background:The Colorado Department of Health conducted a validation project of dialysis event (DE) data entered into the National Health Safety Network (NHSN). Colorado dialysis centers are required by law to report the following DE into NHSN: outpatient intravenous antimicrobial starts (AS); positive blood cultures (PBC); and puss, redness and swelling (PRS) at vascular access sites. Colorado’s law also requires the periodic assessment of validity of reported data to ensure that data comply with Centers for Disease Control (CDC) definitions and criteria. Project objectives were to:
- Assess the extent of and reasons for non-reported DE/infections.
- Assess the extent of and reasons for over-reported DE.
- Provide education to facility staff about common reporting errors and potential causes to ensure consistency with monitoring and reporting events.
Methods: Selected medical records at 25 dialysis clinics in the Denver metro area were reviewed and included patient charts and electronic records for patients with DE that had been entered into NHSN and occurred during a 6-month period before the review date and records for patients with no NHSN DE during the same timeframe.
To identify non-reported DE, patient charts, treatment logs, hospitalization and antibiotic administration logs were reviewed to identify reportable DE. Once identified, NHSN data were checked to see if the DE were reported. To asses over-reporting, NHSN DE without corresponding events in patient charts were investigated through chart and log review to determine why they were entered. To assess knowledge of surveillance methods and NHSN reporting procedures, a survey/interview of each facility’s clinic administrator was conducted.
Results: Of the 484 patient charts reviewed, 235 had no reportable events and 249 had reportable events. A total of 502 events were identified in patient charts and 143 (28%) of those had not been entered into NHSN. The most common type of non-reported event was AS (91, 64%), followed by PBC (30, 21%) and PRS (22, 15%). Of the 413 events that had been entered into NHSN, 54 (13%) were not reportable (over-reported). Of those, 38 (70%) were antibiotic starts, 10 (18%) were PRS and 6 (11%) were PBC. 52% of surveyed staff were unaware of the NHSN reporting protocol and 76% did not know how to correctly report denominator data.
Conclusions: This project enabled the identification of misunderstandings regarding NHSN reporting procedures, definitions and criteria and the education of staff to improve reporting validity and reliability.