Michigan Healthcare-Associated Infection Surveillance: Why Voluntary Reporting Works

BACKGROUND:  The Michigan Department of Community Health (MDCH), Surveillance for Healthcare-Associated and Resistant Pathogens (SHARP) Unit conducts voluntary state-wide Healthcare-Associated Infection (HAI) surveillance via the National Healthcare Safety Network (NHSN). Although the Centers for Medicare and Medicaid Services (CMS) requires hospitals to report certain HAIs into NHSN, only unusual occurrences, outbreaks, and epidemics of HAIs are reportable to MDCH.

METHODS: The SHARP Unit continues to build upon a system of trust with Michigan hospitals. Hospitals are encouraged to submit data including and beyond CMS reporting requirements to the SHARP Unit in exchange for personalized surveillance reports and reporting assistance. Michigan NHSN data is analyzed both individually and overall, and is released to the public in aggregate form only.  

RESULTS:  The SHARP Unit has received signed data use agreements to view NHSN data from 86 of 169 (51%) hospitals in Michigan (acute care, critical access, and rehab). In 2013, of 78 hospitals reporting central line-associated bloodstream infections (CLABSI), 30 (38%) reported from locations beyond the CMS requirement, and 55 of 81 (68%) reporting catheter-associated urinary tract infections (CAUTI) reported from additional locations.  Of 78 hospitals reporting colon surgeries and abdominal hysterectomies, 32 (41%) reported procedure data beyond the CMS requirement.  Of the 81 hospitals reporting methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and Clostridium difficile laboratory-identified (LabID) events facility-wide, 18 (22%) also reported from individual locations beyond the CMS requirement. From the CDC 2011 National and State HAI Standardized Infection Ratio (SIR) Report, the MI CLABSI SIR was 0.362 (95% Confidence Interval (CI): 0.323, 0.404) from 94 hospitals, while the SHARP MI CLABSI SIR was 0.392 (95% CI: 0.347, 0.442) from 73 hospitals.  These numbers are very similar, both significantly lower than the published 2011 national CLABSI SIR of 0.592 (95% CI: 0.583, 0.600).

CONCLUSIONS:  Michigan hospitals share CMS-mandated NHSN data, voluntarily report additional procedures, and include additional locations beyond the CMS requirement. There is a culture of trust in Michigan between hospitals, the MDCH SHARP Unit, and other organizations such as the Michigan Health and Hospital Association Keystone Center for Patient Safety and Quality, and MPRO, Michigan’s quality improvement organization. Hospitals are willing to openly discuss infections, infection prevention, and HAI surveillance in their facilities.  This culture has been a leading factor in the low incidence of HAIs in Michigan. Collaboration, prevention, and openness have created an environment in Michigan where extensive HAI surveillance data are available on a voluntary basis.