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BACKGROUND: Notification of infectious diseases to PHA is a critical component in mitigating public health risks. As a federal agency, VHA has historically been exempt from state/local mandates that require infectious disease reporting to PHA. In 2013, VHA issued Directive 2013-008, Infectious Disease Reporting, mandating such reporting by VHA facilities. We implemented a brief survey of VHA health care facilities to collect baseline infectious disease reporting data, to determine nationwide implementation of the Directive, and identify potential improvements for public health reporting by VHA.
METHODS: We administered an eight-question, self-reported, online survey which included a field for voluntary comments. The survey population was Infection Control Professionals (ICP), or designee, at 140 VHA facilities throughout the nation. Prior to fielding, the instrument was tested to assess validity, logic, and subject-matter accuracy.
RESULTS: All 140 facilities responded to the survey and 100% are reporting some infectious diseases; however, two facilities began reporting to PHA only after the 2013 Directive was issued. While most facilities are reporting sexually transmitted diseases (71.4%), tuberculosis (71.4%), and acute bacterial gastroenteritis (69.3%), only 11 facilities (7.9%) are reporting healthcare-associated infections (HAI), and 31 facilities (22.1%) are reporting multidrug-resistant organisms. The majority of facilities (93.6%) have policies designating reporting responsibility to one or more individuals. Out of 140 respondents, 126 indicated ICP were responsible for reporting to PHA, while 70 respondents designated laboratory staff. The average number of individuals designated to report was 1.9 per facility. Survey results and comments from participants indicated significant variability and uncertainty regarding reporting to PHA based on the location of patients versus facility. The majority of facilities utilized fax and/or phone for reporting to PHA. Electronic laboratory reporting was employed by 66 facilities. Per VHA policy, a written agreement between the VHA facility and PHA is required to allow the facility to disclose infectious disease data. One-hundred nineteen (85.0%) of facilities have a written agreement; fifteen (10.7%) were not sure; six (4.3%) did not.
CONCLUSIONS: VHA facilities were found to generally be in compliance with state/local requirements and VHA Directive 2013-008. However, gaps in reporting, especially HAI, and in compliance with VHA privacy policy were noted and represent areas for further investigation. As this survey was self-reported, a detailed audit is planned to verify findings and further refine facility needs and opportunities for improvement. Survey respondents’ comments endorsed system-wide electronic lab reporting by VHA, but efforts at the national level need to be strengthened.