BACKGROUND: The National Healthcare Safety Network (NHSN) is the most widely used healthcare-associated infection (HAI) tracking system in the U.S., and changes to Centers for Medicare and Medicaid Services incentive programs and rules have greatly increased healthcare facility participation in Arizona. However, the Arizona Department of Health Services (ADHS) has only recently gained direct access to NHSN data, through a data use agreement (DUA) with CDC. An evaluation of the data available to ADHS on key attributes, particularly data quality (completeness) and representativeness, will provide a reference for more accurate interpretation of future findings from NHSN infection and safety data.
METHODS: The system was evaluated using the CDC’s Updated Guidelines for Evaluating Public Health Surveillance Systems. Representativeness was assessed by identifying all Arizona acute care hospitals (ACH) and critical access hospitals (CAH) and comparing data available through NHSN; facilities without available data were identified and characterized. Completeness was assessed by comparing hospitals with NHSN data available to ADHS, by infection type, to those available to CDC. The sensitivity of NHSN for capturing invasive MRSA events reported to Arizona’s communicable disease surveillance system (MEDSIS) was completed by matching all 2014 NHSN LabID MRSA data to 2014 MEDSIS MRSA cases. Additional surveillance system attributes were also considered in the evaluation.
RESULTS: 72% (53/74) of Arizona ACH and 7% (1/14) of CAH reported 2014 data to NHSN that was accessible by ADHS staff. It was calculated that ADHS data include 79% of Arizona hospitals reporting data to CDC for MRSA and C. diff LabID, 90% for CLABSI and CAUTI, 95% for SSI COLO, and 100% for SSI HYST. Veterans Affairs and Indian Health Services hospitals make up a portion of missing facilities. The MRSA analysis revealed a sensitivity of 54% for NHSN capturing MRSA events reported to MEDSIS; 2277 additional NHSN records did not match MEDSIS cases.
CONCLUSIONS: As a result of identifying gaps in facility data completeness, ADHS worked with CDC and was granted access to 18 additional facilities in early December. Although the sensitivity of NHSN for capturing invasive laboratory-reported MRSA cases is rather low, NHSN LabID MRSA surveillance will represent a valuable source of information for monitoring MRSA trends in Arizona by capturing a substantively different group of events. By identifying the completeness and representativeness of the NHSN data available to ADHS, ADHS is better equipped to accurately interpret future findings and effectively use NHSN data for HAI control and prevention.