BACKGROUND: Efficient detection and response to healthcare associated infection (HAI) outbreaks is vital in minimizing patient harm and preventable healthcare expenditures. Issues with detection and investigation may lead to underreporting of facility outbreaks. To better understand outbreak burden and improve facility reporting in Hawaii, we examined HAI outbreak count, detection, and response within acute care hospitals (ACHs) and critical access hospitals (CAHs) across the state in 2015.
METHODS: Using Epi Info 7, an online survey was created and distributed to ACH and CAH infection preventionists (IPs) (N=27) statewide. The self-report survey contained five multi-part questions on 2015 outbreak burden, methods of detection, and investigation process. Using frequency data, results from the survey were analyzed both in aggregate form and by facility type (ACH/CAH). Significant differences in outbreak detection and investigation by facility type were ascertained using Fisher’s exact test in SAS v 9.4.
RESULTS: Completed surveys were received from 14 ACHs and 8 CAHs (N=22; 82% response rate). Nine (41%) hospitals experienced at least one outbreak during 2015. Among all facilities, detection methods most often included identification of an unusual organism or organism of concern (21; 96%), alerts from the laboratory (19; 91%), and notifications from the health department (19; 91%). Number of detection methods utilized ranged from 2 to 7, with no single method used by all facilities. Ten (46%) facilities reported they would complete all 10 outbreak investigation steps recommended by Association for Professionals in Infection Control and Epidemiology (APIC). This comprised 13% of CAHs (n=1) and 63% of ACHs (n=9). ACHs were significantly more likely than CAHs to implement several of the recommended steps, including establishing a preliminary case definition (100% vs 50%; p=.01) and developing a line list (71% vs 12%; p=.02). Eight (41%) facilities indicated they lacked available resources or capacity to respond to an outbreak and would seek assistance from the Hawaii State Department of Health (HDOH).
CONCLUSIONS: Hospitals throughout Hawaii have varying capacity to detect and investigate HAI outbreaks. Many facilities, especially CAHs, are not completing all recommended investigation steps; a substantial proportion would need additional support to address an outbreak. Results from this study are helpful in understanding gaps in outbreak detection and investigation capacity that may lead to underreporting. Next steps will involve exploring reasons behind observed gaps and collaborating with facilities to improve HAI outbreak detection, investigation, and reporting in Hawaii.