BACKGROUND: Acute care hospitals (ACH) have been required to report laboratory-identified (LabID) event data to the Tennessee Department of Health (TDH) through the National Healthcare Safety Network (NHSN) since July 2010. Facilities are required to report two types of LabID events: positive Methicillin-resistant Staphylococcus aureus (MRSA) blood cultures and positive laboratory test results for Clostridium difficile (CDI) toxin A and/or B. TDH conducted a validation of NHSN LabID event data to assess data quality and to identify common reporting errors and misconceptions among Tennessee facilities.
METHODS: TDH used the NHSN external validation toolkit and selected 31 facilities for validation during 01/01/2015–06/30/2015. Twenty three facilities were selected for MRSA and 23 for CDI. Up to 60 positive laboratory specimens were reviewed for each selected event type (MRSA and/or CDI). Patient medical records, including location within the facility and laboratory records, were reviewed to determine if the selected specimen met LabID event criteria
RESULTS: TDH reviewed 512 positive MRSA blood culture results and identified 446 reportable MRSA events. Of the 446 reportable events, 66 had not been reported and 57 events were reported with errors. An average of 3.86 MRSA events per facility were not reported during the evaluation period and an average of 2.6 (range = 0–10) MRSA events per facility contained one or more errors. TDH reviewed 535 positive CDI stool specimen results and identified 516 reportable CDI events. Of the 516 reportable events 53 were not reported and 70 events were reported with errors. An average of 2.6 CDI events per facility were not reported during the evaluation period and an average of 3.2 (range = 0–10) CDI events per facility contained one or more errors. Clinical decision support software (CDSS) was utilized by 63% of facilities while 33% entered data manually. Using a chi-squared test there was no significant difference in reporting accuracy in facilities using CDSS in event identification compared to facilities that manually identified events (72.57% vs. 72.72%, p=0.9655).
CONCLUSIONS: Validation of NHSN LabID data provided TDH with valuable information about data quality as well as common misconceptions of reporting requirements. CDSS is widely used across the state, but does not appear to improve reporting accuracy. The data validation project strengthened relationships with infection preventionists, improving communication between TDH and the ACH community through targeted education and training to ensure broader understanding of NHSN definitions and improve reporting quality.