BACKGROUND: The validation of National Healthcare Safety Network (NHSN) data assures medical facilities are providing high-quality surveillance data through the identification and correction of reporting errors. The Michigan Department of Health and Human Services (MDHHS) has conducted its first voluntary NHSN audit of central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) for 2014 in multiple acute care facilities statewide.
METHODS: The audit was completed using the standardized “CDC NHSN External Validation and Guidance and Toolkit, 2014.” Facilities were targeted for participation using the CDC Targeted Assessment for Prevention (TAP) methodology. Volunteering facilities provided line lists of 2014 positive blood and urine cultures from all NHSN reporting critical care units. Up to 20 reported cultures and 40 non-reported cultures per infection type were randomly selected. The entire admission period was validated.
RESULTS: The validation captured 43% of Michigan critical care beds. A total of 754 admissions and 874 infection episodes were reviewed. Over 83% of urine infection episodes meeting CAUTI definition were reported correctly to NHSN. Thirteen CAUTIs were not reported, five reported events identified an incorrect event date, and three included clerical errors. Additionally, three reported CAUTIs did not meet definition. Eighty-two percent of blood infection episodes meeting CLABSI definition were reported correctly to NHSN. Eleven CLABSIs were not reported and two reported events identified an incorrect event date. Three reported CLABSIs did not meet definition. NHSN event criteria was correctly applied to 97% of aggregate urine and 96% of aggregate blood infection episodes. Clinical overruling, misidentification of new infections, and complicated medical reports were major causes of reporting errors.
CONCLUSIONS: Validation results indicate Michigan acute care facilities are almost always identifying reportable CAUTIs and CLABSIs and correctly applying NHSN definitions. The elimination of clinical judgement from the reporting process is necessary for improving reporting accuracy. This feedback will help empower infection prevention staff to more accurately apply NHSN definitions.