BACKGROUND: Hospitals and nursing homes are required to report all outbreaks and certain communicable diseases to the New York State Department of Health (NYSDOH) Nosocomial Outbreak Reporting Application (NORA). New York State (NYS) also has a role-based directory which allows communication with healthcare personnel, such as infection control practitioners (IPs), when contact information for a person with that role is populated by facilities. As part of performance improvement activities, in 2013 the NYSDOH began contacting facilities that had not reported to NORA and those with no personnel listed in the IP role.
METHODS: A total of 175 hospitals and 613 nursing homes in NYS were analyzed, after excluding Critical Access Hospitals, facilities with 25 or fewer acute care or residential beds, and facilities not open during the time periods analyzed. A facility was considered to be underreporting if it submitted zero NORA reports from 2010 to 2012 or 2013 to 2015. Reporting was analyzed during these two time periods to determine trends. Data from the role-based directory was analyzed to determine if facilities with an assigned IP role were more likely to report. The analysis was performed using SAS 9.3 and Excel.
RESULTS: The number of outbreaks reported to NORA by hospitals increased from 2010-2012 (N=616 total reports) to 2013-2015 (N=930). The number of unique hospitals that reported to NORA between the two time periods decreased from 133 to 132. The number of outbreaks reported to NORA by nursing homes increased from 2010-2012 (N=2,531) to 2013-2015 (N=3,144). The number of unique nursing homes that reported to NORA between the two time periods increased from 518 to 579. Approximately 96% of nursing homes with a person listed in the IP role reported to NORA at least once, compared to 84% of nursing homes with no person listed in the IP role (chi-square p<0.05). No significant difference was found among hospitals with or without a listed IP role.
CONCLUSIONS: There was a marked increase in the number of outbreaks reported to NORA during 2013-2015 compared to 2010-2012. This may be related to NYSDOH outreach. A limitation is that the earliest IP role data available was from January 2016, one month after the time period analyzed. Timely and complete reporting of communicable diseases is critical for NYSDOH response activities. NYSDOH’s efforts to contact facilities with low compliance should be continued, including an assessment of the barriers to NORA reporting.