Implementation of Mandatory Reporting of Healthcare Associated Infections in Long Term Care Facilities in Pennsylvania

Background:

Reports of the patterns of healthcare associated infections (HAIs), especially at the national and state level, have generally focused on the hospital setting.  However, complex types of health care are now being provided outside of the hospital, and it is increasingly important to document the patterns of HAIs in these settings. In 2007, legislation was passed in Pennsylvania requiring reporting of all HAIs from not only the state’s hospitals but also from long term care facilities (LTCFs).  The legislation specified use of the National Healthcare Safety Network by hospitals but did not address system requirements for LTCFs.  After examining the available options, Pennsylvania’s Department of Health and Patient Safety Authority elected to develop a module for HAIs within a pre-existing, web-based system for reporting adverse events in health care settings know as the Pennsylvania Patient Safety Reporting System (PA-PSRS).  The modules, which include individual infections and utilization data, were developed and piloted in late 2008 and early 2009, and after a series of statewide training seminars, phased implementation began in mid-2009. 

Objective:

To describe development, implementation, and utilization of mandatory HAI reporting from LTCFs in Pennsylvania
Methods:

Description of system and descriptive analysis of early data on reported HAIs from LTCFs.

Results: Reporting requirements were based on modifications of the commonly used McGeer criteria for HAIs in LCTFs.  A total of 15 infection types, including urinary, respiratory, skin & soft tissue, gastrointestinal, and device-associated infections, are reportable from the state’s 718 licensed LCTFs, along with daily patient census and use of urinary catheters (patient days and catheter days).  HAI pathogens are also be reported in PA-PSRSs if lab testing is performed.  Between June 1 (when the first LCTFs began reporting) and October 3, 2009, a total of 10,942 non-duplicate HAIs were reported from 716 (>99%) of the facilities, for a mean of 15 infections per facility over the 4 month period.  This translates to just over 600 HAI reports per week.  Among the initial reports, the most common infection types were respiratory (38.3%), skin and soft tissue (24.7%), urinary tract (18.8%) and gastrointestinal (1.8%).  These accounted for almost 84% of all infections. 

Conclusions: Because of a limited infrastructure, HAI reporting from LCTFs is challenging but with adequate support can be achieved.  A separate system that was already familiar to LCTFs was used in PA rather than NHSN for reporting of HAIs.  More than 99% of the state’s LTCFs have successfully submitted data on HAIs.  Efforts should be increased at the federal level and elsewhere to gather data on HAI patterns in sectors of the healthcare system other than hospitals, including long term care and outpatient settings.