Claire Dawson
Healthcare-associated infections (HAI) are a major concern for hospitals and healthcare facilities. HAI data reporting is an important component of quality care measurement, and most states in the US have adopted laws requiring hospitals to report at least one type of HAI. The specific requirements vary across states, with some mandating public disclosure of infection rates, while others allow release upon specific request. Hospitals in Texas, Washington, Florida, Pennsylvania, and Illinois are required to report HAI data, with Texas and Washington utilizing the National Healthcare Safety Network (NHSN) system. This system helps monitor and validate HAI data, supporting quality improvement and infection control efforts.
| Characteristics | Values |
|---|---|
| Reporting of HAIs | In 2005, Florida became the first state to require web-based publication of hospital-specific infection rates. |
| Since 2003, the majority of states and territories have adopted laws requiring the reporting of at least one HAI. | |
| States that have mandated HAI reporting have also required the release of that information to the public. | |
| Hospitals licensed by the Washington State Department of Health are required to report information about certain HAIs using the NHSN system. | |
| Texas hospitals are required to report HAIs through the NHSN. | |
| Pennsylvania hospitals are subject to a phased reporting requirement, which began in 2004 with specific surgical site infections. | |
| Illinois has implemented an "Illinois Action Plan to Prevent Health Care Associated Infections and Antimicrobial Resistance". | |
| Reporting of PAEs | Texas law requires the reporting of Preventable Adverse Events (PAEs). |
| Reporting requirements | Reporting requirements differ based on Healthcare Type. |
| Reporting requirements vary across states. | |
| Reporting requirements can be altered by the state DOH without legislatively amending statutory provisions. | |
| Reporting requirements can be influenced by federal mandates. | |
| Reporting requirements can be phased in over time. | |
| Reporting requirements can be based on general authority requiring reporting of "diseases of public health importance" or specific, detailed legislative authority regarding the reporting of HAIs. | |
| Reporting requirements can include the release of information via Internet posting or only upon specific request. | |
| Reporting requirements can include the release of information with or without individual hospital identifiers. |
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What You'll Learn
NHSN enrolment and reporting
NHSN, or the National Healthcare Safety Network, is the CDC's healthcare-associated infection tracking system. It is used by hospitals to report information about certain HAIs, or healthcare-associated infections.
NHSN Enrollment and Reporting
NHSN enrolment is the first step in HAI reporting. Facilities with more than one campus at different physical locations must enrol each campus location separately, unless they are connected by a sky bridge or another physical connector. After enrolling, facilities must perform set-up steps to add additional users, locations within the facility (if a general hospital), and surgeons (optional).
Once enrolled and set up, facilities must join the appropriate HAI reporting group in NHSN and accept the confer rights template. The only user that can complete this process is the NHSN Facility Administrator, who is usually the person who enrolled the facility in NHSN. After this, additional users can be added.
The Facility Administrator can manage additional users in NHSN, under the User page. New users must follow the steps provided on the CDC NHSN Group Users webpage. If the Facility Administrator leaves, they must reassign the role to another user, or the facility will need to contact NHSN to manually change the administrator.
NHSN Reporting Updates
The CDC has recently announced updates to NHSN reporting for long-term care facilities, effective from the first week of reporting for the fourth quarter of 2024 (September 30 – October 6). These updates include a new definition of "up to date" for COVID vaccination, with individuals now considered up to date if they have received the 2024-2025 updated COVID-19 vaccine. Long-term care facilities will also report on a new combined form for residents in the respiratory pathogens module, which includes vaccination, case, and hospitalization data for COVID, flu, and respiratory syncytial virus (RSV). COVID vaccination, case, and hospitalization data are required, while flu and RSV reporting are optional.
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State-mandated HAI reporting
In the United States, most states and territories have mandated that acute care hospitals report healthcare-associated infections (HAI) to their departments of health. As of January 31, 2013, 37 US states and territories (71%) had adopted laws requiring HAI data submission. However, the specific requirements for data submission vary across states, including how the data is submitted, whether the data is publicly reported, and if facility identifiers are included in the public reports.
Connecticut's HAI reporting requirements are aligned with those established by the federal Centers for Medicaid and Medicare Services (CMS) for facilities participating in CMS quality improvement and reporting programs. Acute care hospitals, long-term acute care hospitals, inpatient rehabilitation facilities, and outpatient dialysis facilities are required to report certain HAIs to the Connecticut Department of Public Health (DPH).
Overall, state-mandated HAI reporting aims to improve infection control and prevention in healthcare facilities by collecting and analyzing data on HAIs. By understanding the trends and specific requirements in each state, healthcare facilities can work towards reducing the incidence of HAIs and improving patient outcomes.
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HAI data release to the public
In the United States, the National Healthcare Safety Network (NHSN) is the system used to report and monitor Healthcare-Associated Infections (HAI). Hospitals licensed by the Washington State Department of Health, for example, are required to report certain HAIs using the NHSN system. The NHSN is also used in Texas, where Chapter 98 of the Texas Health and Safety Code requires the Texas Department of State Health Services to establish the Texas HAI reporting system to provide the public with HAI data and support quality improvement and infection control activities in healthcare facilities.
The NHSN is a program of the Centers for Disease Control and Prevention (CDC). The CDC remains the authority on NHSN data collection protocols, and its Healthcare Associated Infection (HAI) surveillance application vendors monitor, evaluate, and test each release of the HAI implementation guide. The CDC works with Health Level Seven (HL7) to develop and publish additional constraints as reports are modified and new report types are defined.
The NHSN includes a range of tools and information for Infection Control Assessment and Response (ICAR) facilitators, healthcare professionals, and data enthusiasts. HAI reporting requirements, dashboards, reports, and user group calls are all available on the NHSN website. The NHSN also provides interactive dashboards that display the last five years of available data on HAIs that hospitals have to report.
In Texas, the Texas Health Care Safety Network (TxHSN) was developed to help coordinate and simplify the communication process between the state and reporting healthcare facilities. It is a web-based application that facility contacts can log into to view reports and make comments about their HAI data.
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HAI prevention initiatives
Healthcare-associated infections (HAI) are a significant threat to patient safety and can have serious consequences, including prolonged hospital stays, high supplementary costs, and even patient mortality. As such, various initiatives and programs have been implemented to prevent and control HAI occurrences.
One such initiative is the HAI National Action Plan, which serves as a roadmap for preventing HAIs in acute care hospitals, ambulatory surgical centers, end-stage renal disease facilities, and long-term care facilities. The plan includes phases that address common infections, research agendas, integrated information systems, policy options, and public awareness campaigns. It also emphasizes the importance of antibiotic stewardship to prevent resistance in HAIs.
The Agency for Healthcare Research and Quality (AHRQ) also plays a crucial role in HAI prevention. AHRQ's HAI program funds research and implementation projects that advance the science of HAI prevention, develop more effective approaches, and help clinicians apply proven methods to prevent HAIs. They provide toolkits and resources to help intensive care units (ICUs) and long-term care facilities reduce specific types of infections, such as catheter-associated urinary tract infections (CAUTI) and central line-associated bloodstream infections (CLABSI).
The Centers for Disease Control and Prevention (CDC) also fund a network of HAI/Antimicrobial Resistance (AR) Programs to detect, prevent, and respond to HAI/AR occurrences. These programs aim to improve healthcare safety and quality by preventing the emergence and spread of HAIs and promoting antibiotic stewardship. The CDC also provides technical expertise and funding to state, local, and territorial health departments to enhance their contributions in these areas.
Additionally, the CDC initiative States Targeting Reduction in Infections via Engagement (STRIVE) offers courses on technical and foundational elements of HAI prevention. The Nursing Home Infection Preventionist Training Course, developed in collaboration with the Centers for Medicare and Medicaid Services, is a free, specialized course for healthcare workers responsible for infection prevention and control programs.
At the state level, initiatives like Iowa HHS's Project Firstline, in cooperation with the CDC, provide infection control education to frontline healthcare workers. They offer a range of resources, including educational posters and videos, to promote proper infection control practices in healthcare facilities.
These initiatives and programs demonstrate a comprehensive approach to HAI prevention, involving federal, state, and local entities working together to enhance patient safety and improve healthcare quality.
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HAI reporting requirements
In the United States, reporting requirements for healthcare-associated infections (HAI) are determined at the state level. Since 2003, the majority of states and territories have adopted laws requiring the reporting of at least one HAI. States that have mandated HAI reporting have also required the release of that information to the public, through both hospital-based data and aggregate state statistics. However, the specific details of these reporting requirements vary across states.
For example, in Texas, Chapter 98 of the Texas Health and Safety Code requires the Texas Department of State Health Services to establish the Texas HAI reporting system. All facilities are required to report their data through the National Healthcare Safety Network (NHSN). Similarly, in Washington State, hospitals licensed by the Washington State Department of Health are required to report certain HAIs using the NHSN system. The NHSN is a product of the Centers for Disease Control and Prevention (CDC) and is used to monitor patient care quality across institutions. Washington State law also requires the regular evaluation of the quality and accuracy of HAI reporting.
In Pennsylvania, a phased reporting requirement was employed, beginning in 2004 with specific surgical site infections and expanding reporting categories each year until hospitals were required to report all HAIs. Florida was the first state to require web-based publication of hospital-specific infection rates in 2005. Illinois has also implemented a variety of education and prevention initiatives with hospitals, nursing homes, and outpatient primary care providers to prevent HAIs and antimicrobial resistance.
While the specific requirements vary, most states with HAI laws require the reporting of CLABSI, MRSA, and C. difficile infections. Surgical site infections (SSI) are also commonly reported, particularly following inpatient procedures such as abdominal hysterectomy or colon surgery.
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Frequently asked questions
Yes, hospitals do have to report HAI data. However, the reporting requirements differ based on the state and healthcare type.
HAIs, or Healthcare-Associated Infections, refer to infections that are acquired by patients in healthcare facilities.
Some common examples of HAIs include Clostridioides difficile (C. difficile), Methicillin-resistant Staphylococcus aureus (MRSA), and Surgical Site Infections (SSI).
Hospitals typically report HAI data through the National Healthcare Safety Network (NHSN), which provides definitions and guidelines for surveillance and reporting of HAIs.
Reporting HAI data is important for several reasons, including improving patient safety, increasing public awareness, and helping healthcare facilities implement effective infection control measures.
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