Background
Healthcare-associated infections (HAI) are infections that patients acquire during the course of receiving medical treatment for other conditions. HAIs are the most common complication affecting hospitalized patients, with between 5 and 10 percent of patients acquiring one or more infections during their hospitalization.
In 2006, the General Assembly amended the MHCC’s statute to give it authority to collect and report information on healthcare-associated infections in hospitals. HG 19-134(e)(6). Certain information on HAI process measures are publicly reported for each Maryland hospital in the Commission’s Maryland Hospital Performance Evaluation Guide (http://mhcc.maryland.gov/consumerinfo/hospitalguide/index.htm). As discussed below, information on additional quality measures is being collected and reported.
The Commission convened an HAI Technical Advisory Committee (TAC) composed of hospital infection preventionists, hospital epidemiologists, public health professionals, and patients/health care consumers. In December 2007 the TAC released a report, Developing a System for Collecting and Publicly Reporting Data on Healthcare-Associated Infections in Maryland. To view this report click here. With the guidance of a standing HAI Advisory Committee, the MHCC has been implementing the recommendations of the TAC in stages.
In 2006-07, the Commission began collecting and reporting HAI information on three process measures designed to prevent infections for patients undergoing hip, knee, and colon surgery: (1) proportion of patients receiving antimicrobial prophylaxis within one hour prior to incision (SCIP-INF-1); (2) proportion of patients receiving the appropriate antimicrobial agent based on current guidelines (SCIP-INF-2); and, (3) proportion of patients whose antimicrobial prophylaxis is discontinued within 24-hours following surgery (SCIP-INF-3). These measures, referred to as Surgical Care Improvement Project (SCIP) measures, have been endorsed by the National Quality Forum (NQF) and adopted by the Centers for Medicare and Medicaid Services (CMS), the Joint Commission, and Hospital Quality Alliance (HQA). As of January 1, 2009, the MHCC expanded its collection of SCIP INF 1-3 measures to include all surgical strata (CABG, other cardiac, hysterectomy, and vascular surgery). The MHCC added two SCIP infection prevention measures, effective for discharges after January 1, 2009: cardiac surgery patients with controlled 6 a.m. postoperative serum glucose (SCIP-INF-4); and surgery patients with appropriate hair removal (SCIP-INF-6). Data for the expanded SCIP measures were reported on the Hospital Guide beginning in January 2010.
Effective January 1, 2009, Maryland hospitals were required to collect and report quarterly data on Active Surveillance Testing (AST) for methicillin resistant Staphylococcus aureus (MRSA) in Intensive Care Units (ICUs), including all units defined as inpatient adult critical care and pediatric critical care (neonatal intensive care units are excluded from this reporting requirement). Hospitals are reporting data on the total number of ICU admissions and the number of patients admitted to the ICU who had an anterior nares swab cultured for MRSA. This data is updated on the Hospital Guide quarterly. To view this information on the Guide click here.
Public reporting for two additional HAI measures began in 2010, including data on Health Care Worker (HCW) Influenza Vaccination Rates and Central Line-Associated Bloodstream Infections. The Centers for Disease Control and Prevention have long recommended annual influenza vaccinations for all HCWs. The National Quality Forum includes influenza vaccination of health care workers as one of its 34 safe practices that should be utilized universally to reduce risk to patients. All Maryland hospitals are currently collecting a uniform data set on HCW influenza vaccination rates. Using an online survey instrument, hospitals are collecting aggregate data on all paid, full-time and part-time employees and house staff (defined as residents and interns) who received FluMist® or an injectable flu vaccine on-site or off-site between September 1st and April 15, 2010. Data on hospital HCW influenza vaccination rates for the 2009-2010 period were reported on the Hospital Guide in July 2010. In October 2010, data on central line-associated bloodstream infections (CLABSIs) in adult and pediatric intensive care units (ICUs) and Level II/III and III neonatal intensive care units (NICUs) were reported on the Hospital Guide. This new data includes information on CLABSIs experienced in Maryland acute care hospitals for the 12-month period, July 1, 2009 through June 30, 2010. To view this information on the Guide click here.
Effective July 1, 2010, the MHCC required all Maryland acute general hospitals to use the National Healthcare Safety Network (NHSN) system to report Surgical Site Infections (SSIs) for three operative procedure categories: knee replacement surgery; hip replacement surgery; and, coronary artery bypass graft (CABG) surgery. The MHCC will publicly report information on SSIs for these three procedure categories in 2011-2012.
Additional information is provided below.
Health Care Associated Infections (HAI) Advisory Committee
Mission and Vision Statement
Committee Members
2012 Meeting Schedule
Agendas/Minutes
HAI Prevention Planning
Presentation to Joint HGO/Finance Committee Briefing (March 22, 2010)
Maryland HAI Prevention Plan (January 1, 2010)
Presentation to Maryland Health Quality and Cost Council (December 18, 2009)
Surgical Site Infections
NHSN Training for Maryland Hospital: SSI
Maryland Register Notice (3/26/10)
Surgical Site Infections Data Collection - FAQs (4/26/11)
Hospital Hand Hygiene Campaign
Report and Recommendations
Health Care Worker (HCW) Influenza Vaccination
2010-2011 Maryland Hospital HCW Influenza Vaccination Survey Summary and Findings - Presentation to Commission
2011-2012 Maryland Hospital HCW Influenza Vaccination Survey Questions
Hospital HCW Influenza Vaccination Survey - FAQs2011-2012 Maryland Ambulatory Surgery Center HCW Influenza Vaccination Survey Questions
Ambulatory Surgery Center HCW Influenza Vaccination Survey - FAQs
Active Surveillance Testing (AST) for MRSA
2009 Maryland Hospital Quarterly Survey of Active Surveillance Testing (AST) for MRSA
Active Surveillance Testing (AST) for MRSA - FAQs
Surgical Care Improvement Project Measures
Central Line-Associated Blood Stream Infections (CLABSI)
Maryland Register Notice (4/11/08)
Maryland CLABSI: Data Quality Review and Chart Audit Report (6/2010)
Maryland CLABSI: Data Quality Review and Chart Audit Webinar Presentation (6/9/2010)
CDC Train-the-Trainer Workshop
The Centers for Disease Control and Prevention, in coordination with the Society for Healthcare Epidemiology of America (SHEA) and Avaris Concepts, LLC, provided a 3-day train-the-trainer workshop on June 2 – 4, 2011 in Baltimore, Maryland. The training was developed to assist State Health Departments with meeting objectives identified in the HAI Plans for providing evidence-based prevention materials to their partners. The workshop provided participants with materials and related training about implementation methods to address the HHS priority prevention targets to eliminate healthcare-associated infections (HAIs). A summary of the training materials is attached.
