What are HAI's?
Healthcare-associated infections (HAI) are infections that patients acquire during the course of receiving medical treatment for other conditions. HAIs are a common complication affecting hospitalized patients, with about one in 25 hospital patients having an HAI at any time in the United States.
Reporting in Maryland
Current
Acute care hospitals are required to report the following data through the Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network (NHSN):
- Central Line Associated Bloodstream Infections (CLABSI) in neonatal intensive care units (NICUs), all adult and pediatric intensive care units (ICUs) and medical, surgical, and medical/surgical wards.
- Catheter Associated Urinary Tract Infections (CAUTI) in all adult and pediatric intensive care units (ICUs) and medical, surgical, and medical/surgical wards.
- Surgical Site Infections (SSIs) for hip (HPRO) and knee (KPRO) replacement surgeries, coronary artery bypass grafting (CABG/C), colon (COLO) and abdominal hysterectomy (HYST) surgeries.
- Laboratory Identified Clostridium difficile Infections (CDI) for facility wide inpatient locations including the emergency department and 24 hour observation locations (NICUs, Well Baby Nurseries, and Well Baby Clinics are excluded).
- Laboratory Identified Methicillin-resistant Staphylococcus aureus (MRSA) Bacteremia for facility wide inpatient locations including the emergency department and 24 hour observation locations.
- Healthcare Personnel (HCP) Influenza Vaccination including all inpatient and outpatient healthcare personnel.
HAI data is reported on the Commission's Maryland Quality Reporting website.
History
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 acute care hospital on the Commission’s Maryland Hospital Guide. 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. With the guidance of a standing HAI Advisory Committee, the MHCC had been implementing the recommendations of the TAC in stages until 2014 when Maryland aligned with CMS reporting requirements in support of the state's waiver from CMS.
In 2010, the Commission developed the Maryland Healthcare-Associated Infections (HAI) Prevention Plan in consultation with the Department of Health and Mental Hygiene (DHMH) Infectious Disease, Epidemiology and Outbreak Response, and with the Maryland Health Quality and Cost Council. The Commission’s HAI Advisory Committee guided the development of this initial plan and continues to provide on-going guidance.
2016 Revised Maryland Healthcare Associated Infections Prevention Plan: In 2016, DHMH updated the plan to address strategies for tracking, reporting, evaluating, and preventing healthcare-associated infections in the state.
In 2019, the HAI Advisory Committee transitioned to the Maryland Department of Health to support HAI prevention initiatives. Public reporting of HAIs remains a priority for MHCC and staff continue to participate in the Advisory Committee.
Timeline for mandatory HAI reporting by Maryland Hospitals:
2008
- Hospital enrollment in the CDC National Healthcare Safety Network (NHSN) system
- CLABSI in ICUs (Adult/Pediatrics, NICU)
2009
- Active Surveillance Testing for MRSA in ICUs using MHCC survey. The requirement ended in 2012 following sustained hospital performance over 90%.
- Healthcare Worker Influenza Vaccination Rates using MHCC survey
- SCIP INF 1-3 expanded to all surgical strata (CABG, other cardiac, hysterectomy, and vascular surgery)
- Cardiac surgery patients with controlled 6 a.m. postoperative serum glucose (SCIP-INF-4)
- Surgery patients with appropriate hair removal (SCIP-INF-6)
2010
- SSI reporting for hip, knee, and CABG procedures (July 1st)
2013
- Clostridium difficile LabID facility-wide inpatient locations (July 1st)
- Expanded data collection requirements to align with CMS (effective January 1, 2014)
2014
- Maryland aligns with CMS reporting requirements
- CAUTI in adult/pediatric ICUs
- MRSA bacteremia LabID facility-wide inpatient locations
- SSI for abdominal hysterectomy and colon
- NHSN Healthcare Personnel Influenza Vaccination module, reporting expanded to all outpatient healthcare personnel
2015
- Both CLABSI and CAUTI reporting expanded to include adult/pediatric medical, surgical, and medical/surgical wards
Additional information is provided below:
Data Quality Review and Validation
Auditing the HAI data reported by the hospitals is a key component of the MHCC public reporting initiative. MHCC has been reviewing and auditing HAI data since 2009 soon after public reporting began.