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Thirty-two outpatient hemodialysis providers in the UnitedStates voluntarily reported 3699 adverse events to the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) during 2006. These providers were previously enrolled in the Dialysis Surveillance Network. The pooled mean rates of hospitalization among patients with arteriovenous fistulas, grafts, permanent and temporary cen tral venous catheters were 7.7, 9.2, 15.7, and 34.7 per 100 patient-months, respectively. For bloodstream infection the pooled mean rates were 0.5, 0.9, 4.2, and 27.1 per 100 patient-months in these groups. Among the 599 isolates reported, 461 (77%) represented access-associated blood stream infections in patients with central lines, and 138 (23%) were in patients with fistulas or grafts. The microorganisms most frequently identified were common skin contaminants (e.g., coagulase-negative staphylococci). In 2007, enrollment in NHSN opened to all providers of outpatient hemodialysis. Specific information is available at http://www.cdc.gov/ ncidod/dhqp/nhsn_FAQenrollment.html.

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Surveillance of health care-associated infections and antimicrobial resistance is an important aspect of prevention. In 2004, the Centers for Disease Control and Prevention had 3 national health care surveillance systems. During 2004-2005, these will be combined into a single Internet-based system, the National Healthcare Safety Network (NHSN). The NHSN will feature a number of enhancements, and ultimately, all US hospitals and other health care facilities will be encouraged to participate. Health care surveillance using standard methods has been very useful and is cited as a model for prevention. However, alternative approaches may improve health care surveillance by reducing complexity, decreasing the burden of data collection, and improving accuracy. These alternative approaches include adopting simpler methods and more-objective definitions, using sampling and estimation, substituting information in computer databases for manually collected data, and increasing surveillance for process measures with known prevention efficacy. Maintaining successful features of standard systems, adopting alternate surveillance approaches, and exploiting new technologies, such as the Internet, will make health care surveillance an even better tool for prevention.

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