Creating Consensus: Ensuring Inter-Rater Reliability for Reporting Infections Using NHSN Surveillance Criteria

Diagnostic Stewardship to Prevent Diagnostic Error

“…Some approaches to diagnostic testing that are designed solely to avoid meeting reportable HAI definitions have been mistakenly confused with diagnostic stewardship; for example, avoiding testing for C difficile in favor of empirical treatment for all cases of hospital-onset diarrhea. Changing diagnostic testing practices to avoid hospital quality metrics without concern for patient outcomes (eg, not collecting blood cultures from patients with central venous catheters to avoid CLABSI reporting) is not diagnostic stewardship, and the CDC and Centers for Medicare & Medicaid Services released a letter advising that such approaches “puts patients at risk.”…”

Visualizing Infection Surveillance Data for Policymaking Using Open Source Dashboarding

“…The NHSN requires use of standardized forms for data collection procedures, and because these forms are used across the very diversified U.S. health care system, they become prohibitive for individual centers to complete. 10,11 Also, NHSN results are of questionable use for evidence-based policy; NHSN rates of CAUTI are extremely sensitive to case definition features, 12 miss many important cases differentially by location, 13 and suffer from unacceptably low interrater reliability, 14 to name a few issues. Further, the NHSN acknowledged in 2013 that there were issues with HCAI case definitions that affected surveillance estimates, so it undertook a process of revision.…”