Posted on December 18, 2015
In his commentary, Dr. Horowitz (Professor, Division of Infectious Diseases and Immunology at NYU School of Medicine) notes that the surveillance definitions used by infection preventionists (IPs) are necessary to ensure standardized and consistent case-finding for valid intra- and inter-hospital comparisons but that the ignorance of clinical factors used by clinicians to define an infection and inform treatment decisions is not well accepted. He describes a “destructive triangulation” that has risen between hospital administrators, clinicians and IPs primarily fueled by publicly reported HAI rankings and pay-for-performance reimbursement.
High HAI rates derived from an IP’s use of surveillance definitions without clinician agreement has led to pressure on the IP to revise reporting and has led to “an atmosphere of distrust” that undermines the policy development and educational initiatives of the IP. Further, he feels that this distrust has promoted questionable clinician practices or “bad behavior.” He appears to be right as CDC and CMS released their communique alert on the reporting of accurate HAI data not long after Dr. Horowitz’s commentary was published, which calls out two of these behaviors:
I would offer that the subjective bias that is inherent in the use of the surveillance definitions by IPs, coupled with the pressure to “game” the data from hospital administrators and clinicians, are two very good reasons to accelerate the adoption of fully electronic surveillance for HAI reporting.
1 Horowitz HW. Infection control: Public reporting, disincentives, and bad behavior. Am J Infect Control 2015 (43):989-91.
2 Adherence to the Centers for Disease Control and Prevention’s (CDC’s) Infection Definitions and Criteria is Needed to Ensure Accuracy, Completeness, and Comparability of Infection Information. CDC Division of Healthcare Quality Promotion Policy Office: October 2015.