Even with the opportunity to improve systems with better detection, some hospitals may try to "game the system," Niedner adds. By using more lax reporting criteria they "may be able to hide some (cultures) that maybe were infections or maybe weren't, saying since it was a 'maybe,' we'll count it out so it won't be included in public reporting and 'we won't get dinged financially.' "
But that kind of thinking, Niedner says, cripples quality improvement. "You can't see the defects or potential defects in care—including the near misses."
Niedner emphasizes that much of the problem has to do with education rather than in rewriting any definitions of what constitutes a catheter-associated bloodstream infection.
"Everyone says we use the CDC definitions, but if you actually ask them how they would rule on this case or that case, [you realize] they aren't using a definition,” adds Niedner. “Are standards being applied consistently? No. But do people think they're applying them consistently? Yes."
Niedner's report highlights an important weakness in the way hospitals are now being measured, with significant implications for quality reporting.
It's a failing that really could be addressed with a more standardized surveillance system as we enter the brave new age of hospital-acquired condition reporting. Patients, payers and providers can and will use it to judge and compare each institution's quality, so it's important that facilities be on a level playing field.
We need to make sure that everyone is taking the same test.