Things started to change in early 2000 when consumers began to fight back. They would say "my family member got an infection and I don't accept that. I want to know what is going on in that hospital." Legislation in various states required hospitals to begin reporting their infection rates to the CDC.
A critical series of [GAO] reports in 2008 indicated the CDC could do even more to prioritize areas needing stronger guidance. In response to these reports, HHS in 2009 developed the National Action Plan to Prevent Health Care-Associated Infections, with national five-year goals for HAI prevention.
HLM:So what changed?
Cardo:We started working more closely with CMS and the Agency for Healthcare Research and Quality. In addition, we learned that when you start having data (through NHSN), and you make it available, that's when people start paying attention.
Having the data can put people at the table. A lot of the CDC's effort was to make sure that hospitals that were reporting data were reporting it the same way, using the same definitions, and changing those definitions as science advances. In the past, one group used administrative data, another created its own definitions. To participate in NHSN, you have to follow the set definitions; it's a condition of participation.
The CDC also has been working with hospitals to make sure they have the appropriate data collection technology. It has introduced the TAP system, Targeted Assessment for Prevention, to help hospitals with more than the expected rates of infection.
Also of importance is that the CDC and states have several ways of validating the data that hospitals submit. One thing that's great about having data is that you can see what prevention strategies are working, and what more needs to be done.
HLM:One issue is that often providers aren't using the same definitions. How do you get everyone on the same page, to clarify definitions?
Cardo:We get input from users, hospital associations, and health departments to identify ways to improve definitions.
HLM:How are you working with the CMS? Data collection by NHSN is now used in two pay-for-performance programs, the hospital-acquired condition penalty that begins Oct. 1, and the value-based purchasing program that now includes weights for CLABSI and CAUTI.