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Collaborating and Creating: My Experience Working on the CSTE/CDC Healthcare-Associated Infections Data Analysis and Presentation Standardization Toolkit

Posted By Katrina Hansen, Friday, November 13, 2015
Updated: Friday, November 13, 2015
We, the New Hampshire Healthcare-Associated Infections (HAI) Program, have published nine annual reports on the occurrence of HAI in hospitals and ambulatory surgery centers. These reports provide a summary of HAI data routinely reported in accordance with state law and can be used to identify and monitor improvement over time. The original intent of the NH HAI law was to increase transparency for healthcare consumers and assist with making healthcare decisions. However, experience shows that these reports are primarily used by healthcare facilities. With no standardized template available, our reports have evolved over time as we created our own and adapted various practices from other states to accommodate healthcare facilities and consumers. The NH HAI Program has and continues to struggle with balancing the needs of both technical and consumer audiences while preserving the important nuance and details that are needed to understand the data.
The picture above is a snapshot of NH HAI 2014 Hospital Report. NH uses a ‘red, green, and yellow light’ scheme to indicate if measures are higher, lower, or similar to national data, respectively. Example 1: The central line bloodstream infection (CLABSI) standardized infection ratio (SIR) was 0.61 or 39% fewer (green) infections than predicted based on national data. Example 2: The catheter associated urinary tract infection (CAUTI) SIR was 1.26 or 26% more infections than predicted based on national data. However, this different was not statistically significant, which means the over number of CAUTI was SIMILAR (yellow).
With the leadership of Lindsey Weiner (epidemiologist at the Division of Healthcare Quality Promotion, CDC) and Andrea Alvarez (HAI/influenza program coordinator at the Virginia Department of Health), a multidisciplinary group was formed to collaborate and establish best practices in the analysis and display of HAI data, which resulted in the HAI Data Analysis and Presentation Standardization (DAPS) toolkit. I was privileged to be a part of this workgroup, learn from other HAI colleagues, and participate in discussions to develop a tool that can be used by other programs. Throughout my involvement, common themes arose, including:
  1. We are all healthcare consumers and have competing priorities in our day-to-day lives. We need to remember that short and simple messages are best when trying to reach a general audience.
  2. HAI metrics [e.g., the standardized infection ratio (SIR)] and data limitations are not easy to explain to a consumer audience, let alone some technical audiences.
  3. Symbols and colors can quickly and effectively convey a message. The challenge is picking the right symbols and colors applicable to all settings.
  4. HAI data are continuously evolving; state and federal mandates change; and we need to be flexible to adapting needs.

While on this workgroup, I learned a lot from the discussions regarding challenges other jurisdictions encounter when publishing these important data. Coming from a rural and less populated state, we struggle with having robust enough data to present information for certain measures and facility types. I know we are not the only state working within this context and it was helpful learning from others with similar experiences. I kept this in mind when providing feedback on the toolkit and the need to provide an option to states that have comparable restrictions. Similarly, I used our own experience in NH to help contribute to the healthcare personnel vaccination component of the template. Several approaches are addressed and made available within the toolkit in order to provide flexibility to states.

Going forward, I plan to incorporate as much as possible in future reports. I estimate that we will reach a wider audience and ultimately increase HAI knowledge by ensuring that these data are more meaningful and accessible to all. Participating in the CSTE workgroup was a great opportunity to not only improve our own work in New Hampshire, but also to help shape the way healthcare-associated infections programs move forward together across jurisdictions in a complementary and consistent way.

Please click here to access the HAI DAPS Toolkit.

Katrina Hansen, MPH is healthcare-associated infections program manager at the New Hampshire HAI Program. Click the link above to learn more about the HAI DAPS Toolkit and join the HAI Subcommittee for the opportunity to engage in initiatives such as this.

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Roza P. Tammer says...
Posted Friday, November 20, 2015
Thanks to everyone who worked on this toolkit! We plan to apply many of its recommendations when we report 2015 data. I expect that this will benefit HAI programs and healthcare consumers nationwide.
- Roza Tammer, MPH, NHSN Epidemiologist, Connecticut DPH HAI Program
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Carol Wood-Koob RN says...
Posted Tuesday, November 24, 2015
Great work Katrina and Roza! Thank you
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