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Mandatory Reporting of Healthcare-Associated Infections: How do we Measure Success?
The German Approach.
PETRA GASTMEIER, MD.;
Hanover Med. Univ., Hannover, Germany.
In order to measure healthcare-associated infections (HAI), a surveillance system was established in Germany in 1997, which is known under the acronym KISS (Krankenhaus-Infektions-Surveillance-System). The system is based on the experiences and principles of the American NNIS system, but takes into account the local circumstances of participating hospitals in Germany. Hospitals can select among seven KISS components, which focus on the following topics or areas: intensive care units (ICUs), neonatology intensive care patients with very low birth weight, hematology-oncology patients, surgical patients, non-ICU patients with vascular or urinary catheters, as well as outpatients with ambulatory operations. A further module was developed for surveillance of MRSA in hospitals. KISS is a voluntary system, only the reference data are published and can be used for benchmarking by the individual hospitals. Meanwhile more than 400 of a total of about 2000 German hospitals are participating. Healthcare associated infection reduction rates between 20-30 % were achieved for the individual surveillance components.
One of the most crucial points for relying on surveillance data is data validity. Therefore a validation study was performed for the ICU component in 2000. A total of 286 reported infections and 1,195 medical records with no reported infection from 20 randomly selected KISS ICUs were reviewed by two trained physicians. The median specificity was 99.6%, the median sensitivity was 81%, however with a range from 30 to 100%. In 2006 a further validation study using case histories was organized. 10 case studies including 13 HAI were sent to 364 persons responsible for surveillance in their ICUs. The response rate was 46%. The overall median specificity was 94 % (range 65-100%), the overall median sensitivity was 69% (range 31-100%).
Therefore the key questions for mandatory public reporting of HAI remain: Will the information mislead or confuse rather than empower consumers? Will there be an increased motivation for clinicians and hospital administrators to attend to HAI reduction that leads to safer care and fewer HAI? Until now most of the German consumers are not demanding it. However, the insurance companies are more and more demanding mandatory participation in surveillance systems. For example all German neonatal ICUs caring for very low birth weight infants have to participate in the KISS surveillance component for very low birth weight infants. |
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