McKibben Linda, Horan Teresa, Tokars Jerome I, Fowler Gabrielle, Cardo Denise M, Pearson Michele L, Brennan Patrick J
Office of the Director, Division of Healthcare Quality Promotion, National Cancer for Infectious Diseases, Centers for Disease Control and Prevention, United States Department of Health and Human Services, Atlanta, GA 30333, USA.
Am J Infect Control. 2005 May;33(4):217-26. doi: 10.1016/j.ajic.2005.04.001.
Since 2002, 4 states have enacted legislation that requires health care organizations to publicly disclose health care-associated infection (HAI) rates. Similar legislative efforts are underway in several other states. Advocates of mandatory public reporting of HAIs believe that making such information publicly available will enable consumers to make more informed choices about their health care and improve overall health care quality by reducing HAIs. Further, they believe that patients have a right to know this information. However, others have expressed concern that the reliability of public reporting systems may be compromised by institutional variability in the definitions used for HAIs, or in the methods and resources used to identify HAIs. Presently, there is insufficient evidence on the merits and limitations of an HAI public reporting system. Therefore, the Healthcare Infection Control Practices Advisory Committee (HICPAC) has not recommended for or against mandatory public reporting of HAI rates. However, HICPAC has developed this guidance document based on established principles for public health and HAI reporting systems. This document is intended to assist policymakers, program planners, consumer advocacy organizations, and others tasked with designing and implementing public reporting systems for HAIs. The document provides a framework for legislators, but does not provide model legislation. HICPAC recommends that persons who design and implement such systems 1) use established public health surveillance methods when designing and implementing mandatory HAI reporting systems; 2) create multidisciplinary advisory panels, including persons with expertise in the prevention and control of HAIs, to monitor the planning and oversight of HAI public reporting systems; 3) choose appropriate process and outcome measures based on facility type and phase in measures to allow time for facilities to adapt and to permit ongoing evaluation of data validity; and 4) provide regular and confidential feedback of performance data to healthcare providers. Specifically, HICPAC recommends that states establishing public reporting systems for HAIs select one or more of the following process or outcome measures as appropriate for hospitals or long-term care facilities in their jurisdictions: 1) central-line insertion practices; 2) surgical antimicrobial prophylaxis; 3) influenza vaccination coverage among patients and healthcare personnel; 4) central line-associated bloodstream infections; and 5) surgical site infections following selected operations. HICPAC will update these recommendations as more research and experience become available.
自2002年以来，已有4个州颁布了立法，要求医疗保健机构公开披露医疗保健相关感染（HAI）率。其他几个州也在进行类似的立法努力。支持强制公开报告HAI的人认为，公开此类信息将使消费者能够在医疗保健方面做出更明智的选择，并通过减少HAI来提高整体医疗保健质量。此外，他们认为患者有权了解这些信息。然而，其他人担心公开报告系统的可靠性可能会因HAI定义的机构差异，或识别HAI所使用的方法和资源的差异而受到影响。目前，关于HAI公开报告系统的优点和局限性的证据不足。因此，医疗保健感染控制实践咨询委员会（HICPAC）既没有推荐也没有反对强制公开报告HAI率。然而，HICPAC根据既定的公共卫生原则和HAI报告系统制定了本指导文件。本文档旨在协助政策制定者、项目规划者、消费者权益倡导组织以及其他负责设计和实施HAI公开报告系统的人员。该文件为立法者提供了一个框架，但未提供示范立法。HICPAC建议设计和实施此类系统的人员：1）在设计和实施强制性HAI报告系统时使用既定的公共卫生监测方法；2）创建多学科咨询小组，包括在HAI预防和控制方面具有专业知识的人员，以监督HAI公开报告系统的规划和监督；3）根据设施类型和措施阶段选择适当的过程和结果指标，以便为设施留出适应时间并允许对数据有效性进行持续评估；4）向医疗保健提供者定期提供绩效数据的保密反馈。具体而言，HICPAC建议为HAI建立公开报告系统的州根据其辖区内医院或长期护理机构的情况，选择以下一种或多种适当的过程或结果指标：1）中心静脉置管操作；2）外科手术抗菌预防；3）患者和医护人员的流感疫苗接种覆盖率；4）中心静脉导管相关血流感染；5）特定手术后的手术部位感染。随着更多研究和经验的出现，HICPAC将更新这些建议。
