Evaluation of electronic hospital surveillance systems for healthcare-associated infections in Pennsylvania

Background: Healthcare-associated infections (HAIs) have substantial impact on both direct and indirect cost of healthcare in the US. In Pennsylvania, legislatively-mandated reporting of HAIs by all hospitals began in early 2008 and hospitals were encouraged to implement qualified electronic surveillance (QES) systems to aid HAI detection. The goal of this evaluation was to assess the usefulness of these systems. Methods: Interviews and on-line surveys were conducted with a sample of users of the systems in hospitals to determine the acceptability of the systems. Hospital-specific data in NHSN was used to compare infection rates in facilities with QES systems to those without such systems and to assess rates over time in hospitals that implemented electronic systems. Results: Data from July 2008 through December 2009 was used in the analysis of infection rates. Initially, rates in hospitals with QES systems were on average 30% higher than in those hospitals with manual surveillance, but these rates converged at the end of the time period. After controlling for device-utilization ratio and medical school affiliation, which were found to be significant confounders, hospitals with QES systems showed a significant decline in HAI rates; facilities with manual surveillance showed no change in rates (p<.05). Discussion: Over the 18-month time period, use of a QES system appears to have led to better ascertainment of HAIs and implementation of HAI prevention measures than manual detection methods. However, additional data are needed to see if these improvements and trends persist.