Lessons from the Pioneers: Reporting Healthcare-Associated Infections

By Anna Spencer, Deborah Sward, and James Ward


Healthcare-associated infections (HAIs)—also known as hospital-acquired infections or nosocomial infections— exact a significant toll on human life. They are among the leading causes of death in the United States, accounting for 99,000 deaths annually. HAIs affect patients, health care systems and society by increasing the cost of treating infections and causing greater disability and death.

Since 2005, the number of states with laws requiring health care facilities to report HAIs has grown from six to 27. At the heart of public reporting is the belief that promoting transparency will improve quality of care, expand and improve infection prevention measures, reduce the morbidity and mortality associated with HAIs and cut costs. In 2009, the American Recovery and Reinvestment Act (ARRA) authorized $50 million in funding for states to engage in HAI planning and other activities, including public reporting.

Research about outcomes from public reporting is in its infancy and more work will need to be done to assure that reporting meets its goals of higher quality, lower costs, and a more informed public. Setting up a reporting program is complex and time-consuming, and a successful program must have skilled staff and adequate, sustainable financing.

In this report, the National Conference of State Legislatures, with support from the Extending the Cure project, examined reporting laws from nine states and gathered information about the challenges, successes and “lessons learned” from states that have pioneered public reporting.

Challenges and Themes

Through interviews with legislators, providers and other key stakeholders, NCSL learned that developing meaningful reporting programs is particularly challenging. For example, some infections are easier to report objectively than others, and billing codes alone may not accurately detect HAI cases. States may overcome some of these challenges by requiring facilities to report HAI data through the National Healthcare Safety Network (NHSN), a surveillance tool administered by the Centers for Disease Control and Prevention, which enables facilities to report HAIs according to standard, scientifically robust methodologies.

The national surveillance system, however, is not obstacle free. First, enrollment in NHSN is a multi-step process that involves a learning curve for facility staff. In addition, reporting through NHSN can disproportionately strain infection prevention resources in some facilities, particularly in smaller and rural hospitals.

Since most states with reporting laws are just beginning to receive the first round of data from hospitals and other facilities, data collected so far are not sufficient to fully determine the laws’ effects. As data accumulate, the incoming information will let researchers examine the effectiveness and consequences of different variations of healthcare-associated infection reporting laws.

Common themes NCSL encountered through interviews included the difficulty of developing meaningful, effective reporting initiatives; the advantages of incrementally phasing in reporting requirements; the benefits of establishing a multi-disciplinary, multi-stakeholder advisory committee to help develop the reporting program (an approach that enables policymakers to build on their state’s unique circumstances and existing quality improvement activities); the importance of providing enough funding to carry out reporting initiatives; and the significance of recent federal guidance and funding to ensure that stakeholder support and financial resources are available to implement reporting laws.

Download the full report.


This report is sponsored by Extending the Cure, a project of the Center for Disease Dynamics, Economics and Policy, funded in part by the Robert Wood Johnson Foundation.