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The Need for Advancements in the Field of Risk Adjustment for Healthcare-Associated Infections

Healthcare-associated infections (HAIs) have been of concern to infection preventionists and hospital epidemiologists for more than 40 years. However, only in the past decade have these infections drawn increasing attention by stakeholders, such as the public, health insurance carriers, healthcare maintenance organizations, the Centers for Medicare and Medicaid Services (CMS), and politicians. In this issue, Haley et al report findings from their study investigating potential methodological shortcomings in the current National Healthcare Safety Network (NHSN) estimates of healthcare facility-onset Clostridium difficile infection (HO-CDI) rates in New York. The authors observed that the NHSN estimate of statewide incidence of HO-CDI was underestimated by 45% because the denominator data did not accurately represent patient time at risk. Furthermore, the authors identified that elderly and young children were at increased risk of HO-CDI. Consequently, their age-adjusted rates resulted in more meaningful changes in facility rankings compared with those based on NHSN rates.