Use of administrative data in efficient auditing of hospital-acquired surgical site infections, New York State 2009-2010

Infect Control Hosp Epidemiol. 2012 Jun;33(6):565-71. doi: 10.1086/665710. Epub 2012 Apr 20.


Objective: To efficiently validate the accuracy of surgical site infection (SSI) data reported to the National Healthcare Safety Network (NHSN) by New York State (NYS) hospitals.

Design: Validation study.

Setting: 176 NYS hospitals.

Methods: NYS Department of Health staff validated the data reported to NHSN by review of a stratified sample of medical records from each hospital. The four strata were (1) SSIs reported to NHSN; (2) records with an indication of infection from diagnosis codes in administrative data but not reported to NHSN as SSIs; (3) records with discordant procedure codes in NHSN and state data sets; (4) records not in the other three strata.

Results: A total of 7,059 surgical charts (6% of the procedures reported by hospitals) were reviewed. In stratum 1, 7% of reported SSIs did not meet the criteria for inclusion in NHSN and were subsequently removed. In stratum 2, 24% of records indicated missed SSIs not reported to NHSN, whereas in strata 3 and 4, only 1% of records indicated missed SSIs; these SSIs were subsequently added to NHSN. Also, in stratum 3, 75% of records were not coded for the correct NHSN procedure. Errors were highest for colon data; the NYS colon SSI rate increased by 7.5% as a result of hospital audits.

Conclusions: Audits are vital for ensuring the accuracy of hospital-acquired infection (HAI) data so that hospital HAI rates can be fairly compared. Use of administrative data increased the efficiency of identifying problems in hospitals' SSI surveillance that caused SSIs to be unreported and caused errors in denominator data.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Validation Study

MeSH terms

  • Cross Infection / epidemiology*
  • Cross Infection / prevention & control
  • Hospitals, State / standards*
  • Humans
  • Infection Control / methods
  • Infection Control / standards*
  • Medical Audit / methods*
  • Medical Records
  • New York / epidemiology
  • Surgical Wound Infection / epidemiology*
  • Surgical Wound Infection / prevention & control