Background
ICD-9-CM coding alone has been proposed as a method of surveillance for health care-associated
infections (HAIs). The accuracy of this method, however, relative to accepted infection
control criteria is not known.
Methods
Retrospective analysis of patients at an academic medical center in 2005 who underwent
surgical procedures or who were at risk for catheter-associated bloodstream infections
or ventilator-associated pneumonia was performed. Patients previously identified with
HAIs by Centers for Disease Control and Prevention's National Healthcare Safety Network
surveillance methods were compared with those of the same risk group identified by
secondary infection ICD-9-CM codes. Discordant cases identified by only coding were
all rereviewed and adjusted prior to final analysis. When coding and surveillance
were both negative, a sample of patients was used to estimate the proportion of false
negatives in this group.
Results
The positive predictive values (PPVs) ranged from 0.14 to 0.51 with an aggregate of
0.23, even after adjustment for additional cases detected on subsequent medical record
review. The negative predictive values (NPVs) ranged from 0.91 to 1.00, with an aggregate
of 0.96. The estimates of the true variance of PPVs and NPVs across surgical procedures
were small (0.0129, standard error, 0.009; 0.000145, standard error, 0.00019, respectively)
and could be mostly explained by variation in prevalence of surgical site infections.
Conclusion
Administrative coding alone appears to be a poor tool to be used as an infection control
surveillance method. Its proposed use for routine HAI surveillance, public reporting
of HAIs, interfacility comparisons, and nonpayment for performance should be seriously
questioned.
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Article info
Footnotes
Financial disclosures: None.
Supported by the Research Foundation of the Association for Professionals in Infection Control and Epidemiology (APIC Research Foundation).
Identification
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© 2008 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
