How the Health Agency Can Bolster State HAI Prevention

July 20, 2016|2:39 p.m.| ASTHO Staff

Healthcare-associated infections (HAI) are preventable infections acquired by patients while receiving healthcare treatment. These infections account for up to $33 billion in excess medical costs for hospitals every year. State health agency HAI programs play a critical role in HAI prevention and can maximize limited resources by building on federal initiatives and complementing work being done by the healthcare system. Since 2010, CDC and ASTHO have examined the impact of legal interventions on state public health capacity to prevent HAIs.

Recently, ASTHO, CDC, and partners (Public Health Law Research, Columbia University, and The Keystone Center) examined the implementation of state laws to identify facilitators and barriers for successful state HAI programs and their prevention efforts. As reported in, “Impact of Laws Aimed at Healthcare-Associated Infection Reduction: A Qualitative Study,” Stone et al explored the impact of HAI laws by collecting qualitative data from 90 key informant interviews from six states with and six without HAI laws. We reviewed the same key informant interviews to provide additional perspectives from the health agencies and their partners about the effects of state HAI laws on HAI program implementation.

A statewide strategy

All state health agencies have an HAI program with at least one coordinator funded by CDC. Stakeholders in states with and without provisions in state statutes that authorize state action on HAIs recognized the role of the health agency as a convener and technical resource, uniquely positioned to link public health and healthcare prevention efforts. One community representative described public reporting of hospital data as a key activity in driving infection control activities.  

Health agencies can help to develop a statewide strategy to address HAIs and lend visibility and support to issues at the facility level. In states with laws defining their authority to take action on HAIs, health agencies regularly provide technical assistance to facilities and access HAI data to guide prevention. In states without laws, some health agencies identified creative ways to support and educate facility staff, such as sending letters of support to facilities, sponsoring an infection preventionist mentoring program, and providing scholarships for infection control certification.

Importance of data

Key informants noted the importance of using HAI data for prevention. It is important that reporting is not just collecting data but analyzing and using it, enhancing prevention efforts rather than taking away from them. One HAI coordinator noted, “The department of health has really been making sure that the quality of the data were really good. We do validation of the data and then we do more sophisticated interpretation of the data and feed it back to those facilities.”

In most states with laws pertaining to HAIs, HAI data must be publically reported. Health agencies help facilities meet state reporting requirements and summarize data for annual public reports. When health agencies have sufficient access to data, they can identify areas to target for infection prevention. Some facility staff use health agency analysis of data to benchmark and communicate prevention priorities to leadership. Publicly reported data can also be used by HAI advisory groups or by consumers to guide planning and communications activities.

In states without laws pertaining to HAIs, key informants reported difficulty accessing timely data and noted challenges to marking successes or focusing prevention efforts without the data.

Public health authority

Health agencies can harness a number of opportunities to improve prevention efforts, such as using their legal authorities to address infection reporting noncompliance. Health agencies may also leverage policies outside of HAI reporting laws, such as reportable conditions lists. States with HAI laws have greater leverage than states without laws to address issues, but most have not resorted to punitive actions against facilities (e.g., fines, revocation of licensure). In states both with and without laws, state health agencies have relied on their relationships with partner organizations to support and advance HAI prevention.

Coordination with stakeholders

Key informants stated that state and federal reporting requirements have empowered state health agencies to coordinate prevention activities and use resources effectively. They recognized that inconsistencies and duplication in reporting and prevention requirements increase burdens on facilities, and said that these issues need to be addressed through intentional coordination of efforts.

In states with laws pertaining to HAIs, health agencies coordinated prevention activities with partners including hospital associations, quality improvement organizations, and Hospital Engagement Networks. In addition, some state reporting requirements mirror federal ones, asking for the same data in the same format to be reported to the state health agency. In states without HAI laws, health agencies were also viewed to be instrumental in facilitating prevention, appreciating that “being at the table” is often a first step to better alignment of efforts. An HAI coordinator in a state without a law mentioned, “Recognizing that resources are limited, I think the overarching feeling is that we’re stronger together than we are alone.”

Sufficient capacity needed

Key informants reported that state health agencies helped build HAI prevention capacity across jurisdictions. Respondents in states with HAI laws observed that state HAI programs helped initiate prevention activities, but stable resources are required for the continuation of activities. Health agencies also indicated personnel needs, such as a dedicated epidemiologist, to support facilities. Some recommended that health agencies offer specific services, such as site visits, to work with facilities on prevention. In order to optimize impact, health agencies need sufficient capacity to use HAI data for action.

Informants from states without HAI laws described limitations such as lack of staff to implement guidelines, provide training and assistance, and analyze data. They described the need to make state HAI programs a priority.


These findings highlight perspectives of state health agencies and other key stakeholders about the influence of state laws on HAI programs and the unique role these programs play in HAI prevention. In states with public reporting laws, state HAI programs focused on ensuring that reported data were accurate, meaningful, and actionable and used data to enhance collaboration for prevention activities across their jurisdiction. In these states, health agencies coordinated the effective use of resources and reduced burden from duplication of efforts.

In states without laws, HAI programs served as a resource to facilities, conducted trainings, and ensured accurate data were reported to CMS; however, without reporting requirements, it was difficult to access timely data for targeted prevention efforts.

Special thanks to the staff of CDC’s Division of Healthcare Quality Promotion in the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) and CDC’s Public Health Law Program in the Office for State, Tribal, Local and Territorial Support (OSTLTS) for their contributions to this article.