The Expansion of National Healthcare Safety Network Enrollment and Reporting in Nursing Homes

Lessons Learned from a National Qualitative Study

Published in: American Journal of Infection Control, Volume 47, Issue 6, pages 615–622 (June 2019). doi: 10.1016/j.ajic.2019.02.005

Posted on on March 19, 2020

by Patricia Stone, Ashley M. Chastain, Richard Dorritie, Aluem Tark, Andrew W. Dick, Jeneita M. Bell, Nimalie D. Stone, Denise D. Quigley, Melony E. Sorbero

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This study explored nursing home (NH) personnel perceptions of the National Healthcare Safety Network (NHSN).


NHs were purposively sampled based on NHSN enrollment and reporting status, and other facility characteristics. We recruited NH personnel knowledgeable about the facility's decision-making processes and infection prevention program. Interviews were conducted over-the-phone and audio-recorded; transcripts were analyzed using conventional content analysis.


We enrolled 14 NHs across the United States and interviewed 42 personnel. Six themes emerged: Benefits of NHSN, External Support and Motivation, Need for a Champion, Barriers, Risk Adjustment, and Data Integrity. We did not find substantive differences in perceptions of NHSN value related to participants' professional roles or enrollment category. Some participants from newly enrolled NHs felt well supported through the NHSN enrollment process, while participants from earlier enrolled NHs perceived the process to be burdensome. Among participants from non-enrolled NHs, as well as some from enrolled NHs, there was a lack of knowledge of NHSN.


This qualitative study helps fill a gap in our understanding of barriers and facilitators to NHSN enrollment and reporting in NHs. Improved understanding of factors influencing decision-making processes to enroll in and maintain reporting to NHSN is an important first step towards strengthening infection surveillance in NHs.

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