Infection surveillance in US acute care hospitals took root in 1970
when the Centers for Disease Control and Prevention launched the
National Nosocomial Infections Surveillance System.1 In 2005 the
Centers for Disease Control and Prevention integrated the National
Nosocomial Infections Surveillance System, the Dialysis
Surveillance Network, and the National Surveillance of Healthcare
Workers to create the National Healthcare Safety Network (NHSN).2
NHSN provides health care facilities with data that aid in the prevention
of health care-associated infections by identifying changes
in infection rates and sites, risk factors, outcomes, and pathogens.
In recent years, NHSN surveillance efforts have been extended outside
the acute care setting to include outpatient dialysis and ambulatory
surgical centers, long-term acute care hospitals, psychiatric and
rehabilitation hospitals, and nursing homes.3 Despite this expansion,
acute care hospitals and dialysis facilities represent the majority
of facilities in the reporting data. Moreover, little attention has been
given to the use of infection surveillance systems in primary care.
The Patient Protection and Affordable Care Act (ACA) of 2010 is
changing the way US health care is financed and delivered. As many
as 16 million Americans are newly insured as a result of the ACA—a
number projected to reach 32 million.4,5 Accountable care organizations
and the patient-centered medical home are primary care
models promoted by the ACA. Primary health care is delivered in
various settings, including individual office-based practices, hospital
outpatient clinics, community health centers, and integrated