Structured surveillance training and coding accuracy for health care-associated infections: A longitudinal...

Accurate surveillance for health care-associated infections (HAIs) is essential for infection prevention and regulatory compliance. Despite the availability of National Healthcare Safety Network (NHSN) definitions, variation in application persists, and formal training is not universally required. This study evaluated whether structured surveillance training with annual competency testing improves infection preventionists' (IPs') accuracy in applying standardized HAI definitions over time.

This longitudinal observational study analyzed annual surveillance test scores from 69 IPs employed by a single consulting company between 2019 and 2024. All IPs completed standardized onboarding and annual competency tests using a validated 20-question case-scenario test bank. Linear mixed-effects models assessed the association between repeated testing and surveillance performance.

Repeat testers achieved significantly higher mean scores (mean = 0.83, SD = 0.12) compared to first-time testers (mean = 0.66, SD = 0.18; P < .001). Years of experience significantly predicted higher scores (β = 0.15, P < .001), while certification, surveillance hours, and facility type did not. A nonsignificant upward trend in scores was observed among repeat testers over time.

Structured, repeated surveillance training and testing were associated with improved HAI coding accuracy. These findings support the integration of ongoing competency assessments into infection prevention programs to strengthen data quality and standardization.