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Song JE, Kwak YG, Oh GB, Choi YH, Kim SR, Han SH, Yoo SY, Yoo HM, Choi JY, Shin MJ. External and internal validation of healthcare-associated infection data collected by the Korean National healthcare-associated Infections Surveillance System (KONIS). Am J Infect Control 2024; 52:214-219. [PMID: 37406965 DOI: 10.1016/j.ajic.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND This study analyzed the validity of healthcare-associated infection (HAI) data of the Korean National healthcare-associated Infections Surveillance System. METHODS The validation process consisted of external (EV) and internal (IV) validation phases. Of the 193 hospitals that participated from July 2016 through June 2017, EV was performed for 10 hospitals that were selected based on the HAI rate percentile. The EV team reviewed 295 medical records for 60 HAIs and 235 non-HAI control patients. IV was performed for both the 10 EV hospitals and 11 other participating hospitals that did not report any HAIs. RESULTS In the EV, the diagnosis of urinary tract infections had a sensitivity of 72.0% and a specificity of 99.3%. The respective sensitivities of bloodstream infection and pneumonia were 63.2% and 70.6%; the respective specificities were 98.8% and 99.6%. The agreement (ĸ) between the EV and IV for 10 hospitals was 0.754 for urinary tract infections and 0.674 for bloodstream infections (P < .001, respectively). Additionally, IV found additional cases among 11 zero-report hospitals. DISCUSSION This study demonstrates the need for ongoing validation and continuous training to maintain the accuracy of nationwide surveillance data. CONCLUSIONS IV should be considered a validation method to supplement EV.
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Affiliation(s)
- Je Eun Song
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea; Infection Control Office, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Yee Gyung Kwak
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea; Infection Control Office, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea.
| | - Gang-Bok Oh
- Infection Control Office, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Young Hwa Choi
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Sung Ran Kim
- Infection Control Office, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Su Ha Han
- Department of Nursing, Soonchunhyang University of Medicine, Cheonan, Republic of Korea
| | - So-Yeon Yoo
- Department of Nursing, The Catholic University of Korea College of Nursing, Seoul, Republic of Korea
| | - Hyeon Mi Yoo
- Infection Control Office, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
| | - Ji-Youn Choi
- Infection Control Team, Chungang University Hospital, Seoul, Republic of Korea
| | - Myoung Jin Shin
- Infection Control Office, Seoul National University Bundang Hospital, Sungnam, Republic of Korea
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Classen DC, Rhee C, Dantes RB, Benin AL. Healthcare-associated infections and conditions in the era of digital measurement. Infect Control Hosp Epidemiol 2024; 45:3-8. [PMID: 37747086 PMCID: PMC10782200 DOI: 10.1017/ice.2023.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 09/26/2023]
Abstract
As the third edition of the Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals is released with the latest recommendations for the prevention and management of healthcare-associated infections (HAIs), a new approach to reporting HAIs is just beginning to unfold. This next generation of HAI reporting will be fully electronic and based largely on existing data in electronic health record (EHR) systems and other electronic data sources. It will be a significant change in how hospitals report HAIs and how the Centers for Disease Control and Prevention (CDC) and other agencies receive this information. This paper outlines what that future electronic reporting system will look like and how it will impact HAI reporting.
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Affiliation(s)
- David C. Classen
- Division of Epidemiology, University of Utah School of Medicine and IDEAS Center VA Salt Lake City Health System, Salt Lake City, UT, USA
| | - Chanu Rhee
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Division of Infectious Diseases at Brigham and Women’s Hospital, Boston, MA, USA
| | - Raymund B. Dantes
- Division of Hospital Medicine at the Emory University School of Medicine, Atlanta, GA, USA
- Division of Healthcare Quality Promotion at the Centers for Disease Control, Atlanta, GA, USA
| | - Andrea L. Benin
- Division of Healthcare Quality Promotion at the Centers for Disease Control, Atlanta, GA, USA
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Metzger KE, Salim AA, Mikolajczak AR, Dolgin G, Barajas GM, Jenkins CR, Silkaitis CM. A systemwide approach to validation of electronic device denominator data. Infect Control Hosp Epidemiol 2023; 44:965-967. [PMID: 36205050 DOI: 10.1017/ice.2022.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A multidisciplinary team collaborated to develop and validate a process to electronically capture patient and device denominator data at 6 hospitals in the same healthcare system. Validation was completed within 4-16 months. Manual count errors were identified as the main driver of electronic versus manual discrepancies.
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Affiliation(s)
- Kristen E Metzger
- Department of Healthcare Epidemiology and Infection Prevention, Northwestern Medicine, Chicago, Illinois
- Analytics Department, Northwestern Medicine, Chicago, Illinois
| | - Asra A Salim
- Department of Healthcare Epidemiology and Infection Prevention, Northwestern Medicine, Chicago, Illinois
- Analytics Department, Northwestern Medicine, Chicago, Illinois
| | - Anessa R Mikolajczak
- Department of Healthcare Epidemiology and Infection Prevention, Northwestern Medicine, Chicago, Illinois
| | - Gina Dolgin
- Department of Healthcare Epidemiology and Infection Prevention, Northwestern Medicine, Chicago, Illinois
| | - Grace M Barajas
- Department of Healthcare Epidemiology and Infection Prevention, Northwestern Medicine, Chicago, Illinois
| | | | - Christina M Silkaitis
- Department of Healthcare Epidemiology and Infection Prevention, Northwestern Medicine, Chicago, Illinois
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Shenoy ES, Branch-Elliman W. Automating surveillance for healthcare-associated infections: Rationale and current realities (Part I/III). ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e25. [PMID: 36865706 PMCID: PMC9972536 DOI: 10.1017/ash.2022.312] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 06/18/2023]
Abstract
Infection surveillance is one of the cornerstones of infection prevention and control. Measurement of process metrics and clinical outcomes, such as detection of healthcare-associated infections (HAIs), can be used to support continuous quality improvement. HAI metrics are reported as part of the CMS Hospital-Acquired Conditions Program, and they influence facility reputation and financial outcomes.
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Affiliation(s)
- Erica S. Shenoy
- Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Westyn Branch-Elliman
- Harvard Medical School, Boston, Massachusetts
- Section of Infectious Diseases, Department of Medicine, Veterans’ Affairs (VA) Boston Healthcare System, Boston, Massachusetts
- VA Boston Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts
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Beyond the abacus: Leveraging the electronic medical record for central line day surveillance. Am J Infect Control 2019; 47:1397-1399. [PMID: 31278000 DOI: 10.1016/j.ajic.2019.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 11/20/2022]
Abstract
Manual counting is considered the gold standard for device day recording by the National Health Safety Network. We describe the development of a process for an electronic count of central line days across our ten-hospital health care system. Our validation process identified discordance between the electronic count and the manual count for 71% of patient care units. Adjudication of the count differences by chart review identified the electronic count to be correct 97% of the time.
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A systematic review of central-line-associated bloodstream infection (CLABSI) diagnostic reliability and error. Infect Control Hosp Epidemiol 2019; 40:1100-1106. [PMID: 31362804 DOI: 10.1017/ice.2019.205] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To establish the reliability of the application of National Health and Safety Network (NHSN) central-line-associated bloodstream infection (CLABSI) criteria within established reporting systems internationally. DESIGN Diagnostic-test accuracy systematic review. METHODS We conducted a search of Medline, SCOPUS, the Cochrane Library, CINAHL (EbscoHost), and PubMed (NCBI). Cohort studies were eligible for inclusion if they compared publicly reported CLABSI rates and were conducted by independent and expertly trained reviewers using NHSN/Centers for Disease Control (or equivalent) criteria. Two independent reviewers screened, extracted data, and assessed risk of bias using the QUADAS 2 tool. Sensitivity, specificity, negative and positive predictive values were analyzed. RESULTS A systematic search identified 1,259 publications; 9 studies were eligible for inclusion (n = 7,160 central lines). Publicly reported CLABSI rates were more likely to be underestimated (7 studies) than overestimated (2 studies). Specificity ranged from 0.70 (95% confidence interval [CI], 0.58-0.81) to 0.99 (95% CI, 0.99-1.00) and sensitivity ranged from 0.42 (95% CI, 0.15-0.72) to 0.88 (95% CI, 0.77-0.95). Four studies, which included a consecutive series of patients (whole cohort), reported CLABSI incidence between 9.8% and 20.9%, and absolute CLABSI rates were underestimated by 3.3%-4.4%. The risk of bias was low to moderate in most included studies. CONCLUSIONS Our findings suggest consistent underestimation of true CLABSI incidence within publicly reported rates, weakening the validity and reliability of surveillance measures. Auditing, education, and adequate resource allocation is necessary to ensure that surveillance data are accurate and suitable for benchmarking and quality improvement measures over time. REGISTRATION Prospectively registered with International prospective register of systematic reviews (PROSPERO ID CRD42015021989; June 7, 2015). https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID%3dCRD42015021989.
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Stone PW, Chastain AM, Dorritie R, Tark A, Dick AW, Bell JM, Stone ND, Quigley DD, Sorbero ME. The expansion of National Healthcare Safety Network enrollment and reporting in nursing homes: Lessons learned from a national qualitative study. Am J Infect Control 2019; 47:615-622. [PMID: 30850253 PMCID: PMC6544481 DOI: 10.1016/j.ajic.2019.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study explored nursing home (NH) personnel perceptions of the National Healthcare Safety Network (NHSN). METHODS 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. RESULTS 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. CONCLUSIONS 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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Affiliation(s)
- Patricia W Stone
- Center for Health Policy, Columbia University School of Nursing, New York, NY.
| | - Ashley M Chastain
- Center for Health Policy, Columbia University School of Nursing, New York, NY
| | - Richard Dorritie
- Center for Health Policy, Columbia University School of Nursing, New York, NY
| | - Aluem Tark
- Center for Health Policy, Columbia University School of Nursing, New York, NY
| | | | - Jeneita M Bell
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Nimalie D Stone
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
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Distribution of Central Line-Associated Bloodstream Infections Determined From Washington State’s Annual Reporting Validation Program, 2009–2013. Infect Control Hosp Epidemiol 2017; 38:489-492. [DOI: 10.1017/ice.2016.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Healthcare-associated infection reporting validation is essential because this information is increasingly used in public healthcare quality assurances and care reimbursement. Washington State’s validation of central line-associated bloodstream infection reporting applies credible quality sciences methods to ensure that hospital reporting accuracy is maintained. This paper details findings and costs from our experience.Infect Control Hosp Epidemiol 2017;38:489–492
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Cumming M, Osinski A, O'Hearn L, Waksmonski P, Herman M, Gordon D, Griffiths E, Knox K, McHale E, Quillen K, Rios J, Pisciotto P, Uhl L, DeMaria A, Andrzejewski C. Hemovigilance in Massachusetts and the adoption of statewide hospital blood bank reporting using the National Healthcare Safety Network. Transfusion 2017; 57:478-483. [PMID: 27774608 DOI: 10.1111/trf.13872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 08/26/2016] [Indexed: 11/29/2022]
Abstract
A collaboration that grew over time between local hemovigilance stakeholders and the Massachusetts Department of Public Health (MDPH) resulted in the change from a paper-based method of reporting adverse reactions and monthly transfusion activity for regulatory compliance purposes to statewide adoption of electronic reporting via the National Healthcare Safety Network (NHSN). The NHSN is a web-based surveillance system that offers the capacity to capture transfusion-related adverse events, incidents, and monthly transfusion statistics from participating facilities. Massachusetts' hospital blood banks share the data they enter into NHSN with the MDPH to satisfy reporting requirements. Users of the NHSN Hemovigilance Module adhere to specified data entry guidelines, resulting in data that are comparable and standardized. Keys to successful statewide adoption of this reporting method include the fostering of strong partnerships with local hemovigilance champions and experts, engagement of regulatory and epidemiology divisions at the state health department, the leveraging of existing relationships with hospital NHSN administrators, and the existence of a regulatory deadline for implementation. Although limitations exist, successful implementation of statewide use of the NHSN Hemovigilance Module for hospital blood bank reporting is possible. The result is standardized, actionable data at both the hospital and state level that can facilitate interfacility comparisons, benchmarking, and opportunities for practice improvement.
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Affiliation(s)
- Melissa Cumming
- Bureau of Infectious Disease and Laboratory Sciences, Division of Epidemiology and Immunization, Massachusetts Department of Public Health, Jamaica Plain, Massachusetts
| | - Anthony Osinski
- Bureau of Infectious Disease and Laboratory Sciences, Division of Epidemiology and Immunization, Massachusetts Department of Public Health, Jamaica Plain, Massachusetts
| | - Lynne O'Hearn
- Department of Transfusion Medicine and Pathology, Baystate Medical Center
| | - Pamela Waksmonski
- Division of Health Care Facility Licensure and Certification, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Michele Herman
- Department of Pathology, Division of Laboratory and Transfusion Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Deborah Gordon
- Department of Pathology, Heywood Hospital, Gardner, Massachusetts
- Department of Pathology, Athol Memorial Hospital, Athol, Massachusetts
| | - Elzbieta Griffiths
- Department of Pathology, Mount Auburn Hospital, Cambridge, Massachusetts
- Tufts University School of Medicine, Boston, Massachusetts
| | - Kim Knox
- Infection Prevention and Control Department, Milford Regional Medical Center, Milford, Massachusetts
| | - Eileen McHale
- Bureau of Healthcare Safety and Quality, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Karen Quillen
- Department of Pathology & Laboratory Medicine, Boston University Medical Center, Boston, Massachusetts
| | - Jorge Rios
- New England Region American Red Cross Blood Services, Dedham, Massachusetts
| | - Patricia Pisciotto
- New England Region American Red Cross Blood Services, Dedham, Massachusetts
| | - Lynne Uhl
- Department of Pathology, Division of Laboratory and Transfusion Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Alfred DeMaria
- Bureau of Infectious Disease and Laboratory Sciences, Division of Epidemiology and Immunization, Massachusetts Department of Public Health, Jamaica Plain, Massachusetts
| | - Chester Andrzejewski
- Department of Transfusion Medicine and Pathology, Baystate Medical Center
- Tufts University School of Medicine, Boston, Massachusetts
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Prospective Validation of Central Line–Days Derived From an Electronic Medical Record System. Infect Control Hosp Epidemiol 2015; 36:1098-9. [DOI: 10.1017/ice.2015.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Validation of the number of central line–days by hospitals is required by the National Healthcare Safety Network. A prospective study that compared a daily report of such days generated by an electronic medical record with observational audits by nurses revealed that the report was 100% sensitive and 99.9% specific.Infect. Control Hosp. Epidemiol. 2015;36(9):1098–1099
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Denominator doesn't matter: standardizing healthcare-associated infection rates by bed days or device days. Infect Control Hosp Epidemiol 2015; 36:710-6. [PMID: 25782986 DOI: 10.1017/ice.2015.42] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the impact on infection rates and hospital rank for catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP) using device days and bed days as the denominator DESIGN Retrospective survey from October 2010 to July 2013 SETTING: Veterans Health Administration medical centers providing acute medical and surgical care PATIENTS Patients admitted to 120 Veterans Health Administration medical centers reporting healthcare-associated infections METHODS We examined the importance of using device days and bed days as the denominator between infection rates and hospital rank for CAUTI, CLABSI, and VAP for each medical center. The relationship between device days and bed days as the denominator was assessed using a Pearson correlation, and changes in infection rates and device utilization were evaluated by an analysis of variance. RESULTS A total of 7.9 million bed days were included. From 2011 to 2013, CAUTI decreased whether measured by device days (2.32 to 1.64, P=.001) or bed days (4.21 to 3.02, P=.006). CLABSI decreased when measured by bed days (1.67 to 1.19, P=.04). VAP rates and device utilization ratios for CAUTI, CLABSI, and VAP were not statistically different across time. Infection rates calculated with device days were strongly correlated with infection rates calculated with bed days (r=0.79-0.94, P<.001). Hospital relative performance measured by ordered rank was also strongly correlated for both denominators (r=0.82-0.96, P<.001). CONCLUSIONS These findings suggest that device days and bed days are equally effective adjustment metrics for comparing healthcare-associated infection rates between hospitals in the setting of stable device utilization.
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Harvey AR, Basavaraju SV, Chung KW, Kuehnert MJ. Transfusion-related adverse reactions reported to the National Healthcare Safety Network Hemovigilance Module, United States, 2010 to 2012. Transfusion 2014; 55:709-18. [PMID: 25371300 DOI: 10.1111/trf.12918] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 09/11/2014] [Accepted: 09/12/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND In 2010, health care facilities in the United States began voluntary enrollment in the National Healthcare Safety Network (NHSN) Hemovigilance Module. Participants report transfusion practices; red blood cell, platelet (PLT), plasma, and cryoprecipitate units transfused; and transfusion-related adverse reactions and process errors to the Centers for Disease Control and Prevention through a secure, Internet-accessible surveillance application available to transfusing facilities. STUDY DESIGN AND METHODS Facilities submitting at least 1 month of transfused components data and adverse reactions from January 1, 2010, to December 31, 2012, were included in this analysis. Adverse reaction rates for transfused components, stratified by component type and collection and modification methods, were calculated. RESULTS In 2010 to 2012, a total of 77 facilities reported 5136 adverse reactions among 2,144,723 components transfused (239.5/100,000). Allergic (46.8%) and febrile nonhemolytic (36.1%) reactions were most frequent; 7.2% of all reactions were severe or life-threatening and 0.1% were fatal. PLT transfusions (421.7/100,000) had the highest adverse reaction rate. CONCLUSION Adverse transfusion reaction rates from the NHSN Hemovigilance Module in the United States are comparable to early hemovigilance reporting from other countries. Although severe reactions are infrequent, the numbers of transfusion reactions in US hospitals suggest that interventions to prevent these reactions are important for patient safety. Further investigation is needed to understand the apparent increased risk of reactions from apheresis-derived blood components. Comprehensive evaluation, including data validation, is important to continued refinement of the module.
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Affiliation(s)
- Alexis R Harvey
- Office of Blood, Organ and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging, Zoonotic, and Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sridhar V Basavaraju
- Office of Blood, Organ and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging, Zoonotic, and Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Koo-Whang Chung
- Office of Blood, Organ and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging, Zoonotic, and Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew J Kuehnert
- Office of Blood, Organ and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging, Zoonotic, and Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
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