Transcript Introduction to the NHSN

Introduction to the National
Healthcare Safety Network (NHSN)
Richard Rodriguez, MPH
Connecticut Department of Public
Health
4/9/2014
Thank you to CDC for allowing CT-DPH to utilize NHSN training material in the current presentation
Objectives
 Why use the National Healthcare Safety
Network (NHSN) to monitor C.difficile
infection (CDI) in long-term care facilities?
 What is NHSN?
 How can NHSN help you monitor and track
CDI trends over time in your facility?
How NHSN is Being Used in CT
 Ct healthcare facilities currently use NHSN to fulfill
CMS and state reporting mandates
 Type of facilities currently using NHSN to fulfill
mandates

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Acute Care Facilities
Long-term Acute Care Facilities
Inpatient Rehabilitation Facilities
Outpatient Dialysis Facilities
Why use NHSN to Monitor CDI?
 Residents in long term care facilities are at risk of carrying or acquiring
C. difficile
 Infections from C. difficile can be severe, hard to treat, and are
associated with increased risk of hospitalization, debility, and death
 Focused monitoring of C. difficile helps to evaluate trends and changes
in its occurrence and related infections in the facility over time
 Tracking these events can help infection control staff identify problems,
and help evaluate the impact of targeted prevention efforts
 Familiarize yourselves with NHSN before LTC facilities are mandated
to use it
NHSN: What is it?
 Internet-based surveillance system that monitors
patient, resident and healthcare personnel safety
 NHSN maintains data security, integrity, and
confidentiality (all data is viewable to CDC)
 Has capacity for users to share data in a timely
manner between facilities or with other entities
 No fee for participation in NHSN
NHSN: Its Purpose
 Collects data from a sample of U.S. healthcare
facilities to permit valid estimation of :

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the magnitude of adverse events (i.e. HAIs)
healthcare process measures such as healthcare personnel
influenza vaccine status and infection control adherence rates
 Data is analyzed and reported to permit recognition
of trends
NHSN: Its Purpose
 Provides facilities with data that can be used for
 Local quality improvement activities
 Inter-facility comparisons
 Assists facilities in developing surveillance and
analysis methods that permit
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Timely recognition of problems
Prompt intervention with appropriate measures
 Conduct collaborative research studies with
members
Authority and Confidentiality for NHSN
 Public Health Service Act
(42 USC 242b, 242k, and 242m(d))
 Confidentiality protection

Sections 304, 306, 308(d) of the PHS Act
“The information contained in this surveillance system that would
permit identification of any individual or institution is collected with
a guarantee that it will be held in strict confidence, will be used only
for the purposes stated, and will not be disclosed or released without
the consent of the individual, or the institution in accordance with
Sections 304, 306, and 308(d) of the Public Health Services Act (42
USC 242b, 242k, and 242m(d)).”
NHSN Structure
Healthcare
Long-term
Care Facility
Personnel
Safety
Patient
Safety
Components of NHSN
Biovigilance
NHSN Components for Long-term
Care Facilities
 Currently, LTCF can enroll in two NHSN
Components
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Long-term Care Facility Component
Healthcare Personnel Safety Component
Long-term
Care Facility
Healthcare
associated
infection
Laboratory
identified
(Lab ID) event
Prevention
process
measures
Modules of the LTCF Component
Long-term Care Facility Component Modules
 Healthcare Associated Infection Module
 Urinary tract infection events (both catheter- and non
catheter-associated)
 Laboratory Identified (Lab-ID) Event Module
 C. difficile infections (CDI)
 Multidrug-resistance Organisms (MDRO)
 Preventions Process Measures Module
 Hand hygiene
 Gown and glove use
Purpose of Lab-ID Event Reporting for CDI
 To calculate proxy measures for CDI events, exposures, and
healthcare acquisition
 This method is based solely on laboratory data and limited
resident admissions/transfer data
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This includes results of testing performed on residents while at the
facility
 Clinical evaluation of resident is not required, and therefore
this surveillance option is less labor intensive
Reporting Requirements
 Facility survey
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Completed once a year
Collects information on facility characteristics
 Facilities must indicate Lab-ID event surveillance in the
Monthly Reporting Plan for LTCF
 Surveillance must be reported for at least 6 consecutive
months to provide meaningful measures
 CDI surveillance should be performed facility-wide
Reporting Requirements (continued)
 Numerator data
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Collect and report each CDI event that meets the Lab-ID Event
definition
 Denominator data
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Resident-days each month
Resident admissions each month
“
Form for Data
Collection
•
One form per MDRO
or CDI Event
Data Entry in NHSN
 Data entered into NHSN are available to the
facility and CDC as soon as they are saved
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No “transmission” lag
 Data can be edited after they are saved
 Records can be deleted
CDI Definitions for Lab-ID Event
 C. difficile positive laboratory assay: A positive result for a laboratory
test detecting presence of either of the following:
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C. difficile toxin A or B (e.g., enzyme immunoassay or EIA test), OR
toxin-producing C. difficile organism detected in the stool specimen
by culture or other laboratory means (e.g., nucleic acid amplification
testing by polymerase-chain reaction, or PCR).
 Duplicate C. difficile positive assay: Any C. difficile positive
laboratory test from the same resident following a previous C. difficile
positive test within the past 2 weeks
CDI Definitions (continued)
 CDI Lab-ID Event: All non-duplicate C. difficile positive
laboratory assays obtained while a resident is receiving care
in the LTCF
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Lab results from outside facilities, before a resident’s admission,
should not be included in Lab-ID event reporting
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It is helpful to keep a log of all the positive C. difficile tests sent from
your facility so you can track duplicate results to ensure they are not
incorrectly entered as CDI Lab-ID Events
CDI Definitions (continued)
 Once CDI Lab-ID Events are entered into NHSN, they are
further categorized by the NHSN system:
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Incident CDI Lab-ID Event: The first Lab-ID Event ever entered or a
subsequent Lab-ID Event entered > 8 weeks after the most recent
Lab-ID Event reported for an individual resident
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First or new infections that are unrelated to previous infections
Recurrent CDI Lab-ID Event: Any Lab-ID Event entered > 2 weeks
and ≤ 8 weeks after the most recent Lab-ID Event reported for an
individual resident
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Infections that recur after having been thought resolved
Lab-ID Event Categorization
 Based on data provided for the Lab-ID Event, each
event is categorized by NHSN as
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Community-onset (CO) Lab-ID Event: Date specimen
collected ≤ 3 calendar days after current admission to the
facility (i.e., days 1, 2, or 3 of admission)
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Long-term Care Facility-onset (LO) Lab-ID Event : Date
specimen collected > 3 calendar days after current admission
to the facility (i.e., on or after day 4)
Lab-ID Event Categorization (continued)
 LO Events are further sub-classified
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Acute Care Transfer-Long-term Care Facility-onset (ACT-LO):
LTCF-onset (LO) Lab-ID event with specimen collection date ≤
4 weeks following date of last transfer from an Acute Care
Facility (Hospital, Long-term acute care hospital, or Acute
inpatient rehabilitation facility only)
 Categories are based on the date of current
admission to facility and the date specimen collected
What Information Can you Get from NHSN?
 Total CDI Rate (per 10,000 resident-days)
 Long-term Care Facility-onset (LO) Incidence Rate (per)
10,000 resident-days
 Percent that is Community-onset (CO)
 Percent that is Long-term Care Facility-onset (LO) and
CDI LO that is Acute Care Transfer (ACT LO)
 Percent that is Recurrent CDI
Using Your Data
 Data can be used to characterize CDI in your facility
 Data can be looked at over time for trends
 Data can be used to evaluate interventions
NHSN Website
 http://www.cdc.gov/nhsn/
NHSN Website (continued)
NHSN Website (continued)
NHSN Website
Contact Information
Richard Rodriguez, MPH
Epidemiologist
Healthcare Associated Infections Program
Infectious Disease Section
Connecticut Department of Public Health
Tel: (860) 509-7995
Fax: (860) 509-7910
Email: [email protected]