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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. - PowerPoint PPT Presentation
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Introduction to the National Healthcare Safety Network
(NHSN)Richard Rodriguez, MPHConnecticut Department of Public
Health4/9/2014
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 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 : 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 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
Patient
Safety
HealthcarePersonnel
Safety
BiovigilanceLong-term Care Facility
Components of NHSN
NHSN Components for Long-term Care Facilities
Currently, LTCF can enroll in two NHSN Components
Long-term Care Facility Component Healthcare Personnel Safety Component
Long-term Care Facility
Healthcare associated
infection
Laboratory identified
(Lab ID) event
Preventionprocess
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 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 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 Collect and report each CDI event that meets the Lab-
ID Event definition
Denominator data 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 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:
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
Lab results from outside facilities, before a resident’s admission, should not be included in Lab-ID event reporting
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:
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 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 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
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)
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
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 trendsData can be used to evaluate interventions
NHSN Website (continued)
NHSN Website (continued)
NHSN Website
Contact Information
Richard Rodriguez, MPHEpidemiologistHealthcare Associated Infections ProgramInfectious Disease SectionConnecticut Department of Public HealthTel: (860) 509-7995Fax: (860) 509-7910Email: [email protected]