Southern California Renal Disease Council, Inc. ESRD Network 18

Shean Strong, MBA, Quality Improvement Director

Lisle Mukai, RN,Quality Improvement Coordinatory p

NHSN Instructional WebExL A l CALos Angeles, CA

2012

Southern California Renal Disease Council, Inc. – ESRD Network 18

Objectives

Enroll in the National Healthcare Safety Network (NHSN).

Report dialysis infection events as per the “Centers for DiseaseControl and Preventions” (CDC) via the “Dialysis Event Protocol”

Receive a Digital Certificate in NHSN

Surveillance and Prevention of Infections in Dialysis

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Why are we doing this?

The second leading cause of death among Hemodialysis g g y(HD) patients.

2008 approx 40,000 bloodstream infections in dialysis patients with central lines. Approx 1 in 4 either died or were at risk of dying.were at risk of dying.

The cost of hospitalization for HD patients have increased 47% for bloodstream infections and 87% for vascular access infections since 1993.

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Southern California Renal Disease Council, Inc. – ESRD Network 18

Prevention

Vascular Access type (CMS will be using the national average as a performance standard and currently it is AVF t f 60 3% Fi t l Fi t C th t L tAVF rate of 60.3%. Fistula First, Catheter Last.

Tracking these infections identifiesTracking these infections identifies which patients are at riskWhich part of the facility needs improvementAllows for trendingComparison with the National AverageSharing of ideasSharing of ideas

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Southern California Renal Disease Council, Inc. – ESRD Network 18

NHSNNHSNCenters for Medicare and Medicaid Services (CMS) recently published the final rule. This is required by y p q yfacilities to receive full payment under the Prospective Payment System (PPS) and the Quality Incentive Program (QIP)Program (QIP).

The requirement listed in the Federal Register Volume q g76, No. 218 is that all dialysis facilities will enroll and input data into the National Healthcare Safety Network (NHSN) Dialysis Event Reporting Measure(NHSN) Dialysis Event Reporting Measure.

Any facility with a CMS provider number aka CMSAny facility with a CMS provider number aka CMS Certification Number (CCN).

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Go to: http://nhsn.cdc.gov/RegistrationForm/index.jsp

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Step 2Step 2

CCN ID aka CMS Provider #CCN ID aka CMS Provider #

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Southern California Renal Disease Council, Inc. – ESRD Network 18

NHSN

To ensure that the information sent by email is notyblocked by your organization’s anti-spam program,please contact your IT department and request thatthey specifically allow:

phintech@cdc.gov

and

nhsn@cdc.gov

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Digital Certificate

The next step is that you will receive an email from the CDC. p y“Welcome! You are now registered in the National Healthcare

Safety Network (NHSN).”

In this email is your PASSWORD !cdc_sdn_apply! and the link to the secure website. (Print this page and save it in your records).

Go to: https://ca cdc govGo to: https://ca.cdc.govIf you have difficulties logging on to this site go to “TOOLS” , click “INTERNET OPTIONS” “SECURITY”, then to “CUSTOM LEVEL” and make sure the option for “AUTOMATICLEVEL and make sure the option for AUTOMATIC PROMPTING FOR ACTIVE X CONTROLS” is set to “ENABLE”

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Southern California Renal Disease Council, Inc. – ESRD Network 18

Digital Certificate

Once you are on the site: https://ca.cdc.govy p gGo to the Center for Disease Control and Prevention-Digital ID Enrollment page. Y t t th d ! d d l !You must enter the password. !cdc_sdn_apply! Click “Accept”Click the Enroll buttonFill out the form (verify the email address in the message is correct and click “OK” if it is incorrect click “CANCEL” change your email and click “NEXT”g yFrom “Select a Program box” select “National Healthcare Safety Network (NHSN) then from the From “Select Activities box” select “NHSN EnrollmentFrom Select Activities box select NHSN Enrollment only” then click “NEXT

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Enter your Challenge Phrase for your Digital Certificate

In the “Challenge phrase” field type your challenge phrase. In the “Confirm” field type your Challenge phrase again.

Then click “Next”You will get “The Digital Certificate Request Received” message.Within 12-72 hours you will receive an email with more instructions.

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Southern California Renal Disease Council, Inc. – ESRD Network 18

What is a Challenge Phrase?What is a Challenge Phrase?

THIS IS JUST A PASSWORD! Password restrictions

8 characters longOnly English letters and

Password restrictions (cont)Cannot contain your name or any part of your email Only English letters and

numbersPasswords are case-sensitive

address.Cannot spell a word unless the word has three or more sensitive

Must contain at least four different numbers or letters.Cannot contain more that

numbers or symbols before or after the word or numbers and symbols

Cannot contain more that two consecutive characters.

within the word.Use one/more of the following symbols - + : ‘ .

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Southern California Renal Disease Council, Inc. – ESRD Network 18

EXAMPLE OF A CHALLENGE PHRASE AKA

PASSWORD THAT WOULD WORK

:+WXJCT+:

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Southern California Renal Disease Council, Inc. – ESRD Network 18

Digital Certificate (cont)

In the “Challenge phrase” field type your challenge phrase.

In the “Confirm” field type your Challenge phrase againIn the “Confirm” field type your Challenge phrase again.

Then click “Next”

You will get “The Digital Certificate Request Received” message.

Within 12-72 hours you will receive an email with more instructions.

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Southern California Renal Disease Council, Inc. – ESRD Network 18

The second phase of this WebEx will provide you assistance.

YOU MUST USE INTERNET EXPLORER

For step by step instructions on how to install your digital certificate please go to:

https://ca cdc gov/sdncode/sdnapp/doc/DigitalCertificateInhttps://ca.cdc.gov/sdncode/sdnapp/doc/DigitalCertificateInstallation.htm

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VERIFY THAT THE DIGITAL CERTIFICATE IS PROPERLY INSTALLED Check that the user's digital certificate has been installed properly by having the user log on to https://sdn cdc gov and clicking the name of thelog on to https://sdn.cdc.gov and clicking the name of the application to which they requested access. The application link is located in the top left corner of the page.

Before proceeding to the contact information formBefore proceeding to the contact information form complete the hard copy survey found at this linkhttp://www.cdc.gov/nhsn/forms/57.104_PSOutpatientDialysisSur_BLANK.pdf

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Southern California Renal Disease Council, Inc. – ESRD Network 18

Enrollment

Proceed to: http://www.cdc.gov/nhsn/forms/57.101_FacConInf_Blank.pdf

Fill i ll i f i i h i f i f hFill in all contact information using the information from the survey sheet.You will then receive an email from NHSN “ENROLLMENT SUBMITTED” This will have an agreement to participate and a consent form. Print, Sign and Fax to: Jaya Bhargava 203-389-9902Also, send Certified Mail to the address on the email.You will then receive enrollment approval via emailYou will then receive enrollment approval via email.

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Southern California Renal Disease Council, Inc. – ESRD Network 18

Summary (FOLLOW THESE)!!!(FOLLOW THESE)!!!

COMPLETE THE SURVEY

http://nhsn.cdc.gov/RegistrationForm/index.jspRules of BehaviorRules of Behavior

http://nhsn.cdc.gov/RegistrationForm/controller.do?dispatch=regAgree

Register

https://ca.cdc.gov/sdncode/sdnapp/Password !cdc sdn apply!Password !cdc_sdn_apply!

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Southern California Renal Disease Council, Inc. – ESRD Network 18

Final

Print, complete and submit onlineFacility Contact Information FormA i t S fAppropriate Survey form

Print, Sign and return Consent Form to NHSNAgree to follow protocols

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Southern California Renal Disease Council, Inc. – ESRD Network 18

QUESTIONS?

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Southern California Renal Disease Council, Inc. – ESRD Network 18

ReferencesReferencesKitsen, J., “Understanding Dialysis Event (DE) Surveillance and Reporting in National Healthcare (NHSN)”, Connecticut Department of Public Health, Network of New England Centers for Disease Control and Prevention, Association for Professionals in InfectionPrevention, Association for Professionals in Infection Control and Epidemiology.National Healthcare Safety Network (NHSN), retrieved f h // d / h / 01/21/2012from http://www.cdc.gov/nhsn/ on 01/21/2012. Pollock, D. (2012) “Introduction to CDC’s National Healthcare Safety Network” retrieved fromHealthcare Safety Network retrieved from http://www.cdc.gov/nhsn/ on 01/21/2012.Strong,S., Mukai, L. (2010) “A New Quality Approach to Reducing Vascular Access Infections”. Nephrology Nursing Journal Oct 2010.

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Southern California Renal Disease Council, Inc. ESRD Network 18

Shean Strong, MBA, Quality Improvement Director

sstrong@nw18 esrd netsstrong@nw18.esrd.net

Lisle Mukai, RN,, ,Quality Improvement Coordinator

lmukai@nw18.esrd.net

6255 Sunset Boulevard Suite 2211• Los Angeles• California• 900286255 Sunset Boulevard, Suite 2211• Los Angeles• California• 90028(323) 962-2020 • (323) 962-2891/Fax • www.esrdnetwork18.org