Site specific changes to NHSN 2016 SSI - FoundationSite specific changes 2016-SSI Reminders and back to some basics ICD-9 to ICD-10 /CPT code transition NHSN baseline CSV file uploads

New Hampshire Department of Health & Human ServicesNew Hampshire Department of Health & Human ServicesNew Hampshire Department of Health & Human ServicesNew Hampshire Department of Health & Human Services

Katrina Hansen, MPHHAI Program Manager

New Hampshire

Healthcare-Associated Infections

Annual NHSN Workshop: March 7, 2016

NHSN Site Specific Changes-SSI

Infectious Disease Surveillance Section

Bureau of Infectious Disease Control


Site specific changes 2016- SSI

Reminders and back to some basics

ICD-9 to ICD-10 /CPT code transition

NHSN baseline

CSV file uploads

Updated SSI criteria

New appendix added to SSI protocol

Diabetes

Inpatient vs outpatient

PATOS Q & A


Date of Event is the date the first element used to meet NHSN site-specific infection criterion

The Infection Window Period, Present on Admission, Hospital Associated Infection and Repeat Infection Timeframe DO NOT apply to SSI

PATOs or present at time of surgery

Patient note indicating infection at time of surgery should be noted on denominator / event form

Reminder….


Denotes that there is evidence of an infection present at start or during index surgical procedure

This field is required and is found on the SSI event form not on the denominator for procedure form

Does not apply if there was a period of wellness between time of pre-operative condition and surgery

The evidence of infection must be noted preoperatively or found intra-operative in pre-operative note

Reminder (PATOS continued)


Only select “PATOS = Yes” if the depth of the SSI is being attributed to the procedure

If evidence of an infection at time of surgery and later returns with organ/space SSI, PATOS field would be ‘YES’

If superficial or deep SSI, PATOS field would be ‘NO’

The patient does not have to meet the NHSN definition of an SSI at the time of primary procedure but there must be notation that there is evidence of infection or abscess present at the time of surgery

Reminder (PATOS continued)


An NHSN Operative Procedure :

Included in the ICD-10-PCS or CPT NHSN operative procedure code mapping.

Takes place during an operation where at least one incision is made, or reoperation via an incision that was left open during a prior operative procedure Takes place in an operating room (OR), defined as a patient care area that met the Facilities Guidelines Institute’s (FGI) or American Institute of Architects’ (AIA) criteria for an operating room when it was constructed or renovated.

Back to basics: NHSN procedure


Back to basics: SSI SIP/SIS


Back to basics: SSI DIP/DIS


Back to basics: SSI Organ/Space


Back to basics: SSI Organ/Space, cont.,

Criteria for these sites can be found in the Surveillance Definitions for Specific Types of Infections chapter


All procedures and chapters have updated ICD-10 and relevant CPT codes

ICD 10 PCS and CPT code fields will remain optional in 2016

APPY, BILI, CHOL, COLO, GAST, NECK, OVRY, PRST, REC, SB & THOR- several hundred endoscopic procedure codes removed.

Because these procedures do not involve a surgical incision, they are not considered NHSN operative procedures and were removed

ICD-10 and CPT codes


Guidance for HPRO and KPRO Procedures

“Complexity of the ICD-10 PCS code structure hasslowed the development of guidance for HPROand KPRO revisions. NHSN is working with codingexperts to validate…and to develop mappingguidance for revisions. This work has beenprioritized and as soon as {this is complete}, NHSNwill upload this information to the NHSN page andnotify users”



ICD 10 changes:

KPRO:

0SUT092 updated to 0SUT09Z

0SHC08Z and 0SHC48Z removed

COLO:

0DTN4ZZ moved from REC to COLO

SB- 0D1A0KQ added

HYST:

0UB90ZZ removed

CPT changes:

KPRO CPT:

27440, 27441, 27442, and 27443 added



CDC will update risk adjustment of HAI data using event and denominator data reported to NHSN for 2015 or ‘re-baseline’

Expected summer 2016 and new risk adjustment by January 2017

For SSI:

Update risk model for SSI SIRs to address PATOs and procedures with closure other than primary

NHSN baselines


Significant changes to procedure import methods

Prior to 2016, NHSN users have been able to import procedure records using CSV files by two methods

No header row

Header row

CSV File Upload


Significant changes to procedure import methods

The ‘no header row’ methods for importing CSV files will be discontinued.

From that time forward, all data in the import file MUST have a header row and the header names must match the variable names as they appear in the specifications document posted on NHSN website

CSV File Upload


Superficial SSI criterion “c” was updated to reflect a symptomatic patient whose incision opened but no culture is obtained.

Note that if a (+) culture is obtained the patient meets criterion b.

Updated SSI criteria


Appendix I: SSI specific event types attributed to each NHSN category






Diabetes

Go to this website for DM diagnosis codes: http://www.cdc.gov/nhsn/acute-care-

hospital/ssi/index.html


The 80/20 rule for mapping locations does not apply for determining the inpatient or OR suite status

Different from 2015 when procedure inpatient/outpatient status was based on OR area and procedures they perform.

NHSN inpatient vs outpatient operative procedure


Q: If I find an infection that meets criteria for a PATOS SSI do I have to report this as an SSI event?

A: SSI events with the PATOS field = YES still have to be reported to NHSN if they are attributable to an NHSN operative procedure which you are following in your monthly reporting plan

PATOs Q&A

PATOs Q&A adapted from APIC NHNS newsletter 9/2015


Q: If a patient has infection present at time of surgery does that mean that any subsequent SSI will be a PATOS= YES?

A: ONLY select PATOS= YES if it applies to the depth of SSI that is being attributed to the procedure

Ex: if a patient has evidence of IAB at time of surgery

and then later returns with an organ space SSI the

PATOS field would be selected as a YES. If the patient

returned with a superficial or deep SSI, the PATOS field

would be NO.

PATOs Q&A



Q: Are SSI events with the PATOS= YES included in the SIR and for COLO and HYST, are these events reported to CMS?

A: All of the SSI SIRs that use the 2006-2008 baseline will include SSIs that are reported as present at time of surgery if the wound closure method was primary closure.

PATOs Q&A



However…

Procedures with closure method ‘other than primary’ are not included in SIR and not reported to CMS.

In 2016 the SSI events that are PATOS=YES will be

excluded from SIR analysis and from reporting to

CMS

PATOs Q&A



What can be a PATOS?

The evidence of infection or abscess must be noted/documented preoperatively or found intra-op in a pre-op or intra-op note

Examples:

Abscess noted

Mention of infection in OR note (does not need to meet SSI criteria)

Purulence noted

Septic / feculent peritonitis noted

Ruptured appendix

PATOs Q&A



If found alone without finding of infection the following do not meet PATOS=YES

Examples:

Positive culture or path report from specimen

Mention of rupture or perforation of colon

Fecal spillage or nicked bowel

Note of inflammation, necrosis, or gangrene

Contaminated trauma cases

NOTE: PATOS is not diagnosis driven (diverticulitis, peritonitis, appendicitis)

PATOs Q&A




Katrina Hansen, MPHHAI Program Manager(603) [email protected]

For More Information:

Documents

Site specific changes to NHSN 2016 SSI - FoundationSite specific changes 2016-SSI Reminders and back to some basics ICD-9 to ICD-10 /CPT code transition NHSN baseline CSV file uploads