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

http://www.cdc.gov/nhsn/

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: Richard.rodriguez@ct.gov