national healthcare safety network (nhsn) workgroup

National Healthcare Safety Network (NHSN) Workgroup

Deborah Yokoe and Michael HowellHealthcare Infection Control Practices Advisory Committee

May 17, 2018

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Disclaimer: The findings and conclusions herein are draft and have not been formally disseminated by the Centers

for Disease Control and Prevention and should not be construed to represent any agency determination or

policy.

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NHSN Workgroup

• Goal, Scope, and Reportingo To inform NHSN planning and development on subjects such as: analytics,

data elements, definitions and processes.o This workgroup will provide regular and ad hoc input on NHSN-related issues.o Input will be summarized and presented at public HICPAC meetings.

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NHSN Workgroup

• The workgroup is charged with providing input on NHSN topics, including:oData access policies and practicesoData validation oQuality measurement priorities and methodsoData use for HAI prevention at the facility, local, state and national levelso Informatics/information technology advances and surveillance improvements,

including data security and IT platforms

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NHSN Workgroup• Workgroup members:

• HICPAC• Vickie Brown• Vineet Chopra• Michael Howell• Lisa Maragakis• Debbie Yokoe

• EXTERNAL• Hilary Babcock, Barnes-Jewish

and St. Louis Children’s• David Banach, SHEA• Andrea Benin, CT Children’s• Darlene Carey, APIC• Yvonne Chow, HRSA• Missy Danforth, Leapfrog• Sarah Duvall, HANYS• Tricia Elliot, TJC• Sushant Govindan, University

of Michigan• Patti Grant, APIC

• Anthony Harris, University of Maryland

• Charlie Huskins, Mayo Clinic• Lynn Janssen, California

Department of Health• Marion Kainer, CSTE• Lisa McGiffert, CU• Kaede Ota Sullivan, Temple

University• Kathleen Rauch, HANYS• Daniel Schwartz, CMS• Connie Steed, Greenville Health

System• Tom Talbot, Vanderbilt

University• Mary Therriault, HANYS• Judy Trawick, HRSA• Margaret VanAmringe, TJC• Michael Wall, University of

Chicago

• CDC • Rashad Acrement• Jeneita Bell• Kathy Bridson• Sheri Chernetsky Tejedor• Maggie Dudeck• Jonathan Edwards• Denise Leaptrot• Kent Lemoine• Cliff McDonald• Dan Pollock• Eileen Scalise• Katharina Van Santen• Lauren Wattenmaker• Lindsey Weiner

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NHSN Workgroup

• The Workgroup has presented to HICPAC at the following meetings:o July 2017 – High priority topics were identifiedoNovember 2017 – Topics were consolidated into two subgroups (Definitions

and Data, Reports and Communication)

• The groups met by teleconference and by email oBi-monthly teleconferences

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NHSN WorkgroupData and Definitions Subgroup

High-level summary of

possible topics from NHSN/CDC

Surveyed subgroup members

C. difficile Infection testing and risk adjustment

Catheter-associated urinary tract infection (CAUTI) and age consideration for fever

Short-term Goal

Long-term Goal

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NHSN WorkgroupData and Definitions

Subgroup


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NHSN WorkgroupData and Definitions

Subgroup


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Example – Current Protocol

Age ≤ 65 • Meets POA SUTI 1b: Non-CAUTI

with DOE on February 2

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Hospital Day Criteria Foley Status IWPFebruary 1Admit day Fever Foley inserted

FC day #1

February 2 Fever FC day #2DOE

February 3 Fever FC day #3February 4 Fever FC day #4February 5 +UC FC day #5 +UCFebruary 6 Fever FC day #6February 7 FC day #7February 8 FC day #8February 9 FC day #9

February 10 FC day #10February 11 FC day #11February 12February 13February 14February 15February 16February 17February 18


Example – Current Protocol

Age ≤ 65 • Meets POA SUTI 1b: Non-CAUTI

with DOE on February 2

Age > 65• First eligible date for fever is

February 3• Meets SUTI 1a: CAUTI

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Hospital Day Criteria Foley Status IWPFebruary 1Admit day Fever Foley inserted

FC day #1February 2 Fever FC day #2

February 3 Fever FC day #3DOE

February 4 Fever FC day #4February 5 +UC FC day #5 +UCFebruary 6 Fever FC day #6February 7 FC day #7February 8 FC day #8February 9 FC day #9

February 10 FC day #10February 11 FC day #11February 12February 13February 14February 15February 16February 17February 18


• 5/11/18: Subgroup consensus to recommend removal of age restriction for using fever from the SUTI 1a and 1b definitions

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• C. difficile Infection (CDI) Testing Methods and Risk AdjustmentoConcerns about adequate risk adjustment to account for different CDI

testing methods (toxin EIA alone, PCR alone, toxin EIA+GDH followed by PCR for discrepancies, PCR followed by toxin EIA, etc.)

oSome improvement since revision of the CDI risk adjustment model but may still be inadequate for fair/meaningful inter-facility CDI SIR comparisons

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Marra AR, et al. Impact of 2018 changes in National Healthcare Safety Network Surveillance for Clostridium difficile laboratory-identified event reporting. Infect Control Hosp Epidemiol 2018 (available online)

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HICPAC input:• Do you support the subgroup recommendation to remove the age-

related limitations for considering fever from the SUTI definitions?• Is it useful to continue CDI testing method risk adjustment

discussions?• Ideas for possible future long-term topics, e.g.:

oWould the benefits of collecting patient-level data for better risk adjustment outweigh logistical challenges?

oAre there specific opportunities to reshape/refocus HAI surveillance targets to enhance the ability of the HAI measures to drive improvements?

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NHSN WorkgroupReports and Communication Subgroup

• Usability of Reports• Improving the interpretability of reports and metrics for infection preventionists,

other hospital-based quality leaders, public health, and consumers

• Communication and enhancing the “force multiplier” effect• Explore strategies to facilitate use of surveillance data into actionable steps • Improve integration into the HAI prevention work of consumer advocacy groups

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Expanded Subgroup

Representation

Roundtable Discussions

NHSN Measure Selection• Central line-associated blood

stream infections (CAUTI)• Catheter associated urinary

tract infections (CLABSI)• LAB-ID events – C. difficile

infection (CDI) and Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection

• Healthcare worker flu vaccination status

• Bloodstream infections in dialysis patients

LabID Event –CDI, MRSA BSI

Themes• Understandability• Ease of use• Timeliness• Data quality• etc


• Progress to date: • Invitations

• Invited individuals and groups to the subgroup• Professional societies, consumer/healthcare advocates, hospitals, etc.

• Roundtable Discussions• Subgroup participants were asked to provide a brief response to two prompts

• How do you (or your organization) use NHSN data?• How could you (or your organization) use NHSN data to achieve higher impact?

• NHSN Measure Selection• Subgroup participants were asked to rank which NHSN measure to focus on first

• Central line-associated blood stream infections (CLABSI)• Catheter associated urinary tract infections (CAUTI)• LAB-ID events – C. difficile infection (CDI) and Methicillin-resistant Staphylococcus aureus (MRSA)

bloodstream infection• Healthcare worker flu vaccination status• Bloodstream infections in dialysis patients

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• Progress to date: • Invitations

• Invited individuals and groups to the subgroup• Professional societies, consumer/healthcare advocates, hospitals, etc.

• Roundtable Discussions• Subgroup participants were asked to provide a brief response to two prompts

• How do you (or your organization) use NHSN data?• How could you (or your organization) use NHSN data to achieve higher impact?

• NHSN Measure Selection• Subgroup participants were asked to rank which NHSN measure to focus on first

• Central line-associated blood stream infections (CLABSI)• Catheter-associated urinary tract infections (CAUTI)• LAB-ID events – C. difficile infection (CDI) and Methicillin-resistant Staphylococcus aureus (MRSA)

bloodstream infection• Healthcare worker flu vaccination status• Bloodstream infections in dialysis patients

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Questions?

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