using nhsn for multidrug resistant organismand clostridium ... · mdro/cdi module (labid cdc nhsn -...

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Using NHSN for Multidrug Resistant O i d Clostridium difficileOrganism and Clostridium difficileInfect ion (MDRO/CDI) Laboratory-Identified (LabID) Event Report ing

National Center for Emerging and Zoonotic InfectiousDiseases

Division of Healthcare Quality Promotion

For Today,Our Goals Are:• Understand why surveillance for MRSAbacteremia and C.difficile

infections are important.

• Understand Acute Care Hospital and Inpatient Rehabilitat ion Facility• Understand Acute Care Hospital and Inpatient Rehabilitat ion Facility(IRF) requirements for LabID Event report ing to CMSvia NHSN.

• Describe how to correctly set-up monthly report ing plan for MRSAbacteremia and C.difficile LabID Event report ing.

• Understand MRSAbacteremia and C.difficile LabID Event definit ionsand protocols.

• Describe how to correctly enter MRSAbacteremia and C.difficileLabID Event data into NHSN.

• Describe how to correctly enter denominator data for LabID Event report ing into NHSN.

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Why is MRSA BacteremiaSurveillance Important?

► Serious threat level,requiringprompt and sustained action.

► Staph bacteria,including MRSA,are oneof the most common causesofhealthcare- associated infections.

► CDCestimates >80,000 invasive MRSAinfections and >11,000 related deathsoccurred in 2011.

► Despite a slight decrease in thepercentage of S.aureusresistant toOxacillin (MRSA),MRSAcontinuestodominate among pathogens.

Important?

► Urgent threat level,requiringprompt and sustained

Why is C.difficile Surveillance

prompt and sustainedaction.

► C.difficile infections contributeto approximately 14,000deaths/year► ≈ 90% elderly► 400%increase 2000 07► 400% increase,2000-07

► Hospital stays from CDI tripledin the last decade

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Risk Factors: Key Prevention Targets

• Antimicrobial exposure Maindifi bl• Acquisition of C.difficile

• Advanced age

• Underlying illness

• Immunosuppression

• Tube feeds

modifiablerisk factors

• Tube feeds

• Gastric acidsuppression?

Centers for Medicare and MedicaidServices (CMS)



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Online Resources – CMSRelatedhttp://www.cdc.gov/nhsn/acute-care-hospital/cdiff-mrsa/index.html

□ Protocols

□ Training opportunit ies

□ Operational Guidancedocuments

□ Helpful Tips

□ Analysis

If participat ing in CMS Inpatient Quality Reporting (IQR)Program…

Acute care hospitals must report MRSA Bacteremia and C.difficile

LabID Events at Facility-wideInpatient (FacWideIN) levelInpatient (FacWideIN) level

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If participat ing in CMS Long TermCare Hospital* Quality Reporting(LTCHQR) Program…

Facility-wide inpatient (FacWideIN)MRSA Bacteremia and C.difficileLabID Event reporting is required

beginning January 1, 2015beginning January 1, 2015

*Note:LongTerm CareHospitals(LTCH) arereferred to asLongTerm Acute Care Hospitals (LTAC) in NHSN

If participat ing in CMSInpatient Rehabilitat ionFacility Quality Reporting(IRFQR) Program…( ) g

MRSA Bacteremia and C.difficile LabID event reporting is required beginning January 1, 2015 for free-standing IRFs [facility-wideinpat ient (FacWideIN)] and for IRF units

with in an acute care or critical access hospitalwith in an acute care or critical access hospital(by specific location).

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CMSRequirements: LabID Events

Acute Care Hospital Long TermAcute Care(LTAC)

Hospital CMS-IRF Unit

(“T” or an “R” in 3rd position of

Free-standing

CMS-IRF(last 4 digits of

CCN) CCN between 3025-3099)

Effective January 1, 2013 January 1, 2015 January 1, 2015 January 1, 2015

Required Locations

FacWideIN as defined in MDRO& CDI protocol


Each CMS-IRFunit within enrolled hospital


Data Collection

CDC NHSN -MDRO/CDIModule (LabID



CDC NHSN -MDRO/CDIModule (LabIDn Module (LabID

Event)Module (LabIDEvent)

Module (LabIDEvent)

Module (LabIDEvent)

Organisms Methicillin-Resistant Staphylococcus aureus (MRSA) / Clostridium difficile (C. difficile / CDI )

Methicillin-Resistant Staphylococcus aureus (MRSA) / Clostridium difficile (C. difficile / CDI )



Required Data

Non-duplicate MRSA blood / C. diff toxin




NHSNNHSNMult idrug Resistant and Clostridium difficile

(MDROand CDI) Module



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Patient Safety Component 4 Modules

PatientSafetyComponent

Device-associatedModule

Procedure-

associatedModule

AntimicrobialUseand

Resistance(AUR)Module

MDRO& CDIModule

Act ive part icipants must choose main report ingmethod

Reporting Requirements and Options

InfectionSurveillance(MDRO / CDI)

LabID EventReporting(MDRO / CDI)

addit ional opt ions then becomeavailable

PreventionProcessMeasures:PreventionProcessMeasures:• Adherence to Hand Hygiene• Adherence to Gown and Glove Use• Adherence to Active Surveillance Testing (for MRSA/VREOnly)

OutcomeMeasures:• ASTPrevalence / Incidence (for MRSA/VREOnly)

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Definit ions

□ C. difficile:A positive result for a laboratory test for C. difficile toxin Aand/or B (e g enzyme immunoassay or EIA test) OR a toxin-producing Cand/or B (e.g., enzyme immunoassay, or EIA test), OR a 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).

□ MRSA: S. aureus testing oxacillin, cefoxitin, or methicillin resistant; or positive from molecular testing for mecA and PBP2a

Overview of Laboratory-ident ifiedOverview of Laboratory-ident ified(LabID) Event Reporting



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LabID Event ReportingLabID Event reporting allows laboratory testingdata to be used without clinical evaluation of

the patient,allowing for a much less laborp , gintensive method to track C.difficile and MDROs,

such as MRSA.

These provide proxy infection measuresofhealthcare acquisition exposure burden andhealthcare acquisition,exposure burden,and

infect ion burden based primarily onlaboratory and limited admission data

Advantagesof LabIDEvent Reportinginclude…..

► Object ive laboratory-based metrics thatallow the following without extensive chartallow the following without extensive chartreview to:► Ident ify vulnerable patient populations► Estimate infect ion burden► Estimate exposure burden► Assess need for and effect iveness

of interventions► Standardized case definitions

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Important Information aboutFacility-wide Inpatient

FacWideINFacWideIN

Facility-wide Inpatient FacWideIN

Option for LabID Event reporting only!

Includes inpat ient locations*, including observation patientshoused in an inpat ient location

* See C.difficileLabID Event protocol for locationexclusions

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Facility-wide Inpatient FacWideIN

Includes inpat ient locations*PLUS

location specific reporting for the sameorganism and LabID Event type (i.e.,All

Specimens or Blood Specimens Only) fromp p y)each outpatient emergency department (ED)

and 24-hour observation location

* See C.difficileLabID Event protocol for locationexclusions

This Means…..

LabID specimens collected in ED and 24-hourobservation locations must be entered in the

NHSN applicat ion and assigned to theNHSN applicat ion and assigned to theoutpatient location in which the specimenwas collected, regardless of subsequent

inpat ient admission of patient.

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For Example….

If a facility is report ing FacWideIN MRSA Blood OnlyLabID Events, the facility must also map each

emergency department and 24-hour observationlocation and report MRSA Blood Only LabID Events

separately from these outpatient locations.

Likewise, if a facility is report ing FacWideIN MRSA AllSpecimensLabID Events, the facility must also report MRSA All SpecimensLabID Events from each mapped

outpatient emergency department and 24-hourobservation location.

What if the specimen wasll t d f diff tcollected from different

outpatient location?

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Provision to FacWideIN LabID Event Reporting

Specimens collected from any other affiliatedoutpatient location (excluding ED and24-hour observation locations) can be

reported for the inpat ient admitt ing locationif collected on the same calendar day asy

inpat ient admission.

**In this circumstance, the admitt inginpat ient location should be assigned.

Why are these addit ionaldata important?

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To facilitate accurate categorizationof LabID Events when specimens are

collected in the ED or 24-hourobservation units,as well as allow

each facility to capture community-onset cases coming into the facility.

Gett ing Ready for LabIDGetting Ready for LabIDEvent Reporting

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Sett ing up and Report ing: LabID EventsAcute Care Hospital Hospital IRF Unit Free-standing IRF

Enrollment No separate enrollment (already enrolled underthe hospital)

Enroll as separate facility-HOSP-REHAB Will have a unique NHSN orgID

Locations All inpatient locations must be mapped (see Locations guidance in Ch. 15). Additionally, outpatient EDand 24-hour observationlocations must be mapped

Map each CMS-IRF unit to Inpatient Rehabilitation Ward location within enrolled hospital. Must indicate theunit is a CMS IRF on the Location screen and enter the CCN for the IRF unit.

Map each inpatient location to CDC-defined location type (Rehabilitation Ward or Rehabilitation Pediatric Ward)

Monthly Reportin

FacWideIN and outpatientED and 24 locations for same

Location specific foreach CMS-IRF unit in

Facility-wideInpatientp

g PlanED and 24 locations for same organism and LabID event

each CMS IRF unit in hospital

Inpatient (FacWideIN)

Numerator Data(LabID events)

Report LabID eventsseparately for each inpatientunit and ED and 24-hourobservation

Report LabID Events separately for each IRFunit

Report LabIDEvents separatelyfor each location

Denominator Data

FacWideIN and again excluding locations with separate CCNs . Locationspecific counts for each ED and

Location specific counts FacWideIN

“CHECKLIST”For Facility-wide Inpatient MRSA Bacteremia &

C.difficile LabID Event Reporting

□ Review location options and map locationsin NHSN as necessaryin NHSN as necessary.

□ Review Monthly Reporting Plan(s) and update asnecessary.

□ Identify and enter all MRSA bacteremia and C.difficileLabID events into NHSN bylocation.

□ Enter denominator data for each month undersurveillance.

□ Resolve“Alerts”, if applicable.

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If part icipat ing in FacWideIN,must mapeach inpatient locat ion in the facility

Find Locations: All or Specific Search

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Add Location: Specify Location Info

If participat ing in FacWideIN,must also mapeachoutpatient emergency department location.

Includesoff-site EDlocations

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If participat ing in FacWideIN,must also mapeachoutpatient 24-hour observation location.

CMS-licensed IRF unit(s) must beSet-up as Inpat ient Rehabilitation Wardlocation and CCN entered for the IRF unit.

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√ Review location options and map inpatientSlocations NHSN as necessary.

□ Review Monthly Report ing Plan(s) andupdate as necessary.

□ Identify and enter all MRSA bacteremia and C.difficileLabID events into NHSN bylocation.LabID events into NHSN bylocation.

□ Enter denominator data for each monthunder surveillance


Monthly Reporting Plan□ The Monthly Reporting Plan informs CDCwhich modules a facility is

part icipating in during a given month

Referred to as“In-Plan” data

□ The Plan also informs CDCwhich data can be used for aggregateanalyses

This INCLUDESsharing applicable data with CMS!

□ A facility must enter a Plan for every month of the year

□ NHSN will only submit data to CMSfor those complete months inwhich the following are indicated on the monthly report ing planwhich the following are indicated on the monthly report ing plan

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Monthly Report ing PlanFacWideIN and CMS-IRFAt the beginning of each month:

□ Add facility-wide inpatient reporting for MRSA bacteremia and C.difficile LabID events to your monthly reporting plan (MRP) usingthe“FACWIDEIN” location.

□ If reporting FacWideIN,must also add location specific reportingfor the same organism and LabID Event for each outpatient emergency department and 24-hour observation locationemergency department and 24 hour observation location.

□ If applicable,add each CMS-IRF location for MRSA bacteremia andC.difficile LabID events to your MRP.

Creating a Monthly Reporting Plan

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Monthly Reporting PlanFacWideIN

Monthly Report ing PlanCMS-IRF Unit within aHospital□ At the beginning of each month,add MRSAbacteremia and C.

difficile LabID events to your monthly report ing plan using yourCMSIRF locationCMSIRF location.

□ The MDRO/CDI Module section of the plan must contain the tworows shown in the screenshot below in order for your facility’s datato be sent to CMS.

Repeat steps

for eachfor eachCMS-IRF

unit

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Monthly Report ing PlanDon’t Forget to Save

L o c a t i o n s

F A C W I D E I N - F a c i l i t y - w i d e I n p a t i e n t ( F a c W I D E T n )

S p e c i f i c O r g ·a n i s m T y p e

M R S A - M R S AP r o c e s s a n d O u t c o m .e M e a s u r e s

I n f e c t i o n . . I" . b l . d L a b I D E v e n tS u r v e i l l a n c e A S T - T 1 m 1 n g A S T - E 1g1 e I n c 1 e n c e P r e v a l e n c e A l l S p e c i m e n s

L a b I D E v e n tB l o o d S p e c i m e n s O n l y H H G G

X

F A C W I D E I N - F a c i l i t y - w i d e I n p a t i e n t ( F a c W T D E i n )

P r o c e s s a n d O u t c o m e M e a s u r e s

C O I F - C . d i f f i c i l'e

I n f e c t i o n L a b I ' D E v e n t L a b T D E v e n t. A S T - T i m i n g A S T - E i i g i b l e I n c i d e n c e P r e v a l e n c e

S u r v e i l l a n c e A l l S p e c i m e n s

X

B l o o d S p e c i m e n s O n l y H H G G

E D - E M E R G E N C Y D E P A R T M E N T


M R S A -M R S A

I n f e c t i o n . A S T T . . A S T E l b l I L a b I D E v e n t L a b I D 1g1 e n c 1 e n c e P r e v a l e n c e A l l

H H G G. dS u r v e i l l a n c e . - 1 m 1 n g

E v e n t- 1g1 e n c 1 e n c e P r e v a l e n c e A l l S p e c i m e n s

B l o o d S p e c i m e n s O n l y 'X

C D I F - C . d i f f i c i l e

E D - E M E R G E N C Y D E P A R T M E N T


I n f e c t i o n . . I" .b l .d L a b I D E v e n tS u r v e i l l a n c e A S T - T 1 m 1 n g A S T - E 1g1 e I n c 1 e n c e P r e v a l e n c e A l l S p e c i m e n s

X

L a b I D E v e n tB l o o d S p e c i m e n s O n ly H H G G

O B S - 2 4 H R O B S E R V A T I O N


M R S A -M R S A

I n f e c t i o n T . .

I" . b l . d L a b I D E v e n tS u r v e i l l a n c e A S T - 1 m 1 n g A S T - E 1·g 1 e 1 n c 1 e n c e P r e v a l e n c e A l l

S p e c i m e n s

L a b I D E v e n tB l ' o o d S p e c i m e n s O n l y H H G G

X

O B S - 2 4 H R O B S E R V A T I O N '


C D .I F - C . d i f f i c i [ e

L a b I D E v e n t

M R S A & C D IL a b i D E v e n t :

R e p o n i n g f o rt:he A c u t e

C a r e F ac i l i t : y

n v c e a n n c e A S T - T i m i n g A S T - E i i g i b l e I n c i d e n c e P r e v a l e n c e ; . b s

X

e e n n t sL a b I D E v e n tB l o o d S p e c i m e n s O n l y H H G G

R E H A B - R E H A B U N I T


M R S A -M R S A

I n f e c t i o nS u r v e i l l a n c e A S T T i m i n g A S T E l ig i b le I n c i d e n c e P r e v a l e n c e

L a b I D E v e n t- - A l l S p e c i m e n s B r o o d S p e c i m e n s O nly H H

G G

X

L a b I D E v e n t

R E H A B - R E H A B U N I T


C D I . F - C . d i f f i c i l e

S u r v e 1 a n c ei n f e c t i l o l n A S T - T i m i n g A S T - E i i g i b l e I n c i d e n c e P I L a b I D

E v e n tr e v a e n c e A l l S p e c i m e n s B l o o d S p e c i m e n s O n l y H H G G

X

L a b I D E v e n t

M R S A & C D IL a b i D E v·e n t :

R e p o r t i n g f o r t:he I R F

U n i t :

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Monthly Reporting Plan

□ To MODIFY a Plan:



√ Review location options and map locations in NHSN asnecessary.ecessa y

√ Review Monthly Reporting Plan(s) and update asnecessary.

□ Identify and enter all MRSA bacteremia and C.difficileLabID events into NHSN bylocation using theMDRO/CDI LabID Event protocolsMDRO/CDI LabID Event protocols.



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√ Review location options and map locations in NHSN asnecessary.ecessa y


□ Identify and enter all MRSA bacteremia and C.difficileLabID events into NHSN bylocation using theMDRO/CDI LabID Event protocolsMDRO/CDI LabID Event protocols.



OverviewMRSA Bacteremia LabID Event Reporting in NHSN

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Definit ionMRSA Posit ive Blood Isolate

Any MRSA blood specimen obtained forclinical decision making purposes

(excludesscreening cultures,such asthose used foractive surveillance testing)active surveillance testing)

Definit ionMRSA Bacteremia

LabID Event

MRSA posit ive blood specimen for a pat ient ina locat ion with no prior MRSA posit ive bloodspecimen result collected within 14 days forthe pat ientandlocat ion (includesacrosscalendar

months for Blood Specimen Only reporting)p y p g)

Also referred to asnon-duplicate LabID Events

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MRSA isolate from blood perpatient and location

BeginHere

MRSA Bacteremia LabID Event Report ingBlood Specimen Only

Prior (+) MRSAfrom blood

≤ 2 weeks from same pat ientand Locat ion (including across

LabID Event (unique MRSAblood source)

( gcalendar month

NO

Not aLabIDEvent

(Duplicate)

YES

Adapted from Figure 1 MDROTest ResultsAlgorithm for Blood SpecimensOnly LabIDEvents

Add Event Information□ Each month, facilities should use the MDRO/CDI Module protocol to

identify MRSAbacteremia LabID events.

□ All identified LabID eventsmust be entered into NHSN using the specificlocation where the patient was located at the time of specimen

ll ticollection.

□ Userswill not be able to use the FacWideIN location when reportingindividual LabID events.

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Event - PatientInformation

Event InformationSpecimens Collected from

Emergency Dept.or 24-Hour Observat ion

Not requiredfor

outpat ient LabID Event report ing

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Event InformationSpecimens Collected from Inpatients

Beginning 2015, two optionalquestions added to improve trackingthrough the continuum of care…..

No impact oncategorizat ions or analyses

for 2015

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Question:What facility admissiondate should be used?

Acute Care Hospital and CMS-IRFThe admission date should reflect the datethe patient was physically admitted to anthe patient was physically admitted to an

inpatient unit in the hospital

Acute Care HospitalNHSN will Categorize your

MRSA Blood Specimen LabID Events asCO or HOCO or HO

NHSN Application Categorizes* MRSA LabID Events As:

▪ Community-Onset(CO):LabID Event specimen collected in anoutpat ient locat ion or in an inpatient locat ion ≤ 3 days afteradmission to the facility (i.e.,days 1 (admission),2,or 3)

▪ HealthcareFacility-Onset(HO):LabID Event specimencollected > 3 days after admission to the facility (i.e.,onor after day 4)

*Based on Inpat ient Admission & Specimen Collect ionDates

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CMS-IRFUnit Within HospitalNHSN will Categorize your

MRSA Blood Specimen LabID Events asI id t* P l t*Incident* or Prevalent*

NHSN Application Categorizes* MRSA LabID Events As:

▪ Prevalent: LabID Event specimen collected in the IRF unit ≤ 3days after admission into that IRF unit (i.e.,days 1(admission), 2,or 3)

▪ Incident: LabID Event specimen collected > 3 daysafter admission to the IRF unit (i.e.,on or after day 4)

*Based on IRF Unit Admission & Specimen Collect ion Dates

What MRSA bacteremia data arereported to CMS?AcuteCareHospital(ACH):FacWideIN HO MRSA bacteremia standardized infect ion rat io(SIR) d fi d ll bl d d li t L bID E t(SIR),defined asall blood source,non-duplicate LabID Eventsidentified > 3 daysafter admission to theACH.Only data fromlocationswith same CMSCertification Numbers(CCNs) will beincluded.

CMS-IRFUnitinsideHospital:MRSAbacteremia incidence rate for all CMS-certified IRFS bacte e a c de ce ate o a C S ce t edunitscombined,defined asall incident blood source MRSALabID events identified > 3 daysafter admission to an IRFunitand where the patient had no positive MRSAbacteremiaLabID events in the prior 14 days in any CMS-certified IRFunitof that type.

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Don’tForget!

All MRSA bacteremia LabID Events, including community-onset (CO) andprevalent events (IRF units) must be

reported into NHSN so that thereported into NHSN so that thecategorizat ion of incidence and

prevalence can be assigned correct ly.

Let ’s ReviewMRSA Bacteremia LabID Events for

FacWideIN√ MRSA blood specimens MUSTbe monitored throughout allinpat ient locat ions

ithi f ilitwithin a facility.

√ All MRSA blood LabID Event(s) MUSTbe entered whethercommunity-onset (CO) or healthcare facility-onset (HO).

√ A blood specimen qualifies as a LabID Event if there has not been a previousposit ive laboratory result for the pat ient and locat ion within the previous 14days.

√ Like specimens and LabID Events collected from ED and 24 hour√ Like specimens and LabID Events collected from ED and 24-hourobservat ion must be reported for that outpat ient locat ion regardless ofsubsequent pat ient admission. Likewise, denominator counts are reportedseparately for each outpat ient locat ion.

√ Specimens collected from other affiliated outpat ient locat ions (non-ED,non24 hour observat ion) may be entered for FacWideIN ONLY if specimencollect ion date = admission date.

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Let ’s ReviewMRSA Bacteremia LabID Event Report ing

Inpatient Rehabilitat ion Facility (IRF) insidea Hospital

√ Location specific report ing is required,which means numerator anddenominator countsare reported separately for each CMScertifiedIRF unit inside the hospital.

√ All MRSAblood LabID Event(s) MUSTbe entered.

√ A blood specimen qualifies as a LabID Event if there has not been a√ A blood specimen qualifies as a LabID Event if there has not been apreviousposit ive blood culture result for the patient,organism(MRSA),and IRF location within the previous14 days.

What if the patient hasa CLABSIwith MRSA?

Report both a MRSA bacteremia LabIDReport both a MRSA bacteremia LabID Event and a CLABSI. Each Event must bereported separately in NHSN

1. LCBI- CLABSI Event,usingthe applicable HAI criteria,pp ,and

2. LabID Event,using the MRSAbacteremia LabID Eventreporting protocol

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Example of MRSA LabID Event & BSI HAI Event with MRSA

5W - 5 West - ICU

Overview

C diffi il L bID E tC.difficileLabID Event Reporting in NHSN

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Setting

Can occur in any inpat ient or outpatientlocation except locations known to

predominant ly house babies.

This includes:neonatal intensive care unit(NICU), specialty care nursery (SCN),babies inlabor, delivery, recovery,post-partum (LDRP),

well-baby nurseries,or well-baby clinics.

Definit ionCDI Posit ive Laboratory Assay

▪ Apositive laboratory test lt f C diffi il t i Aresult for C.difficile toxin A

and/or B,(includesmolecular assays [PCR]and/or toxin assays)

OR

C. difficile testingonly on

unformed stool samples!!

Stool should conform to shape of container▪ Atoxin-producing C.difficile

organism detected byculture or other laboratorymeans performed on a stoolsample

container

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CDI LabID Event: Laboratory Testing

DiagnosticTest Demonstrates Evidence of Toxigenic

Strain

Comments

YES NO

Glutamatedehydrogenase (GDH)antigen

X Detects antigen in both toxin and non- toxin producing strains

Toxin enzymeimmunoassay (EIA)

X • C.difficile toxin A and/or B• GDH plus EIA for toxin

(2-step algorithm)

Nucleic acid amplificationtest [NAAT](e.g.,PCR,LAMP)

X • C.difficile toxin B gene• GDH plus NAAT (2-step algorithm)• GDH plus EIA for toxin, followed

by NAAT for discrepant resultsby NAAT for discrepant results

Cell cytotoxicity neutralization assay (CCNA)

X • Requires tissue culture

Toxigenic (cytotoxic) C.difficileculture

X+ +Requires use of second test fortoxin detection

Definit ionCDI LabID Event

A toxin-posit ive C.difficile stoolspecimen for a pat ient in a locat ionwith no prior C.difficile specimen

result reported within 14 days for thet i t dl t ipat ient andlocat ion

Also referred to as non-duplicate LabID Events

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Add Event Information

□ Each month, facilities must use the MDRO/CDI Module protocol toidentify C.difficileLabID events.

□ All identified LabID eventsmust be entered into NHSN using theifi l ti h th ti t i d t th ti fspecific location where the patient wasassigned at the time of

specimen collection.

□ Userswill not be able to use the FacWideIN location when reportingindividual LabID events.

Event - PatientInformation

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Event InformationSpecimens Collected from ED

Event InformationSpecimens Collected from24-Hour Observat ion

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Event InformationSpecimens Collected fromInpatient Locations

Acute Care HospitalNHSN will Categorize C.difficile LabIDEvents Based on Inpat ient Admission &

Specimen Collect ion DatesCommunity Onset(CO):LabID Event specimen collected in an▪ Community-Onset(CO):LabID Event specimen collected in anoutpat ient locat ion or in an inpatient locat ion ≤ 3 days afteradmission to the facility (i.e.,days 1 (admission),2,or 3)

▪ HealthcareFacility-Onset(HO):LabID Event specimencollected > 3 days after admission to the facility (i.e.,onor after day 4)

▪ Community-OnsetHealthcareFacility-Associated(CO-HCFA): COLabIDEvent collected from a patient who was dischargedfrom the facility ≤ 4 weeks prior to the date current stoolspecimen was collected.

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IRFUnit Within HospitalNHSN will Categorize C.difficile LabID Events as Incident* or Prevalent*

▪ Prevalent: LabID Event specimen collected in the IRF unit ≤ 3days after admission into that IRF unit (i.e.,days 1(admission), 2,or 3)

▪ Incident: LabID Event specimen collected > 3 daysp yafter admission to the IRF unit (i.e.,on or after day 4)

NHSN will Further CategorizeC.difficile LabID Events based on current SpecimenCollect ion Date & Prior Specimen Collect ion Dateof a Previous CDI LabID Event (that was entered

into NHSN)into NHSN)

▪ Incident CDI Assay: Any CDI LabID Event from a specimenobtained > 8 weeks after the most recent CDI LabID Event(or with no previous CDI LabID Event documented) for thatpatientpatient.

▪ RecurrentCDIAssay:Any CDI LabID Event from aspecimen obtained > 2 weeks and ≤ 8 weeks afterthe most recent CDI LabID Event for that patient.

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What CDI data are reported toCMS?

AcuteCareHospital:FacWideIN incident HO CDI standardized infection ratio(SIR), which isdefined asnon-duplicateO, innsectivdaerinabtleC=.HdOifficileLabID Events identified > 3 daysafter admission to the facility.

IRFUnit insideHospital:CDI incidence rate for all CMS certified IRF nitscombinedCDI incidence rate for all CMS-certified IRFunitscombined,which isdefined as incident CDI LabID events identified > 3 daysafter admission to a CMS-IRFunit and where the patient had nopositive CDI LabID events in the prior 14 days in any CMS-certified IRFunit of that type.

SIRs are calculated for FacWideINsurveillance only; meaning duplicate

LabID Events reported at thelocation level are excluded from SIR

calculat ions.

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Important

Community-onset LabID Events andadmission prevalence of a facility will

play an important role in assignment of LabID Event onset,and so both HO andCO LabID Events must be reported into

NHSN.

Will a patient in my facility still becategorized as CO-HCFA if he/she spent t ime

in another healthcare facility betweenadmissions to my facility?admissions to my facility?

YES. Although the patient could have spent t ime at another facility in the t ime between previous dischargeand the new admission,this addit ional information isnot utilized because of burden for searching outside of

’ f ilitone’s own facility.

The optional fields can be used, if a facility wants totrack such information for internal purposes

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LabID Events categorized as CO-HCFA aresimply an additional level and subset of

the categorized CO events.

Healthcare facilit ies are NOTpenalized for CO-HCFApenalized for CO HCFA

LabID Events

What if the patient was admit ted withdiarrhea,but the stool was not tested for

C. difficile until day 4,will the Event still becategorized as healthcare facility-onset

(HO)?(HO)?

YES. A LabID Event will becategorized as HO if specimen collection is >

3 days after admission to the facility.

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LabID Events are categorized based on thedate of specimen collect ion and the date of

admission

Signs and Symptoms areNOT applicable to LabIDNOT applicable to LabID

Event report ing

A C.difficile LabID Event is categorized asIncident or Recurrent based on current specimen collect ion date and specimen

collect ion date of previous C.difficile LabID pEvent withinthesamefacility

O l i id t HOOnly incident HOC.difficile LabID Event data are

shared with CMS!!!

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Let ’s ReviewC.difficile LabID Event Report ing

√ For FacWideIN,C.diff toxin-posit ive specimens MUST bemonitored throughout all inpat ient locat ions within a facility. Exception:NICUs,SCN,Well Baby Nurseries,and babiesin LDRPunits areexcluded in CDI LabID Event reporting .

√ For FacWideIN,CDI LabID Events collected from ED and 24- hour observat ion must be reported for that outpat ientlocat ion regardless of subsequent pat ient admission.

√ Specimens collected from other affiliated outpat ient locat ions(non-ED,non-observat ion) may be entered for admitt inginpatient unit,ONLY if specimen collect ion date = admissiondate.

Let ’s ReviewC.difficile LabID Event Report ing

√ Location specific report ing is req ired for CMS IRF√ Location specific report ing is required for CMS-IRF.

√ All LabID Event(s) MUST be entered whethercommunity-onset (CO) or healthcare facility-onset (HO).

√ Only loose stools should be tested for C.difficile.

√ A toxin posit ive loose stool specimen qualifies as a LabID Event if there has not been a previous posit ive laboratory result forif there has not been a previous posit ive laboratory result forthe patient and locat ion within the previous 14 days for thepatient and locat ion.

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FacWideIN: Identify the LabID Events

Assume all specimens collected areshown

Pt Admit Date/ L ti

SpecimenCollectionD t /L

Specimen Source

Lab Result

LabID Event? L ti ?

Explanation

Location Date/Loc t Location?

1 Sue 02/15/15CCU

02/16/15CCU

Stool C.Diff toxin +

YES CCU

1st C.diff inlocation (CCU)

2 Sue 02/15/15CCU

02/20/152-Rehab


YES2-Rehab

First C. difffor location

3 Sue 02/15/15 03/01/15 Stool C.Diff NO Duplicate ≤14 days

CCU 2-Rehab toxin +NO

4 Sue 02/15/15CCU

03/10/152-Rehab


NO ≤ 14days previousspecimen

5 Sue 02/15/15CCU

03/10/15ICU


YES ICU

NEW location.No previous C.diff

6 Joe None 4/1/15 Stool C Diff Must be toxin +

FacWideIN: Identify the LabID Events

Assume all specimens collected areshown

Pt Admit Date/ L ti

SpecimenCollectionD t /L

Specimen Source

Lab Result

LabID Event? L ti ?

Explanation

Location Date/Loc t Location?

1 Joe 02/15/151-S

02/16/151-S


YES 1-S

1st C. diff for location with no prior C. diff

2 Joe 02/15/151-S

02/20/152-W


YES 2-W

First C. difffor location

W3 Joe 02/15/15

1-S03/01/152-W


NO Duplicate ≤14 days

4 Joe 02/15/151-S

03/10/152-W


NO ≤ 14days previousspecimen

5 Joe 02/15/151-S

03/10/151-S


YES 1-

>14 days since prev + for location

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“CHECKLIST”For Facility-wide Inpat ient MRSA Bacteremia &

C.difficile LabID Event Report ing

√ Review location options and map inpatient locationsi NHSNin NHSN as necessary.

√ Review Monthly Reporting Plan(s) and updateas necessary.

√ Identify and enter all MRSA bacteremia and C.difficileLabID events into NHSN bylocation.

□ Enter denominator data for each month undersurveillance .


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··- -- p r- .... . . .... . ... . .

-· · · ·---

K;;,:,: . . . .r c F r :S• · - - -------- --

.....--...- -.c-:r -- ---

-··.c -··.....

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--

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Facility-wide Inpat ient Denominator Report ingfor Acute Care Hospitals

□ Must exclude and indicate that inpatient locations with adifferent CMSCertification Number (CCN) have beendifferent CMSCertification Number (CCN) have beenremoved from the acute care facility monthly FacWideINdenominator counts (patient days and admissions).

▪ e.g., inpatient rehabilitation facilities [IRF] andinpatient psychiatric facilities [IPF]

▪ CDCForm 57 127 (MDRO and CDI Prevention Process▪ CDCForm 57.127 (MDRO and CDI Prevention Processand Outcome MeasuresMonthly Reporting)

▪ Detailed guidance available in theTable of Instructionsfor Form 57.127

Entering Denominator Data in NHSNApplication

□ Click on ‘Summary Data’ and then ‘Add’ on the left -hand navigat ion bar.

□ Select ‘MDRO and CDI Prevent ion Process and Outcome Measures MonthlyMonitoring’ from the Summary DataType dropdown menu (see screenshot below). This is a different form than the one you use to report summarydata for CLABSI and CAUTI.

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Denominator Data: FacWideIN□ On the summary data entry screen, select FACWIDEIN as the location for

which you are entering the summary data.

□ After selecting the FACWIDEIN location, month, and year, six summary datafields will become required.

□ Except for CDI section, patient day and admission counts may be the sameif facility does not have units with different CCN

Denominator DataIRF Unit with in a Hospital

□ On the summary data entry screen, you must select the CMS IRF unit asthe location for which you are entering the summary data by clicking onthe drop down menu next to ‘Location Code.’

□ After selecting the appropriate unit, month, and year, two summary datafields will become required.

□ Repeat these steps for each CMS-IRF unit.

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Denominator DataEmergencyDepartment

□ On the summary data entry screen, you must select the EDas the locationfor which you are entering the summary data by clicking on the dropdown menu next to ‘Location Code.’

After selecting the appropriate unit month and year one summary data□ After selecting the appropriate unit, month, and year, one summary datafield will become required (Total EDEncounters/Visits).

□ Repeat steps for 24-hour observation locations.

Repeat steps for 24-hour observation locations andother ED locations (i.e.,(pediatric ED)

“CHECKLIST”For Facility-wide Inpat ient MRSA Bacteremia &

C.difficile LabID Event Report ing

√ Review location options and map locations in NHSN asnecessary.


√ Identify and enter all MRSA bacteremia and C.difficileLabID events into NHSN bylocation.y

√ Enter denominator data for each month undersurveillance.

√ Resolve“Alerts”, if applicable.

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Denominator Data: Report No Events

□ If you have identified and reported both MRSA bacteremia and C.difficile LabIDevents during the month, you are finished with your report ing for the monthand can skip this step.

□ If you have not identified any LabID events for MRSA bacteremia or C difficile at□ If you have not identified any LabID events for MRSA bacteremia or C.difficile atthe end of a month, you must indicate this on the summary data record in orderfor your data to be sent with CMS.

□ On the MDRO and CDI Module summary data form,checkboxes for “Report NoEvents” are found underneath the patient day and admission count fields,asseen in the screenshot below.

□ Must repeat steps for each ED, 24-hour observation, and CMS-IRF location.

These boxes will auto-check foreach event you are following “in-

plan”. If these boxes are notchecked automatically, your dataare not complete and will not be

submitted to CMS

Denominator Data□ For Hospitals:Select CDITest type quarterly (last month of each

calendar-year quarter – March; June;September;December)

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Hints…

Use the resources on the NHSN Website….especially FAQs

using nhsn for multidrug resistant organismand clostridium ... · mdro/cdi module (labid cdc nhsn -...

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