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Minnesota NHSN User Group
July 20, 2017
Reminders
For best sound quality, dial in at 1‐800‐791‐2345 and enter code 11076
Mute your phone during the presentation
Don’t put the call on hold
Please use the chat box to ask questions!
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Agenda
Welcome
NHSN Updates
Case Study
Other Updates & Upcoming Events
Q & A
NHSN Updates
Janet Lilleberg | Epidemiologist
Brittany VonBank | Epidemiologist
July 2017
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Agenda
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Optional Tagline Goes Here | mn.gov/websiteurl 5
TopicsNHSN v8.6 (June 17, 2017) Issues v8.7 Release Notes• CLABSI and CAUTI• MDRO/CDI Summary Data Form Outpatient LocationsProtocol Patient Safety Component • Blood Stream Infection• Procedure Code UpdateAnalysis/Reports Patient Safety Component• Using Descriptive Variable Names• TAP Strategy Dashboard• Standardized Utilization Ratio (SUR) Reports Now AvailableCMS Quality Reporting DeadlinesProvider Review Reports
Janet Lilleberg
Patient Safety NHSN Issues and version NHSN 8.7 Release Notes
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Correction to NHSN v8.6‐Central Line‐associated Bloodstream Infection (CLABSI) standardized infection ratios (SIRs)
NHSN email sent April 26th identified an error in the CLABSI risk adjustment models used for CLABSI SIRS for all facility types under the 2015 baseline affected CLABSI data from 2015 and the first two quarters of 2016. Data prior to this time was not affected.
• CLABSI models have been reconstructed and are now implemented in NHSN
• To correct your facility’s CLABSI SIRs and CLABSI TAP reports first generate new data sets
• Model details found in the “NHSN Guide to the SIR” pages 16‐19 https://www.cdc.gov/nhsn/pdfs/ps‐analysis‐resources/nhsn‐sir‐guide.pdf.
7/20/2017
Email Updates |https://www.cdc.gov/nhsn/pdfs/commup/nhsn‐email‐blast‐clabsi‐update.pdf
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New Issue Identified‐CAUTI
Error in catheter‐associated urinary tract infection (CAUTI) predictive models developed for the 2015 NHSN Standardized Infection Ration (SIR) re‐baseline.
• Effects acute care, long‐term acute care and inpatient rehabilitation facilities.
• CDC is developing new CAUTI models as quickly as possible.
• CDC is working with CMS to determine the impact on CMS programs. Refer all questions about Medicare programs directly to CMS. [email protected]
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Email Updates June 2017 | https://www.cdc.gov/nhsn/pdfs/commup/nhsn‐email‐blast‐cauti‐update.pdf
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New Issue Identified‐User Interface
• Rights Conferral Error defect
• Multiple users experiencing an “error when accepting confer rights”.
• (Note: If you have previously conferred rights to the affected group/s, the group should still be able to receive your data from the previous conferral)
• CSV Import
• “Height is Required” error even though the height in meters is included in the file
• “Error Contacting Server” message when trying to submit import file
• “Patient #### Already Exists” error when import valid duplicate procedures
• Work around is Manual data entry. Estimated fix August 20th
7/20/2017
Email Updates June 2017 | https://www.cdc.gov/nhsn/pdfs/commup/nhsn‐email‐blast‐cauti‐update.pdf
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New NHSN Version 8.7 Release Corrections
1. Issues with the “Alerts” functionality have been resolved. (various defects)
2. The MDRO/CDI summary data form for outpatient locations is functioning
3. Group users can now see results in the MDRO LabID Rate Tables and MRSA Bacteremia SIR Reports.
4. NHSN Procedure Codes (ICD‐10PCS/CPT codes for 2017) updated
5. New TAP Strategy Dashboard for CAUTI, CLABSU, FACWIDEIN CDI
6. New SUR/SIR Reports. These were deferred in NHSN v8.6
To use any of the new analysis output options in NHSN regenerate datasets.
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NHSN v8.7 (June 17, 207) Release Notes | https://www.cdc.gov/nhsn/pdfs/commup/release‐notes‐8.7.pdf
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Janet Lilleberg
Patient Safety Component Protocol and Data Entry
Bloodstream Infection
• January 2017, NHSN excluded a list enteric pathogens previously used to meet laboratory confirmed primary bloodstream infection (LCBI) criterion in the protocol.
• The change in pathogens is not built into the application.
• To update run a line list of blood stream infections
• Exclude LCBI reported for 2017 events, if the only pathogens reported for the event have been excluded in the protocol (Campylobacter, C. difficile, Shigella, Listeria, Yersinia, Enteropathogenic E. coli)
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NHSN Newsletter June 2017 | https://www.cdc.gov/nhsn/pdfs/newsletters/nhsn‐nl‐jun‐2017.pdf
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Procedure Code Correction Instructions
• https://www.cdc.gov/nhsn/pdfs/commup/nhsn‐email‐blast‐code‐corrections.pdf
• https://www.cdc.gov/nhsn/pdfs/commup/compendium‐of‐code‐corrections‐2017‐vendors‐users.xlsx
Surgical Site Infection Procedure Codes Update
New codes apply only to operative procedures performed on or after 1/1/17
Updated procedure code document available https://www.cdc.gov/nhsn/acute‐care‐hospital/ssi/index.html
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Janet Lilleberg
Brittany VonBank
Analysis/Reports Patient Safety Component
• To display full descriptive variable names instead of abbreviations when running a report select “Show descriptive variable names: on the top of the modification window.
• “Print List” is a complete list of the variables available in the patient safety component
Analysis: How to Display Descriptive Variable Names
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TAP Dashboard
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https://www.cdc.gov/nhsn/pdfs/training/2017/Arcement_March21.pdf
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• New feature in NHSN launched in June 2017
• Ability to visualize HAI TAP data on the NHSN home screen
• Data is auto‐populated after signing into NHSN
• CAUTI, CLABSI, and FACWIDEIN CDI without running TAP output options
TAP Dashboard
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https://www.cdc.gov/nhsn/pdfs/training/2017/Arcement_March21.pdf
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• Ability to generate new analysis data sets directly from the TAP dashboard
• Data displayed is from the most recent generated data sets for the user.
• The dashboard contains a bar chart with facility‐wide CADs by TAP category, for the five most recent quarters for any HAI type.
2020 HHS Action Plan:https://health.gov/hcq/prevent-hai-measures.asp
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Tap Dashboard
• Clicking on an HAI‐specific bar opens a location‐specific CAD graph
• –CAD rounded to the next whole number
TAP Dashboard Detail View
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SUR: Standardized Utilization Ratio
• Reports are now available in NHSN
• New Analysis Quick Reference Guide
• https://www.cdc.gov/nhsn/pdfs/ps‐analysis‐resources/run‐interpret‐sur‐reports.pdf
7/20/2017
SUR Reports | https://www.cdc.gov/nhsn/pdfs/ps‐analysis‐resources/run‐interpret‐sur‐reports.pdf
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DUR: Device Utilization Ratio
• Measures device utilization for central lines, catheters, and ventilators
• Issues with DUR
• Not risk‐adjusted
• Can only be calculated at unit‐level
• Compared to national pooled means for same location type
• National pooled means last updated with 2013 data
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SUR Reports | https://www.cdc.gov/nhsn/pdfs/ps‐analysis‐resources/run‐interpret‐sur‐reports.pdf
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DUR = Number of device days/Number of patient days
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SUR: Standardized Utilization Ratio
• Measures device utilization for central lines, catheters, and ventilators
• Calculated using 2015 rebaseline data (only available for 2015 data and onward)
• Functions like the SIR
• Only calculated if number of predicted device days is >=1
• SUR = 1, device utilization equal to predicted
• SUR >1, device utilization higher than predicted (worse than predicted)
• SUR < 1, device utilization lower than predicted (better than predicted)
• Risk‐adjustment: predicted device days calculated using a logistic regression model
• Adjusted for: CDC location, number of hospital beds, medical school affiliation type, and facility type
• Comparable across different locations and facilities
• Can include different locations in one SUR
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SUR Reports | https://www.cdc.gov/nhsn/pdfs/ps‐analysis‐resources/run‐interpret‐sur‐reports.pdf
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SUR = Observed device days/Predicted device days
Running SUR Reports
• Available for each device type and facility type
• Central lines, catheters, ventilators
• Acute Care Hospitals, Critical Access Hospitals, Long‐term Acute Care Hospitals, and Inpatient Rehabilitation Facilities
• Reports located in the device‐associated event folders: Analysis > Reports > Device‐Associated (DA) Module
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SUR Reports | https://www.cdc.gov/nhsn/pdfs/ps‐analysis‐resources/run‐interpret‐sur‐reports.pdf
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Example: Central Line SUR Report
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SUR Reports | https://www.cdc.gov/nhsn/pdfs/ps‐analysis‐resources/run‐interpret‐sur‐reports.pdf
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Example: Central Line SUR Report
• Modify Report options
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SUR Reports | https://www.cdc.gov/nhsn/pdfs/ps‐analysis‐resources/run‐interpret‐sur‐reports.pdf
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Report title and export file format
Date range for data included in SUR
Filter report by certain variables (e.g. location)
Group by 5 different date aggregations (Cumulative, YH, YM, YQ, Yr)
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Example: Central Line SUR Report
• Report Output
• OrgID
• numCLDays: # of central line days
• numPredDDays: # of predicted device days
• SUR: numCLDays/numPredDDays
• SUR_pval: p‐value (generally, p<0.05 indicates statistically significant SUR)
• SUR95CL: 95% confidence interval (if does not include 1.000, then statistically significant)
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SUR Reports | https://www.cdc.gov/nhsn/pdfs/ps‐analysis‐resources/run‐interpret‐sur‐reports.pdf
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Example: Central Line SUR Report
• SUR provided for multiple levels of location granularity
• Overall (By OrgID)
• By Location Type (e.g. CC, Ward)
• By CDC Location Code (e.g. CC:MS, Ward:M)
• By Location (by each location for which CLABSI data is submitted)
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SUR Reports | https://www.cdc.gov/nhsn/pdfs/ps‐analysis‐resources/run‐interpret‐sur‐reports.pdf
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Using the SUR
• Track device utilization over time
• Compare your facility’s performance to expected/predicted performance
• Use in conjunction with TAP/SIR reports
• Help guide HAI reduction efforts
• If high SIR and high SUR, target device utilization
• If high SIR and low SUR, indicates need for other HAI reduction efforts
• National and state‐level SURs
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SUR Reports | https://www.cdc.gov/nhsn/pdfs/ps‐analysis‐resources/run‐interpret‐sur‐reports.pdf
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Janet Lilleberg
CMS Quality Reporting
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Why is your data different than data on Provider Reports (CMS Facility Compare Websites)?
• Provider Report data includes data that was entered in NHSN for a facility at the time of the CMS quarterly deadline, for each individual quarter.
• Review your data in NHSN on the deadline. Print and save these output files for future reference.
• Any additions, deletions, modifications, updates, etc. made to data (events data, summary data, procedure data, annual survey, monthly reporting plans, and/or addressing outstanding data “alerts” on the NHSN home screen) after each quarterly deadline will not be reflected on Preview Reports, but will be reflected within NHSN and the analysis output you receive directly from NHSN.
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NHSN v8.7 (June 17, 207) Release Notes | https://www.cdc.gov/nhsn/pdfs/commup/release‐notes‐8.7.pdf
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Annual Survey Used to Calculate the SIR
• Annual survey, information is included into the calculation of the SIR for data from the current calendar year.
• Surveys are applicable only to those SIR data that match the survey year, unless a survey has not yet been entered in which case, the most recent survey is used.
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Acute Care Hospitals that participate in IQR Program
• 2017 Quarter 1 (January 1 – March 31) data must be entered into NHSN by August 15, 2017
• CLABSI and CAUTI data
• Inpatient COLO and HYST SSI data
• MRSA Bacteremia and C. difficile LabID Events (all healthcare‐onset and community‐onset)
Thank you!Janet Lilleberg
651‐201‐5938
Brittany [email protected]
651‐201‐4148
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Tracking Antibiotic Use in NHSN
Catherine Lexau, PhD, MPH, RN
Health Care‐associated Infections and Antimicrobial Resistance Unit
NHSN Antibiotic Use and Resistance Module
NHSN Antibiotic Use and Resistance (AUR) Module has two options for reporting and tracking:
Antibiotic Use
Antibiotic Resistance
AUR Module is currently available for hospital reporting, including Critical Access Hospitals and LTACHs.
Only reporting method: electronic file submission
Antibiotic Use Option: very useful for antibiotic stewardship programs.
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Example: Antibiotic Restriction and Reduced C. difficile infections
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Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license Terms and Conditions
The Lancet Infectious Diseases 2017 17, 411-421DOI: (10.1016/S1473-3099(16)30514-X)
NHSN Antibiotic Use and Resistance Module
What can be reported from the AUR?
Specific antibiotics and drug classes and different routes of administration
Ward (location)‐specific results, including inpatient, emergency department and outpatient observation units
Numerators: Antimicrobial “days”, a simplified measure, each antibiotic, one or more doses, to one patient on one calendar day
Denominators: Days present (on specified unit) and admissions
Numerous report formats, charts, exported datasets
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Unique Measure Available in AUR Module
Standardized Antibiotic Use Ratio (SAAR)
Observed/Expected antibiotic use, similar to SIR
Compares antibiotic use to that seen nationally
On specific wards, all antibiotics or by clinical categories:
Hospital‐onset/multidrug resistant infections
Community acquired infections
Anti‐MRSA
Surgical prophylaxis
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NHSN Antibiotic Use and Resistance Module
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1. Hospital Enrolled in NHSN
2. Reporting Plans, Locations Mapped
3. Health IT: eMAR or Bar Code Medication Record
4. Health IT: EHR or data mining application
5. Initiate reporting, Validate
submissions
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Resources
Society of Infectious Diseases Pharmacists list of vendors supporting or interested in supporting reporting into AUR module
http://www.sidp.org/aurvendors
Self‐reported EHR vendors and 3rd party vendors
CDC AUR Website:
https://www.cdc.gov/nhsn/acute‐care‐hospital/aur/index.html
Please contact us!
To help you and other antibiotic stewardship staff learn more about the system’s capabilities.
We’d like to learn more from hospitals about the technical issues involved in initiating data submission.
Catherine Lexau 651‐201‐5120 [email protected]
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Lisa Hesse MLS CICCase Study Coordinator
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June 2017 issue AJIC Link to survey questions Answers given after all questions answered Permission to use with attribution
June 1◦ 50 year old male in motor vehicle accident◦ Multiple fractures to upper extremities◦ Bruises to abdomen from seat belt◦ Abdomen tender to palpation
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June 2◦ CT scan of abdomen shows possible free air near
ascending colon, suggesting perforation◦ Pt taken to OR where partial COLO with
anastomosis is performed.◦ Fecal spillage noted in Op Note◦ Drains are placed◦ Fascia closed with sutures, skin loosely stapled◦ Antibiotic treatment started◦ ASA 3◦ Wound Class = ?
June 5◦ Fever 100.7’C◦ Blood cultures collected – grow E coli and B fragilis◦ Abdomen is distended and painful on palpation◦ Anastomotic leak suspected
June 6◦ Pt taken to OR where pus-filled abscess is noted
near leak◦ Additional ascending colon is removed◦ No cultures collected◦ ASA 3◦ Wound class = ?
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June 11◦ Pt complains of nausea and vomiting◦ Abdomen is again painful and distended◦ Temp 101.0’C◦ Blood cultures collected which grow MRSA◦ CT scan shows loculated fluid collection lateral to
ascending colon◦ CT guided aspiration of serosanguinous fluid which
grows B fragilis June 17◦ Pt shows improvement, transferred to inpt rehab
Q1. Does the June 2nd COLO procedure quality for submission into the facility’s NHSN denominator data?◦ No, because wound class is 3 and wound is only
loosely closed◦ No, because there was fecal contamination of the
abdominal cavity◦ No, because trauma = yes◦ Yes, because there are no exclusion for procedure
denominators
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A1. Yes. All COLOS are reported as part of denominator data. There are no exclusions for denominator data, regardless of wound class, closure, trauma, etc.
Q2. Is the June 2nd COLO eligible for SSI surveillance?◦ Yes, there is no reason for exclusion◦ No, because of the perforation and bowel
contamination◦ No, because of the high wound class◦ No, because there were drains placed and the
wound was only loosely closed
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A2. Yes it is eligible for surveillance. There are no exclusions for fecal contamination, wound class, or closure type.
Q3. If an SSI is identified and attributed to the June 2nd COLO procedure, which criteria are met?◦ SSI Deep Incisional Primary (SSI-DIP)◦ SSI Organ Space Gastrointestinal Tract (SSI-GIT)◦ SSI Organ Space Intra-abdominal (SSI-IAB) with 2’ BSI◦ SSI Organ Space Intra-abdominal with 1’ BSI◦ No criteria are met
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A3. SSI Organ Space Intra-abdominal (SSI-IAB) with 2’ BSI◦ DIPs are limited to muscle and fascia layer◦ GIT is limited to GI tracts◦ Meets organ space with OS criterion c – pus filled abscess IAB site specific criterion 2b – puss filled abscess +
blood cultures positive with at least one MBI organism DOE June 5th – when BC was collected
Q4. Was this PATOS?
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A4. No. No infection noted at time of surgery. Gross fecal spillage does not meet criteria.
Note: Wound class is not a criteria for PATOS
Q5. Should the June 6th COLO procedure be included in the facility's SSI denominator data?◦ Yes it is a new NHSN operative procedure with a
new surveillance period◦ No it is not included because an infection was
PATOS◦ No because there is already a COLO procedure
included in the June denominator from June 2nd◦ No, the surgery is combined with the June 2nd COLO
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A5. Yes. Each NHSN operative procedure creates a new denominator. The surveillance period for the June 2nd procedure ends with the June 6th procedure.
Q6. Is there a new SSI event attributable to the June 6th COLO?◦ Yes, SSI criteria are met◦ No, an SSI has already be cited for the pt on June 5th
◦ No, the procedure does not qualify for SSI surveillance◦ No, there was an infection PATOS when the June 6th
COLO was performed.
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A6. Yes. A new surveillance period was started with the June 6th procedure. Neither the previous SSI for June 2nd nor the infection that was PATOS exclude new SSI for new procedure.
Q7. What criteria are met for the SSI subsequent to the June 6th procedure? ◦ SSI OS IAB 3b with 2’ BSI MRSA◦ SSI OS IAB 3a without 2’ BSI◦ SSI OS IAB 1 with 2’ BSI◦ SSI OS IAB 2b with 2’ BSI MRSA◦ No SSI criteria are met
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A7. SSI OS IAB 3a without 2’ BSI. ◦ Meets with organisms identified from aseptically
obtained fluid, and site specific with Nausea, vomiting, abdominal pain and fever. ◦ MRSA does not match site specific isolate◦ Staph is excluded for IAB BSI criteria◦ Fluid collected from drain was described as
serosanguinous not purulent so does not meet criteria 1.
Q8. Is this PATOS?
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A8. YES!!◦ Met definition of PATOS- evidence of infection at
same level. Note that a reportable SSI does NOT automatically meet PATOS.
Review case in AJIC Answer all questions Take survey Review answers and rationale Discuss with colleagues
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Other Updates & Upcoming Events
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Medicare Beneficiary Quality Improvement Project (MBQIP) proposed additions
3 proposed additions for FY 2018 – 2021 (begins Sept. 1, 2018):
• Addition of an antibiotic stewardship program
• Addition of three CMS hospital compare hospital‐acquired infection measures (CAUTI, MRSA, CDI) as core measure requirements under the Patient Safety Domain
• Addition of ED‐1 and ED‐2 CMS Hospital Compare measures as core measure requirements under the Outpatient Safety Domain
CDI Module Training for CAH
Monday, Sept. 18 from 10:30 am – noon
Led by NHSN Trainers
Tailored training/case studies for CAH audience
Q&A to follow
Register online: https://web.telspan.com/register/240mnhospitals/cahcdinhsn
*This training replaces the previously scheduled NHSN user group call for September*
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NHSN ‐ CDI Module Resources
https://www.cdc.gov/nhsn/acute‐care‐hospital/cdiff‐mrsa/index.html
NHSN ‐ CDI Module Resources
https://www.cdc.gov/nhsn/acute‐care‐hospital/cdiff‐mrsa/index.html
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NHSN – MDRO & CDI LabID Event Calculator
https://nhsn.cdc.gov/nhsntraining/labid‐calculator/mdrolabidcalc.html
Polling Question 1
How do you identify positive C. difficile and MRSA results?A. Laboratory sends reports either electronically or on paperB. I can run reports that query the lab system or data warehouse (e.g. Crystal reports, BOE reports)
C. I use a data mining software that alerts me of new cases and/or allows me to run reports (e.g. TheraDoc, Epic Icon, SafetySurveillor)
D. Other method
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Polling Question 2
How do you determine denominators, including patient days, admissions, and Emergency Department encounters?A. Provided by finance department
B. I can run reports that query the data warehouse (e.g. Crystal reports, BOE reports) C. I use a data mining software that allows me to run reports (e.g. TheraDoc, Epic Icon, SafetySurveillor)
D. Other method
E. I do not collect this data
Polling Question 3
Does your facility have a 24‐hour observation unit?A. YesB. NoC. Unknown
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Polling Question 4
Does your facility have swing beds?A. YesB. NoC. Unknown
CHAIN Fall Conference
Sept. 27, 2017, 1 ‐ 4:30 p.m.
Earle Brown Heritage Center
Register online:http://www.mnreducinghais.org/conference/index.html
Sessions include:
• Appropriate testing
• Care transitions
• Antibiotic stewardship
• Hand hygiene
• Presentation of CHAIN award
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CHAIN Award for Excellence
Commends infection prevention and antibiotic stewardship efforts of health care teams working hard to build a safer overall healthcare environment
Award presentation Sept. 27 at the CHAIN Fall Conference
Complete the online nomination by August 11! http://www.mnreducinghais.org/award/index.html
Antibiotic Stewardship Honor Roll
Objectives:
• Encourage commitment to antibiotic stewardship
• Share ASP activities with other health professionals and the public
• Provide incentive for program improvement
• Publicize the importance of antibiotic responsibility
3 levels of achievement recognizing different program levels and progress
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Antibiotic Stewardship Honor Roll
Web recognition includes:• Level of achievement
• Name of physician and pharmacist champions
• Brief description of activities (silver & gold levels)
• Achievement level logo access
Online application: http://www.health.state.mn.us/onehealthabx/honor.html
July 31 is the first round deadline, quarterly updates thereafter
Next NHSN User Group Webinar
Please note, the date/time of the September webinar has changed to Monday, Sept. 18 from
10:30 a.m. – 12:00 p.m.
September’s webinar will be a special training event on the NHSN CDI Module geared toward
critical access hospitals.
Register online: https://web.telspan.com/register/240mnhospitals/
cahcdinhsn
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Additional Webinars Antibiotic Stewardship in Long Term Care Facilities Webinar Series
• Antibiotic Use and the Problem of Resistance ‐ August 1, 1‐2:00 p.m. Register: https://www.lsqin.org/event/ls4‐antibiotics/
• Clostridium difficile: Clinical Overview ‐ August 8, 1‐2:00 p.m. Register: https://www.lsqin.org/event/ls4‐cdiff/
• What Is an Antibiotic Stewardship Program? ‐ August 15, 1‐2:00 p.m. Register: https://www.lsqin.org/event/ls4‐stewardship/
• AS in LTC Facilities: Where Do We Start? ‐ August 22, 1‐2:00 p.m.Register: https://www.lsqin.org/event/ls4‐crnich/
Antibiotic Stewardship National LAN Event ‐ August 30, 2‐3:30 p.m.Register: https://www.lsqin.org/event/event‐webinar‐antibiotic‐stewardship‐national‐lan‐event/This activity is eligible for ACPE, ANCC, AANP, and CDR credit.
Questions?Janet Lilleberg, Minnesota Department of [email protected]
Brittany VonBank, Minnesota Department of [email protected]
Catherine Lexau, Minnesota Department of [email protected]
Lisa Hesse, APIC/Fairview Range Medical [email protected]
Susan Klammer, Minnesota Hospital [email protected]
Nancy Miller, Stratis [email protected]
