NHSN 2015 Rebaseline - tnpatientsafety.com Resources/april... · 3/31/2017  · 2015 . 2015 (New) NHSN Baseline . ... *Preliminary 2016 data CDI HHS 2020 Goal: SIR = 0.7 . Healthcare-Onset

NHSN 2015 Rebaseline and TDH Updates Ashley Fell, MPH

Standardized Infection Ratio (SIR)

SIR = Observed O HAIsPredicted P HAIs

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National Baseline Years

CLABSI and SSI

CAUTI

MRSA/CDI LabID

2006 2008 2010 2011 2009

All HAI Types: CLABSI, CAUTI, SSI,

MRSA/CDI LabID

2015

2015 (New) NHSN Baseline

Original NHSN Baseline 3

Rebaseline: Key Points • Benchmark updated to 2015

• SIRs may change

Better comparison to more current data!

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CAUTI 25% SIR = 0.75

SSI 30% SIR = 0.70

CDI LabID 30% SIR = 0.70

MRSA LabID 50% SIR = 0.50

HHS 2020 Goals

CLABSI 50% SIR = 0.50

5 https://health.gov/hcq/prevent-hai-measures.asp

CLABSI SIR in Adult/Pediatric ICUs

0.75

0.39

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CLABSI in Acute Care Hospitals

Unit Year No. of

Facs TN SIR

No. of Facs with Sig. LOW SIR

No. of Facs with Sig. HIGH SIR

Adult/Pediatric ICUs

2015 86 0.92 5 5

2016* 86 0.86 4 3

Adult/Pediatric Wards

2015 105 0.80 7 1

2016* 104 0.76 6 2

Neonatal ICUs 2015 25 0.92 0 0

2016* 25 0.63 2 0

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*Preliminary 2016 data CLABSI HHS 2020 Goal: SIR = 0.5

CAUTI SIR in Adult/Pediatric ICUs

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1.05

0.68

CAUTI in Acute Care Hospitals

Unit Year No. of

Facs TN SIR

No. of Facs with Sig. LOW SIR

No. of Facs with Sig. HIGH SIR

Adult/Pediatric ICUs

2015 86 1.04 3 5

2016* 86 0.92 4 4

Adult/Pediatric Wards

2015 105 0.67 5 1

2016* 104 0.68 6 1

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*Preliminary 2016 data CAUTI HHS 2020 Goal: SIR = 0.75

Healthcare-Onset CDI SIR

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CDI in Acute Care Hospitals

Year No. of Facs TN SIR No. of Facs with

Sig. LOW SIR No. of Facs with

Sig. HIGH SIR

2015 110 0.97 11 8

2016* 110 0.88 25 11

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*Preliminary 2016 data CDI HHS 2020 Goal: SIR = 0.7

Healthcare-Onset MRSA Bacteremia SIR

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Healthcare-Onset MRSA Bacteremia in TN

23% higher than US in 2015

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MRSA in Acute Care Hospitals

Year No. of Facs TN SIR No. of Facs with

Sig. LOW SIR No. of Facs with

Sig. HIGH SIR

2015 110 1.23 0 6

2016* 110 1.33 3 6

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*Preliminary 2016 data MRSA HHS 2020 Goal: SIR = 0.5

MRSA Prevention Resources

• SHEA – Strategies to Prevent MRSA Transmission and Infection in Acute Care Hospitals: 2014 Update

Available: https://doi.org/10.1017/S0899823X00193882

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2015 Rebaseline Resources

• NHSN Rebaseline Webpage: https://www.cdc.gov/nhsn/2015rebaseline/index.html – Guide to the SIR – Rebaseline FAQs (General and HAI-specific FAQs) – CMS Related Resources – Other Resources include: recordings and slides from webinars,

applicable NHSN Newsletters

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CRE Colonization Screening

CRE Colonization Screening • New! Offered by TDH through the

Antimicrobial Resistance Laboratory Network (ARLN) – Screen and detect CRE

– Prevent further transmission

– Increase laboratory capacity by providing service at no cost to facilities

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CRE Colonization Screening • When to screen

– When a patient has confirmed CRE • Epi-linked contacts (roommates) • Consider broader screening depending on the following:

– Setting – Overlap in the length of stay – Level of care provided – Presence of risk factor (e.g. wound, incontinence)

– Discharged patients • Device exposures • Substantial overlap • High levels of care

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CRE Colonization Screening

Interested in CRE colonization screening? Contact our team at [email protected] to help determine if a CRE case at your facility meets colonization screening criteria

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CRE Colonization Screening- Specimen Flow

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H

SPHL

TDH

Swabs from CR+

patient contacts

CR+

TDH HAI Team

Antimicrobial Use Tracking Options

Stewardship Training Incentive for Pharmacists

• Reimbursement available for pharmacists who complete stewardship training through SIDP or MAD-ID and successfully begin AU module reporting with TDH data sharing

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NHSN Structure

NHSN

Patient Safety Component

Device-Associated Module

Procedure-Associated

Module

MDRO/CDI Module

Antimicrobial Use and Resistance

Module

Antimicrobial Use Option

Antimicrobial Resistance Option

Healthcare Personnel Safety

Component

Biovigilance Component

Long-Term Care Component

Dialysis Component

NHSN Antimicrobial Use and Resistance (AUR) Module • Released in 2011 • Provides mechanism to report and analyze antimicrobial

usage as part of facility-based antimicrobial stewardship efforts – Facility-wide – Unit-based

• Currently voluntary – ~232 facilities in 40 states reporting (Feb 2017) – 4 reporting in Tennessee, including 1 to both AU and

AR modules – One option for Public Health Registry reporting for

Meaningful Use Stage 3

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NHSN AUR Module (cont.)

• Requirements to report: – Electronic Medication Administration Record (eMAR), or – Bar Coding Medication Administration (BCMA) systems

• AND – Ability to collect and package data using HL7 standardized

format (Clinical Document Architecture) – List of participating vendors: http://www.sidp.org/aurvendors or

“homegrown” methods

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NHSN AU Required Metrics

• Monthly aggregate, summary-level data – FACWIDEIN (All units) – Medical and Surgical Wards/ICU – Adult vs. Pediatric Units

• Numerator: Antimicrobial Therapy (DOT) – 89 Antibiotics (IV, IM, Oral, Inhaled) – See CDC Antimicrobial Use and Resistance Module Protocol

Appendix B for Full List • https://www.cdc.gov/nhsn/pdfs/pscmanual/11pscaurcurrent.pdf

• Denominator – Days Present (NOT Patient Days) – Admissions

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Interim Tracking Options

• TDH AU Point Prevalence Survey – Easily set up – Quick data pull, usually on monthly basis – Receive quarterly report with comparisons to other

participating facilities

• Long-term Care version under development to support and align with new Joint Commission Antimicrobial Stewardship Standard

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Antibiotic Use Reporting

• Started in 2014 • Offers an interim way to

fulfill CDC Core Elements of Tracking and Reporting

• Metric: Number of patients on antibiotics/census data – Different from NHSN

• 29 institutions have reported at least once into survey

• ~10-15 do so routinely

• Q3-2016 Data

Antimicrobial Stewardship Recommendations, Adopted by THA Board in October 2015

1. Hospital demonstration of commitment to antibiotic stewardship via a written statement of support and consideration of dedicated pharmacy, clinician and IT staff time for antibiotic stewardship activities

2. All hospitals commit to reporting to the National Healthcare Safety Network (NHSN) antimicrobial use and resistance modules within specified timeframes

3. All hospitals commit to a policy requiring documentation of indications for antibiotic therapy

Antimicrobial Stewardship Recommendations, THA Board Adopted (October 2015)

4. All hospitals commit to implementing a policy requiring an “antibiotic review” at 48-72 hours to allow for appropriate review of clinical indication of need, response and any therapeutic revisions that might be appropriate

5. Participation by hospitals in an antibiotic stewardship collaborative to encourage best practice / lessons learned sharing, and development of appropriate educational programing, as well as any other steps or activities that would assist with antibiotic stewardship

TDH AU Survey Questions

• For sample copy of survey or report:

Contact Chris Evans, PharmD [email protected] or [email protected] 615-532-6604

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Injectable Drug Diversion in

Healthcare Settings

2015 Newsweek Cover Story

http://www.newsweek.com/2015/06/26/traveler-one-junkies-harrowing-journey-across-america-344125.html

TDH Goals

• Support facility prevention efforts – 2017 ASHP Guidelines on Preventing Diversion of

Controlled Substances • Encourage more uniform response to suspected

injectable drug diversion including: – Written protocols and identified team members – Immediate testing for bloodborne pathogens (HIV,

HepB, HepC) following needlestick protocols – Prompt notification of TDH HAI group if positive per

outbreak reporting rules – Prompt reporting to licensing board – Consistent “not eligible for re-hire” response

Am J Health-Syst Pharm. 2017; 74:e10- 33

Ongoing TDH Efforts

• Improved coordination with Health Boards • Engaging stakeholders

– Health Board Investigators Fall 2017 – THA Quality Committee March 2017 – TnPAP director April 2017 – TMF director upcoming – National toolkit for State Health Departments under development

• What can you do?

Ask what your facility is doing to prevent diversion and respond swiftly and appropriately!

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Injectable Drug Diversion Questions

• For additional questions or speaking requests:

Pam Talley MD, MPH [email protected] or [email protected] 615-532-6821

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Contact Us

TDH HAI Team: [email protected]

(615) 741-7247

For more information about CRE Colonization

Screening: [email protected]

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