NHSN 2015 Rebaseline and TDH Updates. Ashley Fell, MPH

Transcription

1 NHSN 2015 Rebaseline and TDH Updates Ashley Fell, MPH

2 Standardized Infection Ratio (SIR) SIR = Observed O HAIs Predicted P HAIs 2

3 National Baseline Years 2015 (New) NHSN Baseline All HAI Types: CLABSI, CAUTI, SSI, MRSA/CDI LabID CLABSI and SSI MRSA/CDI LabID CAUTI 3 Original NHSN Baseline

4 Rebaseline: Key Points Benchmark updated to 2015 SIRs may change Better comparison to more current data! 4

5 HHS 2020 Goals CLABSI 50% SIR = 0.50 CAUTI 25% SIR = 0.75 MRSA LabID 50% SIR = 0.50 CDI LabID 30% SIR = 0.70 SSI 30% SIR =

6 CLABSI SIR in Adult/Pediatric ICUs

7 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 Adult/Pediatric Wards * * Neonatal ICUs * *Preliminary 2016 data CLABSI HHS 2020 Goal: SIR = 0.5 7

8 CAUTI SIR in Adult/Pediatric ICUs

9 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 Adult/Pediatric Wards * * *Preliminary 2016 data CAUTI HHS 2020 Goal: SIR =

10 Healthcare-Onset CDI SIR 10

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

12 Healthcare-Onset MRSA Bacteremia SIR 12

13 Healthcare-Onset MRSA Bacteremia in TN 23% higher than US in

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

15 MRSA Prevention Resources SHEA Strategies to Prevent MRSA Transmission and Infection in Acute Care Hospitals: 2014 Update Available: 15

16 2015 Rebaseline Resources NHSN Rebaseline Webpage: 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 16

17 CRE Colonization Screening

18 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 18

19 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 19

20 CRE Colonization Screening Interested in CRE colonization screening? Contact our team at to help determine if a CRE case at your facility meets colonization screening criteria 20

21 CRE Colonization Screening- Specimen Flow H CR + TDH Swabs from CR + patient contacts SPHL TDH HAI Team 21

22 Antimicrobial Use Tracking Options

23 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 23

24 NHSN Structure NHSN Patient Safety Component Healthcare Personnel Safety Component Biovigilance Component Long-Term Care Component Dialysis Component Device-Associated Module Procedure- Associated Module MDRO/CDI Module Antimicrobial Use and Resistance Module Antimicrobial Use Option Antimicrobial Resistance Option

25 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 25

26 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: or homegrown methods 26

27 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 Denominator Days Present (NOT Patient Days) Admissions 27

28 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 28

29 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 Q Data

30 Antimicrobial Stewardship Recommendations, Adopted by THA Board in October 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

31 Antimicrobial Stewardship Recommendations, THA Board Adopted (October 2015) 4. All hospitals commit to implementing a policy requiring an antibiotic review at 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

32 TDH AU Survey Questions For sample copy of survey or report: Contact Chris Evans, PharmD or

33 Injectable Drug Diversion in Healthcare Settings

34 2015 Newsweek Cover Story

35 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

36 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! 36

37 Injectable Drug Diversion Questions For additional questions or speaking requests: Pam Talley MD, MPH or

38 Contact Us TDH HAI Team: (615) For more information about CRE Colonization Screening: 38