NHSN 2015 Rebaseline and TDH Updates Ashley Fell, MPH
Standardized Infection Ratio (SIR) SIR = Observed O HAIs Predicted P HAIs 2
National Baseline Years 2015 (New) NHSN Baseline All HAI Types: CLABSI, CAUTI, SSI, MRSA/CDI LabID 2006 2008 2009 2010 2011 2015 CLABSI and SSI MRSA/CDI LabID CAUTI 3 Original NHSN Baseline
Rebaseline: Key Points Benchmark updated to 2015 SIRs may change Better comparison to more current data! 4
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 = 0.70 5 https://health.gov/hcq/prevent-hai-measures.asp
CLABSI SIR in Adult/Pediatric ICUs 0.75 0.39 6
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 2015 86 0.92 5 5 2016* 86 0.86 4 3 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 *Preliminary 2016 data CLABSI HHS 2020 Goal: SIR = 0.5 7
CAUTI SIR in Adult/Pediatric ICUs 1.05 0.68 8
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 2015 86 1.04 3 5 2016* 86 0.92 4 4 2015 105 0.67 5 1 2016* 104 0.68 6 1 *Preliminary 2016 data CAUTI HHS 2020 Goal: SIR = 0.75 9
Healthcare-Onset CDI SIR 10
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 *Preliminary 2016 data CDI HHS 2020 Goal: SIR = 0.7 11
Healthcare-Onset MRSA Bacteremia SIR 12
Healthcare-Onset MRSA Bacteremia in TN 23% higher than US in 2015 13
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 *Preliminary 2016 data MRSA HHS 2020 Goal: SIR = 0.5 14
MRSA Prevention Resources SHEA Strategies to Prevent MRSA Transmission and Infection in Acute Care Hospitals: 2014 Update Available: https://doi.org/10.1017/s0899823x00193882 15
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 16
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 18
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
CRE Colonization Screening Interested in CRE colonization screening? Contact our team at ARLN.Health@tn.gov to help determine if a CRE case at your facility meets colonization screening criteria 20
CRE Colonization Screening- Specimen Flow H CR + TDH Swabs from CR + patient contacts SPHL TDH HAI Team 21
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 23
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
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
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 26
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 27
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
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 christopher.evans@tn.gov or HAI.Health@tn.gov 615-532-6604 32
Injectable Drug Diversion in Healthcare Settings
2015 Newsweek Cover Story http://www.newsweek.com/2015/06/26/traveler-one-junkies-harrowingjourney-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! 36
Injectable Drug Diversion Questions For additional questions or speaking requests: Pam Talley MD, MPH pamela.talley@tn.gov or HAI.Health@tn.gov 615-532-6821 37
Contact Us TDH HAI Team: HAI.Health@tn.gov (615) 741-7247 For more information about CRE Colonization Screening: ARLN.Health@tn.gov 38