5/20/14. Current Issues in Ambulatory Infection Surveillance for Surgical Site Infections (SSIs)

Transcription

1 A webinar series that keeps you in the know Brought to you by Progressive Current Issues in Ambulatory Infection Surveillance for Surgical Site Infections (SSIs) May 19, 2014 Kelly L. Podgorny DNP, MS, RN Project Director The Joint Commission Objec&ves- - Address: Objec&ve 1. History of NHSN and the recent change in surgical site infecjon (SSI) implant monitoring 2. Removal of implant monitoring requirements 3. NHSN requirements for ambulatory SSI monitoring 4. Revision to NaJonal PaJent Safety Goal(NPSG) 5. Resources from The Joint Commission Enterprise 6. QuesJons 3 1

2 CDC s Na&onal Healthcare Safety Network The NaJonal Healthcare Safety Network (NHSN) is the Centers for Disease Control and PrevenJon s (CDC) healthcare- associated infecjon tracking system: o Provides facilijes, states, regions, and the najon with data needed to idenjfy problem areas o Measure progress of prevenjon efforts o Focuses on eliminajng healthcare- associated infecjons (HAIs) 4 CDC s Na&onal Healthcare Safety Network NHSN provides medical facilijes, states, regions, and the najon with data collecjon and reporjng capabilijes needed to: o IdenJfy infecjon prevenjon problems by facility, state, or specific quality improvement project o Benchmark progress of infecjon prevenjon efforts o Comply with state and federal public reporjng mandates and uljmately, o Drive najonal progress toward eliminajon of HAIs 5 NHSN s Decision to Remove Implants from SSI Surveillance Healthcare InfecJon Control PracJces Advisory Commi^ee (HICPAC) working group reviewed all aspects of SSI surveillance definijons and methods to: o Reduce subjecjvity o Enhance clinical credibility o Reduce data collecjon burden and o Make amenable to electronic data capture Ryan Fagan, MD Surveillance Branch CDC 6 2

3 NHSN s Decision to Remove Implants from SSI Surveillance Removed the requirement to indicate whether an implant was placed during an NHSN operajve procedure: o Deleted the implant definijon o Removed implant phrase from deep incisional and organ/space SSI definijons o Replaced 1 year follow- up period with 90- day period for certain procedures Ryan Fagan, MD Surveillance Branch CDC 7 Ambulatory Repor&ng Requirements for NHSN SeGngs: Surveillance of surgical pajents will occur in any inpajent and/or outpa&ent segng where the selected NHSN operajve procedure(s) are performed. Surgical Site Infec/on (SSI) Event: h^p:// Requirements: Perform surveillance for SSIs following at least one NHSN operajve procedure category. Collect SSI (numerator) and operajve procedure category (denominator) data on procedures included in the selected procedure categories for at least one month to meet NHSN requirements, or as otherwise specified by state or federal repor&ng requirements. A procedure must meet the NHSN definijon of an operajve procedure in order to be included in the surveillance. Surgical Site Infec/on (SSI) Event: h^p:// Ambulatory Repor&ng Requirements for NHSN NHSN will no longer collect informa&on on implants used during operajve procedures as part of SSI infecjon surveillance. Superficial incisional SSIs are followed for a 30- day period for all procedure types. For Deep Incisional SSIs and Organ/Space SSIs, the durajon of SSI surveillance will no longer be determined by presence of surgical implant, but instead will be determined by the NHSN Procedure Category only. 30- day or 90- day surveillance will be required. NHSN Surveillance Changes for January 2013 h^p:// 9 3

4 Ambulatory 30- Day Repor&ng Requirements Table 3. Surveillance Period for Deep Incisional or Organ/Space SSI Following Selected NHSN for NHSN Operative Procedure Categories. Day 1 = the date of the procedure 30-day Surveillance Surveillance Period for Deep Incisional or Organ/Space SSI Code Operative Procedure Code Operative Procedure AAA Abdominal aortic aneurysm LAM Laminectomy repair AMP Limb amputation LTP Liver transplant APPY Appendix surgery NECK Neck surgery AVSD Shunt for dialysis NEPH Kidney surgery BILI Bile duct, liver or pancreatic OVRY Ovarian surgery surgery CEA Carotid endarterectomy PRST Prostate surgery CHOL Gallbladder surgery REC Rectal surgery COLO Colon surgery SB Small bowel surgery CSEC Cesarean section SPLE Spleen surgery GAST Gastric surgery THOR Thoracic surgery HTP Heart transplant THYR Thyroid and/or parathyroid surgery HYST Abdominal hysterectomy VHYS Vaginal hysterectomy KTP Kidney transplant XLAP Exploratory Laparotomy OTH Other operative procedures not included in the NHSN categories 10 Ambulatory 90- Day Repor&ng Requirements for NHSN Code BRST CARD CBGB CBGC 90-day Surveillance Surveillance Period for Deep Incisional or Organ/Space SSI Operative Procedure Breast surgery Cardiac surgery Coronary artery bypass graft with both chest and donor site incisions Coronary artery bypass graft with chest incision only CRAN FUSN FX HER HPRO KPRO PACE PVBY RFUSN VSHN Craniotomy Spinal fusion Open reduction of fracture Herniorrhaphy Hip prosthesis Knee prosthesis Pacemaker surgery Peripheral vascular bypass surgery Refusion of spine Ventricular shunt 11 The Joint Commission s Na&onal Pa&ent Safety Goal (NPSG) : Implement Evidence- Based Prac&ces for Preven&ng SSI 12 4

5 The Joint Commission s NPSG : SSI Preven&on NPSG was revised in April, 2013 to reflect the NHSN revisions. Element of Performance (EP) 5 states: o Measure surgical site infecjon rates for the first 30 or 90 days following surgical procedures based on NaJonal Healthcare Safety Network (NHSN) procedural codes. The organizajon s measurement strategies follow evidence- based guidelines. 13 The Joint Commission s NPSG : SSI Preven&on Note 1: Surveillance may be targeted to certain procedures based on the organizajon's risk assessment. Note 2: The NHSN is the Centers for Disease Control and PrevenJon s health care associated infecjon tracking system. NHSN provides facilijes, states, regions, and the najon with data needed to idenjfy problem areas, measure progress of prevenjon efforts, and uljmately eliminate health care associated infecjons. For more informajon on NHSN procedural codes, see // cpt.html 14 Ques&ons from the SSI Surveillance Survey I work for a private pracjce board cerjfied plasjc surgeon with his own on- site OR. We monitor our infecjon sites; we haven t had any. Are there any good resources for operajng room staff (as far as educajon) available online? We are EHR and connected to our Surgeons clinics, the MA s should fill out a sheet and give it to the ASC. There are Jmes when the Surgeon himself will let us know. I also can go to into our EHR and find any infecjons reported. We are an Ophthalmic ASC, I would like to hear more on SSI surveillance. The quesjon would be: how long to monitor ophthalmic infecjons? How do facilijes track the implant pajents for CPT specific 30 and/or 90 days? What process is used? We are sjll tracking every implant case and MD s are to report to us for a year. Overkill is be^er than underkill! How specific must documentajon be when querying surgeons? i.e. can they make a blanket statement that says no infecjons in past 30 days? Or must the documentajon include patent name and procedure and they mark yes or no, etc. Not sure how specific it should be. 15 5

6 The Joint Commission: Enterprise Resources 1. Joint Commission Center for Transforming Healthcare: Surgical Site InfecJon Project h^p:// Hand Hygiene Project h^p:// 2. The Joint Commission: HAI Portal h^p:// 3. The Joint Commission: Measuring Hand Hygiene Adherence: Overcoming the Challenges h^p:// 4. The Joint Commission: The SSI ImplementaJon Guide: h^p:// implementajon_guide_for_npsg070501_ssi_change_project/ 5. Joint Commission Resources: Ambulatory h^p:// Keyword=infecJon#keyword=infecJon&guid=bb136652d273461bb9be03b5f30b58f5 &sg=ambulatory- Care 16 Ques&ons? us: 17 Resources on esupport OperaJons/InfecJon Control/InfecJon PrevenJon & InvesJgaJon National Healthcare Safety Network (NHSN) Surgical Site Infection Surveillance (SSI) Surgical Site Infection (SSI) surveillance is a part of the Infection Control Program of ambulatory surgery centers (ASCs). Recently, the Center for Disease Control s (CDC) National Healthcare Safety Network (NHSN) revised their SSI Surveillance definitions and reporting instructions included in the NHSN Procedure Associated Module of the Patient Safety Component, available at: The current SSI event instructions were designed primarily with acute care facilities in mind; however it is also used by outpatient settings including ambulatory surgery centers (ASCs) that are located in states that mandate SSI reporting to NHSN. Those states that mandate SSI reporting by ASCs include Colorado, Massachusetts, Nevada, New Hampshire, New Jersey, and Texas. Missouri also requires reporting by ASCs using NHSN SSI definitions, but to a separate, state-based database. A new NHSN Outpatient Procedure Component (OPC) is under development for voluntary use in ASCs in 2014, however until then ASCs that are required under state mandates to use NHSN methodology to conduct SSI surveillance must use the current, SSI event instructions of the Patient Safety Component. State-Based Reporting Requirements ASCs located in Colorado, Massachusetts, Nevada, New Hampshire, New Jersey, and Texas The revised SSI Surveillance protocol mentioned above must be followed and reported to NHSN according to state requirements. The protocol can be found at ASCs located in Missouri Missouri requires reporting by ASCs using NHSN SSI definitions, but to their state-based database. ASCs located in states excluding Colorado, Massachusetts, Missouri, Nevada, New Hampshire, New Jersey, and Texas The main purpose of this document is to give guidance for ASCs who are tracking SSI but do not have mandatory NHSN SSI surveillance reporting. It is recommended to follow the criteria listed below for SSI surveillance, but not report the data to NHSN at this time. The data can be used for internal benchmarking, trending, and reporting. Table 1 below is adapted from the full, NHSN operative procedure category mappings to ICD-9-CM and CPT Codes in Table 1 of the NHSN, Surgical Site Infection Event chapter, Jan 2013 version at The NHSN Operative Procedure Categories in the adapted table below are those that are subject to various state-based reporting mandates for ASCs and will be included in the upcoming first release of the OPC. Please use the current OPC protocol (when available) to obtain the updated, correct CPT code mappings for these procedure categories. 18 6

7 Resources on esupport Compliance/Policy and Procedure Update/QAPI 19 Mark your calendars! Join us next time for: Credentialing Pearls: A Systematic Approach to Compliance Credentialing Privileging Reappointments Peer Review Monday July 21, am PT/2pm ET Debra Stinchcomb, RN, BSN, CASC Progressive Surgical Solutions Brought to you by 7