NHSN Getting the Data Out Part II Mary Andrus,BA, RN, CIC Infection Preventionist Consultant Learning Objectives Following this presentation, the participant should be able to: 1. Create basic reports for surgical site infections (SSI) 2. Use the Custom Options tool in NHSN Analysis to save a report to use at a later date 3. Use the Advanced Output and Data Quality tools to identify specific issues with surveillance data 1
SSI METRICS SSI Line List 2
SSI Line List Screen For this output, I have chosen to use a time period based on the year of the operative procedure Because I am interested in looking only at hip and knee prosthesis operations, I have selected proccode as the variable and only HPRO and KPRO Because I don t want to see every possible variable in my list, I will select only those that I would like included in the table 3
Line List SSI SSI Frequency Table 4
Frequency Table Generating Output for Procedureassociated Events 5
NHSN Basic Risk Index The patient s SSI risk category is simply the number of these factors present at the time of the operation SSI Rates vs. SIRs The new SSI SIRs will use improved risk adjustment calculated through logistic regression modeling. Not only does this allow for all available risk factors to be considered, but it also allows for the risk factors to be procedure-specific. Each risk factor s contribution will vary according to its significant association with risk. For all NHSN procedures, the models predicted SSI risk better than the basic risk index, and as a result, the basic risk index will no longer be used when analyzing SSI data at a national level. 6
Predictive Risk Factors NHSN Operative Procedure AAA CBGB/C COLO FUSN HPRO HYST KPRO LAM PVBY RFUSN VSHN Risk Factor(s) All SSIs Duration Age, ASA, duration, gender, number of beds* Age, anesthesia, ASA, duration, endoscope, medical school affiliation*, number of beds*, wound class Approach, ASA, diabetes, duration, medical school affiliation*, spinal level, trauma, wound class Age, anesthesia, ASA, duration, HPRO type, number of beds* trauma Age, anesthesia, ASA, duration, endoscope, number of beds* Age, anesthesia, ASA, duration, gender, KPRO type, number of beds*, trauma Anesthesia, ASA, duration, endoscope Age, ASA, duration, gender, medical school affiliation* Approach, diabetes, duration Age, medical school affiliation*,number of beds*, wound class 7
http://www.cdc.gov/nhsn/pdfs/newsletters/nhsn_nl_oct_2010se_final.pdf Procedures/SSIs - SIR The new SSI SIRs provide improved risk adjustment and replace risk-stratified SSI rates. The SIRS use 2006-2008 as the baseline period, and therefore, SIRs are calculated for 2009 and forward. To allow for more precise comparisons, SIRs are calculated only if the number of expected HAIs (numexp) is 1. 8
Procedures/SSIs - SIR Each SSI SIR output option will produce SIRs by half-year (summaryyh) for 2009 and forward. The following tables will be included with each output option: Overall SIR SIR for each procedure SIR for each procedure, by outpatient (Y or N) (All SSI SIRs only) Incomplete and Custom Procedures not Included in SIR SIRs will not be calculated for the current time period. For example, if running the SIRs in November, 2010 by halfyears, the 2010H2 data will not be calculated or displayed, as the time period is not yet complete. Example: Overall SSI SIR During 2009, there were 524 procedures performed and 13 SSIs identified. Based on the NHSN 2006-2008 baseline data, 6.687 SSIs were expected. This results in an SIR of 1.94 (13/6.687), signifying that during this time period our facility identified 94% more SSIs than expected. The p-value and 95% Confidence Interval indicate that the number of observed SSIs is significantly higher than the number of expected SSIs. 9
SSI SIR by Procedure and Half- Year During the first half of 2009 (2009H1), there were 26 HPRO procedures performed and 1 SSI identified. Based on the NHSN 2006-2008 baseline data, <1 SSI was expected and therefore, a precise SIR could not be calculated. When the number expected is less than 1, you should check your data for procedures that were excluded from the SIR The All SSI SIRs will include all procedures and superficial incisional primary, deep incisional primary, and organ/space SSIs. Secondary SSIs are not included. 10
The Complex AR SIRs will include only inpatient procedures and Deep Incisional Primary and Organ/Space SSIs that were identified during admission (A) or readmission to your facility (R), as defined in the NHSN Manual. 11
Advanced Options Procedures Line List Use to obtain a line list of all operative procedures (not SSIs) 12
Example: Line List of Procedures Pathogen Data Useful if you would like to look at pathogen specific data Line list only. 13
Example: Pathogen Data Example: 14
Monthly Reporting Plan 15
Custom Output 16
If this is a report that you would like to generate later for a different time period, check this box If you want to save a particular modified report, you must change the Output Name. 17
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Custom Output 20
Data Quality Data Quality 21
Data Quality Procedures with 0 Duration 22
Data Quality Duplicate Device-associated Events 23
Data Quality Duplicate SSI Events 24
Data Quality SSI Event on Procedure Date 25
Data Quality Extremely High Incidence of SSI 26
Data Quality Events Reported with 0 Device Days 27
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