CMS and NHSN: What s New for Infection Preventionists in 2013 Part II

CMS and NHSN: What s New for Infection Preventionists in 2013 Part II Joan Hebden RN, MS, CIC Clinical Program Manager Sentri7 Wolters Kluwer Health - Clinical Solutions

Objectives Define the two major changes to CMS reporting requirements in 2014/15 for acute care facilities Understand the NHSN recent and proposed definitional changes for CLABSI, VAE and SSI Define SAMS and when this will impact you State how to access the NHSN demo site Understand the rationale for the correct answers to the case study scenarios 1

CMS Mandated HAI Reporting To NHSN 2011 2012 2013 2014 2015 CLABSI Acute Care ICUs (Jan.) CAUTI Acute Care ICUs (except NICUs) (Jan.) CAUTI LTCH, IRF, Cancer Hospitals (Oct) SSI Colon Surgeries and Abdominal Hyst. Acute Care (Jan) Dialysis Events ESRD (Jan) CLABSI LTCH, Cancer Hospitals (Oct) C. Diff LabID Events Acute Care (Jan.) MRSA Bacteremia LabID Events Acute Care (Jan.) HCP Influenza Vaccination Acute Care (Jan.) HCP Influenza Vaccination LTCH (Jan.) HCP Influenza Vaccination ASCs (Oct.) SSI Cancer Hospitals (Jan.) HCP Influenza Vaccination IRF (Oct.) CLABSI Acute Care Med, Surg, Med/Surg Units (Jan.) CAUTI Acute Care Med, Surg, Med/Surg Units (Jan.) MRSA Bacteremia LabID Events LTCH (Jan.) C. Diff LabID Events LTCH (Jan.)

CMS Rules for Acute Care Facilities 2014-15 3

NHSN Updates 4

NHSN SSI Reporting Changes for 2014 5

NHSN SSI Surveillance:Transition from ICD-9-CM codes 6

Ventilator-Associated Event (VAE) Surveillance Update July 2013 VAE surveillance initiated in adult patients in Jan 2013 Over 1200 facilities submitting data VAE Definition Working group received feedback: VAC detected in clinical scenarios as a result of usual processes of care or ventilator strategy differences between providers rather than an actual clinical worsening of the patient July 2013 Change to the definition: daily minimum PEEP values of 0-5 cm H 2 O are considered equivalent Patients must have an increase in the minimum daily PEEP value to 8 cm H 2 O AND sustained at or above 8 cm H 2 O for at least 2 calendar days to meet the VAC definition 7

Ventilator-Associated Event (VAE) Surveillance Update July 2013 8

Is it a CAUTI? 2012 Criteria 2013 Change SUTI/ABUTI in a patient that had a urinary catheter within the 48 hour period before the SUTI/ABUTI No minimum amount of time for device to be in place prior to meeting the CAUTI infection criteria SUTI/ABUTI had an indwelling urinary catheter place for >2 calendar days when the criteria for SUTI/ABUTI were met. If the SUTI/ABUTI occurs on the day the urinary catheter is discontinued or the following calendar day, the CL must have already been in place > 2 calendar days to be considered a CAUTI.

CAUTI Definition Changes on the Horizon 10

CAUTI Definition Changes on the Horizon 11

CAUTI Definition Changes on the Horizon 12

CAUTI Definition Changes on the Horizon 13

LabID Event Update 14

LabID Event Update 15

NHSN Updates: Coming Soon Secure Access Management Services: SAMS Will replace the Secure Data Network (SDN) that is currently used for user identity verification Will no longer need to install a digital certificate annually!! Gradual migration which will take up to 2 years to complete Migration will occur based on each individual s digital certificate expiration date Each individual NHSN user will receive an invitation 60 days prior to the expiration of your digital certificate to become SAMified 16

NHSN Demo 17

NHSN Demo 18

What were the NHSN 2013 changes? Identifying HAIs in NHSN HAI: An infection is considered an HAI if all elements of a CDC/NHSN site-specific infection criterion were first present together on or after the 3rd hospital day (day of hospital admission is day 1). For an HAI, an element of the infection criterion may be present during the first 2 hospital days as long as it is also present on or after day 3. All elements used to meet the infection criterion must occur within a timeframe that does not exceed a gap of 1 calendar day between elements. 19

HAI Event - USE CALENDAR DAYS 20

Device Associated HAIs An infection meeting the HAI definition is considered a deviceassociated HAI if the device was in place for >2 calendar days when all elements of a CDC/NHSN site-specific infection criterion were first present together. HAIs occurring on the day of device discontinuation or the following calendar day are considered device-associated HAIs if the device had been in place already for >2 calendar days. 21

CLABSI Reporting in Dialysis Patients 22

CLABSI Reporting in Dialysis Patients 23

Is it a CAUTI? Q: Can I use a fever from day 2 to meet the CAUTI criteria? Day 1 - patient admitted; Foley inserted; patient is afebrile Day 2 Foley remains in place; temp 38.4 Day 3 Foley in place; urine culture sent and is (+) for >100,000 E. coli Day 4 - Foley in place; afebrile Day 5 Foley in place; afebrile

SSI Reporting Case Study 9/10 Patient admitted and underwent a hemi-colectomy. Wound Class =2. Does well post-operatively and is discharged home on 9/15 10/11 Seen in the ED. Temp 38.7 0 C, abdominal pain. Ultrasound shows abscess along the abdominal wall 10/14 I&D of the abdominal wall abscess and specimen sent for culture. Antibiotics initiated. Abscess culture positive for E. coli Would this patient be reported as an SSI? 1. Yes 2. No 26

SSI Case Study Would this patient be reported as an SSI? 1. Yes 2. No the infection occurred > 30 days after the operative procedure 27

SSI Case Study If the readmission date for this patient was 10/6, would this be reported as an SSI? If so, what type? 1. Yes: a) SIP b) DIP c) Organ Space: Intraabdominal 2. No 28

SSI Case Study If the readmission date for this patient was 10/6, would this be reported as an SSI? If so, what type? 1. Yes: a) SIP b) DIP c) Organ Space: Intraabdominal 2. No 29

VAE Calculator VAC based on PEEP not FiO2 Why? Date of Event 3/4/2013 Why? VAE Window only 4 days Why?

Case Study A 69-year old female is seen in the ER and subsequently admitted to the ICU on a ventilator. Review her ventilator settings and determine if VAE criteria are met. MV Day Daily minimum Daily minimum PEEP FiO 2 1 8 100 2 6 50 3 5 50 4 6 40 5 6 60 6 6 60 7 5 60 8 5 60 9 5 60 A. Yes B. No

Case Study A 69-year old female is seen in the ER and subsequently admitted to the ICU on a ventilator. Review her ventilator settings and determine if VAE criteria are met. If so, on what MV Day does the event occur? MV Day Daily minimum Daily minimum PEEP FiO 2 1 8 100 2 6 50 3 5 50 4 6 40 5 6 60 6 6 60 7 5 60 8 5 60 9 5 60 A. Yes B. No There is not a 20 point change from MV day 3 to MV day 5

What if the settings were as follows? MV Day Daily minimum PEEP Daily minimum FiO 2 A. Yes B. No 1 8 100 2 6 50 3 5 50 4 6 40 5 6 70 6 6 70 7 5 60 8 5 70 9 5 60

The patient eventually develops a fever and is started on antibiotics. Does this meet the IVAC definition? MV Day Daily minimum PEEP Daily minimum FiO 2 Temp Min Temp Max WBC Min WBC Max ABX A. Yes B. No 1 8 100 2 6 50 3 5 50 37.6 38 4.8 4.9 None 4 6 40 38.6 38.9 5.6 5.8 None 5 6 70 39 39.0 5.6 5.8 None 6 6 70 38.8 39.0 5.1 5.4 None 7 5 60 38.0 38.1 5.2 5.4 None 8 5 70 Yes 9 5 60 Yes

The patient eventually develops a fever and is started on antibiotics. Does this meet the IVAC definition? A. Yes MV Day Daily minimum PEEP Daily minimum FiO 2 Temp Min Temp Max WBC Min WBC Max ABX B. No 1 8 100 2 6 50 3 5 50 37.6 38 4.8 4.9 None 4 6 40 38.6 38.9 5.6 5.8 None 5 6 70 39 39.0 5.6 5.8 None 6 6 70 38.8 39.0 5.1 5.4 None 7 5 60 38.0 38.1 5.2 5.4 None Why not IVAC? Temp criterion is met BUT. BUT new antimicrobial agent not started within VAE Window Period 8 5 70 Yes 9 5 60 Yes

THANK YOU FOR ATTENDING 37