Minnesota NHSN User Group January 19, 2017 Reminders For best sound quality, dial in at 1-800-791-2345 and enter code 11076 Mute your phone during the presentation Don t put the call on hold Please use the chat box to ask questions! 1
Agenda Welcome NHSN Updates Case Studies: Invasive Manipulation Update Resource Review: NHSN Survival Guide Other Updates & Upcoming Events Q & A NHSN Updates 2
NHSN Updates January 2017 HAI/AR Unit Release of NHSN version 8.6 2017 NHSN Patient Safety Component Protocols and Data Collection Forms Endocarditis Surveillance Definition Update 2015 Re-baseline Webpage update Patient Safety Annual Facility Survey Release NHSN Training in March 3
Release of NHSN version 8.6 NHSN Version 8.6 contains approximately 150 changes Annual Survey update 2015 baseline for HAI SIRs Changes to the user interface of the NHSN application, impacting all components Expand browser support beyond Internet Explorer Resolves issues related to compliance with Section 508 of the Rehabilitation Act NHSN v8.6 (January 2017) Release Notes 4
2017 Patient Safety Component Protocols and Related Documents The new Patient Safety Component Manual is now online Use this manual is for data collected in 2017. The 2016 PS manual is available at https://www.cdc.gov/nhsn/pdfs/validation/ 2016/pcsmanual_2016.pdf 5
Endocarditis Surveillance Definition change 2017 NHSN infection window period extended to 21 days for ENDO 21 days includes the day of the diagnostic test and the 10 days before and the 10 days after Repeat Infection Timeframe (RIT) is extended to the remainder of the facility admission No more than a single ENDO event should be reported during a single patient admission The secondary BSI attribution period (SBAP) will also be extended for the remainder of the facility admission for the organism associated with the ENDO infection. This SBAP extension applies only for organism(s) in the originally identified ENDO event. All other organisms (even if accompanied by the original ENDO organism[s]), will be eligible as primary BSIs, and potentially CLABSIs. NHSN Pathogen Code Update The NHSN organism codes SNOMED CT codes have been updated based on the U.S. Edition 20150901 version The Mucosal Barrier Injury (MBI) organism and Common Commensal (CC) lists will also be updated. The global list (All Organisms) of active terms will grow from 1,956 to 3,458. The MBI organism list will expand from 498 organisms (32 genera) to 1,003 organisms (89 genera) The CC list will expand from 431 organisms (7 genera) to 540 organisms (13 genera) 2017 updated lists are found under Supporting Materials 6
2015 Baseline is Now Available Generate new datasets SIRs calculated under the original baselines can be run through 2016 data, and are available in a folder titled, Baseline Set 1. Note that all SIRs that are generated under the original baselines will include all of the original rules for inclusions/exclusions of the numerators and denominators. NHSN s Guide to the SIR provides specific details on the new risk adjustment models https://www.cdc.gov/nhsn/pdfs/ps-analysisresources/nhsn-sir-guide.pdf Rebaseline Highlights in the NHSN v8.6 Release New Risk Models https://www.cdc.gov/nhsn/pdfs/psanalysis-resources/nhsnsir-guide.pdf Some Reports will not be available for a couple of months Device-associated Standardized Utilization Ratios (SURs) and Mucosal Barrier Injury (MBI) SIRs reports will be available Summer 2017 Analysis Dataset Names updated 2015 baseline preface is bs2_. The original baseline is bs1_ New Analysis Variables and Variable Name Changes 7
Re-Baseline Website http://www.cdc.gov/nhsn/2015rebaseline/ Topics in the November 30 th Webinar Preview of the new application interface New output options Examples of reports using the new baseline The Annual Survey 8
New Output Options SIRS for critical access hospitals separate from acute care hospitals MBI SIRs VAE SIRs Total VAE IVAC Plus Pediatric SSI SIRs Standardized Utilization Ratios (SURs) for all device types Examples of Analysis and Reporting Trends https://www.cdc.gov/nhsn/pdfs/rebaseline/rebaseline-webinar-p2.pdf 9
Annual Survey https://www.cdc.gov/nhsn/pdfs/rebaseline/rebaseline-webinar-p2.pdf Antibiotic Stewardship and the Annual Survey New option- Responses to questions 23-33 on the Hospital Survey align with the 7 Core Elements of Hospital Antibiotic Stewardship Programs https://www.cdc.gov/nhsn/pdfs/rebaseline/re baseline-webinar-p2.pdf 10
Save the Date NHSN Training March 20-24 th In person attendance by lottery Live web stream Questions? MDH HAI Updates Janet.lilleberg@state.mn.us HAI/AR Unit 11
Case Studies: Invasive Manipulation Update NHSN User Group January 2017 Lisa Hesse, MLS CIC Case Study Coordinator 12
Invasive manipulation Invasive manipulation can end surveillance period but does not always end it Must be no evidence of infection at (the) time of the manipulation Does not have to meet NHSN definition of infection at time of manipulation Subsequent infection (~1 week?) Submit to NHSN 13
If there is any question that the infection may have been brewing at the time of the invasive manipulation and the patient develops an infection within a week or so, you should count/report that infection. If there is NO evidence of infection at the time of the manipulation and the patient does not develop an infection until after a week has passed, then you would not count/report the infection. Cases in the grey area in-between, or if you are uncertain about any of the above situations, those scenarios should be sent to NHSN for individual advice. Depth of procedure Superficial- skin and subcutaneous tissues Deep fascial and muscle layers Organ Space Any part of the body deeper than muscle and fascia Ex. IAB, PJI, VCUF etc Ex. Bone infection is organ space BONE 14
Reporting Report deepest level of infection meeting NHSN criteria If infection goes deeper during surveillance period, report deepest level of infection PATOS only applies to same level of infection Ex. Intraabdominal abscess at time of surgery and subsequent SSI SIP does NOT meet PATOS. Poll: Case Studies What types of NHSN reporting related case studies would be most useful to you on these calls? SSI: Colo SSI: Hyst CLABSI CAUTI C. difficile VAE Other 15
Resource: NHSN Survival Guide HSAG: NHSN Survival Guide https://www.hsag.com/contentassets/ac0f0c9a4ed94ad2 859c314d8f74c450/nhsn-survival-guide_pub-2_508.pdf 16
Other Updates & Upcoming Events Infection Prevention Certification Reimbursement MHA is offering up to $250 reimbursement for costs associated with initial CIC certification Available to the first 10 IPs who pass the certification exam For more information or a reimbursement application, contact MHA: Susan Klammer, Minnesota Hospital Association sklammer@mnhospitals.org Cammie Wadman Baca, Minnesota Hospital Association cjwbaca@mnhospitals.org 17
Educational Opportunities Feb. 14, 11:30 a.m. Antibiotic Stewardship/MDRO collaborative webinar Webinar link: https://zoom.us/j/218934587 1-855-880-1246 (toll-free) or 1-877-369-0926 (toll-free) webinar ID 218 934 587 Feb. 28, 1 p.m. HAI Peer Learning Network Call Topic: SSI Prevention Register online: https://web.telspan.com/register/240mnhospitals/haifeb2017ssi Questions? Janet Lilleberg, Minnesota Department of Health janet.lilleberg@state.mn.us Lisa Hesse, APIC/Fairview Range Medical Center lhesse1@range.fairview.org Sarah Brinkman, Stratis Health sbrinkman@stratishealth.org Susan Klammer, Minnesota Hospital Association sklammer@mnhospitals.org Cammie Wadman Baca, Minnesota Hospital Association cjwbaca@mnhospitals.org 18