2015 NHSN HAI Reporting Changes

2015 NHSN HAI Reporting Changes
Rosalie Giardina, MT (ascp) APIC Chapter 13 NYSDOH HAI Reporting program February 18, 2015

Reasons for 2015 Definition Changes Improve patient care* Decrease subjectivity* Optimize data consistency* Reflect current diagnostic method* Respond to user input* * While avoiding additional surveillance time

General Definition Changes - Additions: Infection Window Period*† Date of Event* Present on Admission Infections*† Healthcare-Associated Infections*† Repeat Infection Timeframe*† Secondary BSI Attribution Period*† Pathogen assignment (as relates to RIT) *† * Does not apply to VAE, LabID Event Surveillance † Does not apply to SSI Surveillance

General Definition Changes – Deletions: Gap Days concept to determine criterion met Logical Pathogens to determine secondary BSI Date of event = Date of LAST element

Infection Window Period – replaces gap day concept A 7-day period during which all site-specific infection criteria must be met. Date of the first positive diagnostic test, that is an element of the site-specific criterion Lab specimen collection date Imaging test, procedure or exam date Physician diagnosis date Date of initiation of treatment 3 calendar days before 3 calendar days after

Infection Window Period (con’t.) For site-specific criterion that do not include a diagnostic test, the first documented localized sign or symptom that is an element of the infection criterion will be used Examples of localized sign or symptom include: Diarrhea Site specific pain Purulent exudate

Date of Event The date the first element used to meet the CDC NHSN site-specific infection criterion occurs for the first time within the 7-day infection window period Present on Admission (POA) vs. Healthcare-Associated Infection (HAI) POA: Date of event occurs on the day of admission or the day after admission to an inpatient location The POA time period continues to include the day of admission, 2 days before and the day after admission HAI: Date of event occurs on or after the 3rd calendar day of admission

Infection Window Period Slide adapted from NHSN Training “What has Changed in 2015” Hospital Day Criterion 8 9 10 11 Temp = 101.5° F Before 12 Temp = 102.1° F 13 Urine culture: > 100,000 cfu/ml, E. coli 14 15 3 After 16 17 Diagnostic Test 7 Day Infection Window Period

Infection Window Period and Date of Event Slide adapted from NHSN Training “What has Changed in 2015” Hospital Day SUTI Criterion 8 9 10 11 Temp = 101.5° F 12 Temp = 102.1° F 13 Urine culture: > 100,000 cfu/ml, E. coli 14 15 16 17 7 Day Infection Window Period Date of Event

Infection Window Period and Date of Event Slide adapted from NHSN Training “What has Changed in 2015” Hospital Day Criterion 8 9 Temp = 100.5° F 10 Temp = 100.7° F 11 12 Temp = 102.1° F 13 Urine culture: > 100,000 cfu/ml, E. coli 14 15 16 17 Date of Event 7 Day Infection Window Period

Repeat Infection Timeframe (RIT) Uses date of event to determine a 14-day timeframe during which no new infections of the same type are reported The date of event is Day 1 of the 14-day Repeat Infection Timeframe If date of event for subsequent potential infection is within 14 days: Do not report new event Additional pathogens identified are added to the original event RIT : meant to be objective requires no interpretation of treatment purpose reduces labor of surveillance

Repeat Infection Timeframe (RIT) - (con’t) The RIT will apply at the level of specific type of infection with the exception of Bloodstream Infection (BSI), Urinary Tract Infection (UTI) and Pneumonia (PNEU) where the RIT will apply at the major type of infection Patient will have no more than one BRST (specific type of major type SST) As opposed to: Patient will have no more than one BSI (e.g., LCBI 1, LCBI 2, MBI-LCBI 1, etc.) Patient will have no more than one UTI (e.g., SUTI, ABUTI) Patient will have no more than one PNEU (e.g., PNU1, PNU2, PNU3)

Secondary Bloodstream Infection (BSI) Attribution Period The period in which a positive blood culture must be collected to be considered as a secondary bloodstream infection to a primary site infection (as long as all other required elements are met) This period includes the Infection Window Period combined with the Repeat Infection Timeframe (RIT) This period is days in length depending on the date of event NOTE: A primary BSI will not have a secondary BSI Attribution Period

Hospital Day SUTI Criterion 9 10 Temp = 101.5° F 11 12 Temp = 102.1° F 13 Urine culture: >100,000 cfu/ml, E. coli 14 15 16 17 18 20 21 22 23 24 25 26 Date of Event Secondary BSI Attribution Period = Infection Window Period + Repeat Infection Timeframe Slide adapted from NHSN Training “What has Changed in 2015” 14 days

Hospital Day SUTI Criterion 9 10 11 12 13 Urine culture: >100,000 cfu/ml, E. coli; Costovertebral angle pain 14 Temp = 101.5° F 15 16 17 18 20 21 22 23 24 25 26 Date of Event Secondary BSI Attribution Period = Infection Window Period + Repeat Infection Timeframe Slide adapted from NHSN Training “What has Changed in 2015” 17 days

Secondary Bloodstream Infection (BSI) Rules Secondary bloodstream infections may be attributed to a primary site infection during the Secondary BSI Attribution Period as per the Secondary BSI Guide (appendix 1) of the BSI event protocol Blood culture pathogen matches at least one organism found in the site-specific infection culture used to meet the primary site infection criterion - OR - The positive blood culture is an element used to meet the primary site infection criterion

Secondary BSI Attribution Secondary BSI attribution requires a matching pathogen or blood culture as element Pathogen Assignment rules replace allowed “logical” pathogen methodology in determining secondary BSIs In order to qualify as a secondary BSI, the positive blood culture must occur within the NHSN Infection Window or the repeat infection timeframe Additional eligible pathogens identified within a repeat infection timeframe are added to the event

includes 14 days from the RIT
2015 NHSN HAI Reporting Changes Day Criterion 9 10 11 Temp = 101.5 12 Temp = 102.1 13 Urine Culture: >100,000 cfu/ml, E. coli 14 15 16 17 18 Blood culture: E.coli 19 20 21 22 23 24 Secondary BSI Attribution Period Infection Window Period Repeat Infection Timeframe 15 days Attribution period is 15 days: includes 14 days from the RIT & 1 additional day from the window period. SUTI: with secondary BSI Pathogen: E. coli Date of Event: Day 11 *Slide from NHSN Training: BSI Definition Changes for 2015 phazamy

Secondary BSI Attribution - (con’t) Pathogen exclusions for specific infection definitions (e.g., UTI, PNEU)* also apply to secondary bloodstream infection pathogen assignment Excluded pathogens must be attributed to another primary site-specific infection as either a secondary BSI or identified as a primary BSI *Refer to the Urinary Tract Infection (Catheter-Associated Urinary Tract Infection [CAUTI] and non-Catheter-Associated Urinary Tract Infection [UTI]) and Other Urinary System Infection (USI) Events and the Pneumonia (Ventilator-Associated [VAP] and non-ventilator associated pneumonia [PNEU]) Events protocols

Date First diagnostic test or sign/symptom Infection Window Period Event (Date of Event) RIT (Specimen & Pathogen) 2ndary BSI Attribution Period Calendar Date / Hospital Day Date of Event Repeat Infection Timeframe - RIT Secondary BSI Attribution Period 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Worksheet for Surveillance Tool to assist users in determining the NHSN infection window period, repeat infection timeframe and secondary BSI attribution period when performing HAI surveillance To promote consistent data collection Blank worksheet:

CDC/NHSN Surveillance Definitions for Specific Types of Infections - CHAPTER 17 MAJOR substantive changes have been made to this chapter, including edits, additions and deletions Definitions for BSI, PNEU, SSI, UTI,VAE have been removed from this chapter and are now found in separate, dedicated chapters Major changes to UTI definitions Clostridium difficile infection (CDI) added (different criteria than LabID Event) This will be used by facilities reporting healthcare associated cases of C. difficile, but will NOT impact CDI LabID Event reporting. Clostridium difficile infection must meet at least 1 of the following criteria: i. Positive test for toxin-producing C. difficile on an unformed stool specimen ii. Patient has evidence of pseudomembranous colitis on gross anatomic (includes endoscopic exams) or histopathologic exam.

Device-Associated Denominator Sampling Alternative method* for collecting CLABSI and CAUTI denominator data Only non-oncology ICU and ward location types with 75 or more device days per month are eligible to use alternative method Requires collection on the number of patient days, central line days, or urinary catheter days on a single day once per week Use Monday-Friday ONLY; no weekend days are to be used for denominator sampling Requires the number of patient days for every day of the month Upon entry of collected monthly data into NHSN, an estimate of central line days or urinary-catheter days will automatically be calculated and used as CLABSI and CAUTI denominator data * Please note: The traditional method (using every day of the month) for CLABSI and CAUTI denominators remains available to all NHSN users.

Device-Associated Denominator Sampling

Additional Reporting Changes for NYS HAI Reporting Program Effective January 1, 2015, hospitals will be required to report CLABSIs in the following new location types: Adult and pediatric medical wards Adult and pediatric surgical wards Adult and pediatric medical-surgical wards Adult and pediatric step-down units Rates in these locations will be included in the 2015 annual HAI public report This change is consistent with the CMS CLABSI reporting with the exception of step down units (Note: Step down units are for NYS Reporting ONLY)

Surgical Site Infection Protocol Changes: NHSN Operative Procedure An NHSN operative procedure is a procedure: That is included in Table 1 - and - Takes place during an operation where at least one incision (including laparoscopic approach) is made through the skin or mucous membrane, or reoperation via an incision that was left open during a prior operative procedure Takes place in an operating room [OR], defines as a patient care area that met the Facilities Guidelines Institute’s (FGI) or American Institute of Architects’ (AIA) criteria for an operating room when it was constructed or renovated. This may include an operating room, C-section room, interventional radiology room, or a cardiac catheterization lab

NHSN Inpatient/Outpatient Operative Procedure Based on feedback provided by NHSN users regarding the changes to the Inpatient and Outpatient OR Procedure definition, NHSN has made a decision to rescind these changes. The SSI protocol and the Table of Instructions in the NHSN manual have been updated to reflect this change.

NHSN Inpatient/Outpatient Operative Procedures NHSN Inpatient Operative Procedure : An NHSN operative procedure performed on a patient whose date of admission to the healthcare facility and the date of discharge are different calendar days. NHSN Outpatient Operative Procedure : An NHSN operative procedure performed on a patient whose date of admission to the healthcare facility and the date of discharge are the same calendar day. Please disregard earlier guidance to identify OR areas/suites as inpatient or outpatient.

Primary Closure Definition Primary closure is defined as closure of the skin level during the original surgery, regardless of the presence of wires, wicks, drains, or other devices or objects extruding through the incision. This category includes surgeries where the skin is closed by some means. Thus, if any portion of the incision is closed at the skin level, by any manner, a designation of primary closure should be assigned to the surgery. If a procedure has multiple incision/laparoscopic trocar sites and any of the incisions are closed primarily, then the procedure is entered as having been primarily closed This change removed the phrase “all tissue levels” from the definition and more closely reflects definitions used by other surgical professional groups.

Non-primary Closure Definition Non-primary closure is defined as closure that is other than primary and includes surgeries in which the skin level is left completely open during the original surgery and therefore cannot be classified as having primary closure. For surgeries with non-primary closure, the deep tissue layers may be closed by some means (with the skin level left open), or the deep and superficial layers may both be left completely open. Examples of non- primary closures include: A laparotomy in which the incision was closed to the level of the deep tissue layers (fascial layers or deep fascia), but the skin level was left open An “open abdomen” case in which the abdomen is left completely open after the surgery Wounds with non-primary closure may or may not be: Described as ‘packed’ with gauze or other material Covered with plastic, ‘wound vacs’, or other synthetic devices or materials. If you have worked with your OR to include Closure in the OR documentation, advise them of this change.

PATOS – Infection Present at Time of Surgery New field on the SSI Event form Denotes that an infection was present at the start of, or during, the index surgical procedure Does not apply if there is a period of wellness between the time of a preoperative condition and surgery Infection must be noted/documented preoperatively or found intra-operatively Only select PATOS = YES if it applies to the depth of SSI that is being attributed to the procedure. (e.g., if patient has intra-abdominal infection at time of surgery and returns with an OS-SSI, the PATOS field would be selected as a YES; however, not if Superficial or Deep) The patient does not have to meet the NHSN definition of a SSI at the time of the primary procedure but there must be a surgeon’s notation that there is evidence of infection or abscess present at the time of surgery SSIs reported with PATOS = YES will be excluded from the SSI SIRs beginning with 2016 data, and analyzed separately

PATOS Example: Yes or No Patient admitted with acute abdomen, to OR for XLAP with findings of an abscess due to ruptured appendix and an APPY is performed. Patient returns 2 weeks later and meets criteria for an OS-IAB SSI. The PATOS field would be YES on this event. Patient admitted with ruptured diverticulum and in the OR surgeon notes multiple abscesses in the intra-abdominal space. Patient returns 3 weeks later and meets criteria for a SIP-SSI. The PATOS field would be NO for this event, since there was no documentation of abscesses in the superficial area at the time of surgery. During an unplanned C-section, the surgeon nicks the bowel and there is contamination of the intra-abdominal cavity. Patient returns 1 week later and meets criteria for an OS-OREP-SSI. The PATOS field would be NO since there was no documentation of evidence of infection or abscess at the time of the CSEC. The colon nick was a complication of surgery, but there was no infection at the time of surgery.

HPRO Revision Procedures (also applies to KPRO) If total or partial revision is performed, also evaluate if any of the following ICD-9 CM diagnosis or procedure codes were coded in the 90 days prior to and including the index HPRO revision If any of the specified codes is recorded, mark YES to the data field “Was the revision associated with prior infection at the index joint?’ It is not necessary to review the medical record for details concerning the prior infection in order to respond to this data field It is solely based on ICD-9 codes

HPRO Revision Procedures (con’t) This variable is defined solely by the presence of one or more of the following ICD-9 CM diagnosis or procedure codes associated with the index HPRO procedure in the 90 day pre-op period (including index revision): Insertion or replacement of (cement) spacer Removal of (cement) spacer V Acquired absence of hip joint, with or without the presence of an antibiotic-impregnated spacer Complications peculiar to certain specified procedures, infection and inflammatory reaction due to internal prosthetic device, implant and graft (extensions 996, 996.6): Due to unspecified device, implant and graft Due to internal joint prosthesis Due to other internal orthopedic device, implant and graft Due to other internal prosthetic device, implant and graft The prior infection at index joint field will be used as a new risk factor to be considered in the risk adjustment models for the new HPRO and KPRO 2015 baselines.

Additional SSI Reporting Changes Diabetes: Along with the current NHSN definition of diabetes, assignment of the discharge ICD-9 codes in the 250 to range will be acceptable to use to answer ‘YES’ to this diabetes field question Change in ‘Scope’ reporting instructions: Check ‘Yes’ if the NHSN operative procedure was coded as a laparoscopic procedure performed using a laparoscopic/robotic assist, otherwise check ‘No’ Transition to ICD-10 codes: Mappings to NHSN operative procedures anticipated by March ICD-10 codes will replace ICD-9 codes on October 1, 2015, but these codes will not be able to be entered until the January 2016 release. Do not enter any ICD-10 codes in the last quarter of 2015.

LabID Event Reporting Facility-wide Inpatient Monthly Denominator Reporting for Acute Care Hospitals For 2015 FacWideIN LabID Event reporting, you are now required to exclude inpatient locations that have a different CCN from the acute care facility. These locations must be removed from the monthly FacWideIN denominator counts (patient days and admissions). These locations may include: Inpatient rehabilitation Inpatient psychiatric Nursing home units

LabID Event Reporting Facility-wide Inpatient Monthly Denominator Reporting for Acute Care Hospitals Acute Care Facilities are required to show removal of the counts from locations with different CCNs. First enter a total count of patient days and admissions Second enter the patient days and admissions of those denominator counts for the facility minus those locations with a separate CCN. Updated Form on next slide… New Summary Fields

Important Information about Facility-wide Inpatient – FacWideIN Option for LabID Event Reporting only! Locations to be mapped* include: Each inpatient location in facility Each outpatient emergency department location Each outpatient 24-hour observation location * To view, add or edit your mapped locations: click on Facility>Locations in the NHSN navigation bar to access the Location Manager.

Facility-wide Inpatient – FacWideIN Includes inpatient locations PLUS Location specific reporting for the same organism and LabIDEvent type (i.e., All Specimens or Blood Specimens only) from each outpatient emergency department (ED) and 24-hour observation location This Means…….. LabID specimens collected in ED and 24-hour observation locations must be entered in the NHSN application and assigned to the outpatient location in which the specimen was collected, regardless of subsequent inpatient admission of patient.

Sample: MDRO Reporting Plan

An encounter is defined as a patient visit to an outpatient location for care. Sample: Reporting Separate Denominators

Facility-wide Inpatient – FacWideIN To ensure accurate categorizations of LabID events (e.g. incident, recurrent, healthcare facility-onset), facilities should continue to report LabID Events from all inpatient locations in the facility, including those locations with different CMS Certification Number (CCN) even though these data will be removed during FacWideIN analysis for the acute care hospital and not shared with CMS or IQR. Locations that may have different CCN number include inpatient rehabilitation facility (IRF), and inpatient psychiatric facility (IPF).

Provision to FacWideIN LabID Event Reporting What if a specimen was collected from a different outpatient location? Specimens collected from any other affiliated outpatient location (excluding ED and 24-hour observation locations) can be reported for the inpatient admitting location if collected on the same calendar day as inpatient admission. ** In this circumstance, the admitting inpatient location should be assigned.

Revisions to CRE Reporting Requirements Additional CRE organism: CRE-Enterobacter, will be added for CRE reporting Facilities will be required to conduct surveillance and report all 3 CRE organisms: E coli, Klebsiella pneumoniae/oxytoca, and Enterobacter. NYS HAI reporting will follow these revisions. Revisions to CRE definition: Addition of the drug ertapenem. Only include those pathogens that have tested “resistant” to a Carbapenem. Surveillance for CRE-Klebsiella limited to Kleb. oxytoca and Kleb. pneumoniae definition cont. next slide…

New Definition for CRE Any E coli, Kleb. oxytoca, Kleb. pneumoniae, or Enterobacter sp. testing resistant to imipenem, meropenem, doripenem, or ertapenem by standard susceptibility testing methods (i.e., minimum inhibitory concentrations of >4 mcg/ml for doripenem, imipenem and meropenem or >2 mcg/ml for ertapenem) OR By production of a carbapenemase (i.e., KPC, NDM, VIM, IMP, OXA-48) demonstrated using a recognized test (e.g., polymerase chain reaction (PCR), metallo-β-lactamase test, modified-Hodge test, Carba-NP) Please share this new definition with laboratory staff

New conditionally required question added to LabID MDRO or CDI Event form to improve tracking through the continuum of care for patients Last physical overnight location of patient immediately prior to arrival into facility (question available for LabID events if the specimen is CO, i.e., collected from an outpatient setting or collected < 4 days after admission). Location selections include: (1)Nursing Home/Skilled Nursing Facility, (2)Other Inpatient Health care Setting or (3)Personal Residence/Residential Care. (Refer to Instructions for Completion of MDRO/CDI Event form Jan 2015) New optional question: Has patient been discharged from another facility in the past 4 weeks? If yes, from where (check all that apply). The following value set will populate: nursing home/skilled nursing facility; other inpatient healthcare setting (i.e., acute care hospital, IRF, LTAC, etc.).

Clarification from CDC/NHSN: Q. The MDRO module update includes a new field for LabID events which is marked as Conditionally required (see below). Is this really an Optional field? A. YES. This is an optional data field. This question is conditional based on the specimen collection and admission dates. In other words, this question is active only when the specimen was collected less than four days after admission into and inpatient unit. Last physical overnight location of patient immediately prior to arriving into facility. Optional. Conditionally Required for specimens collected from the emergency department, observation location(s), or less than four days after admission into an inpatient unit. Using the available variables, select the location in which the patient spent the night immediately prior to arrival into the facility. Selections include: (1) Nursing Home/Skilled Nursing Facility; (2) Other Inpatient Healthcare Setting (i.e., acute care hospital, inpatient rehabilitation facility/IRF, long term acute care facility/LTAC, etc.); or (3) Personal Residence/Residential Care , which includes personal homes or assisted living environments in which 24/7 care is not provided in a group setting; Note: If the patient’s personal residence is a nursing home or skilled nursing facility, then your selection should be Nursing Home/Skilled Nursing Facility.

Analysis Updates All CLABSI SIRs for acute care hospitals produced in 2015 will continue to use a baseline of national data. The 2015 data will then serve as the baseline for SIRs produced in 2016 and forward. Retirement of “All Device-Associated Events” Set of Output Options Addition of MRSA bacteremia and CDI LabID Indicator Variables New Output Options: Analysis Options for HAI Antimicrobial Resistance Option for Targeted Assessment for Prevention (TAP) Strategy (for CLABSI, CAUTI & CDI) Options for CRE-Enterobacter and all CRE combined

CMS Feb 15 Reporting Deadline Extension (CMS) has announced extensions to the upcoming data submission reporting deadlines for NHSN metrics. This extension moves the deadline for the data required to be reported into NHSN from Sunday, February 15, 2015, to Friday, February 27, 2015, at 11:59 pm PT. This extension applies to the February 15 deadline and those facility types currently required to report HAI data to NHSN under the various CMS Programs, including Q data from acute care hospitals (IQR), PPS-exempt cancer hospitals (PCHQR), and inpatient rehabilitation facilities (IRFs), and Q data from long-term acute care hospitals (LTCHs/LTACs). This new deadline requires that all required NHSN data be submitted by users no later than this new date in order for data to be sent to CMS. CDC and CMS strongly encourage all facilities to submit data several days prior to the deadline to allow time to address any submission issues and to provide opportunity to review submissions to ensure data are complete.

Peggy Hazamy, RN, CIC NYS HAI Reporting Program CDC/NHSN Training Materials Marie Tsivitis, MT (ASCP), CIC THANK YOU!! Couldn’t have done it without: My colleagues’ assistance CDC/NHSN Training Materials

2015 NHSN HAI Reporting Changes

Similar presentations

Presentation on theme: "2015 NHSN HAI Reporting Changes"— Presentation transcript:

Similar presentations

About project

Feedback

Log in

Auth with social network:

2015 NHSN HAI Reporting Changes

Similar presentations

Presentation on theme: "2015 NHSN HAI Reporting Changes"— Presentation transcript:

Similar presentations

About project

Feedback