NHSN Reporting for Laboratory-identified Clostridium difficile Infection (CDI) and Methicillin-resistant Staphylococcus aureus (MRSA) (Bacteremia) Presentation.

NHSN Reporting for Laboratory-identified Clostridium difficile Infection (CDI) and Methicillin-resistant Staphylococcus aureus (MRSA) (Bacteremia) Presentation to: Georgia Hospital Association Presented by: Jeanne Negley, MBA, Healthcare Associated Infection Coordinator Date: November 15, 2012

AGENDA Background: Purpose, Requirements, & References
Starting with Reporting Plans and Denominators MRSA Bacteremia Lab ID Event (Numerator) CDI Lab ID Event (Numerator) Using Electronic Reporting Systems Lab ID Event Reporting Categories (includes risk adjustment) Frequently Asked Questions Announcements! The agenda for today’s presentation includes: A patient story regarding C. difficile Background regarding Clostridium difficile reporting in NHSN and Oregon reporting requirements How to identify a LabID event in NHSN Review of NHSN reporting protocol and its application in NHSN Tips for using electronic reporting systems, such as lab data mining programs Frequently Asked Questions regarding Lab ID CDI reporting

Purpose of MDRO and CDI Lab ID Event Reporting
To calculate proxy measures of MDRO and CDI events, exposures, and healthcare acquisition. Provide a monitoring method that enables a facility to rely almost exclusively on data obtained from the laboratory. Also provide a mechanism for facilities to report and analyze MDRO and CDI data to inform infection control staff of impact of targeted prevention efforts. Note: CDI = Clostridium difficile infection reporting. The purpose of Lab-ID CDI is to calculate proxy measures of events, exposures, and healthcare acquisition. This is a proxy measure; so, we are measuring what we can. This is a useful measure to collect data to direct improvement efforts.

CMS Reporting Requirements
Laboratory-Identified (Lab-ID) MRSA (bacteremia) and CDI in NHSN Begins January 2013 for Inpatient Quality Reporting Program for hospitals Overall Facility-Wide Inpatient (LabID, Method C) Laboratory-Identified (Lab-ID) module This presentation is tailored to present information on the Lab-ID facility-wide reporting for CDI. It is important to note that NHSN includes a traditional surveillance module for CDI and we are not using that module. We are using the Lab-ID module, which is a laboratory surveillance driven process. Reporting for your QIO will begin in July 2012. IPPS reporting will begin January 2013. Not an infection event surveillance module Lab-ID is a laboratory driven surveillance process

We are not following CDI infection event surveillance module
This is to further emphasize we are not following the NHSN CDI event surveillance module. This module requires obtaining clinical data from the chart, such as signs and symptoms, and assigning a diagnosis such as gastroenteritis. We are not following this module.

LAB ID MDRO/CDI Reporting References
NHSN MDRO/CDI Module: MDRO/CDI NHSN Protocol: CDC Location Labels and Location Descriptions: Table of Instructions: (Make sure you review instructions for Lab ID for MRSA and CDI.) NHSN definitions can change; consult on-line references. These are the main reference documents for reporting Lab ID CDI. When you review them, be careful that you review sections that pertain specifically to Lab-ID CDI. I have included the reference document for CDC locations and descriptions, because to report Lab ID CDI facility-wide you will need to input all of your inpatient locations into NHSN and map them correctly.

Reporting Forms Enter Online. Hardcopy Paper Forms Available. ( Monthly Reporting Plan Laboratory-Identified MDRO/CDAD Event Form This is the numerator: one form per LabID event MDRO and CDAD Prevention Process and Outcome Measures Monthly Monitoring Form This is the denominator: Inpatient – total patient days, admissions NHSN has three reporting forms. The monthly monitoring plan, which most of you have been using to indicate your surveillance for CLABSI and SSIs. You can now add Lab-ID CDI to the monthly plan. The Lab-ID MDRO/CDAD event form. This form is used to report Lab-ID events; it is the numerator for the metric and one form is completed per event. The MDRO/CDAD Prevent Process and Outcomes form is used to record your monthly group denominator; for inpatient facility-wide reporting, the group denominator is total patient days and admissions.

Starting with Reporting Plans and Denominators
Input Monthly Reporting Plans Recommend input for entire year Incorrect /incomplete reporting plans affect reporting to CMS Map all inpatient locations Both Lab ID MRSA (blood only) and CDI (stool) are for entire facility (all locations)

Patient Safety Monthly Reporting Plan
Reporting PlanAdd. Input Month and Year. Here is the monthly reporting plan. You should recognized this form at the top with the section to input your device-associated plan. To add Lab-ID CDI, you will need to scroll to the bottom, and input “Facility-Wide In” as your location and select “C. difficile” as your organism. The application will automatically select the Lab-ID event surveillance module for you. The next month when you enter the application, you can select the box highlighted in gold to “Copy from Previous Month.” All facilities will need to complete the monthly reporting plan, even if they are using an automated surveillance process. May want to input monthly reporting plan 6 mos. To 1 year in advance. Scroll down page.

Reporting Plan (Cont.) 1 2 4 5 3 6 Input “FacWideIn” for MRSA.
Check Lab ID Event Blood Specimen Only Add Row to input CDI plan Input “FacWideIn” for CDI Check Lab ID Event All Specimens for CDI Select “Copy from Previous Month” to input multiple reporting plans.

Summary Data Requirements
MRSA Blood Cultures: FacWideIn = Total inpatient admissions and total inpatient days for the month. CDI: FacWideIn = Total inpatient admissions and total inpatient days minus admission/pt days accrued in a NICU or well baby nursery.

MRSA Overall Facility-Wide Inpatient
Patient Days = 2950, Admissions = 300 MICU Wards SICU An important concept when preparing to report LabID facility-wide inpatient is to identify all of your inpatient locations. The definition of an inpatient location is a location where patients are housed overnight. This diagram includes examples of inpatient locations, such as surgical and medical ICUs, inpatient wards, and pediatric ICU and wards. To review a list of additional applicable locations, you can use this line to the CDC location list to identify additional inpatient locations. (Additional examples of inpatient locations include organ transplant, inpatient dialysis (pt. receives dialysis as part of their care), behavioral health/psychiatric wards.) The one exception to the inpatient surveillance protocol is that it does not include well baby nurseries and NICUs. (Newborns and children in their first year of life are noted to have the highest colonization rates of C. difficile—SHEA/IDSA guidelines). Please note that you do include maternity patients in the facility-wide inpatient counts. What we talk about what patients to include in the inpatient metric, we are referring to the reporting of Lab-ID positive results and to the patient counts in the summary denominator for this metric. As noted at the top of the slide, the group denominator is patient days and admissions, and we have subtracted web baby and NICU counts from these data. Pediatric ICU and Wards Well Baby Nurseries & NICUs Reference: CDC location list

CDI Overall Facility-Wide Inpatient
Patient Days = 2600, Admissions = 250 MICU Wards SICU Pediatric ICU and Wards An important concept when preparing to report LabID facility-wide inpatient is to identify all of your inpatient locations. The definition of an inpatient location is a location where patients are housed overnight. This diagram includes examples of inpatient locations, such as surgical and medical ICUs, inpatient wards, and pediatric ICU and wards. To review a list of additional applicable locations, you can use this line to the CDC location list to identify additional inpatient locations. (Additional examples of inpatient locations include organ transplant, inpatient dialysis (pt. receives dialysis as part of their care), behavioral health/psychiatric wards.) The one exception to the inpatient surveillance protocol is that it does not include well baby nurseries and NICUs. (Newborns and children in their first year of life are noted to have the highest colonization rates of C. difficile—SHEA/IDSA guidelines). Please note that you do include maternity patients in the facility-wide inpatient counts. What we talk about what patients to include in the inpatient metric, we are referring to the reporting of Lab-ID positive results and to the patient counts in the summary denominator for this metric. As noted at the top of the slide, the group denominator is patient days and admissions, and we have subtracted web baby and NICU counts from these data. Reference: CDC location list Exclude well baby nurseries & NICUs. Include maternity patients and newborn readmitted to pediatric unit. Exclude Well Baby Nursery& NICU

Locations not included in Facility-Wide Inpatient
Do NOT include: Emergency Department Observation Units (<24 hour stay) Outpatient Surgery Outpatient Radiology Outpatient Chemotherapy/Infusion Service Outpatient Dialysis Operating Rooms Clinics Outpatient lab results ADDITIONAL RULES: Emergency Department: If ED pt is admitted as inpatient and lab collected same day as admit, you can report result. Applies to any outpatient location. Observation Bed Patients in Inpatient Setting: These patients are counted as inpatients. While identifying your inpatient locations, it is important to note which locations are outpatient locations, and are excluded from your facility-wide inpatient patient days and admission counts. Examples of outpatient locations that are not included in the definition of inpatient include: your Emergency Department, observation units, outpatient or day surgery units, outpatient radiology and chemotherapy/infusion services. Outpatient dialysis, operating rooms and clinics are excluded as well. One question I have received often is what if a pt. after discharge comes to our lab and tests positive for c. diff.? If the specimen was not collected while the patient was an inpatient, it is not counted. There are two additional rules regarding inpatient vs. outpatient locations in NHSN related to Lab ID. First, we know that the Emergency Department is an outpatient location, but if a patient is admitted from the ED to the inpatient location and a positive specimen is collected on the same day of the transfer, the lab result can be reported. This applies to any outpatient location, such as if you have the patient transfer from another hospital or another care setting, you can use the sample results if (and only if) the specimen was collected on the same day the patient was transferred to your facility. The second rule applies to observation patients sent to an inpatient location for monitoring; these patients should be included for all patient and device day counts. The facility assignment of the patient as an observation patient or an inpatient has no bearing in this instance for counting purposes, since the patient is being housed, monitored, and cared for in an inpatient location.

Inputting Denominator Data (1 of 2)
Summary DataAdd. Select “MDRO and CDI Prevention Process and Outcome Measure Monthly Monitoring. Input denominator data every month; even if you do not have infection events.

Inputting Denominator Data (2 of 2)
For MRSA For CDI

MRSA Bacteremia Events (Numerator)

MRSA Definitions MRSA: S. aureus testing oxacillin-resistant, cefoxitin resistant, or methicillin-resistant by standard susceptibility testing methods, or by a laboratory test that is FDA-approved for MRSA detection from isolated colonies MRSA Isolate: Specimen obtained for clinical decision making that tests positive for MRSA Active surveillance testing specimens (e.g., nasal screen) do not count as clinical specimens MUST have a method to differentiate clinical vs. surveillance cultures (speak with lab)

MRSA Definitions—Blood Culture Only
MRSA Blood Isolate LabID Event: All non-duplicate MRSA blood isolates Duplicate MRSA Blood Isolate: MRSA+ blood culture from the same patient and location, following a previous positive MRSA-positive blood culture within the past 2 weeks (14 days) There should be a full 14 days with no MRSA- positive blood culture for the patient and location before another blood isolate LabID event is entered into NHSN for that patient

Identifying a Lab ID MRSA Event
(+) MRSA blood culture test result (taken for clinical purposes) Prior (+) in < 2 weeks? No Yes This diagrams illustrates how Lab ID CDI events are identified. If you have a positive culture, you ask yourself is there a positive culture for this same patient within the past two weeks. If the answer is no, then it is a unique event and it is entered into NHSN. If the answer is yes, that the same patient has had a positive CDI event in the past two weeks, it is a duplicate, and it is not a Lab ID event and it is not entered into NHSN. Lab ID Event Duplicate MRSA Test Not a Lab ID Event

MRSA Event Example (1 of 3)
As part of the data review, Betty Brown (infection preventionist) identifies new MRSA Lab Events (blood cultures only). For example, Ms. Doe has 5 blood samples reported (+) for MRSA. Applying the 14-day rule, only 3 of the 5 samples will be reported.

Betty proceeds to complete a Lab ID MDRO or CDI event for each of the three unique events. EventAdd.

Always the same Always the same Location = where specimen collected Auto-fill If pt. d/c in past 3 months, input yes and d/c date. Save.

Lab ID Event CDI (Numerator)

Definitions Laboratory-Identified (Lab-ID) CDI event: Any non-duplicate CDI-positive assay on unformed stool. CDI-positive Lab Assay: Positive lab assay for C. difficile toxin A and/or B, or toxin- producing organism detected from stool culture or other lab means. Duplicate C. difficile-positive test: CDI- positive assay from same patient within 2 weeks of previous positive assay. Instead, we are following the Lab-ID module, which relies on three definitions presented here. First, a Laboratory ID CDI event is one that is a non-duplicate CDI-positive assay on unformed stool. If your lab conducts CDI assays on formed stools, it needs to note “formed stool” on the lab report. As noted in the SHEA/IDSA guidelines, C. difficile testing should be performed on unformed stools unless ileus due to c. difficile is suspected. The one lab test that does not fall under this defintion is glutamate dehydrogenase (GDH), which is often used as a screening tool (i.e., if GDH is negative, then you are fairly certain the pt. does not have c. diff.) [Note: (glutamate dehydrogenase) an enzyme produced by all C. difficile isolates, but one that does not distinguish toxigenic vs. nontoxigenic strains]. Thus it is sensitive not specific. Lab testing methods that are included under this definition include EIA for Toxins A, B or both, cytotoxin tests and tests for DNA (includes PCR, LAMP, etc.)

Identifying a Lab ID CDI Event
(+) C. difficile test result (on unformed stool) Prior (+) in < 2 weeks? No Yes This diagrams illustrates how Lab ID CDI events are identified. If you have a positive culture, you ask yourself is there a positive culture for this same patient within the past two weeks. If the answer is no, then it is a unique event and it is entered into NHSN. If the answer is yes, that the same patient has had a positive CDI event in the past two weeks, it is a duplicate, and it is not a Lab ID event and it is not entered into NHSN. Lab ID Event Duplicate C. difficile Test Not a Lab ID Event

CDI Event Example (1 of 3) As part of the data review, Betty Brown identifies new cases of C. diff. Applying the 14-day rule, only the first of the 2 (+) stool specimens will be reported as a LabID event. MRN Last Name First Name DOB Date Admitted to Facility Date admitted to unit Unit Specimen Type Date of Specimen Collection Organ-ism 754321 Pan Peter 5/6/1975 2/2/2009 1 MICU STOOL C. Difficile 2/7/2009

CDI Event Example (2 of 3) EventAdd Auto-fill

CDI Event Example (3 of 3) Location = where specimen collected
Always the same Always the same Always the same Auto-fill Auto-fill Location = where specimen collected To access this form, you select EventAdd. Only items with a red asterisk are required. In the top portion of the form, there are limited data fields to complete. If this patient has already been entered in the system, when you hover of the “find” button, it will input patient information. If the patient is not in the system, then you need to enter gender and date of birth. In the main portion of the form, there is limited laboratory and admission data to complete Two important points about this form: (1) This is not a form an Infection Preventionist needs to complete; it can be completed by trained staff. (2) The area where the most errors occur is with the input of dates. You want to make sure the dates are correct, so that NHSN inputs the results in the correct reporting category, which is discussed later in this presentation. Auto-fill If pt. d/c in past 3 months, input yes and d/c date. Save.

Lab ID Event Categories
You do not have to calculate these rates. NHSN will do this for you!

LabID Events Categorized through NHSN Calculations as
CDI Only LabID Events Categorized through NHSN Calculations as Incident CDI Assay: new cases (specimen obtained >8 weeks after the most recent LabID Event). Recurrent CDI Assay: CDI LabID Event from specimen obtained > 2 weeks and < 8 weeks after the most recent LabID Event. Although I don’t want you to worry about the data buckets and to allow NHSN to categorize the data for you, I do want to know about how data is reported. NHSN categories LAB-ID events as incident and recurrent events. An incident event is one from a specimen collected 8 weeks or more since the last LabID event for the patient. A recurrent event is one from a specimen obtained between 2 weeks to 8 weeks since the last event. Recurrent events are not included in incident outcome metrics.

Healthcare Facility-Onset (HO): LabID Event from specimen collected >3 days after admission to the facility (= on or after day 4) Admission 2 d Day 1 Day 4 Discharge Indeterminate CO-HCFA < 4 weeks 4-12 weeks >12 weeks CO CO* HO * Depending upon whether patient was discharged within previous 4 weeks, CO-HCFA vs. CO (CDI only)

2) Community-Onset (CO): LabID Event from specimen collected from an outpatient or inpatient ≤ 3 days after admission to the facility (Day 1, 2 or 3 with date of admission as Day 1) Admission 2 d Day 1 Day 4 Discharge Indeterminate CO-HCFA < 4 weeks 4-12 weeks >12 weeks CO CO* HO * Depending upon whether patient was discharged within previous 4 weeks, CO-HCFA vs. CO (CDI Only)

CDI Only LabID Events Categorized through NHSN Calculations as 3) CO Healthcare Facility-Associated (CO-HCFA): CO LabID Event collected from a patient who was discharged from this facility ≤ 4 weeks prior to stool collection Admission 2 d Day 1 Day 4 Discharge Indeterminate CO-HCFA < 4 weeks 4-12 weeks >12 weeks CO CO* HO * Depending upon whether patient was discharged within previous 4 weeks, CO-HCFA vs. CO

Facility Healthcare Facility-Onset Incidence for Lab ID Event
# of all Incident HO LabID Events per month in the facility # of patient days for the facility X 1,000 for MRSA or X 10,000 for CDI Note: There are several prevalence and other incident metrics not included in this presentation.

MRSA Blood Lab ID FacWideIn Risk Adjustment Variables
Factor Description Facility Bed Size < 400, >400 Teaching Type Major Teaching vs. All Other Prevalence Rate Continuous By working with a variety of IPs in Oregon, I have learned how they are using their electronic surveillance programs to support reporting of LabID CDI. When I refer to these electronic systems, I am referring to data mining software, such as Medmined, Safety Surveiller, etc.), but I am also referring to electronic systems that record your denominator data, which is patient days and admissions. When working with lab data mining systems, you need to work with a positive culture list, not just “HAIs.” As an example of why you need to use a positive culture list, if the specimen was positive and was collected during the first three days of the stay, it is entered into NHSN and will be categorized as a “community acquired” event. When working with lab data mining systems, it is important to review how your electronic system classifies emergency department patients as to their inpatient or outpatient status. One Oregon IP told me that if an ED patient is receiving services past midnight, then her electronic system was classifying the patient as “inpatient.” The workaround is to create a new category of status: “ED overnight.” Contact your software vendor for workarounds. In reviewing your list of positive cultures, you will need to remove duplications (positive cultures within two weeks). Once you have your list of non-duplicate positive cultures, you can determine if you want to manually enter then or automatically import to NHSN.

CDI Lab ID FacWideIn Risk Adjustment Variables
Factor Description CDI Test Type NAAT (PCR), EIA, Non-NAAT(PCR)/EIA Others Prevalence Rate Continuous (No CO-HCFA) Facility Bed Size < 100, , >245 Teaching Type Major, Graduate, Limited/Non-Teaching NAAT – nucleic acid amplification test PCR – polymerase chain reaction EIA – enzyme immunoassay

Using Electronic Surveillance Systems (1 of 3)
Includes data mining software (MedMined, Safety Surveiller, Theradoc, etc.). Use a positive culture listing; not HAI listing. Emergency Department: may need to designate as “Inpatient & Outpatient” location. Watch for duplicates (within the same month or month to month). Once you retrieve data, you can manually enter into NHSN or prepare to upload electronically. By working with a variety of IPs in Oregon, I have learned how they are using their electronic surveillance programs to support reporting of LabID CDI. When I refer to these electronic systems, I am referring to data mining software, such as Medmined, Safety Surveiller, etc.), but I am also referring to electronic systems that record your denominator data, which is patient days and admissions. When working with lab data mining systems, you need to work with a positive culture list, not just “HAIs.” As an example of why you need to use a positive culture list, if the specimen was positive and was collected during the first three days of the stay, it is entered into NHSN and will be categorized as a “community acquired” event. When working with lab data mining systems, it is important to review how your electronic system classifies emergency department patients as to their inpatient or outpatient status. One Oregon IP told me that if an ED patient is receiving services past midnight, then her electronic system was classifying the patient as “inpatient.” The workaround is to create a new category of status: “ED overnight.” Contact your software vendor for workarounds. In reviewing your list of positive cultures, you will need to remove duplications (positive cultures within two weeks). Once you have your list of non-duplicate positive cultures, you can determine if you want to manually enter then or automatically import to NHSN.

Validating Electronic Data (2 of 3)
VALIDATE your Electronic Reporting System Compare your electronic IC system totals for patient days and admissions against alternate source, like a financial report, using NHSN definitions. Does your system count each transfer between units during same admission as a new admission? Does your system count only the Mom or both Mom & Baby (for CDI)? Does your system count a patient as discharged from your facility within the last 3 months if they were in for outpatient Lab work last week, but had no inpatient admission/discharge for over a year? Another area that you need to validate electronic data is with your counts of patient days and admissions. You should compare your system totals for patient days and admissions against a second source of data and you need to verify that admissions are counted as admissions to the facility and not transfers within the facility. Here are a number of questions you can ask yourself as you validate your electronic data: (review list above)

Validating Electronic Data (3 of 3)
Before submitting your data: Confirm your Positive Culture List against selected patients for download. If they don’t match, you may need to manually add or delete cases. Verify report is complete and fix any issues found during validation For example, discharged from facility within last 3 months Before you submit your data electronically, review your positive culture list again the patients selected for download. If there is a discrepancy, you will need to add or delete cases. You may also need to address issues found during your self-validation, such as if patients have inaccurate data regarding discharge from the facility in the past three months.

FAQ (1) 1) What is the most important action to prepare to report Lab-ID MRSA and CDI? Obtain a listing of MRSA (bacteremia) and CDI from your laboratory. Smaller hospitals that have fewer events can request a list of organisms. This is the best method to know that your data are correct; it is not recommended that you rely on reports to the Infection Prevention team. Another way to consider this is if you were validating this data set, you would first ask for a lab listing for positive C. difficile tests for your facility. It is best for your to ask for this up front. At the recent APIC fair in October, I had one IP come up and tell me after completing her CDI survey for the state, she asked her lab to add C. difficile to her lab reporting list. Sample Spreadsheet for Lab Line List Directions to Use Lab Line List

FAQ (2) 2) What if a smaller hospital admits a pt to a larger hospital in the same health system, and this pt has a positive CDI assay from the smaller hospital? You can report the positive lab if the admission to the new location is on the same day the specimen was collected. This applies to transfers from any other facility or outpatient location. The general rule here is if you have a patient coming from another location outside your facility, and on the same day of this transfer the patient has a specimen collected and it is positive, you can report that specimen in Lab-ID CDI. However, the specimen must be collected on the same day of admission to your facility.

FAQ (3) 3) If we have a number of admits for each unit, would you count a transfer from one unit to another as an admit? No. Facility-Wide Inpatient Admission Count: Include any new patients that are assigned to a bed in any inpatient location within the facility at the time of the facility-wide admission count. Qualification as a new patient means that the patient was not present on the previous calendar day at the time of the patient day count. The daily admission counts are summed at the end of the calendar month for a monthly facility-wide inpatient admission count. Show linked document.

FAQ (4) 4) What if I have a patient that completed his stay at my hospital and then a week later as an outpatient had a specimen drawn that was positive for CDI? We are reporting Lab ID CDI or MRSA for facility-wide inpatient (FacWideIn). Inpatient and outpatient reporting for Lab ID CDI cannot be mixed. Therefore, you do not include outpatient specimens in your reporting for FacWideIn. (You may include this data in your internal reporting system, but do not input into NHSN.)

FAQ (5) 5) When counting patient days and admissions, do we include “observation” patients? As long as a patient is on an outpatient observation unit, you would not count the observation days as patient days. The date of admission will be the date of admission to an inpatient unit. However, if an observation patient is located on an inpatient unit (like a medical ward), you would count the observation days as patient days, with the date of admission being the date of admission to the inpatient unit.

FAQ (6) 6) A patient had a MRSA-positive blood culture
obtained in the ED and was admitted to an inpatient unit on the same day. How do I report this LabID event? If the date of specimen collection in the ED and the date of admission to the inpatient unit are the same calendar date, report the LabID event for the ED and the inpatient unit. If the patient was admitted to the inpatient unit on a later date, you report the event for the ED only.

FAQ (7) 7) My facility has a rehab unit with a different CMS
Certification Number than the rest of the facility. Should this unit be included in LabID surveillance? If a unit is considered a part of the facility (not just sharing walls) and there is potential for patient and staff contact across units, the unit should be included in FacWideIN LabID surveillance.

FAQ (8) 8) As a follow-up to the previous question, my facility discharges patients before counting them as new admissions to the rehab unit. If I include rehab admissions in my monthly FacWideIN summary data, patients who went from the hospital to the rehab unit will be counted twice. What should I do? We don’t want to double-count admissions. If it’s not possible to distinguish between patients who arrived from the facility and those who arrived from elsewhere, exclude rehab admissions in your FacWideIN counts. Continue to include rehab patients in patient-day counts.

Announcement 1 CDC expects to release version 7.1 of NHSN on February 16, 2013. New release will include updated protocol (e.g., present on admission, etc.) We suggest you wait until new release before entering 2013 data.

Announcement 2 Get Smart About Antibiotics Week (November 12-18, 2012). Tools for your antibiotic stewardship program: Get CME/CE on antibiotic stewardship:

Acknowledgements Matthew Crist, MD, MPH
Georgia Department of Public Health Brynn Berger, MPH, CIC Tennessee Department of Public Health Dawn Sievert, PhD, MS Centers for Disease Control and Prevention Division of Healthcare Quality Promotion

Questions? Jeanne Negley, MBA HAI Coordinator
Georgia Department of Public Health 2 Peachtree Street NW, #14-225 Atlanta, GA 30303 Phone: Fax:

NHSN Reporting for Laboratory-identified Clostridium difficile Infection (CDI) and Methicillin-resistant Staphylococcus aureus (MRSA) (Bacteremia) Presentation.

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NHSN Reporting for Laboratory-identified Clostridium difficile Infection (CDI) and Methicillin-resistant Staphylococcus aureus (MRSA) (Bacteremia) Presentation.

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