Welcome to the National Healthcare Safety Network, or NHSN,
Hot Topic Session. This presentation will provide you with
updates to reporting on Multidrug-Resistant Organisms, or
MDRO, and Clostridium difficile in 2015.
The following presentation is focused solely on the
substantive changes to MDRO and C-DIF Lab-ID Event
protocol. CDC's own, in-depth assessment of NHSN,
coupled with invaluable feedback from system users and
subject matter experts, have led to important changes in
definitions, criteria, and business rules. These updates are
intended to enhance the system's performance and produce
new benefits for patient and healthcare worker safety. Please
visit the NHSN Website to view the full protocol.
First changes to Facility-Wide Inpatient, or FacWideIN,
Lab-ID Event reporting. Acute care facilities are required to
exclude and show proof that inpatient locations that have a
different Centers for Medicare and Medicaid Services, or CMS,
Certification Number have been removed from the monthly
facility-wide inpatient denominator counts. Total patient day
and admission counts from all patient care locations within
the acute care facility will be entered and then patient days
and admission counts from patient care units with separate
CMS Certification Numbers must be removed. This may include
CMS inpatient rehabilitation facilities, or IRF, or CMS
inpatient psychiatric facilities, or IPF.
This documentation will occur in the MDRO and CDI Prevention
Process and Outcome Measures Monthly Reporting for FacWideIN.
Total patient day and admission counts from all patient care
locations within the acute care facility are entered and then
patient days and admission counts from patient care units
with separate CCNs must be removed from the MDRO and CDI
summary counts and reported for FacWideIN. This may include
CMS inpatient rehabilitation facilities or CMS inpatient
psychiatric facilities. Hospitals will notice these changes
on the CDI Prevention Process and Outcome Measures Monthly
Reporting form. Specific guidance for completing this form
can be found in the Table of Instructions.
Here's a screen shot of the updated MDRO and CDI Prevention
Process and Outcome Measures Monthly Reporting form.
Facilities following FacWideIN surveillance are required to
show removal of the counts from CMS IRFs and CMS IPFs with
different CCNs. First, users must enter a total count of
patient days and admissions, including all locations in the
hospital. Next, users must enter those denominator counts for
all locations, minus those locations with a separate CCN,
which may include CMS IRFs and CMS IPFs. Remember, for CDI
patient days and admissions, counts for baby locations should
also be excluded. Again, detailed guidance for completing
this form is provided in the Table of Instructions document.
Another change is related to reports from Emergency
departments and 24-hour observation locations.
To facilitate accurate categorization of Lab-ID Events
and to capture community-onset cases a location
specific outpatient reporting requirement has been
added to FacWideINLab-ID Event reporting.
Lab-ID Event reporting for FacWideIN now requires location-
specific surveillance and reporting for that same organism
and Lab-ID Event type from each outpatient emergency
department location and 24-hour observation location
including pediatric and adult emergency department locations.
Facilities must map their outpatient emergency department and
24-hour observation locations in the NHSN application. To
give an example, if a facility is reporting MRSA Blood Only
Lab-ID Events at FacWideIN, the facility must also map each
emergency department and 24-hour observation location and
report MRSA Blood Only Lab-ID Events separately from these
outpatient locations. Likewise, if a facility is reporting
MRSA All Specimens Lab-ID Events at FacWideIN, the facility
must also report MRSA All Specimens Lab-ID Events from each
mapped outpatient emergency department and 24-hour
observation location.
Facilities will no longer assign the admitting inpatient
location to Lab-ID Events when specimens are collected
in the outpatient emergency department or 24-hour
observation locations on the same calendar day
as inpatient admission. Instead, the Lab-ID Event is
assigned to and reported from that outpatient ED or
24-hour observation location. Specimens collected from
any other affiliated outpatient location should be reported
to an inpatient location, but only if collected on the
same calendar day as inpatient admission.
A change for MDRO definitions is that CRE-Enterobacter
has been added as an organism for CRE reporting.
For in-plan reporting of CRE, facilities are required to
conduct surveillance for and report on all three CRE
organisms, which include E. coli, Klebsiella pneumoniae and
oxytoca, and Enterobacter. These organisms are further
defined in the MDRO and CDI protocol in the NHSN Patient
Safety Component Manual. This means users will no longer be
able to choose to monitor only one of the three CRE organisms
for in-plan reporting. Since users must conduct surveillance
for and report on all three CRE organisms, each organism is
reported individually on the Lab-ID MDRO and CDI event form.
We've made several changes to CRE reporting, which
include the following: Addition of the carbapenem drug
ertapenem; inclusion of only those pathogens that
have tested 'resistant' to carbapenem; and surveillance
for CRE- Klebsiella is limited to Klebsiella pneumoniae
and Klebsiella oxytoca only.
Also, the definition for CRE has been updated. All updates
to definitions are defined in the MDRO and CDI protocol in
the NHSN Patient Safety Component Manual.
Finally let's discuss changes to the questions. A new
"optional" question is added to Laboratory-identified
MDRO or CDI Event form (fifty seven point one-twenty eight)
to improve tracking through the continuum of care for
patients. The question asks the last physical overnight
location of a patient immediately prior to arrival at a
facility. Users must select from one of the following four
options: Nursing Home or Skilled Nursing Facility;
Personal residence or Residential care; Other inpatient
healthcare setting (for example acute care hospital, IRF,
or L-TAC); or Unknown. This question is only available for
Community-Onset Lab-ID Events. In other words, if the
specimen is collected from an outpatient setting or
collected less than four days after admission.
Another new "optional" question has been added to
Laboratory-identified MDRO or CDI Event form to improve
tracking through the continuum of care for patients.
The question asks if the patient has been discharged
from another facility in the past four weeks.
The following options are available for users to
select all that apply: Nursing Home or Skilled Nursing
Facility; other inpatient healthcare setting, such as an
acute care hospital; inpatient rehabilitation facility; or
long-term acute care facility.
This concludes the NHSN Hot Topics updates focusing
on MDRO and C-DIF reporting changes for 2015. For
questions about these changes, please contact NHSN
user support at NHSN@cdc.gov