The Targeted Assessment for Prevention (TAP) Strategy
is a framework for quality improvement developed by the CDC
to use data for action
to prevent healthcare-associated infections (HAIs).
The Strategy is supported by a suite of tools
and resources uniquely designed to address the prevention of
catheter-associated urinary tract infections (CAUTI),
central line-associated bloodstream infections (CLABSI)
and Clostridioides difficile infections (CDI).
In this video, we will take a brief look
at how to identify and target healthcare facilities and units
with an excess burden of HAIs.
We’ll also look at how to deploy TAP Facility Assessments
within these identified targeted locations.
The first component of the TAP Strategy, Target,
works by using data to identify facilities and units
with the greatest room for reducing the rate of HAIs
and achieving their hospital safety goals.
One way to target locations for assessment is to generate TAP Reports
within the National Healthcare Safety Network (NHSN).
TAP Reports include a metric called
the cumulative attributable difference, or CAD.
It’s a prioritization metric that identifies the number of infections
a location would have had to prevent to reach their reduction goal
- or in other words - the number of excess infections
above a reduction goal.
TAP Reports can be generated by group users,
such as health departments and healthcare systems,
and by facility-level users.
For group users, TAP Reports rank facilities based on their CAD.
Facilities with higher CADs,
and therefore a higher burden of excess infections,
indicate where partners may direct prevention efforts
to achieve reduction goals more efficiently.
At the facility-level
TAP Reports rank individual units by their CAD
allowing facilities to identify and target specific units
with the greatest opportunity for improvement.
CAUTI and CLABSI TAP Reports
display unit-level CAD data.
Of note, CDI TAP Reports display CAD data
only at the facility-level.
While facility-level TAP Reports are available
for Methicillin-resistant Staphylococcus aureus,
or MRSA,
there are no additional TAP Strategy tools
for MRSA at this time.
Partners may also identify and prioritize facilities
and units based on contextual factors,
patient populations, resources available,
and previous and/or current prevention interventions.
Additional available data sources may be considered,
including case counts and rates per unit,
laboratory testing data,
antibiotic prescribing data,
and routine audits of infection prevention practices.
For a step-by-step detailed description
on how to generate and interpret TAP Reports within NHSN,
check out the video on
‘Tapping into HAI Prevention and using data for action’
by clicking the link on this webpage.
The next step of the TAP Strategy
is to assess infection prevention practices
in targeted locations
to identify opportunities for improvement
using the TAP Facility Assessment Tools.
These are comprehensive assessments
completed by frontline personnel
that provide actionable information from responses
encourage real-time teaching moments,
and can generate cues to action among staff and leadership.
"TAP Assessments allow one to prioritize and systematically close the gaps”
as stated by Jamie Moran, Qualis Health.
Now let’s discuss how to deploy assessments.
TAP Facility Assessment Tools are available for CAUTI, CLABSI, and CDI
and may be deployed within the targeted locations
to assess prevention policies and practices.
Partners can access the TAP Facility Assessment Deployment Packet
available at this website for more detailed information
on how to deploy the TAP Facility Assessments.
This packet includes a checklist
providing step-by-step instructions to guide partners
as they prepare to deploy the TAP Facility Assessments.
It is helpful to start by determining where to deploy assessments.
The TAP Facility Assessment Tools can be deployed across facilities
or within targeted units with the greatest room for improvement.
Partners should use data for action to identify
where to deploy TAP Facility Assessments
by generating TAP Reports in NHSN,
reviewing other data sources as available,
and considering contextual factors.
Next, facilities should determine who will be completing the assessments.
Facilities are encouraged to collect as many Assessments
as possible from a range of respondents.
This may include frontline providers
(such as nurses, nurse assistants, and physicians),
mid-level staff
(such as Quality, Infection Prevention, unit/nurse managers),
senior leadership, and ancillary staff
(such as EVS, physical/occupational therapy, and pharmacy).
Define timeline for collection
It may be helpful to define the start and end dates
for Assessment collection,
noting that this timeline may be extended as needed.
In general, facilities collect Assessments for two weeks,
but this can vary based on factors within the facility and units.
Finding a time that best suits the facility
can help optimize Assessment collection.
Facilities can then select how they would like to deploy the assessments.
TAP Facility Assessments are available for distribution on paper
and electronically through SurveyMonkey,
REDCap, and PDF fillable forms.
Facilities are encouraged to select
the deployment method(s) that are best for them.
It may be helpful to consider multiple methods
based on staff roles and units,
for example, SurveyMonkey may be the best
for those with access to a computer,
while paper forms may be best for staff without computer access.
CDC can provide each facility
with their selected deployment method(s).
Providing paper copies allows staff to complete the Assessments
at their own pace and does not require access to a computer.
Providing a ‘drop box’ for completed Assessments
at a designated location can facilitate collection.
Paper Assessments may also be distributed
and collected during meetings, trainings, or orientations.
CDC is available to perform data entry
of all responses received on paper.
Assessments can also be distributed using SurveyMonkey.
A SurveyMonkey account is not required and CDC
can provide each facility with a unique link to distribute to staff.
The link can be emailed to staff,
added to an intranet page,
or opened on a share computer or tablet.
Staff must complete the Assessment in one sitting,
as they will be unable to save their progress
and will be unable to return to their Assessment
if they close out of the link.
If preferred,
partners may use their own SurveyMonkey account
to collect Assessments.
REDCap is another option for electronic assessments.
REDCap Assessments are available to partners
who have their own REDCap access.
CDC can provide the data dictionaries,
allowing partners to import the Assessment templates
that are ready for distribution into their REDCap account.
This method is useful for partners familiar with REDCap
and provides an electronic collection method
alternative to SurveyMonkey.
PDF fillable forms provide an electronic method for facilities
unable to use either SurveyMonkey or REDCap.
The PDF forms can be emailed to staff
or saved on a shared computer.
As with all electronic modalities,
partners are encouraged to pilot the PDF forms
prior to widely distributing them
to mitigate any technical difficulties.
Once partners have decided on the logistics
they can submit their deployment details.
If you would like CDC to provide tailored Assessments for deployment
please complete the questions in the
TAP Facility Assessment Pre-Deployment Worksheet,
available on Page 4 of the TAP Facility Assessment Deployment Packet.
This worksheet allows the option for facilities
to customize their Assessments by including unit names
and specifying additional edits
to improve staff understanding and interpretation.
For example, facilities may edit the Respondent Role options
to best align with facility staffing structure,
add questions to the demographics section,
and make minor edits to terminology
or remove select questions.
Before deploying assessments,
facilities should identify champions or cheerleaders.
The greater the number of Assessments collected,
the greater the ability to identify gaps.
To increase participation it may be helpful to
identify ‘champions’ or ‘cheerleaders’ within each unit
to encourage completion among staff.
Support from leadership on the importance
and intent of the Assessments may also improve participation.
Consider messaging to notify staff.
Notify senior and unit-level leadership about the Assessments,
including their intent, the collection period,
and which staff and units are participating.
This may help to ensure they are informed and supportive
of staff taking the time to complete Assessments.
When asking staff to complete Assessments,
describe the intent and relevant details,
including that all responses are anonymous,
they take approximately 10 minutes to complete,
and that you are interested in their awareness
and perceptions of policies that are currently in place.
It may also be helpful to provide information
for a facility point of contact if needed for questions.
Example language is provided on Page 5
of the TAP Facility Assessment Deployment Packet.
You are now ready to collect assessments.
Distribute Assessments using the method(s) selected
and work with leadership and champions
or cheerleaders, to encourage collection.
Consider deployment during meetings or trainings
to increase participation.
Send periodic reminders asking staff
to complete the Assessments
and consider adjusting the time period for collection as needed.
When you have finished collecting assessments,
you can submit them for summarization.
CDC is available to summarize Assessments
and create customized Feedback Reports for each facility.
Details on how to submit completed Assessments to CDC
are included in the TAP Facility Assessment Deployment Methods sheet
on Page 3 of the TAP Facility Assessment Deployment Packet.
All Assessment and summarization tools
are also available for partners to use independently.
So, full use of the TAP Strategy and accompanying tools
does not require submission of assessments
to CDC for technical assistance.
In the next video,
we’ll look at how to interpret the TAP Facility Assessment results
to identify opportunities for improvement
and guide prevention efforts.