This National Healthcare Safety Network, or NHSN,
Hot Topics focuses on Patient Safety Analysis with
new and updated analysis items introduced to
NHSN reporting in January 2015.
These updates are done in alignment with updated
NHSN protocols for 2015, as well as new and
updated Centers for Medicare and Medicaid Services,
or CMS, Quality Reporting Program requirements.
Each update is described briefly. Please visit the NHSN
Website to view the full protocol.
The first update to Patient Safety Analysis is related to
the Device-Associated Module. With the new release
of NHSN version 8.3 in 2015, five output options that
appear in the "All Device-Associated Events" Output
Options folder are retiring. These are:
Line Listing - All Device-Associated Events
Frequency Table - All Device-Associated Events
Bar Chart - All Device-Associated Events
Pie Chart - All Device-Associated Events
Rate Table - All Device-Associated Data
We strongly encourage the use of event-specific
output options for those accustomed to using the
"All Device-Associated Events" set of output options.
We understand that some may use the
"All Device-Associated Events" output options in
order to see all related data in a single report.
Custom Output Sets can be created so that
multiple output options can be included in a single
"run" of a report. Instructions for creating a Custom
Output Set are available on the Analysis
Quick Reference Guide webpage.
A second update is that in January 2015, the CMS
Inpatient Prospective Payment System, or IPPS,
reporting requirements for CLABSI and CAUTI are
expanding into select ward locations. That is, in
addition to reporting CLABSI and CAUTI data from
all adult, pediatric, and neonatal ICUs, IPPS hospitals
are required to report CLABSI and CAUTI data from
adult and pediatric medical, surgical, and medical/
surgical wards. The requirement to report from ward
locations is limited to those locations that are
mapped as, or defined as, CDC adult and pediatric
medical, surgical, and medical/surgical wards,
listed in the table on this slide. Therefore, any unit
that meets the definition of - and is mapped as -
a specific type that is not an ICU, NICU, or one of the
six wards listed above, is not required for CMS IPPS
reporting in 2015. An example would be locations mapped
as an orthopedic ward, telemetry ward, or step-down unit.
In order to accommodate the expanded CMS IPPS
reporting requirements, the related Standardized
Infection Ratios, or SIRs, for CLABSI and CAUTI
data is updated in the following manner:
1. Beginning with 2015 first quarter data, the "Overall"
SIR table in each output represents adult, pediatric,
and neonatal ICUs, plus adult and pediatric medical,
surgical, and medical/surgical wards.
2. A new second SIR table is added that includes
only adult, pediatric, and neonatal ICU data.
A third update - CLABSI, CAUTI, and Ventilator
Associated Pneumonia, or VAP, rate tables are
updated so that the NHSN pooled means and
percentiles represent the Data Summary for 2013.
The new pooled means for Long Term Acute Care
Hospitals, or LTACHs, and Inpatient Rehabilitation
Facilities, or IRFs, is used as the baseline data for
new SIRs for these facility types. Additional details
are described later in the presentation.
Pooled means for VAP are only provided for select
pediatric ICU and NICU locations. CLABSI SIRs for
acute care hospitals continue to use a baseline
of 2006 to 2008 national data, and CAUTI SIRs for
acute care hospitals continue to use a baseline
of 2009 national data.
In order to assist NHSN users with determining which
LabID events are included in the various inpatient,
facility-wide rates and SIRs, indicator variables for
all labID events are added. Each indicator variable
will begin with "FW" and is given a value of 1 if that
LabID event would be included in the FACWIDEcount,
as described in the example on this slide.
Beginning in 2015, NHSN allows for central line
insertion practice, or CLIP, bundle adherence
when there are contraindications in patients less
than 120 days of age at the time of insertion.
This change is being made to address updates to
chlorhexidine gluconate product labeling which states
"use with care in premature infants or infants under
2 months of age. These products may cause irritation
or chemical burns". NHSN is utilizing 120 days rather
than 60 days as the cut off, in order to account for
clinician concerns about extremely premature infants
whose skin continues to be very sensitive.
The items shown in the table on this slide are
considered appropriate skin prep for NHSN CLIP
documentation. If the patient's age is the reason
for not using Chlorhexidine gluconate, or CHG,
contraindication to CHG must be reported as "Yes"
in order to be adherent to the skin prep element
of the NHSN CLIP Bundle.
The CLIP analysis datasets and output options are
updated to allow for the new skin prep rules when
determining NHSN CLIP bundle adherence. This is a
temporary modification to address the change in
product labeling. A permanent modification to this
update is planned for 2016, such that it will be
applied when entering events. Additional details
regarding the changes to the CLIP output
options will be provided in early-2015.
New analysis output options are available that are
specific towards antimicrobial resistance data. These
reports allow users to view and analyze antimicrobial
resistance from device-associated and procedure-
associated HAIs. Pre-defined phenotypes are included
in the output, for example, MRSA and CRE, however,
users can modify the output as needed to define
pathogens and drug susceptibilities that are
of interest to them.
Other new output options include a line list and
frequency table available to analyze event-level
data with resistant or non-susceptible pathogens
reported for these select HAIs. In addition, a rate
table displays the percent of all pathogens that tested
resistant or non-susceptible to the applicable drug.
New reports are built to align with the CDC's Targeted
Assessment for Prevention, or TAP, strategy. The
TAP strategy allows for the ranking of facilities,
or units within facilities, in order to identify and target
those areas with the greatest need for improvement.
These new output options, referred to as "TAP Reports,"
are available for facilities and groups and generated
for CLABSI, CAUTI, and FACWIDEIN CDI LabID data.
Detailed documentation and training on how to interpret
and use these reports will be available in early 2015.
New output options are added so that LTACHs are
able to run CLABSI and CAUTI SIRs, and IRFs are
able to run CAUTI SIRs; each of these SIRs use the
2013 device-associated pooled means as the baseline.
These SIRs are available as new standard reports
in the Device-associated Module' output options
folder, as well as in the CMS Reports folder. Acute
care hospitals with a CMS IRF unit will need to run
the IRF-specific CAUTI SIRs, as these data are not
included in the original CAUTI SIR output options.
New analysis reports are available for LTACHS, and
IRFs that are reporting C.difficile and MRSA
Bacteremia LabID Events as part of CMS Quality
Reporting Programs. These reports consist of a single,
facility-wide incidence rate and are available for 2015
first quarter data and forward. Incidence rates include
incident, hospital-onset LabID events identified in
patients with no LabID events in any location in the
previous 14 days, divided by the total applicable
number of patient-days. The new CMS reports are
located under the appropriate folder within the
"CMS Reports" analysis folder. For CMS IRF locations
within an acute care hospital, a location-specific
incidence rate table is displayed in this report.
Finally, due to the redefined, all-inclusive reporting
for CRE, in 2015, output options have been added
users can generate reports for each type of CRE,
as well as for all 3 CREs combined. These options for
LabID and Infection Surveillance include the standard
reports, line lists, frequency tables, rate tables,
bar charts, and pie charts.
This concludes the NHSN Hot Topics updates focusing
on Patient Safety Analysis. Additional resources can
be found on the NHSN website, the Analysis Quick
Reference Guide webpage, and in the CDC Locations
and Descriptions for Mapping Patient Care Locations.
For additional questions about these changes,
please contact NHSN user support at nhsn@cdc.gov.