NHSN Reporting for Critical Access Hospitals Allison Murad, MPH Surveillance for Healthcare-Associated and Resistant Pathogens (SHARP) Unit Michigan Department of Health and Human Services (MDHHS)

Why NHSN? The “Gold Standard” for HAI Reporting and Surveillance Clinical vs. Surveillance Definitions: Clinical: Individualized Used for making therapeutic decisions Surveillance Population-based Must be applied uniformly and consistently

The Essentials of Infection Surveillance Know protocol/criteria Consistently apply the criteria Report events meeting criteria; exclude those that don’t Failure to do so: Breach of NHSN Rules of Behavior Decreased usefulness of national comparative data Unfair comparisons between facilities Possible validation discrepancies Potential impact of CMS Inpatient Quality Reporting score & facility reimbursement

Components of NHSN

Not Enrolled in NHSN? Start here: https://www.cdc.gov/nhsn/acute-care-hospital/enroll.html

Already Enrolled in NHSN for HCP? If you’ve enrolled your facility in NHSN in order to report Healthcare Personnel Influenza Vaccination Data, you can activate the Patient Safety Component by going to: Facility – Add/Edit Component

Add additional users to your facility! Users – Add

Patient Safety Component Device-Associated Module CLABSI CLIP CAUTI VAE VAP Procedure-Associated Module SSI Antimicrobial Use and Resistance Module (AUR) Multidrug-Resistant Organism and Clostridium difficile Infection (MDRO/CDI) Module MRSA LabID CDI LabID

MDRO/CDI Reporting “The NHSN MDRO/CDI Module offers a means for facilities to meet criteria and metrics that are outlined in several organizational guidelines to control and measure the spread of MDROs and CDI within their healthcare system.” “As outlined in the HICPAC guideline, these MDRO and C.difficile pathogens may require specialized monitoring to evaluate if intensified infection control efforts are required to reduce the occurrence of these organisms and related infections. The goal of this module is to provide a mechanism for facilities to report and analyze these data that will inform infection prevention professionals of the impact of targeted prevention efforts.”

LabID Reporting LabID Event reporting is based strictly on laboratory testing data without clinical evaluation of the patient, allowing for a much less labor intensive method to track C. difficile and MDROs, such as MRSA. Advantages of LabID Event Reporting Objective laboratory-based metrics Estimate infection burden Estimate exposure burden Assess need for and effectiveness of interventions Standardized case definitions Increased comparability between settings

Categorization of CDI LabID Events Incident: Event from a specimen obtained >56 days (8 weeks) after the most recent CDI LabID Event (or with no previous CDI LabID Event documented) Day 1 = date of first specimen collection Recurrent: Event from a specimen obtained >14 days (2 weeks) and ≤ 56 days (8 weeks) after the most recent CDI LabID Event Duplicate: Event from the same patient AND location, following a previous lab result within the past two weeks (14 days), even across calendar months and readmissions to the same facility. Duplicate events will prompt a pop-up message that will not allow you to enter

Categorization of CDI LabID Events Healthcare-Onset (HO): Positive toxin tests collected >3 days after admission to the facility (i.e., on or after hospital day 4) Community-Onset (CO): LabID Event collected in an outpatient location or an inpatient location ≤3 days after admission to the facility (i.e., days 1, 2, or 3 of admission). Community-Onset Healthcare Facility-Associated (CO-HCFA): CO LabID Event collected from a patient who was discharged from the facility ≤4 weeks prior to current date of stool specimen collection. Data from outpatient locations (e.g., outpatient encounters) are not included in this definition.

Best part of categorization? NHSN categorizes for you! Running and exporting data will show the rates and ratios of each categorized event type facility-wide

What can you do with the data?

MDHHS Feedback Reports

National NHSN Use As of March 2017:

CMS Reporting Requirements

MDHHS SHARP Unit Validation Activities Statewide NHSN User Group Webinars, Next Call: Wednesday, June 28th at 10am ICAR Assessments/Infection Control Consulting: Noreen Mollon, MollonN@michigan.gov CRE Surveillance and Prevention Initiative: Brenda Brennan, BrennanB@michigan.gov Antimicrobial Resistance: Sara McNamara, McNamaraS5@michigan.gov

Thank you! Allison Murad, MPH Surveillance for Healthcare-Associated and Resistant Pathogens (SHARP) Unit, MDHHS murada@michigan.gov www.michigan.gov/hai