1. Implementation of Texas Healthcare-associated Infection Reporting
Neil Pascoe RN BSN CIC
Epidemiologist
TPHA 4/22/10

2. Today Federal Issues State Process
Reporting ( who, what, when, and how)
Possible LHD and HSR roles

3. Increasing Need for Public Health Approach Across the Continuum of Care
Outpatient/
Ambulatory
Facility
Tranquil Gardens
Nursing Home
Home
Care
Acute Care
Long Term Care

4. Current Landscape of HAI Surveillance - Policy
Emphasis remains mandatory HAI reporting and public reporting of hospital-specific data
possible federal mandate
coupled with renewed interest in data validation
enabling greater public access to machine readable data sets

5. Current Landscape of HAI Surveillance - Scientific
Increasing interest in MDRO
Clostridium difficile-associated disease
HAIs in non-hospital settings
LTCF and ASC
Algorithmic detection of HAIs
Risk modeling
Use of observed-to-predicted (expected) ratios as summary statistics for comparative purposes (SIR)

6. Current Landscape of HAI Surveillance -Technical
Renewed calls for system simplification
Increasing demand for technical solutions that make use of healthcare data in electronic form
Harmonizing data and reporting
Unprecedented federal support for healthcare information technology

7. Healthcare-Associated Infections (HAIs)
Problem
Bloodstream infections, urinary tract infections, pneumonia, surgical site infections
Annual Impact
1.7 million HAIs in hospitals—unknown burden in other healthcare settings
99,000 deaths and $28-33 billion in added costs
Solution
Implementing what we know for prevention can lead to up to a 70% or more reduction in HAIs 7

8. National Initiatives TJC- Patient Safety/NPSG/EOC
CMS- PAO/Reimbursement and Standards
AHRQ: improve the quality, safety, efficiency, and effectiveness of health care
NQF: setting priorities and goals for PI (SRE ≠ PAE)
PSO: The Patient Safety and Quality Improvement Act of 2005
Consumer Advocates- Consumers Union- others
CDC: lead agency for many initiatives and coordination
AHRQ is the lead Federal agency charged with improving the quality, safety, efficiency, and effectiveness of health care
NQF Setting national priorities and goals for performance improvement; Endorsing national consensus standards for measuring and publicly reporting on performance; and Promoting the attainment of national goals through education and outreach programs.
PSOs are organizations that share the goal of improving the quality and safety of health care delivery

10. Caveats There are some discrepancies in the legislation
There are staffing and funding issues
“RULES HAVE NOT BEEN WRITTEN”
Composition of the AP will change
We do not have all of the answers (or for that matter the questions)

11. Background 78th legislative Session (2005) passed study bill
Advisory Panel
79th session passed SB 288
created chapter 98, expanded AP, no $
80th session passed SB 203
expanded AP, PAE, 4 FTE and $$

12. Who has to report >350 ambulatory surgical centers Includes LTAC
500+ general hospitals
Includes LTAC
Includes Pediatric and Adolescent
Excludes long term rehab hospitals
>350 ambulatory surgical centers

13. What has to be reported
Bloodstream infections associated with central lines
Surgical Site Infections
3 pediatric
7 adult
Preventable Adverse Events
National Quality Forum (SRE)
Non-reimbursed Medicare event or condition

14. Healthcare-associated Infections
Patient and procedure information for each reportable surgery
More than 10 reportable surgeries
Each reportable surgery regardless of associated infections
Over 72,000 knee replacement surgeries performed annually in Texas
Over 38,000 hip replacement surgeries performed annually in Texas
Infections occur with 1-2% of these surgeries

15. Approximate number of reports based on 2008 3rd quarter administrative (hospital) data

16. What does DSHS need to do?
Establish a reporting system
Provide education and training
Prepare a summary by health care facility
Succinct facility comments
Publish a summary at least annually
Make summary available on a website
Accept reports from the public
Perform data validations--validation tools
Functionality to conduct and track audits at hospitals and ASCs**

18. HAI - Funding $710,872 to build surveillance infrastructure
General appropriation
$2,173,452 for the biennium and four new FTEs
American Recovery and Reinvestment Act (ARRA)
$1,234,000 total
$710,872 to build surveillance infrastructure
funds for two FTEs

19. How will Facilities Report? (The Reporting System)
National Healthcare Safety Network
Used by over 2,000 healthcare facilities in 50 states (2456 as of 1/18/10)
Healthcare facilities may enter data on:
Device-associated adverse events
Procedure-associated adverse events
Medication-associated adverse events

20. What is NHSN?
National voluntary, confidential system for monitoring events associated with health care
Initial focus on infections in patients and healthcare personnel (NNISS)
Expanding to include noninfectious events (such as process measures)
Accessed through a secure, web-based interface
Open to all US healthcare entities at no charge

21. NHSN
Managed by the Division of Healthcare Quality Promotion (DHQP) at CDC.
Open to all types of healthcare facilities in the United States, including acute care hospitals, long term acute care hospitals, psychiatric hospitals, rehabilitation hospitals, outpatient dialysis centers, ambulatory surgery centers, and long term care facilities.

22. NHSN Eligibility Criteria
US healthcare facility listed in or associated with a facility that is listed in one of the following national databases:
American Hospital Association (AHA)
Centers for Medicare and Medicaid Services (CMS)
Veteran’s Affairs (VA).
high-speed Internet access
digital certificate on computers
willing to follow the selected NHSN component protocols exactly
report complete and accurate data in a timely manner during months when reporting data for use by CDC
willing to share such data with CDC for the purposes stated above.
provide written consent from facility’s chief executive leadership (e.g., Chief Executive Officer).

24. Texas - State HAI Plan Technical Review
From HHS 4/14/10
1) Continue developing infrastructure and partnerships across the healthcare continuum to improve the detection, reporting, and investigation of HAI outbreaks in both inpatient and outpatient facilities.
2) It would be beneficial to work with your advisory committee to monitor the effectiveness of your prevention initiatives activities and time it takes for full implementation.
3) Develop methods of communication to share best practices among the participating healthcare facilities.
4) Continue working on assessing how to use NHSN for statewide standardized reporting of HAI data.
5) Ensure engagement of local health departments in HAI activities.

25. Roles of Local and Regional HD
Education and training
Information transfer and data validation
Outbreak investigation
Other activities???

26. Preventable Adverse Events
NQF Serious Reportable Events and CMS non-reimbursable event
program will not provide additional payment to the facility under a policy adopted by the federal Centers for Medicare and Medicaid Services
Different method for reporting
How many reports?
Separate rules almost a certainty

27. Summary SB 203 went into effect 9/1/09 There will be more legislation
Be watching in Texas Register for proposed and then adopted RULES to provide the ‘how to’ of these new laws

28. Thanks HAI and PAE AP (don’t you love acronyms?)
Sharon Williamson, Patti Grant and NHSN
HAI IPT
TSICP

29. HAI Resources DSHS : www.haitexas.org
Consumers ww.stophospitalinfections.org/
NHSN website:
National Quality Forum:
AHRQ:
Centers for Medicare and Medicaid Services
HICPAC Guidance on Reporting HAIs