National Healthcare Safety
Network (NHSN) in 2015
Ashlie Dowdell
HAI Surveillance Coordinator
SEW APIC, February 5, 2015
Wisconsin Department of Health Services
Agenda
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Review the 2015 definition change highlights.
Recap state and federal NHSN reporting
requirements.
What’s coming in 2015 for:
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Ambulatory surgery centers (ASC).
Long-term care (LTC) facilities.
ICD-10.
When Do I Need To
Incorporate These Changes?
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All definition/surveillance protocol changes
took effect January 1, 2015.
Changes to fields/reporting rules will be part
of the database after the first 2015 version
update (January 31).
Wait until after the version update to enter
2015 reporting plans, data and the annual
facility survey for CY 2014.
PATIENT SAFETY
COMPONENT
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Protecting and promoting the health and safety of the people of Wisconsin
General NHSN Changes
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NHSN Infection Window
Event Date
Repeat Infection Timeframe
Secondary Bloodstream Infection (BSI) Attribution
Period
CDC/NHSN Surveillance Definitions for Specific
Types of Infections (aka Chapter 17)
Note: These general changes do not apply to LongTerm Care Component users.
NHSN Infection Window
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Replaces “gap day” methodology from 2014.
All elements of the criteria must be part of this window.
For criteria that include diagnostic testing:
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Day -3
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Day the first positive diagnostic test included in the infection criteria
was obtained.
Three calendar days before the test.
Three calendar days after the test.
Day -2
Day -1
Day of
first
positive
test
Day 1
Day 2
Day 3
Event Date
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2014: Date the last element of the criteria was met.
2015: Date the first element of the criteria occurs for
the first time within the seven-day infection window.
Event date still determines whether an infection is
present on admission (POA) or healthcareassociated.
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Event dates on the date of admission, two days before and
the day after are POA.
Events dates on or after hospital day 3 (hospital admission
day is day 1) are HAIs for NHSN surveillance.
Repeat Infection Timeframe (RIT)
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14-day period during which repeat infections of the
same type cannot be reported.
Any additional pathogens collected during this
timeframe should be added to the original infection
report.
Event date for the first infection is day 1 of the RIT.
Secondary BSI Attribution Period
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Must meet the Secondary BSI Guideline
criteria and fall during this time period.
14-17-day period (depending on where the
event date falls within the Infection Window):
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7-day Infection Window of the primary infection.
14-day Repeat Infection Timeframe of the primary
infection.
Sun
Mon
Tue
Wed
Thu
Fri
Nov 23
Nov 24
Nov 25
Nov 26
Nov 27
Nov 30
Day -1
before
culture
Dec 1
Fever, +
culture =
CAUTI
Date of Event
Day 1 of RIT
Dec 2
Day 1
after
culture
Dec 3
Day 2
after
culture
Dec 6
Day 2
RIT
Day 3
RIT
Dec 4
Dec 5
Day 3
after
Day 5 RIT
culture
(End of
IW)
Day 4 RIT
Dec 7
Day 7
RIT
Dec 8
Day 8 RIT
Dec 9
Day 9
RIT
Dec 10
Day 10
RIT
Dec 11
Day 11
RIT
Dec 12
Day 12 RIT
Dec 13
Day 13
RIT
Dec 14
Day 14
RIT
(End of
RIT)
Dec 15
Dec 16
Dec 17
Dec 18
Dec 19
Dec 20
Infection Window
Repeat Infection Timeframe
Secondary BSI Attribution Window
Nov 28
Day -3 before
culture =
Beginning of
Infection
Window
Sat
Nov 29
Day -2
before
culture
Day 6
RIT
Excluded Modules for Certain
General HAI Rules
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Protecting and promoting the health and safety of the people of Wisconsin
Specific HAI Definitions/
Chapter 17
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HAI definitions for anything without a devoted
module.
First significant update since the 1990s.
Bring them up to date and make them
consistent with other NHSN changes over
the years.
Available at:
http://www.cdc.gov/nhsn/PDFs/pscManual/17pscNosInfDef_current.pdf
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BSI Protocol
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Secondary BSI Guide
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Will no longer ask whether blood culture organism
is a logical pathogen for the primary site of
infection.
Introduction of the Secondary BSI Attribution
Period (Infection Window + Repeat Infection
Timeframe for the primary infection).
Core temperatures no longer required for
infant fevers. Use the documented
temperature and do not convert.
UTI Protocol
No longer included:
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Colony counts less than 100,000 CFU/ml.
Urinalysis results.
Cultures positive only for yeast, mold, dimorphic fungi,
or parasites.
Uropathogen list for asymptomatic bacteremic UTI
(ABUTI) (will use the same list as for symptomatic
UTI).
Protecting and promoting the health and safety of the people of Wisconsin
New Denominator
Sampling Option
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Alternate method for collecting CLABSI and CAUTI
denominator data.
Can only be used in ICUs and wards with 75 or more
device-days per month.
Collect patient days and device days one day per
week (e.g., every Tuesday) at the same time and
provide the total number of patient days for the month.
NHSN will estimate the device days based on the
collected data for use as the denominator.
Ventilator-Associated Events
(VAE) Protocol
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Combine possible VAP and probable VAP into one event:
PVAP.
Exclude typically environmental pathogens (i.e., communityassociated fungal pathogens) not known/rarely acquired in
healthcare for PVAP.
New optional denominator: Episodes of Mechanical
Ventilation. Vent days and APRV days continue to be
required.
Daily minimum PEEP/FiO2 when there is no value
documented as maintained for 1 hour during the calendar
day: Use the lowest value documented in that calendar day.
Pneumonia/VentilatorAssociated Pneumonia Changes
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Bringing testing, pathogens in line with VAE
definitions.
Cannot report pathogens or attribute secondary BSIs
for PNU1 definition. If blood cultures are collected
and pathogens identified within the required period,
modify the designation to PNU2.
Protecting and promoting the health and safety of the people of Wisconsin
SSI Protocol
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Inpatient/outpatient procedures.
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**Changed 2/3/15**: Back to the 2014 definitions.
Inpatient procedure – different dates of admission
and discharge.
Outpatient procedure – same date of admission and
discharge.
Infection present at the time of surgery
(PATOS). SSIs with PATOS excluded from SSI
SIRs beginning in 2016 with the new baseline.
SSI Protocol, cont.
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Prior infection at the index joint for
HPRO/KPRO revisions.
Primary closure: Any portion closed at the skin
level rather than all tissue levels.
Diabetes: Medication-based definition of
diabetes or ICD-9 discharge codes.
Scope field: Y if the procedure was coded as a
lap procedure performed using a
laparoscope/robotic assist.
MDRO/CDI Protocol: Denominator
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Be prepared to exclude unit-based inpatient rehab
facilities (IRF), inpatient psychiatric facilities (IPF)
and skilled nursing facilities (SNF) with a different
CMS Certification Number (CCN) than the acute
care hospital.
New denominator screen will walk through that
removal:
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Total patient days/admissions = all locations.
MDRO patient days/admissions = exclude IPF/IRF/SNF.
CDI patient days/admissions (if reporting CDI) = exclude
IPF/IRF/SNF and NICU/well baby counts.
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MDRO/CDI Protocol:
New Locations
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Map ERs and dedicated 24-hour observation
locations.
Any time you use FACWIDEIN as a location, you also
need to report the same organism for the ER and
observation.
Attribute cultures taken in the ER to the ER (not the
admitting inpatient unit as was done in 2014).
CRE Changes
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CRE = E. coli, Klebsiella pneumoniae/oxytoca,
and Enterobacter.
Definition changes:
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Ertapenem has been added.
Only includes pathogens testing resistant to a
carbapenem (intermediates will no longer count).
CRE-Klebsiella will be limited to Klebsiella oxytoca
and Klebsiella pneumoniae.
New CRE Definition
Any Escherichia coli, Klebsiella oxytoca, Klebsiella
pneumoniae, or Enterobacter testing resistant to
imipenem, meropenem, doripenem, or ertapenem by
standard susceptibility testing methods (i.e., minimum
inhibitory concentrations of ≥ 4 mcg/mL for doripenem,
imipenem, and meropenem or ≥ 2 mcg/mL for
ertapenem) or by production of a carbapenemase (i.e.,
KPC, NDM, VIM, IMP, OXA-48) demonstrated using a
recognized test (e.g., PCR, metallo-β-lactamase test,
modified-Hodge test, Carba-NP).
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Protecting and promoting the health and safety of the people of Wisconsin
MDRO/CDI Protocol
Optional questions to be added to LabID Event
form:
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Last physical location of patient immediately prior to
arrival to facility (if specimen is community-onset).
Has patient been discharged from another facility in
the past four weeks? (this includes NH, rehab, other
hospitals, LTACs, etc.).
Protecting and promoting the health and safety of the people of Wisconsin
DIALYSIS COMPONENT
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Protecting and promoting the health and safety of the people of Wisconsin
2015 Changes (All Optional –
Not Part of CMS Reporting)
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5 new process measures:
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Hemodialysis catheter connection/disconnection.
Hemodialysis catheter exit site care.
Arteriovenous fistula and graft
cannulation/decannulation.
Dialysis station routine disinfection.
Injection safety.
Influenza vaccination for dialysis patients.
Analysis – data quality reports.
Dialysis Events Form
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New question: “Where was this positive
blood culture collected?”
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Responses include dialysis clinic, hospital (day of
or day following hospital admission) or ER, and
other location.
Loss of vascular access field under the
outcomes section will now be required.
LONG-TERM CARE FACILITY
COMPONENT
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Protecting and promoting the health and safety of the people of Wisconsin
New Required Denominator Fields
Enter the monthly total for each new field when
entering the monthly total resident days:
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If reporting UTI: Number of new antibiotic starts for
UTI indication.
If reporting CDI: Number of admissions on CDI
treatment.
Protecting and promoting the health and safety of the people of Wisconsin
General HAI Surveillance
Definitions
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New terms used in the Patient Safety
Component (infection window, repeat infection
timeframe, etc.) do not apply to the LTC
Component and should not be used at this time.
Refer back to the LTC module protocols
instead.
Updated LTC Component protocols and training
slides available now at
http://www.cdc.gov/nhsn/LTC/index.html.
NHSN REPORTING
REQUIREMENTS
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Protecting and promoting the health and safety of the people of Wisconsin
CMS Healthcare Facility
NHSN HAI Reporting Requirements
Reporting Specifications
Existing Requirement
New Requirement for 2015
Acute Care Hospitals
(Prospective Payment
System – PPS)
CLABSI (ICUs, PICUs, NICUs)
CAUTI (ICUs, PICUs)
SSI (COLO and HYST)
MRSA Bacteremia LabID Event
C. difficile LabID Event
HCP Influenza Vaccination
CLABSI and CAUTI Expansion
(Medical, Surgical and
Medical/Surgical Wards)
Outpatient Dialysis
IV antimicrobial start
Positive blood culture
Signs of vascular access infection
HCP Influenza Vaccination
Long-Term Acute Care (LTAC)
Hospitals
Inpatient Rehabilitation
Facilities (IRF)
Ambulatory Surgery Centers
(ASC)
Inpatient Psychiatric Facilities
(IPF)
Long-Term Care (LTC)
Facilities
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CLABSI
CAUTI
HCP Influenza Vaccination
MRSA Bacteremia LabID Event
C. difficile LabID Event
CAUTI
HCP Influenza Vaccination
Ventilator-Associated Events
(2016)
MRSA Bacteremia LabID Event
C. difficile LabID Event
HCP Influenza Vaccination
None
None
HCP Influenza Vaccination
None
None
State Reporting Requirements
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Medicaid P4P Program.
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CAUTI.
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HCP Influenza Vaccination.
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PPS, CAH, psych and children’s.
2014-15 season due May 15, 2015.
CRE.
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PPS and CAH.
April 2014 – March 2015 due September 30, 2015.
PPS, CAH, children’s and LTAC hospitals.
Data reported monthly even if no positive cultures have
been identified.
Reminder: NHSN 2015
Changes Training
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10-minute videos available now at
http://www.cdc.gov/nhsn/Training/patientsafety-component/index.html
February 17-19 via live webstream, includes
overview of each module and case studies.
DPH January 7 webcast recording available at
http://dhsmedia.wi.gov/main/Play/8d1fc0a5fb8
347fe8d79601709d381c41d.
WHAT’S COMING IN 2015 FOR
AMBULATORY SURGERY,
LONG-TERM CARE AND ICD-10?
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Protecting and promoting the health and safety of the people of Wisconsin
ASCs in 2015
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All should be enrolled or enrolling.
Finishing up the first season of flu reporting
(2014-15). Due May 15.
Outpatient Component due to launch in the
summer.
Protecting and promoting the health and safety of the people of Wisconsin
Outpatient Component - ASCs
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Focus on SSIs, same day adverse events, and IV
antibiotic prophylaxis timing initially.
Start with ASCs, open up to hospital outpatient
departments later.
Start with 10 procedures (breast, colon, hernia,
abdominal hyst, laminectomy, gallbladder, fractures, hip
and knee replacements, vaginal hyst).
Denominators will be aggregate numbers of procedures,
admissions, etc.
Risk adjustment/analysis still TBD.
LTC Participation in NHSN
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13 Wisconsin facilities live (206 across the
country).
3 have conferred rights to DPH so far.
Per the surveillance workshops last fall:
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64 facilities plan to use the protocols outside NHSN.
57 facilities plan to enroll in the near future.
Protecting and promoting the health and safety of the people of Wisconsin
Current LTC Reporting Options
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MDRO/C. difficile – laboratory-identified events
Urinary tract infections
Prevention process measures
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Hand hygiene
Gown and glove use
Staff flu vaccination
Protecting and promoting the health and safety of the people of Wisconsin
LTC in 2015
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Pilot for interested facilities in 2015.
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Enroll (see checklist
http://www.cdc.gov/nhsn/LTC/enroll.html).
Start reporting at least CRE.
Determine the LTC-specific questions, road
blocks, tools, etc. for enrolling and
participating.
Protecting and promoting the health and safety of the people of Wisconsin
Why NHSN for LTC?
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Standardized definitions. NHSN = McGeer’s criteria.
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National standard - try to use protocols, even if you’re not
ready to enroll.
Start to build data for comparison, both locally and
nationally.
Helps with the survey/QAPI process.
2013 National HAI Goal to enroll 5% of nursing
homes by 2017.
Transitioning to ICD-10
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NHSN ICD-10 code mapping is expected to
be available by March 2015.
ICD-10 coding starts October 2015.
ICD-10 codes will be accepted into NHSN
starting January 2016 after the version
update. Between October and January, omit
the ICD code in the procedure record to
avoid error messages.
Protecting and promoting the health and safety of the people of Wisconsin
Questions?
Ashlie Dowdell
HAI Surveillance Coordinator
Wisconsin Division of Public Health
608-266-1122
ashlie.dowdell@wi.gov
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Protecting and promoting the health and safety of the people of Wisconsin