NHSN: What’s New, What’s Hot… What’s Not CDC Atlanta Conference
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Transcript of NHSN: What’s New, What’s Hot… What’s Not CDC Atlanta Conference
NHSN: WHAT’S NEW, WHAT’S HOT…
WHAT’S NOT CDC ATLANTA CONFERENCE
December 5-6, 2011Cherylanne Zeumault
Jeanette Harris
THE HIGH POINTS SSI & CAUTI CAUTI…..not much is new – but if you
have questions…we can help SSI…..LOTS new in 2012
CMS: Colon surgeryCMS: Abdominal HysterectomyAlong with all the Washington MandatoryReportable surgeries
CARD,CBGB,CBGC,HPRO,HYST,KPRO,VHYS http://apps.leg.wa.gov/rcw/default.aspx?cite=43.70&full=true#43.70.056
RESOURCES The new NHSN Patient Safety
Component ManualNew this month
http://www.cdc.gov/nhsn/library.html
CMS REQUIREMENTS (COLONS & HYST) Add to your monthly reporting plan – a MUST Data Verification
800 hospitals Data Quality Output Options – check yourself Go to Output Options – Advanced – Data
Quality, CDC defined Output:
IF YOU HAVE NO SSI TO REPORT…
NEW REPORTING STEPS………….
Click on Event – Incomplete Click on Missing PA Events tab Check report NO EVENTS next to SSI then
“save”
WHY VALIDATE? It’s YOUR data It’s more meaningful, actionable EXTERNAL SCRUTINY Plus it helps everyone else for better
benchmarking Identified
Mis-mapped facility locations – leads to incorrect benchmarking
Incomplete denominators Misidentified linesMisconceptions of definitionsMissed/Overcalled cases
TIME TO DO YOUR ANNUAL CHECK Number of beds? Location mapping? New reporters? Are they all up do date?
Manual CountingElectronic Counting
Do spot checksSSI Procedures
Are they complete? Look for a secondary source for validation
How to find procedures NOT PRIMARILY CLOSED? Check procedure duration and ASA score for all
CBGB and CBGC IT can change things and you wouldn’t know it
PROCEDURE CHANGES FOR DENOMINATOR 1/1/2012 Non-autologous transplants –
No longer needed Estimated Blood loss for C-Sections –
No longer needed Implants: Temp or permanent
Porcine or synthetic valvesMechanical heartMetal rods, screws, sternal wires, cements,
internal staples, hemoclips, other
ADDITIONAL REQUIREMENTS FOR SPECIFIC PROCEDURES 5 procedures that have additional risk
CSEC, Fusion/RefusionHPROKPRO
Height in ft and inches or meters Weight in pounds or Kg C-Sections: Hours of labor in the hospital
Length of time beginning of active labor as an inpatient to delivery
MORE REQUIREMENTS FUSN/RFUSN
Diabetic Y/NSpinal LevelApproach
HPROWhich type - TP, PP, TR, PR
KPROWhich type – Primary, Revision (total or partial)
MORE THAN ONE PROCEDURE? Infection?
Determine which procedure could be associated
If it’s not clear, use the Principal Operative Procedure Selection Lists (Table 3 in the manual)
NUMERATOR CHANGE SSI “Detected” Field
No more “P” (post-discharge) Instead, “Detected” will have 2 values
RO: if SSI identified due to patient admission to a facility other than where the op was performed
RF: if SSI was identified due to patient readmission to the facility where the op was performed
Secondary BSI is required if there was a +BC
The organisms MUST be the same Linking
STANDARDIZED INFECTION RATIO (SIR)
The SIR is an indirect standardized method for summarizing HAI across any number of stratified groups of data.
The SIR is the number of observed infections divided by the predicted (or statistically expected) number of infections.
The expected number is based on the national NHSN average, the number of procedures performed by a hospital and the historical data for those procedures.
STANDARDIZED INFECTION RATIO (SIR)
A SIR of 1.0 means the observed number of infections is equal to the number of expected infections.
A SIR above 1.0 means that the infection rate is higher than that found in the "standard population." For HAI reports, the standard population comes from data reported by the hundreds of U.S. hospitals that use the NHSN system. The difference above 1.0 is the percentage by which the infection rate exceeds that of the standard population.
A SIR below 1.0 means that the infection rate is lower than that of the standard population. The difference below 1.0 is the percentage by which the infection rate is lower than that experienced by the standard population.
EXAMPLE IPist notices that “Hospital X” has a higher
number of KPRO infections than normal (more than one surgeon). IPist….PREPARES FOR BATTLE
During discussing with the Surgery Committee…Comments from surgeons “We have harder cases than hospital “Y” “We do more cases than hospital “Y” “We don’t like being compared to hospital “Y”!!
IPist notes: This is your SIR. It is 1.8 That means that you are 80% higher than other similar
hospitals – NATIONWIDE FYI….Hospital “Y” is not in your group (neener, neener) You are compared to other similar hospitals with similar
beds, risk factors, med school affiliation, etc.
EXAMPLE…CONTINUED Surgery rebuttle:
“What’s our rate compared to the National Rate? What’s the benchmark?
Ipist: There is no more “benchmark” There is only Standardized Infection Ratio This means that you are compared to other
surgeons/hospitals with patients with similar risk factors that include more than just ASA score and wound class
This is a BETTER and MORE ACURATE method of comparison
You’re SIR of 1.8 means that you have 80% more infections than similar hospitals across the nation
Surgery: So we really DO have more infections? Ipist: YES Surgery Committee Chair: I suggest we get a
team together to see what’s going on
MORAL OF THE STORY: RCA discovered that there were
variations in practices that contributed to these infections
Surgery Committee Report:More help during surgeryControl the number of staff in surgery suitePositioningDrapingDressingsStaff training
Outcome: no infection since (6 months)
HAPPY ENDING: