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MDHHS SHARP NHSN USERS CONFERENCE CALL
Wednesday, February 28, 2018 10:00 a.m.
Audio Call-in Number: 877-336-1831 Audio Passcode: 9103755
Webinar: http://breeze.mdch.train.org/mdchsharp/ Enter meeting room as guest, then type your last name and affiliation if you feel comfortable doing so. Meeting room may prompt for Add-On, click yes. Please turn-off any pop-up blockers to help limit problems with the application. Please send any questions, comments, or suggestions about these calls to Sara McNamara at [email protected]. If you have never attended a Connect Pro meeting before, you can test your connection at: http://breeze.mdch.train.org/common/help/en/support/meeting_test.htm NOTE: Please place your phone on mute or press *6 to mute. Do not place your phone on hold as this will cause those on the conference call to hear music or messages that your hospital gives out. If you have to answer another phone call, please hang up and call back into the meeting room after you finish taking the call. THANK YOU!
Agenda:
1. Welcome & Introductions
2. Update on Surveillance Initiative and Reports
3. NHSN Updates and Correspondence
4. SHARP Updates
5. Questions/Discussion
6. Next Meeting – April 25, 2018 at 10am
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Michigan NHSN User Group CallFEBRUARY 28, 2018
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Introductions
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Surveillance Initiative & Reports
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SHARP Reports• Individual Facility TAP Reports will be sent out soon
‒ 2017 Q2
• Aggregate TAP Reports will be posted to: www.michigan.gov/hai‒ 2017 Q2 TAP Reports, Overall and by Region
• Coming Soon‒ 2017 Q3 TAP Report‒ 2016 Annual Report
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New National and State NHSN Reports• 2015 National and State HAI Data Report
• National 2015 SIRs using Historical Baselines
• Healthcare-Associated Infections in the United States, 2006-2016: A Story of Progress
• All reports are available at: https://www.cdc.gov/hai/surveillance/data-reports/index.html
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State Fact Sheet
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NHSN Updates
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Upcoming Deadlines• 2017 Annual Survey due March 1st
• New Agreement to Participate and Consent form due April 14th
• CMS Quality Reporting Program data for 2017 Q4 due May 15th
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NHSN Annual Training • February 26th – March 2nd
• Live web-stream and handout materials available at: http://www.cdc.gov/nhsn/training/annualtraining/index.html
Going on
Now!
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2018 Protocol Changes • CLABSI
‒ LCBI with ECMO, VAD, EB, or MSBP not a CLABSI‒ Device-day and denominator count clarification
• CLIP‒ New skin prep – report new event
• CAUTI‒ SUTI 1a – catheter in place >2 days to use fever in patient >65
yrs‒ Device-day and denominator count clarification‒ Catheter-associated ABUTI reporting clarification
• LabID‒ Freestanding IRFs and LTACs only need to enter 1 set
denominator data on MDRO denominator form‒ CDI test type required for IRF unit denominator form‒ Multi-step CDI testing reporting and risk adjustment based on
last test
• HAI exclusion for organ procurement‒ Clarification for exclusion if DOE on or after consent obtained
• Organism List - updated
• PNEU‒ Endotracheal aspirate eligible as minimally contaminated specimen for
PNEU2 and 3
• VAE‒ Ventilator definition clarification ‒ Additional acceptable imaging test evidence guidance (footnote #14)‒ Daily minimum PEEP and FiO2 values = lowest setting maintained for > 1
hour‒ Delafloxacin added for IVAC and PVAP‒ APRV field and denominator day collection available, optional
• SSI‒ Updated ICD-10-PCS and CPT codes‒ Additional guidance for DOE, Trauma, invasive manipulation/accession
of op site
• Chapter 17‒ GIT: Criterion 1 allows blood as element‒ IAB: Retroperitoneal space added; Criterion 3 for Cholangitis includes
hypotension and elevated transaminate levels; biliary ductal dilation is equivocal finding
‒ VASC: VAD removed from eligible site for matching isolate to exclude CLABSI
‒ ENDO: Enterococcus spp. added for Criteria 4a & 5a; cardiac vegetation includes VAD components
https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf
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Central Line Denominator and Line Access Day Counts
• CHANGE FOR 2018: count central lines whenever it’s present at the time of count
Feb 28 March 1 March 2 March 3 March 4 March 5 March 6
Patient admitted with central line in place
ED
Central line in place, not accessed
ICU
Central line in place, not accessed
ICU
Central line in place, not accessed
ICU
Central line in place,
accessed
ICU
Central line in place,
accessed
ICU
Central line in place,
accessed
ICU
Central line in place,
accessed
Device day for denominator count
1 2 3 4 5 6
Central line day for device attribution
1 2 3 4
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Multi-step CDI Testing• When using multi-step testing for CDI, the final result of the last test finding will determine if the CDI positive laboratory assay definition is met‒ Example 1: EIA GDH Antigen +/toxin - , PCR + → Report LabID event by PCR +‒ Example 2: PCR +, EIA GDH Antigen +/toxin - → NOT a LabID event as toxin –
• For risk-adjustment, the test used for the last step in the algorithm will be used
NHSN Reporting Year
CDI Test Type Event Reporting Risk Adjustment Category
# Observed HO-CDI
# Predicted HO-CDI
SIR
2017 NAAT + EIA if NAAT positive
Specimens that test positive at
any point
NAAT 5 4.74 1.05
2018 NAAT + EIA if NAAT positive
Specimens that test positive from the last
step
EIA 3 2.97 1.01
https://www.cdc.gov/nhsn/pdfs/newsletters/nhsn-nl-dec-2017-508.pdf
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FacWideIn Denonimator Data Entry ErrorError: Row 2 and 3 entered as patient days and admissions for only patients who were positive for an MDRO or CDI
https://www.cdc.gov/nhsn/pdfs/newsletters/nhsn-nl-dec-2017-508.pdf
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FacWideIn Denonimator Data EntryCorrect: Rows 2 and 3 should include patient days and admissions from all eligible inpatient units regardless of infection status.
Rows 2 and 3 are sub-sets of row 1:‒ Row 2: Total Facility Patient Days – (IRF unit patient days) – (IPF unit patient days) = MDRO patient days‒ Row 3: Total Facility Patient Days – (IRF unit patient days) – (IPF unit patient days) – (NICU patient days) –
(Well baby unit patient days) = CDI patient days
https://www.cdc.gov/nhsn/pdfs/newsletters/nhsn-nl-dec-2017-508.pdf
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New Modules Coming Soon• Outpatient Procedure Component (OPC)
‒ Created for Ambulatory Surgical Centers (ASCs)‒ Hospital Outpatient Departments are not included‒ Contains 2 modules: same day outcome measure, surgical site infection measure‒ Replaces PSC SSI module for ACSs‒ Reporting is optional (except where state-mandate)‒ Expected to launch late 2018
• Pediatric Ventilator-Associated Event (PedVAE)‒ Pediatric and neonatal locations in ACH, LTAC, IRF‒ Expected to launch January 2019 ‒ Yet to be determined if PedVAP will remain available for monthly reporting plans when
PedVAE is released
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New Tools Coming Soon• Infection Checklists
‒ Based on TN checklists‒ Plan to release end of March 2018
• Data Quality Checklist in 2018 Internal Validation Toolkit‒ Review data quality prior to data submission
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New Analysis Coming Soon• CMS Reports
‒ In a future release (TBD) users will be able to access their hospital’s SIRs frozen at the time of each CMS quarterly deadline, for any quarter following that NHSN version release date.
‒ Details will be forthcoming from NHSN.
• Updated SAAR models‒ Use 2017 data for new baseline (current baseline uses 2014 data)‒ Assess adding possible new locations‒ Determine if SAAR agent groupings should change‒ Implemented late 2018/early 2019‒ NICU SAARs coming in 2020
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SUR Guide• Standardized Utilization Ratio (SUR) Guide for central line, urinary catheter, and ventilator use
• Includes:‒ Definitions‒ Calculation steps‒ Model parameters for each device type and facility type
• Available at: https://www.cdc.gov/nhsn/pdfs/ps-analysis-resources/nhsn-sur-guide-508.pdf
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SHARP Updates
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SHARP Unit – Coming Soon!• Antimicrobial Stewardship Coordinator - TBD
‒ Interviews next week!!‒ Hopefully starting end of March‒ Communities of Care, AUR Pilot Project, AMS Subcommittee, and other AMS efforts
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CP-CRE Reporting Update• Interim CP-CRE Case Reporting and Investigation Guidance
‒ Reporting / Case Investigation / Case Classification
• Though ELR is available, majority facilities reporting manually‒ Please follow case definition‒ Include carbapenem susceptibilities on the MDSS formo Even if results are suppressed
www.michigan.gov/hai
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New SHEA Expert Guidance • Duration of Contact Precautions for Acute Care Settings
‒ Released online January 2018‒ Addresses MDROs and CDIoMRSAo VREoMDR Enterobacteriaceae, including CP-CRE, ESBL, non-CRE MDR-GNRo Clostridium difficile
https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/duration-of-contact-precautions-for-acutecare-settings/94E38FDCE6E1823BD613ABE4E8CB5E56
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CDC Training on Antibiotic Stewardship• Four-part web-based training course on Antibiotic Stewardship
• Open to all clinicians, pharmacists, physician assistants, nurses, certified health educators, and public health practitioners with an MPH
‒ Eligible to receive up to eight hours of CE
• Fulfills one of the Improvement Activities (IA) requirements under the CMS Merit-Based Incentive Programs (MIPS)
• Register: https://www.cdc.gov/antibiotic-use/community/for-hcp/continuing-education.html
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Next Michigan NHSN User Group Call
Wednesday, April 25, 2018 at 10 AM
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Thank you!Surveillance for Healthcare-Associated and Resistant Pathogens (SHARP) Unit
www.michigan.gov/hai
Brenda Brennan, MSPH – SHARP Unit Manager, HAI & CRE Prevention Coordinator, [email protected]
Chardé Fisher, MSW – Health Educator, [email protected]
Sara McNamara, MPH, MT(ASCP) – Antimicrobial Resistance Epidemiologist, [email protected]
Noreen Mollon, MS, CIC – Infection Prevention Consultant, [email protected]
Elli Ray, MPH – NHSN Epidemiologist, [email protected]