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 mcnamaras5@michigan.gov. 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

Michigan NHSN User Group CallFEBRUARY 28, 2018

Introductions

New NHSN Epidemiologist!• Elisia “Elli” Ray, MPH

‒ RayE7@michigan.gov‒ 517-284-4943

Surveillance Initiative & Reports

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

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

State Fact Sheet

NHSN Updates

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

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!

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

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

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

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

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

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

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

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

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

SHARP Updates

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

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

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

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

Next Michigan NHSN User Group Call

Wednesday, April 25, 2018 at 10 AM

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, brennanb@michigan.gov

Chardé Fisher, MSW – Health Educator, fisherc6@michigan.gov

Sara McNamara, MPH, MT(ASCP) – Antimicrobial Resistance Epidemiologist, mcnamaras5@michigan.gov

Noreen Mollon, MS, CIC – Infection Prevention Consultant, mollonn@michigan.gov

Elli Ray, MPH – NHSN Epidemiologist, raye7@michigan.gov