# Presentation: 075710

## 		NNIS
		NaSH
		DSN

- 		NaSH
- 		DSN

**NHSN**

## General

- Patient Safety Component is a hybrid of NNIS and DSN
- Healthcare Personnel Component is a hybrid of NaSH
- Focus on Patient Safety Component today
- Surveillance Plan is still required

## General Differences

- Event-specific forms and data entry screens
- For some events, will indicate which criterion was used to identify event (e.g., BSI)
- Discharge date is required for each event reported except DI
- Patient data can be entered separately from event and once entered can be duplicated for subsequently entered events

## General Differences

- Custom fields on event forms
- Still optional; customizable for each event type
- More and varied types (2 date, 2 numeric, 10 alpha-numeric)
- Can be labelled; can be analyzed
- Text box for comments (cannot be analyzed)
- Linked to patient record

## General Differences

- Custom events
- Optional; all fields shown are optional
- Contain custom fields and custom text box
- Used for:
- Collecting additional events that are not collected under a module but have a NHSN definition (e.g., gastroenteritis due to *C. difficile*)
- Collecting events that deviate from NHSN definitions (e.g., MYBSI)

## General Differences

- Requirements for enrollment
- Must be from a *bona fide* healthcare facility or delivery venue (CMS or AHA number, VA station code)
- Must have email address and internet access on computer used for reporting
- Must be able to download a digital certificate onto that computer

## General Differences

- Requirements for enrollment (cont.)
- Must complete enrollment survey
- Personnel listing
- If hospital, survey similar to annual survey in NNIS
- Must complete and return consent form by surface mail
- Agree to follow protocols and use definitions exactly
- Send acceptable data 6 month every year, including annual survey

## NHSN Timeline

- Now until mid-2004: Design, develop, and internally test application; develop training materials
- Mid- 2004: Pilot test application & revise; conduct training sessions; begin enrolling current members
- Fall/Winter 2004: Make available to current users

## Training

- Elements include:
- Video conferences that can be viewed live and later
- Enrollment and requirements for participation
- Protocols
- How to do data entry
- How to do data analysis
- Online tutorials
- Online help messages and manual
- Printable forms and manual

## NNIS Legacy Data

- Cannot import your NNIS data into NHSN
- Data on your hard drive do not match those in the NNIS database (e.g., no patient names at CDC)
- Database structures are different in NNIS and NHSN
- Will send you a program that converts NNIS data to a format suitable for import into popular spreadsheets/databases
- Will provide a method that allows import of NNIS rate data into NHSN spreadsheet reports

## CDC’s National Nosocomial Infections Surveillance (NNIS) System

- Antimicrobial
- Use and
- Resistance

- Intensive Care
- Units
- (Adult/Pediatric)

- High Risk
- Nursery

## NNIS ICU Component to NHSNDevice-associated Module

**NNIS**

**Population**

- ICU/HRN

## NNIS ICU Component to NHSNDevice-associated Module

**Numerator**

- All infections

**Population**

- ICU/HRN

**NNIS ICU Component to NHSN****Device-associated Module**

## NNIS ICU Component to NHSNDevice-associated Module

**Numerator**

- All infections

**Denominator**

**Population**

- ICU/HRN

**NNIS ICU Component to NHSN****Device-associated Module**

- Patient-days and
- device-days
- (by ICU type or in HRN,
- by birth weight category)

## NNIS ICU Component to NHSNDevice-associated Module

**Numerator**

- All infections

**Denominator**

- Patient-days and
- device-days
- (by ICU type or in HRN,
- by birth weight category)

**Population**

- ICU/HRN

**Microbiology**

- Up to 4 pathogens
- Complete antibiogram

**NNIS ICU Component to NHSN****Device-associated Module**

## NNIS ICU Component to NHSNDevice-associated Module

**NHSN**

**Population**

- ICU/HRN

- ICU/NICU* (II/III & III)
- Other locations:
-  Specialty care units
-  Other wards
- - LTCF
- - Home therapy

**NNIS ICU Component to NHSN****Device-associated Module**

- *May have more than 1 NICU location

## NNIS ICU Component to NHSNDevice-associated Module

**NHSN**

**Numerator**

- All infections

- Selected DA Infs only
-  CLABSI
-  CAUTI (not in NICU)
-  VAP
- Future: Other DA non-
- infectious events

**Population**

- ICU/HRN

- ICU/NICU/Others

**NNIS ICU Component to NHSN****Device-associated Module**

## NNIS ICU Component to NHSNDevice-associated Module

**NHSN**

**Numerator**

- All infections

- Selected DA Infs/others

**Denominator**

- Patient-days and
- 3 types of device-days
- (by ICU type or in HRN,
- by birth weight category)

-  Patient-days and
- device-days for selected
- event by location
-  In SCA, split CLs into
- temp and permanent
-  In NICU, 5 BWs; split
- CLs and UCs

**Population**

- ICU/HRN

- ICU/HRN/Others

**NNIS ICU Component to NHSN****Device-associated Module**

## NNIS ICU Component to NHSNDevice-associated Module

**NHSN**

**Numerator**

- All ICU infections

- Selected DA Inf

**Denominator**

- Pt-days / Device-days

- Same; selected events

**Population**

- ICU/HRN

- ICU/HRN/Others

**Microbiology**

- Up to 4 pathogens
- Complete antibiogram

- Up to 3 pathogens;
- Selected antibiogram
- for selected organisms
- Vanco/CNS
- Up to 20 agents

**NNIS ICU Component to NHSN****Device-associated Module**

## What do we lose?
Incidence and distribution of infections at all sites in ICU/HRN
Pathogen distribution for infections other than CLABSI, VAP, CAUTI
What do we gain?
Flexibility for selecting the event and population under surveillance
Information on which diagnostic criteria were used
Information on DA infections in nonICU locations

- Incidence and distribution of infections at all sites in ICU/HRN
- Pathogen distribution for infections other than CLABSI, VAP, CAUTI
**What do we gain?**
- Flexibility for selecting the event and population under surveillance
- Information on which diagnostic criteria were used
- Information on DA infections in nonICU locations

**NNIS ICU Component to NHSN****Device-associated Module**

## NNIS SP Component to NHSNProcedure-associated Module

**Population**

**NNIS SP Component to NHSN****Procedure-associated Module**

- Inpatients undergoing
- NNIS operative procedures

## NNIS SP Component to NHSNProcedure-associated Module

**Population**

- Inpatients undergoing
- NNIS operative procedures

**Numerator**

- - All infections
- - SSI only

**NNIS SP Component to NHSN****Procedure-associated Module**

## NNIS SP Component to NHSNProcedure-associated Module

**Denominator**

- Number of inpatients
- undergoing selected NNIS
- operative procedure(s)
- -Basic risk factor data on
- selected NNIS operative
- procedures

**NNIS SP Component to NHSN****Procedure-associated Module**

## NNIS SP Component to NHSNProcedure-associated Module

**Population**

**Numerator**

- All infections/SSI only

**Denominator**

- # inpatients with NNIS
- operative procedure;
- Basic RF data

- Inpatients with NNIS
- operative procedure

**Microbiology**

- Up to 4 pathogens
- Complete antibiogram

**NNIS SP Component to NHSN****Procedure-associated Module**

## NNIS SP Component to NHSNProcedure-associated Module

**NHSN**

**Population**

- In- and out-patients
- undergoing NHSN
- operative procedures
-  35 discrete categories
- - 7  new categories
- - No “other” categories

**NNIS SP Component to NHSN****Procedure-associated Module**

- Inpatients with NNIS
- operative procedure

## 7 new categories
AAA, CEA, FUSN, RFUSN, HTP, KTP, LTP
Delete TP, VS
No “other” categories (e.g., OCVS)
Will be coded as OTH and will not be monitored
For FUSN & RFUSN, must monitor all types but can distinguish different spinal levels and surgical approaches
For HPRO & KPRO, must monitor all types but can indicate whether total, partial, or revision

- AAA, CEA, FUSN, RFUSN, HTP, KTP, LTP
- Delete TP, VS
- No “other” categories (e.g., OCVS)
- Will be coded as OTH and will not be monitored
- For FUSN & RFUSN, must monitor all types but can distinguish different spinal levels and surgical approaches
- For HPRO & KPRO, must monitor all types but can indicate whether total, partial, or revision

**NNIS SP Component to NHSN****Procedure-associated Module**

## NNIS SP Component to NHSNProcedure-associated Module

**NHSN**

**Population**

- In- and out-patients
- undergoing NHSN
- operative procedures
- Future: Patients
- undergoing procedures
- outside of OR
- (e.g., Interventional
-  radiology, cardiac
-  catheterization,
-  arthroscopy)

**NNIS SP Component to NHSN****Procedure-associated Module**

- Inpatients with NNIS
- operative procedure

## NNIS SP Component to NHSNProcedure-associated Module

**NHSN**

**Population**

- In- and out-patients
- undergoing NHSN
- operative procedures

**Numerator**

- SSI only
- Future:
- Deep venous thromb.
- Other surgical comp.

**NNIS SP Component to NHSN****Procedure-associated Module**

- All infections/SSI only

- Inpatients with NNIS
- operative procedure

## NNIS SP Component to NHSNProcedure-associated Module

**NHSN**

**Denominator**

- - In- and out-patients
-   undergoing NHSN
-   operative procedures
- - Basic RF data for all
-   procedures
- - Additional specific
-   RF for certain
-   procedures

**NNIS SP Component to NHSN****Procedure-associated Module**

- # inpatients with NNIS
- operative procedure;
- Basic RF data

## Same basic risk factor data 
For CSEC and FUSN, additional risk factor data
Will enter details on procedure only on denominator record, not on event record as do now in NNIS

- For CSEC and FUSN, additional risk factor data
- Will enter details on procedure only on denominator record, not on event record as do now in NNIS

**NNIS SP Component to NHSN****Procedure-associated Module**

## NNIS SP Component to NHSNProcedure-associated Module

**NHSN**

**Population**

- Inpatients with NNIS
- operative procedure

- In/out patients
- Operative/interventional

**NNIS SP Component to NHSN****Procedure-associated Module**

## What do we lose?
Comparison with some legacy data due to coding changes (e.g., FUSN split into FUSN and RFUSN; TP and VS split into new specific categories; )
What do we gain?
More flexible and efficient data collection on more surgical patients and on more discrete procedures
Improved risk-adjustment techniques (can use risk models and risk index)

- Comparison with some legacy data due to coding changes (e.g., FUSN split into FUSN and RFUSN; TP and VS split into new specific categories; )
**What do we gain?**
- More flexible and efficient data collection on more surgical patients and on more discrete procedures
- Improved risk-adjustment techniques (can use risk models and risk index)

**NNIS SP Component to NHSN****Procedure-associated Module**

## What do we gain?
Ability to link BSI, PNEU, and UTI occurring after an operative procedure to the procedure
Calculate rates by type of procedure
Ability to monitor procedure-associated pneumonia regardless of whether a ventilator is used by type of operative procedure

- Ability to link BSI, PNEU, and UTI occurring after an operative procedure to the procedure
- Calculate rates by type of procedure
- Ability to monitor procedure-associated pneumonia regardless of whether a ventilator is used by type of operative procedure

**NNIS SP Component to NHSN****Procedure-associated Module**

## NNIS AUR Component toNHSN AUR Module

**NNIS**

**Population**

- ICU
- Non-ICU inpatients
- Outpatients

## NNIS AUR Component toNHSN AUR Module

**Population**

**Numerator**

- # resistant isolates
- DDD for each agent

- ICU
- Non-ICU inpatients
- Outpatients

**NNIS AUR Component to****NHSN AUR Module**

## NNIS AUR Component toNHSN AUR Module

**Population**

**Numerator**

- # resistant isolates
- DDD for each agent used*

**Denominator**

- # isolates tested
- # patient-days

- ICU/SCA
- Non-ICU inpatients
- Outpatients

**NNIS AUR Component to****NHSN AUR Module**

- *DDD of agent used = Grams of agent used / DDD value

## Resistant Pathogen Benchmark Rates

***Outpatient areas***

**AR pathogen**

**# tested**

**Pooled**
**Mean***

**10%**

**25%**

**50%**

**75%**

**90%**

**MRSA**

**26,648**

**20.5**

**9.5**

**13.4**

**21.5**

**26.9**

**34.1**

**VRE**

**18,413**

**3.6**

**0.0**

**1.0**

**2.9**

**4.9**

**8.1**

**Imi-R Ps.**

**9,257**

**7.0**

**1.5**

**3.4**

**6.4**

**13.0**

- Prevalence of resistance

**Percentile**

- # resistant isolates

- x100

- =

- # Isolates tested

**9.6**

## Antimicrobial Use Benchmark Rates

***Non-ICU Inpatient Areas***

**Antibiotic**
**Group**

**# DDD**

**Pooled**
**Mean***

**10%**

**25%**

**50%**

**75%**

**90%**

**Ampicillin**

**4,774**

**54.3**

**1.1**

**21.3**

**42.5**

**61.0**

**105.4**

**3****RD**** Ceph.**

**27,584**

**317.0**

**104.0**

**180.2**

**233.8**

**341.3**

**410.1**

**Fluorquinol.**

**13,231**

**151.0**

**29.1**

**75.7**

**142.5**

**310.5**

- DDD per 1000 patient-days

**Percentile**

- DDD of specific agent used

- x1000

- =

- Total # of patient-days

**229.7**

## NNIS AUR Component toNHSN AUR Module

**NHSN**

**Population**

**Numerator**

- # resistant isolates
- DDD for each agent used

- Same

**Denominator**

- # isolates tested
- # Patient-days

- Same

- ICU/SCA
- Non-ICU inpatients
- Outpatients

- Same

**NNIS AUR Component to****NHSN AUR Module**

## So...what’s new?
Can choose to monitor micro or pharm or both
No more prescribing practices survey
Updated list of antimicrobial agents and bug-drug combinations
Use of WHO values of DDD
Provide capability for automated downloading of pharmacy/micro data at isolate and summary levels (electronic data capture)

- Can choose to monitor micro or pharm or both
- No more prescribing practices survey
- Updated list of antimicrobial agents and bug-drug combinations
- Use of WHO values of DDD
- Provide capability for automated downloading of pharmacy/micro data at isolate and summary levels (electronic data capture)

**NNIS AUR Component to****NHSN AUR Module**

## Prototype

- Sample screens for CLABSI event and denominator data entry
- Includes Vitek upload
- Semi-automated process to get microbiology data from lab to computer without data entry
- For AUR option
- Pilot testing in Pittsburgh with 9 hospitals

## Slide 42

**Notes:**
Add Patient

## Slide 43

**Notes:**
Find Patient

## Slide 44

**Notes:**
Patient Search Results

## Slide 45

**Notes:**
Edit Patient Details

## Slide 46

**Notes:**
Enter New Event-Page1

## Slide 47

**Notes:**
Enter New Event-Page2

## Slide 48

**Notes:**
Enter New Event-Page3

**Notes:**
Event Details

## Slide 50

**Notes:**
Event Search

## Slide 51

**Notes:**
Summary-ICU

## Slide 52

**Notes:**
Summary-NICU

## Slide 53

**Notes:**
AUR-Vitek-CSV file upload

## Slide 54

**Notes:**
AUR-Vitek CSV data file uploaded sucessfully.

## Slide 55

**Notes:**
Sample CSV-Vitek DataFile

**It’s gonna happen!**