New Hampshire Healthcare-Associated Infections Annual NHSN Workshop: May 4, 2017 NHSN Analysis

Transcription

1 New Hampshire Healthcare-Associated Infections Annual NHSN Workshop: May 4, 2017 NHSN Analysis Yvette Perron, MPH HAI Surveillance Coordinator Infectious Disease Surveillance Section Bureau of Infectious Disease Control

2 Overview: NHSN analysis Key terms Data Types of available data How to: Access data Creating reports and generating output How to: Generate output Types of output Customizing output Tips and hints

3 Why analyze your data? Internal data validation Confirm HAI program reports Annual data reconciliation Quarterly reports Internal progress reports Internal use at your facility Communicate with leadership, community, other stakeholders Visualize data Use it for response and prevention!

4 Key Terms Navigation Bar: A list of options or functions displayed in the blue bar on the left hand side of the screen Generate Datasets: A function on the Navigation ( Nav ) Bar that allows a user to create one or more analysis datasets according to the user s rights Treeview: A hierarchical view of a list of items or options that can be collapsed or expanded

5 Key Terms Output Option: A specific option in the Analysis Output Option menu that can be executed (e.g., Line Listing Central Line-associated BSI Events) Analysis Data Set: A set of data of a particular type (e.g., CLABSI events) created for a user so that output (reports) may be produced

6 Key Terms Output Type: The general type of output generated using a particular output option (e.g., line listing). Available output types will vary by the measure being analyzed Design Parameters: A list of items that allows a user to customize output Custom Output: A section heading containing output options that have been modified by a user to generate a particular type of output

7 Navigation Bar Click on analysis to begin

8 Types of available data Data that has been entered by the users at your facility and That you have rights to access In most cases, users may access and analyze all data entered for a particular component at a facility However, rights can be restricted

9 Generating Datasets

10 Generating Datasets Click here to generate or update data

11 Collapsed Treeview for Guided Context

12 Each folder section of the Treeview can be expanded by clicking on either the folder icon or name The Modify button allows the user to change the design of each output option Each branch of the Treeview displays a list of pre-defined output options

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14 YH = Half Year YM = Month YQ = Quarter Yr = Year

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16 YH = Half Year YM = Month YQ = Quarter Yr = Year Each user-modified output option design can be saved for later execution and is saved a Custom Output folder in the same branch of the Treeview

17 HAI Program analyses Facilities can generate reports identical to the HAI Program quarterly/annual reports by using the same analysis options NHSN data SSI (BRST, FX, HER) HCP influenza vaccination

18 HAI Program analyses Types of analysis Line listing: Track what was reported or entered into NHSN. Get details on particular infections or procedures Standardized infection ratio (SIR): Summary measure used to track HAIs at the national, state, or local level over time and adjusts for varying risk factors (patient and facility) Data quality line listing: Used to check data quality such as duplicate procedures, procedures with 0 duration, duplicate SSI events, SSIs on procedure date, extremely high SSI incidence or events Rates Table: Can be helpful for Device-related HAIs, SSIs, when there are very few events or procedures reported. Easy for others to understand. Just use with caution because there is limited risk adjustment

19 NHSN output options: Line listing Track what was reported or entered into NHSN Get details on particular infections or procedures

20 NHSN output for hospitals SSI (CABG/CBGB, COLO, KPRO, HYST): Line Listing All Procedures

21 NHSN output SSI (BRST, FX, HER): Line Listing All Procedures Modify Check Use Variable Labels Select Excel Spreadsheet (*.xls) Date Variable Summary YQ Beginning (example: 2017Q1) Ending (example: 2017Q1) Group by Summary YQ Export Output Data Set

22 NHSN output options: Standardized infection ratio (SIR) Summary measure used to track HAIs at the national, state, or local level over time Adjusts for varying risk factors (patient and facility) Compares the actual number of HAIs reported in your facility to national baseline number A SIR greater than 1.0 indicates that there were more HAIs observed than expected A SIR less than 1.0 indicates that there were fewer HAIs observed than expected

23 NHSN output options: SIR Procedure count Infection count Number expected based on national data SIR P-value (assess stat significant) Confidence interval (assess stat significant)

24 NHSN output options: Frequency table Overall count Example: HCW influenza vaccinations

25 Data quality: Advanced reports Procedure level data: Frequency Table Check count of procedures and confirm with OR record

26 NHSN output options: Bar and pie charts Graph data can be a useful visual

27 Data quality: Advanced reports Pie Charts and Bar Graphs

28 NHSN output options: Rate table Can be helpful for Device-related HAIs, SSIs, when there are very few events or procedures reported. SSIs- when SIR doesn t work due to small numbers Can also be troublesome if denominator are too small. May make rates appear high. Easy for others to understand HINT: Use with caution because there is limited risk adjustment

29 NHSN output options: Rate table Broken out by risk category 0,1, and 2,3 For risk category 2,3 there was 1 infection out of 13 procedures for a rate of The denominator was small and this impacted rate

30 Data quality: Advanced reports Data Quality: Line listings for duplicate procedures, procedures on DOB, procedures with 0 duration, duplicate events, SSI on procedure data, high incidence SSI, events reported with 0 device days

31 Data quality: Other options Procedure-associated module Run a procedure-associated report by month to ensure all data is entered Ensure bilateral procedures are entered twice Example: Bilateral breast procedures should be entered for each breast

32 A note about ASC data Limited data Small number of procedures and infections entered May not be able to generate SIR Hint: Use longer time frame (i.e., 1 or 2 years) and/or use rates (with caution) Post-discharge surveillance Fewer infections may be detected or reported

33 Creating output/reports: Tips & hints Use the back button NOT the browser button! Review the NHSN analysis training modules Try it first: You can learn by experimenting with the various options Not all options fit every need

34 So many options! Ask yourself: What are you trying to do? How will the data be used? Who will be using the data? Just infection control? Administration? Public? Remember: All data and output options have limitations!

35 Discussion What do you use? What do you find most helpful? What does your facility administration like to have for review? Any tips for other NHSN users? What is your data analysis wish list? Type of reports, options, etc.?

36 Resources NHSN expertise in the state: NH HAI program NHCQF Foundation for Healthy Communities Other ICPs NHSN at CDC Training modules: html

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38 New Hampshire Healthcare-Associated Infections Program Annual NHSN Workshop: May 4, 2017 Using Quarterly/Annual Reports Yvette Perron, MPH HAI Surveillance Coordinator Infectious Disease Surveillance Section Bureau of Infectious Disease Control

39 Overview: Using Quarterly/Annual Reports How to read/use your quarterly report SSI Data Antibiotic Prophylaxis Data Discussion

40 Tab 2: SSI data (BRST, FX, HER) All SSI data is presented in the same format and is straightforward to interpret Data is arranged by Org ID SSI data includes risk category, number of infections, number of procedures, SIR, p-value for SIR, and comments if necessary SSI: FX (Open reduction of fracture), 2016 Q4 (October 1-December 31) Risk Number of Number of OrgID Category Infections Procedures Rate Comments ,1,2, ,1,2, ,1,2,

41 Tab 2: Interpreting SSI comments What the comments say (examples) No data submitted for this procedure in Q3 of 2017 Please confirm this procedure performed in only 2 months of Q3 of 2017 Please confirm 2 HERs reported as inpatient procedures What the comments mean If 0 procedures and events show up in our reports during a quarter, we include a note in case there are procedures or events that have not been entered. Please check that the number of procedures/events entered matches what is reflected in the report. If procedures are carried out in less than 3 months during a quarter, we include a note in case there are procedures or events that have not been entered. Please check that the number of procedures/events entered matches what is reflected in the report. Typically, procedures performed an ambulatory surgical center are outpatient, so we include a note whenever there is a procedure classified as inpatient. Please check that the procedure is correctly classified.

42 Tabs 3: Antibiotic Prophylaxis Data Antibiotic prophylaxis data are in a similar format; data are presented by OrgID Abx prophy data includes totally prophy administered, total prophy administered on time, and percent prophy administered on time and comments if necessary IV Antimicrobial Prophylaxis, 2016 Q4 (October 1-December 31) % Prophy Facility Total Prophy Total Prophy Administered On name Administered Administered On Time Time Comments % % %

43 Tabs 3: Interpreting Antibiotic Prophylaxis comments What the comments say (examples) Please confirm 9 procedures received antibiotic prophylaxis after incision. This is not considered on time. Please let me know if this occurred or if it is a data entry issue What the comments mean If antibiotics were not administered on time, we would include a note in case there are data entry errors. Please check that the total number of antibiotics administered and antibiotics administered not on time. Please confirm no IV antibiotic prophylaxis data was reported in If there were no antibiotic prophylaxis reported, we include a note in case there were IV antibiotic prophylaxis administered. Please check to see if there were no IV antibiotic prophylaxis administered.

44 Discussion Generally, check the data you have entered (infections and number of procedures) against the data represented in our reports, and read the comments. If there is a discrepancy, let us know! If you are having problems, we want to know! Thank you for your support and patience! Contact HAI Program if you have any questions about these reports Cannot find your org ID Need further explanation re: data/data dictionary/comments Need proc ID numbers for procedures with missing data (ASA, Wound Class, etc.) and/or other output Etc.

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46 New Hampshire Healthcare-Associated Infections Annual NHSN Workshop: May 4, 2017 Global Changes to NHSN in 2017 Yvette Perron, MPH HAI Surveillance Coordinator NH DHHS, DPHS

47 Agenda: 2017 NHSN update Visually different/new Features Alerts Data entry screen Monthly reporting plans Rebaseline Standardized Utilization Ratio PATOS

48 NHSN Patient Safety Component Home Page

49 Monthly Reporting Plans

50 Statistics Calculator

51 Rebaseline Used in-plan data reported for 2015 Used different risk models, along with different incidence and collected under different protocols and definitions than the 1 st baseline. Facility Type Acute Care Hospital (ACH) 3,664 Critical Access Hospital (CAH) 623 Long Term Acute Care Hospitals (LTACH) 489 Inpatient Rehabilitation Facilities (IRF) 1,170 *The number represents the maximum number of facilities contributing to a single model. Number of facilities contribute to each model*

52 Rebaseline Example 1: Baseline 1 (2009 NHSN Data) Year # CAUTI # Predicted SIR P-Value 95%CI Cath Days , Baseline 2 (2015 NHSN Data) Year # CAUTI # Predicted SIR P-Value 95%CI Cath Days ,

53 Rebaseline Example 2: Baseline 1 (2009 NHSN Data) Year # CLABSI # Predicted SIR P-Value 95%CI , Baseline 2 (2015 NHSN Data) Year # CLABSI # Predicted SIR P-Value 95%CI , 4.020

54 Rebaseline Timeline NHSN users will be able to run SIRs for 2015 and 2016 under both the original baseline, and the new baseline Data for 2017 and forward will be available under the new baseline only

55 Standardized Utilization Ratios Summarized risk-adjustment measure for device use Standardized Utilization Ratios (SURs) for all device types Central Line Use Urinary Catheter Use Ventilator Use SURs are not part of CMS Quality Reporting Programs

56 Standardized Utilization Ratios Similar to SIR Calculated as: SUR= # observed device days # predicted device days # Predicted device days is calculated based on multivariable logistic regression models SUR is a scalable measure Can scale up to a facility, state or national level

57 Insert slides about AU

58 Antibiotic Use Option Purpose: To provide a mechanism for facilities to report and analyze antimicrobial usage as part of antimicrobial stewardship efforts at their facilities Voluntary Reporting

59 Antibiotic Use Option Monthly aggregate, summary-level data Numerator: Antimicrobial days (Days of Therapy) 89 antimicrobials includes antibacterial, antifungal, and anti-influenza agents Sub-stratified by route of administration: Intravenous (IV) Intramuscular (IM) Digestive (oral) Respiratory (inhaled)

60 AU Option Cont. Denominators: Days Present - number of days spent in specific unit or facility Days present Patient days Admissions - number of patients admitted to the facility

61 AU Output Options Analysis Options Line Lists Rate Tables Pie Charts Bar Charts SAAR (Standardized Antimicrobial Administration Ratio)

62 AU Line List By Location Sample line list of the most recent month of AU data by location Generates a list of each antimicrobial separated by location Shows total antimicrobial days, days present and substratification of routes of administration for each antimicrobial

63 AU Rate Table Facility-Wide Inpatient Sample rate table for all submitted AU data by FacWideIN (all inpatient locations reporting AU data) Generates a rate of utilization per 1,000 days present for each antimicrobial class for all inpatient locations combined Report includes separate rates for each antimicrobial class for each month of data submitted

64 AU Pie Chart by Location Sample pie chart by location Shows proportion of antimicrobial days per antibacterial class

65 AU Bar Chart by Location Sample bar chart by location Shows proportion of antimicrobial days per antifungal class

66 Standardized Antimicrobial Administration Ratio Standardized metric of antibiotic use available to facilities reporting to the AU option Covers 5 Antibiotic Agent Categories Broad spectrum agents predominantly used for hospital onset Broad spectrum agents predominantly used for community acquired Anti-MRSA agents Agents predominantly used for surgical site infection All antibiotic agents

67 Standardized Antimicrobial Administration Ratio Observed antibacterial use Days of therapy reported by a healthcare facility for a specified category of antimicrobial agents in a specified patient care location or group of locations Predicted/Expected antibacterial use Days of therapy predicted on the basis of nationally aggregated AU data for a healthcare facility s use of a specified category of antimicrobial agents in a specified patient care location or group of locations

68 SAAR A high SAAR that achieves statistical significance may indicate excessive antibacterial use. A SAAR that is not statistically different from 1.0 indicates antibacterial use is equivalent to the referent population s antibacterial use. A low SAAR that achieves statistical significance (i.e., different from 1.0) may indicate antibacterial under use.

69 SAAR Note: A SAAR alone is not a definitive measure of the appropriateness or judiciousness of antibacterial use, and any SAAR may warrant further investigation. For example, a SAAR above 1.0 that does not achieve statistical significance may be associated with meaningful excess of antimicrobial use and further investigation may be needed. Also, a SAAR that is statistically different from 1.0 does not mean that further investigation will be productive.

70 SAAR We should use SAAR to: Search for specific agents driving overall high use Assess for unnecessary combinations Assess use to see if high use reflects large numbers of starts or prolonged courses Compare antibiotic use to resistance patterns Benchmark measures Quickly identify locations and agents where stewardship programs should focus Identify high-yield opportunities to improve use based on past experiences.

71 Antimicrobial Resistance (AR) Option Purpose: Facilitate evaluation of antimicrobial resistance data using standardized approach Provide facilities with improved awareness of a variety of AR issues to aid in clinical decision making and prioritize transmission preventions efforts Voluntary Reporting

72 AR Data Numerator: Patient-level susceptibility results for 19 specific organisms DOB, gender, date admitted to facility, location Specimen collection date, specimen source Blood, cerebral spinal fluid (CSF), urine, lower respiratory Organism & antimicrobial susceptibility data for each antimicrobial required for the isolated organism/specimen type Values for E-test, MIC, or Zone Final lab interpretation S, S-DD, I, R, NS, N Denominator: patient days & admissions (facility-wide only)

73 AR Option 19 Organisms 89 antimicrobials includes antibacterial, antifungal, and anti-influenza agents Sub-stratified by route of administration: Intravenous (IV) Intramuscular (IM) Digestive (oral) Respiratory (inhaled)

74 AR Option- Line List Modifications can be made to the output option to show the antimicrobial tested, susceptibility test values, and final susceptibility interpretation

75 PATOS Present at time of surgery Indicates that there is evidence of an infection present at start or during index surgical procedure Does not apply if there was a period of wellness between time of pre-operative condition and surgery

76 Reminder-PATOS The evidence of infection must be noted preoperatively or found intraoperative in pre-operative note Patient note indicating infection at time of surgery should be included on denominator / event form

77 Reminder (PATOS continued) Only select PATOS = Yes if the depth of the SSI is being attributed to the procedure If evidence of an infection at time of surgery and later returns with organ/space SSI, PATOS field would be YES If superficial or deep SSI, PATOS field would be NO The patient does not have to meet the NHSN definition of an SSI at the time of primary procedure but there must be notation that there is evidence of infection or abscess present at the time of surgery

78 Your reflections This work is done with limited resources The HAI Program and NHSN recognize that any change to reporting requirements/processes represents a burden on workload Let us know how we can support you Share your thoughts directly with NHSN they value facility input!

79 Helpful resources NHSN newsletters December APIC newsletters CDC NHSN Patient Safety Component (PSC) Manual (Updated January 2017) ent.pdf

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81 For More Information: Katrina Hansen, MPH Chief, Infectious Disease Surveillance Section Yvette Perron, MPH HAI Surveillance Coordinator Claudia Alvarado, RN, BSN HAI Prevention Specialist Hannah Leeman CDC Public Health Associate

82 "Paving the Path Forward: 2015 Rebaseline." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 11 Jan Web. 21 Feb Funding for this conference [NHSN Workshop] was made possible by the Centers for Disease Control and Prevention [Cooperative Agreement Number NH3U50CK000427]. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services, nor does the mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.