History and Overview of SENIC, NNIS and NHSN

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History and Overview of SENIC, NNIS and NHSN Powered By Docstoc
					History and Overview of
SENIC, NNIS and NHSN

    Mary Andrus, BA, RN, CIC
      Surveillance Branch
Division of Healthcare Quality Promotion
         B.S. – Before SENIC
• Late 1950’s – early 1960’s staphylococcal
  pandemic in U.S. hospitals
• Infection Control Committees formed
• 1960’s – CDC began to recommend
  surveillance of infections to obtain evidence
  for control measures
• 1970’s – studies indicate surveillance be conducted
  by nurses trained in epidemiology
• Based on pilot study, recommendation for one full-
  time IC nurse for every 250 occupied hospital beds
• By 1975 >50% of U.S. hospitals had infection
  control programs
• 1976 Joint Commission on Accreditation of
  Healthcare Organizations (JCAHO) added infection
  surveillance and control standard
• CDC training courses established
    Study on the Efficacy of
  Nosocomial Infection Control
           (SENIC)

• Early 1970s - SENIC Project initiated
• Goals
  – Measure use of infection control programs
  – Identify specific surveillance and infection
    control characteristics
  – Determine whether or not IC programs
    reduced nosocomial infection rates
         SENIC Study Phases
• Phase I – Preliminary Screening Questionnaire
  – Sent to 6,586 hospitals (86% response)
  – Surveillance index and Control index
• Phase II – Hospital Interview Survey
  – Random sample (338) of hospitals (stratified by distribution
    of indexes)
  – CDC interviews to corroborate questionnaire
• Phase III – Medical Records Survey
  – 500 patient records from 1970 and 500 from 1975-76 from
    each hospital
  – Comprehensive medical record review to diagnose four
    nosocomial infections: BSI, UTI, SWI and PNEU
             SENIC Conclusions
•    Reduction of nosocomial infection rates of up to
     32% if four components were included:
    1.   Ongoing surveillance of infections
    2.   Active control efforts
    3.   Qualified infection control staff
    4.   For surgical wound infections (SWI), feedback of
         infection rates to surgeons
•    The exact measures that are most effective are
     variable for different infection sites
1970 - 2004
Characteristics
• Started in 1970 with 62 hospitals
    – Peaked at 320 hospitals in 42 states
• Participation voluntary and confidential
• Focused on monitoring infections in critical care and
  surgery patients
• Requirements
    – Hospitals with at least 100 occupied beds
    – Trained ICPs: 1 FTE ICP per first 100 beds plus 0.5 FTE
      support staff (median: 1 ICP per 115 beds)
• NNIS hospitals tend to be large, academic institutions
  with higher average daily census; over-represented in
  Northeast/Southeast
Richards C, et al. AJIC 2001;29:400-3.
             NNIS Purposes

• Describe the epidemiology of nosocomial
  infections in U.S. hospitals

• Promote epidemiologically-sound surveillance
  methodology

• Establish comparative rates that can be used
  for local quality improvement efforts
        NNIS System Methods
• Used standard definitions for infections,
  operations, and all data fields
• Used standard protocols to collect data
• Hospitals reported data electronically to CDC
  monthly using CDC-provided software
• CDC published reports of aggregated data
  – www.cdc.gov/ncidod/hip/surveill/nnis.htm
  – American Journal of Infection Control
•Before 1986, NNIS surveillance was hospital-wide.
•1986-1999 Hospital-wide remained an option
•1999 Hospital-wide component eliminated.



               NNIS Protocols
             NNIS Surveillance Components



    AUR             ICU                              Surgical
                                     HRN             Patient
Antimicrobial Intensive Care       High Risk
  Use and          Unit             Nursery
 Resistance (Adult/Pediatric)     (Level II/III
                                 and III NICUs)
Pooled Means and Percentiles of the Distribution of
Central Line-associated Bloodstream Infection (BSI)
Rates, By Type of ICU, NNIS ICU Component, 1/02-6/04
Central line-associated BSI rate**                     Percentile
                   No. of Central Line- Pooled 10% 25%   50% 75%                     90%
Type of ICU         Units      Days     Mean           (median)

Coronary                  60        116,546       3.5      1.0   1.5    3.2    7.0    9.0
Cardiothoracic            48        182,407       2.7      0.0   0.9    1.8    2.7    4.9
Medical                   94        312,478       5.0      0.5   2.4    3.9    6.4    8.8
Medical-Surgical
 Major teaching          100        430,979       4.0      1.7   2.6    3.4    5.1    7.6
 All others              109        486,115       3.2      0.8   1.6    3.1    4.3    6.1
Neurosurgical             30         56,645       4.6      0.0   0.9    3.1    5.8   10.6
Pediatric                 54        161,314       6.6      0.9   3.0    5.2    8.1   11.2
Surgical                  99        358,578       4.6      0.0   2.0    3.4    5.9    8.7
Trauma                    22         70,372       7.4      1.9   3.3    5.2    8.2   11.9

** Number of central line-associated BSI X 1000         NNIS Report 2004; AJIC 32:470-85.
   Number of central line-days
       SSI Rates* by Operation and Risk
     Index Category, NNIS Surgical Patient
            Component, 1/92-6/04
                                                      Risk Index
                                    Duration    0      1      2    3
                                    Cut Point
Abdominal hysterectomy                2 hr      1.4   2.3    5.7   **
Knee arthroplasty                     2 hr      0.9   1.3    2.3   **
Exploratory laparotomy                2 hr      1.7   3.1    4.8   7.2
CABG – Chest & donor site             5 hr      1.2   3.4    5.4   9.8
Cesarean section                      1 hr      2.7   4.1    7.5   **

NNIS Report 2004; AJIC 32:470-85.
                                 Central Line-associated BSI Rates,
Rateper 1000 Central line days
                                      By ICU Type,1990-2004
                                 10

                                 8

                                 6

                                 4

                                 2

                                 0
                                      1990   1992    1994     1996   1998   2000   2002   2004
                                                                Year
                                      Coronary      Medical     Pediatric    Surgical
                       Source: NNIS System, incomplete for 2004
            Decrease in HAI rates, NNIS
                    1990-1999
  Type of ICU CLABSI (%)                               VAP (%)               CAUTI (%)

  Coronary                          43                       42                      40

  Medical                           44                       56                      46

  Surgical                          31                       38                      30

  Pediatric                         32                       26                      59

Gaynes, R, et.al. Feeding back surveillance data to prevent hospital-acquired infections.
EID;2001 7(2)
NNIS - 2004
2005 – present
NHSN is a secure, internet-based surveillance system that integrates all
 surveillance systems previously managed separately in the Division of
             Healthcare Quality Promotion (DHQP) at CDC.


                            NaSH
                 NNIS                     DSN
                             NHSN
                             2005


NNIS      National Nosocomial Infections Surveillance System
NaSH      National Surveillance System for Healthcare Workers
DSN       Dialysis Surveillance Network
            NHSN Premises
• Maintain the goals of predecessor systems
• Minimize data collection and manual data
  entry burden
  – Streamline existing surveillance protocols
  – Increase capacity for capturing electronic data
    (e.g., Laboratory information systems, operating
    room, pharmacy, clinical, administrative
    databases)
  – Web-based application
            NHSN Premises
• Partner with others to minimize data reporting
  burden
• Allow all healthcare delivery entities to
  participate
• Enhance data sharing capabilities without
  compromising CDC’s need to keep the data
  secure and confidential
           Components of NHSN




                 Healthcare
                               Research &
Patient Safety   Personnel                      Biovigilance*
                              Development
                   Safety




                                        *In development
Patient Safety Component Modules
           •CLABSI      •CAUTI    •DE
           •VAP         •CLIP




           •MDRO/CDAD Infection
           •Lab ID •Processes

            •Method A
            •Method B
 Data Collection and Reporting
        Requirements
• Complete an annual facility survey
• Successfully complete one or more Patient
  Safety Modules:
  – Submit a reporting plan each month
  – Submit data for at least one module for a minimum of 6
    months of the calendar year
  – Adhere to the selected module’s protocol(s), exactly as
    described in the NHSN Patient Safety Component Protocol
    document during the month
  – Properly use the CDC definitions and codes for all data
    collection
  Data Collection and Reporting
         Requirements
• Successful completion requires the following:
  (cont.)
  – Report data indicated on the reporting plan to CDC within
    30 days of the end of the month
  – Pass quality control acceptance checks that assess the
    data for completeness and accuracy
  – Agree to report to state health authorities adverse event
    outbreaks identified in their facility by the surveillance
    system
  – Failure to comply with these requirements will result in
    removal from the NHSN
          Staffing Requirements
• There are no specific FTE requirements, but a
  trained Infection Control Professional (ICP) or
  Hospital Epidemiologist should oversee the
  HAI surveillance program
• Other personnel can be trained to
  – Screen for events (e.g., infections)
  – Collect denominator data
  – Collect infection prevention practices (process measure)
    data
  – Enter data
  – Analyze data
   Example of Published NHSN Data




From 2006 NHSN Report
http://www.cdc.gov/ncidod/dhqp/pdf/nhsn/2006_NHSN_Report.pdf
Facilities Enrolled in NHSN




As of April 28, 2008
    NHSN Facilities
Medical School Affiliation




As of April 28, 2008
         NHSN Facilities
          by Bed Size




As of April 28, 2008
As of April 28, 2008
Thank you.

				
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