National and state healthcare-associated infections standardized infection ratio report

The National Healthcare Safety Network (NHSN) is a public health surveillance system that the Centers for Disease Control and Prevention's (CDC) Division of Healthcare Quality Promotion (DHQP) maintains and supports as a mainstay of its healthcare-associated infection (HAI) prevention program. NHSN is used by healthcare facilities in all 50 states; Washington, D.C.; and Puerto Rico. As of December 2012, 30 states_and Washington, D.C. required, or have plans_to require, use of NHSN for state-specific HAI reporting mandates. Hospitals participating in_the Centers for Medicare and Medicaid Services (CMS) Hospital Inpatient Quality Reporting (IQR) Program use NHSN to report HAI data_as part of the program's requirements, including central line-associated bloodstream infections (CLABSI) among adult, pediatric, and neonatal intensive care unit patients beginning in January 2011; in January 2012 required reporting of catheter-associated urinary tract infections (CAUTI) among adult and pediatric intensive_care unit patients and surgical site infections (SSI) among colon surgery and abdominal hysterectomy patients began. The HAI data reported via NHSN to CMS are used to qualify hospitals for their annual payment update and for public reporting at the Department of Health and Human Services Hospital Compare web site. Since NHSN's inception in 2005, DHQP has used HAI data from the system for national-level analysis and reporting. Past reporting includes summary data that define the benchmarks used for inter-facility comparison (such as location- specific, device-associated infection rates), risk adjustment models for surgical site infections, or summarized antimicrobial resistance data for each HAI type reported. Starting in 2009, summary measures of HAIs, national and state- specific, were reported using the standardized infection ratio (SIR). This current SIR report again provides a summary of the characteristics of facilities reporting to NHSN by state and the key metrics of the HAI experience for the United States in 2011. State-specific summary statistics are again presented for CLABSI in this report. However, this report expands upon the 2010 SIR report to include national burden estimates for CLABSI among critical care patients and SSI among select surgical patients; the estimated average reimbursement paid by CMS attributable to a CLABSI also is presented. The goals of this report are to summarize available HAI data on CLABSIs, SSIs, and CAUTIs at the national level for 2011 and to provide an additional perspective on the progress of HAI prevention nationally by comparison to the 2010 experience. This progress report also provides an indication of the extent to which HAI prevention goals established by the Department of Health and Human Services (HHS) Action Plan to Prevent HAIs and by states have been achieved. This report presents data from HAI surveillance during calendar year 2011 that was reported either mandatorily or voluntarily to NHSN from facilities across all 50 states, Washington, D.C., and Puerto Rico. Data included in the report use NHSN definitions that have been in place since 2008 for CLABSI and SSI and 2009 for CAUTI (limited to symptomatic urinary tract infection). These definitions differ slightly from those in use as of January 2013. Any data reported from non-acute care hospitals (e.g., long-term care hospitals, rehabilitation hospitals), outpatient dialysis facilities or inpatient dialysis wards, long term care facilities (e.g., skilled nursing facilities), and outpatient surgical settings were excluded from this report. Data include all reports submitted to NHSN as of September 4, 2012, allowing for_a 9-month latency period to allow for complete reporting of infection events and denominator data through December 2011.written and prepared by Paul J. Malpiedi, Kelly D. Peterson, Minn M. Soe Jonathan R. Edwards, R. Douglas Scott II, Matthew E. Wise James Baggs, Sarah H. Yi, Margaret A. Dudeck Kathryn E. Arnold, Lindsey M. Weiner, Catherine A. Rebmann, Arjun Srinivasan, Scott K. Fridkin, _L. Clifford McDonald.Chiefly tables.2/7/13: date from document properties.CS237937Includes bibliographical references (p.13).Malpiedi PJ, Peterson KD, Soe MM et al. 2011 National and State Healthcare-Associated Infection Standardized Infection Ratio Report. Published February 11, 2013. Available at http://www.cdc.gov/hai/national-annual-sir/index.html

NHSN biovigilance component protocol

The NHSN is a secure, internet-based surveillance system that integrates former CDC surveillance systems, including the National Nosocomial Infections Surveillance System (NNIS), National Surveillance System for Healthcare Workers (NaSH), and the Dialysis Surveillance Network (DSN). NHSN enables healthcare facilities to collect and use data about healthcare-associated infections, adherence to clinical practices known to prevent healthcare-associated infections, the incidence or prevalence of multidrug-resistant organisms within their organizations, trends and coverage of healthcare personnel safety and vaccination, and adverse events related to the transfusion of blood and blood products. Some U.S. states utilize NHSN as a means for healthcare facilities to submit data on healthcare-associated infections (HAIs) mandated through their specific state legislation. The NHSN includes four components, each concerned with various aspects of control and prevention of HAIs. Those four components are Patient Safety, Healthcare Personnel Safety, Biovigilance, and Research and Development. NHSN users do not use the Research and Development Component of the system. NHSN users do however, access and participate in the Patient Safety, Healthcare Personnel Safety, and Biovigilance Components of NHSN. A facility (acute care hospital, ambulatory surgery center, outpatient dialysis center) may use one, two, or all three NHSN components concurrently. The Biovigilance Component of NHSN was developed in collaboration with the transfusion and transplant communities. Biovigilance includes the collection of adverse event data to improve outcomes in the use of blood products, organs, tissues, and cellular therapies. The Hemovigilance Module is the first module of the Biovigilance Component to be developed in NHSN. This module is designed for staff in healthcare facility transfusion services to track adverse events, including recipient adverse reactions and quality control incidents, related to blood transfusion.National Healthcare Safety Network (NHSN) -- Biovigilance component -- Using the NHSN Hemovigilance module -- Appendix A. Adverse reaction case definition criteria -- Appendix B. Adverse reaction clinical and laboratory definitions -- Appendix C. Adverse reaction severity and imputability definitions -- Appendix D. Antibodies associated with hemolytic transfusion reactions -- Appendix E. NHSN occupation codes -- Appendix F. NHSN incident codes -- Appendix G. Incident definitionsJuly 2010

Basic infection control and prevention plan for outpatient oncology settings

"This document has been developed for outpatient oncology facilities to serve as a model for a basic infection control and prevention plan. It contains policies and procedures tailored to these settings to meet minimal expectations of patient protections as described in the CDC Guide to Infection Prevention in Outpatient Settings (available: http://www.cdc.gov/HAI/settings/outpatient/outpatient-care-guidelines.html). The elements in this document are based on CDC's evidence-based guidelines and guidelines from professional societies (e.g., Oncology Nursing Society). This plan is intended to be used by all outpatient oncology facilities. Those facilities that do not have an existing plan should use this plan as a starting point to develop a facility-specific plan that will be updated and further supplemented as needed based on the types of services provided. Facilities that have a plan should ensure that their current infection prevention policies and procedures include the elements outlined in this document. While this plan may essentially be used exactly "as is," facilities are encouraged to personalize the plan to make it more relevant to their setting (e.g., adding facility name and names of specific rooms/locations; inserting titles/positions of designated personnel; and providing detailed instructions where applicable). This plan does not replace the need for an outpatient oncology facility to have regular access to an individual with training in infection prevention and for that individual to perform on-site evaluation and to directly observe and interact regularly with staff. Facilities may wish to consult with an individual with training and expertise in infection prevention early on to assist with their infection control plan development and implementation and to ensure that facility design and work flow is conducive to optimal infection prevention practices."List of abbreviations -- I. Fundamental principles of infection prevention -- Ii. Education and training -- Iii. Surveillance and reporting -- Iv. Standard precautions -- V. Transmission-based precautions -- Vi. Central venous catheters -- Appendix A. Example list of contact persons and roles/responsibilities -- Appendix B. Reportable diseases/conditions -- Appendix C. CDC infection prevention checklist for outpatient settings -- Appendix D. Additional resources"10/18/2011" - date from document propertiesAvailaabe via the World Wide Web as an Acrobat .pdf file (522 KB, 21 p.).Adobe Acrobat file (522 KB, 21 p.).Includes bibliographical references

NHSN overview

The NHSN is a secure, Internet-based surveillance system that expands and integrates patient and healthcare personnel safety surveillance systems managed by the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention. In addition, facilities that participate in certain reporting programs operated by the Centers for Medicare and Medicaid Services (CMS) can do so through use of NHSN. Some U.S. states utilize NHSN as a means for healthcare facilities to submit data on healthcare-associated infections (HAIs) mandated through their specific state legislation. NHSN enables healthcare facilities to collect and use data about healthcare-associated infections, adherence to clinical practices known to prevent healthcare-associated infections, the incidence or prevalence of multidrug-resistant organisms within their organizations, trends and coverage of healthcare personnel safety and vaccination, and adverse events related to the transfusion of blood and blood products. The NHSN includes four components: Patient Safety, Healthcare Personnel Safety, Biovigilance, and Long-term Care Facility.January 2013

Infection prevention checklist for outpatient settings: minimum expectations for safe care

"The following document is a summary guide of infection prevention recommendations for outpatient (ambulatory care) settings. The recommendations included in this document are not new but rather reflect existing evidence-based guidelines produced by the Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee. This summary guide is based primarily upon elements of Standard Precautions and represents the minimum infection prevention expectations for safe care in ambulatory care settings. Readers are urged to consult the full guidelines for additional background, rationale, and evidence behind each recommendation."Companion to: Guide to infection prevention for outpatient settings : minimum expectations for safe care. Atlanta, GA : Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion, 2011.Adobe Acrobat file (537.3 KB, 16 p.).Includes bibliographical references (p. 17)

Guideline for the prevention and control of norovirus gastroenteritis outbreaks in healthcare settings

"Norovirus gastroenteritis infections and outbreaks have been increasingly described and reported in both non-healthcare and healthcare settings during the past several years. In response, several states have developed guidelines to assist both healthcare institutions and communities on preventing the transmission of norovirus infections and helped develop the themes and key questions to answer through an evidence-based review. This guideline addresses prevention and control of norovirus gastroenteritis outbreaks in healthcare settings. The guideline also includes specific recommendations for implementation, performance measurement, and surveillance. Recommendations for further research are provided to address knowledge gaps identified during the literature review in the prevention and control of norovirus gastroenteritis outbreaks. Guidance for norovirus outbreak management and disease prevention in non-healthcare settings can be found at http://www.cdc.gov/mmwr/pdf/rr/rr6003.pdf. This document is intended for use by infection prevention staff, physicians, healthcare epidemiologists, healthcare administrators, nurses, other healthcare providers, and persons responsible for developing, implementing, and evaluating infection prevention and control programs for healthcare settings across the continuum of care. The guideline can also be used as a resource for societies or organizations that wish to develop more detailed implementation guidance for prevention and control of norovirus gastroenteritis outbreaks for specialized settings or populations." - p. 10I. Executive summary -- II. Summary of recommendations -- III. Implementation and audit -- IV. Recommendations for further research -- V. Background -- VI. Scope and purpose -- VII. Methods -- VIII. Evidence review -- IX. Appendices -- Appendix 1. Search strategy for guidelines / Search strategy for systematic reviews/primary literature -- Appendix 2. Evidence, grade and study quality assessment tables -- Appendix 3. Data abstraction tool -- Appendix 4. Quality checklistsTaranisia MacCannell, Craig A. Umscheid, Rajender K. Agarwal, Ingi Lee, Gretchen Kuntz, Kurt B. Stevenson, and the Healthcare Infection Control Practices Advisory Committee (HICPAC).Has appendices in "Supporting files."Includes bibliographical references (p. 43-52).Infectious DiseasePrevention and ControlSupersededTaranisia MacCannell, Craig A. Umscheid, Rajender K. Agarwal, Ingi Lee, Gretchen Kuntz, Kurt B. Stevenson, and the Healthcare Infection Control Practices Advisory Committee (HICPAC).Has appendices in "Supporting files."Includes bibliographical references (p. 43-52).Infectious DiseasePrevention and ControlSupersededTaranisia MacCannell, Craig A. Umscheid, Rajender K. Agarwal, Ingi Lee, Gretchen Kuntz, Kurt B. Stevenson, and the Healthcare Infection Control Practices Advisory Committee (HICPAC).Title from html page.Mode of access: World Wide Web as linked html pages, or as 2 .pdf files: Guideline (676 KB, 52 p.) and Appendices (3.48 MB, 186 p.).Has appendices in "Supporting files."Includes bibliographical references (p. 43-52).Infectious DiseasePrevention and ControlCurrentHICPA

CRE toolkit

This document contains two parts. Part 1 contains recommendations for healthcare facilities and is intended to expand upon the March 2009 "Guidance for Control of Carbapenem- Resistant or Carbapenemase-Producing Enterobacteriaceae in Acute-Care Facilities.: Part 2 reviews the role of public health authorities in the control of carbapenem-resistant Enterobacteriaceae. Unless otherwise specified, healthcare facilities refer to all acute care hospitals and any long-term care facility that cares for patients who remain overnight and regularly require medical or nursing care (e.g., maintenance of indwelling devices, intravenous injections, wound care, etc.). This would include all long-term acute care hospitals and skilled nursing homes (including certain rehabilitation facilities), but would generally exclude assisted living facilities and nursing homes that do not provide more than basic medical care. In addition, this toolkit is not intended for use in ambulatory care facilities.CS231672-A.Selected references (p.29)

Reducing bloodstream infections

"A central line is a tube that a doctor usually places in a large vein of a patient's neck or chest to give important medical treatment. When not put in correctly or kept clean, central lines can become a freeway for germs to enter the body and cause serious bloodstream infections. These infections can be deadly. Of patients who get a bloodstream infection from having a central line, up to 1 in 4 die. Bloodstream infections in patients with central lines are largely preventable when healthcare providers use CDC-recommended infection control steps. Medical professionals have reduced these infections in hospital intensive care unit (ICU) patients by 58% since 2001. Even so, many still occur in ICUs, in other parts of hospitals, and in outpatient care locations. In 2008, about 37,000 bloodstream infections occurred in hemodialysis outpatients with central lines." -p. 1Fact sheet released by the Centers for Disease Control and Prevention's Office of Surveillance, Epidemiology and Laboratory Services (OSELS) in association with: Vital signs: central line--associated blood stream infections --- United States, 2001, 2008, and 2009, published: MMWR. Morbidity and mortality weekly report ; v. 60, no. 8, p. 243-8."CS220503B.""March 2011.""Publication date: 03/01/201."Title from title screen (viewed March 7, 2011).Introduction -- Latest findings -- Who's at risk? -- U.S. state information -- What can be done -- Social mediaMode of access: World Wide WebText document (PDF)

Sharps injury prevention workbook

"An effective sharps injury prevention program includes several components that must work in concert to prevent healthcare personnel from suffering needlesticks and other sharps-related injuries. This program plan is designed to integrate into existing performance improvement, infection control, and safety programs. It is based on a model of continuous quality improvement, an approach that successful healthcare organizations are increasingly adopting." - p. 1Information about the Workbook -- Overview: Risks and Prevention of Sharps Injuries in Healthcare Personnel -- Organizational Steps -- Operational Processes -- Institutionalize a Culture of Safety in the Work Environment -- Implement Procedures for Reporting and Examining Sharps Injuries and Injury Hazards -- Analyze Sharps Injury Data -- Selection of Sharps Injury Prevention Devices -- Education and Training of Healthcare Personnel -- -- References -- Appendix A: Toolkit -- Appendix B: Devices with Engineered Sharps Injury Prevention Features -- Appendix C: Safe Work Practices for Preventing Sharps Injuries -- Appendix D: Problem-Specific Strategies for Sharps Injury Prevention -- Appendix E: Measuring the Cost of Sharps Injury Prevention -- Appendix F: Glossary -- Appendix G: Other Websites.jointly developed by the National Center for Infectious Disease and the National Immunization Program.Title from PDF t.p. (viewed on Feb 15, 2012)."This workbook developed and maintained by CDC's Division of Healthcare Quality Promotion "Available via the World Wide Web as a series of linked HTML pages or as an Acrobat .pdf file (2MB, 168 p.)