National Healthcare Safety Network (NHSN) Overview
NHSN OverviewNational Healthcare Safety Network (NHSN) OverviewThe NHSN is a secure, Internet-based surveillance system that expands and integratespatient and healthcare personnel safety surveillance systems managed by the Division ofHealthcare Quality Promotion (DHQP) at the Centers for Disease Control andPrevention. In addition, facilities that participate in certain reporting programs operatedby the Centers for Medicare and Medicaid Services (CMS) can do so through use ofNHSN. Furthermore, some U.S. states use NHSN as a means for healthcare facilities tosubmit data on healthcare-associated infections (HAIs) mandated through their specificstate legislation.NHSN enables healthcare facilities to collect and use data about HAIs, adherence toclinical practices known to prevent HAIs, the incidence or prevalence of multidrugresistant organisms within their organizations, trends and coverage of healthcarepersonnel safety and vaccination, and adverse events related to the transfusion of bloodand blood products.The NHSN includes five components: Patient Safety, Healthcare Personnel Safety,Biovigilance, Dialysis, and Long-term Care Facility (Figure 1).Figure 1: NHSN ComponentsNHSNComponentsPatient SafetyJanuary 2015HealthcarePersonnel SafetyBiovigilance1-1DialysisLong-term CareFacility
NHSN OverviewThe Patient Safety Component includes four modules that focus on events associatedwith devices, procedures, antimicrobial agents used during healthcare, or multidrugresistant organisms. Device-associated Module:o Bloodstream Infection (CLABSI – Central line-associated bloodstreaminfection)o CLIP – Central line insertion practices adherenceo Urinary Tract Infection (CAUTI – Catheter-associated urinary tractinfection)o VAE – Ventilator-associated events (adult locations only)o Pneumonia (VAP – Ventilator-associated pneumonia) - in pediatriclocations (in-plan* or off-plan*), or NICU and adult locations (off-plan*only)Procedure-associated Module:o SSI – Surgical site infectionAntimicrobial Use and Resistance Module (AUR)Multidrug-Resistant Organism and Clostridium difficile Infection (MDRO/CDI)Module*Note: “In-plan” surveillance means that the facility has committed to following theNHSN surveillance protocol, in its entirety, for that particular event, as shown in thefacility’s NHSN monthly reporting plan. “Off-plan” surveillance is surveillance that isdone because a facility has decided to track a particular event for internal use. Data thatare entered into NHSN “off-plan” are not included in NSHN annual reports or otherNHSN publications. A facility makes no commitment to follow the NHSN protocol for“off-plan” events.Instructions and standardized surveillance methods and definitions for each module of thePatient Safety Component are provided in this manual and on the NHSN website(www.cdc.gov/nhsn). Modules may be used singly or simultaneously.Outpatient hemodialysis centers have several surveillance options tailored to theirpatients and setting in the Dialysis Component. Facilities that treat hemodialysisoutpatients should refer to the Dialysis Component instructions and standardizedsurveillance methods and definitions at http://www.cdc.gov/nhsn/dialysis/index.html.There are two modules in the Healthcare Personnel Safety (HPS) Component of NHSN:the Healthcare Personnel Exposure Module and the Healthcare Personnel VaccinationModule. These modules may be used separately or simultaneously. Instructions andstandardized surveillance methods and definitions for each module are provided in theNHSN Manual: HPS Component Protocol http://www.cdc.gov/nhsn/PDFs/HPSmanual/HPS Manual-exp-plus-flu-portfolio.pdf.January 20151-2
NHSN OverviewThe NHSN Biovigilance Component, Hemovigilance Module facilitates nationalsurveillance of transfusion-related recipient adverse events. The Hemovigilance Moduleis designed for transfusion service staff to collect data on annual facility and transfusionservice characteristics, individual reports on adverse transfusion reactions, errors oraccidents associated with adverse reactions, and monthly counts of transfused ordiscarded components. The Hemovigilance Module surveillance protocol, trainingmaterials, data collection forms, instructions, and other supporting materials are providedon the Hemovigilance Module website: o/index.html.Surveillance TechniquesSome of the options in the following modules require active, patient-based, prospectivesurveillance of events and their corresponding denominator data by a trained InfectionPreventionist (IP). This means that the IP shall seek out infections during a patient’s stayby screening a variety of data sources, such as laboratory, pharmacy,admission/discharge/transfer, radiology/imaging, and pathology databases, as well aspatient charts, including history and physical exam notes, nurses/physicians notes,temperature charts, etc. Others may be trained to screen data sources for these infections,but the IP must make the final determination. Laboratory-based surveillance should notbe used alone, unless all possible criteria for identifying an infection are solelydetermined by laboratory evidence (e.g., LabID event detection in the MDRO/CDIModule). Retrospective chart reviews should be used only when patients are dischargedbefore all information can be gathered. NHSN forms should be used to collect allrequired data, using the NHSN definitions of each data field. To minimize the IP’s datacollection burden, others may be trained to collect the denominator data and process ofcare data (e.g., central line insertion practices).Procedure-Associated ModuleSurgical site infection (SSI) monitoring is offered through a protocol in this module.This protocol requires active, patient-based, prospective surveillance (see SurveillanceTechniques above). To minimize IPs’ workload of collecting denominator data,operating room data may be downloaded (see file specifications Data current.pdf).Both pre-discharge and post-discharge surveillance methods should be used to detectSSIs. Surveillance may include both inpatient and outpatient operative procedures.These methods include 1) direct examination of patients’ wounds during hospitalization,or follow-up visits to either surgery clinics or physicians’ offices, 2) review of medicalrecords or surgery clinic patient records, 3) surgeon surveys by mail or telephone, and 4)patient surveys by mail or telephone (though patients may have a difficult time assessingtheir infections). Any combination of these methods is acceptable for use; however,CDC criteria for SSI must be applied.January 20151-3
NHSN OverviewDevice-Associated ModuleMedical instrumentation increases the risk of development of an HAI and most patientsadmitted for health care are exposed to some kind of medical device in the course of theirtreatment. Such devices include, but are not limited to, venous and urinary catheters, andventilators. NHSN enables facilities to monitor infectious complications associated withthe use of these devices and also to monitor processes related to their use which mightincrease infection risk. Specifically, surveillance of central line-associated bloodstreaminfection (CLABSI), catheter-associated urinary tract infection (CAUTI), ventilatorassociated events (VAE), and/or ventilator-associated pneumonia (VAP) is possible usingthe NHSN. See Dialysis Component for detailed instructions for Dialysis Event (DE)surveillance of hemodialysis outpatients (http://www.cdc.gov/nhsn/dialysis/index.html).In addition, central line insertion practices (CLIP) can be monitored to inform facilities ofthe appropriateness of their processes and how they may relate to HAI development.Device-associated denominator data should be collected at the same time each day, or byweekly sampling methods for CLABSI and CAUTI surveillance (see the CLABSI andCAUTI protocols for guidance). When denominator data are available from electronicdatabases (e.g., ventilator days from respiratory therapy), these sources may be used aslong as the counts are not substantially different ( /- 5%) from manually-collected countsthat have been validated for a minimum of three months. See the respective deviceassociated event protocols for detailed surveillance instructions.Antimicrobial Use and Resistance (AUR) ModuleThe use of antimicrobial agents has a direct effect on antimicrobial resistance patterns ofpathogens. The observed increase in multidrug resistance is in part due to inappropriateprescription of, as well as incomplete completion of, courses of antibiotics.The AUR Module allows facilities to collect information on the amount of antimicrobialsthat are used for patient care within their systems, as well as to collect data on theprevalence of drug-resistant organisms in their inpatient and outpatient areas. Electroniccapture and reporting of microbiology and pharmacy data are the only available optionsfor reporting data into this module.See the Antimicrobial Use and Resistance protocol for detailed surveillance instructions.Multidrug-resistant Organism and Clostridium difficile Infection (MDRO/CDI)ModuleThe NHSN MDRO/CDI Module offers a means for facilities to meet criteria and metricsthat are outlined in several organizational guidelines to control and measure the spread ofMDROs and CDI within their healthcare system. The module has both required andJanuary 20151-4
NHSN Overviewoptional surveillance activities that can be tailored to meet the needs of the facility.Laboratory-identified (LabID) Event and Infection Surveillance are available choices forparticipating NHSN facilities.In addition, the following process measures are available: (1) adherence to hand hygiene;(2) adherence to contact precautions when caring for patients infected or colonized withan MDRO or C. difficile; and (3) adherence to active surveillance testing (AST) ofMRSA and/or VRE. Active surveillance testing outcome measures is also available inlocations where AST adherence is being performed, and enables facilities to use theresults of AST to monitor the incidence and prevalence of positive MRSA and/or VREcultures. See the MDRO/CDI protocol for detailed surveillance instructions.January 20151-5
Identifying Healthcare-associated InfectionsIdentifying Healthcare-associated Infections (HAI) for NHSN SurveillanceTo standardize the classification of an infection as present on admission (POA) or ahealthcare-associated infection (HAI), the following objective surveillance definitions andguidance will be used for NHSN surveillance: 7-day Infection Window PeriodDate of EventPOAHAI14-day Repeat Infection Timeframe (RIT)Secondary Bloodstream Infection Attribution PeriodPathogen Assignment GuidanceThese changes address a variety of scenarios to include repeat infections of the same type,concurrent infections of differing types, and pathogen assignment in multi-pathogeninfections. These new approaches are intended to align criteria and definitions and decreasesubjectivity while maintaining epidemiologic standardization and clinical relevance.Notes: Infection window period, POA, HAI, and RIT and secondary bloodstream infectionattribution period definitions do not apply to SSI, VAE, or LabID Events. (SecondaryBSIs may be attributed to SSI events. For guidance specific to SSIs see SecondaryBSI Attribution Period and the SSI and BSI protocols).Date of Event, as defined in this chapter, does not apply to VAE or LabID Events;however, it is used to identify SSI.Table 1: Definition Application*See SSI specific guidance; N/A Not Applicable2-1January 2015 (Modified April 2015)VAENotApplicableLabIDNotApplicableInfection Window PeriodDate of EventPOAHAIRepeat Infection Timeframe (RIT)Secondary BSI Attribution PeriodSSIN/AYesN/AN/AN/A*
Identifying Healthcare-associated InfectionsObservation Patients in Inpatient Locations:For purposes of NHSN surveillance, if an observation patient is sent to an inpatient location,the patient must be included in infection surveillance, patient day, and device day counts.The facility assignment of the patient as an observation patient or an inpatient has no bearingin this instance for counting purposes. The patient is being housed, monitored, and cared forin an inpatient location and therefore is at risk for acquisition of an HAI.NHSN Infection Window Period:The NHSN Infection Window Period is defined as the 7-days during which all site-specificinfection criteria must be met. It includes the day the first positive diagnostic test that is anelement of the site-specific infection criterion, was obtained, the 3 calendar days before andthe 3 calendar days after. For purposes of defining the Infection Window Period thefollowing are considered diagnostic tests: laboratory specimen collectionimaging testprocedure or examphysician diagnosisinitiation of treatmentFor site-specific infection criteria that do not include a diagnostic test, the first documentedlocalized sign or symptom that is an element of NHSN infection criterion should be used todefine the window (e.g., diarrhea, site specific pain, purulent exudate).With the introduction of the Infection Window Period, “gap days”, used in 2014, will nolonger be used to determine fulfillment of infection criteria.Infection Window PeriodTable 2: Infection Window Period3 days beforeFirst positive diagnostic testORFirst documented localizedsign and/or symptom in theabsence of a diagnostic test3 days after2-2January 2015 (Modified April 2015)
Identifying Healthcare-associated InfectionsDate of Event (Event Date):The Date of Event is the date the first element used to meet an NHSN site-specific infectioncriterion occurs for the first time within the seven-day infection window period.An infection is considered Present on Admission (POA) if the date of event of theNHSN site-specific infection criterion occurs during the POA time period, which isdefined as the day of admission to an inpatient location (calendar day 1), the 2 daysbefore admission, and the calendar day after admission. For purposes of NHSNsurveillance and determination of the Repeat Infection Timeframe (as defined below)if the date of event is determined to be either of the two days prior to inpatientadmission, then the date of event will be hospital day 1.An infection is considered a Healthcare-associated Infection (HAI) if the date ofevent of the NHSN site-specific infection criterion occurs on or after the 3rd calendarday of admission to an inpatient location where day of admission is calendar day 1.Table 3: Date of Event and Classification DeterminationHospital Day2 days before admit1 day before admit12345Date of EventAssignment for RITHospital Day 1Hospital Day 1Hospital Day 1Hospital Day 2Hospital Day 3Hospital Day 4Hospital Day 52-3January 2015 (Modified April 2015)ClassificationPOAHAI
Identifying Healthcare-associated InfectionsTable 4: Infection Window Period and Date of EventNotes: Acceptable documentation includes patient-reported signs or symptoms documented inthe chart by a healthcare professional (e.g., patients states measured fever 38.0 C or100.4 F, nursing home documents fever prior to arrival to the hospital, patient complainsof dysuria). Physician diagnosis can be accepted as evidence of an infection only when physiciandiagnosis is an element of the specific infection definition. For example, physiciandiagnosis is not an element of any UTI criteria; therefore, physician diagnosis of a UTImay not be used to satisfy POA status of a UTI. Infections occurring in newborns with date of event on hospital day 1 or day 2 areconsidered POA. Those with date of event on day 3 or later are HAI. This would includeinfections acquired transplacentally (e.g., herpes simplex, toxoplasmosis, rubella,cytomegalovirus, or syphilis) or as a result from passage through the birth canal (e.g.,Group B Streptococcus). Reactivation of a latent infection (e.g., herpes zoster [shingles], herpes simplex, syphilis,or tuberculosis) is not considered to be HAI.2-4January 2015 (Modified April 2015)
Identifying Healthcare-associated InfectionsRepeat Infection Timeframe (RIT):The RIT is a 14-day timeframe during which no new infections of the same type are reported.The date of event is Day 1 of the 14-day RIT. Additional pathogens recovered during the RITfrom the same type of infection is added to the event.The RIT will apply at the level of specific type of infection with the exception of BSI, UTI,and PNEU where the RIT will apply at the major type of infection.Specific Type Example: Patients will have no more than one BONE infection in an RIT, but may have aBONE and DISC in two overlapping RITs (specific type)Major Type Examples: Patients will have no more than one LCBI in an RIT (e.g., LCBI 1, LCBI 2, MBILCBI 1, etc.)Patients will have no more than one PNEU in an RIT (e.g., PNU1, PNU2, PNU3)Patients will have no more than one UTI in an RIT (e.g., SUTI, ABUTI)The RIT applies during a patient’s single admission, including the day of discharge and theday after, in keeping with the Transfer Rule.2-5January 2015 (Modified April 2015)
Identifying Healthcare-associated InfectionsIn the example below (Table 5), the Date of Event is hospital day 4. The 14-day RIT ishospital day 4 through day 17. On hospital day 12, within the RIT, a urine culture with 100,000 cfu/ml S. aureus is identified. The urine pathogen identified from the hospital day 12culture is added to the original infection reported on day 4. Determination of a new infectionor continuation of ongoing infection is not required.Table 5: Repeat Infection TimeframeNotes: A patient may have negative cultures during the RIT without impact on the RIT. Do not change the device-association determination during the RIT.o Example: A non-catheterized UTI is identified and initiates an RIT. Duringthe RIT, a Foley catheter is placed and more than 2 days later, still in the RIT,another urine culture is collected and reported positive for 100,000 cfu/mlwith a different bacteria. Add this pathogen to the original UTI but do notchange the non-catheter associated UTI to CAUTI.2-6January 2015 (Modified April 2015)
Identifying Healthcare-associated InfectionsSecondary BSI Attribution Period (Refer to Appendix 1, Secondary BSI Guide of the BSIEvent Protocol):The Secondary BSI Attribution Period* is the period in which a positive blood culture mustbe collected to be considered as a secondary bloodstream infection to a primary siteinfection. This period includes the Infection Window Period combined with the RepeatInfection Timeframe (RIT). It is 14-17 days in length depending upon the date of event.For a bloodstream infection to be determined secondary to another site of infection, the bloodculture must be collected during the site-specific infection Secondary BSI Attribution Periodand satisfy one of the following‡ (See Appendix 1: Secondary BSI Guide):1. The blood culture must contain at least one organism that matches an organism foundin a site-specific infection culture used to meet the site-specific infection criterionOR2. The blood culture must be an element used to meet the site-specific infectioncriterion.*Note: SSI surveillance utilizes a 30 or 90 day surveillance period. Since the InfectionWindow Period and RIT do not apply, the secondary BSI attribution period, by name, alsocannot apply. However, a 17-day period that includes the date of SSI event, 3 days prior and13 days after, is still used to attribute a BSI as secondary to an SSI.‡Exception:Since necrotizing enterocolitis (NEC) criteria include neither a site specific culture nor apositive blood culture, an exception for assigning a BSI secondary to NEC is provided.A BSI is considered secondary to NEC if the patient meets one of the two NEC criteria ANDa positive blood culture(s) collected during the secondary BSI attribution period is positivefor an LCBI pathogen or
NHSN Overview National Healthcare Safety Network (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 (DHQP) at the Centers for Disease Control and Prevention.
Review the 2017 updates to National Healthcare Safety Network (NHSN) Patient Safety Component for Healthcare Associated Infections (HAI) Understand the changes in NHSN due to the re-baselining Identify the impact of NHSN re-baselining on the Centers for Medicare & Medicaid Services (CMS) Value-Based Purchasing (VBP) 2
2 Review the steps for National Healthcare Safety Network (NHSN) enrollment to prepare for state-mandated Carbapenem-resistant Enterobacteriacea (CRE) reporting. Learn how to enter CRE data into NHSN. Apply the NHSN CRE
What is NHSN? NHSN is a secure internet based surveillance system that was created and is maintained by the Division of Healthcare Quality Promotion (DHQP) at CDC Provides a tool for healthcare facilities to collect information about healthcare-associated infections (HAIs) and other adverse patient events using –Standardized protocols
Centers for Disease Control and Prevention Atlanta, GA, USA Page 1 of 30 . and the Dialysis Surveillance Network (DSN). NHSN enables healthcare facilities to collect and use data about healthcare-associated infections, . and standardized surveillance methods and definitions for each module are provided in the NHSN Manual
Chapter 15: CDC Locations and Descriptions and Instructions for Mapping Patient Care Locations Chapter 16: General Key terms Chapter 17: CDC/NHSN Surveillance Definitions for Specific Types of Infections . Please Note: The NHSN Patient Safety Component Manual is updated annually based on subject matter expert review and user feedback.
2016 NHSN Surveillance Definition Updates Health Services Advisory Group, Inc. –3– Objectives Relate the changes in the NHSN surveillance definitions for 2016. Utilize the definitions to accurately measure and report select healthcare-associated infections (HAIs). Discuss impacts of changes. –Quality improvement initiatives
8/25/2017 3 GENERAL NHSN GUIDANCE Reporting Reminders Always refer to the protocol! For NHSN reporting, surveillance determinations “trump” clinical judgement Clinical diagnoses are important for treatment of individual patients Surveillance definitions are important in identifying trends within a population Concerns should be sent to nhsn@cdc.gov instead of not
NMX-C181 Materiales termoaislantes. Transmisión Térmica (aparato de placa caliente aislada). Método de Prueba NMX-C-228 Materiales Termoaislantes. Adsorción de Humedad. Método de Prueba. NMX-C-238 Materiales Termoaislantes Terminología . REVISIÓN ESPECIFICACIÓ N SELLO FIDE No. 4129 3 30 SEP 2011 HOJA FIBRAS MINERALES PARA EDIFI CACIONES 8 de 8 12.2. Otros Documentos y Normas ASTM C-167 .
