Volume 8, Issue 4 Reminder! Data For CMS Quality Reporting .

Information on 2014 Patient Safety Protocol ChangesPlease watch for the January 2014 updated protocols, reporting forms, and additional guidance documents to be posted to theNHSN website for your review and use. All previous protocols and forms will be outdated and obsolete for reporting beginningJanuary 1, 2014. Although these changes will not be implemented in the NHSN application until the next application release,expected on January 25, 2014, users are expected to follow all updated guidance for definitions, rules, and criteria for eventsidentified on or after January 1, 2014. Therefore, data from events and procedures that occur on or after January 1, 2014 should becollected according to the new protocols and held on paper copies of the new forms until data entry capability becomes availablein NHSN after January 25, 2014. If you wish to retain 2013 guidance, you have until December 26, 2013 to download and/or printthe current-2013 NHSN protocols as they will be removed from the NHSN website on December 27, 2013 and replaced with theJanuary 2014 NHSN protocols.Changes to CLABSI Reporting in 2014Beginning January 1, 2014 “in-plan” participation in the NHSN Central Line-associated Bloodstream Infection (CLABSI) module willrequire surveillance for, and reporting of, Mucosal Barrier Injury-Laboratory Confirmed Bloodstream Infection (MBI-LCBI) events.In 2013, reporting of this type of LCBI was optional for in-plan reporting.Additionally, the definition of neutropenia in the MBI-LCBI criteria will be expanded to include the 3 calendar days after the positiveblood culture. The neutropenia definition used for 2014 will be: 2 days of absolute neutrophil count (ANC) or white blood cell(WBC) count less than 500 cells/mm3 within the following time period surrounding the positive blood culture - the 3 calendar daysbefore, the day of, and the 3 calendar days after. In 2013, the time period was limited to the 3 calendar days before and the day ofpositive blood culture.In 2014, there will be a new optional question on the BSI form: “Any hemodialysis catheter present?” The purpose of this optionalfield is to help track the proportion of CLABSIs that are potentially related to CVCs used for hemodialysis.Please see the CLABSI chapter of the NHSN Patient Safety Component manual, available on the NHSN website for criteria andsurveillance guidance.Changes to Ventilator-Associated Reporting in 2014Ventilator-Associated Pneumonia (VAP) and Pediatric VAP (pedVAP) In 2014, in-plan pedVAP surveillance will no longer be available in neonatal ICU (NICU) locations in NHSN. Healthcare facilitiesmay still conduct “off-plan” pedVAP surveillance in NICUs using the NHSN definitions, and may enter these events into NHSNfor their own, internal use—but VAP data reported from NICUs to NHSN will no longer be analyzed and included in NHSN’sdata reports. This change will affect only NICUs and other neonatal locations; pediatric ICUs (PICUs) and other pediatriclocations will not be affected. This decision was made by the CDC’s NHSN Team with input from members of the Neonatal and Pediatric VentilatorAssociated Event (VAE) Working Group. The Working Group is composed of representatives from several pediatric, critical andrespiratory care, and healthcare epidemiology/infectious diseases professional societies which includes experts inneonatology. The Pediatric VAE Working Group was convened by the CDC in September 2012 to consider the utility of thecurrent VAP surveillance definitions and explore the feasibility of modifying the recently-implemented adult VAE surveillancedefinitions and methods for future use in PICU and NICU locations. The CDC will continue working with the neonatology andpediatric provider communities to develop and implement measures in NHSN that more appropriately reflect the types ofhealthcare-associated events impacting the safety and well-being of neonates. In 2014, pedVAP in-plan reporting will be conducted by patient care location type. Therefore, ventilated patients who are 18years of age and older and who are cared for in pediatric units can be included in pedVAP surveillance.Page 4

Changes to Ventilator-Associated Reporting in 2014, ContinuedVentilator-Associated Event (VAE)1. As communicated in the October 2013 NHSN Newsletter, in 2014 VAE surveillance will become patient location-based, ratherthan patient age-based, in keeping with other NHSN surveillance methodology. In 2014, VAE surveillance will be restricted toadult inpatient locations; VAE surveillance will not be performed in pediatric, mixed age, or neonatal patient locations. In 2014, the VAE algorithm will ONLY be applicable to mechanically-ventilated patients housed in adult inpatient units(regardless of the age of the patient*). The occasional patient who is under 18 years of age who is cared for in an adult location will be included in VAE surveillance in 2014. Mixed age, pediatric, and neonatal units are excluded from VAE surveillance(even in circumstances where a pediatric unit may occasionally care for patients who are 18 years of age and older).*It is NOT recommended to include in VAE surveillance young children housed in adult ICU locations who are not thoughtto be physiologically similar to the location’s adult patient population. Facilities may want to evaluate their location mapping to be sure that locations are mapped appropriately to the correct CDC location codes. In circumstances where thepopulations of adults and children cared for in the same physical location is more mixed (e.g., 50% adult patients and50% pediatric patients), it is recommended that facilities consider the possibility of establishing a virtual pediatric location for the purposes of surveillance. More information on virtual locations and location mapping can be found tionsDescriptions current.pdf As a result, the application will no longer accept VAE reports from pediatric or mixed age locations (even if those events occurred in 2013) once the 2014 NHSN release has been implemented, which is planned for January 25, 2014. After the release,2013 events from pediatric or mixed age locations will be viewable; however, they will not be able to be edited. Please planaccordingly to enter any 2013 pediatric or mixed age location VAE events prior to the January release date. The applicationdoes not currently accept VAE reports from neonatal locations, and will not accept such reports in 2014. Pediatric and neonatal units are excluded from VAE surveillance (even in circumstances where a pediatric unit may occasionally care for patients who are 18 years of age and older). In 2014, ventilated patients who are 18 years of age and older andwho are cared for in pediatric units will be included in pedVAP surveillance. The PNEU definitions will still be available for those units seeking to conduct off-plan PNEU surveillance for mechanicallyventilated adult and neonatal patients and for non-ventilated adults or children.2. The definitions of “daily minimum PEEP” and “daily minimum FiO2” will be modified, so that the daily minimum PEEP or FiO2setting will be defined as the lowest setting of PEEP or FiO2 during a calendar day that is maintained for at least 1 hour. Thesechanges are being made to standardize the surveillance approach in units where monitoring and recording of ventilator settingsare performed hourly or more frequently than once per hour. In units where ventilator settings are monitored and recordedless frequently than once per hour, the daily minimum PEEP and FiO2 values for VAE surveillance will simply remain the lowestvalues of PEEP and FiO2 recorded for the calendar day.3. Additional instructions will be provided in the January 2014 VAE protocol for facilities attempting to use the purulent respiratory secretions criterion in meeting the Possible and Probable VAP definitions. These instructions will provide greater flexibility forfacilities where the clinical laboratory uses a different format for reporting results of direct examination of respiratory secretionsthan the format specified in the purulent respiratory secretions criterion.4. The list of antimicrobial agents eligible for use in meeting the IVAC definition will be refined in the January 2014 protocol.Agents that will be eliminated from the list include oral cephalosporins and penicillins, chloramphenicol, erythromycin, erythromycin/sulfisoxazole, nitrofurantoin, fidaxomicin, and enteral vancomycin. Note that intravenous vancomycin remains on the listof eligible agents.Page 5

SSI UpdatesNHSN is working on an ICD-9 CM mapping tool for the new HPRO and KPRO denominator for procedure data fields. As soon as thistool is complete we will share this with our NHSN users via an email and we will also make this tool available on the NHSN websitein the SSI section under “Supporting Materials”.Please note that the new 2014 procedure import specifications, as well as a sample procedure import file, are available on the SSIsection of our webpage under “Supporting Materials”: dex.htmlUpdate and Comment on the NHSN Surgical Site Infection (SSI) 2014 Changes(NOTE: The article below was sent in a blast email to all NHSN users on 11/21/2013.)CDC has rigorously reviewed NHSN SSI methodology in partnership with external surgical, infection prevention, and perioperativenursing experts. The consensus input is a call for NHSN to collect and analyze additional SSI data that will enable improved riskadjustment and procedure-specific analyses. CDC concurs with these recommendations and will introduce several important additions and modifications to the NHSN SSI protocol data requirements in 2014, including: height and weight; diabetes status; incisional closure type (primary vs. non-primary); and a modified definition of procedure duration.In planning for modifications to existing NHSN data requirements, CDC considers the implications for NHSN users in terms of added burden and availability of data in electronic health records systems. Some NHSN users have expressed concerns that someimportant SSI risk factors are not consistently available in the perioperative record systems used in their hospitals, and they maynot have sufficient time or resources to capture these elements in existing records systems in time to meet 2014 reporting requirements. CDC acknowledges these concerns and is taking immediate steps to address them. Although all SSI data fields arebuilt into the NHSN application scheduled for release in 2014, CDC has decided to provide interim guidance for reporting diabetesand incisional closure type, which may be particularly burdensome for some NHSN users. NHSN users are strongly encouraged towork with their operating room (OR) liaisons, information technology (IT) departments, or other groups within their facility asneeded, to ensure that diabetes and incisional closure type are readily available for mandatory reporting to NHSN beginning2015.Instructions for entering diabetes and incisional closure data into the NHSN SSI Denominator for Procedure Form,including interim methods for data entries for NHSN users who may not have sufficient time or resources to establish electronic data capture in 2014.Diabetes (Y/N):The diabetes data field calls for a Yes/No data entry depending on whether the patient is a diagnosed diabetic on the basis ofdocumentation in the medical record regarding diabetes management, either insulin or oral anti-diabetic agent(s). Indicate Y ifthe patient has a diagnosis of diabetes requiring management with insulin or a non-insulin anti-diabetic agent. This includes patients with “insulin resistance” who are on management with an anti-diabetic agent. This also includes patients

Dec 01, 2013 · 2013 Quarter 3 (July – September 2013) LASI and AUTI data (IU locations only) 2013 Quarter 3 (July – September 2013) OLO and HYST SSI data . 2013 Quarter 3 (July – September 2013) MRSA acteremia and .difficile LabID Events (FacWideIN) Inpatient Rehabilitation Facilities (IRFs) that par