HAI Surveillance

Overview

• HAI data are used for a variety of purposes, which may include satisfying reporting mandates, comparing infection rates between and within healthcare facilities, providing consumers with information, guiding policies and procedures, evaluating the effectiveness of interventions, and conducting research.
• Surveillance data can be categorized into process measures or outcome measures:

• Infection prevention staff follow standardized definitions to track HAIs; these are surveillance definitions and may be different than clinical definitions, which are used to guide treatment of patients.

Data interpretation / Common HAI measures

• Infection rate
• Number of infections divided by the population at risk (denominator), which varies depending on the type of infection
• Device-associated infections
• For catheter-associated urinary tract infections (CAUTI), the population at risk is measured in catheter days
• For central line-associated bloodstream infections (CLABSI), the population at risk is measured in central line days
• For ventilator-associated pneumonia (VAP), the population at risk is measured in ventilator days
• Procedure-associated infections
• For surgical site infections (SSI), the population at risk is measured in surgical procedures
• Rate usually expressed per 1,000 device days (if device associated) or per 100 procedures (if procedure-associated)
• Rate may also be expressed per 100 patients/residents to get a percentage of the selected population with a given type of infection. This measure is commonly calculated in long-term care facilities.
• Example: The percentage of residents with a urinary tract infection (UTI) is calculated by dividing the number of residents in the surveillance area who meet the criteria for a new UTI by the number of residents in the surveillance area for the same time period, and multiplying by 100.
• Device utilization ratio
• Number of device-associated infections (i.e. CLABSI, CAUTI, VAP) divided by the number of device days
• Standardized infection ratio (SIR)
• A summary measure used to track HAIs at a national, state, or local level over time. Adjusts for patients of varying risk within each facility.
• SIR compares the observed number of HAIs reported to the predicted (determined from baseline data reported to NHSN)
• If the SIR <1.0, fewer HAIs were observed than predicted
• If the SIR = 1.0, the number of HAIs observed were the same as what was predicted
• If the SIR >1.0, more HAIs were observed than predicted
• NHSN E-news: Guide to the Standardized Infection Ratio
• VDH webinar - SIR 101: Interpretation and Public Reporting (April 19, 2012) (presentation) (audio)
• VDH webinar - SIR 201: Calculating the SIR, Generating Reports, and Presenting the Data (May 3, 2012) (presentation) (audio)
• VHQC QualitySync conference breakout session – Sir, Can You Please Explain the SIR? (June 13, 2012)(presentation)

National Healthcare Safety Network (NHSN) and surveillance tools

• NHSN - a secure, internet-based surveillance system designed and maintained by the Centers for Disease Control and Prevention (CDC).
  • Training
  • Healthcare Personnel Safety Component – includes modules to track healthcare personnel influenza vaccinations and healthcare personnel exposures to blood/body fluids and influenza.
    • Overview of the NHSN Healthcare Worker Influenza Vaccination Module and Reporting Requirements (webinar) – September 2012
      • Powerpoint slides
      • Webinar recording
  • Long-Term Care Facility Component – designed for use by nursing homes, skilled nursing facilities, chronic care facilities, and assisted living and residential care facilities. As of September 2012, contains modules to report urinary tract infections, C. difficile, methicillin-resistant Staphylococcus aureus and other drug-resistant infections, and prevention process measures including hand hygiene adherence.
  • Patient Safety Component – includes device-associated module, procedure-associated module, multidrug-resistant organism and Clostridium difficile infection (MDRO/CDI) module, and vaccination module.
    • NHSN Surveillance: What’s New for 2013 (webinar) – March 2013
      • Powerpoint slides
      • Webinar recording (note that the slides displayed on the screen may not match the audio; download the slides above to view the presentation)
      • NHSN Newsletter Changes for 2013 Surveillance Definitions
  • NHSN HAI Summary Data Reports – reports that include both national data and state-specific data for states mandated by state law to report HAIs.
• HAI reporting crosswalk – resource for acute care facilities outlining the reporting requirements of various voluntary and mandatory reporting initiatives (August 2011)
• Data presentation strategies
  • Translating data presentation pilot results into practice (Fall 2011) – Examples of strategies provided by Virginia facilities to increase HAI data dissemination and improve effectiveness of HAI data.
  • Standardized Infection Ratio (SIR) presentation (Fall 2011) – This PowerPoint explains the SIR and gives examples that can be used to educate staff and other stakeholders about how to interpret the SIR.  Ideas and samples of how to visually share and explain SIR data are also included.
  • Surgical site infection (SSI) surveillance pilot project, data presentation collaborative, and SSI mini-grant report
• How to Identify an Outbreak of Communicable Disease
• Resources for assisted living facilities and nursing homes
  • Stone ND, Ashraf MS, Calder J, Crnich CJ, Crossley K, Drinka PJ, Gould CV, Juthani-Metha M, Lautenbach E, Loeb M, et al. Surveillance Definitions of Infections in Long-Term Care Facilities: Revisiting the McGeer Criteria. Infection Control and Hospital Epidemiology. 2012 Oct;33(10):965-977
• Surveillance in Assisted Living Facilities and Nursing Homes FAQ
• Definitions of UTIs in Long-Term Care: McGeer and F-Tag 315 (Fall 2011)
• UTI Surveillance FAQs
• Sample surveillance logs / tracking sheets (editable)
• Monthly Infection Surveillance Tracking Sheet
• Resident Gastrointestinal Illness (GI) Log
• Resident Illness Log
• Resident Respiratory Illness Log
• Staff Gastrointestinal Illness (GI) Log
• Staff Respiratory Illness Log
• UTI Event Form and UTI Denominator Form (Fall 2011)
• Resources for other healthcare facilities
  • Surveillance in Healthcare Facilities FAQ
• Sample surveillance logs/tracking sheets
• Monthly Infection Surveillance Tracking Sheet
• Patient Gastrointestinal Illness (GI) Log
• Patient Illness Log
• Patient Respiratory Illness Log
• Staff Gastrointestinal Illness (GI) Log
• Staff Respiratory Illness Log

HAI program activities to enhance surveillance

• Needs assessments
• Acute care hospitals – surveyed infection preventionists (IPs), quality improvement professionals (QIs), and administrators to describe current HAI surveillance practices, infection prevention staff responsibilities and available resources, education and training needs, organizational culture, and relationships between IPs and QIs.
• Assisted living facilities and nursing homes - surveyed the infection prevention point of contact to describe facility demographics, infection prevention-related policies and training, current HAI surveillance practices, frequency of different types of infections, education and training needs, inter-facility communication, and the facility’s relationship with the health department and the licensing agency. 
• Surgical site infection (SSI) surveillance pilot project
• 18 hospitals voluntarily participated in this project, which involved surveillance of coronary artery bypass graft (CABG), hip replacement, or knee replacement surgeries using NHSN to evaluate the feasibility of public reporting of these infections, quantify time requirements for surveillance, and gather lessons to help prepare other facilities in the event of future reporting requirements
• All about SSIs: Lessons learned from the SSI surveillance pilot, SSI mini grant program, and the data presentation collaborative (Powerpoint presentation)
• Surgical site infection (SSI) surveillance pilot project, data presentation collaborative, and SSI mini-grant report
• SSI mini-grant program
• Conducted in collaboration with the Virginia Hospital & Healthcare Association (VHHA)
• 22 hospitals applied for and were awarded funds to assist with implementation of the NHSN Procedure-Associated Module in preparation for reporting surgical site infections to the Centers for Medicare and Medicaid Services (CMS) in 2012
• Funds were used for equipment and services, training and education, consultative and technical assistance, and/or administrative support
• Surgical site infection (SSI) surveillance pilot project, data presentation collaborative, and SSI mini-grant report
• Urinary tract infection (UTI) prevention collaborative

• 12 nursing homes in the Eastern region piloted the collection of UTI data using a standardized form as part of the UTI prevention collaborative
• UTI data collection forms (Fall 2011)