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The Surgical Care Improvement Project (SCIP) & CDC’s National Healthcare Safety Network. Linda McKibben, SCIP Team Leader Teresa Horan , Chief, Performance Measurement Section John Jernigan , Chief, Intervention and Evaluation Section Amy Curtis , Epidemiologist

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The surgical care improvement project scip cdc s national healthcare safety network l.jpg
The Surgical Care Improvement Project (SCIP) & CDC’sNational Healthcare Safety Network

Linda McKibben, SCIP Team Leader

Teresa Horan, Chief, Performance Measurement Section

John Jernigan, Chief, Intervention and Evaluation Section

Amy Curtis, Epidemiologist

Chesley Richards, Quality Research Team Leader

Bonnie Zell, Senior Advisor for Partnerships

Denise Cardo, Director

Division of Healthcare Quality Promotion

National Center for Infectious Diseases


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NHSN is CDC’s Model Public Health - Healthcare Safety Improvement Program

Partnership and tools for healthcare providers to:

  • Identify problems and their risk factors

  • Evaluate the success of interventions

  • Collect and analyze outcomes data over time

  • Target most important adverse events

    Goal is to prevent targeted adverse events.


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http://www.cdc.gov/ncidod/hip Improvement Program/


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Healthcare Safety Challenges Improvement Program

In 5 Years …

  • Reduce targeted adverse events by 50%

How?


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Quality and Safety Impact Improvement ProgramSnapshots of Successhttp://www.academyhealth.org/connectingthedots/impacts.htm

  • Prevention Epicenter (Washington University)

    • Successful education program to reduce catheter associated blood stream infections

  • Chicago Antimicrobial Resistance Project

    • Automated surveillance and a series of QI projects improves antimicrobial prescribing and infection control practices


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NNIS/NHSN is a Model for Healthcare Safety Improvement Improvement Program1,2

  • High quality data used for hospitals’ performance improvement

  • Reductions in national infection rates have been achieved

  • NHSN will expand and enhance this model for patient and healthcare personnel safety

1Leape LL. Reporting of adverse events. NEJM 2002;347:1633-8.

2Burke JP. Infection control—a problem for patient safety. NEJM 2003;348:651-6.


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About NNIS Improvement Program

  • Begun in 1970 with 62 hospitals

    • now >300 hospitals in 42 states

  • Participation voluntary and confidential

  • Focused on monitoring infections in critical care and surgery

  • Current participants

    • Hospitals with at least 100 occupied beds

    • Inpatients only

    • Somewhat over-represents Northeast/Southeast regions, and academic institutions*

*Richards C, et al. AJIC 2002


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Goals of the NNIS System Improvement Program

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

  • Establish benchmark comparison rates

  • Promote epidemiologically-sound surveillance and infection control practices in hospitals


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NNIS System Characteristics Improvement Program

  • Uses standard definitions for infections and all data fields

  • Uses standard protocols to collect data

  • Hospitals send data electronically to CDC monthly


Cdc reports aggregated data annually www cdc gov ncidod hip surveill nnis htm l.jpg
CDC Reports Aggregated Data Improvement ProgramAnnuallywww.cdc.gov/ncidod/hip/surveill/nnis.htm


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  • Why? What? Improvement Program

    • Multi-disciplinary

    • teams

  • Is there an important problem?

    • Aggregated comparative

    • NNIS rates

How to affect change?

Education

Feedback

New protocols

New products

  • Do the changes work?

    • Intrahospital comparative data

Infection Prevention The Cycle for Success

Richards C, et al. Emerg Infect Dis 2001


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Key Program Features for Success Improvement Program

  • Standard definitions for events

  • Specified monitoring protocols

  • Feedback to participants

  • Trained personnel for data collection and for interventions (e.g., ICPs)

Gaynes R, et al. Clin Infect Dis 2001; Richards C, et al Emerg Infect Dis 2001


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CDC’s National Nosocomial Infections Surveillance (NNIS) System

NNIS System

Surgical

Patient

HRN

AUR

ICU

Antimicrobial

Use and

Resistance

Intensive Care

Unit

(Adult/Pediatric)

High Risk

Nursery

(NICU)


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Variables in NNIS Surgical Component System

  • Type of operation

  • Infections

    • Specific site, organism, antimicrobial susceptibility

  • Risk adjustment

    • NNIS Risk Index: Surgical wound class, ASA score, Operation duration, laparoscope/endoscope

    • Age, sex, trauma, emergency, multiple procedures through same incision, implant, general anesthesia

    • Device exposure


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SSI Rates* by Operation and Risk Index Category System

DurationRisk

Cut Point0123

Abdominal Hysterectomy 2 hr 1.4 2.3 5.3 **

Knee Prosthesis 2 hr 0.9 1.3 2.2 **

Exploratory Laparotomy 2 hr 1.8 3.1 4.8 7.2

CABG - chest & donor site 5 hr 1.2 3.5 5.5 10.2

Cesarean Section 1 hr 2.8 4.2 7.7 **

* SSI per 100 operations

** Risk index categories 2 & 3 combined

NNIS Report, Issued August 2003


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16 System

12

Medium

low risk

8

4

0

1992

1993

1994

1995

1996

1997

1998

1999

Trends in Surgical Site Infection

(SSI) Rates By Risk Group*

High risk

Medium

high risk

SSIs per 100 operations

Low risk

1986-90

Years

*NNIS, Unpublished data.


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Current / NNIS System

Nosocomial

Acute care focus

Limited enrollment

Manual data collection

Infections only

Comparative data feedback

New / NHSN

Healthcare-associated

All delivery venues

Open enrollment

Electronic data capture

Healthcare safety events

Knowledge system

NNIS to NHSN Evolution


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NHSN is the System

integration of 3 current

patient and healthcare personnel

surveillance systems.

NNIS

NaSH

DSN

NHSN


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NHSN Protocols System

  • Patient Safety Component

    • Based on NNIS and DSN systems

    • Device-, Procedure-, and Medication-associated

  • Healthcare Personnel Safety Component

    • Based on NaSH system

  • Research and Development Component

    • For studies, demonstration projects, etc


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NHSN is Part of Systemthe CDC’s Public Health Information Network (PHIN)

  • Web-based knowledge system

  • Accumulating, exchanging and integrating relevant information and resources

  • Supports local efforts to promote healthcare safety


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Summary 1 System

  • NNIS system is a model for patient safety

    • High quality data used for local performance improvement

    • Reductions in national infection rates have been achieved

  • NHSN will replace NNIS, NaSH, and DSN

  • Voluntary and confidential; all healthcare entities


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Summary 2 System

  • NHSN will provide

    • Secure web-based reporting and knowledge system

    • Provide comparative data

    • Access to guidelines, prevention tools

  • Integrated data repository at CDC

  • Efforts underway to integrate with other federal patient safety reporting systems


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NHSN Web Application Timeline System

  • Completed:

    • Protocols, data collection forms

    • Initial prototype for web based BSI reporting

  • Q1-Q2 2004

    • Further develop and internally test web application

  • Q3-Q4 2004

    • Pilot test application & revise; conduct training sessions; begin enrolling current members

  • Q4 2004: Make available to current users

  • Q3-Q4 2005: Make available to others


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