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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
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

nhsn is cdc s model public health healthcare safety improvement program
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.

healthcare safety challenges
Healthcare Safety Challenges

In 5 Years …

  • Reduce targeted adverse events by 50%

How?

slide5
Quality and Safety ImpactSnapshots 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
nnis nhsn is a model for healthcare safety improvement 1 2
NNIS/NHSN is a Model for Healthcare Safety Improvement1,2
  • 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.

slide7
About NNIS
  • 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

goals of the nnis system
Goals of the NNIS System
  • Describe the epidemiology of nosocomial infections in U.S. hospitals
  • Establish benchmark comparison rates
  • Promote epidemiologically-sound surveillance and infection control practices in hospitals
nnis system characteristics
NNIS System Characteristics
  • 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
CDC Reports Aggregated DataAnnuallywww.cdc.gov/ncidod/hip/surveill/nnis.htm
infection prevention the cycle for success
Why? What?
      • 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

key program features for success
Key Program Features for Success
  • 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

cdc s national nosocomial infections surveillance nnis system
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)

variables in nnis surgical component
Variables in NNIS Surgical Component
  • 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
ssi rates by operation and risk index category
SSI Rates* by Operation and Risk Index Category

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

slide16
16

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.

nnis to nhsn evolution
Current / NNIS

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
nhsn is the

NHSN is the

integration of 3 current

patient and healthcare personnel

surveillance systems.

NNIS

NaSH

DSN

NHSN

nhsn protocols
NHSN Protocols
  • 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
nhsn is part of the cdc s public health information network phin
NHSN is Part ofthe 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
summary 1
Summary 1
  • 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
summary 2
Summary 2
  • 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
nhsn web application timeline
NHSN Web Application Timeline
  • 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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