History and Overview of SENIC, NNIS and NHSN

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History and Overview of SENIC, NNIS and NHSN

• Mary Andrus, BA, RN, CIC
• Surveillance Branch
• Division of Healthcare Quality Promotion

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B.S. Before SENIC

• Late 1950s early 1960s staphylococcal
  pandemic in U.S. hospitals
• Infection Control Committees formed
• 1960s CDC began to recommend surveillance of
  infections to obtain evidence for control measures

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• 1970s studies indicate surveillance be
  conducted by nurses trained in epidemiology
• Based on pilot study, recommendation for one
  full-time IC nurse for every 250 occupied
  hospital beds
• By 1975 gt50 of U.S. hospitals had infection
  control programs
• 1976 Joint Commission on Accreditation of
  Healthcare Organizations (JCAHO) added infection
  surveillance and control standard
• CDC training courses established

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Study on the Efficacy of Nosocomial Infection
Control (SENIC)

• Early 1970s - SENIC Project initiated
• Goals
• Measure use of infection control programs
• Identify specific surveillance and infection
  control characteristics
• Determine whether or not IC programs reduced
  nosocomial infection rates

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SENIC Study Phases

• Phase I Preliminary Screening Questionnaire
• Sent to 6,586 hospitals (86 response)
• Surveillance index and Control index
• Phase II Hospital Interview Survey
• Random sample (338) of hospitals (stratified by
  distribution of indexes)
• CDC interviews to corroborate questionnaire
• Phase III Medical Records Survey
• 500 patient records from 1970 and 500 from
  1975-76 from each hospital
• Comprehensive medical record review to diagnose
  four nosocomial infections BSI, UTI, SWI and PNEU

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SENIC Conclusions

• Reduction of nosocomial infection rates of up to
  32 if four components were included
• Ongoing surveillance of infections
• Active control efforts
• Qualified infection control staff
• For surgical wound infections (SWI), feedback of
  infection rates to surgeons
• The exact measures that are most effective are
  variable for different infection sites

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1970 - 2004
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Characteristics

• Started in 1970 with 62 hospitals
• Peaked at 320 hospitals in 42 states
• Participation voluntary and confidential
• Focused on monitoring infections in critical care
  and surgery patients
• Requirements
• Hospitals with at least 100 occupied beds
• Trained ICPs 1 FTE ICP per first 100 beds plus
  0.5 FTE support staff (median 1 ICP per 115
  beds)
• NNIS hospitals tend to be large, academic
  institutions with higher average daily census
  over-represented in Northeast/Southeast

Richards C, et al. AJIC 200129400-3.
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NNIS Purposes

• Describe the epidemiology of nosocomial
  infections in U.S. hospitals
• Promote epidemiologically-sound surveillance
  methodology
• Establish comparative rates that can be used for
  local quality improvement efforts

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NNIS System Methods

• Used standard definitions for infections,
  operations, and all data fields
• Used standard protocols to collect data
• Hospitals reported data electronically to CDC
  monthly using CDC-provided software
• CDC published reports of aggregated data
• www.cdc.gov/ncidod/hip/surveill/nnis.htm
• American Journal of Infection Control

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NNIS Protocols

• Before 1986, NNIS surveillance was hospital-wide.
  
• 1986-1999 Hospital-wide remained an option
• 1999 Hospital-wide component eliminated.

NNIS Surveillance Components
Surgical Patient
AUR
ICU
HRN
Antimicrobial Use and Resistance
Intensive Care Unit (Adult/Pediatric)
High Risk Nursery (Level II/III and III NICUs)
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Pooled Means and Percentiles of the Distribution
of Central Line-associated Bloodstream Infection
(BSI) Rates, By Type of ICU, NNIS ICU Component,
1/02-6/04
Central line-associated BSI rate
Percentile No.
of Central Line- Pooled 10 25 50 75 90
Type of ICU Units Days Mean (median) Coronary
60 116,546 3.5 1.0 1.5 3.2 7.0
9.0 Cardiothoracic 48 182,407
2.7 0.0 0.9 1.8 2.7 4.9 Medical 94 312,478
5.0 0.5 2.4 3.9 6.4 8.8 Medical-Surgical
Major teaching 100 430,979 4.0 1.7 2.6 3.4
5.1 7.6 All others 109 486,115
3.2 0.8 1.6 3.1 4.3
6.1 Neurosurgical 30 56,645
4.6 0.0 0.9 3.1 5.8 10.6 Pediatric 54 161,314
6.6 0.9 3.0 5.2 8.1 11.2 Surgical 99 358,578
4.6 0.0 2.0 3.4 5.9 8.7 Trauma 22 70,372
7.4 1.9 3.3 5.2 8.2 11.9
Number of central line-associated BSI
Number of central line-days
NNIS Report 2004 AJIC 32470-85.
X 1000
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SSI Rates by Operation and Risk Index Category,
NNIS Surgical Patient Component, 1/92-6/04
NNIS Report 2004 AJIC 32470-85.
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Central Line-associated BSI Rates, By ICU
Type,1990-2004
Source NNIS System, incomplete for 2004
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Decrease in HAI rates, NNIS 1990-1999
Gaynes, R, et.al. Feeding back surveillance data
to prevent hospital-acquired infections. EID2001
7(2)
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NNIS - 2004
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2005 present
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NHSN is a secure, internet-based surveillance
system that integrates all surveillance systems
previously managed separately in the Division of
Healthcare Quality Promotion (DHQP) at CDC.
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NHSN Premises

• Maintain the goals of predecessor systems
• Minimize data collection and manual data entry
  burden
• Streamline existing surveillance protocols
• Increase capacity for capturing electronic data
  (e.g., Laboratory information systems, operating
  room, pharmacy, clinical, administrative
  databases)
• Web-based application

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NHSN Premises

• Partner with others to minimize data reporting
  burden
• Allow all healthcare delivery entities to
  participate
• Enhance data sharing capabilities without
  compromising CDCs need to keep the data secure
  and confidential

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Components of NHSN
In development
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Patient Safety Component Modules

• CLABSI
• VAP

• CAUTI
• CLIP

• DE

• MDRO/CDAD Infection
• Lab ID

• Processes

• Method A
• Method B

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Data Collection and Reporting Requirements

• Complete an annual facility survey
• Successfully complete one or more Patient Safety
  Modules
• Submit a reporting plan each month
• Submit data for at least one module for a minimum
  of 6 months of the calendar year
• Adhere to the selected modules protocol(s),
  exactly as described in the NHSN Patient Safety
  Component Protocol document during the month
• Properly use the CDC definitions and codes for
  all data collection

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Data Collection and Reporting Requirements

• Successful completion requires the following
  (cont.)
• Report data indicated on the reporting plan to
  CDC within 30 days of the end of the month
• Pass quality control acceptance checks that
  assess the data for completeness and accuracy
• Agree to report to state health authorities
  adverse event outbreaks identified in their
  facility by the surveillance system
• Failure to comply with these requirements will
  result in removal from the NHSN

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Staffing Requirements

• There are no specific FTE requirements, but a
  trained Infection Control Professional (ICP) or
  Hospital Epidemiologist should oversee the HAI
  surveillance program
• Other personnel can be trained to
• Screen for events (e.g., infections)
• Collect denominator data
• Collect infection prevention practices (process
  measure) data
• Enter data
• Analyze data

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Example of Published NHSN Data
From 2006 NHSN Report http//www.cdc.gov/ncidod/
dhqp/pdf/nhsn/2006_NHSN_Report.pdf
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Facilities Enrolled in NHSN
As of April 28, 2008
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NHSN FacilitiesMedical School Affiliation
As of April 28, 2008
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NHSN Facilitiesby Bed Size
As of April 28, 2008
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As of April 28, 2008
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Thank you.