NNIS

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• NNIS
• NaSH
• DSN

NHSN
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General

• Patient Safety Component is a hybrid of NNIS and
  DSN
• Healthcare Personnel Component is a hybrid of
  NaSH
• Focus on Patient Safety Component today
• Surveillance Plan is still required

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General Differences

• Event-specific forms and data entry screens
• For some events, will indicate which criterion
  was used to identify event (e.g., BSI)
• Discharge date is required for each event
  reported except DI
• Patient data can be entered separately from event
  and once entered can be duplicated for
  subsequently entered events

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General Differences

• Custom fields on event forms
• Still optional customizable for each event type
• More and varied types (2 date, 2 numeric, 10
  alpha-numeric)
• Can be labelled can be analyzed
• Text box for comments (cannot be analyzed)
• Linked to patient record

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General Differences

• Custom events
• Optional all fields shown are optional
• Contain custom fields and custom text box
• Used for
• Collecting additional events that are not
  collected under a module but have a NHSN
  definition (e.g., gastroenteritis due to C.
  difficile)
• Collecting events that deviate from NHSN
  definitions (e.g., MYBSI)

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General Differences

• Requirements for enrollment
• Must be from a bona fide healthcare facility or
  delivery venue (CMS or AHA number, VA station
  code)
• Must have email address and internet access on
  computer used for reporting
• Must be able to download a digital certificate
  onto that computer

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General Differences

• Requirements for enrollment (cont.)
• Must complete enrollment survey
• Personnel listing
• If hospital, survey similar to annual survey in
  NNIS
• Must complete and return consent form by surface
  mail
• Agree to follow protocols and use definitions
  exactly
• Send acceptable data 6 month every year,
  including annual survey

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NHSN Timeline

• Now until mid-2004 Design, develop, and
  internally test application develop training
  materials
• Mid- 2004 Pilot test application revise
  conduct training sessions begin enrolling
  current members
• Fall/Winter 2004 Make available to current users

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Training

• Elements include
• Video conferences that can be viewed live and
  later
• Enrollment and requirements for participation
• Protocols
• How to do data entry
• How to do data analysis
• Online tutorials
• Online help messages and manual
• Printable forms and manual

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NNIS Legacy Data

• Cannot import your NNIS data into NHSN
• Data on your hard drive do not match those in the
  NNIS database (e.g., no patient names at CDC)
• Database structures are different in NNIS and
  NHSN
• Will send you a program that converts NNIS data
  to a format suitable for import into popular
  spreadsheets/databases
• Will provide a method that allows import of NNIS
  rate data into NHSN spreadsheet reports

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CDCs National Nosocomial Infections Surveillance
(NNIS) System
Antimicrobial Use and Resistance
Intensive Care Units (Adult/Pediatric)
High Risk Nursery
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NNIS ICU Component to NHSNDevice-associated
Module
NNIS
ICU/HRN
Population
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NNIS ICU Component to NHSNDevice-associated
Module
NNIS
ICU/HRN
Population
Numerator
All infections
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NNIS ICU Component to NHSNDevice-associated
Module
NNIS
ICU/HRN
Population
Numerator
All infections
Patient-days and device-days (by ICU type or in
HRN, by birth weight category)
Denominator
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NNIS ICU Component to NHSNDevice-associated
Module
NNIS
ICU/HRN
Population
Numerator
All infections
Patient-days and device-days (by ICU type or in
HRN, by birth weight category)
Denominator
Microbiology
Up to 4 pathogens Complete antibiogram
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NNIS ICU Component to NHSNDevice-associated
Module
NNIS
NHSN
ICU/HRN

• ICU/NICU (II/III III)
• Other locations
• Specialty care units
• Other wards
• - LTCF
• - Home therapy

Population
May have more than 1 NICU location
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NNIS ICU Component to NHSNDevice-associated
Module
NNIS
NHSN
ICU/HRN
ICU/NICU/Others
Population

• Selected DA Infs only
• CLABSI
• CAUTI (not in NICU)
• VAP
• Future Other DA non-
• infectious events

Numerator
All infections
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NNIS ICU Component to NHSNDevice-associated
Module
NNIS
NHSN
ICU/HRN
ICU/HRN/Others
Population
Selected DA Infs/others
Numerator
All infections
Patient-days and 3 types of device-days (by ICU
type or in HRN, by birth weight category)

• Patient-days and
• device-days for selected
• event by location
• In SCA, split CLs into
• temp and permanent
• In NICU, 5 BWs split
• CLs and UCs

Denominator
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NNIS ICU Component to NHSNDevice-associated
Module
NNIS
NHSN
ICU/HRN
ICU/HRN/Others
Population
Selected DA Inf
Numerator
All ICU infections
Pt-days / Device-days
Same selected events
Denominator
Up to 4 pathogens Complete antibiogram

• Up to 3 pathogens
• Selected antibiogram
• for selected organisms
• Vanco/CNS
• Up to 20 agents

Microbiology
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NNIS ICU Component to NHSNDevice-associated
Module

• What do we lose?
• Incidence and distribution of infections at all
  sites in ICU/HRN
• Pathogen distribution for infections other than
  CLABSI, VAP, CAUTI
• What do we gain?
• Flexibility for selecting the event and
  population under surveillance
• Information on which diagnostic criteria were
  used
• Information on DA infections in nonICU locations

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NNIS SP Component to NHSNProcedure-associated
Module
NNIS
Inpatients undergoing NNIS operative procedures
Population
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NNIS SP Component to NHSNProcedure-associated
Module
NNIS
Inpatients undergoing NNIS operative procedures
Population
- All infections - SSI only
Numerator
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NNIS SP Component to NHSNProcedure-associated
Module
NNIS

• Number of inpatients
• undergoing selected NNIS
• operative procedure(s)
• -Basic risk factor data on
• selected NNIS operative
• procedures

Denominator
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NNIS SP Component to NHSNProcedure-associated
Module
NNIS
Inpatients with NNIS operative procedure
Population
All infections/SSI only
Numerator
inpatients with NNIS operative procedure Basic
RF data
Denominator
Up to 4 pathogens Complete antibiogram
Microbiology
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NNIS SP Component to NHSNProcedure-associated
Module
NNIS
NHSN

• In- and out-patients
• undergoing NHSN
• operative procedures
• 35 discrete categories
• - 7 new categories
• - No other categories

Inpatients with NNIS operative procedure
Population
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NNIS SP Component to NHSNProcedure-associated
Module

• 7 new categories
• AAA, CEA, FUSN, RFUSN, HTP, KTP, LTP
• Delete TP, VS
• No other categories (e.g., OCVS)
• Will be coded as OTH and will not be monitored
• For FUSN RFUSN, must monitor all types but can
  distinguish different spinal levels and surgical
  approaches
• For HPRO KPRO, must monitor all types but can
  indicate whether total, partial, or revision

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NNIS SP Component to NHSNProcedure-associated
Module
NNIS
NHSN
In- and out-patients undergoing NHSN operative
procedures Future Patients undergoing
procedures outside of OR (e.g., Interventional
radiology, cardiac catheterization, arthroscopy)
Inpatients with NNIS operative procedure
Population
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NNIS SP Component to NHSNProcedure-associated
Module
NNIS
NHSN
Inpatients with NNIS operative procedure
In- and out-patients undergoing NHSN operative
procedures
Population

• SSI only
• Future
• Deep venous thromb.
• Other surgical comp.

All infections/SSI only
Numerator
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NNIS SP Component to NHSNProcedure-associated
Module
NNIS
NHSN
- In- and out-patients undergoing NHSN
operative procedures - Basic RF data for all
procedures - Additional specific RF for
certain procedures
Denominator
inpatients with NNIS operative procedure Basic
RF data
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NNIS SP Component to NHSNProcedure-associated
Module

• Same basic risk factor data
• For CSEC and FUSN, additional risk factor data
• Will enter details on procedure only on
  denominator record, not on event record as do now
  in NNIS

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NNIS SP Component to NHSNProcedure-associated
Module
NNIS
NHSN
Inpatients with NNIS operative procedure
In/out patients Operative/interventional
Population
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NNIS SP Component to NHSNProcedure-associated
Module

• What do we lose?
• Comparison with some legacy data due to coding
  changes (e.g., FUSN split into FUSN and RFUSN TP
  and VS split into new specific categories )
• What do we gain?
• More flexible and efficient data collection on
  more surgical patients and on more discrete
  procedures
• Improved risk-adjustment techniques (can use risk
  models and risk index)

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NNIS SP Component to NHSNProcedure-associated
Module

• What do we gain?
• Ability to link BSI, PNEU, and UTI occurring
  after an operative procedure to the procedure
• Calculate rates by type of procedure
• Ability to monitor procedure-associated pneumonia
  regardless of whether a ventilator is used by
  type of operative procedure

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NNIS AUR Component toNHSN AUR Module
NNIS
ICU Non-ICU inpatients Outpatients
Population
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NNIS AUR Component toNHSN AUR Module
NNIS
ICU Non-ICU inpatients Outpatients
Population
resistant isolates DDD for each agent
Numerator
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NNIS AUR Component toNHSN AUR Module
NNIS
ICU/SCA Non-ICU inpatients Outpatients
Population
resistant isolates DDD for each agent used
Numerator
isolates tested patient-days
Denominator
DDD of agent used Grams of agent used / DDD
value
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Resistant Pathogen Benchmark Rates
Outpatient areas
Percentile
Pooled Mean
AR pathogen
tested
10
25
50
75
90
MRSA
26,648
20.5
9.5
13.4
21.5
26.9
34.1
VRE
18,413
3.6
0.0
1.0
2.9
4.9
8.1
Imi-R Ps.
9,257
7.0
1.5
3.4
6.4
13.0
9.6
resistant isolates

• Prevalence of resistance

x100
Isolates tested
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Antimicrobial Use Benchmark Rates
Non-ICU Inpatient Areas
Percentile
Pooled Mean
Antibiotic Group
DDD
10
25
50
75
90
Ampicillin
4,774
54.3
1.1
21.3
42.5
61.0
105.4
3RD Ceph.
27,584
317.0
104.0
180.2
233.8
341.3
410.1
Fluorquinol.
13,231
151.0
29.1
75.7
142.5
310.5
229.7
DDD of specific agent used

• DDD per 1000 patient-days

x1000
Total of patient-days
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NNIS AUR Component toNHSN AUR Module
NNIS
NHSN
ICU/SCA Non-ICU inpatients Outpatients
Same
Population
resistant isolates DDD for each agent used
Same
Numerator
isolates tested Patient-days
Same
Denominator
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NNIS AUR Component toNHSN AUR Module

• Sowhats new?
• Can choose to monitor micro or pharm or both
• No more prescribing practices survey
• Updated list of antimicrobial agents and bug-drug
  combinations
• Use of WHO values of DDD
• Provide capability for automated downloading of
  pharmacy/micro data at isolate and summary levels
  (electronic data capture)

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Prototype

• Sample screens for CLABSI event and denominator
  data entry
• Includes Vitek upload
• Semi-automated process to get microbiology data
  from lab to computer without data entry
• For AUR option
• Pilot testing in Pittsburgh with 9 hospitals

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Its gonna happen!