Infection Prevention and NHSN Webinar Series NHSN: Surgical Site - PowerPoint PPT Presentation

An Initiative of the Florida Hospital Association Hospital Improvement Innovation Network Infection Prevention and NHSN Webinar Series NHSN: Surgical Site Infection (SSI) Surveillance Identification and Analysis October 23, 2018

Agenda • Welcome & FHA Mission to Care HIIN Overview – Cheryl Love, RN, BSN, BS-HCA, MBA, LHRM, CPHRM, Director of Quality and Patient Safety and Improvement Advisor, FHA • NHSN: Surgical Site Infection (SSI) Surveillance Identification and Analysis – Linda R. Greene, RN, MPS, CIC, FAPIC, Manager of Infection Prevention, UR Highland Hospital, Rochester, NY • Q&A • Upcoming HIIN Events and Opportunities • Evaluation Survey & Continuing Nursing Education

HIIN Core Topics – Aim is 20% reduction • Adverse Drug Events (ADE) • Catheter-associated Urinary Tract Infections (CAUTI) • Clostridium Difficile Infection (CDI) • Central line-associated Blood Stream Infections (CLABSI) • Hospital-onset MRSA Bacteremia • Injuries from Falls and Immobility • Pressure Ulcers (PrU) • Sepsis • Surgical Site Infections (SSI) • Venous Thromboembolisms (VTE) • Ventilator Associated Events (VAE/IVAC/PVAP) • Readmissions (12% reduction) • Worker Safety

SSI Resources, Trainings and Tools http://www.fha.org/health-care-issues/quality-and-safety/mtc-hiin.aspx http://www.hret-hiin.org  SSI Change Package  SSI Top 10 Checklist  SOAP UP Resources  Watch Past Webinars  HRET HIIN Resource Library  Guides  Case Studies

UP Campaign  Simplify safe care and streamline interventions  Reduce multiple forms of harm with simple, easy-to-accomplish activities  Consolidate basic interventions that cut across several topics to decrease harm http://www.fha.org/up

FHA Mission to Care Update: SSI - Colon 7.00 6.00 5.00 Rate per 100 4.00 3.00 2.00 1.00 0.00 BL 10/16 11/16 12/16 1/17 2/17 3/17 4/17 5/17 6/17 7/17 8/17 9/17 10/17 11/17 12/17 1/18 2/18 3/18 4/18 5/18 6/18 7/18 FL Rate 4.26 5.35 4.02 5.81 5.38 4.85 4.36 3.46 3.76 3.84 4.64 5.33 4.94 3.79 3.70 5.36 4.52 5.00 4.97 4.62 3.98 4.47 4.34 HRET HIIN Rate 5.15 4.71 4.67 4.81 4.89 4.54 4.55 4.18 4.73 4.61 4.56 5.06 5.13 4.70 4.58 4.96 4.91 5.39 4.79 4.75 4.69 5.05 4.70 # FL Reporting 82 81 81 80 79 79 79 79 79 79 79 79 79 79 79 79 79 79 79 79 79 76 65 #HRET HIIN Reporting 1,109 1,125 1,125 1,124 1,125 1,122 1,121 1,119 1,118 1,115 1,113 1,112 1,115 1,116 1,111 1,111 1,105 1,092 1,091 1,059 1,031 970 785 Source: HRET Comprehensive Data System, October 22, 2018

FHA Mission to Care Update: SSI - Hysterectomy 2.50 2.00 1.50 Rate per 100 1.00 0.50 0.00 BL 10/16 11/16 12/16 1/17 2/17 3/17 4/17 5/17 6/17 7/17 8/17 9/17 10/17 11/17 12/17 1/18 2/18 3/18 4/18 5/18 6/18 7/18 FL Rate 1.47 1.29 2.08 0.62 0.74 0.92 0.78 0.99 1.34 1.42 1.49 1.06 1.15 1.10 0.96 1.15 0.45 0.69 1.07 1.04 1.17 0.40 1.51 HRET HIIN Rate 1.47 1.14 1.36 1.02 1.18 1.31 1.21 1.34 1.36 1.34 1.22 1.16 1.40 1.14 1.25 1.10 1.17 1.00 1.25 1.28 1.19 1.08 1.29 # FL Reporting 81 80 79 80 78 78 78 78 78 78 78 78 78 78 78 77 78 78 78 78 78 73 65 #HRET HIIN Reporting 1,066 1,081 1,082 1,083 1,077 1,077 1,081 1,073 1,076 1,073 1,070 1,068 1,071 1,072 1,068 1,064 1,062 1,034 1,034 1,015 987 930 757 Source: HRET Comprehensive Data System, October 22, 2018

FHA Mission to Care Update: SSI - Knee 1.50 1.25 1.00 Rate per 100 0.75 0.50 0.25 0.00 BL 10/16 11/16 12/16 1/17 2/17 3/17 4/17 5/17 6/17 7/17 8/17 9/17 10/17 11/17 12/17 1/18 2/18 3/18 4/18 5/18 6/18 7/18 FL Rate 0.77 0.87 0.56 0.67 0.50 0.72 0.46 0.60 0.49 0.47 0.81 0.41 0.46 0.59 0.85 0.31 0.50 0.47 0.51 0.69 0.60 0.29 0.24 HRET HIIN Rate 0.74 0.57 0.58 0.74 0.50 0.50 1.00 0.82 0.98 0.63 0.81 0.63 0.88 1.08 0.99 0.49 0.55 0.42 0.57 0.79 0.84 0.72 0.47 # FL Reporting 68 65 66 65 64 64 64 63 61 60 60 61 62 61 61 61 61 60 58 57 57 56 52 #HRET HIIN Reporting 828 834 834 833 867 863 866 863 863 861 856 849 856 856 853 851 845 836 824 791 754 710 576 Source: HRET Comprehensive Data System, October 22, 2018

FHA Mission to Care Update: SSI - Hip 2.00 1.75 1.50 1.25 Rate per 100 1.00 0.75 0.50 0.25 0.00 BL 10/16 11/16 12/16 1/17 2/17 3/17 4/17 5/17 6/17 7/17 8/17 9/17 10/17 11/17 12/17 1/18 2/18 3/18 4/18 5/18 6/18 7/18 FL Rate 1.44 0.90 1.15 0.80 1.18 0.90 1.16 0.42 1.07 1.25 1.51 1.13 0.87 0.97 1.00 1.03 1.07 0.63 0.99 1.37 1.50 0.87 0.30 HRET HIIN Rate 1.21 1.00 1.18 0.99 1.04 1.17 1.13 1.18 1.31 1.01 1.26 1.06 1.26 1.26 0.98 1.14 1.22 1.00 1.20 1.12 0.97 1.27 0.70 # FL Reporting 67 64 65 65 64 64 64 63 61 60 60 61 61 61 61 61 61 60 59 57 57 57 52 #HRET HIIN Reporting 810 819 816 813 852 848 847 843 842 841 836 828 829 834 831 831 824 824 811 777 754 703 564 Source: HRET Comprehensive Data System, October 22, 2018

FHA Mission to Care Update: Florida | SSI Rates

Infection Prevention and NHSN Webinar Series: 2018-2019 Date Topic Register Online Oct. 23 NHSN: SSI Surveillance Identification and Today’s event archive Analysis (Virtual Event) will be posted online Nov. 20 SSI-Colon: How to Assess Root Cause and https://cc.readytalk.com/r /x6cg3sako1xq&eom Prevention Strategies (Virtual Event) Dec. 4 Infection Prevention NHSN Workshop III – http://www.cvent.com/d/ 8bqwm5/2K Orlando, FL (In-Person Event) Dec. 18 NHSN topic to be announced (Virtual Event) https://cc.readytalk.com/r /ag8n7ef9vryt&eom Access Event Archives (Recordings | Slides) on the Mission to Care HIIN Website

NHSN SSI Definitions and Analysis Linda R Greene, RN, MPS,CIC, FAPIC Manager Infection Prevention University of Rochester, Highland Hospital Linda_greene@urmc.rochester.edu

Reminders NHSN Infection Window Period (Does NOT apply to SSI, VAE, or LabID Event surveillance) Date of Event (Event Date) (Does NOT apply to VAE or LabID Event surveillance) Repeat Infection Timeframe (RIT) (Does NOT apply to SSI, VAE, or LabID Event surveillance)

Polling Question #1 Can the culture be used to meet SSI criteria?  Yes  No

Polling Question #2 Does this case meet criteria for PATOS?  Yes  No

When in doubt – e-mail NHSN

Polling Question #3 Does this case meet criteria for a superficial SSI?  No. The culture shows no growth  Yes. Meets SIP criteria  No. Meets DIP infection  No. Intact fascia

Analysis of Surgical Site Infections

What Information do I need today? Helpful to run a line list

Variables

Other Variables

Recently Published Data 2016 Analysis

Standardized Infection Ratios Refresh our memory SIR = Observed infections Expected infections Same Worse Better 0 1 2 SIR

https://www.cdc.gov/hai/data/portal/progress-report.html

Colon SSI Percentile Distribution 0.000 0.000 0.000 0.085 0.343 0.444 0.558 0.627 0.710 0.801 55% 60% 65% 70% 75% 80% 85% 90% 95% 0.880 0.959 1.082 1.207 1.336 1.504 1.683 1.919 2.337 https://www.cdc.gov/hai/data/portal/progress-report.html

Looking Down the Road

Looking Down the Road

Check Procedures

Exclusions

Tips - Review

Tips  Review your data.  Standardized review forms will help with consistency

Review Sheet

Opportunities for Improvement  Use available data to drive improvement  NHSN provides a rich variety of information

Upcoming HIIN Events Virtual Events: • Oct. 25 - HRET HIIN & CMS | Mapping Medicare Disparities • Nov. 1 - HRET HIIN | Multi-Drug Resistant Organism (MDRO) Discovery and Direction Series: Organizational Risk Assessment • Nov. 7 - FHA HIIN | Hot Topics Monthly Virtual Event • Nov. 9 - HRET HIIN | Readmissions Multi Visit Patient (MVP) Webinar #2 • Nov. 14 - HRET HIIN | Culture of Safety Virtual Event - Workplace Violence: Up Close • Nov. 15 - HRET HIIN | Falls Fishbowl #2 • Nov. 15 - HRET HIIN | MDRO Discovery and Direction Series: Horizontal Practices • Nov. 20 - FHA HIIN | Infection Prevention & NHSN Series - SSI-Colon: How to Assess Root Cause and Prevention Strategies • Nov. 29 - HRET HIIN | MDRO Discovery and Direction Series: Special Approaches and Essential Questions In-Person Event: • Dec. 4 (Orlando, FL) - FHA HIIN | Infection Prevention NHSN Workshop III Check the weekly MTC HIIN Upcoming Events for details and registration