Using NH NHSN N for or Mul ultidrug ug Resistant O Orga gani - PowerPoint PPT Presentation

Using NH NHSN N for or Mul ultidrug ug Resistant O Orga gani nism an and Clo lostridium d diffic ifficile Infect ection (MDRO/CDI) Labor orator ory-Iden entified ed (Lab abID) Even ent Re Reporting National Center for E merging and Zoonotic Infectious Diseases Place Descriptor Here

Objec ectives es  Review the structure of the Multidrug-Resistant Organism & Clostridium difficile Infection (MDRO/CDI) Module within the Patient Safety Component of NHSN  Describe the rationale for monitoring MDROs and CDI  Review requirements for MRSA Bacteremia and CDI LabID Event reporting to CMS through NHSN  Describe the methodology, protocols, and definitions used in data collection and reporting under the MDRO/CDI LabID Event Reporting in NHSN  Review the correct method for entering MRSA Bacteremia and CDI LabID Events into NHSN  Apply knowledge through case studies

Patien ent S Saf afet ety C Component 5 M Modu dule les Patient Safety Component Antimicrobial Use Procedure- Device-associated and Resistance MDRO & CDI Vaccination Module associated Module (AUR) Module Module Module

Mul ultidrug ug-Resi sist stant Organism sm & & Clostrid idiu ium d diffic fficile ile Infection on Mod Module (MDR DRO/CDI DI) Labor orator ory- Prevent ntion on Inf nfection n Outco come Iden entified ed Process ss Surveilla illance Meas easures es (Lab abID) Even ent Meas easures es Hand nd H Hygi giene ne AST MDRO RO MDRO RO Preval alen ence/ e/ Gown wns/Glo loves Inc ncidenc nce MRS RSA & & VRE RE o only Adher eren ence t e to Act ctive e Survei eillan ance e Only in CD CDI CDI CD Testing ng (AST) locations MRS RSA & V VRE RE only where AS T adherence done

Backg kground nd

Goal of t the MDRO and C d CDI M Modu dule le Monitoring of MDR Os and C. difficile infection (CDI) helps to  evaluate local trends and changes in the occurrence of these pathogens and related infections This module provides a mechanism for facilities to report  and analyze MDRO and CDI data, in order to inform infection control staff of the impact of targeted prevention efforts

Why C C. difficile ile ?  Unlike many causes of healthcare associated infections (HAIs), C. difficile diarrheal infections have increased, and are now at his istoric ic hi highs ghs C. difficile infections are linked to about 14, 14,000 d 000 deaths each year, with  approximately 90% being among the elderly  Antibiotic use and healthcare exposure are two of the greatest risk factors  Careful attention to surface cleaning, and wearing gowns and gloves when treating those known to be infected, can reduce spread by 20% R enewed interest:  – Reporting to CMS via NHSN CDC. (2012). Vital signs: Preventing clostridium difficile infections, MMWR, 61.

http://www.cdc.gov/mmwr/pdf/wk/mm61e0306.pdf

S HE A/HICP AC Position Paper (October 2008): R ecommendations for MDR O Metrics in Healthcare S ettings  Define reasonable and practical metrics to best measure impact of prevention  Authors from APIC, CDC, SHEA, HICPAC  Five Categories of MDRO Outcome Measures 1. Tracking Patients 2. Monitoring Susceptibility Patterns 3. Estimating Infection Burden 4. Estimating Exposure Burden 5. Quantifying Healthcare Acquisition (which includes Transmission)

Recommended metrics from the SHEA/HICPAC Position Paper were the basis for the new MDRO and CDI Module

Organism sms 1) Methicillin-R esistant S taphylococcus aureus (MRSA) [option w/ Methicillin-Sensitive S . aureus (MSSA)] ancomycin-Resistant E nterococcus spp. (VRE) 2) V 3) Cephalosporin-Resistant (CephR) Klebsiella spp. 4) Carbapenem-Resistant (CRE) Klebsiella spp. 5) Carbapenem-Resistant (CRE) E . coli spp. 6) Multidrug-Resistant (MDR) Acinetobacter spp. 7) Clostridium difficile

Defin init itio ions  MR S A: S . aureus testing oxacillin, cefoxitin, or methicillin resistant; or positive from molecular testing for mecA and PBP2a  MSSA: S . aureus testing oxacillin, cefoxitin, or methicillin intermediate or susceptible; or negative from molecular testing for mecA and PBP2a  VRE: Any Enterococcus spp. testing resistant to vancomycin  CephR- Klebsiella : Klebsiella spp. testing intermediate or resistant to ceftazidime, ceftriaxone, cefotaxime, or cefepime  CRE- Klebsiella : Klebsiella spp. testing intermediate or resistant to imipenem, meropenem, or doripenem  CRE- E . coli : E . Coli spp. testing intermediate or resistant to imipenem, meropenem, or doripenem

Defin init itio ions (2 (2)  MDR- Acinetobacter : Acinetobacter spp. testing intermediate or resistant to at least one drug within at least 3 antimicrobial classes of 6, including: β -lactam/ β -lactamase inhibitor combo (PIP, PIPT AZ) cephalosporins (CEFEP, CEFT AZ) carbapenems (IMI, MERO, DORI) aminoglycosides (AMK , GENT , TOBRA) fluoroquinolones (CIPRO, LEVO) sulbactam (AMPSUL)  C. difficile : C. difficile is identified as the associated pathogen for LabID Event or HAI reporting [Gastrointestinal System Infection (GI) -Gastroenteritis (GE) or Gastrointestinal Tract (GIT)]

Rep eporting R Req equirem emen ents an and Options Active e par articipan ants must c choose e mai ain r rep eporting met ethod Infection S urveillance LabID E vent R eporting additional ad al options t then en b bec ecome e avai ailab able Prevention Process Measures: • Adherence to Hand Hygiene • Adherence to Gown and Glove Use • Adherence to Active S urveillance T esting (for MR S A /VR E Only) Outcome Measures: • AS T Prevalence / Incidence (for MR S A/VR E Only)

CMS Rep eporting R Req equirem emen ents LabID E Even ent f for Fac acWideIN

Heal ealthcar are e Fac acility HAI Rep eporting to CMS via a NHSN – Curren ent an and Proposed ed Req equirem emen ents DR AFT (11/ 1/23/ 23/2011 2011)

CMS 201 013 MRSA Bac acter eremia LabID E Event Organism: Methicillin-R esistant S taphylococcus aureus (MRSA) Data Collection: CDC NHSN - MDRO/CDI Module Required Locations: All inpatient locations (=FacWideIN) for LabID Events Required Data: Communi unity-On Onset ( (CO) O) and Heal ealthcar are-On Onset ( (HO) O) Event MRSA blood specimens at the facility-wide inpatient level

CMS 2 2013 13 C. dif iffic icile le La LabID Event  Orga gani nism: Clostridium difficile (C. diff )  Dat ata Colle llectio ion: : CDC NHSN - MDRO/CDI Module (LabID Event)  Req equired ed Loc ocation ons: : All inpatient locations at Facility-wide Inpatient level (FacWideIN) minus NICU, SCN, or other Well Baby locations (e.g. Nurseries, babies in LDRP)  Req equired ed Dat ata: – Communi unity-On Onset (CO) O) and Heal ealthcar are-On Onset (HO) O) Events – All ll C. difficile LabID Events on unformed stool specimens at the facility-wide Inpatient level

F acility -wide Inpatient FacWideIN Inclu ludes all ll in inpatie ient lo locatio ions, inc nclud uding o ng observation n patients ho hous used i in a n an n inp npatient location

CMS 2 2013 13 What Data Will N ill NHSN R Report t to CMS? MRSA B Blood ood a and C C. diffic ifficil ile Heal ealthcar are e Facilit ility-Onset (HO) La LabID E Events CD CDI: Al All n non-dupl duplicate, n non on-rec ecurren ent L LabID E E ven ent s spec ecimen ens c collected > 3 3 d days s af after ad admission to o the facili ility MRSA B Blood ood: Al All n non-du dupl plicate, L Lab abID E E vent s specimens c col ollected > d >3 day ays af after admis issio ion to the facili ility

Get etting R Read eady for Rep eporting

Creating ng a Monthl hly Reporting P ng Plan

Mo Monthly R y Reporting Plan C. diff and MR S A LabID ( blood specimens only ) Events must be included in Monthly Reporting Plan each month for data to be reported on behalf of the facility to CMS All specimens are not required for CMS, but if state mandates, require facility to report all specimens, then it is okay and only bloods will be counted for CMS reporting

Location Reporting Op Options CMS S Req equirem emen ent Facilit ility-Wid ide I Inpatie ient or Facilit ility-Wide O e Outpat atient: Options currently available only for LabID E vent reporting  R eport from throughout all of a facility’s inpatient or outpatient locations  Numerator (MDR O/CDI E vents)- report separately for each location in  facility S ingle denominators for entire facility:  FacWideIN – patient days and admissions  Separate counts for MDR O and CDI  Minus baby locations for CDI  FacWideOUT – encounters  Lo Loca cation S Speci cific: Select only a few locations or every location for full facility coverage  R eport separately from each selected location in the facility  Separate denominators for each location:  Patient days and admissions for inpatient locations  E ncounters for outpatient locations 

Location R Reporting Op Options Location Specific Overall Facility-wide Inpatient (FacWideIN) and/or Outpatient (FacWideOUT) Selected All Locations Locations

Adding L ng Locations ns