The Surgical Care Improvement Project (SCIP) & CDC’s National Healthcare Safety Network

1. 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

2. 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.

3. http://www.cdc.gov/ncidod/hip/

4. Healthcare Safety Challenges In 5 Years … • Reduce targeted adverse events by 50% How?

5. 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

6. 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.

7. 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

8. 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

9. 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

10. CDC Reports Aggregated DataAnnuallywww.cdc.gov/ncidod/hip/surveill/nnis.htm

11. 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

12. 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

13. 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)

14. 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

15. 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

16. 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.

17. 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

18. NHSN is the integration of 3 current patient and healthcare personnel surveillance systems. NNIS NaSH DSN NHSN

19. 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

20. 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

21. 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

22. 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

23. 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