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The Surgical Care Improvement Project (SCIP) & CDC’sNational Healthcare Safety Network: 

The Surgical Care Improvement Project (SCIP) andamp; CDC’s National 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

NHSN is CDC’s Model Public Health - Healthcare Safety Improvement Program: 

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.

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

Healthcare Safety Challenges: 

Healthcare Safety Challenges In 5 Years … Reduce targeted adverse events by 50%

Quality and Safety ImpactSnapshots of Success http://www.academyhealth.org/connectingthedots/impacts.htm: 

Quality and Safety Impact Snapshots of Success http://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

NNIS/NHSN is a Model for Healthcare Safety Improvement1,2: 

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.

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Begun in 1970 with 62 hospitals now andgt;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

Goals of the NNIS System: 

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

NNIS System Characteristics: 

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

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

CDC Reports Aggregated Data Annually www.cdc.gov/ncidod/hip/surveill/nnis.htm

Infection Prevention The Cycle for Success: 

Infection Prevention The Cycle for Success Richards C, et al. Emerg Infect Dis 2001

Key Program Features for Success: 

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

CDC’s National Nosocomial Infections Surveillance (NNIS) System: 

CDC’s National Nosocomial Infections Surveillance (NNIS) System NNIS System AUR ICU HRN Surgical Patient Antimicrobial Use and Resistance Intensive Care Unit (Adult/Pediatric) High Risk Nursery (NICU)

Variables in NNIS Surgical Component: 

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

SSI Rates* by Operation and Risk Index Category : 

SSI Rates* by Operation and Risk Index Category Duration Risk Cut Point 0 1 2 3 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 andamp; 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 andamp; 3 combined NNIS Report, Issued August 2003

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Trends in Surgical Site Infection (SSI) Rates By Risk Group* 1986-90 Years SSIs per 100 operations Low risk Medium high risk High risk *NNIS, Unpublished data.

NNIS to NHSN Evolution: 

NNIS to NHSN Evolution 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

NHSN is the: 

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

NHSN Protocols: 

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

NHSN is Part ofthe CDC’s Public Health Information Network (PHIN): 

NHSN is Part of the 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

Summary 1: 

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

Summary 2: 

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

NHSN Web Application Timeline: 

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 andamp; revise; conduct training sessions; begin enrolling current members Q4 2004: Make available to current users Q3-Q4 2005: Make available to others

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