Tracking infections with the CDC
Providers find CDC’S tracking system for HAIS valuable but burdensome
Enrollment in the Centers for Disease Control and Prevention’s National Healthcare Safety Network, the federal system for tracking healthcare-associated infections, has grown exponentially in recent years. The number of facilities reporting to the NHSN has jumped from roughly 3,000 in 2010 to about 8,200 facilities currently, more than 4,000 of which are hospitals, according to the CDC.
But among infection preventionists who are charged with collecting and submitting the data to the network, there are some who say participation in the NHSN is burdensome and takes time away from other critically important duties, such as rounding with nurses and spearheading prevention initiatives.
Maureen Spencer, corporate infection preventionist for 134-hospital Universal Health Services, King of Prussia, Pa., says many of the health system’s infection preventionists are “basically chained to their desks” in order to meet the NHSN’S mandatory reporting requirements.
“They don’t have the resources and the time to do the things they need to do because they’re spending so many hours each day on NHSN surveillance,” Spencer says.
First launched in 2005, the network’s explosive growth has been fueled by everincreasing awareness of the dangers associated with HAIS, which affect an estimated 1 in every 20 patients, leading to the deaths of tens of thousands and costing healthcare systems billions each year, according to HHS.
More than 20 states mandate some form of HAI reporting via the NHSN, including New York and Pennsylvania, which were among the first states to require hospitals to use the network to report their HAIS.
In January 2011, the CMS began requiring hospitals to report their incidences of central line-associated bloodstream infections using the NHSN in order to receive their full payment update for 2013. And this past January, the CMS also mandated reporting of catheter-associated urinary-tract infections and two types of surgical site infection—inpatient colon and abdominal hysterectomy—via the NHSN for 2014’s payment update.
The CDC’S secure, online tracking system has won wide praise for its use of standardized surveillance protocols and definitions, which experts say has allowed for a more through and scientific view of infection prevalence.
But for infection preventionists, that level of precision can sometimes come at a price.
“Like anything else, it gets easier as you get used to it, but it does take time away from infection preventionists’ other duties,” says Ginny Heberly, an infection preventionist at 27-bed Northern Montana Hospital in Havre.
Unlike some hospitals that have installed a specialized electronic surveillance system, Northern Montana Health Care collects and enters data manually, Heberly says, adding that an automated system would likely make the process much easier. Despite the added workload, she says she believes the NHSN is a valuable tool.
“It’s time-consuming, just like any quality-improvement process, but I do think that it’s serving its purpose,” she says.
When reporting to the NHSN, facilities must include data on each infection, which serves as the numerator, but they must also submit denominator data for each device— central lines, urinary catheters, ventilators— or surgical procedure. For instance, when entering data on central-line associated bloodstream infections, a facility must also include their total number of central line days as their denominator.
Gathering such data for surgical-site infections can be even more arduous, infection preventionists say, because each procedure has its own set of specific denominator data that must be collected for every patient who undergoes that surgery.
“If you’re doing 400 cases a year and you’re looking at each one manually, that will take some time, of course,” says Linda Greene, director of infection prevention and control for two-hospital Rochester (N.Y.) General Health System. “But there are ways that the electronic medical record can capture that information, transmit it to a file and automatically upload it to the NHSN.”
Having a system that automatically extracts data from an EMR and imports it to the CDC’S network can free up a lot more time for infection preventionists, says Greene, who also serves as board secretary of the Association for Professionals in Infection Control and Epidemiology, a professional organization with more than 14,000 members. APIC’S website lists vendors that offer such systems, Greene adds.
But even resource-strapped hospitals that aren’t yet able to invest in a software product for reporting can still employ strategies to make the process more efficient, such as using spreadsheets to skip data-entry steps or developing systems in-house, she says.
“From a process-improvement perspective, it is an amazing tool,” Greene says of the NHSN. “It gives real-time data and for those organizations that have been using it for a while, it has been invaluable. Right now there may be some people that view it as a labor burden, but I think as they look on the horizon, they’ll see that it gives us the information we need to get better.”
Dr. Daniel Pollock, surveillance branch chief for the CDC’S Division of Healthcare Quality Promotion, acknowledges that identifying cases and collecting information for the NHSN takes time, but like Greene, he says technological systems can and will streamline the process.
The CDC has also worked to enhance the system’s usability and minimize the administrative burden, he adds. The agency has conducted several pilot studies looking at ways to introduce sampling of denominator data in order to simplify the collection process. Those studies are in the field-testing stage, and the CDC expects to incorporate new practices by January 2014, Pollock says.
“In the meantime, there are ways to use IT systems to capture denominator data electronically,” Pollock says. “We have been working with vendors and we see those IT solutions as the way forward.”
Health IT certainly has made participating in the NHSN easier for the staff at 323-bed Bryn Mawr (Pa.) Hospital, part of five-hospital Main Line Health, says Patricia Mcbride, an infection preventionist at Bryn Mawr. The hospital recently began using its EMR to collect denominator data, reducing its reliance on manual entry.
There have been some glitches, Mcbride says, but overall the system has made the surveillance process run more smoothly.
“Now with the electronic record, we can just search for the operative report and find out when the operation started and antibiotic usage,” she says. “In the past, we had to go up to the floor and hope the chart was on the unit or order it from medical records and hope we got it right away. The information is a lot more accessible now.”
But using electronic systems to collect data also can sometimes create more work, says Spencer, corporate infection preventionist at UHS. The system recently implemented a specialized module for infection surveillance that has come with its own set of growing pains. For instance, she says, instead of counting central line days using the insertion day as day one, the system began counting on the first day that the central line was in use—a programming error that required a lot of extra backtracking and lost time, she says.
Still, Spencer says she’s hopeful that electronic systems’ capabilities will improve steadily, allowing better data collection and seamless interfacing with the NHSN. “That would help a lot,” she says.
In the meantime, a coalition of groups such as APIC, the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America, are pressing Congress to appropriate $12 million in additional funding for the NHSN in fiscal 2013 to develop programs and accommodate the network’s sizable growth in enrollment. According to an APIC spokeswoman, the campaign has resulted in more than 3,000 letters to Congress from the organization’s members during the past month.
“Those funds would help us tremendously to shore up the network’s technological infrastructure, expand the capacity of our systems, expand reporting and to modernize and streamline operations as we manage new requirements,” says Pollock of the CDC. “It’s a very high priority for us to work with partner organizations to secure additional resources that we think are vitally important.”
Reporting requirements for the CDC’S tracking system has left many infection preventionists “basically chained to their desks,” according to one health system.