ICPs are urged to join unprecedented national patient safety network
CDC’s ambitious network based on proven systems
In a move that may push infection control professionals to the fore of the patient safety movement, the Centers for Disease Control and Prevention (CDC) is launching a nationwide Internet-based network on infections and adverse events occurring in both patients and health care workers, Hospital Infection Control has learned.
The creation of the CDC National Healthcare Safety Network (NHSN) was announced in Nashville, TN, at the annual conference of the Association for Professionals in Infection Control and Epidemiology. ICPs were encouraged to join the network, sharing infection rates and other adverse outcomes within a confidential system that eventually will include a wide variety of health care settings. The CDC will collect and analyze the data, much as it does with its current sentinel networks.
"There will be no limit on hospital size or type of institution," said Teresa Horan, MPH, CIC, an epidemiologist in the CDC division of healthcare quality promotion. "If you are a legitimate facility and we have a category for you, we want you to join. If we don’t have a category and you are a legitimate entity, talk to us and we will make one. We would like everybody."
The NHSN will replace three existing CDC surveillance systems, including the highly regarded National Nosocomial Infection Surveillance (NNIS) system. In addition, the CDC’s National Surveillance System for Health Care Workers (NaSH) and the Dialysis Surveillance Network (DSN) will be folded into the network. Data from such systems typically are used as a benchmarking tool for ICPs, and the new network should eventually generate much more comparative data than are currently available. NNIS, for example, primarily provides data on infections in intensive care units or high-risk nurseries, Horan said.
"The difference here is that you will be able to choose events you want to monitor and then choose the location where you want to study that event," she said. "There will be a lot more flexibility for the users. We anticipate and hope — everyone keep your fingers crossed — that we can actually deploy the NHSN in the first quarter of next year." In addition, the network is expected to ultimately include noninfectious adverse events such as medication errors and patient falls. "We can add noninfectious adverse events as we develop the definitions and the protocols," Horan said.
In that sense, the move is more an expansion, as the CDC brings proven infection control methods to other settings and disciplines, said Patti Grant, RN, BSN, MS, CIC, director of infection control at RHD Memorial Medical Center in Dallas. "They are designing a system that we know works," she said. "They are expanding it for use for other disciplines without reinventing the wheel." The development of use of standard definitions for noninfectious events will generate exciting new data, she added. "In the same way that we all have definitions for a central-line bacteremia, I’m sure they are going to have a definition for a medication error or what is a patient fall. And once we know it, it won’t take too long to stratify it. It’s going to be cool."
The aforementioned three CDC sentinel networks will link up and trial the program for about six months, then the network will be expanded to affiliated institutions and sister hospitals of the original members. "Then, the third step will be to open the membership to all comers," Horan said. "The enrollment process will be totally on-line, and when we are ready to announce it for everyone to join, we will put the information out everywhere we can. I hope you’ll join us when the time is right."
The plan was well received by the APIC audience, and individual ICPs favored the move in interviews with HIC. "It is the natural next step," said Elaine Larson, RN, PhD, a longtime infection control researcher and professor of pharmaceutical and therapeutic research at Columbia University School of Nursing in New York City. "We have had NNIS for more than a decade. It’s the world model for surveillance of infections. I see this as just expanding the same surveillance techniques beyond health care-associated infections to other kinds of adverse events and complications. It is very promising."
With ICPs already moving strongly into the patient safety movement, participation in the new CDC system could further solidify their patient safety roles. "It certainly could," Larson said. "It could also expand the cadre of professionals that are reporting to the CDC on adverse events. Either way, I think it’s great."
A major benefit of the proposed system will be the collection of data that essentially have been unavailable, as CDC sentinel systems have been focused on a limited number of facilities and procedures, she noted. "If the network were able to provide data and protect the confidentiality of the institutions, there would be the possibility of having a large enough sample size that you really could look at interventions that wouldn’t be possible [previously]," she said. However, the voluntary nature of the program will create some misrepresentation in the data, as the facilities that usually participate in sentinel systems have high-quality programs, Larson added.
"I think that will always be a problem," she said. "No matter what the numbers are, it represents only those that are willing to give the data. But I think that’s the way it should be. I would not be supportive of requiring, at least initially, [participation]. I don’t think we would get honest reporting."
In that regard, Horan strongly emphasized the confidentiality of the data and the protection of participating institutions. The CDC will issue digital certificates to members, and the data will be encrypted during transmission, she said. "We will also provide each facility with control of who can access the data," she said. "If someone is responsible for selecting surgical-site infection data, you may not want to them to be able to enter and add records on device-associated infections. You can control the access of who gets what data and how they can manipulate it."
Asked whether the data will be reported to patient safety groups or regulatory agencies, Horan said, "Not by us. Currently, we are collecting the data for aggregate purposes. We would never, for example, give a single hospital’s data to some other entity."
More than a data repository, the NHSN will provide information and tools for patient safety interventions, Horan emphasized. The network will include prevention tools, lessons learned, and best practices. "Who but you are better to give them to us?" she asked APIC attendees. "You all have success stories, and at meetings like this, we have a chance to share them. Well, wouldn’t it be great if we could share and access them on-line anytime?"
The network is seen as a way to achieve an ambitious set of CDC goals, including reducing catheter-associated infections by 50% over the next five years. "We hope that we will be able to make at least that much in terms of reduction," Horan said. "On the other hand, there is going to be lots of data that we are collecting that we have never had before. So for some areas, it will be a time of collecting baseline data and then we will have to make appropriate targets for reduction in the future."
The network will be a source for performance measurement data and national comparative rates and ratios. Ideally, reports could be created easily, leaving more time for infection prevention efforts.
"One of the things that we think is very important is that it is critical for you to have the data at your fingertips and have the tools to analyze the data," Horan said. "Because you can’t do your work if you can’t analyze the data. There is no use in collecting it if you can’t analyze and use it for prevention. We recognize that you have a great need for data analysis so we will have line listings, tables, graphs, control charts that can easily created, printed, and exported."
Likewise, hospital systems can form their own groups to compare data among affiliated facilities. Beyond surveillance and analysis, the network also will be used to sound alerts for adverse events such as recalls. In light of confusion about a recent bronchoscope recall, many observers have said such a broad-based sentinel system could be useful in getting the word out about important developments.
"The system can be programmed so that when a sentinel event occurs it sends a signal that [says] an immediate response and perhaps a root-cause analysis should be undertaken." Horan said. "Also this should be proactive, built on algorithms where unusual events might be identified and tagged as a signal of preventable threats to patient safety. You could initiate steps ahead of time to prevent the bad outcome from happening."
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