The Jan. 1, 2012, NHSN reporting deadline for surgical site infections (SSI) is rapidly approaching, and many infection preventionists and hospital executives are asking whether electronic surveillance systems (ESS) can help meet the workload, quality and cost challenges inherent in the CMS reporting mandate.
We discussed these challenges with Tracy Gustafson, MD, a CDC-trained epidemiologist, software architect and a director of medical affairs in BD Diagnostics Infection Prevention and Management unit.
Q: What concerns Infection preventionists and administrators most about responding to the new CMS and NHSN reporting mandates?
A: Beyond the obvious financial pressure to improve performance year-to-year to receive quality-related incentives and avoid penalties, infection preventionists are most concerned that data collection and reporting will divert their resources away from real prevention efforts. This is already a concern with bloodstream infection reporting required in 2011. Surgical procedure and SSI reporting requirements in 2012 will increase the reporting burden ten-fold.
Additional concerns relate to the unique challenges in reducing SSIs. Many steps and personnel are involved in pre-operative, perioperative and post-discharge care of surgical patients. These factors make identifying root causes and opportunities for surgical improvement difficult without a sophisticated surveillance system capable of extracting and mining process-related data.
Q: What makes SSI data collection and reporting so time-consuming?
Before reporting an SSI, the hospital has to report the denominator data. For example, to report a mediastinal infection after coronary artery bypass graft (CABG), at least 19 data elements must be reported on every patient who has a CABG. Then, numerator (infection) data must be collected on every patient who contracts a deep infection in this surgical site within 30 days of surgery. Hospital staff must collect surgical and infection data inside their facilities, and check with surgeons who are seeing patients post-discharge and track those outcomes as well.
Q: Why do infection preventionists need to be involved in collecting surgical data? For example, can non-clinical staff collect and report the data?
A: Identifying SSIs requires clinical judgment. For example, an infection preventionist evaluates signs and symptoms of infection, and uses rules provided by the CDC to help define whether an infection is an HAI. Collection and validation against NHSN rules can be automated to help identify possible infections for investigation, electronically document the infection and provide post-discharge follow-up capability.
Q: You mentioned "data validation." Do ESS now diagnose healthcare-associated infections (HAI)?
A: No, quite the opposite. A viable ESS provides data that help the clinician determine when a HAI might be present, but the clinician must have the final say. Software can help by determining whether the data it receives are valid according to NHSN definitions and business rules. For example, in NHSN:
Each surgical procedure has slightly different required data elements.
Only specific sites of infection can follow each type of surgical procedure.
Each site of infection must be documented by a specific combination of lab results, signs and symptoms.
Data requirements also vary depending on the patients age.
Q: Weve talked about surgical data. Does NHSN accept other kinds of data electronically?
A: NHSN has enabled electronic reporting of detailed device-day denominators, surgical procedure data, surgical site infections, central line-associated bloodstream infections (CLABSIs), urinary tract infections (UTIs), central line insertion practices (CLIP), and lab-identified MDRO/CDAD results.
Q: How can an ESS help reduce infections?
A: They can help by going beyond single event "alerts" to provide tools to study the epidemiology of infections in a given facility. Many ESS systems focus on providing alerts and line lists, but affecting change requires the ability to easily analyze processes and related outcomes.
Q: If I am an infection preventionist, how do I evaluate an ESS to see if it is right for me?
A: Focus on outcomeswhat tools the system provides and how the tools will help you prevent infections. Ask for a list of alerts and reports produced by the system, how easy it is to create graphs and control charts inside the system, whether the system helps track processes as well as outcomes. Ask whether the system can benchmark to NHSN and produce graphs based on Standardized Infection Ratios, which NHSN plans to use to compare hospitals. Ask exactly which NHSN-required data elements can be transferred into coded fields for analysis. Ask whether you own your data at the end of a contract. If the answers to these questions are satisfactory, then youve probably found a system that benefits your patients, your healthcare staff and your bottom line.