Web-based surveillance allows CDC to expand sites

Tracking system follows infections

The infection tracking system of the Centers for Disease Control and Prevention (CDC) no longer will be limited to certain hospitals, the CDC recently announced.

The revised web-based, National Healthcare Safety Network (NHSN) will allow the CDC to track infections at all health care facilities in the United States.

"The new NHSN is built on experience and has expanded capabilities significantly," says Chesley Richards, MD, deputy director of the division of healthcare quality promotion at the CDC.

"First, it's a web-based system, and while the focus is still on hospitals, it has allowed us to have flexibility to look at other environments," Richards says. "We know as more health care moves out of hospitals, more infection control issues move to other settings, including ambulatory centers, nursing homes, and doctors' offices."

This new tool will make it possible for the CDC to do more for outpatient settings, Richards adds.

"We've grown the system to 700 hospitals, and now we're opening it up to any health care facility in the country," Richards says.

Dialysis centers and long-term care centers associated with hospitals are becoming a part of the surveillance network as well.

"One of the challenges is the types of data collected are most pertinent to hospitals, so we'll build into the system definitions and surveillance practices more pertinent to outpatient practices," Richards says. "We'll engage professionals in those settings so we can provide tools more pertinent to those settings."

For example, as more surgeries move to ambulatory surgery centers, there is less time for data collection, he explains.

"Patient comes in and has day surgery and then goes home," Richards says. "When the surgery was done in the hospital, they'd stay for several days, and we'd have time to see an infection develop and collect data on it."

Ambulatory settings don't permit that luxury, so it's causing CDC officials to rethink how they conduct surveillance work, he adds.

Some of the demonstration projects the CDC is funding involve collecting electronic data from pharmacies and laboratories.

"The web-based system is encrypted and secure so data entered in are secure, and we protect the confidentiality of patients," Richards says.

"As we move closer to an electronic health record that can be accessible from hospitals or other settings then this electronic format is the type of record we can use to populate some of our surveillance records," he explains. "We see the future of health care surveillance more and more using those kinds of data, and that's what gives us tools to do more in the outpatient setting where people move to various health care providers."

When a hospital joins the network, it has a dedicated contact in the hospital that has access to the NHSN system for inputting data, which remains a manual process, Richards says. "Where we want to transition is to utilize electronic data already available in the lab and other systems, which will cut down on the manual system."

Confidentiality is one of the challenges to this transition, he notes. "We've got demonstration projects where we're receiving data, and it's in that phase, but the biggest challenge is building systems that protect confidentiality of patients and making sure data is secure in the way it moves," Richards says.

Private information technology vendors have been working with the CDC on this project, and the CDC is working with the Centers for Medicare & Medicaid Services (CMS), which also has some projects in which hospitals are required to collect data for their quality improvement projects.

"What we're doing with CMS is developing some methods where the data they collect can come into our system also, so we don't have to require people in the hospital to collect data twice," Richards says. "This decreases the collection burden, and it may be important in the future for physician practices and other outpatient settings."

Since CMS runs Medicare and Medicaid payments, which are the leading insurance payments physicians receive, especially in the care of older adults, CMS' participation helps. "Our goal is to try to work things out with CMS where we have overlapping interests," Richards says.

Physicians should be interested in the NHSN because there has been a dramatically increased interest among consumers in legislators in understanding why health care providers have not made advances in reducing health care-associated infections, Richards says.

"There has been a lot of intense legislative activity in a number of states, mandating that hospitals have to report their infection rates publicly," he says. "This has happened in hospitals, but this is a movement that could extend to outpatient settings, especially to ambulatory surgery centers and dialysis centers."

More importantly, health care-associated infections have a severe impact on patients, and it's good patient care to take the necessary infection control precautions to prevent infections, Richards says. "The third reason why physician practices should be interested in this area is because with the changing health care system, we see much more complicated patients being managed in outpatient settings that historically would have been hospitalized," he adds. "They are at high risk and have indwelling devices, catheters and central lines and are receiving care in the outpatient setting."

These types of patients are at a high risk of becoming infected with staph and methicillin-resistant Staphylococcus aureus (MRSA), Richards says.

The NHSN builds on the CDC's National Nosocomial Infection Surveillance (NNIS) system, which has existed for more than 30 years and has helped IC professionals and hospitals improve infection control practices and surveillance.

NHSN's partners include the Department of Veterans Affairs (VA) hospitals, and eight states have designated NHSN as the system to use when implementing legislation requiring hospitals to report health care-associated infections.

"We have put out press releases and have a web site and have presented at professional meetings, and right now that's drummed up a lot of business," Richards notes.

"We've seen a dramatic increase, a doubling in numbers of hospitals in the system," he says. "We have 80% of all the hospitals in New York, and 70%-80% in South Carolina."

California has just passed legislation that will use part of the NHSN system for the state's reporting initiative, as well, he adds.

"By the end of 2008, we expect to have 1,500 to 2,000 hospitals in our system," Richards reports.

"The number of outpatient sites will be more variable," he notes. "We have a lot of development work to do to really tailor our tools to the needs of an outpatient environment, because these vary so dramatically."

Still, the CDC has opened up the system to all health care facilities, and as various entities join the NHSN, the CDC will continue to develop the work that will make sure the system is relevant to each system's needs, Richards says. "We want people to join the system," he adds.