National Healthcare Safety Network (NHSN)
OMB Control No. 0920-0666
Expiration 12/31/2017
Revision Request
Supporting Statement Part B
Daniel A. Pollock. MD
Surveillance Branch Chief
Division of Healthcare Quality Promotion
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention
Atlanta, Georgia 30329-4018
Phone: (404) 639-4237
Fax: (404) 639-4043
Email: [email protected]
OMB No. 0920-0666
National Healthcare Safety Network (NHSN)
Revision Request, June 2015
Supporting Statement Part B – Table of Contents
Statistical Methods
Respondent Universe and Sampling Methods
Procedures for the Collection of Information
Methods to Maximize Response Rates and Deal with Nonresponse
Test of Procedures or Methods to be Undertaken
Individuals Consulted on Statistical Aspects and Individuals Collecting and/or Analyzing Data
Attachments
Surveillance Methods Supporting Materials
Crosswalk for Supporting Documentation in Attachment G and Corresponding Data Collection Forms in Attachment C
Antimicrobial Use and Resistance
Biovigilance Component
Catheter-Associated Urinary Tract Infection
Central Line-Associated Blood Stream Infection
Central Line Insertion Practices Adherence
Denominators for Patient Safety Component
Dialysis Event
Dialysis Patient Influenza Vaccination
Dialysis Prevention Process Measures
Healthcare Personnel Exposure
LTCF MDRO CDI
LTCF Prevention Process Measures
LTCF Urinary Tract Infection
MDRO & CDI
Outpatient Procedure Component
Surgical Site Infection
Surveys – Hospital, LTAC, IRF, and Dialysis
Ventilator-Associated Event
Ventilator-Associated Pneumonia
OMB No. 0920-0666
National Healthcare Safety Network (NHSN)
Revision Request, June 2015
B. Collections of Information Employing Statistical Methods
1. Respondent Universe and Sampling Methods
NHSN is an ongoing surveillance system that does not employ probability sampling methods for selecting participating hospitals. The respondent universe for NHSN is potentially all institutions in the United States that provide healthcare, including, but not limited to, acute or long-term care facilities, long term acute care facilities, oncology facilities, inpatient rehabilitation facilities, inpatient psychiatric facilities, outpatient dialysis centers, and ambulatory surgery centers. According to the March 2015 Medicare Payment Advisory Commission Report to Congress on the Medicare Payment Policy (http://www.medpac.gov/documents/reports/march-2015-report-to-the-congress-medicare-payment-policy.pdf?sfvrsn=0), in 2013 there were roughly 4,700 acute care facilities, 6,000 dialysis facilities, 240 free-standing inpatient rehabilitation facilities (IRFs), 410 long-term acute care facilities (LTAC/LTCHs), 5,360 ambulatory surgery centers (ASCs), and over 15,000 long-term care and skilled nursing facilities (LTCFs) that billed for Medicare reimbursement.
As of June 2015, there are over 15,400 healthcare facilities enrolled in NHSN. Of these, there are over 4,700 acute care facilities, 6,200 dialysis facilities, 295 inpatient rehabilitation facilities, 225 long-term care facilities, 3,300 ambulatory surgery facilities, and 525 long-term acute care facilities.
2. Procedures for the Collection of Information
NHSN data collection methods vary by component and event type under surveillance as chosen by the participating facility. For example, many facilities opt to do surveillance for ventilator-associated events (VAE) in ICUs only, while facilities participating in transfusion safety surveillance, or hemovigilance, must monitor blood transfusions facility-wide. Denominator data (central line days, ventilator days, units of blood components transfused, etc.) are entered on a monthly basis. Event data (CLABSI, surgical site infections, transfusion-associated lung injury, etc.) are collected and entered on a per-event basis. Each event must meet the case definitions provided in the surveillance protocols. Collection of information methods are explained in detail in the surveillance protocols (Attachment G).
3. Methods to Maximize Response Rates and Deal with No response
Participation in NHSN is open to all healthcare institutions with patient population groups that are addressed by the NHSN modules. Participating institutions have complete autonomy on choice of modules to use and modules are reported each year. This is unchanged from the original application for OMB approval of NHSN. Healthcare institutions must apply for membership in NHSN by completing a series of forms that include identifying and contact information and agree to collect and report data using the NHSN protocols. However, many stakeholders external to CDC encourage or require participation in NHSN for varying purposes. The flexibility of NHSN that permits healthcare institutions to choose from a wide array of options while participating in a national surveillance system that will permit them to comply with accreditation requirements and provide confidentiality to them and their patients has resulted in increasing numbers of participants. Three examples are provided below.
As of March 2015, 33 states and the District of Columbia require facilities in their jurisdictions to join NHSN to comply with legal requirements – including but not limited to state or federal laws, regulations, or other requirements – for mandatory reporting of healthcare facility-specific adverse event, prevention practice adherence, and other public health purposes.
The U.S. Centers for Medicare and Medicaid Services (CMS) has identified NHSN as the surveillance mechanism to enable healthcare facilities to report HAI and prevention practice adherence data in fulfillment of CMS’s quality measurement reporting requirements for those data.
Hospitals accredited by The Joint Commission (TJC) are required to conduct ongoing hospital infection surveillance but the surveillance methodology or patient groups to be included in the surveillance are not specified. The Joint Commission accepts participation in NHSN to satisfy their surveillance requirements.
Methods to deal with non-response do not apply to NHSN as it is a voluntary surveillance system that neither samples from a specified respondent universe nor attempts a census of a specified respondent universe. The data reported to NHSN are aggregated, summarized, and disseminated to participating facilities and the public through peer-review journal publications. Aggregate statistics (pooled means, median event rates, standardized infection ratios, etc.) are built into the NHSN application to allow participating facilities to compare the facility’s data with published aggregate statistics. Detailed analysis methods and results can be reviewed in the NHSN data summary reports published in the American Journal of Infection Control and Infection Control and Hospital Epidemiology, which can be found on the NHSN website: http://www.cdc.gov/nhsn/dataStat.html. Similar analyses of the other NHSN components’ data are planned. CDC has limited ability to make population-based national estimates using these data.
NHSN is used for a variety of surveillance purposes, including estimates of the magnitude of HAIs, monitoring HAI trends, facilitating interfacility and intrafacility comparisons with risk-adjusted data, and assisting healthcare facilities in their efforts to identify and respond to patient safety problems. These purposes, along with other NHSN purposes, are listed comprehensively in the section titled Purpose and Use of Data Collection of the Supporting Statement Part A. Historically and currently, the sample of hospitals participating in NHSN was not selected randomly and might not represent all acute care hospitals in the U.S. As a result, use of NHSN for national estimates of the magnitude of HAIs or for national HAI trend analyses must be done with caution and with appropriate caveats. Limitations of NHSN data for HAI magnitude estimates and trend analyses are acknowledged and discussed in individual reports published by CDC. These limitations should be balanced against strengths of the system for HAI surveillance, including use of a single set of HAI definitions and methods by surveillance staff in hospitals throughout the U.S. and a rapidly increasing number of U.S. hospitals participating in the system. Largely because of state and federal reporting requirements, participation in NHSN has increased to approximately 4,700 hospitals in spring 2015, a significant rise since the system’s inception in 2005 that includes an influx of smaller hospitals that were previously underrepresented. One consequence is that interfacility comparisons with risk-adjusted data are now possible for a wider range of hospital sizes. Also, intrafacility comparisons with risk-adjusted data are strengthened as more data are available to improve the performance of risk models used to risk adjust outcomes in individual facilities.
4. Tests of Procedures or Methods to be Undertaken
NHSN is a surveillance system that integrates legacy patient and healthcare personnel safety surveillance systems managed by the Division of Healthcare Quality Promotion (DHQP) at CDC, served as successful pilot tests of the NHSN surveillance methods. Those systems were the National Nosocomial Infection Surveillance (NNIS) system, the National Surveillance System for Healthcare Workers (NaSH), and the Dialysis Surveillance Network (DSN).
5. Individuals Consulted on Statistical Aspects and Individuals Collecting and/or Analyzing Data
It is the responsibility of the CDC Division of Healthcare Quality Promotion, Surveillance Branch staff to manage and analyze data collected through NHSN. In addition, facilities and groups of facilities (quality improvement organizations, state health departments, prevention collaborative) are able to analyze their data for their own purposes.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Amy Schneider |
| File Modified | 0000-00-00 |
| File Created | 2021-01-24 |