Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-9 (of 9 Records) |
Query Trace: Horan TC[original query] |
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National Healthcare Safety Network report, data summary for 2011, device-associated module
Dudeck MA , Horan TC , Peterson KD , Allen-Bridson K , Morrell G , Anttila A , Pollock DA , Edwards JR . Am J Infect Control 2013 41 (4) 286-300 This report is a summary of Device-associated (DA) Module data collected by hospitals participating in the National Healthcare Safety Network (NHSN) for events occurring from January through December 2011 and reported to the Centers for Disease Control and Prevention (CDC) by August 1, 2012. This report updates previously published DA Module data from NHSN and provides contemporary comparative rates.1 This report complements other NHSN reports, including national and state-specific reports of standardized infection ratios (SIRs) for select healthcare-associated infections (HAIs).2,3,4 | NHSN data collection, reporting, and analysis are organized into three components: Patient Safety, Healthcare Personnel Safety, and Biovigilance, and use standardized methods and definitions in accordance with specific module protocols.5,6,7 Institutions may use modules singly or simultaneously, but once selected, they must be used for a minimum of one calendar month for the data to be included in CDC analyses. All infections are categorized using standard CDC definitions that include laboratory and clinical criteria.7 The DA Module may be used by facilities other than hospitals, including outpatient dialysis centers. A report of data from this module for outpatient dialysis centers was published separately.8 NHSN facilities contributing HAI surveillance data to this report did so voluntarily, in response to state mandatory reporting requirements or in compliance with the Centers for Medicare and Medicaid Services’ (CMS) Hospital Inpatient Quality Reporting (IQR) Program. CDC aggregated these data into a single national database for 2011, consistent with the stated purposes of NHSN, which were to: | Collect data from a sample of healthcare facilities in the United States to permit valid estimation of the magnitude of adverse events among patients and healthcare personnel. | Collect data from a sample of healthcare facilities in the United States to permit valid estimation of the adherence to practices known to be associated with prevention of these adverse events. | Analyze and report collected data to permit recognition of trends. | Provide facilities with risk-adjusted metrics that can be used for inter-facility comparisons and local quality improvement activities. | Assist facilities in developing surveillance and analysis methods that permit timely recognition of patient and healthcare worker safety problems and prompt intervention with appropriate measures. | Conduct collaborative research studies with NHSN member facilities (e.g., describe the epidemiology of emerging healthcare-associated infection [HAI] and pathogens, assess the importance of potential risk factors, further characterize HAI pathogens and their mechanisms of resistance, and evaluate alternative surveillance and prevention strategies). | 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 data. | Enable healthcare facilities to report HAI and prevention practice adherence data via NHSN to the U.S. Centers for Medicare and Medicaid Services (CMS) in fulfillment of CMS’s quality measurement reporting requirements for those data. | Provide state departments of health with information that identifies the healthcare facilities in their state that participate in NHSN. | Provide to state agencies, at their request, facility-specific, NHSN patient safety component and healthcare personnel safety component adverse event and prevention practice adherence data for surveillance, prevention, or mandatory public reporting. | Patient- and facility-specific data reported to CDC are kept confidential in accordance with sections 304, 306, and 308(d) of the Public Health Service Act (42 USC 242b, 242k, and 242m(d)). |
Device-associated infections among neonatal intensive care unit patients: incidence and associated pathogens reported to the National Healthcare Safety Network, 2006-2008
Hocevar SN , Edwards JR , Horan TC , Morrell GC , Iwamoto M , Lessa FC . Infect Control Hosp Epidemiol 2012 33 (12) 1200-6 OBJECTIVE: To describe rates and pathogen distribution of device-associated infections (DAIs) in neonatal intensive care unit (NICU) patients and compare differences in infection rates by hospital type (children's vs general hospitals). PATIENTS AND SETTING: Neonates in NICUs participating in the National Healthcare Safety Network from 2006 through 2008. METHODS: We analyzed central line-associated bloodstream infections (CLABSIs), umbilical catheter-associated bloodstream infections (UCABs), and ventilator-associated pneumonia (VAP) among 304 NICUs. Differences in pooled mean incidence rates were examined using Poisson regression; nonparametric tests for comparing medians and rate distributions were used. RESULTS: Pooled mean incidence rates by birth weight category (750 g or less, 751-1,000 g, 1,001-1,500 g, 1,501-2,500 g, and more than 2,500 g, respectively) were 3.94, 3.09, 2.25, 1.90, and 1.60 for CLABSI; 4.52, 2.77, 1.70, 0.91, and 0.92 for UCAB; and 2.36, 2.08, 1.28, 0.86, and 0.72 for VAP. When rates of infection between hospital types were compared, only pooled mean VAP rates were significantly lower in children's hospitals than in general hospitals among neonates weighing 1,000 g or less; no significant differences in medians or rate distributions were noted. Pathogen frequencies were coagulase-negative staphylococci (28%), Staphylococcus aureus (19%), and Candida species (13%) for bloodstream infections and Pseudomonas species (16%), S. aureus (15%), and Klebsiella species (14%) for VAP. Of 673 S. aureus isolates with susceptibility results, 33% were methicillin resistant. CONCLUSIONS: Neonates weighing 750 g or less had the highest DAI incidence. With the exception of VAP, pooled mean NICU incidence rates did not differ between children's and general hospitals. Pathogens associated with these infections can pose treatment challenges; continued efforts at prevention need to be applied to all NICU settings. |
An American Journal of Infection Control and National Healthcare Safety Network data quality collaboration: a supplement of new case studies
Wright MO , Hebden JN , Allen-Bridson K , Morrell GC , Horan TC . Am J Infect Control 2012 40 S32-40 The rationale for the case study series is presented, along with results of the first 5 American Journal of Infection Control-National Healthcare Safety Network case studies. Although the respondents were correct in their assessments more often than not, opportunities for improvement remain. Ten new case studies with questions are provided. Participants are provided with instructions on how to submit responses for continuing education credit through the Centers for Disease Control and Prevention. Answers with referenced explanations will be provided immediately to those who seek continuing education credit and at a later date via the online journal for those who do not. |
Improved risk adjustment in public reporting: coronary artery bypass graft surgical site infections
Berrios-Torres SI , Mu Y , Edwards JR , Horan TC , Fridkin SK . Infect Control Hosp Epidemiol 2012 33 (5) 463-9 OBJECTIVE: The objective was to develop a new National Healthcare Safety Network (NHSN) risk model for sternal, deep incisional, and organ/space (complex) surgical site infections (SSIs) following coronary artery bypass graft (CABG) procedures, detected on admission and readmission, consistent with public reporting requirements. PATIENTS AND SETTING: A total of 133,503 CABG procedures with 4,008 associated complex SSIs reported by 293 NHSN hospitals in the United States. METHODS: CABG procedures performed from January 1, 2006, through December 31, 2008, were analyzed. Potential SSI risk factors were identified by univariate analysis. Multivariate analysis with forward stepwise logistic regression modeling was used to develop the new model. The c-index was used to compare the predictive power of the new and NHSN risk index models. RESULTS: Multivariate analysis independent risk factors included ASA score, procedure duration, female gender, age, and medical school affiliation. The new risk model has significantly improved predictive performance over the NHSN risk index (c-index, 0.62 and 0.56, respectively). CONCLUSIONS: Traditionally, the NHSN surveillance system has used a risk index to provide procedure-specific risk-stratified SSI rates to hospitals. A new CABG sternal, complex SSI risk model developed by multivariate analysis has improved predictive performance over the traditional NHSN risk index and is being considered for endorsement as a measure for public reporting. |
Network approach for prevention of healthcare-associated infections
Horan TC , Arnold KE , Rebmann CA , Fridkin SK . Infect Control Hosp Epidemiol 2011 32 (11) 1143-4 We applaud the successful reduction of healthcare-associated infection (HAI) rates achieved by hospitals | that participated for 5 years or more in the Duke Infection | Control Outreach Network (DICON), as described by Anderson and colleagues in their recent report.1 | DICON provides a successful example of HAI reduction, using validated, | risk-adjusted local data to drive prevention activities, and it | adds to existing evidence supporting this HAI prevention | strategy.2 | " | 4 | To help ensure an accurate understanding of the | current landscape of HAI-reporting infrastructures that can | contribute to such reductions, we would like to clarify that | the National Healthcare Safety Network (NHSN) can, and in | some states does, also function much as DICON does to | provide complete, validated, risk-adjusted data for local action, with the distinction that funding for NHSN and, particularly, validation requires public support, whereas DICON | is funded directly by the facilities it serves. We disagree with | the authors' statement that NHSN data are "obtained from | convenience samples (ie, are not complete), are not validated, | and are not fed back to individual hospitals in a timely fashion," for the following reasons. While it is true that not all | US hospitals report HAIs to NHSN and participation in | NHSN is still voluntary in some states, increasingly it is being | used as a platform for state mandatory reporting of HAIs (23 | states and the District of Columbia as of July 2011). Also, | beginning in January 2011, NHSN became the reporting tool | for central line-associated bloodstream infections in hospitals | with intensive care units that participate in the Hospital Inpatient Quality Reporting Program of the Centers for Medicare and Medicaid Services (CMS).5 | The result is that now | more than 4,200 of the 5,800 hospitals in the United States | belong to NHSN and are reporting data continuously on a | variety of HAIs, with central line-associated bloodstream infections and surgical site infections being the most common | focus of surveillance and reporting. Therefore, we believe that | as currently constituted, NHSN has become representative of | US hospitals for certain HAI types, and future expansion is | likely |
Improving risk-adjusted measures of surgical site infection for the National Healthcare Safety Network
Mu Y , Edwards JR , Horan TC , Berrios-Torres SI , Fridkin SK . Infect Control Hosp Epidemiol 2011 32 (10) 970-86 BACKGROUND: The National Healthcare Safety Network (NHSN) has provided simple risk adjustment of surgical site infection (SSI) rates to participating hospitals to facilitate quality improvement activities; improved risk models were developed and evaluated. METHODS: Data reported to the NHSN for all operative procedures performed from January 1, 2006, through December 31, 2008, were analyzed. Only SSIs related to the primary incision site were included. A common set of patient- and hospital-specific variables were evaluated as potential SSI risk factors by univariate analysis. Some ific variables were available for inclusion. Stepwise logistic regression was used to develop the specific risk models by procedure category. Bootstrap resampling was used to validate the models, and the c-index was used to compare the predictive power of new procedure-specific risk models with that of the models with the NHSN risk index as the only variable (NHSN risk index model). RESULTS: From January 1, 2006, through December 31, 2008, 847 hospitals in 43 states reported a total of 849,659 procedures and 16,147 primary incisional SSIs (risk, 1.90%) among 39 operative procedure categories. Overall, the median c-index of the new procedure-specific risk was greater (0.67 [range, 0.59-0.85]) than the median c-index of the NHSN risk index models (0.60 [range, 0.51-0.77]); for 33 of 39 procedures, the new procedure-specific models yielded a higher c-index than did the NHSN risk index models. CONCLUSIONS: A set of new risk models developed using existing data elements collected through the NHSN improves predictive performance, compared with the traditional NHSN risk index stratification. |
National Healthcare Safety Network (NHSN) report, data summary for 2009, device-associated module
Dudeck MA , Horan TC , Peterson KD , Allen-Bridson K , Morrell GC , Pollock DA , Edwards JR . Am J Infect Control 2011 39 (5) 349-367 This report is a summary of Device-Associated (DA) module data collected by hospitals participating in the National Healthcare Safety Network (NHSN) for events occurring between January and December 2009 and reported to the Centers for Disease Control and Prevention (CDC) by October 18, 2010. This report updates previously published DA module data from the NHSN and provides contemporary comparative rates.1 Procedure-Associated module data will be reported separately. Surgical site infection data will be reported as standardized infection ratios using new logistic regression models, and postprocedure pneumonia rates for 2009 are available on the NHSN's public Web site. This report complements other NHSN reports, including national and state-specific standardized infection ratios for selected health care–associated infections (HAIs).2, 3, 4 | The NHSN was established in 2005 to integrate and supersede 3 legacy surveillance systems at the CDC: the National Nosocomial Infections Surveillance system, the Dialysis Surveillance Network, and the National Surveillance System for Healthcare Workers. NHSN data collection, reporting, and analysis are organized into 3 components—Patient Safety, Healthcare Personnel Safety, and Biovigilance—and use standardized methods and definitions in accordance with specific module protocols.5, 6, 7 The modules may be used singly or simultaneously, but once selected, they must be used for a minimum of 1 calendar month. All infections are categorized using standard CDC definitions that include laboratory and clinical criteria.7 The DA module may be used by facilities other than hospitals, including long-term care facilities and outpatient dialysis centers. A report of data from this module for outpatient dialysis centers has been published separately.8 For this report, only data from the Patient Safety component are presented. NHSN facilities report their HAI surveillance data voluntarily or in response to state mandatory reporting requirements. The CDC aggregates these data into a single national database for the stated purposes in place in 2009, as follows: | • | Collect data from a sample of US health care facilities to permit valid estimation of the magnitude of adverse events among patients and health care personnel. | • | Collect data from a sample of US health care facilities to permit valid estimation of the adherence to practices known to be associated with prevention of these adverse events. | • | Analyze and report collected data to permit recognition of trends. | • | Provide facilities with risk-adjusted metrics that can be used for interfacility comparisons and local quality improvement activities. | • | Assist facilities in developing surveillance and analysis methods that permit timely recognition of patient and health care worker safety problems and prompt intervention with appropriate measures. | • | Conduct collaborative research studies with NHSN member facilities (eg, describe the epidemiology of emerging HAIs and pathogens, assess the importance of potential risk factors, further characterize HAI pathogens and their mechanisms of resistance, and evaluate alternative surveillance and prevention strategies). | | The identity of each NHSN facility is kept confidential by the CDC in accordance with Sections 304, 306, and 308(d) of the Public Health Service Act [42 USC 242b, 242K, and 242m(d)]. |
National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009
Edwards JR , Peterson KD , Mu Y , Banerjee S , Allen-Bridson K , Morrell G , Dudeck MA , Pollock DA , Horan TC . Am J Infect Control 2009 37 (10) 783-805 This report is a summary of Device-Associated (DA) and Procedure-Associated (PA) module data collected and reported by hospitals and ambulatory surgical centers participating in the National Healthcare Safety Network (NHSN) from January 2006 through December 2008 as reported to the Centers for Disease Control and Prevention (CDC) by July 6, 2009. This report updates previously published DA and PA module data from the NHSN.1 | The NHSN was established in 2005 to integrate and supersede 3 legacy surveillance systems at the CDC: the National Nosocomial Infections Surveillance (NNIS) system, the Dialysis Surveillance Network (DSN), and the National Surveillance System for Healthcare Workers (NaSH). Similar to the NNIS system, NHSN facilities voluntarily report their health care–associated infection (HAI) surveillance data for aggregation into a single national database for the following purposes: | • | Estimation of the magnitude of HAIs | • | Monitoring of HAI trends | • | Facilitation of interfacility and intrafacility comparisons with risk-adjusted data that can be used for local quality improvement activities | • | Assistance to facilities in developing surveillance and analysis methods that permit timely recognition of patient safety problems and prompt intervention with appropriate measures. | | In addition, many facilities use these same data to comply with state reporting mandates. Identity of all NHSN facilities is kept confidential by the CDC in accordance with Sections 304, 306, and 308(d) of the Public Health Service Act [42 USC 242b, 242k, and 242m(d)]. |
Trends in incidence of late-onset methicillin-resistant Staphylococcus aureus infection in neonatal intensive care units: data from the National Nosocomial Infections Surveillance System, 1995-2004
Lessa FC , Edwards JR , Fridkin SK , Tenover FC , Horan TC , Gorwitz RJ . Pediatr Infect Dis J 2009 28 (7) 577-81 BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly being reported to cause outbreaks in neonatal intensive care units (NICUs). We assessed the scope and magnitude of MRSA infections with disease onset after 3 days of age (late-onset MRSA infections) in NICUs. METHODS: We analyzed data reported by NICUs participating in the National Nosocomial Infections Surveillance system from 1995 through 2004. For each surveillance month, all healthcare-associated infections as defined by National Nosocomial Infections Surveillance criteria were reported, along with antimicrobial susceptibility patterns of the isolates. We pooled the data from all NICUs by birth weight category and calendar year. Poisson regression was used to assess changes in incidence of late-onset MRSA infections per 10,000 patient-days. RESULTS: Overall, 149 NICUs reported 4831 S. aureus infections and 5,878,139 patient-days. Methicillin testing data were available for 4302 S. aureus isolates, of which 975 (23%) were MRSA. Incidence of late-onset MRSA infection per 10,000 patient-days, combining all birthweight categories, increased 308% from 0.7 in 1995 to 3.1 in 2004 (P < 0.001). A significant increase in incidence of MRSA infections was observed among all 4 birthweight categories analyzed separately (<or=1000 g, 1001-1500 g, 1501-2500 g, and >2500 g). The distribution of MRSA infection by type of infection did not vary during the study period; 299 (31%) of MRSA infections were bloodstream infections, 174 (18%) were pneumonia, and 161 (17%) were conjunctivitis. CONCLUSION: The incidence of late-onset MRSA infections increased substantially between 1995 and 2004, indicating a need to reinforce infection control recommendations and to explore potential sources and routes of transmission. |
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