![[ Visit Client Website ]](images/banner.png)
BACKGROUND: An estimated 37,000 central line-associated bloodstream infections (BSI) occurred in the U.S. among patients receiving outpatient hemodialysis (OHD) in 2009. The Tennessee Department of Health (TDH) required reporting of dialysis events (DE) to the National Healthcare Safety Network (NHSN) from all Tennessee OHD facilities starting in October 2012. In response to delayed notification of an outbreak at a single facility in 2013, TDH developed an automated program to detect potential organism-specific clusters at the facility level.
METHODS: NHSN DE surveillance requires the reporting of every intravenous antimicrobial start, positive blood culture (with organism and its resistance pattern), and any pus, redness, or swelling at the vascular access site among patients from each OHD facility in Tennessee. An automated batch file is scheduled monthly using SAS 9.3 to convert the most recently downloaded NHSN DE linelisting into a formatted file that is automatically imported, standardized, and analyzed using a suite of free software known as the WHONET Workshop (including WHONET 5.6 and BacLink). Output from WHONET 5.6 allows for rapid review by TDH staff of organism-specific clusters at the facility level.
RESULTS: Two potential BSI clusters were identified from two facilities in Tennessee in May and June 2013 (Staphylococcus aureus at Facility A and Staphylococcus epidermidis at Facility B). Facility A reported 12 central venous catheter (CVC)-associated infections in May and June of 2013 when only one had been reported in the prior 6 months. Facility B reported 16 CVC-associated infections through March-July 2013, with 10/16 (62.5%) attributable to S. epidermidis. In coordination with End Stage Renal Disease (ESRD) Network 8, TDH hosted a conference call with facility leadership to discuss the cluster and identify any gaps in infection prevention. Discussion identified data entry errors and issues with catheter care as potential sources of the increase. The total and rate of infections at each facility decreased after each conference call.
CONCLUSIONS: The ability to automate SAS and WHONET procedures allows TDH staff to produce a monthly report summarizing potential BSIs by organism and facility over time in an easy to read format. A low subjective threshold can be applied to the interpretation of the WHONET report to review additional facility-specific NHSN data and determine whether further investigation is warranted. This action further strengthens the collaboration between TDH, ESRD Network 8, and the OHD community in the prevention of DE in Tennessee.