BACKGROUND: The Tennessee Department of Health (TDH) requires acute care hospitals to report central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) in intensive care units and medical, surgical, and medical-surgical ward locations to the National Healthcare Safety Network (NHSN). TDH distributes monthly reports to facilities regarding NHSN data quality and completeness as well as quarterly reports summarizing HAI performance. However, until 2016 TDH did not systematically review CLABSI or CAUTI data to identify potential clusters of infections.
METHODS: Using SAS 9.4, NHSN data were analyzed to identify potential clusters of infections and organisms at the unit-level, location type (ICU vs. ward), and facility-level. For each potential cluster, a report was generated including a table summarizing monthly data for the location, the CAUTI/CLABSI rate, organisms isolated, and a visual display of the CAUTI/CLABSI rate, compared to the facility-wide and statewide CAUTI/CLABSI rate over the previous 12 months. Twice a month, the reports are reviewed by HAI staff to identify significant clusters of infections and distributed to the hospital when follow-up is warranted. After sharing the report with the hospital, follow-up is conducted via email or phone.
RESULTS: Since implementing the reports in October 2016, 28 potential clusters have been identified. Of the potential clusters, 22 were reviewed and determined to not require any follow-up with the facility. Generally, these are situations with a single-month increase, followed by several months with no additional infections. Six reports were shared with the hospital infection prevention staff and follow-up was conducted. In one case, follow-up was conducted via phone call with infection prevention staff where TDH provided consultation and additional prevention resources to the hospital. In all 6 cases, the infection prevention staff were already aware and addressing the increase in infections.
CONCLUSIONS: While in the early stages of implementation, these reports provide a method of monitoring NHSN data on a regular basis to identify potential clusters of infections or organisms. There are opportunities to refine the method of cluster detection, but the format of the report, including a visual comparison of performance across the hospital and appropriate statewide comparison has received very positive feedback from hospitals. Hospitals appreciated external review of their NHSN data and the additional resources offered. This process has also given TDH an opportunity to strengthen our relationship with hospitals and improve communication regarding suspected HAI clusters and outbreaks.