BACKGROUND: A coordinated approach to public health surveillance is necessary to prevent the spread of healthcare-associated infections (HAIs); however, much work is needed to increase the availability of standardized surveillance data from non-acute healthcare settings. To address this surveillance gap, the National Healthcare Safety Network (NHSN) Long-Term Care (LTC) module was released in 2012 to track HAIs within long-term care facilities. In 2016, the District of Columbia (DC) implemented a new regulation mandating skilled nursing facilities (SNFs) to report Clostridium difficile infections (CDI) and selected MDROs to the Department of Health (DOH) through NHSN. Implementing this regulation requires in-depth training and supervision of surveillance practices by the SNFs as they learn to navigate and correctly report. Lessons learned during a pilot round of trainings will be used to improve and customize trainings for the remaining facilities.
METHODS: DC DOH presented the updated regulations to the DC Healthcare Association (DCHCA), which represents the 18 DC SNFs, and partnered with Delmarva Foundation (DF), the DC quality improvement organization (QIO), to conduct a pilot NHSN training. DF recruited five SNFs to participate in online trainings twice a month between September and November 2016. These webinars highlighted the importance of surveillance and the benefits of NHSN, and provided step-by-step enrollment instructions. DF led the webinars, using slides from CDC and DF, and DC DOH assisted. Each SNF was assigned a mentor from DF or DOH who provided additional one-on-one assistance. Mentors conducted on-site visits to assist facilities with unit mapping and conferring of rights.
RESULTS: New reporting requirements and the use of NHSN was well received by the SNFs. Five SNFs were enrolled in NHSN by the end of November 2016, and four completed facility mapping in December 2016. Major challenges identified during the onboarding process were: 1) fully understanding the technical specifications for NHSN (i.e., using the correct internet browser); 2) lack of familiarity with seemingly basic logistical tasks, such as where to find a notary public for identity verification; 3) the need for one-on-one assistance for initial NHSN navigation and facility survey completion and 4) mapping patient care units that have dynamic patient populations.
CONCLUSIONS: Successful implementation of the NHSN LTC module requires personalized and proactive hands-on technical support to ensure all facilities understand the fundamental principles of standardized infectious disease surveillance. These lessons can help inform other health departments implementing surveillance in long-term care facilities to help contain the spread CDI and MDROs.