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HAI Subcommittee Call NotesTuesday, May 15, 2018 center41910003:00PM – 4:30PM ETAgenda:Roll Call85 AttendeesCMS Payment Update – Jeremy GoodmanTwo reference documents emailed out. One is a breakdown on changes to proposed rule. The other are some internal analysis – how this may affect certain states. CMS Initiatives - Patient Over Paperwork Initiative and Meaningful Measures Initiative: Over past year, CDC has worked with CMS – ensure quality reporting measures, improve patient safetySome recent changes, proposed rule for hospital payment system for improved care, inpatient rehabilitation facilities, PPS-exempt cancer hospitalsIdea of streamline quality reporting measures for CMS meaningful measures initiative – determine which settings most appropriateReducing reporting burden, improving antibiotic use, overall improving patient safetyA lot of changes in proposed rule: include restructuring how hospital patient quality reporting system, hospital purchasing system, hospital reduction systemReduce duplicate while maintaining HAI reporting for five main infections Administrative change – those originally part of hospital purchasing program moved. Facilities still required to report infections, CMS recommendations continue.Additional rules – exempt cancer hospital and LPAC.Remove MRSA bacteremia as part of inpatient rehabilitation quality reporting program – due to low quality reporting. These are just proposed changesAcute care hospitals: infections stay the same. Move from value-based purchasing program to HAC program. Change the penalty and performance payments provided to facility. Doesn’t change what needs to be reported from acute care hospitals.PPS exempt cancer hospitals: still required to report surgical side infections MRSA and C. Diff but no longer CLABSI and CAUTI data.LTACs – remove MRSA. Still CLABSI, CAUTI, and C. DiffInpatient Rehabilitation Facilities (IRFs): remove MRSA. Still report CAUTI and C. DiffSome of the reasoning of proposed numbers – not sufficient numbers historically. Is that also for why changes for acute care and long-term care?Mainly for LTACS and IRFs. The exact terms – the burden of reporting may outweigh benefits of dataLTACs – ventilator associated events no longer reported? Yes trueMoving to the HAC program, will there be any changes in how calculated or run. Conditions reported as part of sufficient quality program, failure to report had penalty as well. Some facilities just take penalty rather than report. Has that been considered? What mechanisms?Haven’t reviewed that section – not sure. We would review that. All the administrative required moved to HAC, likely that was one of the requirements moved.Could describe more the proposed public reporting of hospital-specific data in 2019?Discussing the potential changes to what would be publicly reported in 2019. Changes the timing of that – administrative aspect. Would be moved into HAC. Basically, outlines that.HAC calculated every two years rather than every year with the value-based.What proportion of the HAC calculated NHSN? Not just that – there’s others.Changed a lot of the weighting. Most included in HAC is going to be in NHSN as well at ARHQ PSI-90 patient safety measure.Basically, outline in proposed rule change. Idea of HAC of where all patient safety events contained. Shifting some of the value-based purchasing, quality/dollar spent. Inpatient - more of the day-to-day.Believe would raise penalties up to 2%Based on our review of it, looks like for most states, it wouldn’t be an exact issue. One might be – Arkansas – inpatient quality reporting program. Caveat – or successor – could argue moving to HAC program account for that. In general, most say per CMS requirements. Shouldn’t have large effect on acute care hospitals. Marion, if they’re basing these changes off numbers, is it the time to write comments about surgical side infection reporting for colon and hysterectomy – don’t find those valuable for our state. Something for us to consider. Originally, position statement, now policy briefComments due to CMS (federal register): June 24-25, depending on rule Our reporting regulations also say acute care hospitals need to report per CMS inpatient quality reporting. That’s actually in our law. Will need to go all the way back to code – which would be hard to make the change. Considering making administrative change anyways. It will probably take a couple of years to change. Would consider working with state to change. Best channel to change. Would make general counsel aware.Recommend submit comment or plan change? Would do bothDepending on how many states impacted, may want to make comment on behalf of CSTE. States particularly impacted, would make comment.Reporting rule IPPS rule – would be broader. Since HAC is part of IPPS, should be fine. Additional questions aboutNHSN or HAI reporting should be directed to Jeremy The rule should be directed to the CMS channels provided on websiteUpdate from CDC on Hepatitis C reporting from Dialysis Facilities – Nicole GualandiNicole Gualandi – infection preventionist at CDC DHQP.More of a request. Been getting through that nephrologist transforming dialysis safety group increased outreach to dialysis facilities and nephrologists. Been getting notices about trouble reporting Hepatitis C seroconversions (potentially healthcare-related) due to variability of programs in local and state health department.See if could provide some general language or something to tell them exact who and what to report to. There are the nationally notifiable definition, but not always reported to CDC. A lot of confusion in facilities. NCDS has been working on an algorithm to help reduce some confusion. May bring to group in near future. Some thoughts – some general language of what to provide to facilities and who to report to. For Hep C alone or also Hep B? Focus mostly on Hep C right now – most acute need, see the mostIf they get what appears to be a seroconversion, who was in the state or PH jurisdiction need to notify? Confusion of centralized vs. decentralized. Some go to communicable disease. Coming up with some general guidance. Maybe if there’s some examples of language – sent to us. Or someone can tell us what those areCurious to hear – would HAI program or Hep C be involved?Nebraska: for us HAI coordinator, but work closely with Hepatitis group, could send languagePossibility to have a way for dialysis facilities to have a notifiable disease poster in general? Just in general, have seen that they don’t have one. I think that’s a great idea. Something talked about before. Create specifically for dialysis facilities or give them typical poster – large with all reportable diseases – the large poster.Those in workgroup looking for one process that could work for every state. Each state functions in different way, not everyone same. Probably why getting a lot of calls, correct?Because of work been doing and outreach, this is going to forefront. Folks want to do right thing, but so variable from state to state. Feel like calling the wrong people.Want to make this as easiest as possible to folks in facilities. Seems that if report to local or state health department, in our state, would get to the right place. There’s also a Hep C subcommittee, would be helpful to run by them as well. Could consider in absence of having any other knowledge, could direct to HAI coordinator, then could direct to Hepatitis if appropriate. What would people think? In MA, people have good idea who to report to, good process. Hesitate about changing. Some of the problem.Have 1-800 line and people know how to direct things. As HAI coordinator, don’t want to direct traffic, rather have the line direct traffic.Our HAI program – we work with but not with communicable disease. Home-rule state. There’s general reportable diseases list but then also some specific reporting requirements based on facility type. Wondering if CSTE – could we map out the reportable diseases list. There is some work in progress to say which disease reportable in each state called the Reportable Conditions Knowledge Management System (RCKMS). Right now, no clear simple solution for you.NCDS trying to get own database – own map. Position Statement Update – Marion KainerOne on Candida auris. Should have latest iteration attached to the email Michael had sentHas been quite a significant amount of wordsmithing – to make clearer. Not many changes to contentLast year – standardized case definition of Candida auris. Because change of performance characteristics of certain diagnostic tests, update certain position statements. Asked Candida auris be made nationally notifiableHave 3 types of laboratory criteria: confirmatory, presumptive, supportiveConfirmatory: if actual got it, culture or culture-independentPresumptive: from a warm body siteSupportive: basically, three items: Candida haemulonii (from a wound maybe) or from organism that commonly represents Candida identification or have an isolate that is – try to speciate but could not speciate (part of lab evidence, need to double check)Four types of epi linkagesSame household, same healthcare facility, healthcare facility that commonly shares patients, have overnight stay in healthcare facility with documented C. auris Case classification: divided up into clinical and screening cases. Based on whether or not – intent of taking culture.If take urine because concerned about UTI, then isolate C. auris, then counted as clinicalIf did urine to enhance surveillance, then screening caseIf don’t have additional informationurine and respiratory – clinicalskin swab or rectal – screening Clinical sampleConfirmed: confirmed laboratory from clinical specimenProbable: with presumptive lab with epi linkageSuspect: presumptive and no epi, supportive lab and epi linkageCandida auris screening: very similar to clinicalNo epi linkageConfirmed: confirmed labProbable: presumptive labSuspect: supportive labImmediately notifiable (to CDC) - never identified in jurisdiction beforehand, not known as recognized ongoing transmission, completely new or unrecognized cluster or outbreakRoutinely notifiable – ongoing transmission, known outbreak (then not within 24 hours report)Tracked changes and some clarifications in webinar last week. Urine – may represent colonization, but the way organized – specimen collectionUnder reporting – this criteria is sufficient to report case – states isolates from species when species-specific identification cannot be made. Will result in a lot.Only in case you try (attempt) to speciate but couldn’t – may try to make this clearerWould appreciate any recommendations on wordingDo we want to account for isolate submission or supportive lab evidence for urine isolates that are refractory to azol therapy?May want to go and include in what is reportable – please send emailWill be presenting PS at all states epi call Welcome any other suggestionsEncourage subcommittee members to speak to state epidemiologists to support this position statementAppendix I: looks like there are specific findings with specific methods that would also need to be in the criteria. Some thought in operationalizing that? This is something – is there a way to simplify this? Very rapidly moving field. The reason why we took these items out of the position statements and put them into the appendix, so we can update this. As manufacturers update software, this will be updated. This may change. Second and third column – might come true – this overlap. All the clinical suspected on the righthand side. The information in the appendix – determine whether you should send it in the first place – what appendix is about. Is it this specific? How specific do you want people to be when you write logic?Mainly a case of – your instrument can’t recognize, then need to send in for characterization. You want to look at that isolate. Trigger for isolate submission. CSTE UpdatesCatherine Staes Activity Update (5 minutes)Work on the RCKMS team and worked on HAI tasks as consultant.Provide feedback in ballot comments for HL7 standards related for HAI. Comments due about a week agoThere were two HL7 standards – standards defining that information needs to be collected from clinical systems to NCHS. There are two standards. The one standard is fire-related standard – new one proposed in order to implement from the health systems to NCHS using fire standards (new way to pull data from EHR and report that way). In the very early stages – only reporting for late onset meningitis onset. Going through process of setting it up – what does/doesn’t. Initial ballot for that.Review of standard – everything looked good. Minor issues formatting and typos. A couple of instances where there were terminology that wasn’t quite right. They’ll be reviewing comments on that. Something that will be happening in the future.Other ballot – CDA ballot. Standard for HL7 reporting. They didn’t update the whole implementation guide – certain sections. Reviewed part of it. Looked pretty good. Needed to fix – related to the wrong text for the wrong code. Reviewing the comments. Reviewing the implementation guide. Been listening in to the calls related to the CDA work that’s been going on for position statement related to interfacility HAI controls. Pathogens across healthcare settings. Asked to review ballots but work hasn’t progressed enough to review. It’s progressing along. Right now, they’re really addressing issue of how much content to put in report. One of the major things that will come out of work – to enhance the laboratory information that is included in the template for the CDAs. This project will hopefully lead to template – same kind of reporting.This is the 2016 position statement. Any requirements put into place on interfacility transfer, from federal level?For long term care facilities, requirementsCurrently for acute care hospitals, there’s a proposed rule, but not final rule from CMS that specifies from information needed provided from communicated providers. This information has to be communicated in some way. Anyone representing CSTE and clinical on the call?Idea behind workgroup – automated instead of printed form. Also but automating, can pull out a bit more information. The really technical parts are not my forte but bringing to point, the priorities that should be on the first page. Then, there would be additional information on fingertips.Trying to figure out if should put state mandate in place – but don’t want to if there will be a federal mandate.Preliminary discussions – really don’t knowDrug Diversion Toolkit Update – Michael AndersonWe’re on our way to completing it. Have toolkit completed or close to completed draft – by CSTE conference. There will be a roundtable and will send out an email. In the process of having substance abuse folks and disease intervention specialists review the toolkit. Will have workgroup review as well. DAPS Toolkit Evaluation – Complete by Friday, June 8th, 2018Have been working on for a while, announce in April. Included a link for the evaluation – in email as well as the agenda. Evaluation is geared towards helping us understand how state/local health departments and other organizations using toolkit.Ask that one person from each health department fill out the evaluation.June 8 – have time to look at results and talk about it at the CSTE conference.Please reach out to Zhi for any questions.CSTE Annual Conference Workshop: Request for NHSN related questions – Complete by Friday, June 1st, 2018 Planning to have sessions related to NHSN In terms of what’s distributed to attendants – still draftingKnow we had something more detailed than the paragraph blurb. Almost have the draft agendaFirst, workshop from 9-5pm. Session 1 hr 15 min focused on training – one on public health workforce (resources and needs), component for healthcare provider trainingNext main session – tabletop exercise - outbreak. A number of folks on response team organizing.20 min session of NHSN updates. Followed by 20 min to review the main meeting and the HAI content. Session that will talk about some containment issues – focused on acute care.3-4pm: session on building effective and collaborative relationships. These are all focused on table-level discussions. Organized in tables – state, city, local health departments. Other option – healthcare regulators. May be able add couple of tables – effective epi lab relationships.4pm: NHSN novice users session (optional)Qualtrics form for any questions beforehandDHQP expert – running side conversations – focus group. How we do performance metrics. Could be a step towards informing that.About 140 registrantsWill send out agenda out beforehand, also available on the CSTE conference applicationOpen Mic ................
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