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COVID-19: NHSN Response, 6/04 · The SHEA Podcast

• 0:08
  SPEAKER_00: Welcome to the Rapid Response Podcast, brought to you by the Society for Healthcare Epidemiology of America, today, promoting the prevention of healthcare-associated infections and antibiotic resistance and seeking to advance the fields of healthcare epidemiology and antibiotic stewardship.
• 0:22
  SPEAKER_00: I am Dr.
• 0:22
  SPEAKER_00: David Bannock from the University of Connecticut School of Medicine and will serve as today's podcast moderator.
• 0:28
  SPEAKER_00: Discussion on the podcast does not reflect state perspective, but rather facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:37
  SPEAKER_00: Today is excited to launch the 16th episode of this podcast series, COVID-19 updates, what we know now.
• 0:43
  SPEAKER_00: Our speaker today is Dr.
• 0:44
  SPEAKER_00: Andrea Bennin, the Deputy Chief of the Surveillance Branch of the Vision of Healthcare Quality Promotion at the CDC.
• 0:52
  SPEAKER_00: And Dr.
• 0:53
  SPEAKER_00: Bennin has a leadership role in the National Healthcare Safety Network today's largest book to use the online surveillance system for tracking healthcare system infections.
• 1:01
  SPEAKER_00: That's what we'll be discussing in today's episode.
• 1:04
  SPEAKER_00: Thank you for joining us today.
• 1:05
  SPEAKER_00: I'd like to get us started with a brief news and guidance update from this week.
• 1:09
  SPEAKER_00: So at this point, in the total number of cases of COVID-19 in the US as of today, there were 1.8 million total cases of COVID-19 in the United States and 106,202 deaths.
• 1:24
  SPEAKER_00: In terms of recent publications, there was a publication this past week in the Lancet, which was a systematic review and meta-analysis performed by two et al.
• 1:35
  SPEAKER_00: which included 172 observational studies across 16 countries and six continents, essentially evaluating the effect of physical distance, face mask, and eye protection on virus transmission in healthcare and non-healthcare funded settings.
• 1:50
  SPEAKER_00: And that included multiple different coronaviruses, including SARS-CoV-2, SARS, and MERS.
• 1:57
  SPEAKER_00: And what this study found was that there were several factors associated with reduced transmission of viruses.
• 2:04
  SPEAKER_00: These included physical distancing of one meter or more compared to physical distancing of less than one meter, protection using a face mask compared to no face mask use, protection from using an N95 or similar respirator compared to no respirator use and the use of eye protection.
• 2:25
  SPEAKER_00: All these factors were found to be associated with a lower rate of virus transmission.
• 2:31
  SPEAKER_00: It's important to note that there were no studies that included a direct comparison between N95 respirator versus mass use.
• 2:39
  SPEAKER_00: In other news, I recently issued two statements.
• 2:44
  SPEAKER_00: One announcement urged President Trump to reconsider his decision to terminate the U.S.
• 2:48
  SPEAKER_00: relationship with the WHO, emphasizing that elimination of the U.S.
• 2:53
  SPEAKER_00: involvement in WHO will leave our country and the world more vulnerable to infectious cases at a time when a comprehensive and coordinated international response is more important than ever.
• 3:22
  SPEAKER_00: I would encourage you to go to the Shay website to view these statements in their entirety.
• 3:29
  SPEAKER_01: Great.
• 3:29
  SPEAKER_01: Thank you, David.
• 3:30
  SPEAKER_01: And thank you so much for having me here today.
• 3:34
  SPEAKER_00: So I was hoping you might be able to provide us with a bit of the background on why CDC added this COVID NHSN module.
• 3:42
  SPEAKER_01: Our mission at NHSN is around patient safety, as you well know.
• 3:48
  SPEAKER_01: And as you might imagine, if you're the kind of person and the kind of doctor who works at CDC, you're the kind of person who spent most of January and February completely glued to the news.
• 4:00
  SPEAKER_01: So I had personally reached the point as the epidemic was evolving in Wuhan reading the New York Times and the Washington Post multiple times per day, probably more times than is advisable for anybody's sanity.
• 4:13
  SPEAKER_01: But again, as you might imagine, as we were all watching that, and if you're the kind of public health person who's dedicated their career to patient safety and to infection prevention, you pay a lot of attention to the stories in that setting about what was going on in the hospitals in Wuhan.
• 4:27
  SPEAKER_01: And we had been watching those news stories very carefully.
• 4:32
  SPEAKER_01: And as the listeners, I'm sure, will remember, they were pretty eye-opening and pretty frightening.
• 4:38
  SPEAKER_01: So we were sitting in an NHSN branch leadership meeting saying to each other, what should we be doing?
• 4:45
  SPEAKER_01: We can see this coming.
• 4:46
  SPEAKER_01: And if it comes in the way that it looked like it might from Wu-Con, the scenes in the hospitals could really be out beyond anything that any of us had seen or imagined.
• 4:57
  SPEAKER_01: So our reason for being at NHSN is to provide highly rigorous surveillance data in order to support patient safety and improvements in care.
• 5:10
  SPEAKER_01: So NHSN has never been in the field of preparedness, right?
• 5:13
  SPEAKER_01: Preparedness and hospital preparedness and emergency preparedness is a field in and of itself.
• 5:18
  SPEAKER_01: And we knew that there would be some states that would have really great infrastructure for hospital data in the setting of preparedness.
• 5:25
  SPEAKER_01: And we were familiar with some of what some of the states had, but we also knew that other states might appreciate NHSN being able to help out with data.
• 5:32
  SPEAKER_01: And so we started to develop what we thought would be the relevant questions in this preparedness space around hospitals and the impact on hospitals with an eye to what mattered for patient safety and infection prevention in that setting.
• 5:46
  SPEAKER_01: We used our experience with data and surveillance, and we used our experience from working in hospitals, and we reached out to our stakeholders, hospital infection preventionists and states, to pilot and to test some questions and to give us feedback on what might be useful.
• 6:03
  SPEAKER_01: And on top of it, one of the really important issues that we wanted to address would be the need for having a national lens into how hospitals were impacted by the pandemic.
• 6:15
  SPEAKER_01: So while states may have individual lenses, we knew that there would be a need to have a standardized approach across the country to be able to understand what was happening in hospitals and develop that national lens.
• 6:29
  SPEAKER_01: So as we got close to being ready to launch something, we actually got a call from the main CDC person who was working with the response in Washington, D.C.
• 6:39
  SPEAKER_01: and asking if we might actually be able to collect some hospital capacity data.
• 6:43
  SPEAKER_01: And there we were.
• 6:44
  SPEAKER_01: We were ready to go live, as it were.
• 6:47
  SPEAKER_01: And now leadership in the response was actually starting to ask those questions.
• 6:51
  SPEAKER_01: And so we went live at the end of March with our first pathway covering patient impact and hospital capacity.
• 6:59
  SPEAKER_01: On top of that, we felt very passionate about protecting frontline workers.
• 7:06
  SPEAKER_01: Many of the frontline workers are our friends, family, and colleagues as well.
• 7:11
  SPEAKER_01: And so we felt very strongly that if there was a role we could play in providing data that could support getting the frontline what they needed as far as supplies, that we should look into what that role would be.
• 7:25
  SPEAKER_01: Our world is the world of infection prevention, as listeners well know, and infection prevention and PPE.
• 7:31
  SPEAKER_01: And we have always lived in the situation where getting people to wear PPE and to wear it properly is the hard part, not this question of were we even going to have enough.
• 7:41
  SPEAKER_01: And adding that to the idea that we might end up in a situation where frontline workers and friends of ours might not have what was needed to care for others safely really heightened our ability to ensure that NHSN was helpful in the setting of this emerging pandemic.
• 7:58
  SPEAKER_01: So we decided that if NHSN could add information to the response about what facilities needed, then we should also collect that information both because of the impact on patient safety and transmission in the hospital, but also, of course, to address the issues of provider safety.
• 8:15
  SPEAKER_01: So we had subsequently then gone live with the supplies and staffing pathways within the COVID-19 module that exists within NHSN.
• 8:28
  SPEAKER_01: Those modules were amplified by a letter from Vice President Pence on March 29th, encouraging submission of the COVID-19 data.
• 8:39
  SPEAKER_01: And then subsequently on April 10th, Secretary Azar sent another letter to hospital administrators again, urging them to submit the COVID-19 data to the federal government.
• 8:50
  SPEAKER_00: That's great.
• 8:51
  SPEAKER_00: Now I think the ability to harness a robust national surveillance system like NHSN is really, you know, such a critical piece of our response.
• 9:00
  SPEAKER_00: I think it's terrific that that was brought to the forefront.
• 9:03
  SPEAKER_00: Now, you mentioned that the rollout was in March.
• 9:06
  SPEAKER_00: Can you kind of walk us through the process of how this module evolved and sort of what the uptake has been like amongst acute care facilities?
• 9:14
  SPEAKER_01: So NHSN is the largest surveillance system for hospital-associated conditions in the country and has been in existence since about 2005.
• 9:24
  SPEAKER_01: NHSN includes regular reporting by about 25,000 healthcare facilities.
• 9:30
  SPEAKER_01: And that number has actually, over the course of the past month, gone up to about 38,000 facilities over the part of this where we've been starting to enroll long-term care facilities.
• 9:42
  SPEAKER_01: And the NHSN has always had detailed data definitions and a rigorous approach to developing metrics and has had robust technical and user support infrastructure so that data could be used for public health and quality improvement.
• 9:58
  SPEAKER_01: One of the great benefits of NHSN and the work that the team has done over all of these years is that because of the rigorous standards and rigorous hospital-acquired condition measurement, CMS has used these metrics for their payment programs.
• 10:15
  SPEAKER_01: And because of that, we have had near complete reporting by hospitals into NHSN over the years.
• 10:23
  SPEAKER_01: And so we knew that we could reach most, if not all, of the acute care hospitals in the country with our surveillance system and that they would all also be familiar with how to use NHSN.
• 10:36
  SPEAKER_01: And so we were able to start with that space.
• 10:39
  SPEAKER_01: And from there, you know, we started with measuring the numbers of patients with COVID-19 who were hospitalized at any given time, as well as the available beds, ICU beds, and ventilators and the percentages of COVID-19 patients using those resources.
• 10:58
  SPEAKER_01: And we were able to launch that initially.
• 11:02
  SPEAKER_01: And then a few weeks later, we were able to launch monitoring the shortages of healthcare personnel and of personal protective equipment in order to be able to add that to round out the surveillance.
• 11:16
  SPEAKER_01: So it was really the combination of having, as you said, a long-standing established surveillance system that was in place where we had a way to reach hospitals and then being able to combine that with bringing in the additional data that would be valuable.
• 11:33
  SPEAKER_01: We currently are in a situation where there are about 3,500 facilities that report data on a daily basis, which represents for us about 61%, 60 or 61% of the acute care facilities in the country.
• 11:48
  SPEAKER_01: And we're using that out of the facilities that we have registered in NHSN to make those calculations.
• 11:55
  SPEAKER_00: So that's great.
• 11:56
  SPEAKER_00: Thanks for walking our listeners through that evolution.
• 11:59
  SPEAKER_00: I think it's it's so incredible to think about the data that can be collected through the NHSN surveillance system.
• 12:06
  SPEAKER_00: Now, I think what a lot of listeners are interested in is what's that data being used for?
• 12:10
  SPEAKER_00: Now we know that NHSN provides great data on patient safety in the United States, particularly with healthcare-associated infections, and that's used in a lot of different ways.
• 12:18
  SPEAKER_00: But I think there's interest in what's really happening with this COVID-19 related data.
• 12:23
  SPEAKER_00: So can you share what's happening with the data that's being collected?
• 12:27
  SPEAKER_00: How is that being used in monitoring and coordinating the national response?
• 12:32
  SPEAKER_01: Yeah, the most important thing from our perspective is that the data gets used and is helpful for the response.
• 12:38
  SPEAKER_01: And so that data is analyzed every morning.
• 12:41
  SPEAKER_01: It goes through an analytical process, and then we send out those analyses into the response as well as into a handful of other places.
• 12:52
  SPEAKER_01: And twice a week we send the data out to the states as a push function.
• 12:57
  SPEAKER_01: Now, the states are able to download the data directly from the NHSN application as they are longstanding group users of NHSN.
• 13:08
  SPEAKER_01: But in addition, because we knew that there would be some users who were not the normal hospital infection type of users, but that there would be people in the preparedness world and other worlds who would need access to the information.
• 13:22
  SPEAKER_01: We do have a way that we push out the data twice a week to the states so that they can use that if it's helpful to them.
• 13:30
  SPEAKER_01: On a daily and weekly basis, depending on the type of information, the data is fed into the response activities at CDC as well as into the response activities in Washington, DC.
• 13:46
  SPEAKER_01: And so the data is used by a number of the response task forces that are being led by FEMA and others and ASPR to be able to make decisions about key activities in the response.
• 14:01
  SPEAKER_01: And that's an ongoing daily process.
• 14:04
  SPEAKER_01: In addition, we do feed our raw data into a White House Task Force warehouse that's called HHS Protect.
• 14:13
  SPEAKER_01: One of the things that we have been very excited about that we've been able to do with the data that's reported is to develop estimates based on the data that is reported.
• 14:23
  SPEAKER_01: And those estimates are able to represent the entire country, the entire state, and very soon counties.
• 14:30
  SPEAKER_01: And so we actually use those estimates in order to be able to follow the data and the information longitudinally.
• 14:37
  SPEAKER_01: That data is posted on our external website for people to be able to see how states are being impacted with regard to hospitalizations.
• 14:47
  SPEAKER_01: So if any of the listeners were interested, that data is available on our NHSN website in map format so that you can see how that NHSN data looks when we roll it into estimates for country, states, and counties.
• 15:04
  SPEAKER_00: That's great.
• 15:04
  SPEAKER_00: It sounds like you're really able to use this data in near real time to really analyze what's happening and provide that information to several different stakeholders.
• 15:14
  SPEAKER_00: I think the audience will be really pleased to hear that that data that's being collected is being used in a very robust way.
• 15:21
  SPEAKER_00: You mentioned earlier about the transition from acute care hospitals into long-term care with the COVID NHSN module.
• 15:28
  SPEAKER_00: Can you elaborate a little bit upon that?
• 15:30
  SPEAKER_00: And a lot of our listeners are either practicing in long-term care or have a very significant investment in what's happening in long-term care as it affects acute care hospitals.
• 15:38
  SPEAKER_00: So can you elaborate upon where things stand with long-term care data collection and what the future might look like?
• 15:44
  SPEAKER_01: Sure.
• 15:45
  SPEAKER_01: I think anybody who has been watching this epidemic knows that COVID-19 has been a pretty horrible problem for nursing homes.
• 15:53
  SPEAKER_01: And the experience has really highlighted issues that such an epidemic can have for the most vulnerable among us.
• 16:00
  SPEAKER_01: NHSN has a longstanding collaboration with CMS.
• 16:05
  SPEAKER_01: So since 2012, CMS has used data reported to NHSN from hospitals for value-based purchasing and quality reporting and public reporting programs.
• 16:16
  SPEAKER_01: So given the situation in the nursing home environment, the leadership at CDC and at CMS got together to kind of say NHSN has been really valuable for collecting information that we can use to track and influence the burden on hospitals.
• 16:31
  SPEAKER_01: Can we do the same thing for nursing homes?
• 16:33
  SPEAKER_01: Now, historically, NHSN had had a nursing home component and had had a collaboration with CMS for several years, but there had been some struggle to get uptake on that nursing home component.
• 16:45
  SPEAKER_01: A main barrier for the uptake in that environment was the need for an advanced security level that we have in general for accessing patient-level data that we consistently have applied in NHSN.
• 16:58
  SPEAKER_01: But CMS was very interested in creating a regulatory mandate for reporting, which had never before existed for the nursing home industry.
• 17:07
  SPEAKER_01: And we knew that we had to overcome that barrier and make NHSN more readily accessible for these users and make it easier for them to be able to comply with what was going to be a really big deal as far as a regulation.
• 17:21
  SPEAKER_01: So we ended up rebuilding a version of NHSN that is still very secure but has a lower level of security.
• 17:28
  SPEAKER_01: And we could do this because the COVID-19 data that is needed from nursing homes is not patient-level.
• 17:40
  SPEAKER_01: So that means that we can have a lower level of security than we normally have for patient-level data.
• 17:46
  SPEAKER_01: And that means that the users at the facilities do not need to have grid cards and the CDC authentication that's known to have been a barrier for nursing homes in the past.
• 17:59
  SPEAKER_01: And we were able to create kind of a more standard login and password approach so that nursing homes can enroll and get a login and a password.
• 18:09
  SPEAKER_01: So this was an enormous win in our ability to create something where we could enroll nursing homes.
• 18:16
  SPEAKER_01: We were excited because it really reflected the creativity that our team had to take on to figure out a solution to what had previously really been a surprisingly enormous obstacle.
• 18:27
  SPEAKER_01: And it meant the facilities could enroll in under 24 hours rather than in the weeks that it previously took, because previously, you know, you had to enroll and get a background check and a grid card mailed to you, and you had to fax things and this type of thing.
• 18:42
  SPEAKER_01: So we had only a few weeks even to develop this module because of the birding platform that really existed to try to help nursing homes.
• 18:51
  SPEAKER_01: And we had a few weeks to do what normally we tend to like to do over years, but we did we created the module and it of itself in a few weeks.
• 19:00
  SPEAKER_01: And then we only had a few weeks to enroll over 15,000 facilities.
• 19:04
  SPEAKER_01: I think anybody who's ever been in this space knows how essentially ridiculously impossible this is.
• 19:09
  SPEAKER_01: And so I'm still not sure how we did it.
• 19:11
  SPEAKER_01: It has been crazy, and we've definitely learned some things along the way.
• 19:16
  SPEAKER_01: But the long-term care reporting component of NHSN is live and the number of facilities that are enrolled, we consider to be a major success story.
• 19:23
  SPEAKER_01: It's been an enormous lift for CDC and for CMS, as well as for the facilities, of course.
• 19:29
  SPEAKER_01: And you know, we've had key associations like ACA and Leading Age who've been really instrumental in working with their stakeholders to make it happen.
• 19:36
  SPEAKER_01: And so at this point, we have uh just over 15,000 facilities.
• 19:41
  SPEAKER_01: It's a slightly different number.
• 19:43
  SPEAKER_01: Not all of those are ones that are CMS certified.
• 19:46
  SPEAKER_01: You'll hear a couple of different numbers, but you know, we have a lot of facilities that are reporting data now, and we're really grateful to the partners who made it possible and really provided exceptional support, and it's ongoing because we're still enrolling people today.
• 19:59
  SPEAKER_00: Yeah, it's great.
• 20:00
  SPEAKER_00: I mean, it sounds like so much work to be done to get this up and running, but thank you for your efforts in doing this.
• 20:06
  SPEAKER_00: And I think this is gonna really pay big dividends, not just for COVID-19, but even in a lot of other areas moving forward in the future to NHSN for being able to do that.
• 20:15
  SPEAKER_00: So I think the last question that I want to touch upon is something that a lot of A members are interested in, is when it comes to NHSN and kind of mutual NHSN activities, which is primarily focused on healthcare system, how has what's happened with COVID-19 impacted the uh broader approach that NHSN has on understanding HAI in the United States and maybe thinking about some of the disproportionate impact that COVID-19 may have had across hospitals?
• 20:44
  SPEAKER_00: Has NHSN in sort of the bigger picture and thinking broadly about uh the ramifications?
• 20:50
  SPEAKER_01: So we are very interested in understanding how this pandemic and the dress that it's caused on a lot of hospitals will impact HAIs as well as their surveillance.
• 21:03
  SPEAKER_01: We are hoping that facilities will be able to continue to enter that data into NHSN so that we can all as a larger infection prevention community be able to answer some of the questions that you are alluding to.
• 21:20
  SPEAKER_01: Right now, CMS has suspended their requirements for facilities to submit data for the first half of the year, but we are really hoping that facilities will continue to submit their data to NHSN because we believe it is critically important that we understand the impact that such a crisis has on patients.
• 21:46
  SPEAKER_00: I agree.
• 21:46
  SPEAKER_00: I think uh, you know, the data that we'll generate from NHSN is going to be so informative to the broader impact of the COVID-19 pandemic and how it's affected hospitals more broadly.
• 21:57
  SPEAKER_00: So I hope that you'll be able to continue to collect your data widely.
• 22:01
  SPEAKER_00: Do you have any last thoughts that you want our podcast audience to know about what's happening at NHSN with regard to COVID-19 or sort of the broader aspects of NHSN?
• 22:12
  SPEAKER_01: From our perspective at NHSN, you know, we know that NHSN is not collecting just data, right?
• 22:20
  SPEAKER_01: We're collecting information that represents our mothers, our fathers, our grandparents, our neighbors, our coworkers, potentially represents ourselves.
• 22:28
  SPEAKER_01: We are really committed to collecting rigorously defined information that is designed purposefully to be used to make a difference and to be able to save lives and protect our loved ones, whether it's in kind of normal times or in the setting of this public health crisis.
• 22:46
  SPEAKER_01: And our team has been working round the clock for months to take up what we see as a critical mission to be part of saving lives and helping in that setting.
• 22:58
  SPEAKER_01: So even though our team is exhausted, we are truly honored to be able to serve at this time of extreme national crisis and to really be able to stand with so many of your listeners and others who have been working in healthcare and in public health around the clock and have had to rise to the challenge to use our expertise and situation to assist in the response and to move forward.
• 23:25
  SPEAKER_00: Thank you, Dr.
• 23:26
  SPEAKER_00: Bannon.
• 23:26
  SPEAKER_00: I think what you've described really illustrates an essential part of the public health response through Interstin.
• 23:32
  SPEAKER_00: And, you know, I can speak on behalf of our audience that we're really grateful for the great work that you and your team are doing in facilitating that response to COVID-19.
• 23:40
  SPEAKER_01: Yeah, thanks so much for having me, David.
• 23:43
  SPEAKER_00: So thank you very much to our speaker, Dr.
• 23:45
  SPEAKER_00: Bennon, for sharing your perspective and experience.
• 23:48
  SPEAKER_00: And here thank you from today to all the healthcare personnel for all that you are doing to respond to COVID-19.
• 23:53
  SPEAKER_00: This podcast can be accessed on Shay's online education center, Learning CE, under the rapid response program.
• 24:00
  SPEAKER_00: You will also find additional resources such as recorded webinars, healthcare facility onbreak preparedness, and the Shay COVID-19 town hall.
• 24:09
  SPEAKER_00: Additional resources available on Learning CE pertinent to this pandemic include the Shay CDC Outbreak Response Training Program, ORTP, and the Prevention Course in HAA Knowledge and Control Prevention Check.
• 24:22
  SPEAKER_00: That concludes this episode of the Rapid Response Podcast.
• 24:25
  SPEAKER_00: Thank you for tuning in.