Tennessee's Tools and Trainings for Healthcare-Associated Infection Reporting

Background: Infection preventionists (IPs) are typically responsible for reporting healthcare-associated infections (HAIs) to the National Healthcare Safety Network (NHSN).  The Centers for Disease Control and Prevention (CDC) provides education to IPs via webinars and web-based resources.  However, CDC trainings are not tailored to state reporting requirements, and, given the complexity of the NHSN system and making HAI determinations, IPs may struggle with accurate HAI reporting. 

Objective: To aid IPs in the HAI reporting process, the Tennessee Department of Health (TDH) aimed to develop a variety of cost-effective tools and trainings, which would be tailored to state reporting requirements and would address specific reporting issues identified by TDH HAI staff.

Methods: Topics for IP trainings and educational tools were chosen based on common reporting questions and requests for additional instruction submitted to TDH by IPs, data quality problems recognized during TDH’s data quality checks and validation efforts, and reporting issues identified by CDC.  TDH used standard, commercially available software programs to develop instructional materials.  Costs, IP input, and time and travel limitations were considered when selecting training formats.

Results: TDH staff identified common errors in conferring rights, completing the monthly reporting plan, entering multidrug-resistant organism/ Clostridium difficile­-associated disease (MDRO/CDAD) summary data, and identifying HAIs.  Errors in conferring rights and monthly plans were associated with confusion over reporting requirements that differ between TDH, the Tennessee Center for Patient Safety, and the state quality improvement organization (QSource), while MDRO/CDAD summary data errors were related to “off-plan” data entry.  To address these issues, TDH staff created documents with step-by-step instructions and corresponding screen shots of the NHSN application.  TDH staff also developed checklists for identifying HAIs using NHSN definitions and created instructions for identifying laboratory-identified (LabID) methicillin-resistant Staphylococcus aureus (MRSA) and C. difficile infection (CDI) events using Microsoft Excel.  These materials were shared via email and the Tennessee HAI Online Workspace, a website that allows members to communicate, join groups, and post resources.  In May 2010, TDH staff held an all-day, in-person IP training in each of Tennessee’s three Grand Divisions (East, Middle, West).  The trainings covered NHSN enrollment, facility set-up, and reporting of central line-associated bloodstream infections, surgical site infections, and MRSA and CDI LabID events.  Webinars on these topics were also held May–October 2010.

Conclusions: IPs provided positive feedback regarding the trainings and educational tools.  By participating in educational efforts, HAI staff are better able to assist IPs with HAI reporting to NHSN.