One of the main tools the Centers for Disease Control (CDC) and Prevention has to help it control and prevent is the National Health Safety Network (NHSN). As the nation’s most widely used healthcare-associated infection tracking system, it ensures the folks whose job it is to help patients are being protected themselves. For an overview of how the NHSN works and the role it plays in CDC’s mission, the Federal Drive with Tom Temin welcomed Arjun Srinivasan, deputy director for Program Improvement in the Division of Healthcare Quality Promotion at the CDC.

Interview transcript:

Eric White So let’s just start with the National Healthcare Safety Network. Give us a little background on it when it was started, if you can, and how it actually works.

Arjun Srinivasan Yeah. So the National Healthcare Safety foundation of this network is actually incredibly long standing. So the CDC has had a system to monitor and track infections that occur while people are getting health care going back, way back into the 70s and early 80s. So the foundation of this system is unbelievably strong. It’s a very well-established system. The current kind of modern web based iteration of the National Healthcare Safety Network itself dates back to about 2006. So it’s a really, really well-established long standing system that has grown dramatically over the years. When it began, it was really kind of a voluntary system. About 300 hospitals from around the country who volunteered to track these infections in order to give us benchmarks, to help other hospitals know, Okay, if I have six infections, how does that compare nationally? So it grew from that voluntary 300 hospitals way back in the 80s, and now NHSN has expanded not just to include literally every acute care hospital in the country, but also includes every dialysis facility, every nursing home, every ambulatory surgical center. So, Eric, there are more than 38,000 health care facilities in the country that currently report their data into the National Healthcare Safety Network. Some of that reporting continues to be voluntary, but a lot of that reporting now is mandatory. And so this has been a wonderful growth of the national health care safety network, as you were pointing out, it’s a system that is used by so many people. And one of the big users is the Centers for Medicare and Medicaid Services. And so, many years ago, when they became interested in tracking health care associated infections and beginning to use that information for some of their quality reporting programs, we collaborated, but then we said, hey, you don’t need to create another system for this, we have one. And so there is a lot of that reporting that is now mandated by CMS. So it’s a really long standing and stable system. A little bit on how it works, it is a web based system so people can enter data into the system. But one of the things, and we can talk a little bit more about this in the interview, because I think it is incredibly exciting. But is it increasingly moving towards a fully automated, an electronic system where the reporting nobody has to enter any data anymore? Rather, the data is coming straight out of electronic health records and into the system. And that is the future state that we’re aiming towards with the National Health Care Safety Network. So it’s a time of exciting transition and growth and change for NHSN.

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Eric White Yeah, we’ll get into the reporting mechanism shortly here. But I do want to just break down the overall use that CDC has for this kind of information. You get infection numbers from a certain health care facility or a certain area. What does the CDCs policymakers and folks that track this stuff do with that information?

Arjun Srinivasan Yeah, it’s used by a host of different users. And so that is one of the beauties of the National Health Care Safety Network, it doesn’t serve just one purpose. So we at CDC use the information to track national trends, to track state trends, to allow states to see where they stand with respect to other states. We use it to inform our programs. We have funded programs in every state and many large cities. These are folks that are specifically tasked with helping the facilities in their states, reduce these types of infections. So they are looking at that information on a regular basis to say like, is there a hospital out there or a nursing home that’s seeing an unusually large number of infections? And if so, let’s give them a call. Let’s find out what’s going on there. How can we help that facility? What can we do to support them? As we discussed, it’s used by the Centers for Medicare and Medicaid Services and some of their quality and reporting and payment programs. But it’s also, and I think perhaps most importantly, it’s used by the facilities themselves. They’re actually perhaps the most important users of this information because they are the ones who are really taking the action to prevent these infections and these other types of adverse events. And so the beauty of NHSN is that everybody has access to the same information at the same time.

Arjun Srinivasan So when the data goes in, we can see it here in the government, but the states can see it, the facilities can see it, and everybody has that same visibility and can then look at that information and say, well, why are infections going up in this particular area? Is there something going on? Why are infections going down? Is there something that we could learn from the state that seen a larger reduction or this facility that seen a larger reduction than these other types of facilities? So it has so many different purposes. And I think any time you have so many different smart people looking at the same information with slightly different perspectives, it’s only to the benefit of everybody involved. It’s also information that’s publicly available. So CMS posts the NHSN and data at the facility level on some of their quality reporting websites. And so the public has access to some of this information that allows them to be informed consumers of their health care. We tell people, if you see high infection rates at the hospital where you’re going, that’s a question that you might want to ask. What are you doing to keep me safe and protect me from infection? So it’s powerful information in the hands of a whole host of people who can really use it to make a difference.

Eric White We’re speaking with Arjun Srinivasan. He is the deputy director for Program Improvement in the Division of Health Care Quality Promotion at the Centers for Disease Control and Prevention. So, yeah, let’s get into a bit of the tech behind the NHSN. You mentioned it as a web based mandated reporting mechanism. How does it work and what is the kind of new technology that you had mentioned going behind us as far as artificial intelligence and using other methods? And a big contract was just awarded to Leidos for a modernization of the program itself. What can you tell me about the future of NHSN?

Arjun Srinivasan Yeah, we’re particularly excited about where NHSN is going, and this is tremendous leadership from the team that runs NHSN. They are really working to try and see into the future and try to anticipate where do we need this program to be. And we recognize that, gone are the days or should be gone are the days where people had to manually go to a website and enter data into a system. We know that the information to do all of this reporting sits in electronic health records. And so we are increasingly working towards automated systems where the data that’s required or needed for the reporting comes straight out of the electronic health record and straight into the National Health Safety Network so that people don’t have to do the entry, they can simply open up the application and see the data that’s been reported. They can check it to make sure that it’s correct, but they don’t have to do the entry. And we’ve already entered that future state with some of the different types of reporting within the National Health Care Safety Network. Best example is facilities are now required to report information on antibiotic use, an antibiotic resistance into CDC. We think this is vitally important information to help us protect people from these infections that don’t respond properly to antibiotics. That reporting there is no manual option for that. That reporting must be done electronically. So it comes straight out of the electronic health record from the pharmacy systems, from the bed systems, and all that information comes straight in to the application and then users can get back not only their rates of antibiotic use and resistance, but they also get, as we discuss, these important comparators of how does your antibiotic use compare to someone else’s antibiotic use? And that is where we are going.

Arjun Srinivasan So we envision a future where measures are what they call these digital or electronic quality measures, where the information comes straight out of an electronic health record into NHSN and all of the analytics or the outcomes happens within NHSN. And this is possible through some of these new technologies, one that NHSN is really working with called Fast Healthcare Interoperability Resources. And some of your users may be very familiar with that, or some of the more tech savvy folks may know about that. But it’s a really exciting way that facilities can exchange data where they don’t have to do all the analytics. They don’t have to review the data, the event determination, if you will, happens within the application and then people get reports back. That is where we see the future. We are focused on developing all our measures as these electronic or digital quality measures, and increasingly NHSN is looking to expand beyond just doing infections. We already have some reporting or noninfectious events we can look at adverse events, for example, related to blood transfusions. That capacity already exists in the system, and we are collaborating closely with CMS and envisioning a variety of different non infectious measures, because we think the platform, and CMS agrees that the platform that NHSN provides and the methodologies that NHSN is working towards are the right ways to move reporting, quality reporting forward. And so we are excited by this collaboration with CMS to really try and harmonize this system, and hopefully someday have NHSN be kind of a unified health care quality work for all of our government needs. We’re obviously a long way from that. There are a lot of measures that are not in NHSN, but increasingly we are, like I said, collaborating with CMS to develop these electronic measures so there is a future state where people don’t have to spend any time doing data entry. Rather they can spend their time acting on the data that we’re able to provide to them.

Eric White And finishing up here, I’d be remiss to ask about the role that it played in the most significant threat that frontline and health care workers face, which was the 2020 COVID pandemic. What role did NHSN play in keeping those frontline workers safe from a disease that many in the early aughts did not know how it actually was transferred from person to person.

Arjun Srinivasan Yeah, NHSN played a number of really vital roles during the pandemic. So early on, relatively early on in the pandemic. And actually, I would point out continuing to this day, hospitals and nursing homes are reporting information into the NHSN, previously that information was was about COVID, of course during the pandemic. Now that information is actually expanded because we recognize that new flu is still here and the potential of a flu pandemic with the reports of H5, there’s concern about that. There have been spikes in cases of respiratory syncytial virus or RSV. And so now hospitals and nursing homes are actually required to report all three of those into the National Health Care Safety Network. And so over the past several years, NHSN really has been kind of the source of truth for what is going on with COVID, and now it will be for flu and RSV, what is going on in our nation’s health care facilities? Where are there facilities that have a lot of cases? Are there outbreaks that we need to be aware of and helping facilities combat? That information, we also have vaccine information, so it’s been really helpful. During the early days of the pandemic, it was used for facilities that had low vaccination rates. We collaborated with CMS, and CMS was actually sending teams into some of those places to help them vaccinate their staff and their residents. State health departments were sending teams into nursing homes that were reporting large numbers of cases. So it was incredibly actionable. Data was being used in real time. There was an option for nursing homes, for example, to report shortages of personal protective equipment. That information went directly to the federal supply control, what they call the control tower. And it was a way that the supplies could be sent directly to nursing homes that reported shortages.

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Arjun Srinivasan So it’s really used very actively to help understand the outbreak and to respond to the outbreak. And some of the information in the National Healthcare Safety Network was also used in some of the very early studies on assessing the effectiveness of the vaccine and of our prevention measures. As you just mentioned, Eric, early on, we didn’t know like does masking work? Do vaccines work? Do these policies that we’re working to implement, are they preventing infections? And we were able to use the National Healthcare Safety Network to better understand the effectiveness of some of these policies, particularly vaccines in nursing homes. There was a lot of use of the NHSN to really understand just how effective those vaccines were in saving lives in nursing homes.

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