The Targeted Assessment for Prevention (TAP) Strategy
The Targeted Assessment for Prevention (TAP) Strategy is a framework for quality improvement developed by the Centers for Disease Control and Prevention (CDC) to use data for action to prevent healthcare-associated infections (HAIs). The TAP Strategy consists of three components: 1) Running TAP Reports in the National Healthcare Safety Network (NHSN) to target healthcare facilities and specific units with an excess burden of HAIs. 2) Administering TAP Facility Assessment Tools to identify gaps in infection prevention in the targeted locations. 3) Accessing infection prevention resources within the TAP Implementation Guides to address those gaps. The TAP Reports use a metric called the cumulative attributable difference (CAD). The CAD is the number of infections that must be prevented to achieve an HAI reduction goal and is calculated by subtracting a numerical prevention target from an observed number of HAIs. The TAP Reports allow for the ranking of facilities, or locations within individual facilities, by the CAD to prioritize prevention efforts where they will have the greatest impact.
*New* TAP Strategy Learning Series
The TAP Strategy Learning Series consists of four videos and introduces the TAP resources available, guiding hospitals and public health partners as they implement the TAP Strategy.
Video 1: Introduction to the TAP Strategy provides an introduction to the TAP Strategy, including the resources available to guide hospitals in improving their infection prevention practices and reducing healthcare-associated infections.
Video 2: Deploying TAP Facility Assessments provides a detailed summary of the TAP Facility Assessments and step-by-step instructions for deploying and collecting assessments among healthcare personnel to help identify potential infection prevention gaps.
Video 3: Translating TAP Assessment Data Into Action provides detailed instruction on how to review and interpret results from TAP Facility Assessments collected from healthcare personnel as well as step-by-step directions for navigating the assessment summary tools available.
Video 4: Prioritizing Gaps to Target Interventions explores illustrative examples to guide partners in understanding and prioritizing gaps identified from TAP Facility Assessments and provides next steps for implementing infection prevention interventions to address those gaps.
- TAP Strategy Partner Testimonials: May 2019 Volume 1, Issue 2 [PDF – 1 page] – TAP Strategy implementation tips for success and lessons learned
- TAP Strategy Partner Testimonials: March 2019 Volume 1, Issue 1 [PDF – 1 page] – TAP Strategy implementation tips for success and lessons learned
- TAP Infographic (print only) [PDF – 1 page] – One page Infographic describing the TAP Strategy to engage leadership and encourage facility participation
- TAP Strategy: Facility User ‘How To’ Guide – May 2019 [PDF – 14 pages] – Guidance and tips for success to facilitate implementation of the TAP Strategy, for individual facility users
- TAP Strategy: Group User ‘How To’ Guide – May 2019 [PDF – 15 pages] – Guidance and tips for success to facilitate implementation of the TAP Strategy, for group users
- Targeted Assessment for Prevention of Healthcare-Associated Infections: A New Prioritization Metric – Journal article by Soe et al. published in Infection Control & Hospital Epidemiology describing the cumulative attributable difference (CAD) metric.
- Example Letter [DOC – 172 KB] – From a State Health Department to a Healthcare Facility, encouraging participation in state and regional prevention collaboratives.
- TAP Strategy Reports – NHSN Guidance on Generating a TAP Report
- TAP Glossary of Terms March 2021 [PDF – 125 KB]
- TAP Training – NHSN Data Entry and Analysis
- TAP Facility Assessment Deployment Packet – February 2021 [PDF – 5 pages] – Resources to guide partners as they prepare to deploy TAP Facility Assessments
- CAUTI TAP Facility Assessment Tool v2.0 – May 2016 [PDF – 2 MB]
- CLABSI TAP Facility Assessment Tool v4.0 – May 2022 [PDF – 9 pages]
- CDI TAP Facility Assessment Tool v6.0* – April 2022 [PDF – 10 pages]
- NEW – CDI TAP Facility Assessment Tool v6.0 – Spanish [PDF – 10 pages]
- NEW – Environmental Services (EVS) CDI TAP Facility Assessment Tool v1.0 – March 2022 [PDF – 7 pages] – Assessment tool for Environmental Services staff members to complete; created to accompany the CDI TAP Facility Assessment Tool
- NEW – EVS CDI TAP Facility Assessment Tool v1.0 – Spanish [PDF – 7 pages]
- CDI Laboratory Assessment Tool v6.0 [PDF – 2 pages]
- NEW – CDI Deep Dive for Infection Preventionists v6.0 [PDF – 22 pages] – Supplemental assessment tool designed to be completed once per facility by the infection preventionist or lead of CDI prevention; created to accompany the CDI TAP Facility Assessment Tool and allow for further assessment of possible areas for improvement in CDI prevention practices
All TAP Facility Assessment Tools are also available in SurveyMonkey and REDCap templates. To compile and summarize Assessment responses, CDC has developed TAP Excel Spreadsheets to create accompanying TAP Feedback Reports. Please email CDC at HAIPrevention@cdc.gov to request these additional TAP tools.
CDC’s Division of Healthcare Quality Promotion (DHQP) is available to provide technical assistance to healthcare facilities and other partners for TAP Strategy implementation and HAI prevention. For any questions and/or requests for technical assistance, please email HAIPrevention@cdc.gov.
When requesting assistance, facilities should be aware that State Health Department partners may be notified in an effort to align statewide support. Notification shall be limited to a description of assistance provided, and will not include facility-level information without consent from the participating facility.
*In addition to the CDI TAP Facility Assessment Tool (completed by multiple respondents across the facility), partners may also use the EVS CDI TAP Facility Assessment Tool to collect responses among Environmental Services staff members on topics most relevant to their practices. Partners may also complete the CDI Laboratory Assessment Tool to review their CDI-specific laboratory and testing practices. The CDI Laboratory Assessment Tool is meant to be completed just once per facility by a staff member who is knowledgeable of the practices at the laboratory that performs the facility’s C. difficile testing.
Additionally, the CDI Deep Dive for Infection Preventionists is designed to accompany the CDI TAP Facility Assessment Tool and be completed once per facility by the infection preventionist (or lead of CDI Prevention). This tool allows for further assessment of possible areas for improvement in C. difficile prevention practices and provides examples of implementation tools, strategies, and resources.
Partners may also complete the Antibiotic Stewardship Practices questions within the NHSN Annual Hospital Survey [PDF – 14 pages] (questions 31-50) with a staff member who is most knowledgeable about the facility’s antibiotic stewardship practices (e.g., pharmacist or physician stewardship lead) as an opportunity to review their stewardship program. Partners are encouraged to confirm that their most recent NHSN Annual Hospital Survey responses align with their current stewardship practices.
- TAP CAUTI Toolkit Implementation Guide: Links to Example Resources
- TAP CDI Implementation Guide: Links to Example Resources
- TAP CLABSI Implementation Guide: Links to Example Resources
- TAP Strategy Gap Prioritization Worksheet – March 2021 [PDF – 4 Pages] – Worksheet to guide in the identification and prioritization of infection prevention gaps following deployment of TAP Facility Assessments. Facilities may send their completed worksheet to CDC to receive tailored feedback including example tools, strategies, and resources to help address priority areas identified. Facilities also may use this worksheet as part of continued quality improvement efforts, updating and revising the content as they work to implement interventions over time.
- TAP Prevention Prioritization Toolkit – May 2019 [PDF – 22 pages] – Compilation of templates to help facilities prioritize infection prevention gaps and develop strategies to implement corresponding interventions.
For questions pertaining to the TAP Strategy and the accompanying TAP tools, please contact: HAIPrevention@cdc.gov
WHO is using the TAP Strategy?
CDC is working with partners such as the Centers for Medicare & Medicaid Services (CMS) Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) and Hospital Improvement Innovation Networks (HIINs), State Health Departments, healthcare systems, and facilities to incorporate the TAP Strategy into their quality improvement work. Prevention partners engaged in quality improvement and collaborative work may use the TAP Strategy to identify and reach out to facilities within their jurisdictions to assist them with prioritizing their HAI prevention efforts. In this way, groups and facilities can use data for action to target gaps for prevention and intervention.
WHERE do data for TAP Reports come from?
Data used for the TAP Reports are reported by healthcare facilities to CDC’s National Healthcare Safety Network (NHSN). Healthcare facilities may use their own data to generate TAP Reports for different HAIs and patient care locations. Other entities (e.g., QIN-QIOs, HIINs, Health Departments, hospital associations) that have access to NHSN data through NHSN’s “Group” function may also generate TAP Reports for the healthcare facilities within their groups/states. Publically available data from NHSN (e.g., CMS Hospital Compare) may also be used to rank facilities according to their CAD.
WHY is CDC using the TAP strategy?
CDC strives to move toward the goal of HAI elimination by using data to target prevention efforts and measure progress. The CDC TAP Strategy uses the CAD metric to identify healthcare facilities, or locations within facilities, with a disproportionate burden of HAIs above the Department of Health and Human Services (HHS) prevention targets or a customized prevention target so that limited prevention resources can be used most effectively. This strategy can be tailored to specific HAI reduction goals and healthcare settings. The CAD is based upon and complimentary to CDC’s main HAI metric, the Standardized Infection Ratio (SIR). The CAD will not replace the SIR; the SIR will remain CDC’s main measure of progress toward the elimination of HAIs. Instead, the CAD will be used in conjunction with the SIR, specifically serving as the metric for the TAP Strategy that is intended to accelerate prevention to meet goals on the way toward elimination.
WHEN did the TAP Strategy become available?
In January 2015, TAP Reports became available within the NHSN application for use by hospitals and NHSN Groups with access to hospital data. These reports are available for catheter-associated urinary tract infections (CAUTI), central line-associated bloodstream infections (CLABSI), Clostridioides difficile infections (CDI), and Methicillin-resistant Staphylococcus aureus (MRSA). Acute Care Hospitals are able to run TAP Reports for CAUTI, CLABSI, CDI, and MRSA; Long Term Acute Care Hospitals are able to run TAP Reports for CAUTI, CLABSI, and CDI; and Inpatient Rehab Facilities (IRFs) and IRF Units are able to run TAP Reports for CAUTI and CDI. The TAP Facility Assessment Tools and TAP Implementation Guides were developed in 2016 and are now available for CAUTI, CLABSI, and CDI. While there is no TAP Facility Assessment or Implementation Guide available for MRSA, partners with questions regarding MRSA bloodstream infection prevention may email HAIPrevention@cdc.gov for assistance and to further discuss prevention strategies. Strategies to prevent hospital-onset Staphylococcus aureus bloodstream infections in acute care facilities are available at https://www.cdc.gov/hai/prevent/staph-prevention-strategies.html.