The Targeted Assessment for Prevention (TAP) Strategy

TAP logo

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.

TAP Resources

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Assess

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 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.

Partners may also complete the Antibiotic Stewardship Practices questions within the NHSN Annual Hospital Survey pdf icon[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.

Prevent

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 targetsexternal icon 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.