December 2020 LTCF Newsletter
My NHSN colleagues and I want to extend our deepest appreciation and heartfelt gratitude to our partners in long-term care facilities throughout the nation who have contributed tirelessly to our surveillance efforts during the COVID-19 pandemic. Your extraordinary contributions have been vital to the pandemic response at the local, state, and national levels. Tracking, understanding, and responding to the impact of COVID-19 on residents and staff of long-term care facilities remain essential as we look ahead to 2021. For now, as we look back at a grim year that surprised us all, the way that you stepped up and went above and beyond is truly remarkable. Your contributions speak loudly about your commitments to the health and wellbeing of your residents. We are inspired by your dedication and grateful for our association with you.
Daniel Pollock, MD
Surveillance Branch Chief
Division of Healthcare Quality Promotion
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention
Be on the lookout for communications about the release of the 2020 LTCF Component Annual Facility Survey. The survey will open in January and must be completed prior to March 1, 2021. After March 1st, facilities will be unable to enter new monthly reporting plans until required Annual Facility Surveys are completed. Unless otherwise specified, items in the survey pertain to facility characteristic and practices during January 1, 2020 through December 31, 2020.
If a 2019 survey was completed for your facility, it may be a useful reference for completing the 2020 version. Additionally, users may want to consider reviewing and/or completing the Annual Facility Survey data collection form prior to entering the information into the web application because incomplete surveys cannot be saved in NHSN. This means that all of the required questions must be answered prior to being able to save the survey.
Be sure to review the Table of Instructions for completing the survey, which is located under the Data Collection Forms tab in each of the NHSN LTCF Modules, accessed from the NHSN LTCF Home Page.
For questions, please e-mail the NHSN helpdesk at email@example.com with “LTCF Annual Survey “in the subject line.
The survey will open in January and must be completed prior to March 1, 2021. After March 1st, facilities will be unable to enter new monthly reporting plans until required Annual Facility Surveys are completed.
It’s that time of the year again! Below you will find a summary of the NHSN LTCF Component updates coming in January 2021. Users will be notified once the new forms and protocols are posted to the NHSN LTCF Home Page. If you need to save 2020 versions, now is a good time to save a copy, as they will be removed in the near future. Keep in mind, any changes to NHSN surveillance criteria or data collection requirements will go into effect beginning on January 1, 2021.
Summary of Modifications
Healthcare-associated Infection Module: Urinary Tract Infections (UTI) Events
The definition of leukocytosis changed from “> 14,000 cells/mm3, or Left shift (> 6% or 1,500 bands/mm3)” to “ (> 10,000 cells/mm3), or Left shift (> 6% or 1,500 bands/mm3)”.
Healthcare-associated Infection Module: UTI Pathogen Susceptibility Data Collection Forms
Changes were made to the UTI pathogen susceptibility data collection from. Specifically, Proteus mirabilis selection now requires a response for the following : Ampicillin; Amoxicillin; Cefuroxime (Second Generation Cephalosporins); Ceftriaxone. Cefixime (Third Generation Cephalosporins); Ciprofloxacin, Levofloxacin (Fluroquinolones); Ertapenem, Meropenem, Imipenem. Additionally, Nitrofurantoin was added as a drug option for the following organisms: E coli, Citrobacter spp., E. faecalis, Enterobacter spp., Klebsiella spp., E. faecium. Additional revisions were made to the susceptibility antibiograms for UTI event reporting, including the removal and addition of specific antimicrobials to susceptibility data collection and result values were changed for some of the existing antimicrobials. All of these changes are effective for events dated 1/1/2021 and greater.
LabID Event Module: C. difficile
The multiplier for calculating the Total CDI Rate and CDI Long-term Care Facility-onset Incidence Rate changed from 10,000 resident days to 1,000 resident-days.
All Data Collection Forms
Social security number has been removed as an option for newly entered residents.
Some modifications made to improve consistency with variable names. For example, variables in footnotes for line listing and rate tables will default to descriptive variable names. The “utiPlan” (UTI Plan) variable replaced “CAU Plan” variable to align with UTI reporting requirements specific to the LTCF Component.
Users will notice Vaccination Summary option is now available on the NHSN LTCF Homepage in the left navigation bar. This means users do not have to enroll or log-in separately to the Healthcare Personnel Safety Component to enter vaccine summary data.
Are you confused about the types of COVID-19 data that must be reported to NHSN and the pathways and tools that should be used? The following questions and answers can clarify the facts and clear up misunderstandings.
Question: Both the NHSN COVID-19 Resident Impact and Facility Capacity (RIFC) Pathway and the NHSN Point of Care (POC) Test Reporting Tool collect data about COVID-19 testing. What is the difference?
Answer: Among other data, the RIFC Pathway collects aggregate (summary) data about the number of COVID-19 tests performed among residents and staff and facility personnel. The collected data includes counts for point-of-care (POC) tests, and nonpoint-of-care (NONPOC) performed on residents and staff and facility personnel. These are simply total numbers of the various types of tests that are performed within a facility during the reporting time-period. The counts do not include tests performed on visitors. Differently, the POC Tool collects what is known as “line-level” data for positive and negative test results, meaning that information is collected regarding each test in particular, including the demographic data about the resident or staff tested, which can be used for contact tracing or other outbreak control activities. Currently test results for visitors to the facility cannot be recorded in the POC Tool, but this capability will be added in the near future.
If you believe you have been reporting to NHSN via the POC Test Reporting Tool, yet your state health department is telling you that it has not received your facility’s POC test data from NHSN, please check to ensure you are reporting via the POC Test Reporting Tool in addition to the RIFC pathway. More information, including training and Frequently Asked Questions for the POC Reporting Tool can be found on the LTCF COVID-19 Module webpage.
Q: My facility was contacted by the state health department (SHD) about a positive COVID-19 POC test result in a resident, but in the NHSN system the test result is negative. What could be the cause?
A: Each time a test result is entered into the NHSN POC Test Reporting Tool, a message is generated and sent to the Association for Public Health Laboratories Informatics Messaging System (AIMS) platform and from there to the SHD. This means that if a test result is edited, say from positive to negative in the NHSN system, even if it is edited immediately after the test result was saved, two messages with test results will be sent to the SHD; one will be positive and the other negative.
CDC released new weekly COVID-19 vaccination data reporting modules in December. These modules will allow reporting of COVID-19 vaccination coverage among:
- Healthcare personnel working in long-term care facilities;
- Residents of long-term care facilities; and
- Healthcare personnel working in non-long-term care facilities (acute care hospitals, critical access hospitals, long-term acute care hospitals, inpatient rehabilitation facilities, outpatient dialysis centers, and ambulatory surgery centers).
An additional module for reporting COVID-19 vaccination coverage for patients cared for by outpatient dialysis facilities is planned for release in 2021.
Comparable to the weekly influenza vaccination reporting, data will not be reported for individuals, but rather the cumulative number of healthcare personnel, long-term care facility residents, or dialysis patients receiving COVID-19 vaccine are to be reported in these modules. In addition, the weekly COVID-19 vaccination modules allow for reporting of COVID-19 vaccine supply and number of clinically significant COVID-19 vaccination adverse events in the last week, with a link to the Vaccine Adverse Event Reporting System (VAERS) for reporting individual cases of adverse events.
Facility-level data collected through NHSN as part of the COVID-19 vaccination modules will be made available to a broader set of federal, state, and local agency data users than other data typically collected by NHSN. Specifically, COVID-19 data at the state, county, territory, and facility level submitted to NHSN will continue to be used for public health emergency response activities by CDC’s emergency COVID-19 response, by the U.S. Department of Health and Human Services’ (HHS’) COVID-19 tracking system maintained in the Office of the Assistant Secretary of Preparedness and Response as part of the National Response Coordination Center at the Federal Emergency Management Agency (FEMA), and by the White House Coronavirus Task Force.
CDC launched new weekly influenza vaccination data reporting modules in September 2020. This optional reporting aims to help facilities track influenza vaccination coverage of healthcare personnel and residents in long-term care and non-long-term care facilities during an influenza season.
After reviewing preliminary data, CDC modified data collection forms to reduce the reporting burden on facilities and improve data accuracy. Revised NHSN data reporting modules were released in November 2020. To review the revised data collection forms and training materials:
- Long-term care facilities can visit here.
- Non-long-term care facilities can visit here. Click on your facility type (such as acute care facilities) and then click on “Surveillance for Healthcare Personnel Vaccination”.
CDC encourages facilities to review these new materials and continue to report weekly influenza vaccination data through NHSN. Please send an e-mail to: firstname.lastname@example.org with “HPS Flu Summary” in the subject line if you have any questions.