Hospitals report infections in a variety of categories to the National Healthcare Safety Network. Those in the Inpatient Quality Reporting Program must report cases of common healthcare-acquired infections, providing detailed information about each incident, such as the date and location a catheter was inserted, the characteristics of the patient, procedure codes, lab and diagnostic tests, and outcomes like secondary infections or death.
Using all this information, TAP's three-stage framework targets infections, then assesses them with the goal of identifying process improvements to help prevent them.
When the CDC rolled out TAP reports two years ago, the system generated reports for CAUTI, CLABSI and C. difficile infections to acute-care hospitals. In addition, reports for CAUTI and CLABSI became available to long-term acute-care facilities. And reports for CAUTI were offered to inpatient rehabilitation facilities.
By 2016, facilities had access to assessment tools, developed throughout 2015 through pilot projects with Quality Innovation Network-Quality Improvement Organizations. In March, C. difficile infection reports became available to long-term acute-care and inpatient rehabilitation facilities.
The CDC plans to expand TAP to cover other infections, such as Methicillin-resistant Staphylococcus aureus.
The TAP system uses infection data that hospitals, under the CMS Inpatient Quality Reporting Program, are required to report quarterly to the National Healthcare Safety Network. The system generates reports that show which hospital units have infection rates for CAUTI, CLABSI and C. difficile infections that exceed expected rates.
"Hospitals dump all of this information into the NHSN," McDonald said. "They can go in any time and generate a new data set, and then they can get in and run all sorts of reports."
The reports calculate the cumulative attributable difference (CAD), or the difference between the observed number of infections and a targeted prevention goal, which is based on a national Standardized Infection Ratio. If the CAD measure is positive, the facility or unit needs to reduce the number of infections to meet the goal. In ranking units by CAD, hospitals can see where prevention efforts are needed most.
TAP is unique in its capacity to allow hospitals to target locations with excess infections, said Ronda Sinkowitz-Cochran, a behavioral scientist in the CDC's Division of Healthcare Quality Promotion. And the CAD measure provides them with concrete goals to drive corrective action.
After pinpointing a unit such as the intensive-care for improvement, the hospital can use TAP's Facility Assessment Tool to help identify possible safety gaps. Hospital quality leaders then can survey staff and gauge whether best-practice policies are in place and are being followed.
A tool to assess CAUTI, for instance, might ask how frequently ordering providers appropriately document the indications for inserting urinary catheters. From there, the hospital can generate a feedback report to develop a plan to reduce infections. The prevention tool for CAUTI would suggest areas for improvement.
Over for the past 18 months, the Wisconsin Hospital Association has been working with its member hospitals to implement the TAP strategy and break down data into actionable components.
The detailed TAP data make it easier for hospitals to understand the source of infections, said Kelly Court, the association's chief quality officer. The TAP report complements hospitals' ongoing infection-prevention work and their Plan-Do-Study-Act model for process improvement.
"What hospitals tell us is that the ability to take the tool and drill the data down to the nursing unit level really helped engage bedside nurses at that unit level," Court said.