The National Healthcare Safety Network (NHSN) was established in 2005 to integrate and supersede 3 legacy surveillance systems at the Centers for Disease Control and Prevention (CDC). NHSN is a secure, internet-based surveillance system that provides CDC and healthcare facilities across the country a way to track, analyze, and interpret data on healthcare-associated infections (HAIs). Member NHSN facilities, such as hospitals and clinics, report their HAI surveillance data for aggregation into a single national database for the following purposes:
	Estimation of the magnitude of HAI such as surgical site infections (SSIs), blood stream infections (BSIs), urinary tract infections (UTIs), and pneumonias
	Discovery of HAI trends
	Facilitation of inter-and intra-hospital comparisons with risk-adjusted data that can be used for local prevention and quality improvement activities
	Assistance for facilities in developing surveillance and analysis methods that permit timely recognition of patient safety problems and prompt intervention with appropriate measures
	Making each hospital stay safer and shorter

The NHSN includes Patient Safety, Healthcare Personnel Safety, Biovigilance, and Research and Development components.  Data for each component is collected using standardized methods and definitions and are grouped into specific module protocols.  The Patient Safety component is comprised of the:

	Device-associated module which provides coverage for central-line associated BSIs,   ventilator-associated pneumonias, and catheter-associated UTIs.
	Procedure-associated module provides coverage for inpatients or outpatients undergoing selected operative procedures for the presence of SSIs or post-procedure pneumonia.
	Medication-associated module: Report susceptibility data for selected organisms and/or antimicrobial-use data for selected agents.

The internet facing Java web application allows the CDC and its healthcare and public health partners to collect and analyze data on Healthcare-Associated Infections (HAIs), Healthcare Personnel Exposures and Events, and blood transfusion events in accordance with specified case definitions and data standards, serving current scientific and programmatic needs, with minimal deployment issues, and fast turn around times from requirements to deployment. Extensive use of custom AJAX, dynamic HTML, and the Apache Commons Validator have significantly improved the user experience; Health Level 7 standard (HL7 v3) imports of data has helped greatly to integrate with existing software at hospitals; and the use of SAS as the analytical tools has provided a great deal of power and flexibility for reporting.

Yes

Yes

NHSN enables healthcare facilities to track their own data, report data for aggregation and analysis on the national level by CDC, share data with State agencies and other third parties in a timely manner, and compare their data to the national rates reported by CDC.  This enables hospitals to measure their clinical performance over time and identify opportunities for improvement.  NHSNs data requirements reflect the infection prevention practices recommended in the form of infection control guidelines developed by CDCs Healthcare Infection Control Practices Advisory Committee (HICPAC).

Tennessee -- The Tennessee Center for Patient Safety, an initiative of the Tennessee Hospital Association, is working to reduce rates of HAIs by compiling data on baseline rates, best practices adherence, and specific interventions.  Using the standard definitions and methodology developed for NHSN, they are ensuring data are comparable across different healthcare facility sizes and types.  Many healthcare facilities use NHSN to compile data, which is then transferred to Tennessees in-house website, thereby reducing the need for facilities to enter data into multiple systems, saving time and money.

At the local level -- In Pittsburgh, 70% of eligible hospitals participated in a bloodstream infection prevention effort using data compiled by NHSN for Pennsylvania.  The effort resulted in a 68% reduction in CLABSIs between April 2001 and March 2005, with an estimated 40 lives saved each year.  

NSHN is the only national-level HAI surveillance system in the U.S., and is currently used by over 2,000 healthcare facilities across 48 States.  NHSN is a cornerstone of CDCs efforts to prevent and eliminate HAIs and other adverse events.

Some of the key features of NHSN include:
	Enables healthcare facilities to report sensitive, patient-identifiable data to CDC in a secure and confidential technical environment
	Enables healthcare facilities to share specified data with State agencies and other third parties
	Provides analysis options for comparisons of facility HAI rates with NHSN risk-stratified aggregate rates
	Provides functionality for custom data fields for local use  
Our innovative and fine grained security system which handles row & column level security and helps direct a user GUI customized by security rights, and other business rules.  Appendices A & B illustrate some of how business rules drive the GUI without web message round trips via dynamic HTML.  We make extensive use of AspectJ to enforce security on the front end and the back end.  NHSN also uses a robust CORBA interface with SAS to facilitate many standard reporting options and a very capable ad-hoc reporting mechanism. Appendix C shows a small number of the standard SAS based reports that are available, each of which can be customized per user via our SAS interface.

Coordinating all the competing constraints to bring a new version of the application into production; such as the initial and ongoing budget for enhancements, prioritizing new requirements from multiple sources, scheduling new releases with all the affected parties.

o	Getting initial funding
o	Integrating 3 existing systems into a single application
o	Getting funding to sustain the effort
o	Keeping pace with rapidly evolving data requirements for surveillance of healthcare associated infections  
o	Adding system enhancements to meet the needs of States for mandatory HAI reporting
o	Enhancing system performance to enable an exponential increase in system users

Exceeded

NSHN is currently working on interfaces with complementary patient safety systems to yield new benefits for surveillance and prevention by aggregating and analyzing data across systems.  Additionally, CDC is currently consulting with other countries who are interested in utilized NHSN for their HAL surveillance system.

Project growth in terms of users and member hospitals and facilities has exceeded expectation.  Currently, 19 States mandate the use of a surveillance system (like NHSN) by all hospitals to report HAIs, with an additional six States considering mandating its use.  In total, individual healthcare facilities in 48 States participate in NHSN and due to proposed mandates at both the State and federal levels, it is expected that NHSN will continue to grow in the coming months.