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The Targeted Assessment for Prevention (TAP) Strategy

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National Healthcare Safety Network (NHSN) Update

Please note: As of March 2017, the NHSN application has been updated to Version 8.6.2. Implications pertaining to running TAP Reports in NHSN include:

  • The risk adjustments used to calculate the Standardized Infection Ratios (SIRs) have been updated in accordance with the new 2015 Rebaseline. All NHSN PS risk-adjusted summary measures, including the metric used by TAP Reports to rank locations and/or facilities, the Cumulative Attributable Difference (CAD) metric, will use this updated Rebaseline moving forward. Visit CDC’s NHSN website for more information about the 2015 Rebaseline.
  • The application interface for NHSN has been updated. Users are still able to run and modify reports, but the modification screen has now changed. After choosing to modify a report, select the “Display Options” tab to choose the SIR Goal. Users will notice that previous to the application update, an SIR Goal could be specified by creating a custom CAD Multiplier (prevention target) or using the HHS goal SIRs or National SIRs. The CAD Multiplier is now referred to as the “SIRgoal”. Please note that the 2015 National SIRs are currently not available in the application. Users should instead use the Custom value options to create an SIR goal or use the Department of Health and Human Services (HHS) Prevention targets, also known as the HHS goals.
  • Similar to Acute Care Hospitals, Long Term Acute Care Hospitals may now run TAP Reports for CLABSI and CAUTI data at the location/facility level and FACWIDEIN CDI LabID TAP Reports.
  • Inpatient Rehabilitation Facilities (IRFs), including IRF units within the acute care hospital, can now create TAP Reports for CAUTI data and will have the ability to run CDI LabID TAP Reports in the near future.

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.

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 does the data that is used for the 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), and laboratory-identified (LabID) event Clostridium difficile infections (CDI). As of March 2017, Acute Care Hospitals and 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.