Data collection is crucial to helping health care stakeholders—including medical providers and public health experts—evaluate antibiotic prescribing practices, ensure their appropriate use, and slow the emergence of deadly antibiotic-resistant pathogens, or “superbugs.”
The Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) gathers data on a range of health care-associated infections that patients acquire during hospitalization, long-term care facility stays, outpatient surgery center visits, or medical procedures such as dialysis.
This surveillance system also collects data specific to antibiotic-resistant infections and antibiotic prescribing from inpatient facilities through the Antimicrobial Use and Resistance (AUR) Module—allowing these facilities to better understand their prescribing practices and improve antibiotic stewardship efforts—with the goal of reducing antibiotic-resistant infections.
This interview with Melissa Cumming, who leads the Healthcare-Associated Infections and Antibiotic Resistance Program at the Massachusetts Department of Public Health, is one in a Pew series of interviews with five state health department officials to learn about antibiotic stewardship efforts to encourage data reporting. This interview has been edited for clarity and length.
Q: Can you tell us about your program in the Massachusetts Department of Public Health?
A: Our health care-associated infections, antibiotic stewardship, and antibiotic resistance program encompasses a lot: We cover disease surveillance, infection prevention and control, and monitoring of multidrug-resistant organisms as well as other types of health care-associated infections. We also oversee many of Massachusetts’ stewardship and antibiotic use monitoring initiatives.
Q: Does your team encourage hospitals to report their antibiotic use data into the National Healthcare Safety Network’s Antimicrobial Use and Resistance Module?
A: We do. In 2018, we used a small amount of funding from CDC to offer “mini grants” of less than $5,000 to help acute care hospitals begin reporting their antibiotic use data into NHSN, share that data with us, and help us promote reporting with their colleagues in other facilities. The mini grants worked well: We had 12 acute care facilities on board by 2019; to put that into perspective, we have about 70 acute care facilities in the state.
Q. Did you initially focus on specific types of settings?
A: We initially targeted acute care facilities with neonatal intensive care units (NICUs), because we participate in a neonatal quality improvement collaborative that wanted to look more closely at antibiotic use across NICUs in Massachusetts. Now, all but one of the state’s NICU hospitals report antibiotic use data. That’s great because facilities can benchmark themselves against aggregate statewide data and other similar facilities.
Over time, we’ve seen increased interest in reporting, and now 50% of our acute care hospitals report antibiotic use data to NHSN and also allow for their data to be shared with us, which we’ve been able to use to run additional analyses and create benchmarking reports. The increase in reporting is not just because of the grants; many facilities now realize the benefits of the AUR Module because they can use the tools built into the system, and the benchmarking reports we generate, to assess their own prescribing patterns.
Q: What else do you do to capture antibiotic use data in the state?
A: In addition to the AUR Module, we have a program and survey tool that engages long-term care facilities to report monthly antibiotic start data—basically, how many new antibiotics were ordered and administered. Facilities enter how many prescriptions they started each month for several different antibiotics, along with how many days a patient received these therapies. We then routinely feed that information back to them with a benchmarking report showing how their use compares to other long-term care facilities in the state. We also will now be providing additional guidance to facilities on actions they can take based on their reports.
Q: Did the tool pick up any changes in antibiotic use in long-term care facilities during the pandemic?
A: In late 2020, it showed a clear increase in prescriptions for antibiotics commonly given for respiratory infections. Fortunately, that prescribing rate went down quickly. But it was great that we had a system in place able to detect the change.
Q: Where do you think there’s opportunity to increase NHSN reporting?
A: We want to increase reporting from the 14 long-term acute care hospitals in Massachusetts. Those facilities, by virtue of their patient population, can be reservoirs for multidrug-resistant organisms; they care for high-risk patients with complex, high acuity needs and often with extensive exposure to other health care facilities. We want to support these facilities in their antibiotic stewardship efforts.
As of now just one of these 14 facilities is reporting antibiotic use data. It would be beneficial if we could get access to data for the rest, to help them better understand their prescribing practices.
Q: Why aren’t more facilities reporting data?
A: It’s mostly IT and technical challenges rather than a lack of interest in submitting data to the NHSN AUR Module. But often when you ask a facility to share data, their immediate concern is whether it can be used for any regulatory or punitive purpose.
Even if the stewardship team in a facility thinks it’s a great idea to report antibiotic use data to NHSN, their quality and compliance colleagues often have concerns over what will be shared. I think it’s important to ensure facilities understand that antibiotic use reporting in NHSN is nonregulatory, nonpunitive, and currently exists for quality improvement and surveillance reasons.
Q: Any other advice you’d give to other states looking to encourage NHSN AUR reporting?
A: Engage champions and early adopters who have the respect of their peers. They can help other facilities become more comfortable with reporting. When we were working to expand NHSN antibiotic use reporting participation, the first place we went was to facilities that were already using the AUR Module so they could help us spread the word.
Anytime you ask for data, you must provide feedback, so the reporter doesn’t feel like they are reporting into a “black hole.” You want them to be able to use the benchmarking to inform their work.