National Nosocomial Infections Surveillance System

National Nosocomial Infections Surveillance System
Name	National Nosocomial Infections Surveillance System
Abbreviation	NNIS
Formation	1970s
Dissolved	2005
Successor	National Healthcare Safety Network
Type	Surveillance program
Headquarters	Centers for Disease Control and Prevention
Region served	United States

National Nosocomial Infections Surveillance System

The National Nosocomial Infections Surveillance System was a United States surveillance program operated by the Centers for Disease Control and Prevention designed to monitor healthcare-associated infections in hospitals. Established during the late 1970s and active through the early 2000s, the program influenced infection control practice at institutions such as Johns Hopkins Hospital, Mayo Clinic, Massachusetts General Hospital, and service networks linked to Department of Veterans Affairs. It informed policy discussions involving agencies like the Department of Health and Human Services and shaped guidance referenced by journals including The New England Journal of Medicine and The Lancet.

History

The NNIS emerged from collaborations among the Centers for Disease Control and Prevention, state health departments such as the California Department of Public Health and the New York State Department of Health, and academic centers including University of Iowa Hospitals and Clinics and University of Minnesota Medical Center. Influences included landmark reports from Public Health Service panels and infection control leaders associated with institutions like Stanford Hospital and Johns Hopkins Hospital. During the 1980s and 1990s NNIS expanded participation to tertiary centers such as Cleveland Clinic and pediatric hospitals like Children's Hospital of Philadelphia, while interacting with regulatory bodies such as the Joint Commission and advisory committees convened by the National Institutes of Health.

Objectives and Scope

NNIS aimed to provide standardized surveillance of surgical site infections, catheter-associated bloodstream infections, ventilator-associated pneumonia, and urinary tract infections across acute-care hospitals. The system sought to produce benchmark rates that were used by hospitals including Barnes-Jewish Hospital, research centers like Harvard Medical School, and policy institutions such as the Agency for Healthcare Research and Quality. Its scope included intensive care units in centers such as Mayo Clinic Hospital, neonatal intensive care settings at institutions like Massachusetts General Hospital for Children, and specialized units in hospitals operated by the Department of Veterans Affairs.

Methodology

NNIS developed standardized definitions and risk adjustment methods informed by infectious disease experts at institutions like University of California, San Francisco and Columbia University Medical Center. Core methods included device-associated denominator calculations, NHSN-style risk indices later codified in guidance from organizations such as the Infectious Diseases Society of America, and statistical approaches used by analysts affiliated with Johns Hopkins Bloomberg School of Public Health. Surveillance relied on trained infection preventionists, often certified by programs linked to Association for Professionals in Infection Control and Epidemiology.

Data Collection and Reporting

Participating hospitals submitted aggregate and line-list data using standardized forms to central NNIS databases maintained by the Centers for Disease Control and Prevention. Data elements mirrored those used in multicenter studies from institutions like Vanderbilt University Medical Center and included patient-days, device-days, and procedure counts consistent with protocols seen in trials at University of Pennsylvania Health System. Reports generated by NNIS were disseminated in CDC publications and presented at meetings such as the Infectious Diseases Society of America Annual Meeting, the Society for Healthcare Epidemiology of America conferences, and forums hosted by the American Hospital Association.

Impact and Findings

NNIS supplied benchmark infection rates that hospitals and academic centers including UCLA Medical Center, Mount Sinai Hospital (Manhattan), and University of Washington Medical Center used to assess performance. Analyses based on NNIS data identified trends in methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus that informed stewardship efforts referenced by committees at the Food and Drug Administration and recommendations in journals such as Clinical Infectious Diseases. NNIS-derived publications influenced clinical bundles later promoted by programs associated with Centers for Medicare & Medicaid Services and quality initiatives advocated by The Joint Commission.

Criticisms and Limitations

Critiques of NNIS highlighted selection bias because participating hospitals included many large tertiary centers like Cleveland Clinic and academic medical centers such as Yale New Haven Hospital, limiting generalizability to community hospitals represented by networks including Community Health Systems. Other limitations cited by analysts from institutions like Johns Hopkins Hospital and University of Michigan Hospitals included variable case finding, inter-rater reliability challenges discussed at conferences such as the Society for Healthcare Epidemiology of America meeting, and delays in reporting compared with real-time needs advocated by the Institute of Medicine.

Legacy and Successor Programs

NNIS was superseded by the National Healthcare Safety Network, a CDC-managed system that expanded electronic reporting used by hospitals, long-term acute-care facilities, and dialysis centers including networks tied to Fresenius Medical Care and DaVita. Elements developed within NNIS—standardized definitions, risk adjustment methods, and benchmarking approaches—persist in NHSN guidance cited by agencies such as the Centers for Medicare & Medicaid Services, professional societies including the Infectious Diseases Society of America, and academic centers like Emory University School of Medicine.

Category:Public health surveillance systems Category:Centers for Disease Control and Prevention