OPC Annual Training 2024

hello and welcome to outpatient procedure component 101 a training designed to assist new and experienced users of the outpatient procedure component with all aspects of surveillance and Analysis my name is Melissa Otis and I am a member of the protocol and training team at nhsn I'm joined today by my colleague Irene Khan from the nhsn acute care analytics team our objectives today for protocol training and enrollment will be to demonstrate how to implement a surveillance program for your Ambulatory Surgery Center by the end of this presentation the user will be able to understand how to enroll in nhsn and the outpatient procedure component determine how to implement a surgical sight infection or SSI and same day outcome measure or sdom surveillance program for your Ambulatory Surgery Center using nhsn and finally to identify benefits of using OPC for SSI and SD surveillance and Reporting our objectives for analysis will be to demonstrate how to conduct analysis on OPC reports for the surgical site infection module by the end of this lesson you will be able to understand the importance of OPC analysis reports navigate the nhsn application to access the OPC analysis reports analyze breast data entered into OPC through line listing reports and finally to interpret reports of the analytic report in order to best demonstrate our objectives today Irene and I have put together some background on our test facility that we will be walking through today you're the newly appointed infection preventionist at downtown Surgery Center your facility does meet the definition of an Ambulatory Surgery Center as to in the nhsn outpatient procedure component an ambulatory Surgical Center or ASC means any distinct entity that operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization in which the expected duration of services would not exceed 24 hours following an admission an ASC must be certified by the center for Medicare and Medicaid services licensed by a state agency or both your state does not mandate reporting ssis but in order to better understand how your prevention efforts are impacting the occurrence of SSI events in your facility you have decided to begin reporting SSI data into nhsn in addition you've opted to report SD data in order to track and Trend adverse outcomes at your facility your facility primarily reports breast procedures so you will be Begin by reporting breast procedures and N SSI events for sdom you will be reporting all operative procedure categories step one will be the enrollment process if you're already enrolled in nhsn with the HPS component for example adding the outpatient procedure component can be done in just a few clicks please note only the facility administrator can add a new component first you'll select facility from the left navigation bar in the nhsn application next you'll select add edit component and update the Box shown will then appear and any components you follow will be selected from here you'll just need to select the outpatient procedure component and then you'll be prompted to complete information for the primary contact for your facility if you're a new user to nhsn this side highlights steps you'll need to take to enroll with nhsn please note more detailed instructions can be found on the nhsn web page the first step will be to prepare your computer you'll want to use an updated browser and make sure you add cdc.gov and verisign.com to your trusted websites and permit popups you'll also want to check spam blocker settings and allow emails from nhsn cdc.gov and sam-- reply at cdc.gov you'll want to register your facility with nhsn by agreeing to the nhsn rules of behavior entering all required Fields including the name your correct email address and your CMS Certification Number if applicable please note you can also request a temporary enrollment number from nhsn you'll want to select am surge outpatient surgery facility as your facility type next you'll register with the secure access Management Services or Sams you'll receive two emails after you register your facility and using the invitation to register with Sam's email um that will be sent to you you'll want to select the link and follow the steps to complete your Sam's registration finally you'll complete your nhsn ASC enrollment you'll access the Sam's login page by clicking on the link provided enter your usern name and password to log in on the Sam's homepage under my applications you'll click nhsn enrollment next you'll go to the nhsn enrollment page and finally you'll select enroll a facility you'll then see a popup that's provided here and you'll want to select okay please know that our user support team is always available to assist with any enrollment related questions or issues please reach out by emailing the team or creating a service now request detailed conf contact information will be provided at the conclusion of this presentation one additional useful step that may be helpful but is certainly not required is the addition of your surgeons for your facility you can manually enter this information by using the steps outlined above the first step is to select facility from the left nav ation bar in the nhsn application next you'll select surgeons and then you'll be prompted to enter a surgeon code the surgeon code is a unique code that you create for each of your surgeons and is not provided by nhsn you also see that the status is pre-populated to active and you can modify this status as necessary in addition you can choose to add your surgeon name but this information is not required in order to save the surgeon code you can also enter this information by uploading a CSV file using the import surgeon codes button on this slide please note I will show some more detailed instructions of the CSV file process a little bit later in this presentation step to be step two will be to enter your monthly reporting Plan before you can enter any data for the month you will need to enter a monthly reporting plan we commonly refer to this as an MRP at nhsn um to enter the reporting plan you will first select reporting plan from the left navigation bar followed by add you will then enter what information you will be collecting and entering into nhsn for the month selected if you choose to report SD data you'll select that box a little further on in this presentation I'll cover what SD data is for for SSI you'll also have to select the operative procedure categories that you will be reporting on for the month selected in our test facility example we will be collecting breast data so we have entered breast as the operative procedure category please note you can enter as many operative procedure categories as you would like in this list make sure to select save before you leave the screen The Next Step will be to collect your procedure data for all operative procedure categories these are the required fields that you will collect for all procedures performed within each category you'll collect the patient data which is their ID gender and date of birth the nhsn procedure code this is also referred to as the category for example in our case this is breast category the CPT code the date of the operative procedure duration wound class general anesthesia ASA score scope diabetes height and weight step four will be to enter the procedure data that we've just collected you have two options for collecting and Reporting your procedure data you can manually enter this information for each procedure or you can use a CSV or comma separated values file which is essentially an Excel spreadsheet that you can use to enter all of your procedure level data on and then upload this to the application all at once I have included a link here to the OPC SSI web page uh where you can easily access the CSV import guide as well as a test file or temporary file that you can store to your computer we will cover that here shortly so you can see what it looks like if you're manually entering your procedures this is a picture from the application for the denominator for procedure reporting screen the red asteris designate all required Fields these data may be entered manually for each procedure or as I mentioned um uploaded via the comma separated values file that we'll talk about next this is a screenshot of the test file that you can access on the OPC SSI web page and this is all test data please note this is all fictitious and this data includes or this file includes all of the categories that we've just covered and you will enter this for all of the operative procedure categories for whatever time period for which you want to upload and then you can upload this to the application all at once in order to utilize a c SV upload function um you'll select import/export from the left navigation bar next you'll select procedures and then you'll be prompted to upload your saved CSV file with all the procedures you'll be reporting based on your monthly reporting plan this is the same process that you will take for uploading your surgeon level data please note the steps will be essentially the same you'll again select import/export but instead of selecting procedures you'll select surgeons step five will be to perform surveillance for the SSI events surgical sight infections or ssis are identified and reported based on the tissue level for nhsn reporting purposes uh The Superficial level including the skin and subcutaneous tissue the Deep level includes the muscle and the fascia and the organ Space level is any tissue below the muscle or fascia and we'll jump into these a bit deeper here on the next few slides for SSI reporting in the outpatient procedure component there are two sets of criteria available both General and breast specific criteria this is for all tissue levels the breast category is used for SSI surveillance for all nhsn qualifying breast procedures and the general category is used for all other nhsn operative procedure Cate ories for superficial incisional ssis uh the general criteria and the breast are identical and cover the following either a purulent drainage from The Superficial incision B organisms identified from an aseptically obtained specimen from The Superficial incision or subcutaneous tissue by culture or non-culture-based microbiological testing method C is a superficial incision that is deliberately opened by a surgeon physician or physician design and culture or non-culture-based testing of The Superficial incision or subq tissue is not performed and they must have a qualifying sign or symptom which is either localized pain or tenderness finally criteria D is diagnosis of a superficial incisal SSI by a physician or a physician design please note the surveillance period for all superficial incisional ssis is 30 days regardless of the operative procedure category for deep inal ssis the criteria again are identical for both General and breast and include the following for deep incisional the surveillance period can either be 30 days or 90 days depending on the operative procedure category it involves theep soft tissues of the incision for example the muscle or fascial layers and the patient has to meet one of the following please note they do not have to meet all of these just one criteria a is purulent drainage from the deep incision criteria B is a deep incision that spontaneously dehis or is deliberately opened or aspirated by a surgeon physician or physician design and organisms are identified from the deep soft tissues of the incision by culture or non-culture microbiological testing which is performed for purposes of clinical diagnosis or treatment um and may include or may not include active surveillance in addition one criteria is that there is no culture performed and finally the patient must have one of the following qualifying signs or symptoms including fever or localized pain or tenderness finally criteria C is an abscess or other evidence of infection involving the Deep incision detected either on Gross anatomical or hystopathological exam or imaging test for organ space surgical site infection again the surveillance period for this can either be 30 or 90 days depending on the operative procedure category performed and it involves any part of the body deeper than the muscle or fascia that is um either opened or manipulated during the operative procedure and the patient has to meet one of the following for General criteria um criteria a is purulent drainage from a drain placed into the organ space for example closed suction drainage open drain t- tube or ctg guided drainage criteria B is organisms are identified from an aseptically obtained fluid or tissue in the organ Space by a culture or non-culture based test or criteria C which is an abscess or other evidence of infection involving the organ space detected either on Gross anatomical histopathological or imaging test evidence consistent with infection finally we have the organ space criteria for breast specific procedures criteria a includes pent drainage from a drain placed into the organ Space level for example closed suction drainage system open drain T tube CT kited drainage B organisms identified from the affected breast tissue or fluid obtained by invasive procedure by a culture or non-culture-based microbiological testing or c is either a breast absess or other evidence of infection detected on Gross anatomic or histopathological exam or imaging test consistent with breast infection you might ask why there is a separate SSI criteria for breast surgery this is a great question remember the goal of OPC is to address the unique care environment of asc's and the breast SSI criteria was developed with this specific goal as the focus breast procedures were selected because these are the procedures found to be the highest volume as well as the highest risk for developing ssis based on ASC data available in nhsn the me measure specifications were developed by C DC in collaboration with the ASC QC and it is consensus-based entity endorsed SSI surveillance in an Ambulatory Surgery Center does present some unique nuances so in order to best assist you with this process we do have the post discharge surveillance toolkit available for your use this toolkit includes a sample letter post discharge SSI worksheet a procedure line list along with instructions and helpful suggestions as we've discussed monitoring for SSI events does require this post- discharge surveillance the process of how the SSI event is identified or detected is a required element and this process can be categorized as either active or passive we do recommend an active process an active surveillance process is a process in which the facility has an active plan for identifying infections this plan may include but is certainly not limited to review of the patient's medical record post discharge Sur surgeon survey post discharge patient letter postd discharge patient phone call uh the patient may return to the outpatient facility for followup uh or it could include Cooperative infection prevention processes between facilities a passive process is one that was not initiated by the facility and the facility is not taking any specific actions to identify infections this may include patient or caregiver contacts a facility to report an infection or the surgeon contacts the facility to report an infection in addition you may receive a report from another facility an inpatient um facility a health department an emergency department Etc we do have the post discharge surveillance toolkit to best assist you and we really do help that it help hope that it helps you with this process so step six is entering your SSI events in order to add an SSI event in the nhsn left navigation bar you'll select event and add and you'll enter all mandatory fields that are marked here with a red asteris this is a patient level data which includes the patient ID the gender and date of birth in addition you'll complete all this detailed information as you've as I've noted here all mandatory fields are marked with a red asterisk and the next slide will give you a little bit better view this is more the specific criteria that's used but slide here will really identify for you some of the more event level level data that you will be entering for your patients again the red asterisk indicates all required Fields let's talk a little bit about sdom events for SD events you'll monitor all encounters regardless of the operative procedure category let's talk a little bit about what an encounter is for for the purposes of nhssn reporting an encounter is defined as any patient visit to an outpatient location where upon entry into the facility the patient completes the registration process some asc's may refer to this as an admission into the facility SD includes four distinct measures which are monitored the measures are similar to ASC 1-4 which you may be familiar with if you have Ru reporting to CMS via the ASC Quality Reporting program when following this module all patient encounters are monitored for all four of the sdom events sd1 is patient burn sd2 is patient fall S3 is wrong site wrong side wrong patient wrong procedure or wrong implant commonly referred to as wrong our S4 is all cause Hospital transfer or admission as I have mentioned before surveillance is All or Nothing when you follow the sdom module asc's will monitor all patient encounters for all four SD events rather than relying on anecdotal evidence monitoring for these events can help an ASC to notice Trends and determine if prevention efforts are effectives effective EXC excuse me patient Burns reflect Hazard which are present in the operating room environment Falls include the sudden uncontrolled unintentional downward displacement of the body a wrong event is a procedure that is inconsistent with the documented informed consent an all cause Hospital transfer or admission is a transfer or admission to a hospital directly from the ASC for any reason for sdom reporting with nhsn the number of events is your numerator and the number of encounters is your denominator as mentioned before these are similar to CMS ascqr reporting measures 1-4 which you may already be reporting um and Reporting NH reporting these to nhsn does not replace this reporting requirement however the use of OPC SD will allow facilities to continue to collect and report this data on all payer types and not just the Medicare patients and may offer a more comprehensive view of your data next let's talk about a few benefits of using the outpatient procedure compon the OPC SSI protocol was created specifically for asc's it's a centralized system for collecting and analyzing adverse event data it may minimize reporting burden for asc's while ensuring that all all validated credible and actionable data is reported provides an opportunity to analyze multiple multiple payer data you can monitor outcomes of adherence to infection prevention and control practices and guidelines in addition you can track incidents of surgical sight infections and other adverse outcomes and enables the use of surveillance data for measuring clinical quality and benchmarking performance against National nationally aggregated data exerting positive change in patient care practices and then public reporting and other accountability purposes and finally building knowledge related to infection risk in the ASC environment I'm now going to pause and hand the presentation over to my colleague Irene Khan to cover the analysis portion of this presentation thanks Melissa now that you know all about the outpatient procedure component how to enroll how to um add your enter your data perform surveillance you are now ready to analyze your data in the component and access the an the analytic reports that are available I want to provide a brief overview of the importance of data analysis in the healthcare setting data analysis allows healthc Care Professionals to make informed decisions based on evidence by analyzing data sets Healthcare Providers can identify Trends patterns and correlations to make informed decisions data analysis plays a critical role in improving the quality of care provided to patients Healthcare organizations can track key performance indicators monitor patient outcomes and identify areas for improvement through data analysis this leads to enhanced patient safety data analysis also empowers organizations with actionable insights into disease Trends and atrisk populations enabling them to drive continuous Improvement in patient care for example through surgery center policies on post-d discharge surveillance methods the analytic Tools in nhsn allow ASC to optimize these resources and enhance patient outcomes and ultimately improve the overall delivery of healthc care services in the outpatient setting generating data sets after completing data entry in nhsn is crucial to ensuring that all additions are Incorporated into analysis reports this process freezes the data at a specific point in time and copies it to a defined data set it is necessary whenever changes to the data need to be reflected in the analysis reports additionally data sets are user specific meaning each user must generate their own data sets to analyze data effectively there are detailed guides available on the nhsn website on how to generate a data set I'll provide a brief overview of what this generating data set looks like when you select generate data sets in nhsn a box appears that will prompt you to select a beginning and end date as your date parameter the beginning date is how far back you want the application to incorporate those data changes the ending date is the limit at when you want the data to stop generating it's important to note that all analysis reports will be restricted to the time period that the user specifies on the screen any data that exists outside of this time period will not appear in analysis reports once your time period has been indicated you will select the generate reporting data sets to start the data data set generation process once data set generation is completed you will select analysis from the left NH HSN left-and navigation Pane and select reports once you are in the analysis Tree View there are subfolders under the outpatient procedure component measures folder when you click on the folder labeled SSI a series of analysis reports related to the measure is populated these include different analytic reports such as line list frequency tables bar charts pie charts and Sir reports similar to identifying analytic reports under these specific OPC measures you have the option to view additional reports that highlight different elements of the data for example procedure level data event level data facility and plan information although the parent folder is called Advanced there is nothing really difficult or Advanced about these analysis reports it's just a folder name that houses the additional or supplemental reports and when you click on each of these subfolders that like for example the patient level event level it will expand to show you all the analytical reports associated with this so ex um just like those line list frequency tables bar charts and pie charts so let's utilize the procedure level data analytic reports um we want to analyze the breast data that was entered and one of the ideal methods is to run a line listing of breast procedure records and breast event records when using a line list insures a data quality check it leads to record level review and modifications can be made to look at variables of Interest the analytic reports for analyzing procedures and events um can be performed in different different ways so for the event level data you can select that from the outpatient procedure component measures parent folder under SSI and that will have all event level data in there so we will we can select the line listing of all SSI events similarly for procedure level data we can use the advanced folder to look at specific procedure level information so under that subfolder there's also line listing of all procedures so let's review a case example uh we want to analyze breast data us utilizing a line listing report I want to give you a quick disclaimer here that all data presented in this presentation is fictitious for training purposes only and does not reflect any of um any facilities data so don't expect to see your D your facility data pop up in this presentation um so let's talk about the purpose of that line listing again a line list is an organized detailed list of each record entered into to nhsn nhsn applies default variables when there are no modifications made to the report so for example your ASC facility entered 15 breast surgery procedures with a reporting of seven SSI events in third quarter Q3 of 2023 you want to know number one all if all all the 15 procedure records were recorded into nhsn and number two the detection method of SSI events that were identified for the first step to determine if all procedures were entered into NHS and OPC we will want to modify our line listing so parameters can be modified to customize analysis to specific needs or requirements in this instance our line list will be adjusted to tailor the analysis to different subsets of data and to account for specific variables so under our Advanced folder we will select procedure level data and line listing and choose the fun of modifying the report to set these parameters once you select modify report you are taken to the modified line listing of all procedures here you can make changes to the report title we can CH make changes to the format of the report output we can make changes to time period filter display variable sort variables and the display options of a report so we are interested in confirming that those 15 breast procedure records we entered for 2023 Q3 is accurately reflected in our procedure specific line list the modifications to the report include the time period set to 2023 Q3 and selecting a procedure category that only shows our breast surgery procedures the time period tab in the modification screen allows you to select a specific time period for your report to restrict the data report to a specific specific time period select a DAT variable from the date variable drop-down menu and specify the beginning and ending date for the desired time period if the ending date is left blank the results will include all data from the beginning time period and up to the data indicated on the data set generation screen note that if you do not select that time period and you leave it blank your results will still include all data reported but only for the time period included in your analysis data sets so you can have an ending date or you can have um a blank date but just remember that it's all based on the last gen the date that you specified in that data set generation screen this is your this is the screen that shows you the tab for a time period and how we will set it up um quick thing to note here um this show descriptive variable names is a helpful tool to utilize to view the userfriendly variable labels in the report output you can use the link that says print list next to it to get the list of all the um variable labels that are included in the report for space purposes nhsn by default does not have that item checked and you will see an abbreviated label list the available date date variables can vary within each report you can filter your report by year half year quarter or month date variables are based on the calendar year if fiscal year is desired specify time period by exact date or month range for specifying those time variables by the date the date year year half year quarter year month it was you can start to enter the numbers for beginning and ending dates and the application will automatically enter any of those slash marks and letters such as H and Q for a year half and year quarter when applicable so for example if you're entering just a proc procedure date or proc date your beginning will be of two-digit month two-digit day and two four-digit year you will just enter the numbers and those slash marks are autop populated for you the same thing with the procedure date year half you will start entering the year first and then the number that corresponds with the year the half year that you are selecting so either the first half of the year or second half of the Year and that H will be pre-populated for you so let's go back to our case example we wish to analyze procedure data that occurred in Q3 of 2023 one way to do this would be to select the date VAR variable procedure date yq indicating that you wish to restrict the report to procedures performed during this time period by quarter the beginning and ending values would be 2023 Q3 and the only procedures included in the analysis report will be those procedures where the procedure date was in Q3 of 2023 so from July through September of 2023 and just remember that when you start to enter that the time period in the beginning and ending fields that Q will already be populated for you after you've entered that year now we can modify the filters because we are only interested in looking at breast surgeries this report allows for filtering of the data that will be considered for the report the list of available variables is dependent on the data set used for the report for example procedures data event data the data will have their unique data set that has all the um available variables um that is available to them you can use the drop- down feature to select a variable after selecting a variable to filter click in the empty box with the drop- down arrow to select the operator for example equal then specify desired values of that variable that should be included in the report various operators can be selected to modify the report enter the value criteria or use the drop down for pre-selected values wherever appropriate a group in this section refers to a set of r rules combined to make one filter for example if you wanted to generate a procedure line list for all colon procedures in adult patients or all breast procedures regardless of age you could set up two group filters each with their own rules so we wish to analyze breast surgery procedures and we would use the drop- down to select the variable proc code which refers to procedure categories we want to restrict the line listing of report to only display breast surgeries or brst which is the proc code used here therefore we set the proc code equal to brst the other report modifications options include the title format which is where you can customize the report name and choose the format in which to display the report the time period which we've already set which sets the date to restrict your records the filters which we have already set as well is the ability to choose those different elements to show in the report the display variables tab allows the ability to select more variables to display on the report than is than is already populated by the default variables the sort variables Place those selected variables in order of viewing in the report and the display options allows you to organize the pages in the report once your modifications are set you may run the report as is you can save the report for in you know it can save into your custom folders in nhsn so we can use it for future use or you can actually export the analysis data sets if you're looking at all data elements in the report this is this is the actual report Outlook um output of our report again another disclaimer that the data that's presented here is fictitious it's all test data and is for training purposes and does not represent any facilities data so we modified our line listing of procedures to be limited to 2023 Q3 and for breast surgeries all 15 records are included in the line list based on the report modifications so that's a data quality check right there for you that all those 15 data that you records that you have entered are now reflected on an analysis reports and since no changes were made to the variables displayed on the report nhsn pre-selected variables are populated the line list could be used for data quality purposes ensuring that no types were made during data entry no missing gender or date of birth values Etc and these uh quick thing to note here is those default variables that are pre-selected by nhsn they're just there to kind of help guide you with the report you can add additional variables that might help you do more record level reviews but we set these default variables just to kind of start the whole process of looking at these records so now that we've determined that breast procedures were entered correctly and reflected in the analysis reports we can analyze an SSI event line list to see the patterns in SSI event detection to do this we will select analysis uh outpatient procedure component measures in the analysis treeview and select SSI next line listing of all SSI events and select the function of modifying the report our modifications for this SSI event line list report include the time period set to 2023 Q3 and our procedure code set to bre test procedures only note in the screenshot that you're seeing here in this report no modifications were made to the variable shown the variables that are seen are these nhsn pre-selected default variables as you can see here our line list includes your or ID the patient ID the op event type so these are all SSI events that were identified the specific event type so the you know the tissue level uh of the events identified the procedure date of when the events were identified and the procedure date is important here because the proc the SSI events are based on procedure dates because procedures carry the risk of infection the procedure code is just confirming that these are all breast surgeries we have the date of birth of the patient age of patients gender duration of the surgery um we it shows that these are all outpatient procedures and this column right here when detected shows you the detection methods either if it was active or passive and this other other last column here the all adult excl or stands for all adult excluded that refers to um records that were included or excluded from the sir report so one being yes they're included zero being no they're not included so that would be helpful when you are looking um at your sir reports for breast surgery looking taking a closer look at this report and trying to understand what this report line listing is telling us we start to look for patterns so we start looking at seeing kind of some commonalities between each of those records so I've put these arrows here kind of just to guide you to maybe are there patterns in the specific event type are there are we seeing a lot of deep incisional secondary infections um more than organ space are we seeing a different certain age group that are getting a lot of breast um SSI events but we're interested in looking at the when detected variable so you know if their patients are if these SSI events are being identified via passive F surveillance or active surveillance so the data shows us that in 2023 quarter 3 there was a total of eight SSI events detected across 15 breast procedures that were performed in the same time period the when detected refers to the post-d discharge surveillance methods of ss identification active and passive in order to inter and how we would we interpret this SSI event l list we would say that there were more SSI ident SSID identified via passive surveillance this observation may prompt an ASC to ramp up their postd discharge surveillance process so that ssis can be detected earlier and patients can avoid an adverse event from their outpatient procedure there's also an ability to enhance pattern detection using frequency tables for those large facilities that have large larger volumes of data so users can utilize the SSI frequency table and they can get the same conclusion as a line list which will show the total count of SSI events for each detection method so instead of under the SSI folder instead of going to the line list you can use for a larger facility you can use a frequency table and that will show you the total count and then the percentage of how often those SSI events are detected so in summary analytic Tools in nhsn allows as's to optimize resources enhance patient outcomes and ultimately improve the overall delivery of healthcare services in the outpatient setting there are many analysis reports found in the outpatient procedure component measure folder and the advanced analysis folder the use of a line list is a valuable tool in healthcare for organizing and tracking data and identifying pth patterns to help Target interventions more effectively we have provided a list of resources that will help you with accessing your analyzing accessing and analyzing your reports there's a generate data set so you'll have a detailed guide of why we generate data sets and how each of those buttons are Incorporated a resource on filtering your data by time period so it's a more detailed guide that guide than what I have presented presented and modifying your reports this guide will show you and walk you through each of those tabs in the modification screen and then lastly you have the ASC surveillance and nhsn OPC website where you will find valuable tools on the protocol surveillance criteria CPT code line list and also analysis resources and links to the trainings um for OPC we thank you for taking the time to listen to this presentation for any questions or concerns please contact the nhsn help desk using the nhsn service now feature this new portal can be accessed via https at services. cdc.gov nhsn CSP users will be authenticated using the CDC secure access Management Services or Sams the same way you access nhsn if you do not have a Sam's login or unable to access service now you can still email the nhsn help desk at nhsn cdc.gov