2017 State of the State Address on Prevention of Health Care Associated Infections and Antimicrobial Resistance

Transcription

1 2017 State of the State Address on Prevention of Health Care Associated Infections and Antimicrobial Resistance Erica Runningdeer, MSN, MPH, RN HAI Prevention Coordinator Division of Patient Safety & Quality November 2017

2 Disclaimers No conflict of interest to report Funding for the HAI/AR Prevention Program is made possible (in part) by the Centers for Disease Control and Prevention. The views expressed in my presentation do not necessarily reflect the official policies of the Department of Health and Human Services, nor does the mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

3 Objectives Discuss current initiatives to prevent health care associated infections and antimicrobial resistance lead by IDPH Division of Patient Safety and Quality Evaluate your team s role in achieving the statewide goals outlined in the Illinois Action Plan to Prevent Health Care Associated Infections and Antimicrobial Resistance

4 Illinois Action Plan to Prevent HAIs & AR Vision: The state of Illinois ensures health and patient safety through prevention of healthcare associated and antimicrobial resistant infections driven by a sustainable, collaborative and coordinated healthcare system. Mission: Reduce healthcare associated and antimicrobial resistant infections through education, practice guidance, surveillance, and data-driven public policy and quality improvement efforts that strategically engage healthcare consumers, providers, and stakeholders.

5 Illinois Action Plan to Prevent HAIs &AR Priority Areas & Goals A B C D Infection Prevention Infrastructure, Standards, and Practices Goal #1 Illinois will implement a comprehensive and effective infection prevention and control system with standards, policies, and practices in place for all healthcare settings Assessment/Treatment/Outbreak Goal #2 Improve detection, investigation and response to infectious outbreaks including community and healthcare associated infections (HAI) and antimicrobial resistant (AR) organisms Antimicrobial Stewardship Goal #3 Improve antimicrobial prescribing practices across all healthcare settings Goal #4: Raise public awareness about antibiotic use and misuse Multi-Drug Resistant Organisms Goal #5 Slow the emergence of resistant bacteria and C. difficile, and prevent their transmission

6 Key Strategies & Cross-Cutting Topics Education & training Policy Data & Surveillance Communication

7 Illinois HAI/AR Prevention Timeline Mandated NHSN Reporting & Launch of Illinois Hospital Report Card & Consumer Guide to Health Care CLABSI, ICUs Med/surg, peds, other Surgical Site Infections (SSI) KPRO & CABG C. diff & MRSA Acute Care, LTACH, IRF ALL NHSN Measures reported to CMS st quality improvement collaborative launched with 20 hospitals (focus: C. diff) Released training video: Not Just a Maid Service NHSN AU reporting pilot 1 st Antimicrobial Stewardship Collaborative Illinois Action Plan to Prevent Healthcare Associated Infections and Antimicrobial Resistance Infection Prevention Liaison Program (ICAR) HAI/AR Program developed through CDC grants. Total CDC award since 2009 = $8,972,844

8 Where to start?: Personal Reflections on core questions that I ask myself nearly every day (and want you to ask yourself, too): How can I help create RADICAL sustained improvement?

9 1: You will need resources the most important being an AWESOME TEAM Meet the newest member of Illinois HAI/AR Prevention Team Illinois Antimicrobial Resistance Prevention Coordinator CDR Gregory A. Raczniak, MD

10 How can I help create RADICAL sustained improvement? 2. Use the So what? test to stay focused Example: re-focusing on what motivates me: So what? What difference will it make if we prevent HAIs? HAIs are: 1) Preventable (meaning change is possible!) 2) harmful & a source of suffering 3) Costly Example: decide what you will and WILL NOT invest energy/resources/time in: So, you want to make hundreds of Infection Preventionists manually enter susceptibility profiles into the XDRO registry? So what will that accomplish? What will you actually do differently based on that information?

11 How can I help create RADICAL sustained improvement? 3. Think like an industrial/systems engineer Make it easy & rewarding to do the right thing Examples: Grant to APIC Consulting for Infection Prevention Liaison Program LTC Certificate Course Make it difficult & unpleasant to do the wrong thing Example: increased regulations & penalties

12 Contact:

13 Antimicrobial Resistance Data - Illinois Extensively Drug Resistant Organism Registry: CRE reported in Illinois (as of November 5, 2017) # patients (unique cases): 4,602 # reports submitted: 7,411 # unique facilities with access: 628 # facilities that have ever queried: 179

14 Example: Make it easier to do the right thing XDRO automated alerts (Admissions Feed) Report (Real-time alert) As of November 5, 2017: 1,358 autoalerts sent for 576 unique patients We now have 24 facilities connected to autoalerts including 2 LTACHs

15 XDRO auto alert progress as of 5/19/17 Credit: Emily Augustini, Pawel Nowak

16 Alert Tracking Tool* *Data summaries in following slides come from alert tracking tool 16

17 Alert Summary, Pilot Hospitals, 1/7/2015 8/22/2017 Hospital Hospital Size Duration (mo.) Inpatient Alerts (n) Alerts/ mo. Correct person n (%) Known CRE n (%)* On contact precautions n (%)* 1/2 Med/Sm (96%) 55 (57%) 20 (21%) 3 Large (100%) 168 (77%) 142 (65%) 4 Med (100%) 75 (81%) 87 (94%) 5 Large (100%) 149 (97%) 133 (86%) 6 Med (97%) 75 (82%) 85 (92%) 7 Med (100%) 27 (68%) 30 (75%) 8 Small (100%) 9 (100%) 8 (89%) 9 Small (100%) 19 (83%) 20 (87%) 10 Small (100%) 13 (87%) 11 (73%) Hospital size: Small (<200 beds), Med ( ), Large (>500) Inpatient alerts and feedback data may not add up due to missing data *Denominator = # alerts that correctly identified the patient Slide adapted from: Mike Lin, Rush University Medical Center/Chicago CDC Epicenter 17

18 Alert Summary, Additional Hospitals, 8/29/2016 8/22/2017 Hospital Hospital Size Duration (mo.) Inpatient Alerts (n) Alerts/ mo. Correct person n (%) Known CRE n (%) On contact precautions n (%) 11 Med (92%) 7 (64%) 7 (64%) 12 Med (100%) 15 (94%) 16 (100%) 13 Small Small (100%) 1 (100%) 1 (100%) 15 Small (100%) 3 (100%) 3 (100%) 16 Med (100%) 30 (48%) 43 (68%) 17 Med (100%) 25 (48%) 30 (58%) 18 Large (100%) 11 (48%) 14 (61%) 19** Med < Hospital size: Small (<200 beds), Med ( ), Large (>500) Inpatient alerts and feedback data may not add up due to missing data **Hospital was connected for about a week before they switched to a new EHR and stopped their feed. They haven t yet started sending their ADT data again. 18

19 Aggregate Alert Outcomes, 1/7/15 8/22/ Inpatient alerts at 18 hospitals Missing data: 48 (5%) Complete data: 918 (95%) Incorrect pt: 8 (1%) See notes below for additional details Correct pt: 910 (99%)

20 Alert Outcomes: All correct inpatient alerts, 1/7/15 8/22/ alerts Prior to alert, did IP know pt had CRE? Yes 682 (75%) No 228 (25%) In contact precautions when IP viewed alert? Yes No Yes No 559 (82%) 123 (18%) 91 (40%) 137 (60%) 29% of patients with a history of CRE were NOT in CP at time of alert. Slide adapted from: Mike Lin, Rush University Medical Center/Chicago CDC Epicenter

21 If the patient is already a known CRE, how did you find out? (N=682) Previous positive at our facility Communicated by other facility 80% 60% 70% 50% 60% 50% 40% 40% 30% 30% 20% 20% 10% 10% 0% Yes No Unknown 0% Yes No Unknown

22 US Antibiotics Awareness Week Nov Annual one-week observance to raise awareness of antibiotic resistances and the importance of appropriate antibiotic use CDC s Be Antibiotics Aware Campaign Goal: raise awareness of antibiotic resistance and promote the appropriate use of antibiotics Target audience: Outpatient healthcare providers & general public Partner Toolkit: Outlines US Antibiotics Awareness Week Activities Includes newsletter templates, sample social media posts, and new materials

23 Center for Disease Control and Prevention: Be Antibiotics Aware Campaign (3) Public Service Announcements The Right Tool h?time_continue=2&v=detk7jc- XWA

24 Antibiotics Awareness Week in Illinois Gubernatorial Proclamation Read here. Press Release Daily social media posts Dental Toolkit Mailing

25 Why? Antibiotics Awareness Week in Illinois: Dental Mailing & Survey Dentists account for 10% of outpatient antibiotic prescriptions or 24.5 million prescriptions nationwide Dentists have the 4 th highest antibiotic prescribing rate Target audience: Licensed dentists in downstate IL counties Purpose: Assess knowledge, attitudes and behaviors of dentists Provide resources and tools for improving antibiotic prescribing in dental offices

26 Antibiotics Awareness Week: How can you participate? Distribute Be Antibiotics Aware resources Post to your organization s social media page using #BeAntibioticsAware and #USAAW17 Join the #AntibioticResistance Global Twitter chat on Thursday, November 16 from 12-2PM CST Use drop-in newsletter article templates

27 National Healthcare Safety Network (NHSN) Prescribing Data - Illinois NHSN Antibiotic Use (AU) module 12 (of 183) acute care hospitals in IL are reporting NHSN facility survey Only 44% of hospitals have all seven core elements of antimicrobial stewardship in place

28 Thank You for listening & Much Gratitude to the following AMAZING people for being so involved in working to achieve our vision: Chinyerre Alu Angela Tang Anh-Thu Runez Jessica Ledesma Suzanne Williams Barbara Fischer Deb Burdsall Mary Alice Lavin Bill Trick Mike Lin Stephanie Black Massimo Pacilli Sarah Kemble Chicago CDC Prevention Epicener Chicago Dept. of Public Health and many, many more!