5/9/17. Healthcare-Associated Infections Cultural Shift. Background. Disclosures and Disclaimers

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1 National Center for Emerging and Zoonotic Infectious Diseases HAIs in Healthcare Settings: How Did We Get Here & What s Being Done to Address the Issue? Joseph Perz, DrPH MA Team Leader, Quality Standards & Safety Prevention and Response Branch Division of Healthcare Quality Promotion Centers for Disease Control and Prevention Disclosures and Disclaimers The findings and conclusions in this presentation are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention No relevant financial disclosures For a complete list and description of CDC Foundation-funded projects in which DHQP participates, see May Healthcare-Associated Infections Cultural Shift Background Most infections are inevitable. Some may be preventable Each infectionis preventable unless shownotherwise How Many Healthcare Associated Infections (HAIs) are Preventable? q Many more than we used to think q SENIC study- 32% Am J Epidemiol 1985;121:182 q We were all pretty satisfied with that for a long time Prevention of Central Line Associated Blood Stream Infections (early-mid 2000s) BSIs/1000 catheter days ICUs at 67 Michigan hospitals, 18 months 0 18 ~ 70% prevented Pronovost et al, NEJM

2 C. Difficile Rates per 100,00 Population UK Primary Care Organizations The Las Vegas Hepatitis C Outbreak % Reduction DOUBLE DIP Syringes were routinely reused to withdraw multiple doses for individual patients colonoscopies Remaining volume in single dose propofol vials was used for subsequent patients Growing awareness of the preventability of healthcare associated infections merged with increasing awareness of the burden and seriousness of the problem to create unprecedented pressure to both report and prevent HAIs and led to calls to eliminate HAIs 100% Preventable 0% Acceptable Federal Activities to Track and Prevent HAIs

3 2009 HHS Action Plan in Response to GAO Data for action Adherence to evidence-based prevention practices Aligning incentives Innovation research/emerging issues Strategy Strategy Prevent HAIs and control transmission Improve antibiotic use Detect, respond and control Data for Action NHSN Emerging Infections Program (EIP) Outbreaks Guidelines and Tools Programs & Partnerships for Implementation Prevent HAIs and control transmission Improve antibiotic use Detect, respond and control Data for Action NHSN Emerging Infections Program (EIP) Outbreaks Guidelines and Tools Programs & Partnerships for Implementation Innovation Innovation Data for Action: National Healthcare Safety Network National Healthcare Safety Network (NHSN) NHSN: U.S. system for reporting infections in over 21,000 healthcare facilities nationwide NHSN is used by: Facilities across healthcare to track HAIs and antimicrobial resistance, and direct prevention activities States for public reporting and regional prevention HHS and its components Track national progress Prevention initiatives 3

4 Central-line Associated Bloodstream Infections (CLABSI): NHSN Catheter-associated Urinary Tract Infections (CAUTI): NHSN Trends in central line-associated bloodstream infections in hospitals, Source: CDC s National Healthcare Safety Network (NHSN) Trends in catheter-associated urinary tract infections (CAUTI) in hospitals, Source: CDC s National Healthcare Safety Network (NHSN) Standardized infection ratio Overall ICU Wards NICU Overall ICU Wards 20 CLABSI and CAUTI NHSN Data for Local Action: Targeted Assessment for Prevention Progress varies by: State Type of unit (e.g., ICUs, Neonatal ICU, Wards) Pathogen Ø Targeted approach Ø Need for new interventions TAP Report Identify facilities, hospitals or units with excess infections Technical Assistance Health Departments CMS Networks AHRQ Networks Other Partners Targeted Assessment for Prevention (TAP) Strategy Target Assess Prevent Clostridium difficile (CDI) Infections: NHSN CDI in Acute Care Hospitals, Target facilities/units with high burden/excess of HAIs Assess gaps in infection prevention in targeted facilities/units Prevent infections by implementing interventions to address the gaps A linear progression framework for quality improvement Standardized infection ratio (SIR) Prelim Clostridium difficile, facility-wide 4

5 HAI Prevention Implementation and Innovation CDC Networks of Innovation HAI/AR Prevented Preventable Working to address current and future gaps and opportunities Ongoing innovation for identifying and evaluating new strategies for prevention: Prevention Epicenters Collaborate with leading medical investigators and state health departments to more rapidly identify the best approaches to prevent the spread of infections in health care facilities, including antimicrobial resistance and other important infectious threats Patient-level interventions Prevention approach unknown Healthcare facility interventions Regional interventions Work done through a combination of intramural and extramural (EIP, EpiCenters, BAA, SHEPheRD) innovation mechanisms Emerging Infections Program Exploration of innovations to improve national surveillance and evaluation of healthcareassociated infection prevention and control strategies 12 Emerging Infections Program (EIP): Healthcare-Associated Infections/Community Interface Platform for identifying targets and settings to address HAI/AR and develop/refine innovative surveillance strategies Emerging Resistant Threats Prevalence survey to assess HAI burden and antibiotic use (as of January 31, 2017) Target surveillance across healthcare and the community C. difficile infections Invasive MRSA Multi-drug resistant gram negatives (as of February 2, 2017) (as of January 31, 2017) Detect new/changing issues or populations 28 Geographical Distribution of KPC Producers 2001 and 2015 Patients Move Infections & Pathogens Move With Them 5

6 Central Role of Health Departments Growth of HAI-AR Programs CDC HAI-AR Programs Current Status HAI Program Origins: ARRA Funding (2009) All 50 state health departments, 6 local health departments and Puerto Rico using HAI/AR programs to detect, respond and prevent to HAI/AR threats across healthcare settings State HAI/AR programs facilitate public health and healthcare partnerships to ensure the successful prevention of infections Implement HHS Action Plan Support expanded use of NHSN Public Health HAI Workforce: Initial investment Tennessee Example 33 CDC-Funded State HAI Programs: History State HAI Plans and Advisory Groups est HAI coordinator in every state through the Epidemiology and Laboratory Capacity (ELC) Cooperative Agreement Partners included state hospital associations, CMS-funded networks, hospital networks, APIC, others 2011 Affordable Care Act (ACA) funding Continued level support Momentum Behind CDC/DHQP Funding for HAI/AR Programs HHS HAI Action Plan (2009), ARRA Funding for State HAI Programs (2009) CMS reporting NHSN (2011), Affordable Care Act (2011), MERS-COV (2012), Fungal Meningitis Outbreak (2012) CDC s AR Threat Report (2013) National Strategy on Combating Antibiotic-Resistant Bacteria (CARB) President s Council of Advisors on Science and Technology (2014) Ebola Outbreak in West Africa (2014) National Action Plan for CARB (2015) 6

7 Spring 2015 Domestic Ebola Supplement to ELC Supported increased collaboration between HAI-AR programs, preparedness programs, other partners On-site presence to continue Ebola Assessment Hospital visits, transitioning to Health Departments and translating this model for more general use Emphasized critical importance of infection control competency across all healthcare settings First significant increase in HAI program resources since 2009 ARRA ELC Domestic Ebola Supplement Healthcare Infection Control Assessment and Response (ICAR) Activity A 2 year funding $32 Million, 61 Awardees A.1: Expand State HAI Plan and Advisory Group A.2: Improve coordination between DOH and healthcare settings A.3: Assess readiness of designated Ebola facilities A.4: Assess and improve HAI outbreak reporting and response Activity B Optional; 3 year funding $53 Million B.1 Expand infection control assessments (53 Awardees) B.2: Increase infection control competency and practice (43 Awardees) B.3: Enhance surveillance analytic and reporting capacity (38 Awardees) ICAR Activity B1: Expanding Infection Control Assessments CDC funding and technical support to state and local health departments Opportunity for health departments to expand their outreach to healthcare facilities Created a structured approach for identifying gaps in infection control practices and procedures Helps inform training and resources to strengthen infection prevention program capacity Expanded State HAI Plan and Advisory Group Expand HAI Advisory Group to include additional partners, specifically hospital preparedness Ideally, representation from hospital associations, QIN/QIOs, and licensing agency with surveyor authority Engage Advisory Group in implementing State HAI Plan Update current State HAI Plan to include expanded activities Actively assessing and intervening to achieve best practice across all of healthcare Identifying and addressing emerging threats National Action Plan for Combating Antibiotic- Resistant Bacteria (CARB) National Action Plan for CARB called for a CDC response to: Detect and respond to resistant pathogens Prevent spread of resistant infections Encourage innovation for new strategies Implementing CARB Steps needed to meet CARB goals: Build state capacity Expand nation-wide lab capacity Expand efforts to address community AR threats 7

8 Expanding HAI/AR Programs to Every State CDC has expanded implementation of prevention networks where public health and healthcare work together to better prevent and stop spread of infections and improve antibiotic use Detection & Contain: In all 50 states, 6 cities and Puerto Rico, CDC is supporting local AR expertise and lab capacity to improve identification and response to all emerging threats, leading to synchronized action across healthcare and communities to quickly protect patients and control spread. Prevention & Stewardship: In 25 states and 3 cities, CDC is aggressively expanding CRE, C. difficile, and other MDRO prevention and antibiotic stewardship programs, implementing proven strategies in healthcare facilities to prevent infections and transmission across healthcare settings. State HAI/AR Programs: History, Revisited 2009 ARRA funding established state HAI programs and required state HAI advisory groups and state plans 2011 ACA funding continued level support 2015 Ebola supplement (ICAR; 3 year funding) provided first significant increase in support to state programs 2016 AR funding Part of CDC core funding Sustained HAI Program support 43 Moving Towards HAI Elimination Moving Towards HAI Elimination Working with Healthcare Providers 600 professional partnerships Linking through internal resources Clinician listservs and calls NHSN users, HICPAC, Prevention EpiCenters Medscape collaboration CDC expert commentaries to date CME courses Working with Patients Prevention is Our Goal and Responsibility At the end of the day, we're all patients Thank You For more information, contact CDC CDC-INFO ( ) TTY: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. 8