Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC Annual ConferenceBoise, Idaho Topics Public Health and HAI prevention National level activities Idaho HAI Program HAIs in Idaho Antimicrobial Resistance 10/23/2015
Public Health Involvement in healthcare-associated infection prevention 10/23/2015 Remember this? November 29, 1999 Establish a national focus to create leadership, research, tools, and protocols to
enhance the knowledge base about safety. Center for Patient Safety Develop a nationwide public mandatory reporting system and by encouraging healthcare organizations and practitioners to develop and participate in voluntary reporting systems 10/23/2015 Why HAIs Matter to Public Health Widespread and PREVENTABLE Significantly contributes to morbidity and
mortality Importance to public health increasing (economic and human impact): Increasing numbers and crowding of people More frequent impaired immunity (age, illness, treatments) New microorganisms Increasing bacterial resistance to antibiotics 10/23/2015 MRSA Experience Community Healthcare Associated Hospital
Acquired (Spreads to other patients in the healthcare environment) (Moves from healthcare environments to the community (Most severely ill hospitalized patients) 10/23/2015
HHS Operating Divisions 1,200 Recommended Practices 500 Strongly Recommended Practices 6 Divisions HHS has multiple methods to influence hospitalsissuing guidelinesrequiring hospitals to
comply with certain standards releasing data to expand informationof the problem, and .using hospital payment methods to encourage the reduction of HAIs. PRIORITIZATION & COORDINATION 10/23/2015 GAO Recommendations HHS Solution HHS Steering Committee for the Prevention of Healthcare Associated Infections 10/23/2015
10/23/2015 National Action Plan Developed in 2009 Three phases Revised annually Accompanied by separate roadmap document 10/23/2015 Pillars of HAI Elimination The Elimination of HAIs will require (1) adherence to evidence-based practices; (2)
alignment of incentives; (3) innovation through basic, translational, and epidemiological research; and (4) data to target prevention efforts and measure progress. These efforts must be underpinned by sufficient investments and resources. -Moving toward Elimination of Healthcare Associated Infections: A Call to Action. ICHE, 11/2010: Vol 31, No 11 10/23/2015 HAI Elimination: One of
CDCs Winnable Battles Promote use of National Healthcare Safety Network (NHS) data to target prevention Expand collaborations and partnerships to promote and implement proven HAI prevention practices Develop innovative approaches to prevent HAIs across the healthcare system Goals: Improve adherence to infection prevention guidelines Improve national surveillance Improve capacity at state and local health departments 10/23/2015 Idaho HAI Program
10/23/2015 Idaho HAI Program Started: September 2009 Funding targeted to build Healthcare Associated Infections Prevention Infrastructure in State Public Health Agencies Personnel infrastructure for program Data validation, technical assistance, collaboration, NHSN training/support Infection prevention education Staffing: K. Turner / FTE through contract 10/23/2015
Ebola Supplemental Funding State Fiscal Year 2016 (July 1, 2015) Update Idahos HAI Prevention Plan Work with Idahos Advisory Group and expand to include other members Original: January 2010 Last update: September 2012 Inventory of all healthcare settings IC POC Available HAI-related data Current regulatory / licensing oversight 10/23/2015 Ebola Supplemental Funding On-site infection control assessments
Minimum: all Ebola-designated assessment hospitals Identify gaps in infection control readiness Address gaps through consultation / planning Perform follow-up assessments Assess capacity of HC facilities to detect, report, respond to outbreaks Develop assessment tool as template Provide / fund training on hospital epidemiology Communication, outreach, education 10/23/2015 Changes to State HAI Program Idaho Hospital Association HAI boots on the ground contract since
2010 Project Director retired in December 2014 February 2015: IHA no longer has capacity to perform SOW Program activities moved in-house IHA Activities + expand to LTCF Programmatic oversight / reporting 10/23/2015 Bureau of Communicable Disease Prevention Immunization
TB Program Epidemiology Operations State Public Health Vet Food Protection Refugee Health Screening Healthcare Associated
Infections 10/23/2015 https://labor.idaho.gov/DHR/ATS/StateJobs/jobannouncement.aspx? announcement_no=07640057044 10/23/2015 Focus: HAIs and AR/AS Provide overall management of the HAI program Facilitate statewide efforts Oversee and develop program materials Grant application / reporting Evaluate HAI Surveillance TA to facilities
Lead/participate in multi-disciplinary teams NHSN Group Administrator 10/23/2015 Healthcare Associated Infections How Idaho Compares 10/23/2015 CLABSI and CAUTI rates - 2013 CENTRAL LINE ASSOCIATED BLOOD STREAM INFECTIONS (CLABSI) All Location CLABSI rates are very low compared with national rates No Idaho facilities had SIRs higher than national (0.54) Idaho SIR = 0.29 (Idaho rank: 5th lowest)
CATHETER-ASSOCIATED URINARY TRACT INFECTION (CAUTI) All Location CAUTI rates could be improved One ID facilitys SIR higher (1.270) than national (1.057) Idaho SIR = 1.003 (Idaho rank: 21st lowest) 10/23/2015 Table 9. Changes in state-specific standardized infection ratios (SIRs), 2012 compared to 2013 9a. Central line-associated bloodstream infections (CLABSI), all locations1 2012 2013 % Direction State
SIR SIR Change of Change p-value South Dakota 0.275 0.194 29% Decrease 0.3155 Oregon 0.390 0.301 23% Decrease 0.1211 New Mexico 0.613 0.486 21% Decrease 0.1473 New Hampshire 0.433 0.345
Table 9. Changes in state-specific standardized infection ratios (SIRs), 2012 compared to 2013 9b. Catheter-associated urinary tract infections (CAUTI), all locations1 Percent Direction of State 2012 SIR 2013 SIR Change Change p-value Louisiana 0.816 0.809 1% Decrease
5/19/2015 SSI and HO-MRSA BSI LabID SURGICAL SITE INFECTION (SSI) SSI following colon surgery: One ID facilitys SIR higher (1.130) than national (0.919) Idaho SIR = 0.797 (Idaho rank: 12th lowest) HOSPITAL ONSET (HO) MRSA BSI HO-MRSA BSI rates are very low compared with national rates No Idaho facilities SIRs higher than national (0.917) Idaho SIR = 0.452 (Idaho rank: 5th lowest) 10/23/2015
HO-C.diff LabID HOSPITAL ONSET (HO) CLOSTRIDIUM DIFFICILE HO-C. diff infection rates are very low compared with national rates No Idaho facilities SIRs higher than national (0.904) Idaho SIR = 0.666 (Idaho rank: 9th lowest) 10/23/2015 5/19/2015 5/19/2015 Antimicrobial Resistance The Next Big Thing
5/19/2015 FOUR CORE ACTIONS Prevent infections and prevent the spread of resistance Track resistant bacteria Improve use of antibiotics Promote the development of new antibiotics and new diagnostic tests for resistant bacteria
5/19/2015 AR and the Presidents Budget Nearly Double: >$1 billion investment in FY 2016 10/23/2015 Discussion New HAI Program Manager What would you like to see happen now that the Division of Public Health will have increased HAI Program Capacity? Surveillance / data validation? Guidelines / assessments? Communication?
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