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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
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.
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
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.
Illinois Action Plan to Prevent HAIs & ARhttp://www.dph.illinois.gov/sites/default/files/publications/publicationsoppsil-action-plan-prevent-haier.pdf
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.
A
Infection Prevention Infrastructure, Standards, and Practices
B
Assessment/Treatment/Outbreak
C
Antimicrobial Stewardship
D
Multi-Drug Resistant Organisms
Illinois Action Plan to Prevent HAIs &ARPriority Areas & Goals
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
Goal #2 Improve detection, investigation and response to infectious outbreaks including community and healthcare associated infections (HAI) and antimicrobial resistant (AR) organisms
Goal #5 Slow the emergence of resistant bacteria and C. difficile, and prevent their transmission
Goal #3 Improve antimicrobial prescribing practices across all healthcare settings
Goal #4: Raise public awareness about antibiotic use and misuse
Key Strategies & Cross-Cutting Topics
Education & training
PolicyData &
SurveillanceCommunication
Mandated NHSN Reporting & Launch of Illinois Hospital Report Card & Consumer Guide to Health Care
Illinois HAI/AR Prevention Timeline
CLABSI, ICUsMed/surg, peds, other
ALL NHSN Measures reported to CMS
1st quality improvement collaborative launched with20 hospitals (focus: C. diff)
C. diff & MRSAAcute Care, LTACH, IRF
Surgical Site Infections (SSI) KPRO & CABG
HAI/AR Program developed through CDC grants. Total CDC award since 2009 = $8,972,844
1st Antimicrobial Stewardship Collaborative
2009 2010 2011 2012 2013 2014 2015 2016 2017
NHSN AU reporting pilot
Released training video: Not Just a Maid Service
Illinois Action Plan to Prevent Healthcare Associated Infections and Antimicrobial Resistance
Infection Prevention Liaison Program (ICAR)
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?
CDR Gregory A. Raczniak, MD
Meet the newest member of Illinois’ HAI/AR Prevention
Team
Illinois Antimicrobial Resistance Prevention
Coordinator
1: You will need resources
– the most important being an AWESOME TEAM
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 Preventionistsmanually enter susceptibility profiles into the XDRO registry? So… what will that accomplish? What will you actually do differently based on that information?
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
http://dph.illinois.gov/topics-services/prevention-wellness/patient-safety-quality/crewww.xdro.org
Contact: [email protected]
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
XDRO automated alerts
(Admissions Feed)
(Real-time alert)
Report
As of November 5, 2017: • 1,358 autoalerts sent for 576 unique patients
• We now have 24 facilities connected to autoalerts including 2 LTACHs
Example: Make it easier to do the right thing
XDRO auto alert progress as of 5/19/17
Credit: Emily Augustini, Pawel Nowak
Alert Tracking Tool*
16*Data summaries in following slides come from alert tracking tool
Alert Summary, Pilot Hospitals, 1/7/2015 – 8/22/2017
HospitalHospital
SizeDuration
(mo.)
Inpatient Alerts
(n)Alerts/
mo.
Correct personn (%)
Known CREn (%)*
On contact precautions
n (%)*
1/2 Med/Sm 31 100 3.2 96 (96%) 55 (57%) 20 (21%)
3 Large 25 219 8.8 219 (100%) 168 (77%) 142 (65%)
4 Med 25 93 3.7 93 (100%) 75 (81%) 87 (94%)
5 Large 21 156 7.4 154 (100%) 149 (97%) 133 (86%)
6 Med 19 95 5.0 92 (97%) 75 (82%) 85 (92%)
7 Med 19 43 2.3 40 (100%) 27 (68%) 30 (75%)
8 Small 19 17 0.9 9 (100%) 9 (100%) 8 (89%)
9 Small 19 23 1.2 23 (100%) 19 (83%) 20 (87%)
10 Small 19 23 1.2 15 (100%) 13 (87%) 11 (73%)
17
Hospital size: Small (<200 beds), Med (200-500), 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
Alert Summary, Additional Hospitals, 8/29/2016 – 8/22/2017
HospitalHospital
SizeDuration
(mo.)
Inpatient Alerts
(n)Alerts/
mo.
Correct personn (%)
Known CREn (%)
On contact precautions
n (%)
11 Med 11 12 1.1 11 (92%) 7 (64%) 7 (64%)
12 Med 10 16 1.6 16 (100%) 15 (94%) 16 (100%)
13 Small 9 0 -- -- -- --
14 Small 9 3 0.3 1 (100%) 1 (100%) 1 (100%)
15 Small 9 3 0.3 3 (100%) 3 (100%) 3 (100%)
16 Med 8 63 7.9 63 (100%) 30 (48%) 43 (68%)
17 Med 6 52 8.7 52 (100%) 25 (48%) 30 (58%)
18 Large 5 45 9.0 23 (100%) 11 (48%) 14 (61%)
19** Med <1 3 -- -- -- --
18
Hospital size: Small (<200 beds), Med (200-500), 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.
Aggregate Alert Outcomes, 1/7/15 – 8/22/17
966 Inpatient alerts at 18 hospitals
Missing data: 48 (5%)
Complete data: 918 (95%)
Incorrect pt: 8 (1%)
Correct pt: 910 (99%)
See notes below for additional details
910 alerts
Yes
682 (75%)
Yes
559 (82%)
No
123 (18%)
No
228 (25%)
Yes
91 (40%)
No
137 (60%)
Prior to alert, did IP know pt had CRE?
In contact precautions when IP viewed alert?
Alert Outcomes: All correct inpatient alerts, 1/7/15 – 8/22/17
Slide adapted from: Mike Lin, Rush University Medical Center/Chicago CDC Epicenter
29% of patients with a history of CRE were NOT in CP at time of alert.
If the patient is already a “known CRE”, how did you find out? (N=682)
0%
10%
20%
30%
40%
50%
60%
70%
80%
Yes No Unknown
Previous positive at our facility
0%
10%
20%
30%
40%
50%
60%
Yes No Unknown
Communicated by other facility
US Antibiotics Awareness WeekNov 13-19 2017Annual 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: https://spark.adobe.com/page/pd0u80TFAsq6G/
– Outlines US Antibiotics Awareness Week Activities
– Includes newsletter templates, sample social media posts, and new materials
Center for Disease Control and Prevention:Be Antibiotics Aware Campaign (3)
• Public Service Announcements– The Right Tool
https://www.youtube.com/watch?time_continue=2&v=dETK7Jc-XWA
Antibiotics Awareness Week in Illinois
• Gubernatorial Proclamation
– Read here.
• Press Release
• Daily social media posts
• Dental Toolkit Mailing
Antibiotics Awareness Week in Illinois:Dental Mailing & Survey
• Why?
– Dentists account for 10% of outpatient antibiotic prescriptions or 24.5 million prescriptions nationwide
– Dentists have the 4th 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
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
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
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!