Clifford McDonald, M.D.Senior Adviser for Science and IntegrityDivision of Healthcare Quality Promotion

Centers for Disease Control and Prevention

National Center for Emerging and Zoonotic Infectious Diseases

Division of Healthcare Quality Promotion

Healthcare-associated Infections and Antibiotic

Resistance

Healthcare-associated Infections (HAIs)

Infections that patients acquire during the course of receiving treatment for other conditions within a healthcare setting

HAIs increase cost: $26-33 billion annually

CDC estimates 1 in 25 hospital patients has an infection, including

Central-line associated bloodstream infections Catheter-associated urinary tract infections Surgical site infections Pneumonias - ventilator-associated and others Clostridium difficile infections

Many infections are caused by resistant microorganisms Carbapenem-resistant Enterobacteriaceae (CRE) Methicillin-resistant Staphylococcus aureus (MRSA)

National Healthcare Safety Network (NHSN): real-time data system

Evidence-based guidelines; the standard of care to prevent HAIs

CDC supports healthcare facilities and health departmentsto investigate and control outbreaks

CDC implements prevention strategies with public and private partners

CDC provides national and international laboratory expertise

CDC conducts applied research to inform prevention

CDC: Science and Data for Action

State Health Departments CDC assists in outbreak responses CDC releases state-specific progress

reports CDC serves as a reference laboratory CDC guides prevention collaboratives

Eliminating Healthcare Associated Infections

Strengthening public health- healthcare collaboration

CDC’s National Healthcare Safety Network is used to report infection data to CMS under pay for performance requirements

CDC infection prevention expertise helps populate surveyor checklists

CDC infection prevention expertise providing guidance on content and data collection

CDC outbreak investigations guide FDA product recalls

CDC infection prevention guidelines serve as the basis for checklists

CDC provides expertise for HHS HAI Action Plans

CDC provides data for tracking national progress

Healthcare Facilities CDC guidelines drive the standard of

care CDC’s NHSN provides data for local

improvement (e.g. HAI, antibiotic use)

NHSN is a national surveillance and quality improvement system NHSN is used by

Facilities across healthcare to track HAIs and antimicrobial resistance, and direct prevention activities

States for public reporting and regional prevention CMS for quality reporting and prevention initiatives HHS to measure national progress

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CDC’s National Healthcare Safety Network (NHSN)

NHSN: Tracking infections in over 16,000 healthcare facilities nationwide*

HAI Event Number of Facilities Enrolled In NHSN

Initial Target Number of Facilities

ACUTE CARE HOSPITALS 5,900 5,000CLABSI - ICU† 3,450

3,400CAUTI - ICU 3,400

CLABSI – Non-ICU 1,700

4,000CAUTI – Non-ICU 2,250

SSI 3,900MRSA Bacteremia 4,550

C. difficile LabID Event 4,600

DIALYSIS FACILITIES 6,750 5,600

LONG TERM ACUTE CARE FACILITIES (LTAC) 575 430

INPATIENT REHABILITATION FACILITIES (IRF) 1,250 1,200

AMBULATORY SURGICAL CENTERS (ASC) 3,150 5,300

NURSING HOMES/SKILLED NURSING FACILITIES 280 15,000

* - Data as of February 19, 2015

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Target hospitals with highest number of

excess infections • AHRQ funded networks

• CMS funded networks

• Health Departments

• Other partners

NHSN DataOver 4,800

hospitals currently reporting CAUTI, CLABSI, and C. difficile data

Target

Partnering for Prevention

NHSN Data For ActionTargeted Assessment For Prevention (TAP)

Progress reducing healthcare-associated infections: 2008-2013

-50%

-40%

-30%

-20%

-10%

0%

-46%

-32%

-19%

*CLABSI: Central line-associated bloodstream infections†MRSA: Methicillin-resistant Staphylococcus aureus

Healthcare and HAIs have moved beyond hospitals….

Hospitals

Ambulatory facilities

Long-term care

Dialysis facilities

~5,000

~5,000

~16,000

~6,000

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Detect and Protect Regional prevention collaborative

H

HL L

Healthcare Facilities

Health Department

CRE surveillance(reporting of outbreaks)

Provide situational awarenessLab

supportProvide expertise, build capacity

Outbreak response, technical guidanceEducation and training

Facilitateinter-facility communication

Detect and ProtectAntibiotic Use and Resistance (AUR) Module

FY2015 proposed President’s budget will support developing AUR Module of NHSN: Collect data from healthcare facilities and improve antibiotic prescribing Use real-time electronic AU and AR data from healthcare facilities allowing rapid analysis Provide national benchmarks to compare antibiotic use and antibiotic resistance across facilities

Antibiotic Use Module Provides data to assess and improve

local and national appropriate antibiotic use

Lab, pharmacy data captured electronically

Addresses the need for standardized and accurate antibiotic use data

Provides essential data to prevent C.difficile through controlled antibiotic use

Antibiotic Resistance Module Monitoring of local, regional, national Resistance patterns in healthcare

settings Tracking of resistance patterns across

and between facilities and within communities

Innovations to improve patient safety

CDC prevention epicenters program

Unique research program in which CDC collaborates with academic investigators to conduct innovative infection control and prevention research

This collaboration protects patients by filling prevention knowledge gaps identified by CDC’s outbreak response and surveillance data

Emerging Infections Program (EIP)Early warning system for new and changing

threats

CDC funded network of 10 state health departments collaborating with local health departments, academic institutions, other federal agencies, laboratories, infection preventionists, and healthcare providers

Conduct surveillance on infectious disease, foodborne disease, influenza, HAIs, and antibiotic resistance to estimate national burden numbers

Conduct applied research, e.g. risk factors and prevention strategies

EIP population (~44 million) representative of the U.S. (e.g. age, gender, race, population density, percent at or below poverty level)

Recently released 2011 HAI and Antimicrobial Use Prevalence Survey Estimated 722,000 HAIs in US hospitals in 2011, or 1 in 25 patients Estimated 75,000 patients with HAIs died during hospitalization

CDC’s Clinical and Environmental Microbiology Laboratory

Assist EIP surveillance by providing reference testing and diagnostic capacity of pathogens causing HAIs and antibiotic resistant infections

Serve as national and an international reference laboratory for antimicrobial susceptibility testing

Develop and evaluate methods to reliably detect emerging antimicrobial resistance

Conduct applied research on improved detection methods for HAIs

Provide environmental microbiology methods for measuring contamination of healthcare environment

Assist in Healthcare-associated outbreak investigations Various settings, infection sources, and organisms Culture medical devices, medications, environmental samples Conduct typing of organisms

Additional Slides

Antibiotic Resistance

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In 2013, CDC identified four core actions to help fight antibiotic resistance:

Antimicrobial Resistance: The strategy

• Threat to economic stability

• Modern medicine is at risk

• Loss of effective antibiotic treatment could make routine infections deadly

Antibiotic resistance in the US

• Patients who receive specialized care will be at highest risk

• Need to act now or even drugs of last resort will soon be ineffective

Detect and Protect – FY16 proposal

A down payment to improve our country’s abilityto start tackling our biggest drug-resistant threats The FY 2016 President’s Budget requests

$264M to• Slow development of resistant bacteria

and prevent spread of resistant infections

• Strengthen surveillance to track AR threats and measure impact

• Advance development and use of rapid and innovative diagnostic tests

• Accelerate research and development for new antibiotics, other therapies, and vaccines

• Support partnerships for prevention, detection, control, and research

AR Initiative: key activities

CDC plans to award more than 85% of its FY 2016 AR initiative funding to States, communities, health care providers, universities, and other groups to: • Establish a “Detect” network of 7

regional labs to characterize emerging resistance and rapidly identify outbreaks of dangerous drug-resistant threats

• Double number of Emerging Infection Program sites from 10 to 20 to expand our ability to track all urgent and serious threats for focused prevention

• Establish State AR Prevention “Protect” Programs in 50 states and 10 large cities for health care to better track outbreaks, improve prescribing, and prevent infections

• Improve antibiotic prescribing in hospitals and across health care settings and target community AR threats

• Track how antibiotics affect the human microbiome and how the microbiome might protect humans from AR infections

• Greatly scale up rapid detection of AR infections transmitted to humans through food and other pathways

• Enhance collaboration and capacities to combat AR internationally

Antibiotic Resistance Initiative could reduce many infections

Substantial Cost Savings from Aggressive AR Intervention

Projected burden of healthcare-associated invasive MRSA,healthcare-associated CDI, healthcare-associated CRE,

and hospital-onset MDR Pseudomonas infections

2011 2012 2013 2014 2015 2016 2017 2018 20190

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Over 5 years prevention will result in:> 1/2 million AR infections avertedThousands of AR infection attributable deaths avertedBillions in medical costs averted

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