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Hospital Outreach Unit:Local public health and HAIs
Dawn Terashita MD, MPH
Acute Communicable Disease Control
Los Angeles County Department of Public Health
November 2012
1
Background History
• In 2002, healthcare-associated infections consisted of– Investigation of hospital outbreaks – Outreach & surveillance for antimicrobial
resistance & blood borne pathogens.
2
Background History
• In early 2003, during the SARS situation, BT LPHNs assisted in infection control and prevention in the hospital setting
• In November 2003, ACDC created the new Hospital Outreach Unit
4
Hospital Outreach Unit (HOU) Mission
• To enhance emerging infectious disease preparedness and response efforts and improve hospital disease reporting by hospitals in LAC through strengthened communications, collaboration, and consolidations of resources
5
Summary
• 102 licensed acute care hospitals
• 174 infection preventionists
• HOU divided the county into 5 areas
• Each area is assigned a Liaison Public Health Nurse
6
Hospital Outreach Unit: Objectives
• Collaboration and communications between Public Health and hospitals
• Bioterrorism and pandemic disease preparedness and response
• Hospital outbreak investigations• Healthcare-associated infection prevention and
surveillance• Mandatory disease reporting• Identify and respond to new and emerging threats
7
GOAL 1: Prevent
• Infection Control Education– Visit every hospital at least annually– Attend infection control committee meetings– Promote WEBvCMR– Distribute educational materials– Distribute disease alerts such as measles alerts– Review the pandemic flu plan– Attend training, table-tops and exercises– Give presentations
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Goal 1: PreventInfection Control Education2006 - 2010 2006 2007 2008 2009 2010
Infection control meetings (31)
59 60 55 71 55
Trainings, table tops, and exercises
63 87 20 1 2
Web-based disease reporting system training
70 88 47 55 55
APIC chapter meeting 30 41 30
Educational materials distributed
79,233 95,931 35,987 79534 51.584
HAI hospital visits 459
GOAL 2: Detect and Report
• 100% LAC hospitals now using NHSN
• 100% LAC hospitals have conferred rights to LADPH
• Validation of CLABSI, MRSA and VRE BSI, C. diff NHSN data completed on 20 LAC hospitals
• CRKP surveillance June 1, 2010 to July 31, 2012
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GOAL 3: Investigate • Hospital Outbreak Investigation
– Site visits & chart review– Collect specimens from patients & environmental
areas– Interview staff, etc.
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Goal 3: Investigate 2008 – 2010
Year # Investigated
Hospital Visits 2008 366
2009 331
2010 339
Hospital Phone Contacts
2008 643
2009 1518
2010 1122
Hospital Email Contacts
2008 3399
2009 4913
2010 4764
Outbreak Investigation
2008 23
2009 16
2010 2712
Other Hospital Outreach Unit Activities• Liaison between ACDC/Public Health and
non-acute healthcare settings such as:– Hospital based SNF and dialysis centers– Acute psychiatric hospitals– Large clinics– Jail medical services
• Keep key hospital contact information up-to-date, including email, fax, and phone numbers – IP, ICC, ED, Lab, Pharmacy, ID, etc.
13
Other HAI Activities• California Healthcare-Associated Infections
Advisory Working Group
• Hospital Association of Southern California HAI Taskforce
• National Healthcare Safety Network (NHSN) State User Group
• CSTE Nosocomial Infections Workgroup
14
CDPH HAI Program Collaboration
• ARRA funded collaboration with CDPH
• 1 HAI field staff assigned to Los Angeles County (Feb 2010 to Dec 2011)
• HAI and HOU staff will visit every hospital– Ensure enrollment into NHSN with rights
conferred to CDPH and LACDPH– Serve as consultant for HAI issues– Evaluate data collection and reporting methods
15