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Public Health and HAIsKathryn Turner, PHD MPH
Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention
October 23, 2015
I-APIC Annual Conference Boise, Idaho
Topics
Public Health and HAI prevention
National level activities
Idaho HAI Program
HAIs in Idaho
Antimicrobial Resistance
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Public Health Involvement in healthcare-associated infection
prevention
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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
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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
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MRSA Experience
Hospital Acquired(Most severely ill hospitalized patients)
Healthcare Associated(Spreads to other patients in the healthcare environment)
Community(Moves from healthcare environments to the community
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HHS Operating Divisions
HHS “…has multiple methods to influence hospitals…issuing guidelines…requiring hospitals to comply with certain standards…releasing data to expand information…of the problem, and ….using hospital payment methods to encourage the reduction of HAIs.”
PRIORITIZATION & COORDINATION
1,200Recommended Practices
500“Strongly” Recommended Practices
6 Divisions
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GAO Recommendations
HHS SolutionHHS Steering Committee for the Prevention of Healthcare Associated Infections
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National Action Plan
Developed in 2009
Three phases
Revised annually
Accompanied by separate roadmap document
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“The Elimination of HAI’s 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
Pillars of HAI Elimination
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HAI Elimination: One of CDC’s 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
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Idaho HAI Program
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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
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Ebola Supplemental Funding
State Fiscal Year 2016 (July 1, 2015)
Update Idaho’s HAI Prevention Plan Work with Idaho’s 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
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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
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Changes to State HAI Program
Idaho Hospital AssociationHAI “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
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Bureau of Communicable
Disease Prevention
ImmunizationTB Program
Epidemiology Operations
State Public Health Vet
Food Protection
Refugee Health
Screening
Healthcare Associated Infections
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https://labor.idaho.gov/DHR/ATS/StateJobs/jobannouncement.aspx?announcement_no=07640057044
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
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Healthcare Associated InfectionsHow Idaho Compares
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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 facility’s 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
State2012 SIR
2013 SIR
% Change
Direction of Change p-value
South Dakota 0.275 0.194 29% Decrease 0.3155Oregon 0.390 0.301 23% Decrease 0.1211New Mexico 0.613 0.486 21% Decrease 0.1473New Hampshire 0.433 0.345 20% Decrease 0.4769Oklahoma 0.480 0.394 18% Decrease 0.0761Virginia 0.578 0.501 13% Decrease 0.0540Idaho 0.322 0.287 11% Decrease 0.7357
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Table 9. Changes in state-specific standardized infection ratios (SIRs), 2012 compared to 2013
9b. Catheter-associated urinary tract infections (CAUTI), all locations1
State 2012 SIR 2013 SIRPercent Change
Direction of Change p-value
Louisiana 0.816 0.809 1% Decrease 0.8897New Hampshire 0.956 0.918 4% Decrease 0.7976Nebraska 0.975 0.925 5% Decrease 0.5998Arkansas 1.099 1.040 5% Decrease 0.4579Washington 1.074 1.012 6% Decrease 0.3658Rhode Island 1.349 1.269 6% Decrease 0.5914Arizona 1.092 1.024 6% Decrease 0.2732Iowa 0.943 0.884 6% Decrease 0.5377Illinois 1.039 0.967 7% Decrease 0.0794Mississippi 1.192 1.078 10% Decrease 0.1458Maine 1.906 1.718 10% Decrease 0.3609Utah 1.839 1.640 11% Decrease 0.2204Connecticut 1.868 1.654 11% Decrease 0.0637Idaho 1.145 1.003 12% Decrease 0.4421
SSI and HO-MRSA BSI LabID
SURGICAL SITE INFECTION (SSI)SSI following colon surgery: One ID facility’s 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)
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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)
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Antimicrobial ResistanceThe Next Big Thing
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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
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AR and the President’s BudgetNearly Double: >$1 billion investment in FY 2016
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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?
Email me! [email protected]
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