State of the State Address on HAIs - November 16 & 17, 2017 · State of the State Address on HAIs...
Transcript of State of the State Address on HAIs - November 16 & 17, 2017 · State of the State Address on HAIs...
State of the State Address on HAIs
Erica Runningdeer, MSN, MPH RN HAI Prevention Coordinator
November 21, 2014
Disclosure/Conflict of Interest
I have no disclaimers or conflicts of interest to report
IDPH Healthcare Associated Infection (HAI) Prevention Program
• Housed in the Office of Health Policy and Planning, Division of Patient Safety & Quality
• Funding is primarily provided through cooperative agreements with the Centers for Disease Control and Prevention (CDC)
IDPH Division of Patient Safety & Quality Division Chief – Mary Driscoll, RN, MPH
HAI Prevention Coordinator – Erica Runningdeer, MSN, MPH, RN
Program Director, Antimicrobial Stewardship & CDI – Chinyere Alu, MPH
CDC Public Health Prevention Service Fellow – Robynn Cheng Leidig, MPH
Project Director, CRE – Angela Tang, MPH
Project Director, CDI – Jessica Ledesma, M. Ed, MPH
Epidemiologist – Anh-Thu Runez, MPH
Program Assistant – Jennifer Polk, BS
Section Chief, Public Reporting – Barbara Fischer, RN
HAI Prevention “Team Illinois” WHO WE ARE
IDPH Division of Infectious Diseases, Communicable Disease Section
HAI Advisory Council Stakeholders & Subject
Matter Experts
Chicago CDC Prevention EpiCenter
Telligen (State QIO)
Local Health Departments
APIC & Infection Preventionists from various facility types/settings
Trade Organizations
Payers/Insurance
Patient advocates
National Partners
CDC
CSTE
ASTHO
NACCHO
Other states’ HAI programs
Share “lessons learned”
HAI Prevention “Team Illinois” WHO WE ARE
• Surveillance and reporting of HAI data
– NHSN Illinois Hospital Report Card & Consumer Guide to Healthcare http://www.healthcarereportcard.illinois.gov/
– XDRO registry not publicly reported
• Use the data for action
– Lead and assist healthcare organizations with improving the quality and safety of services
• Develop a state plan to prevent HAIs
– Align state priorities with national HAI Roadmap to Elimination http://www.hhs.gov/ash/initiatives/hai/actionplan/
HAI Prevention “Team Illinois” WHAT WE DO
HAI Prevention Initiatives 2014-2015
HAI Prevention Landscape
Evaluation Project: Data for Action
HAI Prevention Plan
Antimicrobial Stewardship
C. difficile prevention collaborative
CRE detect & protect
Inpatient Collaborative Outpatient Campaign
XDRO Registry
Shared Goals: the Triple Aim
• framework to optimize health system performance Integration of public health
and clinical medicine
Align priorities • Federal
• State
• County
• Community
• Facility Improve
Patient
Care
Improve
Population
Health
Reduce
Cost
Developed by the Institute for Healthcare Improvement (IHI)
Central component of ACA, National Quality Strategy, and many National action plans to improve health & healthcare
HAI Prevention Landscape
• State-wide assessment to inform the revised HAI Prevention State Plan – Evaluate trends in infection rates
– Identify gaps in data
– Identify potential new sources of data
– Survey current and/or ongoing prevention activities by organizations and facilities
– Identify gaps/needs for prevention efforts
– Find areas for enhancement of coordination among partners
HAI Prevention Plan
• Establish (SMART) goals for HAI Prevention
• Align state goals/priorities with National priorities (HHS Action Plan to Prevent Health Care Associated Infections: Road Map to Elimination)
• Recommend strategies and future projects to achieve goals
• Antimicrobial stewardship to be key component/strategy for addressing HAIs
HAI Progress Report
http://www.cdc.gov/HAI/pdfs/progress-report/hai-progress-report.pdf
HAI Progress in Illinois % change
2013 vs 2012 Illinois
% difference IL vs national
2013
% difference 2013 IL
vs national baseline
CLABSI 17%↓ 13%↓ 53%↓ CAUTI 7%↓ = 9%↓ 3%↓ = MRSA 17%↓ 23%↓ 29%↓ C. DIFF 2%↓ = < 1%↑ = 9%↓ =
SSI HYST 36%↓ 33%↓ 42%↓ SSI COLON 32%↑ 12%↓ 19%↓ SSI KPRO** 36%↓ 24%*↓ 64%↓ SSI CABG** 14%↓ 21%*↓ 52%↓ SSI combined 21%*↓ 37%*↓
*data is for 2012; data for 2013 not yet available **SSI KPRO & SSI CABG measures for IL analyzed by state fiscal year: 2012 = 7/2011-6/2012; 2013=7/2012-6/2013
HAI Progress in Illinois
2013 IL SIR
% difference 2013 IL
vs national baseline
HHS 2013 Prevention
TARGET % reduction
Target Met?
CLABSI 0.47 53%↓ 50%↓ YES CAUTI 0.97 3%↓ 25%↓ NO MRSA 0.72 29%↓ 50%↓ NO C. DIFF 0.91 9%↓ 30%↓ NO
SSI HYST 0.58 42%↓ SSI COLON 0.81 19%↓ SSI KPRO** 0.36 64%↓ SSI CABG** 0.48 52%↓ SSI combined 0.63* 37%*↓ 25%↓ YES
*data is for 2012; data for 2013 not yet available **SSI KPRO & SSI CABG measures for IL analyzed by state fiscal year: 2012 = 7/2011-6/2012; 2013=7/2012-6/2013
• How many infections would we need to have prevented to meet our target?
Targeted Assessment for Prevention (TAP) Strategy
• The TAP strategy allows for the ranking of facilities (or locations) in order to identify and target those areas with the greatest need for improvement.
• New output options, referred to as “TAP Reports”, will be available for facilities and groups and will be generated for CLABSI, CAUTI, and CDI LabID data.
• http://www.cdc.gov/nhsn/PDFs/Newsletters/vol9-3-eNL-Sept-2014.pdf
Cumulative Attributable Difference (CAD)
• A measure to help focus prevention efforts toward areas (facilities/units) with the highest burden of excess infections.
CAD = OBSERVED – (PREDICTED * SIRtarget)
FAC
RANK
ORG
ID
MED TYPE
BEDS PT. DAYS CO HCFA
PREV. RATE
HO CDI EVENTS
PREDICTED EVENTS
CAD SIR SIR
TEST
1 001 M >600 141,000 0.21 195 141.97 95.60 1.37 SIG
2 003 M >600 160,000 0.40 192 156.37 82.50 1.23 SIG
3 004 U 246 49,000 0.38 110 43.60 79.50 2.52 SIG
4 010 M >600 159,500 0.19 176 144.25 75.00 1.22 SIG
5 050 M 552 116,000 0.36 148 110.37 70.70 1.34 SIG
6 020 M 675 194,602 0.23 189 182.08 61.50 1.04
7 070 G 298 57,675 0.23 97 55.82 57.90 1.74 SIG
Sample CDI TAP Report
Ranked by CAD in descending order
http://health.state.tn.us/ceds/HAI/calculator.shtml
Tennessee example: the CAD Calculator
18
TAP REPORT: CDI (2013Q1 - 2013Q4) Statewide and Chicago-wide CAD 'Cummulative
Attributable Difference')
REGION
HOSPITAL
ONSET CDI
EVENTS
PREDICTED
EVENTS CAD SIR LLIMIT ULIMIT
ILLINOIS 4465 4926.13 1016.70 0.91 0.8801 0.9333
CHICAGO 1132 1380.65 165.50 0.82 0.7732 0.8687
How many infections would we need to have prevented to meet our target?
A national security priority
Antimicrobial Stewardship
2010 2011 2012 2013 2014 2015
1st AMS Collaborative (5 acute care hospitals)
AMS Summit (250 attendees)
Assess AMS practices (466 LTCFs)
AMS webinar series (6 webinars)
Antimicrobial use reporting to NHSN (21 acute care hospitals)
1st CDI Collaborative (20 acute care hospitals)
2nd CDI Collaborative (20 acute care hospitals)
ICE C. diff Campaign (254 acute care hospitals, LTACHs, & LTCFs)
2nd AMS Collaborative (6 acute care hospitals)
AMS: -2nd Summit; Campaign -Assessments -Strategic plan
3rd CDI Collaborative
IDPH Antimicrobial Stewardship (AMS) and CDI Prevention Initiatives
ANTIMICROBIAL STEWARDSHIP ACTIVITIES (2014-2015)
1. Illinois Collaborative for Hospital Antimicrobial Stewardship Enhancement (ICHASE)
2. Illinois Summit on Antimicrobial Stewardship
3. Precious Drugs & Scary Bugs campaign • Get Smart Week 2014
4. State Strategic Plan for Antimicrobial Stewardship
(1) ICHASE
• Setting: Inpatient
• Participation: Six acute care hospitals submitting data to the NHSN Antimicrobial Use Option
• Goals: – Evaluate impact of implementing institutional guidelines on
antimicrobial prescribing
– Identify and develop other interventions to improve antimicrobial use
– Collaborate with CDC to assess correlation between use of specific broad spectrum antibiotics and appropriateness of use
• Setting: Inpatient, outpatient, long term care
• Participation: Healthcare professionals and providers
• Thursday, March 5, 2015 in Chicago
• Collaborating with Northwestern and Telligen
(2) 2nd Illinois Summit on Antimicrobial Stewardship
(3) Precious Drugs & Scary Bugs campaign
• Setting: Outpatient
• Participation: Primary care and ED providers in year 1
• Goals:
– Improve provider knowledge and attitudes related to antibiotic resistance and antibiotic use
– Increase provider adherence to appropriate antibiotic prescribing for outpatient visits (for upper respiratory infections*)
– Improve coordination and exchange among stakeholders around antibiotic stewardship
*Focus URIs: Otitis media, sinusitis, pharyngitis, bronchitis,
and the common cold
(3) Precious Drugs & Scary Bugs campaign
• Core intervention: public commitment letters
– Achieved 19.7% reduction in inappropriate prescribing for ARIs, compared to control group in Meeker et al study
• Implement tiered approach to engage providers
– Level 1: Providers enroll in initiative + complete baseline survey
– Level 2: Level 1 + participate in webinars
– Level 3: Level 2 + customize and utilize public poster-sized commitment letters* + complete post-survey
– Level 4: Level 3 + collect and submit data on antibiotic prescribing using template provided
*Meeker D, et al Nudging Guideline-Concordant Antibiotic Prescribing: A Randomized Clinical Trial. JAMA Intern Med. 2014 ; 174(2):425-431.
Activities
November 17 – 23, 2014
• Quick-learn webinars – Collaborate with Telligen to host mini-webinar series
– Topics: Immunization, CDI, antibiotic use
• Social media – CDC twitter chat on November 18
• Signage on BCBSIL building (under exploration)
• Op-ed piece
• Part of Illinois HAI Prevention Plan
• Informed by:
– Assessment of long term care facility antimicrobial prescribing
– Assessment of acute care hospital AMS practices
– Gaps and needs identified from HAI landscape study
– Lessons learned from previous & ongoing initiatives
– Stakeholder feedback
(4) State Strategic Plan for Antimicrobial Stewardship
CDI Transitions of Care (CDITOC) Prevention Collaborative
Statewide multi-year initiative with regional approach
Pilot in Chicago (2014-2015)
4 to 8 acute care hospitals
8 to 16 skilled nursing facilities (SNFs) or long term acute care hospitals (LTACHs)
Partner with Chicago Department of Health
Establish a state level workgroup to guide planning and implementation
Goals
Enhance communication about CDI events between transferring and receiving healthcare facilities Improve care coordination to maintain appropriate
infection control precautions for patients with CDI upon transfer to receiving facility Improve surveillance through rapid identification of
patients with CDI Improve implementation of CDI prevention strategies
within LTACHs and SNFs
Develop a model that can be spread regionally
across Illinois
Reduce rates of healthcare facility onset CDI
Activities
Refine and test communication processes for CDI patient transfers
Facilitate SNF enrollment and reporting to NHSNs
Multidrug-Resistant Organism & Clostridium difficile Infection Module Perform monthly review of NHSN input/results
Facilitate sharing and learning through cross-organizational meetings and webinars
XDRO registry
www.idph.state.il.us/patientsafety/cre www.xdro.org
Carbapenem-resistant Enterobacteriaceae (CRE) Activities
Activity 1: CRE Task Force
Purpose
• Gather key CRE experts and stakeholders statewide
• Develop a coordinated regional approach to CRE surveillance and prevention
• Promote CRE guidelines at healthcare facilities and local health departments
CRE Activities
Activity 2: Three regional training workshops
• Purpose
– Bring together acute and long-term care facilities, labs, and health departments to work out a coordinated approach to CRE surveillance and response
• Selected suggested topics
– Role of local health departments
– Infection control (esp. case studies and LTC)
– Antimicrobial stewardship
– Rectal swab screening tests
CRE Activities
Activity 3: Laboratory validation of CRE reported to the Extensively Drug-Resistant Organism
(XDRO) registry
CRE +
Validation Testing
Send isolates
Report
CRE
Not CRE
CRE Activities
Activity 4: XDRO registry development
•Automatic alert pilot • Cluster detection using SaTScan
Graphics courtesy of Chicago CDC Prevention Epicenter Note: cluster data are fictitious
Unique CRE patients reported to XDRO registry
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2013 2014
Pat
ien
ts (
n)
1083 patients reported since Nov. 2013 (avg. 2-3 pts reported/day) Data as of Nov. 5, 2014
XDRO registry: usage trends
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Nov Dec Jan Feb Mar Apr May Jun Jul Aug
2013 2014
Patient queries Webpage views
112 facilities have searched for patients 1487 times Data as of Sept. 15, 2014
Start of CRE Campaign Webinars