Transcript Slide 1

State HAI Prevention
Planning
Presented to:
APIC Greater Atlanta
January 13, 2010
Kate Arnold MD, GA Division of Public Health, [email protected]
with many thanks to Nancy White, NHSN Coordinator, GA EIP
What is Driving HAI Prevention Planning in
Public Health?
• Government Accountability Office (GAO)
recommended to Health & Human Services (HHS)
to improve the coordination and support of infection
prevention and surveillance.
• January 2009 HHS Action Plan to reduce HAIs
(HHS response to GAO): Public Health to become
involved in the prevention of healthcare associated
infections across the continuum of care.
State HAI Plan Legislation
Fiscal Year 2009 Omnibus Bill:
• States receiving Preventive Health Services (PHHS) Block
Grant funds required to submit a plan to the Secretary of
HHS by January 1, 2010.
– Consistent with HHS Action Plan to Prevent HAIs
– Blueprint” for state HAI activities going forward
HHS Action Plan
• Develop specific metrics and national targets to
prevent HAIs
• Develop approach to reduce disease transmission
• Prioritize and facilitate rapid implementation of
recommended prevention practices
• Support research to address gaps in the science of
HAI prevention
Take Home Message
• Prevention of HAIs is cost effective, saves lives and
reduces disability for healthcare consumers
• The time to act on HAIs is now and HHS is working
closely with its partners to help accomplish the
established targets to prevent HAIs.
http://www.hhs.gov/ophs/initiatives/hai
HHS Phase 1
• Focus on Acute Care Facilities
– (Phase II will expand to include LTC facilities)
• 6 HHS Priority Areas are associated with devices
and procedures:
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Central line associated blood stream infection (CLABSIs)
Catheter Associated Urinary Tract Infections (CAUTIs)
Ventilator Associated Pneumonia (VAP)
Surgical Site Infections (SSIs)
MRSA
Clostridium difficile
HHS Standardized Metric
The standardized infection ratio (SIR) is proposed
as the next generation in epidemiological
approaches for monitoring and feeding back risk
adjusted infection rate
Observed Number (your facility)
Expected Number (benchmark data)
SIR (con’t)
• Like the standardized mortality ratio, the advantage is one
generalizable quality index regardless of the mix of operations
performed
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95% confidence interval describes the variability around the estimate
or the range in which the true value should fall
• The standardized population comes from the historical NHSN data
• Ideally, one would want a facility SIR of less than one to demonstrate
a ratio that is lower than the standard population
State and Local Programs
• Funding Source:
• American Reinvestment and Recovery Act (ARRA)
• CDC given $50 M to build programs to prevent HAIs
– $10 M to CMS to address ambulatory surgery centers
– $40 M to divide among 50 states based on an application
process
– State of Georgia got minimal funding: $242k (only enough to fund one
employee salary and benefits for 2 years)…no operational budget for
program
– Additional funds to Georgia EIP are helping establish infrastructure
and will eventually be used for special projects
Georgia’s Plan
• States submitted plans to HHS before January 1
– Georgia plan to establish infrastructure to achieve measurable
5 year goals, with milestones toward the prevention of HAIs
– Requires us to
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Establish advisory committee
Establish centralized surveillance system
Choose metrics and goals for surveillance baseline
Take periodic or longitudinal measurements
Build reductions on facility efforts and prevention collaboratives
– Progress report to Congress due by June 1, 2010
Existing HAI Reduction Collaboratives in GA
• Comprehensive Unit-based Safety Program (CUSP): STOP
BSI Project
• GA initiative led by Denise Flook, GHA
• 23 GA Hospitals enrolled
• Encouraging additional hospitals to join www.safercare.net
• AHRQ’s Team Strategies and Tools to Enhance
Performance and Patient Safety (Team STEPPS) MRSA
reduction program
• 8 GA Hospitals participating through GMCF (CMS-QIO)
• Requires NHSN enrollment
• http://teamstepps.ahrq.gov/index.htm
GA State Plan
– Use of NHSN infrastructure previously agreed upon
– No mandate in GA for participation or public reporting
• Though this may occur at some point
– Stakeholders Meeting on Dec 2 at State Offices:
• Required to select 2 priority prevention targets in support of the HHS HAI
Action Plan
• Chosen based on importance to patient safety, reliable data, and proven
preventability, and existing infrastructure and collaboratives.
• Use of NHSN system, definitions and parameters
– Stakeholders choices for prevention metrics:
• CLABSI, and SSI for at least one of [hip, knee, abdominal
hysterectomy]
HHS Metrics and 5 Year Targets
for CLABSIs
• Decrease CLABSIs per 1,000 device days by 50%, using
NHSN definitions and a metric which benchmarks against
expected rates
• 100 % Compliance with Process Measures:
• NHSN Central Line Insertion Practices (CLIP)
HHS Metrics and 5 Year Targets
for SSIs
• Reduce SSIs by 25% for deep incision and organ
space infections, using NHSN definitions and a
metric which benchmarks against expected rates
• Expect at least 95% compliance rate to SCIP/NQF
infection prevention process measures
You’re Invited !!!
• In January 2010, all acute care facilities with at least
25 beds will be invited to:
– Begin reporting to CDC’s NHSN
• CLABSI
• At least one of [hip, knee, abdominal hysterectomy]
– Join G-SNUG (Georgia State NHSN Users’ Group)
• To begin contributing information for establishing baseline
rates of HAIs
What is G-SNUG ?
• A group within NHSN established by the state health
department and the GA EIP (agents of the state) to allow
statewide surveillance for HAIs
– To establish G-SNUG infrastructure, state and EIP will work hand-inhand to recruit and support reporting facilities
– G-SNUG permits state epis and EIP to view and analyze aggregate
or facility-level information, but not patient information, as agreed to
by the reporting facility.
• State’s purpose: conduct surveillance toward HHS goals and assist facilities
with HAI problems
• EIP purpose: conduct special studies (needs assessment and evaluations of
prevention practices)
Why Would We Join G-SNUG??
• Look GOOD just in case!
– Proactively take control of our facility’s infection prevention
practices/discipline before a PUBLIC reporting mandate is
issued by federal and/or state legislation
• Avoid a “bad” mandate!
– Demonstrate that infection prevention is improving in GA,
just like other states required to deal with difficult reporting
mandates
Why Would We Join G-SNUG??
• Raise the bar!
– Collaborate with colleagues to identify new best
practices
• Get on the moving train!
– Ensure that our facility and all of GA achieves HHS five
year HAI prevention goals
• Strut our stuff together!
– Demonstrate the Great Teamwork and Collaboration
among GA IPs
What if I’m Worried about Joining G-SNUG?
• Facilities NOT joining G-SNUG may appear to have
“something to hide” or to be unwilling to embrace
transparency about their quality of care
• This is a PROBLEM in the current era of
transparency
Other Advantages To Joining G-SNUG
• Standardized definitions and gold-standard NHSN
methodology
• Provides risk-adjusted comparisons to national data
• Assists in the development of data analysis skills to
recognize trends in patient safety issues
• Additional training for IPs
• Conduct collaborative research initiatives
How to Join the G-SNUG
• NHSN Enrollment
• Complete Application and C-Suite Approval
• Training for start up and modules in use
• Digital Certificate – need IT Administrator rights or
IT support to install
• Establish ‘location’ codes in NHSN and input
monthly surveillance plan
• Input your Facility’s surveillance data
What to Do NOW??
• Enroll Your Facility/Health System in NHSN
• Once joined, Facility Administrator confers rights to
the GA State NHSN Users Group (G-SNUG) to
access data based on the data use agreement
G-SNUG Goal :
– January begin recruitment
– March 1 = 10 Facilities enrolled
– May 1 = 20 Facilities enrolled
WHAT’S COMING in Georgia?
• Additional training for Infection Preventionists
• CDC’s commitment to simplify data collection and
data entry methodology
Coming Soon: Improvements to NHSN
• Collection of CL device days outside of the ICU
• Software vendors establishing an HL7 standard for
importing data from EMRs to NHSN
Theradoc
Premiere
Medmind
vigilant
AICE
Pharmacy I
epiquest
• Additionally, CDC speaking w McKesson, Cerner and Sunquest
CDC Piloting electronic transfer of data into
NHSN modules
• First two NHSN modules working well
• BSI (summary and ICU location)
• SSI (denominator, procedure)
• 3 additional modules go live, hopefully, in March
• UTI
• Pneumonia
• MDRO labID events
Unresolved Issue
• Protection of facility ID and the Open Records Act
– How big is this problem, and shouldn’t we be more
positive and proactive? Don’t we WANT people to know
how well we are/ strive to be doing?
• GA DHR exploring possible solutions
– No simple answers per our lawyers…even those used
by other states
• Need to hear from facility decision-makers where
this is a road-block…organize meeting with legal
team and public health leadership
2010
• Let’s meet the challenges of Infection Preventionists
collectively and collaboratively rather than
individually
Comments and Questions
???