Transcript Long Term Care CDI/MDRO Prevention Collaborative

Long Term Care CDI/MDRO Prevention
Collaborative:
Connecticut Program Update
Richard Melchreit, MD
HAI Program Coordinator
National Metrics and 5-Year Targets
Metric
Source
National 5-year
Prevention Target
On Track to Meet
2013 Targets?
Bloodstream
infections
NHSN
50% reduction
Yes
Clostridium difficile
(hospitalizations)
HCUP
30% reduction
No
Clostridium difficile
infections
NHSN
30% reduction
No
Urinary tract
infections
NHSN
25% reduction
No
MRSA invasive
infections
(population)
EIP
50% reduction
Yes
MRSA bacteremia
(hospital)
NHSN
25% reduction
No
Surgical site
infections
NHSN
25% reduction
Yes
CMS Reporting Requirements:
sorted by year
Year
HAI Event
Facility type/location
2011
CLABSI
ACH/ICUs
2012
CAUTI
ACH/ICUs
SSI:COLO, SSI:HYST
ACH/all inpatient
DE
Outpatient Dialysis
MRSA bacteremia LabID, CDI LabID
ACH/all inpatient
HCW vaccination
ACH
CLABSI, CAUTI
LTACH/all inpatient
CAUTI
IRF/adult, pediatric wards
CLABSI, CAUTI
ACH/wards
HCW vaccination
ACH/outpatient; LTACH, IRF, ASC
MRSA bacteremia LabID, CDI LabID
LTACH/all inpatient
2013
2015
CSTE recommendation: CDI reporting (NHSN) to
public health departments
Organism/
specimen
Type of facility
Type of
location
Time frame
2013
C. difficile
Infection
LabID Event
2014
Acute Care
Hospitals
All inpatient
LTACH
All inpatient
X
CHA
All inpatient
X
IRF
All inpatient
X
Other non IQR
All inpatient
LTCFs*
All residents
2015
Exceptions
2016
X
NICUs, well
baby
nurseries
X
x
* Will require enough facilities to develop the infrastructure and skills necessary to
effectively use NHSN.
CSTE recommendation: MRSA Bacteremia
reporting (NHSN) to public health departments
Organism/
specimen
Type of facility
Type of
location
Time frame
2013
MRSA
Bacteremia
LabID Event
2014
Acute Care
Hospitals
All inpatient
LTACH
All inpatient
X
CAH
All inpatient
X
IRF
All inpatient
X
Other non IQR
All inpatient
LTCFs*
All residents
2015
Exceptions*
2016
X
None
X
x
* Will require enough facilities to develop the infrastructure and skills necessary to
effectively use NHSN.
Connecticut State Health Improvement
Plan (SHIP) HAI Objectives
Objective
# Description
Benchmark
measure
Benchmark
Goal
4.27
Increase public reporting of HAIs
NHSN HAI facility
types, locations,
events
5% over baseline
4.33
Reduce # healthcare associated
influenza outbreaks
ID Section
institutional
outbreak database
5% below
baseline
4.34
Reduce MDRO isolates
CRE, MRSA ABCS
5% below
baseline
4.29
Reduce CAUTIs, CDI LabID Event
in Long Term Care Facilities
NHSN LTC CAUTI,
CDI Lab ID Event
5% below
baseline
Assessment Survey: Infection Control Policies in Connecticut LTCFs, June 2012
Overview:
Program
Challenges
Most Challenging HAI
• C. Difficile (30%)
• “Other” included
lower-respiratory tract
infections, noncatheter-associated
UTIs, pneumonia
Most Challenging IC
Aspect
• Isolation/MDROs
(21%)
• “Other” included
cohorting, resident
cooperation, transfer
data and screening
Incidence of MRSA by Place of Onset
and Year, Connecticut, 2001-2011
All MRSA
Rate per 100,000 population
30
HO
HACO
CA
25
p<0.01a
20
15
p<0.01a
10
p<0.01a
p<0.01a
5
0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Year
aChi-square
for trend
Revised Annualized National Estimates,
ABCs MRSA 2005-2010 (updated Nov,
2012)
Estimated No. Infections, U.S.
120,000
100,000
80,000
Overall
CA
60,000
HO
~50% were discharged
from acute care in
previous 3 months
40,000
20,000
HACO
~27% were outpatient
dialysis patients
0
2005
2006
2007
2008
2009
2010
2011
Revisions include:
Adjustment for dialysis; incorporation of interval estimates (not included);enhanced case finding (TN) and resolved data
transmission error (2006-2007). Data accessed (frozen) November 2012.
Vancomycin-resistant Enterococci
(VRE) Connecticut: 2000-2010
VRE Incidence by Age
VRE Incidence by Hospital Staffed Bed Size
Percent
Percent of CLABSI organisms that were
VRE or MRSA: 2009-2012
18.0
16.0
14.0
12.0
10.0
8.0
6.0
4.0
2.0
0.0
2009
2010
VRE
2011
MRSA
2012
Emerging Infections Program HAI
prevalence survey CT 2011
EIP Antimicrobial Use Survey CT 2011
Carbapenem-resistant
Enterobacteriacea
• Two KPC isolates from
CT hospitals confirmed
by CDC
• One NDM
• NHSN has reporting
capability
• Laboratories report
CREs in some other
states
• Laboratory Reportable
Condition 2014
Clostridium difficile (CDI) Infections Toolkit
Activity C: ELC Prevention Collaboratives
Carolyn Gould, MD MSCR
Cliff McDonald, MD, FACP
Division of Healthcare Quality Promotion
Centers for Disease Control and Prevention
Last reviewed - 2/29/12 --- Disclaimer: The findings and conclusions in this presentation are those of the
authors and do not necessarily represent the official position of the Centers for Disease Control and
Prevention.
Prevention Strategies
• Core Strategies
– High levels of scientific
evidence
– Demonstrated
feasibility
• Supplemental
Strategies
– Some scientific
evidence
– Variable levels of
feasibility
*The Collaborative should at a minimum include core prevention
strategies. Supplemental prevention strategies also may be used.
Most core and supplemental strategies are based on HICPAC
guidelines. Strategies that are not included in HICPAC guidelines will
be noted by an asterisk (*) after the strategy. HICPAC guidelines may
be found at www.cdc.gov/hicpac
Summary of Prevention Measures
Core Measures
• Contact Precautions for
duration of illness
• Hand hygiene in
compliance with
CDC/WHO
• Cleaning and disinfection
of equipment and
environment
• Laboratory-based alert
system
• CDI surveillance
• Education
Supplemental Measures
•
•
•
•
•
•
•
Prolonged duration of
Contact Precautions*
Presumptive isolation
Evaluate and optimize
testing
Soap and water for HH
upon exiting CDI room
Universal glove use on
units with high CDI
rates*
Bleach for environmental
disinfection
Antimicrobial
stewardship program
* Not included in CDC/HICPAC 2007 Guideline for Isolation Precautions
National Center for Emerging and Zoonotic Infectious Diseases
Division of Healthcare Quality Promotion
Upcoming DPH activities
• Commissioner’s Call to Action for antimicrobial
stewardship
• Antimicrobial stewardship survey of acute care
hospitals, later follow with LTCFs
• Posting of hospital-specific 2012 CLABSI, CAUTI,
and SSI (COLO, HYST) data on DPH website
• Nursing Home HAI Prevalence and Antimicrobial
Use Survey pilot 2014, full survey 2016