Transcript HAI Program Update - Tennesse Department Of Health

HAI Program Update
Meredith Kanago, MSPH
TDH Statewide CEDEP Meeting
30 April 2014
Outline
• Background
• HAI Burden
• HAI Surveillance
▫ Tennessee
▫ National
•
•
•
•
Public Reporting In Tennessee
HAI Prevention Progress
Antimicrobial Stewardship
Recent HAI Outbreaks
Background
• For the purpose of surveillance, a healthcareassociated infection (HAI) is a localized or
systemic condition resulting from an adverse
reaction to the presence of an infectious
agent(s) or its toxin(s) that was not present
on admission to the facility.
• HAIs occur in all types of care settings,
including:
▫ Acute care within hospitals
▫ Same-day surgical centers
▫ Ambulatory outpatient care in health care
clinics
▫ Long-term care facilities (e.g., nursing homes
and rehabilitation facilities)
http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=17
HAI Burden
• In 2011, there were ~722,000 HAIs in
U.S. acute care hospitals
▫ Significant additional burden in other
settings
• Nearly 75,000 deaths associated with
HAIs
▫ 6th leading cause of death in the US
• $33 billion in added healthcare costs
CDC, 2014
HAI Surveillance in TN
National HAI Surveillance
• Facilities are required to report HAIs and
other events to CMS for payment incentives
▫ Examples:
 Acute care hospitals: IPPS
 Dialysis clinics: ESRD QIP
• Failure to report -> loss of 1% annual
payment update
• Pay-for-reporting -> pay-for-performance
▫ Revenue neutral: bonus if in top 25%; money
comes from bottom 25%
• TDH aligns requirements closely with CMS to
minimize reporting burden while maximizing
available data
National Healthcare Safety Network
• A secure, Internet-based surveillance
system for collecting and utilizing data on
HAIs
• Requires active, patient-based (or
laboratory-based), prospective
surveillance of events and corresponding
denominator data
• Surveillance is conducted by infection
preventionists (IPs) at healthcare facilities
NHSN for Regional Epidemiologists
• Good news – you don’t actually have to
use (or know how to use) the NHSN
application!
• What you do need to know:
▫ Which HAIs and MDROs are reportable in
NHSN according to TN rules/regs
▫ Which MDROs are reportable in NBS
▫ What to do if you receive questions about
NHSN
 ([email protected])
Public Reporting in Tennessee
• Tennessee’s first public
report on HAIs was
published in December
2009
▫ Included aggregate state
data and facility-specific
CLABSI data
• Published semi-annually,
and includes facilityspecific data on:
▫
▫
▫
▫
CLABSI in adult/ped ICUS NICUS
CAUTI in adult /ped ICUs
SSI (COLO and HYST)
LabID Events (MRSA and CDI) in
acute care
Standardized Infection Ratio
SIR =
Observed (O) HAIs
Predicted (P) HAIs
● To calculate O, sum the number of HAIs among a group
● To calculate P, requires the use of the appropriate
aggregate data (risk-adjusted rates) (e.g., national NHSN
data for 2006–2008)
● SIR > 1.0: # infections are HIGHER than predicted
▫ SIR= 1.5: # infections = 50% HIGHER than predicted
● SIR < 1.0: # infections are LOWER than predicted
▫ SIR= 0.4: # infections = 60% LOWER than predicted
CAUTI Standardized Infection Ratio (SIR) for Adult and Pediatric Intensive Care Units in
Facilities with ≥1 Predicted CAUTI, Tennessee, 01/01/2013 - 06/30/2013
Data Reported from adult/pediatric ICUs as of January 30, 2014.
N = number of types of intensive care units reporting
OBS = observed number of CAUTI
PRED = statistically 'predicted' number of CAUTI, based on NHSN baseline data
SIR = standardized infection ratio (observed/predicted number of CAUTI)
UCD = number of urinary catheter days
NA = data not shown for hospitals with <50 urinary catheter days
** Significantly higher than national baseline
Significantly lower than national baseline
* Zero infections, but not statistically significant
1.8
CLABSI –Adult/Pediatric ICUs Over Time
Tennessee SIR
1.6
NHSN 2006-2008 Baseline SIR
1.4
HHS 5-Year Goal
1.2
SIR
1
0.8
0.6
0.4
0.2
0
Q1-2008 Q3-2008 Q1-2009 Q3-2009 Q1-2010 Q3-2010 Q1-2011 Q3-2011 Q1-2012 Q3-2012 Q1-2013
Quarter
Provisional Data
2.2
CLABSI – NICU SIRs Over Time
Tennessee SIR
NHSN 2006-2008 Baseline SIR
2
HHS 5-Year Goal
1.8
1.6
1.4
SIR
1.2
1
0.8
0.6
0.4
0.2
0
Q3-2008
Q1-2009
Q3-2009
Q1-2010
Q3-2010
Q1-2011
Quarter
Q3-2011
Provisional
Q3-2012
Q1-2013
Q1-2012
Q3-2013
CAUTI – A/P ICU SIRs Over Time
2
Tennessee SIR
NHSN 2009 Baseline SIR
1.8
HHS 5-Year Goal
1.6
1.4
SIR
1.2
1
0.8
0.6
0.4
0.2
0
Q1-2012
Q2-2012
Q3-2012
Q4-2012
Q1-2013
Quarter
Provisional
Q2-2013
Q3-2013
Q4-2013
MRSA – ACH SIR Over Time
2
Tennessee SIR
NHSN 2010-11 Baseline SIR
HHS 5-Year Goal
1.75
1.5
SIR
1.25
1
0.75
0.5
0.25
0
Q1-2012
Q2-2012
Q3-2012
Q4-2012
Quarter
Q1-2013
Q2-2013
Q3-2013
Provisional
Q4-2013
TN: 3rd Highest Outpatient Antibiotic Use
(TN: 1,159 Rx vs 801 Rx per 1,000 persons)
http://www.cddep.org/resistancemap/use/all
Antimicrobial Stewardship Collaborative
Prevalence of Antimicrobial Use in
Hospitalized Patients
(10 States (EIP), 2011)
70%
59.0%
60%
51.9%
50%
46.4%
40%
• GOALS:
▫ Improve appropriate
antibiotic use
▫ Reduce unnecessary
antibiotic use
▫ Reduce emergence &
spread of multidrug
resistant organisms
▫ Reduce Clostridium
difficile
30%
20%
10%
0%
CO
TN
Overall
(lowest) (highest)
Antimicrobial Stewardship (continued)
• Simplified monthly point prevalence survey
• Monthly webinar topics include:
▫ Assessing the Gaps and Identifying Champions
for Antimicrobial Stewardship
▫ Multidisciplinary Efforts in Antimicrobial
Stewardship
▫ Creating and Utilizing Antibiograms
▫ Dose Optimization and Kinetic Dosing
▫ Antimicrobial Stewardship in Small Hospitals
▫ De-Escalation
▫ Measurement in Stewardship Programs and
Reporting Metrics to Stakeholders
Recent HAI Outbreak
• MSSA joint injections at an outpatient
clinic
▫ September 9, 2013: TDH is notified of 3
joint infections among patients who
received injections of triamcinolone acetate
and lidocaine at a single outpatient clinic on
the same day
▫ Triamcinolone was produced in out-of-state
compounding pharmacy
▫ Medications were sequestered and
injections were stopped
Recent HAI Outbreak
• MSSA joint infections (continued)
▫ Follow-up showed 4/5 pts receiving
injections on 9/5 had evidence of a joint
infection
▫ MSSA isolated from 3 cases (PFGEindistinguishable strains); cultured meds
negative
▫ Site visit revealed suboptimal med prep and
hand hygiene; no separate clean area for
med prep
▫ Recommendations provided, including
avoiding use of multi-use vials
Questions?
• [email protected]