Transcript Title of Presentation Myriad Pro, Bold, Shadow, 28pt

Engaging long-term care
facilities in HAI prevention:
Assessing current practices
and developing new resources
Nimalie D. Stone, MD/MS
Ambulatory and Long Term Care Team
Division of Healthcare Quality Promotion
CSTE Annual Conference
June 13, 2011
*Nothing to disclose
National Center for Emerging and Zoonotic Infectious Diseases
Division of Healthcare Quality Promotion
Session Objectives
• Provide examples of state projects that are
raising awareness, developing resources, and
engaging long-term care facilities (LTCF) in
infection prevention and control activities.
– Understand the current challenges facing infection
control programs in LTCF
– Describe approaches to developing resources to
improve infection prevention and control activities
in the LTC setting
– Understand the opportunities and challenges to
engaging and sustaining HAI prevention programs
for LTCF
Acute care has a shrinking role in
healthcare delivery
Acute Care
Facility
Home
Care
Tranquil Gardens
Nursing Home
Long Term Care Facility
Outpatient/
Ambulatory
Facility
What is “long term care”?
• Long-term care is a variety of services that
includes medical and non-medical care to people
who have a chronic illness or disability.
– Long-term acute care hospitals, chronic
ventilator care
– Skilled nursing facilities/ Rehabilitation facilities
– Nursing homes (custodial care / dementia care)
– Assisted-living facilities
– Hospice
– Home-based care / Senior day care services
http://www.medicare.gov/longTermCare/static/home.asp
Changing population in NHs
• 3.2 million residents received care in 15, 956
certified NH/SNF in the US in 2008
– Acute care hospitals are the primary source of new
admissions (90% of facilities take post-acute care)
• From 1999 to 2008
– 10% increase in the number of residents cared
for in NHs
– Increasing proportion of individuals under the age
of 65 are receiving care in NHs (13.6% in 2008)
• Custodial care has shifted to assisted-living
facilities (ALFs)
– Fastest growing segment of LTC
– 975,000 beds in 2004 (>2x the numbers in the
1990’s)
Nursing Home Compendium 2009, CMS
Growing complexity in the NH
resident population

Increasing post-acute care
population
 Growing medical complexity
and care needs
 Increasing exposure to
Community-based
devices, wounds and
care
antibiotics
 High prevalence of multidrugresistant organisms

Dynamic movement across
healthcare settings
 Impacts where healthcareassociated infections manifest
Acute care
Tranquil
Gardens
Nursing
Home
Long-term care
Burden of HAIs in US NHs*




Very limited data on national
incidence of HAIs
Estimated 1.6-3.8 million
infections annually
 Account for ~30-50% of
hospital transfers
Including costs from
hospitalization, likely results
in >1 billion $ in additional
health costs annually
Rate of deaths from
infections ranges from 0.04 to
0.71 per 1000 resident-days
 >100,000 deaths/year
*Extrapolated from small studies over
10 years old in Strausbaugh LJ et al.
ICHE 2000. 21(10): 674--679
Updated NH regulations for Infection
Control - 2009
• Collapsed F441, F442, F443, F444, F445 into a single tag
• Expanded from 8 pages in 1995 to 38 pages and including
an investigative protocol
• Incorporates/references many CDC guidelines for IC in
healthcare settings
CMS Manual System, Pub 100-07, Transmittal 51 “Interpretive
Guidelines for Long-Term Care Facilities, Tag F441”, 7-2009
National NH IC Citation Trends,
2000-2010
Data courtesy of Ed Mortimer,
CMS Survey&Cert., March2011
Challenges for LTC infection
prevention programs


Lack of trained/dedicated infection prevention staff
Limited guidance for infection surveillance
methodology in LTC




Absence of national benchmarks
Limited ability to relate to clinical practices such as
antibiotic utilization
Limited evidence-based prevention practices
which have been evaluated in LTC settings
Communication barriers of HAI risks and
exposures made available at transitions of care
between acute and LTC facilities
Promoting state HAI
prevention work in LTC
• 14 state plans mentioned specific interest in
including or expanding prevention work into LTC
– Most anticipated work starting in 2011
– Some already had active programs for LTC or plans to
include them in initial collaboratives
• LTC Prevention Collaborative Calls
– 20 -25 states participating on a given call
– Calls facilitate for state progress updates, information
and resource sharing, highlighting successes
State Initiatives for Engaging
LTC
• Implement needs assessments for longterm care facilities
• Develop infection control resources
and/or training programs
• Include long-term care facilities in specific
HAI prevention collaboratives
LTC Baseline Prevention
Practices Assessment Tool
• Completed by the primary person
responsible for coordinating day-to-day
infection prevention and control activities for
the facility
• Primary domains about the program
– Personnel resources
– Policies/ specific activities
– Sufficiency of program resources
Highlighting State HAI Prevention
Activities in LTC







Introductions to LTC issues (5/2010)
LTC Needs assessments/ IC training (7/2010)
CDI/CA-UTI data and metrics for LTC (7/2010)
LTC needs assessment tool implementation,
featuring VT and GA (9/2010)
Developing/sustaining IC training for LTC,
featuring NE (1/2011)
Prevention collaboratives for LTC, featuring VT
and IN (3/2011)
Regional MDRO prevention, featuring WA (5/2011)
Take Home Points
Changes in the LTC resident population has
increased the risk of HAI in this setting
 Infection prevention in LTCF has taken
greater priority nationally
 LTCF have many resource challenges to
overcome to meet the goals of infection
prevention
 CDC has developed programs and
resources to promote expansion of state
HAI prevention efforts in LTC

Thank you!!
Email: [email protected] with
questions/comments
For more information please contact Centers for Disease Control and
Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: [email protected] Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the Centers for Disease Control and Prevention.
National Center for Emerging and Zoonotic Infectious Diseases
Division of Healthcare Quality Promotion