hai program update meredith kanago, msph tdh statewide cedep meeting 30 april 2014
TRANSCRIPT
HAI Program UpdateMeredith Kanago, MSPHTDH Statewide CEDEP Meeting30 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 healthcare-associated 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 facility-specific 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
● 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
SIR = Observed (O) HAIsPredicted (P) HAIs
Standardized Infection Ratio
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 reportingOBS = observed number of CAUTIPRED = statistically 'predicted' number of CAUTI, based on NHSN baseline dataSIR = standardized infection ratio (observed/predicted number of CAUTI)UCD = number of urinary catheter daysNA = data not shown for hospitals with <50 urinary catheter days** Significantly higher than national baselineSignificantly lower than national baseline* Zero infections, but not statistically significant
Provisional Data
CLABSI –Adult/Pediatric ICUs Over Time
Q1-200
8
Q2-200
8
Q3-200
8
Q4-200
8
Q1-200
9
Q2-200
9
Q3-200
9
Q4-200
9
Q1-201
0
Q2-201
0
Q3-201
0
Q4-201
0
Q1-201
1
Q2-201
1
Q3-201
1
Q4-201
1
Q1-201
2
Q2-201
2
Q3-201
2
Q4-201
2
Q1-201
3
Q2-201
3
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
Tennessee SIRNHSN 2006-2008 Baseline SIRHHS 5-Year Goal
Quarter
SIR
CLABSI – NICU SIRs Over Time
Provisional Data
Q3-2008
Q4-2008
Q1-2009
Q2-2009
Q3-2009
Q4-2009
Q1-2010
Q2-2010
Q3-2010
Q4-2010
Q1-2011
Q2-2011
Q3-2011
Q4-2011
Q1-2012
Q2-2012
Q3-2012
Q4-2012
Q1-2013
Q2-2013
Q3-2013
Q4-2013
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
Tennessee SIR
NHSN 2006-2008 Baseline SIR
HHS 5-Year Goal
Quarter
SIR
CAUTI – A/P ICU SIRs Over Time
Provisional Data
Q1-2012 Q2-2012 Q3-2012 Q4-2012 Q1-2013 Q2-2013 Q3-2013 Q4-20130
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8Tennessee SIRNHSN 2009 Baseline SIRHHS 5-Year Goal
Quarter
SIR
MRSA – ACH SIR Over Time
Provisional Data
Q1-2012 Q2-2012 Q3-2012 Q4-2012 Q1-2013 Q2-2013 Q3-2013 Q4-20130
0.25
0.5
0.75
1
1.25
1.5
1.75
2Tennessee SIRNHSN 2010-11 Baseline SIRHHS 5-Year Goal
Quarter
SIR
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
•GOALS:▫Improve appropriate
antibiotic use ▫Reduce unnecessary
antibiotic use
▫Reduce emergence & spread of multidrug resistant organisms
▫Reduce Clostridium difficile
0%
10%
20%
30%
40%
50%
60%
70%
46.4%
59.0%
51.9%
Prevalence of Antimicrobial Use in Hospitalized Patients(10 States (EIP), 2011)
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 (PFGE-indistinguishable 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