Kelley Garner, MPH MLS(ASCP)CM Ongoing and Upcoming Educational Opportunities and Quality Improvement Efforts Gary Wheeler, MD MPS Chief Medical Officer Kelley Garner, MPH MLS(ASCP)CM HAI Program Coordinator/Epidemiologist November 18th, 2016

Both presenters have no financial relationships to disclose. Financial Disclosure Both presenters have no financial relationships to disclose.

Objectives Describe new initiatives funded under the various CDC grants related to infection prevention and antibiotic stewardship Discuss Infection Control Assessment and Readiness (ICAR) visits Review NHSN rebaselining and how this may affect SIRs

Lessons Learned from Ebola Preparedness Coordination of efforts regarding high consequence pathogens Identification of assessment and treatment facilities Training and competency assessments for core infection control principles and use of PPE Development of communication network for rapidly evolving situation to distribute updates, guidance, and provide assistance Infections anywhere are infections everywhere!

New and Continuing Funding HAI Prevention and Surveillance Coordinate, collaborate, and facilitate HAI/AR Prevention (i.e. dedicated staff) Outbreak management and database development National Healthcare Safety Network (99 facilities have conferred rights to ADH) Support Analysis Validation Data for action visits Collaboration with stakeholders

New and Continuing Funding Antimicrobial Resistance/Stewardship Establish access and analyze antibiotic resistance and prescribing data Promote the use of NHSN’s AU/AR module Implement collaboratives and support facilities to prevent and control antibiotic resistant pathogens Focus: MRSA, CRE, and C Diff Facilitate communications and align activities with other stakeholders Establish clinical leadership that can promote best practices and guidelines throughout the state

Ebola Response Establish regional network of assessment and treatment hospitals Improve capacity for data management Mapping initiative to strengthen communication network Infection Control Assessment and Readiness visits (ICAR) Monthly webinar series Regional core infection prevention training conferences

Webinar Series ADH led but hosted by UAMS Distance Learning Once a month with a primary educational topic and HAI hot topic Free and includes CNE Wednesday, Nov. 9th – Device reprocessing by Pam Higdem, Director of Infection Prevention at UAMS Heater-cooler device updates Previous presentations are available and covered Clostridium difficile, visitors, Mumps, etc. Please search for my name at https://learnondemand.org

ADH Webinar Webinar Structure Webinar dates Focused education Content based on Needs Assessment Summarize guidelines Share practical resources Discussion Ask questions Share challenges Share solutions Updates on hot topics Webinar dates August 10, 2016 September 14, 2016 October 19, 2016 November 9, 2016 December 14, 2016 January 18, 2017 February 1st, 2017 March 8th, 2017

Given your current job responsibilities in the following Healthcare-Associated Infection (HAI) topic areas, please indicate your training interest: Outbreak investigation Communicable disease reporting HAI surveillance in outpatient settings HAI surveillance in non-ICU inpatient setting HAI surveillance in ICU setting 2016 ADH Needs Assessment, unpublished data

Special Topic Areas 2016 ADH Needs Assessment, unpublished data Other topics include: -When to remove isolation measures -Types of ABX used for what infections -Identification of infectious disease processes -Staff engagement -Isolation requirements 2016 ADH Needs Assessment, unpublished data

Special Patient Populations 2016 ADH Needs Assessment, unpublished data

Social Network Healthcare facilities are not islands but interconnected Knowledge and disease sharing Public health relies on healthcare facilities, laboratories, clinicians, healthcare workers, and communities to alert us of clusters or unusual infections to respond locally and statewide Not all social networks overlap and health departments can play a key role in facilitating communication

Emergence & Rapid Regional Spread of K Emergence & Rapid Regional Spread of K. pneumoniae Carbapenemase-Producing Enterobacteriaceae Hospital and Long-term Care Interrelations Social Network depiction of LTACH, Nursing Home, & Hospital spread of KPC (Carbapenem-resistant Klebsiella pneumoniae) LTACH, Long term acute care hospital; MDRO, Multidrug resistant organism Legend LTACH Nursing Home Acute Hospital Patient Won et al, Clin Infect Dis 2011; 53(6):532-40 14 Slide developed by the Centers for Disease Control and Prevention

“Making Health Care Safer: Stop Spread of Antibiotic Resistance” “Making Health Care Safer: Stop Spread of Antibiotic Resistance”. Vital Signs. CDC, August 2015. http://www.cdc.gov/vitalsigns/stop-spread/index.html [Accessed on 04/01/2016].

Coordinated Public Health Efforts Potential Effect on Transmission and Resistance An estimated 619,000 infections and 37,000 deaths over 5 years could be averted. Slayton, Rachel B., et al. "Vital Signs: Estimated Effects of a Coordinated Approach for Action to Reduce Antibiotic-Resistant Infections in Health Care Facilities — United States." MMWR. Morbidity and Mortality Weekly Report  64.30 (2015): 826-31

ICAR Visits New initiative funded by CDC ICAR = Infection Control Assessment and Readiness On-site visits to assess infection control program and provide guidance and resources 3 C’s: No Cost, Collaborative, and Confidential Data is being collected nationally to develop education and programs to mitigate common gaps

ICAR Visit - Goals Increase infection control capacity around the state Build collaboration and communication between ADH and facilities Improve efforts to prevent HAIs and antibiotic resistant infections

What’s Involved for the IP? Provide a day of time (~7 hours) Fill out CDC assessment tool (yes/no answers) Agenda Welcome Overview of the assessment and the IP Program Round with IP Cover data on Infection Control Assessment Tool Tour ICU, microbiology lab, isolation room Compile data Provide summary with typed report to follow

CDC Assessment Tool Topics include: Hand Hygiene Personal Protective Equipment HAI Prevention Activities Injection Safety Prevention of Clostridium difficile Infection Environmental Cleaning Device Reprocessing Antibiotic Stewardship Available at: http://www.cdc.gov/hai/prevent/infection-control-assessment-tools.html.

CDC Assessment Tool Focuses on Infection Prevention Program activities in regards to: Training Frequency and competency based are recurrent across the measures Audits Communication with frontline staff Surveillance Policies

Calculating a Standardized Infection Ratio (SIR) To calculate O, sum the number of HAIs among a reporting entity To calculate P, requires the use of the appropriate aggregate data from a standard population National baseline contains data from 2006-2008 for CLABSI and SSI, 2009 for CAUTI, and 2010-2011 for MRSA and C. difficile Laboratory-Identified Events. If the SIR: It means that: Equals 1 The state had infections at the same rate as would be predicted from national rates Is higher than 1 The state had more infections than predicted from national rates Is less than 1 The state had fewer infections than predicted from national rates CDC. NHSN e-News: SIRs Special Edition. December 2010. Available at: http://www.cdc.gov/nhsn/pdfs/newsletters/nhsn_nl_oct_2010se_final.pdf. Accessed on 10/19/2016.

Number of observed infections SIR Table 1 Summary of Arkansas Healthcare-Associated Infections (HAI) and Standardized Infection Ratios (SIR) for 2015 HAI Metric Number of observed infections SIR SIR Interpretation as compared to national baseline Number of Infections needed to be prevented to meet national goals* Central line-associated bloodstream infections (CLABSI) 260 0.66 34% 65 Catheter-associated urinary tract infections (CAUTI) 183 0.63 37% Surpassed Prevention Goal Surgical Site Infections (SSI) after colon surgeries 87 0.93 7% 17 Surgical Site Infections (SSI) after abdominal hysterectomies 0.49 51% MRSA bloodstream infections 94 1.09 9% 30 Clostridium difficile infections (CDI) 628 0.67 33% This data was collected and analyzed using the Center for Disease Control and Prevention’s National Healthcare Safety Network. *National prevention goals have been set by the US Department of Health and Human Services in the 2013 National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination. These goals represent a decrease beyond the national baseline (SIR =1.0) The SIR goals are 0.5 for CLABSI, 0.75 for CAUTI, both SSI, MRSA bloodstream infections, and 0.70 for CDI. Page 2

NHSN Rebaseline CDC has developed new prediction models based on data from NHSN reported in 2015 New models will account for changes in surveillance definitions, new facility types, and prevention progress over time All measures are moving to a regression model (i.e. no more pooled means) New measure – standardized device utilization ratio Available to run in NHSN on January 7th More information: http://www.cdc.gov/nhsn/2015rebaseline/

NHSN Rebaseline CDC. Paving the Path Forward: 2015 Rebaseline. Available at: http://www.cdc.gov/nhsn/2015rebaseline/. Accessed on 11/17/2016.

Questions? Margaret Holaway, RN, BSN Kelley Garner, MPH MLS(ASCP)CM Hospital Infection Control Nurse Liaison (501) 614-5280 Margaret.Holaway@arkansas.gov Kelley Garner, MPH MLS(ASCP)CM Program Coordinator/Epidemiologist (501) 661-2296 Kelley.Garner@arkansas.gov