Health Departments and Healthcare-Associated Infection Prevention Research: A New Land of Opportunity? Matthew Wise, MPH, PhD Epidemiologist, Office of Prevention Research and Evaluation CSTE Annual Conference June 3, 2012 National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion

CDC’s Healthcare-Associated Infection (HAI) Prevention Research Program  Group of mechanisms to provide external partners and vendors funding to address research questions  Grants  Cooperative agreements  Contracts  Objective: To foster research that advances prevention and control of:  HAIs  Antimicrobial resistance  Other adverse healthcare events

CDC HAI Prevention Research Program Prevention Epicenters Cooperative agreement mechanism Academic partners with HAI expertise SHEPheRD* Program Contract mechanism Vendors and insurers with access to large amounts of healthcare data Health Department CoAg (Potential) Cooperative agreement mechanism State and local health departments *Safety and Healthcare Epidemiology Prevention Research Development

Paradigm Shift in HAI Prevention: In the Past…  Healthcare facilities were at the center of HAI prevention efforts  Research dominated by large academic centers  Often conducted by single facilities in a “vacuum”  Led by infection control experts  Little multidisciplinary involvement  HAIs primarily considered a clinical issue

Paradigm Shift in HAI Prevention: Today…  Growing public interest in HAIs  Health departments are increasingly at the center of HAI surveillance and prevention  Increasing collaborative regional and national interventions across facilities  Health departments, hospital associations, and quality improvement organizations expected to work together  Multidisciplinary approach  HAIs considered a public health issue

Prevention Research Areas: Regional Efforts to Prevent HAIs  Health departments can play a key role in assessing effectiveness of regional interventions

Prevention Research Areas: HAIs Across the Spectrum of Care  Robust epidemiologic data exist on prevention of many hospital-onset infections, but…  Prevention of community-onset infections?  Prevention of infections acquired at outpatient clinics, hemodialysis centers, and ambulatory surgical centers?  Less systematic evidence of intervention effectiveness  HAIs prevented through the use of vaccine may have their onset in a variety of settings  Assessing vaccine impact may require a population-based approach

Potential Benefits of a Health Department Cooperative Agreement 1. Mechanism to conduct HAI prevention research from a public health perspective  Public health and academic research agenda not always aligned 2. Support for the state/local health department role in HAI prevention  Strengthen partnerships between public health and healthcare institutions 3. Facilitation of research on issues exceeding the purview of healthcare facilities or academic centers

Conclusions / Moving Forward  Evidence, evidence, evidence  Challenges exist in implementing state-based HAI prevention research  But likely necessary to address some prevention questions  Current TN pilot project examines impact of a long- term care intervention on outcomes in multiple settings  Funded using the existing Emerging Infections Program cooperative agreement  If successful, potential expansion of health department HAI prevention research funding