1. CDC Winnable Battles: Preventing Healthcare-Associated Infections (HAIs) National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion

2. Healthcare-Associated Infections (HAIs)

3. Antibiotic resistance in the United States  Sickens >2 million people/year  Kills at least 23,000 people/year Plus 15,000 per year from C. difficile  >$20B/year in health care costs  Threatens modern medicine Loss of effective antibiotic treatment could make routine infections deadly Patients who receive specialized care will be at highest risk  Need to act now or even drugs of last resort will soon be ineffective

4. Antibiotic Resistant Threats in the U.S.  CDC’s AR Report ranked 18 drug-resistant threats: Urgent, Serious, and Concerning  Many of these AR threats are causes of healthcare-associated infections  Urgent threats include Carbapenem-resistant Enterobacteriaceae (CRE) Clostridium difficile  Serious threats include Drug-resistant Pseudomonas Methicillin-resistant Staphylococcus aureus Access CDC’s AR Report at http://www.cdc.gov/drugresistance/threat-report-2013/http://www.cdc.gov/drugresistance/threat-report-2013/

5. Federal and State Alignment of HAI/AR Programs  CDC Winnable Battle  National Plans and Goals HHS HAI Action Plan and HHS Agency Priority Goal National Strategy and Action Plan for Combating Antibiotic-Resistant Bacteria (CARB) CMS Value-based Purchasing  State Legislation and HAI/AR programs

6. States with Mandatory Public Reporting Policies for Healthcare-Associated Infections (HAIs) DC* 2004 2016 States with legislation for HAI reporting

7. CDC’s National Healthcare Safety Network (NHSN)  NHSN: Tracking infections in over 19,000 healthcare facilities nationwide  NHSN is used by Facilities across healthcare to track HAIs and antimicrobial resistance, and direct prevention activities States for public reporting and regional prevention CMS for quality reporting and prevention initiatives HHS to measure national progress

8. Progress reducing healthcare-associated infections: 2008-2014 *CLABSI: Central line-associated bloodstream infections † MRSA: Methicillin-resistant Staphylococcus aureus, reduction since 2011

9. HAI Progress Report Based on 2014 data; published March 2016  National summaries of healthcare-associated infections in acute care hospitals 50% decrease in CLABSI between 2008 and 2014 17% decrease in SSIs related to the 10 select procedures tracked in the report between 2008 and 2014 No change in CAUTI between 2009 and 2014, but 5% decrease from 2013 to 2014 13% decrease in hospital-onset MRSA bacteremia between 2011 and 2014 8% decrease in hospital-onset C. difficile infections between 2011 and 2014 Source: http://www.cdc.gov/hai/surveillance/progress-report/http://www.cdc.gov/hai/surveillance/progress-report/

10. HAI Progress Report Based on 2014 data; published March 2016  National summaries of healthcare-associated infections in long-term acute care hospitals (LTACHs) and inpatient rehabilitation facilities (IRFs) LTACHs 9% decrease in CLABSI in LTACHs between 2013 and 2014 11% decrease in CAUTI in LTACHs between 2013 and 2014 IRFs 14% decrease in CAUTI in IRFs between 2013 and 2014 Source: http://www.cdc.gov/hai/surveillance/progress-report/http://www.cdc.gov/hai/surveillance/progress-report/

11. Using CDC’s NHSN Data for Action: Targeted Assessment for Prevention (TAP) Strategy Targeting → Assessment → Implementation  Identify healthcare facilities with excess infections  Assess gaps in infection prevention in targeted facilities/units using CDC tools  Implement interventions to address gaps in infection prevention using CDC Implementation Guidance  Partner among health departments and hospital networks with CDC and clinical expertise to prevent infections

12. Healthcare, infections, and antibiotic resistance have moved beyond hospitals

13. State HAI/AR Prevention Programs  CDC supports HAI/AR Programs in every state through the Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Cooperative Agreement  State health departments work with state hospital associations, CMS-funded networks, and hospital networks to: Track infections in healthcare facilities Focus HAI prevention efforts using CDC’s NHSN data Implement prevention strategies across healthcare settings using CDC’s tools and evidence-based guidelines

14. State HAI/AR Prevention Programs: Detect, Prevent, Respond  Expand the core capacity in all 50 states to detect, respond to, protect against HAI/AR threats  Across all healthcare settings, networks of facilities in up to 25 states working with health departments to: Prevent infections Improve prescribing http://www.cdc.gov/drugresistance/solutions-initiative http://www.cdc.gov/vitalsigns/stop-spread

15. CDC Modeling Predicts Growth of Drug-Resistant Infections and C. difficile Can Be Curbed With Coordinated Prevention Approach Access CDC Vital Signs at http://www.cdc.gov/vitalsigns/issues.htmlhttp://www.cdc.gov/vitalsigns/issues.html  Public health departments track and alert health care facilities to drug-resistant outbreaks in their area and the threat of germs coming from other facilities, and  Health care facilities work together and with public health authorities to implement shared infection control actions to stop the spread of antibiotic-resistant germs and C. difficile between facilities.

16. CDC Recommends All Hospitals Implement Antibiotic Stewardship Programs Access CDC Vital Signs at http://www.cdc.gov/vitalsigns/issues.htmlhttp://www.cdc.gov/vitalsigns/issues.html

17. Actions State Health Departments Can Take to Advance Antibiotic Stewardship  Gain an understanding of antibiotic stewardship activities in the state or area  Facilitate efforts to improve antibiotic prescribing and prevent antibiotic resistance  Provide educational tools to facilities to help prescribers improve practices  Promote CDC core elements for antibiotic stewardship programs

18. CDC Recommends Doctors and Nurses Combine Efforts to Protect Patients from HAI/AR Threats Access CDC Vital Signs at http://www.cdc.gov/vitalsigns/issues.htmlhttp://www.cdc.gov/vitalsigns/issues.html  Prevent the spread of bacteria between patients  Prevent infections related to surgery and/or placement of a catheter  Improve antibiotic use through stewardship

19. Innovations to Improve Patient Safety: CDC Prevention Epicenters Program  CDC collaborates with academic investigators to conduct innovative infection control and prevention research  Fills prevention knowledge gaps identified by CDC’s outbreak response and surveillance data

20. Emerging Infections Program (EIP) Early Warning System for New and Changing Threats  CDC funds network of 10 state health departments collaborating with local health departments, academic institutions, other federal agencies, laboratories, infection preventionists, and healthcare providers  Conducts surveillance and special studies on HAIs and AR to assess overall burden and prevention impact across all healthcare facilities  Recently released 2011 HAI and Antimicrobial Use Prevalence Survey Estimated 722,000 HAIs in US hospitals in 2011, or 1 in 25 patients Estimated 75,000 patients with HAIs died during hospitalization

21. CDC’s Clinical and Environmental Microbiology Laboratory  Serves as national and an international reference laboratory for testing and diagnostic capacity of pathogens causing HAIs and antibiotic resistant infections  Develops and evaluates methods to reliably detect emerging antimicrobial resistance  Conducts applied research on improved detection methods for HAIs  Provides environmental microbiology methods for measuring contamination of healthcare environment  Assists in healthcare-associated outbreak investigations

22. Antibiotic Resistance Patient Safety Atlas  Includes open and interactive data about HAIs caused by antibiotic-resistant bacteria Makes HAI AR data reported to CDC’s NHSN accessible Provides awareness about antibiotic resistance patterns at national, state, and regional levels Users can create customized visualizations or download raw data for further exploration  Shows percent resistance for 31 bug-drug combinations Percent resistance (%R) metric shows the number of HAIs reported that were caused by resistant bacteria Data was reported to CDC by 4,000+ healthcare facilities from 2011 to 2014 Includes urgent and serious resistance threats identified in CDC’s AR Threat Report www.cdc.gov/hai/surveillance/ar-patient-safety-atlas

23. CDC’s AR Solutions Initiative http://www.cdc.gov/drugresistance/solutions-initiative Detect and Respond  50-state lab capacity to track and stop the nightmare bacteria, carbapenem-resistant Enterobacteriaceae (CRE)  Robust systems to track resistance, antibiotic use, infections in the community and healthcare  AR Lab Network for nationwide detection of new and known threats Prevent  Strategies to prevent HAI and AR spread in all healthcare settings  State prevention programs to drive adoption of the coordinated approach  Education, prevention for antibiotic stewardship and sepsis prevention Innovate  Discover new ways to protect patients from resistant infections  AR Isolate Bank to support new drug and diagnostic development  Microbiome research to unlock mysteries of the gut-drug relationship

24. 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: cdcinfo@cdc.gov 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. For more information: www.cdc.gov/winnablebattles National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion