1. 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

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

3. 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

4. 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!

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. Special Patient Populations
2016 ADH Needs Assessment, unpublished data

13. 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

14. 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

15. “Making Health Care Safer: Stop Spread of Antibiotic Resistance”
“Making Health Care Safer: Stop Spread of Antibiotic Resistance”. Vital Signs. CDC, August [Accessed on 04/01/2016].

16. 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):

17. 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

18. 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

19. 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

20. 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:

21. 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

22. 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 for CLABSI and SSI, 2009 for CAUTI, and 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 Available at: Accessed on 10/19/2016.

23. 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.
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24. 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:

25. NHSN Rebaseline
CDC. Paving the Path Forward: 2015 Rebaseline. Available at: Accessed on 11/17/2016.

26. Questions? Margaret Holaway, RN, BSN Kelley Garner, MPH MLS(ASCP)CM
Hospital Infection Control Nurse Liaison
(501)
Kelley Garner, MPH MLS(ASCP)CM
Program Coordinator/Epidemiologist
(501)