1. Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

2. Healthcare Associated Infections: What’s On the Horizon Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

3. Objectives By the end of today’s presentation, participants will be able to – Define Healthcare-Associated Infections (HAIs) and identify 5 broad classifications of HAIs – Discuss the financial burden of HAIs – Describe key legislative, regulatory and reimbursement issues as they relate to HAIs Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

4. Healthcare Associated Infections (HAIs) Definition: Largely preventable infections that are directly resultant from the delivery of clinical care, that were not present or incubating upon entry into a healthcare setting Settings: Hospitals (Intensive Care Units, Special Care Units, other hospital settings), long-term care facilities (LTCFs), outpatient facilities such as ambulatory surgical clinics (ASCs), dialysis centers Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

5. HAIs: Broad Classifications Catheter-associated urinary tract infections (CAUTI) Surgical site infections (SSI) Post-procedure pneumonia (PPP) Central line-associated blood stream infections (CLABSI) Ventilator-associated pneumonia (VAP) Multi-drug resistant organism (MDRO) Clostridium difficile infections (CDI) Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

6. Annual Burden of HAIs 1.7 million infections in hospitals – Most (1.3 million) were outside of ICUs – 9.3 infections per 1,000 patient-days – 4.5 per 100 admissions Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

7. HAI Costs Direct Costs – Increased LOS – Increased acuity of care – Increased treatment costs – Bed blockage Indirect Costs – Lost wages – Lost productivity – Suffering – Travel expenses – Litigation / Reputation Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It" Josie King (1999-2001)

8. Estimates of preventable infections, deaths, and costs based on existing published literature Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It" Source: Umschied, C. University of Pennsylvania. Presentation at HICPAC, March 2009

9. The Good News HAI Prevention – Implementing what we know for prevention can lead to up to a 70% or more reduction in HAIs Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

10. CMS Reimbursement Deficit Reduction Act (2005) – No increased Medicare payments for selected complicating conditions not present at admission CAUTI CLABSI SSI (cardiac, orthopedic) – Implemented in 2008 Impact? Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

11. National Policy Issue 2009 Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

12. GAO Report: Key Recommendations Improve central coordination of HHS-supported prevention and surveillance strategies Identify priorities among CDC guidelines to: – Promote implementation of high priority practices – Consider inclusion into CMS Conditions of Participation and Conditions for Coverage Establish greater consistency and compatibility of the HAI-related data across HHS systems to: – Increase reliable national estimates of HAIs Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

13. HHS Tier One Priorities HAI Priority Areas Catheter-Associated Urinary Tract Infections Central Line-Associated Bloodstream Infections Surgical Site Infections Ventilator-Associated Pneumonia MRSA Clostridium difficile Implementation Focus Hospitals Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

14. Measuring Success MetricSource National 5-year Prevention Target Coordinator Bloodstream infectionsNHSN50% reductionCDC Adherence to central-line insertion practicesNHSN100% adherenceCDC Clostridium difficile (hospitalizations) NHDS HCUP 30% reductionCDC/AHRQ Clostridium difficile infectionsNHSN30% reductionCDC Urinary tract infectionsNHSN 25% reduction CDC MRSA invasive infections (population)EIP50% reductionCDC MRSA bacteremia (hospital)NHSN25% reductionCDC Surgical site infectionsNHSN25% reductionCDC Surgical Care Improvement Project MeasuresSCIP95% adherenceCMS

15. HHS Tier Two Priorities HAI Priority Areas Antimicrobial IV Start (process measure) CLABSI SSI Healthcare personnel influenza vaccination* Implementation Focus End state renal disease Ambulatory surgical centers Acute care facilities* Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

16. HHS Tier Three Priorities HAI Priority Areas To be determined Implementation Focus Likely Long Term Care and CRITICAL ACCESS HOSPITALS Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

17. CMS IPPS Final Rule: CLABSI in ICU Required by CMS FY 2010 IPPS rule Locations include: – All adult ICU – All pediatric ICU – Level II/III neonatal intensive care units and – Level III neonatal intensive care units Data collection began January 2011 for FY 2013 Medicare payment First ever de facto mandate Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

18. *Reporting of CLABSI in ICUs by 2011 and SSIs by 2012 Status of HAI Reporting 2003 State Laws 2011 State Laws 2011 Federal Requirements*

19. CMS IPPS Final Rule: SSI Required by CMS FY 2011 IPPS rule CDC and the American College of Surgeons collaborated to develop SSI measure for CMS reporting Prototype measure to include colon surgeries and abdominal hysterectomies – Deep incisional and organ/space SSIs in inpatients age 18+ – Prototype will be followed by more comprehensive set of measures that expand procedures and SSI risk adjustment – Reporting requirements for prototype involve no changes to NHSN Patient Safety Protocol for SSIs – Measure is currently under review by NQF Data collection to begin January 2012 for FY 2014 Medicare payment – no change Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

20. FY 2012 Acute Care Hospitals– Proposed Rule Acute Care Hospitals Proposed for FY 2014 Medicare payment determination : CAUTI – reported through NHSN CLIP Adherence percentage Proposed for FY 2015 Medicare payment determination: MRSA C.Diff. HCP influenza vaccination All reported through NHSN Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

21. LTCH Prospective Payment Systems – Proposed Rule Long-Term Care Hospitals For the first time, CMS also proposed quality measure reporting for Long- term Care Hospitals for FY 2014 payment determination. Measures include: CAUTI CLABSI Pressure ulcers that are new or have worsened Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

22. Inpatient Rehabilitation Facilities (IRF) Prospective Payment Systems – Proposed Rule Also for the first time, CMS proposed quality measure reporting for IRFs for FY 2014 payment determination. Measures include: CAUTI Pressure ulcers that are new or have worsened Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

23. Influenza Vaccination Standard – Proposed Rule Proposed Rule would make offering annual influenza vaccination for hospital inpatients and outpatients a Medicare Condition of Participation (CoP) Final rule expected from CMS around September 1, 2011 Implementation for 2011-2012 flu season Implementation of this program on this timeline raises serious concerns about: Supplies Policies/Procedures Safe Injection Practices Who qualifies as an “outpatient”? Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

24. Influenza Vaccination Standard – Proposed Rule APIC recommendation: delay implementation so that: Year 1 (2011-2012) flu season – staffing/resource planning Year 2 (2012-2013) flu season – implement for hospital inpatients Year 3 (2013-2014) – incorporate outpatients into program ONLY after detailed evaluation of impact of proposal on outpatient population. Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

25. Healthcare Facility HAI Reporting to CMS via NHSN – Current and Proposed Requirements DRAFT (8/5/2011) HAI EventFacility TypeReporting Start Date CLABSI Acute Care Hospitals Adult, Pediatric, and Neonatal ICUs January 2011 CAUTI Acute Care Hospitals Adult and Pediatric ICUs January 2012 SSI Acute Care Hospitals Colon and abdominal hysterectomy January 2012 I.V. antimicrobial start (proposed)Dialysis Facilities January 2012 Positive blood culture (proposed)Dialysis Facilities January 2012 Signs of vascular access infection (proposed)Dialysis Facilities January 2012 CLABSI Long Term Care Hospitals * October 2012 CAUTI Long Term Care Hospitals * October 2012 CAUTI Inpatient Rehabilitation Facilities October 2012 MRSA Bacteremia Acute Care Hospitals January 2013 C. difficile LabID Event Acute Care Hospitals January 2013 HCW Influenza Vaccination Acute Care Hospitals January 2013 HCW Influenza Vaccination OP Surgery, ASCs October 2013 SSI ( proposed ) Outpatient Surgery/ASCs January 2014 * Long Term Care Hospitals are called Long Term Acute Care Hospitals in NHSN

26. Trends in State Legislation Infection Control Requirements in Healthcare Facilities - FL: Pain management facilities - TN: Pain management facilities - NC: adult care homes - NV: Hospitals and ASCs Mandatory Isolation for Tuberculosis Patients - ND and SC Compliance with Safe Injection Practices Guidelines - NC: Adult care home medication aides - NV: Healthcare professionals, medical laboratories, radiation facilities Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

27. Other Enacted Bills Reporting of CLABSIs (redundant with federal requirement), AR Reporting by skilled nursing facilities, NV MRSA and C. diff reporting, ME Expansion of HAI reporting to include infections resulting in death, TX Reporting in format that allows for comparison of medical facilities, NV Authorization for school-based influenza program, MS Influenza vaccinations for healthcare workers, NE Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

28. Questions and Discussion Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

29. For additional information, please contact Kansas Department of Health and Environment Bureau of Epidemiology and Public Health Informatics Healthcare Associated Infections Program 1000 SW Jackson St., Suite 210 Topeka, KS 66612-1274 Joseph M. Scaletta, MPH, RN, CIC (785) 296-1059 jscaletta@kdheks.gov Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

30. Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It" www.kdheks.gov