1. ACT 52 - Healthcare-Associated Infections
Mandatory Reporting Requirements and implications for Long-term Care Facilities
Hello, and thank you for joining us. My name is [Author Name]. This presentation addresses [subject].
This presentation is based on an article published in the [Month Year] PA-PSRS Patient Safety Advisory. It is available on the Web site of the Pennsylvania Patient Safety Authority, which is responsible for the Pennsylvania Patient Safety Reporting System or PA-PSRS.
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2. HAI Reporting Requirements for Long-term Care
Background for Development of the Infection List and Criteria
Act 52 requires that nursing homes electronically report patient/resident-specific health care-associated infections (HAIs) to the Patient Safety Authority (known as the Authority) and the Department of Health (known as the Department) using nationally recognized standards based on Centers for Disease Control and Prevention (CDC) definitions.
As defined in Act 52, the final list of infections and criteria were developed in consultation with the Department and the Authority’s Health Care-Associated Infection Advisory Panel. The criteria for determining HAIs were developed utilizing the McGeer Criteria together with CDC definitions, which were adapted to the long-term care setting. 1
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3. HAI Reporting Requirements for Long-term Care
Nursing homes will begin mandatory reporting on April 1, 2009.
Nursing homes will report HAIs to both the Authority and the Department through a single web-based interface: the Pennsylvania Patient Safety Reporting System (PA-PSRS). Using a single reporting system eliminates the need for duplicate reporting to both the Authority and the Department.
The format for electronic reporting is being established by the Authority in consultation with the Department and the HAI Advisory Panel. This will be addressed in detail during upcoming training programs for nursing homes.
Additional requirements are addressed in the final notice which was published on September 20. A copy can be found at 2
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4. HAI Reporting Requirements for Long-term Care
Educational Programs
Training
Training will include opportunities for both in-person and online education relating to the following:
Infection list
Criteria
Format for reporting
A series of in-person and electronic training sessions will be held throughout the State between January and March 2009.
Nursing homes will be notified of available training opportunities through direct mailings, outreach to industry associations and future public notices. 3
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5. HAI Reporting Requirements for Long-term Care
Educational Programs
HAI Prevention
PSA with assistance of the advisory panel is currently developing educational programs to address HAI prevention for future presentation, utilizing various formats.
The quarterly Patient Safety Advisory publication contains educational articles pertaining to Act 52/HAI prevention and in accordance with the Act, these advisories are to be distributed to all staff in nursing homes, including physicians. 4
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6. HAI Reporting Requirements for Long-term Care
List of Reportable Infections
1. Symptomatic Urinary Tract Infection
1.1 Indwelling urinary catheter related
1.2 Non-urinary catheter related
2. Respiratory Tract Infection
2.1 Lower Respiratory Tract Infection (Pneumonia/Bronchitis/tracheobronchitis)
2.2 Influenza-like illness 5
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7. HAI Reporting Requirements for Long-term Care
3. Skin and Soft Tissue Infection
Cellulitis
Burns
Vascular and diabetic ulcer (chronic/non healing)
Device-associated soft tissue/wound infection
Tracheostomy site
Peripheral/ Central IV catheter site
G-tube site
Supra pubic catheter site
In-dwelling drain
In-dwelling vascular catheters (dialysis)
Decubitus Ulcer (pressure related) 6
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8. HAI Reporting Requirements for Long-term Care
4. Gastrointestinal Tract Infection
5. Other infections
Intra-abdominal infection (peritonitis/deep abscess)
Meningitis
5.3. Viral Hepatitis
5.4. Osteomyelitis
5.5. Primary Bloodstream Infection 7
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9. HAI Reporting Requirements for Long-term Care
Additional Act 52 Requirements for Long-term Care – Impact on Nursing Home Staff
Nursing Homes were required to develop an infection control plan within 120 days of the SB 968 effective date (08/19/07). Deadline for submission to DOH was 12/31/07.
The plan must include a system to identify and designate patients known to be colonized or infected with MRSA or other MDRO.
Procedures to include cultures and screenings for nursing home residents admitted to a hospital.
Procedures and protocols for staff who may have been exposed to MRSA or other MDRO. 8
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10. HAI Reporting Requirements for Long-term Care
Additional Act 52 Requirements for Long-term Care – Impact on Nursing Home Staff
An outreach process for notifying a receiving health care facility of any patient know to be colonized with MRSA or an MDRO
A procedure for distribution of advisories from the Patient Safety Authority
Best Practice questions
Quality Improvement Payments – DOH Benchmarking to begin in 2010 9
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11. HAI Reporting Requirements for Long-term Care
References
Senate Bill 968
PHCA SB key points for Nursing Homes 10
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12. Antibiotic-resistant Organisms in Long-term care
Exponential increase in the incidence of antibiotic-resistant organisms (infections and colonization) in health-care settings
Nursing homes are receiving patients from hospitals with multi-drug resistant organisms such as MRSA, VRE and Extended Spectrum Beta Lactamases ( ESBLs).
Incidence rates of infections with antibiotic resistant organisms for LTC are variable depending on geographic location, type of resident including age, type of facility, services offered including device associated services etc. 11
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13. Antibiotic-resistant Organisms in Long-term care
A year-long study in 2003 in 5 states of newly admitted residents with at least a one-year stay at the facility revealed an incidence rate of 12.7 infections per 1000 residents with considerable variability by state and for specific types of residents regardless of admission diagnosis
Risk factors include:
Younger residents more likely to develop infection
Men at greater risk than women after adjustment for other factors
Risk was elevated in residents with diabetes mellitus and PVD, with MRSA being the predominant infection
Dialysis patients at high risk for invasive MRSA infection 45.2 cases per 1000 dialysis recipients in 2005 12
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14. Antibiotic-resistant Organisms in Long-term care
Indwelling urinary catheters result in the greatest proportion of device-related antibiotic-resistant infections
Feeding tubes including nutritional preparations and tube-rinsing solutions
IV therapy – strong association with MRSA
Multidrug-resistant Organisms (MDROs)
Defined as microorganisms, predominantly bacteria, that are resistant to one or more classes of antimicrobial agents
MDROs include MRSA, VRE, enterobacteriaceae such as Proteus, Acinetobacter etc. and Extended Spectrum Beta Lactamases (ESBLs) 13
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15. Methicillin-resistant Staphylococcus aureus MRSA
MRSA first identified in the late 1960s
By 2003, 59.5% of all Staphylococcus aureus isolates in hospital ICUs were resistant to Methicillin
Colonized and infected residents serve as the major reservoir of MRSA in LTC – Point prevalence studies indicate that 23-35% of residents in VA hospitals may become colonized over a period of one to two years
Main mode of transmission of MRSA is person to person via hands
Environmental surfaces play a limited role in transmission
MRSA strain is the predominant strain found in community- acquired skin and soft tissue infections 14
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16. Strategies for prevention of healthcare-associated infections (HAIs)
An effective infection control program including a committee and Infection Control designee to oversee the program
Policies and Procedures and easy access facility-wide of the IC manual
Facility-wide educational programs
Effective surveillance programs using standardized criteria to determine infections
Outbreak control 15
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17. Strategies for prevention of healthcare-associated infections (HAIs)
Communicable disease reporting as per State requirements
Effective hand hygiene measures – hand washing and use of alcohol based sanitizers
Resident Health programs including influenza and pneumococcal vaccine
Employee health programs
Antibiotic stewardship and effective monitoring
Environmental cleaning programs 16
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18. Strategies for prevention of healthcare-associated infections (HAIs)
Appropriate assessment of residents colonized with resistant organisms
Appropriate assessment of roommates for placement of colonized residents
Case by case assessments
Appropriate isolation of colonized/infected residents 17
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