1. Hospital Outreach Unit: Local public health and HAIs Dawn Terashita MD, MPH Acute Communicable Disease Control Los Angeles County Department of Public Health dterashita@ph.lacounty.gov November 2012 1

2. Background History In 2002, healthcare-associated infections consisted of –Investigation of hospital outbreaks –Outreach & surveillance for antimicrobial resistance & blood borne pathogens. 2

3. Background History 3

4. In early 2003, during the SARS situation, BT LPHNs assisted in infection control and prevention in the hospital setting In November 2003, ACDC created the new Hospital Outreach Unit 4

5. Hospital Outreach Unit (HOU) Mission To enhance emerging infectious disease preparedness and response efforts and improve hospital disease reporting by hospitals in LAC through strengthened communications, collaboration, and consolidations of resources 5

6. Summary 102 licensed acute care hospitals 174 infection preventionists HOU divided the county into 5 areas Each area is assigned a Liaison Public Health Nurse 6

7. Hospital Outreach Unit: Objectives Collaboration and communications between Public Health and hospitals Bioterrorism and pandemic disease preparedness and response Hospital outbreak investigations Healthcare-associated infection prevention and surveillance Mandatory disease reporting Identify and respond to new and emerging threats 7

8. GOAL 1: Prevent Infection Control Education –Visit every hospital at least annually –Attend infection control committee meetings –Promote WEBvCMR –Distribute educational materials –Distribute disease alerts such as measles alerts –Review the pandemic flu plan –Attend training, table-tops and exercises –Give presentations 8

9. Goal 1: Prevent Infection Control Education 2006 - 2010 20062007200820092010 Infection control meetings (31) 5960557155 Trainings, table tops, and exercises 63872012 Web-based disease reporting system training 70884755 APIC chapter meeting304130 Educational materials distributed 79,23395,93135,9877953451.584 HAI hospital visits45 9

10. GOAL 2: Detect and Report 100% LAC hospitals now using NHSN 100% LAC hospitals have conferred rights to LADPH Validation of CLABSI, MRSA and VRE BSI, C. diff NHSN data completed on 20 LAC hospitals CRKP surveillance June 1, 2010 to July 31, 2012 10

11. GOAL 3: Investigate Hospital Outbreak Investigation –Site visits & chart review –Collect specimens from patients & environmental areas –Interview staff, etc. 11

12. Goal 3: Investigate 2008 – 2010 Year# Investigated Hospital Visits2008366 2009331 2010339 Hospital Phone Contacts 2008643 20091518 20101122 Hospital Email Contacts 20083399 20094913 20104764 Outbreak Investigation 200823 200916 201027 12

13. Other Hospital Outreach Unit Activities Liaison between ACDC/Public Health and non-acute healthcare settings such as: –Hospital based SNF and dialysis centers –Acute psychiatric hospitals –Large clinics –Jail medical services Keep key hospital contact information up-to- date, including email, fax, and phone numbers –IP, ICC, ED, Lab, Pharmacy, ID, etc. 13

14. Other HAI Activities California Healthcare-Associated Infections Advisory Working Group Hospital Association of Southern California HAI Taskforce National Healthcare Safety Network (NHSN) State User Group CSTE Nosocomial Infections Workgroup 14

15. CDPH HAI Program Collaboration ARRA funded collaboration with CDPH 1 HAI field staff assigned to Los Angeles County (Feb 2010 to Dec 2011) HAI and HOU staff will visit every hospital –Ensure enrollment into NHSN with rights conferred to CDPH and LACDPH –Serve as consultant for HAI issues –Evaluate data collection and reporting methods 15

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17. Future Direction Increase outreach to hospitals to alleviate infection control deficits Continue expansion of HAI activities to non- acute care settings (SNFs, dialysis centers, ambulatory surgery centers) Initiate analysis of NHSN data 17