CHAIN
Collaborative Healthcare-associated
Infection (HAI) Network
September 7, 2012
Objective
• Describe the Collaborative for HAI network
(CHAIN) goals and how the 10th scope of work,
hospital engagement network, MN HAI
advisory committee fits in with these goals to
provide an overall plan for reducing HAIs in
Minnesota.
HAI Advisory Group
Minnesota Statewide HAI Plan
Culture
Other groups
•TCAB
•MAPS
•Reportable events
•Meaningful Use
•Quality reporting &
Improvement
CUSP
CRE- Carbapenem-resistant Enterobacteriaceae
MRSA- Methicillin-resistant Staphylococcus Aureus
VAP- Ventilator Associated Pneumonia
CDI- Clostridium Difficile
SSI- Surgical Site Infections
CAUTI- Catheter-associated Urinary Tract Infections
CLABSI- Central Line-associated Blood Stream Infections
Environmental
Injection
Antimicrobial
Hand
Transmission
Cleaning
Practices
Stewardship
Hygiene
Precautions
Collaborative Healthcare-Associated Infection (HAI) Network
Hospital
Nursing Home
CHAIN
CHAIN
Ambulatory
CHAIN
LTAC
CHAIN
Home Care
CHAIN
HDC
ASC
CHAIN
CHAIN
CHAIN Partners
APIC
Stratis
Health
CHAIN
MHA
MDH
CHAIN Partnership Panel
Jane Harper, MDH
Linell Santella, APIC-MN
Julie Apold, MHA
Vicki Tang Olson, Stratis Health
MDH American Recovery and Reinvestment Act
(ARRA) Funding for HAI Prevention 9/2009 – 12/2011
• Identified HAI Coordinator
• Developed MN State HAI Action Plan
(HAI prevention across the continuum of care)
• Established multi-disciplinary HAI Advisory Group
(ongoing)
• Led CDI, SSI prevention initiatives (9/2010 – 10/2011)
• Initiated NHSN User Group to promote participation in
NHSN and provide a forum for case discussion
• HAI and antimicrobial use point prevalence survey
(2011)
Ongoing MDH AR / HAI Prevention
Unit Activities
• Outbreak investigation and consultation
– Endoscope reprocessing
– Product recalls
– Unusual clusters
• Emerging pathogen surveillance
– Invasive MRSA, Carbapenem-resistant Enterobacteriaceae (CRE),
CDI, Influenza
– Studies in collaboration with CDC
• Infection prevention and control recommendations
to address emerging pathogens/infections or
situations
– MRSA, CRE (acute care and long term care), H1N1, etc.
Ongoing MDH AR / HAI Prevention
Unit Activities (cont’d.)
• Antimicrobial Stewardship
– Guide for Comprehensive Antimicrobial Stewardship Programs
• www.health.state.mn.us/divs/idepc/dtopics/antibioticr
esistance/index.html
– Kick-off September 27, 2012
– Key audience: physicians and pharmacists
• Coordination with other MDH Sections /Divisions
– Facility Provider Compliance
– Health Policy and Health Reform
– Immunization Program
MDH AR/HAI Prevention Unit
Role with CHAIN
• NHSN User Group
• Participate with Stratis Health and APIC-MN
• Content and surveillance expertise (infectious
diseases, infection prevention and control)
• Possible future collaborative activities with
MHA / Stratis Health / APIC-MN
CHAIN is an effort lead by the Association for Professionals in Infection Control and EpidemiologyMinnesota (APIC), Minnesota Department of Health, Minnesota Hospital Association, and Stratis Health.
APIC MN
• As chapter president in 2011, invited to
participate on CHAIN Steering Committee
• APIC strategic plan: network with other
organizations
• The Fit:
– Subject: HAI collaboration across MN
– Could it fit any better?
– And who better to join forces with―Stratis Health,
MHA, MDH
APIC MN
• After all, what is our work?
– Combating HAIs in our facilities
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Researching evidence-based practices
Developing strategies
Educating our staff and patients
Monitoring for compliance
Measuring outcomes
Reporting outcomes to the state…to NHSN
Doing what we can to keep our facilities solvent-reducing infections, CMS reporting for reimbursement
APIC MN
• With CHAIN we will now have
– Support from other community leaders
– A format to share tools, ideas, expertise
• My role with CHAIN
– To represent APIC MN Infection Preventionists to the
best of my ability
– To share with CHAIN what we do, how we do it, and
what we need
– To share the work at APIC MN meetings and seek
input from infection preventionists
CMS Partnerships for Patients
• National public/private partnership to
improve the quality, safety and affordability of
healthcare
• Center for Medicare and Medicaid Innovation
(CMMI) allocated $1 billion in funding for
Partnerships for Patients Initiatives
• Goals by the end of 2013:
– Decrease preventable hospital-acquired conditions by 40%
– Decrease preventable hospital readmissions by 20%
Hospital-Acquired Conditions
• 10 Hospital-acquired conditions
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Pressure ulcers
Falls
Adverse drug events
Obstetrical adverse events
Catheter associated urinary tract infection (CAUTI)
Surgical site infection (SSI)
Central line associated blood stream infection (CLABSI)
Ventilator-associated pneumonia (VAP)
Venous thromboembolism (VTE)
Readmissions
• 2 Additional topics
– Culture
– TCAB
AHRQ
Culture
All HC settings
(MAPS)
OAT
TCAB
Partnership for Patients
CHAIN
HAI
ADE
&
VTE
OB
Falls
PU
Safe
Surgery
Retained
Objects
Calls-to-Action
Readmissions
RARE
Safe Tranistions
Project Red
CTI
How does it fit together?
Accountable Care Act
Center for Medicare & Medicaid
Partnership for Patients
-Hospital Engagement Network (MHA)
-QIO 10th Scope of Work (Stratis)
12 focus areas
Falls / Safe
from Falls
Pressure
Ulcers / Safe
Skin 2.0
Adverse Drug
Events
Perinatal
care
VTE
Hospital
aquired
infection
• CLABSI,
CAUTI, SSI,
VAP
Readmission
s
Culture
Transforming
Care at the
Bedside
Medicare QIO Promgram
Beneficiary
Individual Care
Integrating Care
Populations
• Protection
• Family Centered Care
• Hospital Associated Infections – CLABSI, CAUTI, SSI, CDI
• Nursing Home Pressure Ulcers/Restraints
• Adverse Drug Events
• Quality Reporting and Improvement/Value-Based Purchasing
• Readmissions
• Immunizations/screenings – Influenza, pneumococcal, Breast
cancer screening, colorectal cancer screening
• Cardiovascular screening – aspirin, blood pressure control, LDL
control, smoking cessation
Other focus areas
• Rural Health
• Health Disparities
• HIT
CAUTI/SSI initiative
• 12 Hospitals
• Monthly Reporting to NHSN
• CUSP Training
• Gap Analysis and Action Plan
• Group Calls – Best Practices
CDI/SSI
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12 Hospitals recruited
May 2012 – July 2014
Begin first with monthly entry into NHSN
MDH is developing antimicrobial stewardship
roadmap for release in fall
• Improvement cycles begin January 2013
MDH Antimicrobial Stewardship
Program Survey
Does your hospital have an antimicrobial stewardship
program in place?
CAH
(n= 37)
PPS
(n=28)
Total
Yes
10 (27%)
18 (64%)
28
No
27 (73%)
10 (36%)
37
Relationship between Roadmap
and Initiatives
CAUTI
SSI
CDI
CHAIN Activities
HAI Advisory
Roadmaps
HAI SAFE
Environmental
Cleaning
SSI
Communication
Chain Branding
Website
Antimicrobial
stewardship
Hand hygiene
CDI
CAUTI
Measurement
SAFE from HAI
Roadmap
Process
Measures
Transmission
Precautions
VAP
CLABSI
Initiatives
SAFE
from HAI
Injection
Practices
MDRO
Education
Action Days
Webinars
Listserv
NHSN
Outcome
Measures
CAUTI
Group Calls
1:1 Support
CDI
MN infection
SSI
SSI
VAP Bundle
SSI
CMS
SQRMS
Central Line Bundle
Healthcare Personnel
Influenza Vaccination
MRSA
CDI
CAUTI
SSI
CLABSI
Public Reporting
State Infection
Reporting
MN HAI Infrastructure
• MDH HAI Advisory Group
– Oversee Overall Minnesota HAI Plan
• CHAIN
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Support Minnesota HAI plan
Support SAFE from HAI
Identify infection prevention gaps and opportunities
Provide input and direction on implementation needs
and reporting efforts across the state
– Provide education and resources
CHAIN Operations Group
• Work together in partnership to provide seamless
support to Minnesota Hospitals
• Coordinate implementation efforts between
partnering organizations to maximize resources
• Identify funding sources as needs are identified
• Evaluate success of interventions and impact on
outcomes
Consumer Feedback
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Stratis Health Consumer Group
May 2012
Alcohol-based Disinfection
Handwashing
MN NHSN Users Group
• Purpose: support infection preventionists with
NHSN definitions, entry, and reporting
• Standard agenda – 1st Thursday, 1-2p.m.
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Updates from MDH/CDC
Updates from Stratis Health
Best practices sharing
Case studies/Troubleshooting/Networking
• APIC joining as co-leader
• Join NHSN/HAI distribution list for agenda/minutes
CHAIN Website
www.MNreducinghai.org
Organized according to roadmap
 SAFE
 Building blocks/Prevention Strategies
 Targeted Infections
HAI Roadmap
SAFE = common across infection topics
• S = SAFE from HAI teams
• A = Accurate and concurrent reporting
• F = Facility expectations
• E = Education for patients and families
Safe from HAI Roadmap
• Building Blocks/Core Prevention
- Handwashing
- Antimicrobial Stewardship
- Instituting environmental cleaning
- Injection Practices
- Transmission Precautions
Clinical Bundles
Clinical Bundles
• CLABSI
• CAUTI
• CDI
• SSI
• VAP
What is on the Horizon?
• Support SAFE from HAI
– Webinars
• Quarterly CHAIN webinars; additional on-going opportunities
– In-person action days
– Listserv
– On-going advisory group review of data; identify and
address gaps
– Development of tools/resources as needed
• Continued support from NHSN Users Group
• Continued coordination of infection reporting
• Continued coordination and support for all Minnesota
Infection Prevention activities
How do I get involved?
• Share tools/resources with colleagues via listserv or
posting on CHAIN website
• Participate in educational opportunities
• Access website resources: www.MNreducingHAIs.org
• Sign up for Safe from HAI: kolson@mnhospitals.org
• Sign up for listserv: kolson@mnhospitals.org
• Sign up for NHSN/HAI distribution list:
mmontury@stratishealth.org
• Sign up for CAUTI and/or CDI initiative for targeted
support: bjohnson@stratishealth.org
Key Contacts
CHAIN, or CAUTI/SSI/CDI-specific support
Bruce Johnson, Program Manager, Stratis Health
952-853-8560
bjohnson@stratis.org
SAFE from HAI
Mickey Reid, Manager, Patient Safety/Quality, Minnesota Hospital Association
651-641-1121
mreid@mnhospitals.org
Statewide HAI Plan
Jean Rainbow, Nurse Specialist, Minnesota Department of Health
651-201-5104
jean.rainbow@state.mn.us