Healthcare-Associated
Infection (HAI) Prevention
Jane Carmean, RN, BSN, CIC
Ohio Department of Health
Bureau of Disease Investigation and Surveillance
Outbreak Response Bioterrorism Investigation Team
(ORBIT)
(614) 995-5599 (ORBIT phone)
(614)-644-2709 (desk phone)
jane.carmean@odh.ohio.gov
How Do HAIs Impact Ohio?
Based on national estimates¹, HAIs affect 5 to
10 percent of hospitalized patients annually
For Ohio this translates into over 80 thousand
infections
nearly 4 thousand deaths
adds $180 to $230 million to healthcare costs
¹ McKibben, L., et.al., AJIC 205:33:4, 217-226.
CDC Statement: Public Reporting of
Healthcare-Associated Infections
The Centers for Disease Control and Prevention
(CDC) believes public reporting of healthcareassociated infections (HAIs) is an important
component of national HAI elimination efforts
Research shows that when healthcare facilities
are aware of their infection issues and
implement concrete strategies to prevent them,
rates of certain hospital infections can be
decreased by more than 70%
CDC Statement: Public Reporting of
Healthcare-Associated Infections, cont
“Eliminating HAIs is a top priority for CDC.”
“The tracking and reporting of HAIs is an important
step toward healthcare transparency.”
“Infection data can give healthcare facilities, patients
and public health agencies the knowledge needed to
design and implement prevention strategies that
protect patients and save lives.”
Quotes of Denise Cardo, director of CDC’s Division of
Healthcare Quality Promotion
HAIs—National Attention
US Department of Health and Human
Services (HHS) developed an action plan
to prevent healthcare-associated
infections
Support for HAI prevention has been
enhanced through the American Recovery
and Reinvestment Act (ARRA)
Congress Allocated
$40 Million Through CDC
Support state health department efforts to
prevent HAIs by enhancing state capacity for
HAI prevention
Leverage the CDC’s National Health Care
Safety Network (NHSN) to assess progress and
support the dissemination of the HHS evidencebased practices within healthcare facilities
Pursue state-based collaborative
implementation strategies
How the CongressAllocated Money Flows
American Recovery and Reinvestment Act, (ARRA)
U.S. Department of Health and Human Services
(HHS),
Centers for Disease Control and Prevention (CDC)
To the State Health Departments by way of the
Epidemiology and Laboratory Capacity for Infectious
Diseases (ELC) grant
Healthcare-Associated Infections - Building and
Sustaining State Programs to Prevent Healthcareassociated Infections
Ohio’s Piece of the Pie
Ohio Department of Health submitted a letter of
intent in May, 2009
The grant application was submitted the
following month
The Ohio Department of Health (ODH) was
awarded $373,868
Three Activities Offered in the Grant
Activity A
– Coordination and Reporting of HealthcareAssociated Infection (HAI) Prevention
Efforts
Activity B
– Detection and Reporting of HealthcareAssociated Infection Data - HAI
Surveillance
Activity C (not funded in Ohio)
– addressed the formation of a prevention
collaborative among hospitals
Activity “A”
ODH will compute Ohio’s baseline
measurements for at least two HHS
prevention measure targets
Measures were selected based on
recommendations by the
multidisciplinary ODH Director’s
Advisory Committee on Emerging
Infections
Activity “B”
ODH will create infrastructure for
electronic laboratory reporting for up to
11 Ohio hospitals
Participating hospitals will map and
successfully submit an acceptable
standardized health level
(HL) 7 message to the ODH HL7
gateway
Reporting HAIs in Ohio
The OAC 3701-3-02-C-3 was revised in 2008
to explicitly include healthcare-associated
outbreaks effective January 1, 2009
This consequently strengthens the
infrastructure of Ohio’s HAI prevention plan
Reporting HAIs in Ohio
The Ohio Department of Health Director’s
Advisory Committee on Emerging Infections has
assumed a leadership role in the statewide effort
to reduce HAI in acute care facilities across
Ohio.
This committee is a well established
multidisciplinary group of individuals first brought
together in the mid 1990s to address current and
emerging infectious disease concerns.
Reporting HAIs in Ohio
Membership includes representatives from the
Infectious Diseases Society of Ohio, five Ohio
Association for Professionals in Infection Control
and Epidemiology (APIC) chapters, local public
health departments, academia, the Ohio
Hospital Association and the Ohio Nurses
Association.
For the purpose of developing a State
healthcare-associated infection prevention plan,
representation from KePRO, Ohio’s quality
improvement organization, and additional
stakeholders interested in the reduction of HAIs
have joined the committee.
Four Top Concerns
Facing Ohio Hospitals
A September 2009 survey of Ohio’s hospital
infection preventionists identified:
– Methicillin-resistant Staphylococcus aureus (MRSA)
– Clostridium difficile (C. difficile) infections
– Surgical site infections
– Non-MRSA multi-drug resistant organisms (MDRO)
as the
Measures Being Monitored
ODH will be implementing these activities for
three of the HAI measures that are required for
Ohio House Bill 197 compliance and outlined in
Ohio Administrative Code 3701-14-04:
– Laboratory identified Hospital-acquired Clostridium difficile
– Laboratory identified Hospital-acquired Methicillin Resistant
Staphylococcus aureus bacteremia
– Laboratory identified Hospital-acquired Methicillin
Susceptible Staphylococcus aureus bacteremia
Evaluation and Oversight
Program evaluation is an essential component
of public health
Communicating the evaluation results allow for
learning and ongoing improvement to occur
Evaluation activity of the prevention targets will
be discussed and determined during future
meetings of the Director’s Advisory Committee
CDC Surveillance for
HAIs
Voluntary system for monitoring
nosocomial infections (1970 2004)
Voluntary system for monitoring
healthcare- associated events
and processes (2005 - )
Increasingly used to comply with
State legislation that mandates
reporting of HAI data (2007 - )
Also being used as a tool for
prevention collaboratives
Why use NHSN
for HAI Reporting?
Provides standard definitions, protocols
and methodology
Not just a reporting tool, comparative rates
used for performance improvement
Useful analysis tools are included
CDC provides training and user support
Use of the application is free
Ability to share data with a Group
Reporting to a
National Data Base
Surveillance data collection must use
– sound epidemiologic principles
– scientifically credible and validated data
Surveillance systems must be able
– to document the impact of HAIs
– monitor trends
– evaluate the effectiveness of prevention efforts
NHSN Demographics
125 “Groups” in NHSN
– 22 state health departments
– 45 QIOs and QIOSC
– 4 state hospital associations
– 22 hospital systems
– 1 Emerging Infections
Program (EIP) site
Why Enroll with NHSN?
Enrolling in NHSN allows a facility to
compare its data to national aggregated
data, which helps drive the prevention
process
Unlike facility-based systems, the
maintenance and support for NHSN is
conducted by CDC … so there is no
additional cost for the facility
Data Sharing
in NHSN: Groups
CDC does not send NHSN data to state
health departments or other entities
Health departments or others obtain data
directly from NHSN facilities – By
becoming a group in NHSN –
Facilities join the group and confer rights
to certain data
What is a “Group” in NHSN?
A Group is a collection of
facilities that have joined
together within the NHSN
framework to share some or
all of their data at a single
(group) level for a mutual
purpose (e.g., performance
improvement, state and/or
public reporting)
Data Sharing
in NHSN: Groups, cont
The group can analyze the data of its
member facilities
Facilities within the group cannot see each
other’s data
Facilities may join multiple groups
Steps to form a Group in NHSN
1. Complete required reading and training
for the Group Administrator or Group
User
2. An NHSN facility “nominates” the Group
3. The Group Administrator obtains a
digital certificate
Steps to form a
Group in NHSN, cont
4. The Group Administrator adds additional
users to the group and sets a Group
joining password.
5. The Group Administrator sends the
Group ID and Group joining password to
facilities and invites them to join the
Group.
6. Facilities join the Group and confer
some/all rights to data.
CDC Support for the
Group-Level User
Consultation on experience from other States
Presentations to Advisory Groups
Collaboration with CSTE, SHEA, APIC, IDSA, other
Federal agencies including CMS and AHRQ
Access to “test” facilities
NHSN State Users Group
– Conference calls monthly
– Web Board to share materials
Consultation on analysis, HAI comparison metrics
Summary of the
NHSN Group Function
Any entity can form a Group in NHSN
An NHSN facility “nominates” the group
Facilities join the group and confer
some/all rights to data
The group can analyze the data of its
member facilities
Facilities within the Group cannot see
each other’s data
Facilities can join as many Groups at they
like
Components of NHSN
Patient Safety
Healthcare
Personnel
Safety
Biovigilance
Research and
Development
Components of NHSN
Patient Safety
Healthcare
Personnel
Safety
Biovigilance
Research and
Development
Patient Safety Component Modules
Deviceassociated
•CLABSI
•CLIP
Procedureassociated
•• SSI
SSI
•• PPP
PPP
Medicationassociated
AUR Pharmacy
•• AUR
• AUR Microbiology
MDRO/CDAD
Patient Influenza
Immunization
•CAUTI •DE
•VAP
•MDRO/CDAD Infection
•Lab ID •Processes
•Method A
•Method B
Benefit of Reporting into the
MRDO-lab identified event
Laboratory testing results can be used
without clinical evaluation of the patient,
allowing for a much less labor-intensive
means to track MDROs.
When denominator data are available from
electronic databases, these sources may
be used as long as the counts are not
substantially different (+ or – 5%) from
manually collected counts.
Benefit of Reporting into the
MRDO-lab identified event, cont
This method allows the facility to rely
almost exclusively on easily obtained data
from the clinical microbiology laboratory.
However, some data elements, such as
date admitted to the facility would require
other data sources.
How Data Are Used
In aggregate, CDC analyzes and
publishes surveillance data to estimate
and characterize the national burden of
healthcare-associated infections
At the local level, the data analysis
features of NHSN that are available to
participating facilities range from rate
tables and graphs to statistical analysis
that compares the healthcare facility’s
rates with the national aggregate metrics
Laboratory And Admission Data
To Calculate Proxy Measures
admission prevalence rate
MDRO bloodstream infection incidence
rate
Overall facility-wide: report only one
denominator for the entire facility
Data Analysis
NHSN will categorize LabID Events as
healthcare facility-onset vs. community-onset
This is realized
– by classifying positive cultures obtained on day 1
(admission date), day 2, and day 3 of admission as
community-onset (CO) LabID Events
– and positive cultures obtained on or after day 4 as
healthcare facility-onset (HO) LabID Events.
Laboratory-identified (LabID)
Events reporting for CDI
Data collected without clinical evaluation
Limited admission date data required
Proxy measures of C. difficile provides
– healthcare acquisition,
– exposure burden,
– and infection burden
Question, Needs and Resources
Are Ohio IPs interested in face to face
training in our State (CDC sponsored) for
NHSN use?
ODH is requesting an NHSN facility to
“nominate” ODH to form a “Group”
http://www.cdc.gov/hai/recoveryact/map.html
http://www.cdc.gov/nhsn/