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Antimicrobial Stewardship: an HAI response activity in Connecticut

Antimicrobial Stewardship: an HAI response activity in Connecticut. Richard Melchreit, MD HAI Program Coordinator. National Metrics and 5-Year Targets. Source: http://www.hhs.gov/ash/initiatives/hai/nationaltargets/index.html#table1 . CMS Reporting Requirements: sorted by year.

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Antimicrobial Stewardship: an HAI response activity in Connecticut

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  1. Antimicrobial Stewardship: an HAI response activity in Connecticut Richard Melchreit, MD HAI Program Coordinator

  2. National Metrics and 5-Year Targets Source: http://www.hhs.gov/ash/initiatives/hai/nationaltargets/index.html#table1

  3. CMS Reporting Requirements: sorted by year

  4. CSTE recommendation: CDI reporting (NHSN) to public health departments * Will require enough facilities to develop the infrastructure and skills necessary to effectively use NHSN.

  5. CSTE recommendation: MRSA Bacteremia reporting (NHSN) to public health departments * Will require enough facilities to develop the infrastructure and skills necessary to effectively use NHSN.

  6. Methods and Case Definitions Invasive (sterile site) MRSA isolates reported from labs statewide Medical Record Review Hospital-Onset (HO-MRSA) Isolate collected >2 days after hospital admission Community-Associated (CA-MRSA) No HACO risk factors Health Care-Associated Community-Onset (HACO-MRSA) -Central venous lineat time of culture -Hospitalization, surgery, dialysis, or LTCF residence in year before culture

  7. Incidence of MRSA by Place of Onset and Year, Connecticut, 2001-2011 p<0.01a p<0.01a p<0.01a p<0.01a aChi-square for trend

  8. Revised Annualized National Estimates, ABCs MRSA 2005-2010 (updated Nov, 2012) Revisions include: Adjustment for dialysis; incorporation of interval estimates (not included);enhanced case finding (TN) and resolved data transmission error (2006-2007). Data accessed (frozen) November 2012.

  9. Revised Annualized National Estimates, ABCs MRSA 2005-2010 (updated Nov, 2012) ~50% were discharged from acute care in previous 3 months ~27% were outpatient dialysis patients Revisions include: Adjustment for dialysis; incorporation of interval estimates (not included);enhanced case finding (TN) and resolved data transmission error (2006-2007). Data accessed (frozen) November 2012.

  10. Vancomycin-resistant Enterococci (VRE) Connecticut: 2000-2010 VRE Incidence by Age VRE Incidence by Hospital Staffed Bed Size

  11. Percent of CLABSI organisms that were VRE or MRSA: 2009-2012

  12. Percent of CAUTI and SSI organisms that were VRE or MRSA 2012

  13. Emerging Infections Program HAI prevalence survey CT 2011

  14. EIP Antimicrobial Use Survey CT 2011

  15. Carbapenem-resistant Enterobacteriacea • Two KPC isolates from CT hospitals confirmed by CDC • One NDM • NHSN has reporting capability • Laboratories report CREs in some other states • Laboratory Reportable Condition 2014

  16. CRE Laboratory Reporting Algorithm

  17. National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion

  18. Fair Haven Community Health Center HCHC project • AMS in the outpatient setting (70% of patients are Latino) • Assessment of AMS (facility level) • Provider and patient knowledge, attitude, practices assessment • Provider, patient education (Get Smart materials) • Chart reviews to assess prescribing

  19. Upcoming DPH activities • Commissioner’s Call to Action for antimicrobial stewardship • Antimicrobial stewardship survey of acute care hospitals • Posting of hospital-specific 2012 CLABSI, CAUTI, and SSI (COLO, HYST) data on DPH website • Emerging Infections Program: antimicrobial use paper (descriptive) and new appropriateness survey

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