LD 960 “ Resolve, Requiring Rulemaking by the Maine Quality Forum Regarding C. difficile and Methicillin-resistant Staph

1. Report from the MH IPCC and the MIPC LD 960“Resolve, Requiring Rulemaking by the Maine Quality Forum Regarding C. difficile and Methicillin-resistant Staphylococcus aureus” (Prevalence of MRSA in Maine Hospitals)

2. MDRO Metrics Workgroup • MQF • MHDO • MIPC • MHA • NHCQF • Infection Preventionists • Infectious Disease Physicians • Health Systems and Hospital Leadership • MSNA • Consumer advocate

3. Rule Making • Define metrics/protocol around MRSA screening • Sampling methods • Decisions around implementation and timetables • Data collection and reporting tool • Reporting period (January 4 – June 30, 2010) • Hospitals -> MQF (September 1) • MQF -> Maine legislators and hospitals (December 1) • Process for data review and analysis

4. Purpose: • Prospective active surveillance cultures of population group members admitted to Maine hospitals to determine prevalence of MRSA colonization in these population groups Action: • Perform active surveillance culture (ASC) on patients who meet the inclusion criteria and who are not excluded by the exclusion criteria within 24 hours of hospital admission. The admission time is defined as the admission time on the face sheet of the chart.

5. Line Listing for Active Surveillance Culture (ASC) – Potential "High Risk" Populations for MRSA*

6. Reporting and Analysis • MQF to calculate rates • MRSA colonization • High risk categories • Positive screening rate equal to or greater than 7%, provided there are at least three positive screens OR • Any category with a screening rate of less than 50%

7. Mandated Screening • ASC will continue for those high-risk groups • Groups not meeting on-going screening criteria will not require further mandated ASC unless subsequently implicated in a local outbreak or identified in subsequent prevalence studies

8. MRSA Survey • Sent to all ICPs – due December 1st • Questions included: • Annual risk assessment strategy • Clinical culture results/antibiogram • Measurement of compliance to infection prevention activities • Lab-based alert system and flagging of MDROs (ESOs) • Basic policies and intensified measures when increases MDROS is identified (consistent w/ CDC guidelines) • Educational programs • Staff, BOT, patients, and families • Antibiotic Stewardship • Hand hygiene policy • Hand hygiene compliance monitoring • Standard precautions for all patients • Transmission-based precautions per CDC • Adequate environmental cleaning and decontamination processes • Cleaning checklists

9. Additional Activities • NHSN participation • MDRO module • NHCQF assisting hospitals with sign-on, training, and data entry • HAI AARA Federal Grant - Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) and Healthcare-Associated Infections (HAI) – Building and Sustaining State Programs to Prevent HAI: • The grant purpose is to create capacity in the ME CDC for supporting infection prevention programs in partnership with the MIPC. • Activity A: Coordination and Reporting of State HAI Prevention Efforts • Activity B: Detection and Reporting of Healthcare-Associated Infection Data (HAI Surveillance) and the NHSN MDRO Module • Activity C: Establishing a Prevention Collaborative (MIPC)

10. Report to the State • Annual report to the State Legislature • Activities of the MIPC • Increase awareness of what hospitals are already doing to reduce HAIs • Highlight achievements • Outline future goals • Reduce mandates • Reviewed by the MIPCCC • Delivered by Josh Cutler during January session

11. Sneezins Greetings! The MH IPCC wishes to thank MaineHealth for their continued support. Have a happy and healthy holiday!