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Long Term Care CDI/MDRO Prevention Collaborative: Connecticut Program Update

Long Term Care CDI/MDRO Prevention Collaborative: Connecticut Program Update. Richard Melchreit, MD HAI Program Coordinator. National Metrics and 5-Year Targets. CMS Reporting Requirements: sorted by year. CSTE recommendation: CDI reporting (NHSN) to public health departments.

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Long Term Care CDI/MDRO Prevention Collaborative: Connecticut Program Update

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  1. Long Term Care CDI/MDRO Prevention Collaborative:Connecticut Program Update Richard Melchreit, MD HAI Program Coordinator

  2. National Metrics and 5-Year Targets

  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. Connecticut State Health Improvement Plan (SHIP) HAI Objectives Benchmark measure

  7. Overview: Program Challenges Most Challenging HAI C. Difficile (30%) “Other” included lower-respiratory tract infections, non-catheter-associated UTIs, pneumonia Most Challenging IC Aspect Isolation/MDROs (21%) “Other” included cohorting, resident cooperation, transfer data and screening Assessment Survey: Infection Control Policies in Connecticut LTCFs, June 2012

  8. 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

  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. Emerging Infections Program HAI prevalence survey CT 2011

  13. EIP Antimicrobial Use Survey CT 2011

  14. 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

  15. Clostridium difficile (CDI)Infections ToolkitActivity C: ELC Prevention Collaboratives Carolyn Gould, MD MSCR Cliff McDonald, MD, FACP Division of Healthcare Quality Promotion Centers for Disease Control and Prevention Last reviewed - 2/29/12 --- Disclaimer: The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

  16. Prevention Strategies • Core Strategies • High levels of scientific evidence • Demonstrated feasibility • Supplemental Strategies • Some scientific evidence • Variable levels of feasibility *The Collaborative should at a minimum include core prevention strategies. Supplemental prevention strategies also may be used. Most core and supplemental strategies are based on HICPAC guidelines. Strategies that are not included in HICPAC guidelines will be noted by an asterisk (*) after the strategy. HICPAC guidelines may be found at www.cdc.gov/hicpac

  17. Summary of Prevention Measures Core Measures Supplemental Measures • Contact Precautions for duration of illness • Hand hygiene in compliance with CDC/WHO • Cleaning and disinfection of equipment and environment • Laboratory-based alert system • CDI surveillance • Education • Prolonged duration of Contact Precautions* • Presumptive isolation • Evaluate and optimize testing • Soap and water for HH upon exiting CDI room • Universal glove use on units with high CDI rates* • Bleach for environmental disinfection • Antimicrobial stewardship program * Not included in CDC/HICPAC 2007 Guideline for Isolation Precautions

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

  19. Upcoming DPH activities • Commissioner’s Call to Action for antimicrobial stewardship • Antimicrobial stewardship survey of acute care hospitals, later follow with LTCFs • Posting of hospital-specific 2012 CLABSI, CAUTI, and SSI (COLO, HYST) data on DPH website • Nursing Home HAI Prevalence and Antimicrobial Use Survey pilot 2014, full survey 2016

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