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HHS Efforts to Prevent Healthcare-Associated Infections

2. Healthcare-Associated Infections (HAIs). What are they?Bloodstream infections, urinary tract infections, pneumonia, surgical site infectionsThe Problem1.7 million HAIs in hospitals?unknown burden in other healthcare settings 99,000 deaths per year $28-33 billion in added healthcare costsHAI PreventionImplementing what we know for prevention can lead to up to a 70% or more reduction in HAIs.

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HHS Efforts to Prevent Healthcare-Associated Infections

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    1. 1 HHS Efforts to Prevent Healthcare-Associated Infections Don Wright, M.D. M.P.H. Principal Deputy Assistant Secretary for Health Professional & Public Stakeholder Meetings June-September 2009

    2. 2 Healthcare-Associated Infections (HAIs) What are they? Bloodstream infections, urinary tract infections, pneumonia, surgical site infections The Problem 1.7 million HAIs in hospitals—unknown burden in other healthcare settings 99,000 deaths per year $28-33 billion in added healthcare costs HAI Prevention Implementing what we know for prevention can lead to up to a 70% or more reduction in HAIs

    3. 3 HHS Action Plan to Prevent Healthcare-Associated Infections Development and Implementation

    4. 4

    5. 5 GAO Report: Recommendations for HHS Improve central coordination of HHS-supported prevention and surveillance strategies Identify priorities among CDC guidelines to: Promote implementation of high priority practices Establish greater consistency and compatibility of the HAI-related data across HHS systems to: Increase reliable national estimates of HAIs

    6. 6 HHS Steering Committee for the Prevention of HAI Charge: Develop an Action Plan to reduce, prevent, and ultimately eliminate HAIs Plan will: Establish national goals for reducing HAIs Include short- and long-term benchmarks Outline opportunities for collaboration with external stakeholders Coordinate and leverage HHS resources to accelerate and maximize impact

    7. 7 Tier One Priorities HAI Priority Areas Catheter-Associated Urinary Tract Infection Central Line-Associated Blood Stream Infection Surgical Site Infection Ventilator-Associated Pneumonia MRSA Clostridium difficile Implementation Focus Hospitals

    8. 8 Steering Committee Working Group Structure Alt text: Organizational chart showing the HHS Steering Committee for the Prevention of HAIs. Under the Steering Committee, there are five working groups: 1) the Prevention and Implementation Working Groups, led by the Centers for Disease Control and Prevention, 2) the Research Working Group, led by the Academy for Health Research and Quality, 3) the Information Systems and Technology Working Group, co-led by Office of the Secretary/Office of the National Coordinator for Health Information Technology and the CDC, 4) the Incentives and Oversight Working Group, led by Centers for Medicare and Medicaid Services, and 5) the Outreach and Messaging working group, led by the Office of the Secretary, Office of Public Health and Science. Alt text: Organizational chart showing the HHS Steering Committee for the Prevention of HAIs. Under the Steering Committee, there are five working groups: 1) the Prevention and Implementation Working Groups, led by the Centers for Disease Control and Prevention, 2) the Research Working Group, led by the Academy for Health Research and Quality, 3) the Information Systems and Technology Working Group, co-led by Office of the Secretary/Office of the National Coordinator for Health Information Technology and the CDC, 4) the Incentives and Oversight Working Group, led by Centers for Medicare and Medicaid Services, and 5) the Outreach and Messaging working group, led by the Office of the Secretary, Office of Public Health and Science.

    9. 9 Stakeholder Feedback Working Group Chairs will share what they heard and changes to the Action Plan Initial version finalized, recognizing the Action Plan is and will continue to be a “living document” in response to emerging science, etc. Today’s meeting is focused on the next step: How to operationalize plans at the regional, state, and local level in a manner that leads to reducing and preventing HAIs

    10. 10 State Action Plans

    11. 11 State Action Plans State plans will: Be consistent with the HHS Action Plan Contain measurable 5-year goals and interim milestones for preventing HAIs

    12. 12 State Action Plans Fiscal Year 2009 Omnibus Bill: Requires states receiving Preventive Health and Health Services (PHHS) Block Grant funds to certify that they will submit a plan to the Secretary of HHS not later than January 1, 2010 Authorizes CDC to withhold 25% of states allocated funds until this certification is submitted All state have submitted a certification Be reviewed by the Secretary of HHS with a report submitted to Congress by June 1, 2010 Technical assistance sessions and calls to assist states in plan development CDC distributed a template to assist states in plan development

    13. 13 American Reinvestment and Recovery Act & Other Federal Funds Preventing Healthcare-Associated Infections

    14. 14 Building State Programs to Prevent HAIs Project Description: Create and expand state-based HAI prevention collaboratives Build a public health HAI workforce in states Enhance states abilities to assess where HAIs are occurring Agency Lead: CDC Collaborating Agencies: AHRQ and CMS Funds Source & Amount: ARRA ($40 million)

    15. 15 New Ambulatory Surgery Center Infection Instrument Project Description: Nationwide application of a new infection control survey instrument (designed by CMS & CDC) Use of new tracer methodology Use of multiple-person teams for ASCs over a certain size or complexity Greater inspection frequency than the current 10-year average inspection frequency (Goal = 3 years) Funds Source & Amount: 2-year funding with ARRA grant dollars of $1 million in FY09 and the remaining $9 million in FY10

    16. 16 Comprehensive Unit-Based Safety Program (CUSP)/CLABSI Initiative Project Description: Builds on success of the “Keystone” (Michigan Hospital Association's Keystone Center and Johns Hopkins University) project, which dramatically reduced central-line bloodstream infections Expands efforts to reach additional hospitals nationwide and to address other infection sites and other settings Agency Lead: AHRQ Collaborating Agencies: CDC Funds Source & Amount: FY 2009 Appropriations ($9 million)

    17. 17 Future Direction

    18. 18 HHS Commitment to Reducing Healthcare-Associated Infections Tier 2

    19. 19 Tier Two Priorities Ambulatory Surgical Centers Dialysis Centers

    20. 20 Growth in Outpatient Care Shift in healthcare delivery from acute care settings to ambulatory care, long term care and free standing specialty care sites Infection control oversight often lacking Approximately 1.2 billion outpatient visits / year Number of Dialysis Centers 2008: 4,950 (72% increase since 1996) Number of Ambulatory Surgical Centers 2008: 5,100 (240% increase since 1996) 2007: More that 6 million surgeries performed in ASC and paid by Medicare

    21. 21 Increasing numbers of surgical procedures are moving from the inpatient to the outpatient setting

    22. 22 Healthy People 2020: Defining the Nation’s Health Objectives

    23. 23 Healthy People: What is it Now? A comprehensive set of national ten-year health objectives A framework for public health priorities and actions Guided health policy decisions for 3 decades Slide 4: Healthy People, What is it now? So, what is Healthy People? It is a comprehensive set of health objectives for the United States to achieve by the year 2010. Its 28 focus areas were developed by leading Federal agencies using the most relevant scientific expertise. However, this product is also the result of a collaborative process. Over 350 national membership organizations and 250 State health, mental health, substance abuse, and environmental agencies participated in this process. And, over 11,000 public comments on the draft objectives were received. The combined efforts of these participants produced a framework for public health priorities and actions.  Slide 4: Healthy People, What is it now? So, what is Healthy People? It is a comprehensive set of health objectives for the United States to achieve by the year 2010. Its 28 focus areas were developed by leading Federal agencies using the most relevant scientific expertise. However, this product is also the result of a collaborative process. Over 350 national membership organizations and 250 State health, mental health, substance abuse, and environmental agencies participated in this process. And, over 11,000 public comments on the draft objectives were received. The combined efforts of these participants produced a framework for public health priorities and actions.  

    24. 24 Draft Mission Statement Healthy People 2020 strives to: Identify nationwide health improvement priorities; Increase public awareness and understanding of the determinants of health, disease, and disability and the opportunities for progress; Provide measurable objectives and goals that are applicable at the national, state, and local levels; Engage multiple sectors to take actions to strengthen policies and improve practices that are driven by the best available evidence and knowledge; Identify critical research, evaluation, and data collection needs.

    25. 25 Healthy People 2020 – Phase II New Topic Areas Access to Health Services Adolescent Health Children’s Health Genomics Global Health Older Adults Healthcare-Associated Infections Quality of Life Social Determinants of Health Blood Disorders and Blood Safety Healthy Places Preparedness

    26. 26 Partnership Opportunities? Prevention is a shared responsibility between healthcare institutions, healthcare providers, and consumers

    27. 27 Stakeholder & Public Engagement Hold five stakeholder/public engagement meetings Washington, DC – Tuesday, June 30 (National Level) Denver, CO – Saturday, July 25 (Regional/State Level) Chicago, IL – Thursday, July 30 (Regional/State Level) Seattle, WA – Thursday, Aug 27 (Regional/State Level) Chicago, IL – Tuesday, Sept 22 (Regional/State Level) Engage the public and stakeholders in conversations about how to operationalize the HHS Action Plan in a manner that results in reducing and preventing HAIs

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