CHAIN Collaborative Healthcare-associated Infection (HAI) Network September 7, 2012

1. CHAIN Collaborative Healthcare-associated Infection (HAI) Network September 7, 2012

2. Objective • Describe the Collaborative for HAI network (CHAIN) goals and how the 10th scope of work, hospital engagement network, MN HAI advisory committee fits in with these goals to provide an overall plan for reducing HAIs in Minnesota.

3. Other groups • TCAB • MAPS • Reportable events • Meaningful Use • Quality reporting & Improvement Minnesota Statewide HAI Plan HAI Advisory Group Culture CUSP CRE- Carbapenem-resistant Enterobacteriaceae MRSA- Methicillin-resistant Staphylococcus Aureus VAP- Ventilator Associated Pneumonia CDI- Clostridium Difficile SSI- Surgical Site Infections CAUTI- Catheter-associated Urinary Tract Infections Environmental Cleaning CLABSI- Central Line-associated Blood Stream Infections Hand Hygiene Transmission Precautions Antimicrobial Stewardship Injection Practices Collaborative Healthcare-Associated Infection (HAI) Network Hospital Nursing Home Ambulatory LTAC Home Care HDC ASC CHAIN CHAIN CHAIN CHAIN CHAIN CHAIN CHAIN

4. CHAIN Partners CHAIN Minnesota Hospitals

5. CHAIN Partnership Panel Jane Harper, MDH Linell Santella, APIC-MN Julie Apold, MHA Vicki Tang Olson, Stratis Health

6. MDH American Recovery and Reinvestment Act (ARRA) Funding for HAI Prevention 9/2009 – 12/2011 • Identified HAI Coordinator • Developed MN State HAI Action Plan (HAI prevention across the continuum of care) • Established multi-disciplinary HAI Advisory Group (ongoing) • Led CDI, SSI prevention initiatives (9/2010 – 10/2011) • Initiated NHSN User Group to promote participation in NHSN and provide a forum for case discussion • HAI and antimicrobial use point prevalence survey (2011)

7. Ongoing MDH AR / HAI Prevention Unit Activities • Outbreak investigation and consultation • Endoscope reprocessing • Product recalls • Unusual clusters • Emerging pathogen surveillance • Invasive MRSA, Carbapenem-resistant Enterobacteriaceae (CRE), CDI, Influenza • Studies in collaboration with CDC • Infection prevention and control recommendations to address emerging pathogens/infections or situations • MRSA, CRE (acute care and long term care), H1N1, etc.

8. Ongoing MDH AR / HAI Prevention Unit Activities (cont’d.) • Antimicrobial Stewardship • Guide for Comprehensive Antimicrobial Stewardship Programs • www.health.state.mn.us/divs/idepc/dtopics/antibioticresistance/index.html • Kick-off September 27, 2012 • Key audience: physicians and pharmacists • Coordination with other MDH Sections /Divisions • Facility Provider Compliance • Health Policy and Health Reform • Immunization Program

9. MDH AR/HAI Prevention Unit Role with CHAIN NHSN User Group Participate with Stratis Health and APIC-MN Content and surveillance expertise (infectious diseases, infection prevention and control) Possible future collaborative activities with MHA / Stratis Health / APIC-MN

10. APIC MN • As chapter president in 2011, invited to participate on CHAIN Steering Committee • APIC strategic plan: network with other organizations • The Fit: • Subject: HAI collaboration across MN • Could it fit any better? • And who better to join forces with―Stratis Health, MHA, MDH

11. APIC MN • After all, what is our work? • Combating HAIs in our facilities • Researching evidence-based practices • Developing strategies • Educating our staff and patients • Monitoring for compliance • Measuring outcomes • Reporting outcomes to the state…to NHSN • Doing what we can to keep our facilities solvent-- reducing infections, CMS reporting for reimbursement

12. APIC MN • With CHAIN we will now have • Support from other community leaders • A format to share tools, ideas, expertise • My role with CHAIN • To represent APIC MN Infection Preventionists to the best of my ability • To share with CHAIN what we do, how we do it, and what we need • To share the work at APIC MN meetings and seek input from infection preventionists

13. CMS Partnerships for Patients • National public/private partnership to improve the quality, safety and affordability of healthcare • Center for Medicare and Medicaid Innovation (CMMI) allocated $1 billion in funding for Partnerships for Patients Initiatives • Goals by the end of 2013: • Decrease preventable hospital-acquired conditions by 40% • Decrease preventable hospital readmissions by 20%

14. Hospital-Acquired Conditions • 10 Hospital-acquired conditions • Pressure ulcers • Falls • Adverse drug events • Obstetrical adverse events • Catheter associated urinary tract infection (CAUTI) • Surgical site infection (SSI) • Central line associated blood stream infection (CLABSI) • Ventilator-associated pneumonia (VAP) • Venous thromboembolism (VTE) • Readmissions • 2 Additional topics • Culture • TCAB

15. AHRQ Culture All HC settings (MAPS) OAT Partnership for Patients TCAB CHAIN RARE Safe Tranistions Project Red CTI ADE & VTE HAI Re-admissions OB Calls-to-Action Falls PU Retained Objects Safe Surgery

16. Accountable Care Act How does it fit together? Center for Medicare & Medicaid

17. Medicare QIO Promgram

18. Other focus areas • Rural Health • Health Disparities • HIT

19. CAUTI/SSI initiative • 12 Hospitals • Monthly Reporting to NHSN • CUSP Training • Gap Analysis and Action Plan • Group Calls – Best Practices

20. CDI/SSI • 12 Hospitals recruited • May 2012 – July 2014 • Begin first with monthly entry into NHSN • MDH is developing antimicrobial stewardship roadmap for release in fall • Improvement cycles begin January 2013

21. MDH Antimicrobial Stewardship Program Survey Does your hospital have an antimicrobial stewardship program in place?

22. Relationship between Roadmap and Initiatives SAFE from HAI SSI CDI CAUTI

23. CHAIN Activities

24. HAI Advisory HAI SAFE Roadmaps Environmental Cleaning Hand hygiene Antimicrobial stewardship Transmission Precautions Injection Practices SSI CDI CAUTI VAP CLABSI MDRO Communication Measurement Initiatives Education SAFE from HAI Roadmap Process Measures Chain Branding SAFE from HAI Action Days Webinars Website Listserv NHSN Outcome Measures CAUTI SSI Group Calls 1:1 Support CDI SSI MN infection

26. MN HAI Infrastructure • MDH HAI Advisory Group • Oversee Overall Minnesota HAI Plan • CHAIN • Support Minnesota HAI plan • Support SAFE from HAI • Identify infection prevention gaps and opportunities • Provide input and direction on implementation needs and reporting efforts across the state • Provide education and resources

27. CHAIN Operations Group • Work together in partnership to provide seamless support to Minnesota Hospitals • Coordinate implementation efforts between partnering organizations to maximize resources • Identify funding sources as needs are identified • Evaluate success of interventions and impact on outcomes

28. Consumer Feedback • Stratis Health Consumer Group • May 2012 • Alcohol-based Disinfection • Handwashing

29. MN NHSN Users Group • Purpose: support infection preventionists with NHSN definitions, entry, and reporting • Standard agenda – 1st Thursday, 1-2p.m. • Updates from MDH/CDC • Updates from Stratis Health • Best practices sharing • Case studies/Troubleshooting/Networking • APIC joining as co-leader • Join NHSN/HAI distribution list for agenda/minutes

30. CHAIN Website www.MNreducinghai.org Organized according to roadmap • SAFE • Building blocks/Prevention Strategies • Targeted Infections

31. HAI Roadmap SAFE = common across infection topics • S = SAFE from HAI teams • A = Accurate and concurrent reporting • F = Facility expectations • E = Education for patients and families

32. Safe from HAI Roadmap • Building Blocks/Core Prevention - Handwashing - Antimicrobial Stewardship - Instituting environmental cleaning - Injection Practices - Transmission Precautions

33. Clinical Bundles Clinical Bundles • CLABSI • CAUTI • CDI • SSI • VAP

34. What is on the Horizon? • Support SAFE from HAI • Webinars • Quarterly CHAIN webinars; additional on-going opportunities • In-person action days • Listserv • On-going advisory group review of data; identify and address gaps • Development of tools/resources as needed • Continued support from NHSN Users Group • Continued coordination of infection reporting • Continued coordination and support for all Minnesota Infection Prevention activities

35. How do I get involved? • Share tools/resources with colleagues via listserv or posting on CHAIN website • Participate in educational opportunities • Access website resources: www.MNreducingHAIs.org • Sign up for Safe from HAI: kolson@mnhospitals.org • Sign up for listserv: kolson@mnhospitals.org • Sign up for NHSN/HAI distribution list: mmontury@stratishealth.org • Sign up for CAUTI and/or CDI initiative for targeted support: bjohnson@stratishealth.org

36. Key Contacts CHAIN, or CAUTI/SSI/CDI-specific support Bruce Johnson, Program Manager, Stratis Health 952-853-8560 bjohnson@stratis.org SAFE from HAI Mickey Reid, Manager, Patient Safety/Quality, Minnesota Hospital Association 651-641-1121 mreid@mnhospitals.org Statewide HAI Plan Jean Rainbow, Nurse Specialist, Minnesota Department of Health 651-201-5104 jean.rainbow@state.mn.us