CDC Winnable Battles: Preventing Healthcare-Associated Infections ( HAIs )

1. CDC Winnable Battles: Preventing Healthcare-Associated Infections (HAIs) National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion

2. Medical Therapeutics Standard • 16) Assess the differences between healthcare-associated infections and non-healthcareassociated infections using examples drawn from mock patient documents or case studies. Support explanations with relevant surveillance statistics, preventive measures, and methodologies concerning outbreak detection, management, and education.

3. Videos • https://www.youtube.com/watch?v=5rpep33F6lE • https://www.youtube.com/watch?v=AlFnPAydJgk

4. Healthcare-Associated Infections (HAIs)

5. Antibiotic resistance in the United States • Sickens >2 million people/year • Kills at least 23,000 people/year • Plus 15,000 per year from C. difficile • >$20B/year in health care costs • Threatens modern medicine • Loss of effective antibiotic treatment could make routine infections deadly • Patients who receive specialized care will be at highest risk • Need to act now or even drugs of last resort will soon be ineffective

6. Antibiotic Resistant Threats in the U.S. • CDC’s AR Report ranked 18 drug-resistant threats: Urgent, Serious, and Concerning • Many of these AR threats are causes of healthcare-associated infections • Urgent threats include • Carbapenem-resistant Enterobacteriaceae (CRE) • Clostridium difficile • Serious threats include • Drug-resistant Pseudomonas • Methicillin-resistant Staphylococcus aureus Access CDC’s AR Report at http://www.cdc.gov/drugresistance/threat-report-2013/

7. Federal and State Alignment of HAI/AR Programs • CDC Winnable Battle • National Plans and Goals • HHS HAI Action Plan and HHS Agency Priority Goal • National Strategy and Action Plan for Combating Antibiotic-Resistant Bacteria (CARB) • CMS Value-based Purchasing • State Legislation and HAI/AR programs

8. DC* DC* States with Mandatory Public Reporting Policies forHealthcare-Associated Infections (HAIs) 2004 2016 States with legislation for HAI reporting

9. CDC’s National Healthcare Safety Network (NHSN) • NHSN: Tracking infections in over 19,000 healthcare facilities nationwide • NHSN is used by • Facilities across healthcare to track HAIs and antimicrobial resistance, and direct prevention activities • States for public reporting and regional prevention • CMS for quality reporting and prevention initiatives • HHS to measure national progress

10. Progress reducing healthcare-associated infections: 2008-2014 *CLABSI: Central line-associated bloodstream infections †MRSA: Methicillin-resistant Staphylococcus aureus, reduction since 2011

11. HAI Progress ReportBased on 2014 data; published March 2016 • National summaries of healthcare-associated infections in acute care hospitals • 50% decrease in CLABSI between 2008 and 2014 • 17% decrease in SSIs related to the 10 select procedures tracked in the report between 2008 and 2014 • No change in CAUTI between 2009 and 2014, but 5% decrease from 2013 to 2014 • 13% decrease in hospital-onset MRSA bacteremia between 2011 and 2014 • 8% decrease in hospital-onset C. difficile infections between 2011 and 2014 • Source: http://www.cdc.gov/hai/surveillance/progress-report/

12. HAI Progress ReportBased on 2014 data; published March 2016 • National summaries of healthcare-associated infections in long-term acute care hospitals (LTACHs) and inpatient rehabilitation facilities (IRFs) • LTACHs • 9% decrease in CLABSI in LTACHs between 2013 and 2014 • 11% decrease in CAUTI in LTACHs between 2013 and 2014 • IRFs • 14% decrease in CAUTI in IRFs between 2013 and 2014 • Source: http://www.cdc.gov/hai/surveillance/progress-report/

13. Using CDC’s NHSN Data for Action:Targeted Assessment for Prevention (TAP) Strategy Targeting → Assessment → Implementation • Identify healthcare facilities with excess infections • Assess gaps in infection prevention in targeted facilities/units using CDC tools • Implement interventions to address gaps in infection prevention using CDC Implementation Guidance • Partner among health departments and hospital networks with CDC and clinical expertise to prevent infections

14. Healthcare, infections, and antibiotic resistance have moved beyond hospitals

15. State HAI/AR Prevention Programs • CDC supports HAI/AR Programs in every state through the Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Cooperative Agreement • State health departments work with state hospital associations, CMS-funded networks, and hospital networks to: • Track infections in healthcare facilities • Focus HAI prevention efforts using CDC’s NHSN data • Implement prevention strategies across healthcare settings using CDC’s tools and evidence-based guidelines

16. State HAI/AR Prevention Programs: Detect, Prevent, Respond • Expand the core capacity in all 50 states to detect, respond to, protect against HAI/AR threats • Across all healthcare settings, networks of facilities in up to 25 states working with health departments to: • Prevent infections • Improve prescribing http://www.cdc.gov/drugresistance/solutions-initiative http://www.cdc.gov/vitalsigns/stop-spread

17. CDC Modeling Predicts Growth of Drug-Resistant Infections and C. difficile Can Be Curbed With Coordinated Prevention Approach • Public health departments track and alert health care facilities to drug-resistant outbreaks in their area and the threat of germs coming from other facilities, and • Health care facilities work together and with public health authorities to implement shared infection control actions to stop the spread of antibiotic-resistant germs and C. difficile between facilities. Access CDC Vital Signs at http://www.cdc.gov/vitalsigns/issues.html

18. CDC Recommends All Hospitals Implement Antibiotic Stewardship Programs Access CDC Vital Signs at http://www.cdc.gov/vitalsigns/issues.html

19. Actions State Health Departments Can Take toAdvance Antibiotic Stewardship • Gain an understanding of antibiotic stewardship activities in the state or area • Facilitate efforts to improve antibiotic prescribing and prevent antibiotic resistance • Provide educational tools to facilities to help prescribers improve practices • Promote CDC core elements for antibiotic stewardship programs

20. CDC Recommends Doctors and Nurses Combine Efforts to Protect Patients from HAI/AR Threats • Prevent the spread of bacteria between patients • Prevent infections related to surgery and/or placement of a catheter • Improve antibiotic use through stewardship Access CDC Vital Signs at http://www.cdc.gov/vitalsigns/issues.html

21. Innovations to Improve Patient Safety:CDC Prevention Epicenters Program • CDC collaborates with academic investigators to conduct innovative infection control and prevention research • Fills prevention knowledge gaps identified by CDC’s outbreak response and surveillance data

22. Emerging Infections Program (EIP)Early Warning System for New and Changing Threats • CDC funds network of 10 state health departments collaborating with local health departments, academic institutions, other federal agencies, laboratories, infection preventionists, and healthcare providers • Conducts surveillance and special studies on HAIs and AR to assess overall burden and prevention impact across all healthcare facilities • Recently released 2011 HAI and Antimicrobial Use Prevalence Survey • Estimated 722,000 HAIs in US hospitals in 2011, or 1 in 25 patients • Estimated 75,000 patients with HAIs died during hospitalization

23. CDC’s Clinical and Environmental Microbiology Laboratory • Serves as national and an international reference laboratory for testing and diagnostic capacity of pathogens causing HAIs and antibiotic resistant infections • Develops and evaluates methods to reliably detect emerging antimicrobial resistance • Conducts applied research on improved detection methods for HAIs • Provides environmental microbiology methods for measuring contamination of healthcare environment • Assists in healthcare-associated outbreak investigations

24. Antibiotic Resistance Patient Safety Atlas • Includes open and interactive data about HAIs caused by antibiotic-resistant bacteria • Makes HAI AR data reported to CDC’s NHSN accessible • Provides awareness about antibiotic resistance patterns at national, state, and regional levels • Users can create customized visualizations or download raw data for further exploration • Shows percent resistance for 31 bug-drug combinations • Percent resistance (%R) metric shows the number of HAIs reported that were caused by resistant bacteria • Data was reported to CDC by 4,000+ healthcare facilities from 2011 to 2014 • Includes urgent and serious resistance threats identified in CDC’s AR Threat Report www.cdc.gov/hai/surveillance/ar-patient-safety-atlas

25. CDC’s AR Solutions Initiative http://www.cdc.gov/drugresistance/solutions-initiative • Detect and Respond • 50-state lab capacity to track and stop the nightmare bacteria, carbapenem-resistant Enterobacteriaceae (CRE) • Robust systems to track resistance, antibiotic use, infections in the community and healthcare • AR Lab Network for nationwide detection of new and known threats • Prevent • Strategies to prevent HAI and AR spread in all healthcare settings • State prevention programs to drive adoption of the coordinated approach • Education, prevention for antibiotic stewardship and sepsis prevention • Innovate • Discover new ways to protect patients from resistant infections • AR Isolate Bank to support new drug and diagnostic development • Microbiome research to unlock mysteries of the gut-drug relationship

26. For more information: www.cdc.gov/winnablebattles National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion