CSTE Annual Conference June 13, 2011 * Nothing to disclose

1. Engaging long-term care facilities in HAI prevention: Assessing current practices and developing new resources Nimalie D. Stone, MD/MS Ambulatory and Long Term Care Team Division of Healthcare Quality Promotion CSTE Annual Conference June 13, 2011 *Nothing to disclose National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion

2. Session Objectives Provide examples of state projects that are raising awareness, developing resources, and engaging long-term care facilities (LTCF) in infection prevention and control activities. Understand the current challenges facing infection control programs in LTCF Describe approaches to developing resources to improve infection prevention and control activities in the LTC setting Understand the opportunities and challenges to engaging and sustaining HAI prevention programs for LTCF

3. Tranquil Gardens Nursing Home Acute care has a shrinking role in healthcare delivery Acute Care Facility Home Care Outpatient/ Ambulatory Facility Long Term Care Facility

4. Long-term care is a variety of services that includes medical and non-medical care to people who have a chronic illness or disability. Long-term acute care hospitals, chronic ventilator care Skilled nursing facilities/ Rehabilitation facilities Nursing homes (custodial care / dementia care) Assisted-living facilities Hospice Home-based care / Senior day care services What is “long term care”? http://www.medicare.gov/longTermCare/static/home.asp

5. Changing population in NHs 3.2 million residents received care in 15, 956 certified NH/SNF in the US in 2008 Acute care hospitals are the primary source of new admissions (90% of facilities take post-acute care) From 1999 to 2008 10% increase in the number of residents cared for in NHs Increasing proportion of individuals under the age of 65 are receiving care in NHs (13.6% in 2008) Custodial care has shifted to assisted-living facilities (ALFs) Fastest growing segment of LTC 975,000 beds in 2004 (>2x the numbers in the 1990’s) Nursing Home Compendium 2009, CMS

6. Tranquil Gardens Nursing Home Growing complexity in the NH resident population • Increasing post-acute care population • Growing medical complexity and care needs • Increasing exposure to devices, wounds and antibiotics • High prevalence of multidrug-resistant organisms • Dynamic movement across healthcare settings • Impacts where healthcare-associated infections manifest Acute care Community-based care Long-term care

7. Burden of HAIs in US NHs* Very limited data on national incidence of HAIs Estimated 1.6-3.8 million infections annually Account for ~30-50% of hospital transfers Including costs from hospitalization, likely results in >1 billion $ in additional health costs annually Rate of deaths from infections ranges from 0.04 to 0.71 per 1000 resident-days >100,000 deaths/year *Extrapolated from small studies over 10 years old in Strausbaugh LJ et al. ICHE 2000. 21(10): 674--679

8. Updated NH regulations for Infection Control - 2009 • Collapsed F441, F442, F443, F444, F445 into a single tag • Expanded from 8 pages in 1995 to 38 pages and including an investigative protocol • Incorporates/references many CDC guidelines for IC in healthcare settings CMS Manual System, Pub 100-07, Transmittal 51 “Interpretive Guidelines for Long-Term Care Facilities, Tag F441”, 7-2009

9. National NH IC Citation Trends, 2000-2010 Data courtesy of Ed Mortimer, CMS Survey&Cert., March2011

10. Challenges for LTC infection prevention programs • Lack of trained/dedicated infection prevention staff • Limited guidance for infection surveillance methodology in LTC • Absence of national benchmarks • Limited ability to relate to clinical practices such as antibiotic utilization • Limited evidence-based prevention practices which have been evaluated in LTC settings • Communication barriers of HAI risks and exposures made available at transitions of care between acute and LTC facilities

11. Promoting state HAI prevention work in LTC • 14 state plans mentioned specific interest in including or expanding prevention work into LTC • Most anticipated work starting in 2011 • Some already had active programs for LTC or plans to include them in initial collaboratives • LTC Prevention Collaborative Calls • 20 -25 states participating on a given call • Calls facilitate for state progress updates, information and resource sharing, highlighting successes

12. State Initiatives for Engaging LTC Implement needs assessments for long-term care facilities Develop infection control resources and/or training programs Include long-term care facilities in specific HAI prevention collaboratives

13. Completed by the primary person responsible for coordinating day-to-day infection prevention and control activities for the facility Primary domains about the program Personnel resources Policies/ specific activities Sufficiency of program resources LTC Baseline Prevention Practices Assessment Tool

14. Highlighting State HAI Prevention Activities in LTC • Introductions to LTC issues (5/2010) • LTC Needs assessments/ IC training (7/2010) • CDI/CA-UTI data and metrics for LTC (7/2010) • LTC needs assessment tool implementation, featuring VT and GA (9/2010) • Developing/sustaining IC training for LTC, featuring NE (1/2011) • Prevention collaboratives for LTC, featuring VT and IN (3/2011) • Regional MDRO prevention, featuring WA (5/2011)

15. Take Home Points Changes in the LTC resident population has increased the risk of HAI in this setting Infection prevention in LTCF has taken greater priority nationally LTCF have many resource challenges to overcome to meet the goals of infection prevention CDC has developed programs and resources to promote expansion of state HAI prevention efforts in LTC

16. Email: nstone@cdc.gov with questions/comments Thank you!! National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion