2017 State of the State Address on Prevention of

Health Care Associated Infections

and Antimicrobial Resistance

Erica Runningdeer, MSN, MPH, RN

HAI Prevention Coordinator

Division of Patient Safety & Quality

November 2017

Disclaimers

• No conflict of interest to report

• Funding for the HAI/AR Prevention Program is made possible (in part) by the Centers for Disease Control and Prevention. The views expressed in my presentation do not necessarily reflect the official policies of the Department of Health and Human Services, nor does the mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Objectives

• Discuss current initiatives to prevent health care associated infections and antimicrobial resistance lead by IDPH Division of Patient Safety and Quality

• Evaluate your team’s role in achieving the statewide goals outlined in the Illinois Action Plan to Prevent Health Care Associated Infections and Antimicrobial Resistance

Vision: The state of Illinois ensures health and patient safety through prevention of healthcare associated and antimicrobial resistant infections driven by a sustainable, collaborative and coordinated healthcare system.

Illinois Action Plan to Prevent HAIs & ARhttp://www.dph.illinois.gov/sites/default/files/publications/publicationsoppsil-action-plan-prevent-haier.pdf

Mission: Reduce healthcare associated and antimicrobial resistant infections through education, practice guidance, surveillance, and data-driven public policy and quality improvement efforts that strategically engage healthcare consumers, providers, and stakeholders.

A

Infection Prevention Infrastructure, Standards, and Practices

B

Assessment/Treatment/Outbreak

C

Antimicrobial Stewardship

D

Multi-Drug Resistant Organisms

Illinois Action Plan to Prevent HAIs &ARPriority Areas & Goals

Goal #1 Illinois will implement a comprehensive and effective infection prevention and control system with standards, policies, and practices in place for all healthcare settings

Goal #2 Improve detection, investigation and response to infectious outbreaks including community and healthcare associated infections (HAI) and antimicrobial resistant (AR) organisms

Goal #5 Slow the emergence of resistant bacteria and C. difficile, and prevent their transmission

Goal #3 Improve antimicrobial prescribing practices across all healthcare settings

Goal #4: Raise public awareness about antibiotic use and misuse

Key Strategies & Cross-Cutting Topics

Education & training

PolicyData &

SurveillanceCommunication

Mandated NHSN Reporting & Launch of Illinois Hospital Report Card & Consumer Guide to Health Care

Illinois HAI/AR Prevention Timeline

CLABSI, ICUsMed/surg, peds, other

ALL NHSN Measures reported to CMS

1st quality improvement collaborative launched with20 hospitals (focus: C. diff)

C. diff & MRSAAcute Care, LTACH, IRF

Surgical Site Infections (SSI) KPRO & CABG

HAI/AR Program developed through CDC grants. Total CDC award since 2009 = $8,972,844

1st Antimicrobial Stewardship Collaborative

2009 2010 2011 2012 2013 2014 2015 2016 2017

NHSN AU reporting pilot

Released training video: Not Just a Maid Service

Illinois Action Plan to Prevent Healthcare Associated Infections and Antimicrobial Resistance

Infection Prevention Liaison Program (ICAR)

Where to start?: Personal Reflections on core questions that I ask myself

nearly every day (and want you to ask yourself, too):

How can I help create

RADICAL

sustained

improvement?

CDR Gregory A. Raczniak, MD

Meet the newest member of Illinois’ HAI/AR Prevention

Team

Illinois Antimicrobial Resistance Prevention

Coordinator

1: You will need resources

– the most important being an AWESOME TEAM

How can I help create RADICAL sustained improvement?

2. Use the “So what?” test to stay focused

Example: re-focusing on what motivates me: So what? What difference will it make if we prevent HAIs?

• HAIs are:1) Preventable (meaning change is possible!)2) harmful & a source of suffering 3) Costly

Example: decide what you will and WILL NOT invest energy/resources/time in:

So, you want to make hundreds of Infection Preventionistsmanually enter susceptibility profiles into the XDRO registry? So… what will that accomplish? What will you actually do differently based on that information?

How can I help create RADICAL sustained improvement?

3. Think like an industrial/systems engineer

Make it easy & rewarding to do the right thing

• Examples: Grant to APIC Consulting for

– Infection Prevention Liaison Program

– LTC Certificate Course

Make it difficult & unpleasant to do the wrong thing

• Example: increased regulations & penalties

http://dph.illinois.gov/topics-services/prevention-wellness/patient-safety-quality/crewww.xdro.org

Contact: DPH.XDROregistry@illinois.gov

Antimicrobial Resistance Data - Illinois

Extensively Drug Resistant Organism Registry: CRE reported in Illinois (as of November 5, 2017)

• # patients (unique cases): 4,602

• # reports submitted: 7,411

• # unique facilities with access: 628

• # facilities that have ever queried: 179

XDRO automated alerts

(Admissions Feed)

(Real-time alert)

Report

As of November 5, 2017: • 1,358 autoalerts sent for 576 unique patients

• We now have 24 facilities connected to autoalerts including 2 LTACHs

Example: Make it easier to do the right thing

XDRO auto alert progress as of 5/19/17

Credit: Emily Augustini, Pawel Nowak

Alert Tracking Tool*

16*Data summaries in following slides come from alert tracking tool

Alert Summary, Pilot Hospitals, 1/7/2015 – 8/22/2017

HospitalHospital

SizeDuration

(mo.)

Inpatient Alerts

(n)Alerts/

mo.

Correct personn (%)

Known CREn (%)*

On contact precautions

n (%)*

1/2 Med/Sm 31 100 3.2 96 (96%) 55 (57%) 20 (21%)

3 Large 25 219 8.8 219 (100%) 168 (77%) 142 (65%)

4 Med 25 93 3.7 93 (100%) 75 (81%) 87 (94%)

5 Large 21 156 7.4 154 (100%) 149 (97%) 133 (86%)

6 Med 19 95 5.0 92 (97%) 75 (82%) 85 (92%)

7 Med 19 43 2.3 40 (100%) 27 (68%) 30 (75%)

8 Small 19 17 0.9 9 (100%) 9 (100%) 8 (89%)

9 Small 19 23 1.2 23 (100%) 19 (83%) 20 (87%)

10 Small 19 23 1.2 15 (100%) 13 (87%) 11 (73%)

17

Hospital size: Small (<200 beds), Med (200-500), Large (>500)Inpatient alerts and feedback data may not add up due to missing data*Denominator = # alerts that correctly identified the patient

Slide adapted from: Mike Lin, Rush University Medical Center/Chicago CDC Epicenter

Alert Summary, Additional Hospitals, 8/29/2016 – 8/22/2017

HospitalHospital

SizeDuration

(mo.)

Inpatient Alerts

(n)Alerts/

mo.

Correct personn (%)

Known CREn (%)

On contact precautions

n (%)

11 Med 11 12 1.1 11 (92%) 7 (64%) 7 (64%)

12 Med 10 16 1.6 16 (100%) 15 (94%) 16 (100%)

13 Small 9 0 -- -- -- --

14 Small 9 3 0.3 1 (100%) 1 (100%) 1 (100%)

15 Small 9 3 0.3 3 (100%) 3 (100%) 3 (100%)

16 Med 8 63 7.9 63 (100%) 30 (48%) 43 (68%)

17 Med 6 52 8.7 52 (100%) 25 (48%) 30 (58%)

18 Large 5 45 9.0 23 (100%) 11 (48%) 14 (61%)

19** Med <1 3 -- -- -- --

18

Hospital size: Small (<200 beds), Med (200-500), Large (>500)Inpatient alerts and feedback data may not add up due to missing data

**Hospital was connected for about a week before they switched to a new EHR and stopped their feed. They haven’t yet started sending their ADT data again.

Aggregate Alert Outcomes, 1/7/15 – 8/22/17

966 Inpatient alerts at 18 hospitals

Missing data: 48 (5%)

Complete data: 918 (95%)

Incorrect pt: 8 (1%)

Correct pt: 910 (99%)

See notes below for additional details

910 alerts

Yes

682 (75%)

Yes

559 (82%)

No

123 (18%)

No

228 (25%)

Yes

91 (40%)

No

137 (60%)

Prior to alert, did IP know pt had CRE?

In contact precautions when IP viewed alert?

Alert Outcomes: All correct inpatient alerts, 1/7/15 – 8/22/17

Slide adapted from: Mike Lin, Rush University Medical Center/Chicago CDC Epicenter

29% of patients with a history of CRE were NOT in CP at time of alert.

If the patient is already a “known CRE”, how did you find out? (N=682)

0%

10%

20%

30%

40%

50%

60%

70%

80%

Yes No Unknown

Previous positive at our facility

0%

10%

20%

30%

40%

50%

60%

Yes No Unknown

Communicated by other facility

US Antibiotics Awareness WeekNov 13-19 2017Annual one-week observance to raise awareness of antibiotic resistances and the importance of appropriate antibiotic use

CDC’s Be Antibiotics Aware Campaign• Goal: raise awareness of antibiotic resistance and promote

the appropriate use of antibiotics

• Target audience: Outpatient healthcare providers & general public

• Partner Toolkit: https://spark.adobe.com/page/pd0u80TFAsq6G/

– Outlines US Antibiotics Awareness Week Activities

– Includes newsletter templates, sample social media posts, and new materials

Center for Disease Control and Prevention:Be Antibiotics Aware Campaign (3)

• Public Service Announcements– The Right Tool

https://www.youtube.com/watch?time_continue=2&v=dETK7Jc-XWA

Antibiotics Awareness Week in Illinois

• Gubernatorial Proclamation

– Read here.

• Press Release

• Daily social media posts

• Dental Toolkit Mailing

Antibiotics Awareness Week in Illinois:Dental Mailing & Survey

• Why?

– Dentists account for 10% of outpatient antibiotic prescriptions or 24.5 million prescriptions nationwide

– Dentists have the 4th highest antibiotic prescribing rate

• Target audience:

– Licensed dentists in downstate IL counties

• Purpose:

– Assess knowledge, attitudes and behaviors of dentists

– Provide resources and tools for improving antibiotic prescribing in dental offices

Antibiotics Awareness Week:How can you participate?

• Distribute Be Antibiotics Aware resources

• Post to your organization’s social media page using #BeAntibioticsAware and #USAAW17

• Join the #AntibioticResistance Global Twitter chat on Thursday, November 16 from 12-2PM CST

• Use “drop-in” newsletter article templates

National Healthcare Safety Network (NHSN)Prescribing Data - Illinois

• NHSN Antibiotic Use (AU) module

– 12 (of 183) acute care hospitals in IL are reporting

• NHSN facility survey

– Only 44% of hospitals have all seven core elements of antimicrobial stewardship in place

Thank You for listening

& Much Gratitude to the following AMAZING people for

being so involved in working to achieve our vision:• Chinyerre Alu

• Angela Tang

• Anh-Thu Runez

• Jessica Ledesma

• Suzanne Williams

• Barbara Fischer

• Deb Burdsall

• Mary Alice Lavin

• Bill Trick

• Mike Lin

• Stephanie Black

• Massimo Pacilli

• Sarah Kemble

• Chicago CDC Prevention Epicener

• Chicago Dept. of Public Health

• and many, many more!