mqf hai subcommittee: hai plan update june 24, 2013 peg shore, mt, msph, ph.d., cic hai prevention...
TRANSCRIPT
![Page 1: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/1.jpg)
MQF HAI Subcommittee: HAI Plan Update
June 24, 2013Peg Shore, MT, MSPH, Ph.D., CIC
HAI Prevention Coordinator
![Page 2: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/2.jpg)
Introduction to HAIs
• Healthcare-Associated Infections• 99,000 deaths/ year (more than breast cancer,
prostate cancer and AIDs combined!)• 1.7 million HAIs per year (2002)• Cost: total $36 billion to $45,000,000,000
(2007 dollars)/ year in U.S.
![Page 3: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/3.jpg)
Types of HAIs
• Central line infections (CLABSIs)• SSIs: superficial and deep• Catheter-associated UTIs• Clostridium difficile• MRSA-HAI
![Page 4: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/4.jpg)
Deaths by HAIs, U.S., 2002
• Pneumonia 35,000• Bloodsteam infection 31,000• UTI 13,000• C. difficile** 9,000• SSI 8,000
![Page 5: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/5.jpg)
CDC estimates
• Could reduce between 33% to 50% of these infections, at a savings of $6.6 to 8.4 billion.
• Could save 33,000 lives/ year in U.S.
![Page 6: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/6.jpg)
Changing Healthcare Landscape
• Since 2002, shift in philosophy: Public demand for:
• Accountability• Transparency
• Financial reimbursement (Medicare & MaineCare-Medicaid primarily)= no pay for HAIs
![Page 7: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/7.jpg)
Maine State Reporting Mandates- All hospitals
• 2007: Central line associated bloodstream infections (CLABSIs), central line bundles, central line insertion practice (CLIP), surgical care improvement program (SCIP), ventilator associated pneumonia (VAP) bundle.
• 2011: Added MRSA-HAI and C. difficile (lab confirmed- inpatients only)
![Page 8: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/8.jpg)
Current Medicare (CMS) Mandates: IPPS hospitals only (CAHs exempt)
• Central line infections (CLABSIs)• Catheter-associated UTIs (CAUTIs)• SSIs: colons, abdominal hysterectomies• MRSA bacteremias• C. difficile- Lab ID event• HCW influenza vaccination
![Page 9: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/9.jpg)
Medicare Reimbursement: How Important is it?
• For larger hospitals, Medicare is 50 percent of hospital’s payment for services.
• Critical access hospitals, it is often 2/3rds of hospital reimbursement.
• Mandated reporting of HAIs (CMS): if miss deadline, reduce payment by 2%. (5.5 months lag)
![Page 10: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/10.jpg)
Public Health & HAI Prevention: ARRA funding
• As 5th cause of death in the US, it has become a public health issue.
• 2009, American Recovery and Rehabilitation Act (ARRA) funded 49 states to build programs.
• HAI Prevention Programs: 1) infrastructure, 2) prevention & surveillance, 3) communication.
![Page 11: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/11.jpg)
Maine HAI Prevention Program
• Initially, focus on hospitals with Maine Infection Prevention Collaborative as the advisory group.
• Expanded into LTC. Worked with QIO. Offered 10 day long seminars all over the state.
• Working on antibiotic stewardship to reduce C. difficile and resistant organisms (multiple drug resistant organisms-MDRO).
![Page 12: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/12.jpg)
Data validation
• How do we know if the numbers reported are accurate?
• Must validate the data• State law: Maine CDC must validate C. difficile
and MRSA-HAI• Maine Quality Forum: validating CLABSI.
Being done by John Snow Institute (JSI)-Boston, MA.
![Page 13: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/13.jpg)
Maine HAI Plan
• Create infrastructure• Surveillance & Prevention• Communication
• After 3 years of work, we are in a NEW place. We have created program in Maine CDc, gathered & validated data, are analyzing, and communicating with hospitals.
![Page 14: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/14.jpg)
State of Maine HAI Plan
• We have accomplished all that was in the grant, and more:– LTC– ASP– Outbreak reporting and assistance– Distributed educational materials for patients– Surveillance and feedback to hospitals– Self-sustaining model for HH compliance– NHSN used by all hospitals/ validation of data
![Page 15: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/15.jpg)
ASP
• Maine CDC is analyzing MaineGeneral antibiogram and creating pocket reference guide for outpatient prescribing.
• Working with MMA- Maine Independent Clinical Information Service to do academic detailing of antibiotics. Rollout is scheduled for November, 2013.
![Page 16: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/16.jpg)
CLABSI validation
• JSI plans to do a 2 day visit to Peer Group A hospitals.
• Will do a 1 day visit to 2 of largest hospitals in Peer Group B (St. Mary’s and Mercy). Other B hospitals will be done by sharing data remotely.
![Page 17: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/17.jpg)
Types of Communication
• Facility-specific dashboard reports to hospital• Hand hygiene compliance every 6 months• Influenza vaccination of HCW comparing all
hospitals, yearly.• Meet with MIPC monthly= all hospitals IP• Maine Quality Council: HAI subcommittee
![Page 18: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/18.jpg)
State of Infection Control & Prevention(Maine CDC/ MQF Annual Report)
• CLABSI- adult and NICU: • CLABSI: high mortality rate 14%-25%
– majority of infections are in the 3 largest hospitals/ more complicated patient/ more CLs
– Device utilization statewide is low– MMC made huge progress in past 5 years but is
still above the national average for CLABSIs.
![Page 19: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/19.jpg)
Statewide analysis: CAUTI
• CAUTI for IPPS hospitals: Mandated reporting by CMS/ Most common type of HAI.– A few larger hospitals had higher CAUTI rates,
sometimes in a single unit.– Most hospitals had decreasing urinary
catheterization utilization rates. Again, some units had high DU rates. Often these units also had high CAUTI rates.
![Page 20: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/20.jpg)
SSI
• Very limited data, CMS requires only colon and abdominal hysterectomy data from IPPS hospitals.
• Critical Access Hospitals do not report any SSI data.
![Page 21: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/21.jpg)
MRSA-HAI
• Rates varied widely between hospitals.• 50% in ICU and 50% in non-ICU• Highest type of MRSA-HAI
– SSI 42% (47)– Pneumonia 22% (25)– BSI 19% (22)
![Page 22: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/22.jpg)
0.180.19
0.260.27
0.000.00
0.100.11
0.140.15
0.270.37
0.000.00
0.110.13
0.000.000.00
0.490.000.000.000.000.000.000.000.000.000.000.00
0.150.25
0.360.75
CMMC (8/43,488)EMMC (20/106,194)MGMC (12/46,175)MMC (43/156,969)
Mercy (0/26,172)Aroostook (0/9,137)
St. Joseph (2/20,075)Mid Coast (2/18,911)
York (2/13,936)SMMC (3/20,127)
St. Mary's (4/14,732)Pen Bay (5/13,400)
Cary (0/4,261)Maine Coast (0/9,681)
Franklin (1/9,518)Goodall (1/7,821)
Inland (0/6,009)Miles (0/6,842)
NMMC (0/4,290)Parkview (2/4,046)Blue Hill (0/4,171)
Bridgton (0/3,830)CA Dean (0/4,360)
Calais (0/3,091)Down East (0/3,040)
Houlton (0/4,109)Mayo (0/4,620)
Millinocket (0/3,946)Rumford (0/5,294)
Sebasticook (0/4,368)Waldo (0/5,074)
Pen Valley (1/6,624)St. Andrews (1/3,927)
Red-Fairview (2/5,504)Stephens (4/5,306)
Gro
up
AG
ro
up
BG
ro
up
CG
ro
up
DG
ro
up
EWeighted average
0.19 cases per1,000 patient days
Lower rates are better
![Page 23: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/23.jpg)
![Page 24: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/24.jpg)
C. difficile
• Every peer group had one or more hospitals with higher than average rates.
• Rates varied from 0 to 19/10,000 patient days.• State average is 6.6/ 10,000 days. This will
become the threshold by which to measure progress.
• Rates included healthcare facility onset and community onset/ healthcare facility associated.
![Page 25: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/25.jpg)
C difficile categories in NHSN
• Healthcare facility onset (HO:) Patient had positive specimen on day four or later.
• Community onset Healthcare Facility associated (CO-HCFA): specimen from patient who was discharged from the facility 4 weeks or less.
• Community Onset (CO): specimen occurs
![Page 26: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/26.jpg)
MQF Annual Report
Three new pages (see handout or pages 33,35,36 of the report): •MRSA-HAI for 2011 (validated data) by hospital/ by peer group.•C. difficile LabID rates (2011Q4-2012Q3, all validated data). Does include both HO and CO-HCFA data. Is a proxy measure. When viewing all 3 (HO, CO-HCFA, CO) it shows the hospital burden of C. difficile.
![Page 27: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/27.jpg)
![Page 28: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/28.jpg)
5.36.1
7.812.0
0.91.6
4.55.7
6.912.5
13.717.9
4.34.4
6.0
10.4
0.05.3
7.210.0
0.00.00.0
2.22.22.8
3.23.84.0
4.75.7
7.58.5
9.89.8
18.9
MMC (79/148,727)EMMC (60/97,854)MGMC (41/52,493)CMMC (44/36,662)
MidCoast (2/21,596)St Marys (5/31,119)
York (6/13,398)PenBay (7/12,339)SMMC (13/18,752)
St. Joseph's (23/18,395)Aroostook (12/8,754)
Mercy (38/21,288)
Cary (3/7,023)Franklin (4/8,997)Goodall (5/8,327)
MaineCoast (9/8,616)
Parkview (0/3,711)Inland (3/5,662)
NMMC (4/5,526)Miles (7/7,028)
Blue Hill (0/3,772)CA Dean (0/7,573)
Sebasticook (0/3,117)Stephen's (1/4,486)
Waldo (1/4,456)Bridgton (1/3,555)
Downeast (1/3,083)Rumford (2/5,265)
MDI (2/5,041)Calais (3/6,414)
St. Andrews (2/3,518)RFGH (4/5,334)Mayo (4/4,704)
Pen Valley (3/3,067)Millinocket (2/2,032)
Houlton (7/3,711)
Gro
up
AG
rou
p B
Gro
up
CG
rou
p D
Gro
up
E
Peer Group
Statewide rate: 6.6 cases per 10,000
patient days
Rates per 10,000patient days
Lower rates are better
![Page 29: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/29.jpg)
C. difficile Results 10/1/2011- 9/30/2012
• Total Inpatient positive labs (whole state): 780
• Total hospital-related C. difficile (HO & CO-HCFA): 397
• 397 C. difficile compared to 119 MRSA-HAI
Summary: C. diff bigger problem than MRSA
![Page 30: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/30.jpg)
![Page 31: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/31.jpg)
![Page 32: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/32.jpg)
Prevention: Statewide Efforts
• HH: All hospitals doing internal and external audits. Slowly improving with each external audit. Median: 63% in Fall of 2011 to 81% in December of 2012.
![Page 33: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/33.jpg)
Statewide analysis
Influenza vaccination of HCWs: •State average last year was 77%.•2012-13 state average improved to 84%.•(New Hampshire: hospitals w/o a policy=78%, hospitals with a policy=93%, hospitals that terminate unvaccinated HCW w/o an exemption=98% vaccination rate.)
![Page 34: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/34.jpg)
MQF Annual Report
– HAI 3: Central line bundle: improved from 71% (2007-08) to 94%(2011-12)
– CLABSI rates: improved from 2.5/ 1,000 CL days (07-08) to 1.7/1,000 (2011-2012). National avg=1.2in 2010.
– NICU CLABSI rates: improved from 3.8/ 1,000 CL days (07-08) to 2.5 (11-12). National average=1.6 in 2010.
![Page 35: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/35.jpg)
Are we seeing improvement in Maine?
• CLABSIs: Yes, although a few hospitals still above national average. Huge improvement since 2007 (66) to 2011 (47)= 19 less, 5 persons who didn’t die in 2011.
• MRSA and C. difficile: too early to tell, but we now have baseline.
• SSIs: not enough data, only following 2 surgeries.• CAUTI: only collected since 2012, but device
utilization is low in most hospitals and very good in nursing homes.
![Page 36: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/36.jpg)
HAI program work continues
• Validation of NHSN MRSA-HAI • Validation of NHSN C. difficile lab ID• Continue working with hospitals to audit hand
hygiene.• Continue to analyze data, communicate
analysis to hospitals.• Increase efforts to LTC and physician offices.
![Page 37: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/37.jpg)
New Efforts
• Collaboration with QIO to reduce C. difficile in the Augusta area: early diagnosis, contact precautions, environmental cleaning, antibiotic stewardship.
• ASP: Educating several hospitals, working with MICIS, developing physician pocket reference.
• CRE: include as a reportable, ASP as prevention. Develop state lab as reference to confirm.
• Outbreak assistance for LTC C. difficile outbreaks.
![Page 38: MQF HAI Subcommittee: HAI Plan Update June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator](https://reader031.vdocuments.mx/reader031/viewer/2022032106/56649e105503460f94afc289/html5/thumbnails/38.jpg)
HAI Network• Maine CDC collaborates with:• Maine Infection Prevention Collaborative and
MIPC-CC• MHDO & MQF• UNE School of Pharmacy• Maine Medical Association- MICIS• Maine Healthcare Association (LTC)• QIO/MaineGeneral Med. Ctr./ 5 area NHs• Maine Health• Legislature/ rule making process.