public health and hais kathryn turner, phd mph deputy state epidemiologist and chief, bureau of...
TRANSCRIPT
![Page 1: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/1.jpg)
Public Health and HAIsKathryn Turner, PHD MPH
Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention
October 23, 2015
I-APIC Annual Conference Boise, Idaho
![Page 2: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/2.jpg)
Topics
Public Health and HAI prevention
National level activities
Idaho HAI Program
HAIs in Idaho
Antimicrobial Resistance
10/23/2015
![Page 3: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/3.jpg)
Public Health Involvement in healthcare-associated infection
prevention
10/23/2015
![Page 4: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/4.jpg)
Remember this? November 29, 1999• Establish a national focus to
create leadership, research, tools, and protocols to enhance the knowledge base about safety. “Center for Patient Safety”
• Develop a nationwide public mandatory reporting system and by encouraging healthcare organizations and practitioners to develop and participate in voluntary reporting systems
10/23/2015
![Page 5: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/5.jpg)
Why HAIs Matter to Public Health
Widespread and PREVENTABLE
Significantly contributes to morbidity and mortality
Importance to public health increasing (economic and human impact): Increasing numbers and crowding of people
More frequent impaired immunity (age, illness, treatments)
New microorganisms
Increasing bacterial resistance to antibiotics
10/23/2015
![Page 6: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/6.jpg)
MRSA Experience
Hospital Acquired(Most severely ill hospitalized patients)
Healthcare Associated(Spreads to other patients in the healthcare environment)
Community(Moves from healthcare environments to the community
10/23/2015
![Page 7: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/7.jpg)
HHS Operating Divisions
HHS “…has multiple methods to influence hospitals…issuing guidelines…requiring hospitals to comply with certain standards…releasing data to expand information…of the problem, and ….using hospital payment methods to encourage the reduction of HAIs.”
PRIORITIZATION & COORDINATION
1,200Recommended Practices
500“Strongly” Recommended Practices
6 Divisions
10/23/2015
![Page 8: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/8.jpg)
GAO Recommendations
HHS SolutionHHS Steering Committee for the Prevention of Healthcare Associated Infections
10/23/2015
![Page 9: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/9.jpg)
10/23/2015
![Page 10: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/10.jpg)
National Action Plan
Developed in 2009
Three phases
Revised annually
Accompanied by separate roadmap document
10/23/2015
![Page 11: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/11.jpg)
“The Elimination of HAI’s will require (1) adherence to evidence-based practices; (2) alignment of incentives; (3) innovation through basic, translational, and epidemiological research; and (4) data to target prevention efforts and measure progress. These efforts must be underpinned by sufficient investments and resources.”
-Moving toward Elimination of Healthcare Associated Infections: A Call to Action. ICHE, 11/2010: Vol 31, No 11
Pillars of HAI Elimination
10/23/2015
![Page 12: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/12.jpg)
HAI Elimination: One of CDC’s Winnable Battles
Promote use of National Healthcare Safety Network (NHS) data to target prevention
Expand collaborations and partnerships to promote and implement proven HAI prevention practices
Develop innovative approaches to prevent HAIs across the healthcare system
Goals: Improve adherence to infection prevention guidelines
Improve national surveillance
Improve capacity at state and local health departments
10/23/2015
![Page 13: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/13.jpg)
Idaho HAI Program
10/23/2015
![Page 14: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/14.jpg)
Idaho HAI Program
Started: September 2009
Funding targeted to build Healthcare Associated Infections Prevention Infrastructure in State Public Health Agencies
Personnel infrastructure for program
Data validation, technical assistance, collaboration, NHSN training/support
Infection prevention education
Staffing: K. Turner / FTE through contract
10/23/2015
![Page 15: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/15.jpg)
Ebola Supplemental Funding
State Fiscal Year 2016 (July 1, 2015)
Update Idaho’s HAI Prevention Plan Work with Idaho’s Advisory Group and
expand to include other members
Original: January 2010
Last update: September 2012
Inventory of all healthcare settings IC POC
Available HAI-related data
Current regulatory / licensing oversight
10/23/2015
![Page 16: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/16.jpg)
Ebola Supplemental Funding
On-site infection control assessments Minimum: all Ebola-designated assessment
hospitals
Identify gaps in infection control readiness
Address gaps through consultation / planning
Perform follow-up assessments
Assess capacity of HC facilities to detect, report, respond to outbreaks Develop assessment tool as template
Provide / fund training on hospital epidemiology
Communication, outreach, education
10/23/2015
![Page 17: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/17.jpg)
Changes to State HAI Program
Idaho Hospital AssociationHAI “boots on the ground” contract since
2010
Project Director retired in December 2014
February 2015: IHA no longer has capacity to perform SOW
Program activities moved in-house IHA Activities + expand to LTCF
Programmatic oversight / reporting
10/23/2015
![Page 18: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/18.jpg)
Bureau of Communicable
Disease Prevention
ImmunizationTB Program
Epidemiology Operations
State Public Health Vet
Food Protection
Refugee Health
Screening
Healthcare Associated Infections
10/23/2015
![Page 19: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/19.jpg)
10/23/2015
https://labor.idaho.gov/DHR/ATS/StateJobs/jobannouncement.aspx?announcement_no=07640057044
![Page 20: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/20.jpg)
Focus: HAIs and AR/AS
Provide overall management of the HAI program
Facilitate statewide efforts
Oversee and develop program materials
Grant application / reporting
Evaluate HAI Surveillance
TA to facilities
Lead/participate in multi-disciplinary teams
NHSN Group Administrator
10/23/2015
![Page 21: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/21.jpg)
Healthcare Associated InfectionsHow Idaho Compares
10/23/2015
![Page 22: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/22.jpg)
CLABSI and CAUTI rates - 2013
CENTRAL LINE ASSOCIATED BLOOD STREAM INFECTIONS (CLABSI)
All Location CLABSI rates are very low compared with national rates
No Idaho facilities had SIRs higher than national (0.54)
Idaho SIR = 0.29 (Idaho rank: 5th lowest)
CATHETER-ASSOCIATED URINARY TRACT INFECTION (CAUTI)
All Location CAUTI rates could be improved
One ID facility’s SIR higher (1.270) than national (1.057)
Idaho SIR = 1.003 (Idaho rank: 21st lowest)10/23/2015
![Page 23: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/23.jpg)
Table 9. Changes in state-specific standardized infection ratios (SIRs), 2012 compared to 2013
9a. Central line-associated bloodstream infections (CLABSI), all locations1
State2012 SIR
2013 SIR
% Change
Direction of Change p-value
South Dakota 0.275 0.194 29% Decrease 0.3155Oregon 0.390 0.301 23% Decrease 0.1211New Mexico 0.613 0.486 21% Decrease 0.1473New Hampshire 0.433 0.345 20% Decrease 0.4769Oklahoma 0.480 0.394 18% Decrease 0.0761Virginia 0.578 0.501 13% Decrease 0.0540Idaho 0.322 0.287 11% Decrease 0.7357
10/23/2015
![Page 24: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/24.jpg)
5/19/2015
Table 9. Changes in state-specific standardized infection ratios (SIRs), 2012 compared to 2013
9b. Catheter-associated urinary tract infections (CAUTI), all locations1
State 2012 SIR 2013 SIRPercent Change
Direction of Change p-value
Louisiana 0.816 0.809 1% Decrease 0.8897New Hampshire 0.956 0.918 4% Decrease 0.7976Nebraska 0.975 0.925 5% Decrease 0.5998Arkansas 1.099 1.040 5% Decrease 0.4579Washington 1.074 1.012 6% Decrease 0.3658Rhode Island 1.349 1.269 6% Decrease 0.5914Arizona 1.092 1.024 6% Decrease 0.2732Iowa 0.943 0.884 6% Decrease 0.5377Illinois 1.039 0.967 7% Decrease 0.0794Mississippi 1.192 1.078 10% Decrease 0.1458Maine 1.906 1.718 10% Decrease 0.3609Utah 1.839 1.640 11% Decrease 0.2204Connecticut 1.868 1.654 11% Decrease 0.0637Idaho 1.145 1.003 12% Decrease 0.4421
![Page 25: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/25.jpg)
SSI and HO-MRSA BSI LabID
SURGICAL SITE INFECTION (SSI)SSI following colon surgery: One ID facility’s SIR
higher (1.130) than national (0.919)
Idaho SIR = 0.797 (Idaho rank: 12th lowest)
HOSPITAL ONSET (HO) MRSA BSI HO-MRSA BSI rates are very low compared with
national rates
No Idaho facilities’ SIRs higher than national (0.917)
Idaho SIR = 0.452 (Idaho rank: 5th lowest)
10/23/2015
![Page 26: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/26.jpg)
HO-C.diff LabID
HOSPITAL ONSET (HO) CLOSTRIDIUM DIFFICILE HO-C. diff infection rates are very low compared with
national rates
No Idaho facilities’ SIRs higher than national (0.904)
Idaho SIR = 0.666 (Idaho rank: 9th lowest)
10/23/2015
![Page 27: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/27.jpg)
5/19/2015
![Page 28: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/28.jpg)
5/19/2015
![Page 29: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/29.jpg)
Antimicrobial ResistanceThe Next Big Thing
5/19/2015
![Page 30: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/30.jpg)
FOUR CORE ACTIONS
Prevent infections and prevent the spread of resistance
Track resistant bacteria
Improve use of antibiotics
Promote the development of new antibiotics and new diagnostic tests for resistant bacteria
5/19/2015
![Page 31: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/31.jpg)
AR and the President’s BudgetNearly Double: >$1 billion investment in FY 2016
10/23/2015
![Page 32: Public Health and HAIs Kathryn Turner, PHD MPH Deputy State Epidemiologist and Chief, Bureau of Communicable Disease Prevention October 23, 2015 I-APIC](https://reader035.vdocuments.mx/reader035/viewer/2022062807/5697bfa41a28abf838c96f9c/html5/thumbnails/32.jpg)
Discussion – New HAI Program Manager
What would you like to see happen now that the Division of Public Health will have increased HAI Program Capacity?Surveillance / data validation?
Guidelines / assessments?
Communication?
Email me! [email protected]
10/23/2015