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MQF HAI Subcommittee: HAI Plan Update. June 24, 2013 Peg Shore, MT, MSPH, Ph.D., CIC HAI Prevention Coordinator. 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)

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Mqf hai subcommittee hai plan update

MQF HAI Subcommittee: HAI Plan Update

June 24, 2013

Peg Shore, MT, MSPH, Ph.D., CIC

HAI Prevention Coordinator

Introduction to hais
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.

Types of hais
Types of HAIs

  • Central line infections (CLABSIs)

  • SSIs: superficial and deep

  • Catheter-associated UTIs

  • Clostridium difficile


Deaths by hais u s 2002
Deaths by HAIs, U.S., 2002

  • Pneumonia 35,000

  • Bloodsteam infection 31,000

  • UTI 13,000

  • C. difficile** 9,000

  • SSI 8,000

Cdc estimates
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.

Changing healthcare landscape
Changing Healthcare Landscape

  • Since 2002, shift in philosophy: Public demand for:

  • Accountability

  • Transparency

  • Financial reimbursement (Medicare & MaineCare-Medicaid primarily)= no pay for HAIs

Maine state reporting mandates all hospitals
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)

Current medicare cms mandates ipps hospitals only cahs exempt
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

Medicare reimbursement how important is it
Medicare Reimbursement: How Important is it? exempt)

  • 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)

Public health hai prevention arra funding
Public Health & HAI Prevention: ARRA funding exempt)

  • 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.

Maine hai prevention program
Maine HAI Prevention Program exempt)

  • 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).

Data validation
Data validation exempt)

  • 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.

Maine hai plan
Maine HAI Plan exempt)

  • 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.

State of maine hai plan
State of Maine HAI Plan exempt)

  • 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

ASP exempt)

  • 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.

Clabsi validation
CLABSI validation exempt)

  • 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.

Types of communication
Types of Communication exempt)

  • 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

State of infection control prevention maine cdc mqf annual report
State of Infection Control & Prevention exempt)(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.

Statewide analysis cauti
Statewide analysis: CAUTI exempt)

  • 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.

SSI exempt)

  • Very limited data, CMS requires only colon and abdominal hysterectomy data from IPPS hospitals.

  • Critical Access Hospitals do not report any SSI data.

Mrsa hai
MRSA-HAI exempt)

  • 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)

C difficile
C. difficile exempt)

  • 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.

C difficile categories in nhsn
C difficile categories in NHSN exempt)

  • 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

Mqf annual report
MQF Annual Report exempt)

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. difficileLabID 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.

C difficile results 10 1 2011 9 30 2012
C. difficile Results exempt)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

Prevention statewide efforts
Prevention: Statewide Efforts exempt)

  • 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.

Statewide analysis
Statewide analysis exempt)

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.)

Mqf annual report1
MQF Annual Report exempt)

  • 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.

Are we seeing improvement in maine
Are we seeing improvement in Maine? exempt)

  • 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.

Hai program work continues
HAI program work continues exempt)

  • 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.

New efforts
New Efforts exempt)

  • 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.

Hai network
HAI Network exempt)

  • 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.