Reducing Healthcare-Associated Infections (Text Version)

Slide presentation from the AHRQ 2009 conference.

On September 14, 2009, Don Wright, Clifford McDonald, Barry Straube, and William Munier made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (7.5 MB) (Plugin Software Help).

Slide 1

Reducing Healthcare-Associated Infections

Don Wright, MD, MPH, OPHS
L Clifford McDonald, MD, FACP, CDC
Barry M Straube, MD, CMS
William B Munier, MD, MBA, AHRQ
AHRQ 2009 Annual Conference—September 14, 2009

 

Slide 2

Presentation Overview

  • Introduction
  • DHHS overview
  • CDC initiatives
  • CMS role in HAI reduction
  • AHRQ HAI portfolio
  • Discussion

 

Slide 3

Participants

  1. Don Wright, MD, MPH
    Principal Deputy Assistant Secretary for Health, Office of Public Health & Science
  2. L Clifford McDonald, MD
    Chief, Prevention and Response Branch, Division of Healthcare Quality Promotion, CDC
  3. Barry M Straube, MD
    CMS Chief Medical Officer & Director, Office of Clinical Standards & Quality, CMS
  4. William B Munier, MD, MBA
    Director, Center for Quality Improvement & Patient Safety, AHRQ

 

Slide 4

DHHS Overview

 

Slide 5

HHS Efforts to Prevent Healthcare-Associated Infections

Don Wright, MD, MPH
Principal Deputy Assistant Secretary for Health, Office of Public Health & Science

AHRQ Annual Conference
Rockville, MD
Monday, September 14, 2009

 

Slide 6

Presentation Overview

  • HHS Action Plan: Development and Implementation
  • State Action Plans: States Adopt National Plan
  • Recovery Act Funds: Targeting HAIs
  • Future Direction in Reducing HAIs: Tier 2
  • Healthy People 2020
  • Questions

 

Slide 7

Healthcare-Associated Infections (HAIs)

  • What are they?
    • Bloodstream infections, urinary tract infections, pneumonia, surgical site infections
  • The Problem
    • 1.7 million HAIs in hospitals—unknown burden in other healthcare settings
    • 99,000 deaths per year
    • $28-33 billion in added healthcare costs
  • HAI Prevention
    • Implementing what we know for prevention can lead to up to a 70% or more reduction in HAIs

 

Slide 8

HHS Action Plan to Prevent Healthcare-Associated Infections

Development and Implementation

 

Slide 9

Healthcare-Associated Infections In Hospitals

Image: Cover of the GAO report on the statement made before the Subcommittee on Health Care, U.S. Senate.

Slide 10

GAO Report:
Recommendations for HHS

  • Improve central coordination of HHS-supported prevention and surveillance strategies
  • Identify priorities among CDC guidelines to:
    • Promote implementation of high priority practices
  • Establish greater consistency and compatibility of HAI-related data across HHS systems to:
    • Increase reliable national estimates of HAIs

 

Slide 11

HHS Steering Committee for the Prevention of HAI

  • Charge:
    • Develop an Action Plan to reduce, prevent, and ultimately eliminate HAIs
  • Plan will:
    • Establish national goals for reducing HAIs
    • Include short- and long-term benchmarks
    • Outline opportunities for collaboration with external stakeholders
    • Coordinate and leverage HHS resources to accelerate and maximize impact

 

Slide 12

Tier One Priorities

HAI Priority Areas

  • Catheter-Associated Urinary Tract Infection
  • Central Line-Associated Blood Stream Infection
  • Surgical Site Infection
  • Ventilator-Associated Pneumonia
  • MRSA
  • Clostridium difficile

Implementation Focus

  • Hospitals

*Tier Two will address other types of healthcare facilities

 

Slide 13

Steering Committee
Working Group Structure

Image: Chart shows the structure of the HHS Steering Committee Working Group:

  • Prevention and Implementation, Lead: CDC
  • Research, Lead: AHRQ
  • Information Systems and Technology, Co-Leads: OS/ONC & CDC
  • Incentives and Oversight, Lead: CMS
  • Outreach and Messaging, Lead: OS/OPHS

 

Slide 14

Stakeholder & Public Engagement

  • Hold five stakeholder/public engagement meetings
  • Washington, DC—Tuesday, June 30 (National Level)
  • Denver, CO— Saturday, July 25 (Regional/State Level)
  • Chicago, IL—Thursday, July 30 (Regional/State Level)
  • Seattle, WA— Thursday, Aug 27 (Regional/State Level)
  • Chicago, IL—Tuesday, Sept 22 (Regional/State Level)
  • Engage professional and public stakeholders in the HHS Action Plan
  • Request input on priorities and strategies

 

Slide 15

State Action Plans

 

Slide 16

State Action Plans

  • State plans will:
    • Be consistent with the HHS Action Plan
    • Contain measurable 5-year goals and interim milestones for preventing HAIs

 

Slide 17

State Action Plans

  • Fiscal Year 2009 Omnibus Appropriations Act:
    • Requires states receiving Preventive Health and Health Services (PHHS) Block Grant funds to certify that they will submit a plan to the Secretary of HHS not later than January 1, 2010
    • Authorizes CDC to withhold 25% of states allocated funds until this certification is submitted
    • All states have submitted a certification
    • Be reviewed by the Secretary of HHS with a report submitted to Congress by June 1, 2010
  • Technical assistance sessions and calls will be planned to assist states in plan development
  • CDC has created a template to assist states in plan development

 

Slide 18

American Reinvestment and Recovery Act Funds

Preventing Healthcare-Associated Infections

 

Slide 19

Building State Programs
to Prevent HAIs

  • Project Description:
    • Create and expand state-based HAI prevention collaboratives
    • Build a public health HAI workforce in states
    • Enhance states abilities to assess where HAIs are occurring
  • Agency Lead: CDC
  • Collaborating Agencies: AHRQ and CMS
  • Funds Source & Amount: American Reinvestment and Recovery Act Funds ($40 million)
  • CDC HAI Recovery Act Website
    • wwwcdc.gov/nhsn/ra

 

Slide 20

New Ambulatory Surgery Center Infection Instrument

  • Project Description:
    • Nationwide application of a new infection control survey instrument (designed by CMS & CDC)
    • Use of new tracer methodology
    • Use of multiple-person teams for ASCs over a certain size or complexity
    • Greater inspection frequency than the current 10-year average inspection frequency (Goal = 3 years)
  • Funds Source & Amount: 2-year funding with ARRA grant dollars of $1 million in FY09 and the remaining
  • $9 million in FY10

 

Slide 21

Future Direction

 

Slide 22

HHS Commitment to Reducing Healthcare-Associated Infections

Tier 2

 

Slide 23

Tier Two Priorities

  • Ambulatory Surgical Centers
  • Dialysis Centers

 

Slide 24

Growth in Outpatient Care

  • Shift in healthcare delivery from acute care settings to ambulatory care, long term care and free standing specialty care sites
    • Infection control oversight often lacking
  • Approximately 1.2 billion outpatient visits / year
  • Number of Dialysis Centers
    • 2008: 4,950 (72% increase since 1996)
  • Number of Ambulatory Surgical Centers
    • 2008: 5,100 (240% increase since 1996)
    • 2007: more that 6 million surgeries performed in ASC and paid by Medicare

 

Slide 25

Surgical Procedures Moving to Outpatient Setting

Image: Bar Chart shows a steady increase of surgical procedures being performed in outpatient settings between 1981 and 2005.

Source: Avalere Health analysis of Verispan's Diagnostic Imaging Center Profiling Solution, 2004, and American Hospital Association Annual Survey data for community hospitals, 1981-2004.
*2005 values are estimates.
All Outpatient Settings Hospital Inpatient Procedures (millions)

 

Slide 26

Healthy People 2020:
Defining the Nation's Health Objectives

 

Slide 27

Healthy People:
What is it Now?

  • A comprehensive set of national ten-year health objectives
  • A framework for public health priorities and actions
  • Guided health policy decisions for 3 decades
  • www.healthypeople.gov

 

Slide 28

Healthy People 2020—Phase II
New Topic Areas

  • Access to Health Services
  • Adolescent Health
  • Children's Health
  • Genomics
  • Global Health
  • Older Adults
  • Healthcare-Associated Infections

 

Slide 29

Points of Contact & Links

  • HHS Action Plan to
  • Prevent Healthcare-Associated Infections &
  • Stakeholder Meeting Information
  • www.hhs.gov/ophs/initiatives/hai

 

Slide 30

CDC Initiatives

 

Slide 31

CDC Approach to Eliminating Healthcare-associated Infections

L. Clifford McDonald, MD, FACP
Chief, Prevention and Response Branch
Division of Healthcare Quality Promotion
Centers for Disease Control and Prevention
The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention

No Conflicts of Interest to Disclose

 

Slide 32

Patient Safety within CDC's Division of Healthcare Quality Promotion (DHQP)

Healthcare Safety

  • Healthcare-associated Infections
  • Adverse Drug Events
  • Transfusion/Transplant Safety
  • Antimicrobial Resistance
  • Healthcare Preparedness
  • Immunization Safety

Outbreak Investigations
Surveillance
Prevention Recommendations
Intervention Implementation
Extramural Research
Laboratory Research and Support

 

Slide 33

CDC's Role in HAI Elimination

  • Provide technical support to states, local health agencies, and healthcare facilities
    • Field investigations, consultations, training
  • Define the scope of the problem and impact of interventions
    • National Healthcare Safety Network (NHSN)
    • Population-based surveillance systems
  • Identify best practices
  • Work with partners to promote prevention
  • Complement other HHS agencies and support state/local health departments

 

Slide 34

Image: Photograph of patients in an Intensive Care ward.

 

Slide 35

DHQP Field Investigations of Healthcare Associated Outbreaks, United States, 2004-2009

Image: Map of the United States showing the locations of HAI outbreaks:

n = 61, as of July 2009

  • Hospital: 34
  • Outpatient Setting: 13
  • LTCF: 7
  • Community: 6
  • Hospital and Outpatient : 1

 

Slide 36

Epidemic Clostridium difficile Infections:
Detection, Understanding, Surveillance, and Prevention

Images: A line graph shows National estimates of short-stay hospital dischanges with Clostridium difficile listed as primary or as any diagnosis; the estimated numbers rise from 1996 to 2003 (Emerg Infect Dis 2006;12(3):409-15). Another line graph shows the rising rates of hospital onset Clostridium difficile (Infect Control Hosp Epidemiol 2009; 30:264-272). The titles of two articles on Clostridium difficile are also shown.

 

Slide 37

Nevada Field Investigation of Hepatitis C Transmission in Ambulatory Surgery Centers
Discovered reuse of syringes and single dose vials

Image: Map of the United States, with a red dot in Nevada. Text pointing to this dot reads:

  • Discovered reuse of syringes and single dose vials
  • Resulted in massive patient notification: risks of bloodborne viral infections due to unsafe injection practices

 

Slide 38

Image: Title and opening paragraphs of articles by Thompson et al. in Ann Intern Med 2009;150:33-39.

  • 33 outbreaks in 15 states
    • Outpatient clinics, n=12
    • Dialysis centers, n=6
    • Long term care, n=15

 

Slide 39

Image: Box text shows injection safety recommendations (MMWR; May 16, 2008; 57:19). Over this image, the following text is transposed in a bright blue box:

Implementation Challenge
-> Awareness and Adherence

 

Slide 40

Injection Safety Campaign

Images: Posters encourage the single use of syringes, tissues, and cotton swabs.

 

Slide 41

Collaboration with CMS

  • Improve infection control in survey and certification process for ASCs
  • Advise on the adoption of infectious "Hospital Acquired Conditions" for reduced reimbursement
    • Part of the Deficit Reduction Act (DRA)
  • Collaborate on HAI reduction through QIOs
    • MRSA in the 9th Scope of Work
    • Pilot for the 10th Scope of Work
  • Hospital Compare
    • Role for NHSN

 

Slide 42

Surveillance

National Healthcare Safety Network (NHSN)

  • Patient Safety
  • Healthcare Personnel Safety
  • Research and Development
  • Biovigilance

 

Slide 43

National Healthcare Safety Network (NHSN)

  • Voluntary, secure, internet-based surveillance system
  • Includes information about infections, microorganisms, and practices for HAI prevention
  • Over 2200 hospitals from 50 States currently report to NHSN; 21 States mandate the use of NHSN for HAI reporting

 

Slide 44

States Mandating NHSN for Reporting (as of August 2009)

Image: Map of the United States showing states that have mandated NHSN, and the date the mandate was established.

 

Slide 45

NHSN eSurveillance Moving Towards the Future

NHSN

  • Component: Patient Safety
    • Events Modules
      • Device Associated
      • Procedure Assoc.
      • Medication Assoc.
      • MDRO and CDAD
      • High Risk
      • Inpatient Influenza Vaccination
  • Component: Healthcare Personnel Safety
  • Component: Biovigilance
    • Modules
      • Hemovigilance
  • Component: Research and Development
    • eSurveillance
      • HL7 CDA
      • HL7 Messages Prevention research

Data Transmission Standards

  • Structured documents for infection reports, denominators, and process of care measures
  • Messages for laboratory results, admission/discharge/transfer, and pharmacy data

MDRO = Multidrug-resistant organism
CDAD = Clostridium difficile associated disease
HL7 = Health Level Seven
CDA = Clinical Document Architecture

 

Slide 46

NHSN Data for Action

  • Data for local action
    • Outcomes, adherence, analysis
    • Compare trends and benchmark
  • Data for regional/state action
  • Data for national metrics from HHS plan

 

Slide 47

HICPAC
The Healthcare Infection Control
Practices Advisory Committee

  • Guideline production
    • Revised, systematic rapid-cycle evidence analysis
  • Urgent infection prevention recommendations for emerging threats (e.g., SARS)
  • June 2008, HHS Charge to HICPAC in response to findings of the GAO investigation:
    • Prioritization of recommendations from HICPAC guidelines
    • Identification of major infection prevention strategies for Department-wide promotion

 

Slide 48

From Guidelines to Checklist

Images: Title, sample text, and sample checklist from MMWR.

 

Slide 49

Following CDC Guidelines Reduces Healthcare-associated Infections in States- Examples of Success: Pennsylvania, Michigan

Images: Line graph shows decreasing rate of central-line associated bloodstream infections from April 2001 to April 2005 (MMWR 2005;54:1013-16). Bar graph shows BSIs/1,000 catheter days in ICUs at 103 Michigan hospitals over 18 months (Pronovost P. New Engl J Med 2006;355:2725-32).
 

 

Slide 50

Hospitals Participating in NHSN are Preventing MRSA Bloodstream Infections

Trends in Bloodstream Infections by ICU Type, NHSN hospitals, 1997-2007

Image: Line graph shows trends in bloodstream infections decreasing.

 

Slide 51

Prevent Infection

Image: Patient lying in bed, with the following points noted: Bundles (sets of infection control recommendations) to prevent infection when inserting devices or performing procedures.

 

Slide 52

Prevent Transmission

Image: Two patients lying in bed, with the following points noted:
Hand Hygiene,
Isolation,
Environmental
Cleaning, etc

 

Slide 53

Image: Title page of Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007.

 

Slide 54

CDC's MRSA Prevention Initiatives

Image: Chart shows initiatives at the Unit, Facility, Regional, and National levels.

 

Slide 55

CDC and AHRQ collaborating to prevent MRSA/HAIs

  • AHRQ receiving supplemental funds for MRSA/HAI research
    • CDC and AHRQ are collaborating on MRSA/HAI prevention research in a healthcare system, including acute care hospitals and long-term facilities
    • CDC provides technical expertise into what research questions need answering
  • CDC will put research results into action, and use results to:
    • Update existing recommendations as appropriate
    • Advise prevention implementation campaigns on how best to prevent HAIs

 

Slide 56

CDC Works with Healthcare Facilities and States

  • Technical and direct support (e.g. field investigations and consultation)
  • Data for action (e.g., NHSN, emerging infections program)
  • Training and tools
  • Funding with accountability (e.g., epidemiology and laboratory capacity)

 

Slide 57

CDC Successfully Collaborates with States to Prevent Healthcare-associated Infections

Image: Line graph shows decrease in central-line infection rates between June 2005 and May 2007.

  • New York: CDC guidelines basis for prevention implementation initiatives
    • Greater New York Hospital Association prevention initiative
    • Collaborative partnership with 46 hospitals
  • Focused on incrementally building infrastructure needed for BSI and other future prevention initiatives (e.g. C. difficile)
  • Communications to share best practices
  • Culture of accountability
    • CEO to support staff levels involved
    • Site visits, monthly reporting
  • Adopted bundles of practices

 

Slide 58

Preventing Healthcare-associated Infections... the Time is NOW

  • Problem is critical and costly but preventable
  • Interventions can have an immediate national impact
  • Interventions can be cost savings
  • Ongoing efforts are needed to address changes in healthcare

 

Slide 59

Keys for the Elimination of
Healthcare-associated Infections

  • Collect data and disseminate results
    • Communication with consumers
    • Evaluate how we're doing
  • Full adherence to best practices
  • Recognize excellence
  • Identify and respond to emerging threats
  • Improve science for prevention through research

 

Slide 60

Public Health Continuum

  1. Prepare For Health Threats
  2. Detect and Define Health Threats
  3. Analyze Agent, Host, and Environment as Risk Factors
  4. Propose and Research Prevention Strategies
  5. Develop and Implement Surveillance
  6. Translate Proven Strategies into Practice
  7. Evaluate Impact of Policy and Prevention

 

Slide 61

Increasing Needs for Public Health Approach Across the Continuum of Care

Image: Chart shows relationship between Home Care, Acute Care Facility, Outpatient/Ambulatory Facilty, and Long Term Care Facility.

 

Slide 62

Infection prevention is EVERYONE's responsibility!

http://www.cdc.gov/ncidod/dhqp/

 

Slide 63

Save the Date
Fifth Decennial.International Conference on Healthcare-Associated Infections
March 18-22, 2010
Hyatt Regency Atlanta.Atlanta, Georgia
Co-organized by:
www.decennial2010.com

 

Slide 64

CMS Role in HAI Reduction

 

Slide 65

Healthcare Acquired Infections:
CMS Driving Improvement

Barry M. Straube, M.D.
CMS Chief Medical Officer
Director, Office of Clinical Standards & Quality
Centers for Medicare & Medicaid Services (CMS)

 

Slide 66

Ensuring Quality & Value:
CMS Strategies

"Traditional Quality Improvement"
Transparency: Public Reporting & Data Sharing
Incentives:
- Financial: Value-Based Purchasing
- Non-financial
Regulatory vehicles
Demonstrations, pilots, research
Leveraging efforts with other HHS components, state/federal agencies & private sector

 

Slide 67

Traditional QI

Prioritization of potential topics

Evidence-based metrics and interventions

Accountability: Administrative & financial

Attribution of interventions to outcomes

Scientific evaluation of outcomes as well as cost-benefit analysis of each initiative

Continue, build, retire or new direction?

 

Slide 68

Traditional QI

QIO Program: 9th SOW
- August 1, 2008—July 31, 2011
- Four themes:
  - Patient Safety
  - Prevention
  - Care Transitions
Beneficiary Protection
- Cross-cutting issues
  - HIT adoption and use
  - Health Disparities
  - Value in Healthcare

 

Slide 69

Traditional QI

QIO Program 9th SOW
- HAIs under patient safety theme
- Reduction of MRSA infections in 440 hospitals nationwide
  - CDC National Healthcare Safety Network (NHSN)
  - AHRQ TeamSTEPPS methodology
- Pilot programs:? 10th SOW inclusion
C. difficile infection reduction
  - Urinary tract catheter infection reduction

 

Slide 70

Traditional QI

ESRD Network Program QI activities
- Individual ESRD Networks have included activities to address infections in vascular access as well as other infection control issues, including facility-acquired infections (dialysis facilities and some hospitals)
Collaboration with other HHS agencies, other state/federal agencies, private sector organizations

 

Slide 71

Transparency

Hospital Compare Website as prototype
- 27 quality process measures (all patients)
- 6 quality outcomes measures (Medicare only)
- HCAHPS survey for experience of care (all)
- Medicare payment and volume (Medicare only)
- Several infection-related quality measures
  - Influenza and pneumonia vaccinations
  - Therapeutic and prophylactic antibiotics
  - Pre-op hair removal, blood cultures, etc.

 

Slide 72

Transparency

Additional reporting of HAI measures
- Considering for future Hospital Compare updates
- Requires NQF endorsement and Hospital Quality Alliance and other stakeholder input
- Expand to other provider sites, starting with:
  - Ambulatory surgery centers
  - Dialysis facilities
- Link to transitions of care and episodes of care

 

Slide 73

Transparency

The White House, the Secretary and HHS have prioritized the concept of HHS making its data available to all healthcare stakeholders

www.data.gov development and expansion

CMS has now added the concept that as part of its public health agency role, collecting, reporting and making healthcare data available is a core competency/mission

 

Slide 74

Incentives

Value-based Purchasing (VBP)
- Hospital VBP Report to Congress (Nov 2007)
- Physician VBP RTC due May 2010
- ESRD Quality Incentive Program to be implemented by January 1, 2012
- All other settings with plans
Healthcare Reform debate may define better
HAI focus may be included in all

 

Slide 75

Incentives: Hospital Acquired Conditions

DRA Section 5001(c) authorized this approach

Beginning October 1, 2007, IPPS hospitals were required to submit data on their claims for payment indicating whether diagnoses were present on admission (POA)

Beginning October 1, 2008, CMS stopped assigning a case to a higher DRG based on the occurrence of one of the selected conditions, if that condition was acquired during the hospitalization

 

Slide 76

Incentives: HACs

By statute CMS had to select conditions that are:
- High cost, high volume, or both
- Assigned to a higher paying DRG when present as a secondary diagnosis
- Reasonably preventable through the application of evidence-based guidelines
CMS and CDC convened an internal workgroup to select the HACs

 

Slide 77

Incentives: HACs

Almost all HACs might have indirect relationship to potential HAIs
HACs clearly linked to HAIs
- Catheter-associated UTI
- Vascular catheter associated infection
- Surgical site infections
  - Mediastinitis after CABG
  - Certain orthopedic surgeries
  - Bariatric surgery for obesity

 

Slide 78

Incentives: HACs

HAC payment policies currently relate to outlier payments under Medicare Part A
- Could consider expansion of payment to more than the outlier portion
In some cases can supplement payment policy restrictions with Coverage Policy via National Coverage Decisions (NCDs)
- Affects not only Part A (hospitals), but Part B (physicians, clinicians, suppliers, etc.)

 

Slide 79

Conditions of Participation

COPs are minimum health and safety standards set by CMS for facilities that may receive Medicare payments
Current Infection Control COPs generally address reduction of HAIs
Expansion possibilities for COPs
- Require facilities to incorporate specific standards of practice or guidelines set by the Secretary
- Require that infection control be part of the QAPI program

 

Slide 80

Conditions of Participation

Infection control regulations already strengthened
- Conditions for Coverage for ESRD facilities (April 15, 2008)
- CfC for Ambulatory Surgery Centers (ASCs) (November 18, 2008)
Other current considerations
- Omnibus COP/CfC Rule for HAIs
- Individual setting strengthening of current regs

 

Slide 81

Survey & Certification

All U.S. healthcare facilities certified by Medicare are expected to be in compliance with all current regulations, as well as applicable state laws
S&C process uses interpretive guidelines to assess compliance with regulations
- Focus on HAIs can be prioritized
- Surveyor training has included HAI emphasis
- Web-based training & surveyor tools being developed
- Interpretive guidelines for 2010 to include QAPI opportunities for hospitals

 

Slide 82

Other

Demonstrations, pilots, research
- ARRA funding and other funding sources should also focus on HAIs as they fall under:
  - Comparative Effectiveness Research
  - Prevention, Wellness, Patient Safety
- CMS will incorporate HAI topics into its demos, when appropriate
Cross Agency HHS collaboration (a priority for all issues from the Secretary), as well as with other federal/state agencies, private sector

 

Slide 83

Contact Information

  • Barry M. Straube, M.D.
  • CMS Chief Medical Officer, &
  • Director, Office of Clinical Standards & Quality
  • Centers for Medicare & Medicaid Services
  • 7500 Security Boulevard
  • Baltimore, MD 21244
  • Email: Barry.Straube@cms.hhs.gov
  • Phone: (410) 786-6841

 

Slide 84

AHRQ HAI Portfolio

 

Slide 85

Overview

  • Background
  • Current Initiatives
  • Future Directions

 

Slide 86

Background

  • General AHRQ approach
  • Keystone ICU Project—2003
    • First major AHRQ HAI project: $454,000
    • Enormously successful in reducing central line infections in ICUs in Michigan
  • Barriers and Challenges for Preventing HAIs in 34 Hospitals Initiative—2007
    • 5 ACTION networks: $2 million

 

Slide 87

MRSA—2008

  • $5 million in appropriated funds
  • Coordinated with CDC & CMS
  • Funded 7 projects, e.g.,
    • Implementation of MRSA-reducing practices
    • Contribution of community & LTC to rising occurrence of MRSA in hospital patients
    • Rapid-cycle state and national estimates
    • Understanding MRSA reservoirs

 

Slide 88

MRSA & CUSP—2009

  • $17 million in appropriated funds
    • $8 million for MRSA => 7 MRSA projects
    • $9 million for CUSP => 6 CUSP projects
  • Included projects also directed at:
    • C. difficile
    • KPC-producing organisms
    • Urinary tract infections
    • Surgical site infections
    • Antibiotic usage
    • Hemodialysis

 

Slide 89

AHRQ HAI Investments

Image: Bar Chart shows AHRQ investments in CUSP/CLABSI*, Other CUSP, and MRSA** research in 2003, 2007, 2008, and 2009.

* CUSP = Comprehensive Unit-based Safety Program
** Includes other related infections

 

Slide 90

Current Efforts

  • Roll-out of CLABSI initiative in all 50 states, in cooperation with private sector
  • Commencement of numerous new projects addressing effective implementation of known techniques & research on better methods of prevention of HAIs by organism & by infection site

 

Slide 91

Future Plans

  • Maintain alignment with DHHS
  • Continue rollout of CLABSI nationwide
  • Promote best practices & research findings via proven techniques
  • Align HAI efforts with those of Patient Safety Organizations (PSOs), which are collecting data on adverse events using AHRQ's "Common Formats"

 

Slide 92

Image: Cover of AHRQ Fact Sheet, Efforts to Prevent and Reduce Health Care-Associated Infections.

 

Slide 93

Your questions?

Current as of December 2009
Internet Citation: Reducing Healthcare-Associated Infections (Text Version). December 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2009/munier-mcdonald-straube-wright/index.html