Long Term Care CDI/MDRO Prevention Collaborative:

Connecticut Program Update

Richard Melchreit, MDHAI Program Coordinator

National Metrics and 5-Year TargetsMetric Source National 5-year

Prevention TargetOn Track to Meet 2013 Targets?

Bloodstream infections NHSN 50% reduction Yes

Clostridium difficile (hospitalizations) HCUP 30% reduction No

Clostridium difficile infections NHSN 30% reduction No

Urinary tract infections NHSN 25% reduction No

MRSA invasive infections (population)

EIP 50% reduction Yes

MRSA bacteremia (hospital) NHSN 25% reduction No

Surgical site infections NHSN 25% reduction Yes

CMS Reporting Requirements: sorted by year

Year HAI Event Facility type/location

2011 CLABSI ACH/ICUs

2012 CAUTI ACH/ICUs

SSI:COLO, SSI:HYST ACH/all inpatient

DE Outpatient Dialysis

2013 MRSA bacteremia LabID, CDI LabID ACH/all inpatient

HCW vaccination ACH

CLABSI, CAUTI LTACH/all inpatient

CAUTI IRF/adult, pediatric wards

2015 CLABSI, CAUTI ACH/wards

HCW vaccination ACH/outpatient; LTACH, IRF, ASC

MRSA bacteremia LabID, CDI LabID LTACH/all inpatient

CSTE recommendation: CDI reporting (NHSN) to public health departments

Organism/ specimen

Type of facility Type of location

Time frame Exceptions

2013 2014 2015 2016

C. difficile Infection LabID Event

Acute Care Hospitals

All inpatient X NICUs, well baby nurseries

LTACH All inpatient X

CHA All inpatient X

IRF All inpatient X

Other non IQR All inpatient X

LTCFs* All residents x

* Will require enough facilities to develop the infrastructure and skills necessary to effectively use NHSN.

CSTE recommendation: MRSA Bacteremia reporting (NHSN) to public health departments

Organism/ specimen

Type of facility Type of location

Time frame Exceptions*

2013 2014 2015 2016

MRSA Bacteremia LabID Event

Acute Care Hospitals

All inpatient X None

LTACH All inpatient X

CAH All inpatient X

IRF All inpatient X

Other non IQR All inpatient X

LTCFs* All residents x

* Will require enough facilities to develop the infrastructure and skills necessary to effectively use NHSN.

Connecticut State Health Improvement Plan (SHIP) HAI Objectives

Benchmark measureObjective # Description Benchmark Goal

4.27 Increase public reporting of HAIs NHSN HAI facility types, locations, events

5% over baseline

4.33 Reduce # healthcare associated influenza outbreaks

ID Section institutional outbreak database

5% below baseline

4.34 Reduce MDRO isolates CRE, MRSA ABCS 5% below baseline

4.29 Reduce CAUTIs, CDI LabID Event in Long Term Care Facilities

NHSN LTC CAUTI, CDI Lab ID Event

5% below baseline

Overview: Program ChallengesMost Challenging HAI• C. Difficile (30%)• “Other” included

lower-respiratory tract infections, non-catheter-associated UTIs, pneumonia

Most Challenging IC Aspect• Isolation/MDROs

(21%)• “Other” included

cohorting, resident cooperation, transfer data and screening

Assessment Survey: Infection Control Policies in Connecticut LTCFs, June 2012

Incidence of MRSA by Place of Onset and Year, Connecticut, 2001-2011

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120

5

10

15

20

25

30All MRSA HO HACO CA

Year

Rate

per

100

,000

pop

ulati

on

p<0.01a

aChi-square for trend

p<0.01a

p<0.01a

p<0.01a

Revised Annualized National Estimates, ABCs MRSA 2005-2010 (updated Nov,

2012)

2005 2006 2007 2008 2009 2010 20110

20,000

40,000

60,000

80,000

100,000

120,000

OverallCAHOHACO

Estim

ated

No.

Infe

ction

s, U

.S.

Revisions include:Adjustment for dialysis; incorporation of interval estimates (not included);enhanced case finding (TN) and resolved data transmission error (2006-2007). Data accessed (frozen) November 2012.

~27% were outpatient dialysis patients

~50% were dischargedfrom acute care in previous 3 months

Vancomycin-resistant Enterococci (VRE) Connecticut: 2000-2010

VRE Incidence by Hospital Staffed Bed Size

VRE Incidence by Age

Percent of CLABSI organisms that were VRE or MRSA: 2009-2012

2009 2010 2011 20120.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

VRE Linear (VRE ) MRSA Linear (MRSA)

Perc

ent

Emerging Infections Program HAI prevalence survey CT 2011

EIP Antimicrobial Use Survey CT 2011

Carbapenem-resistant Enterobacteriacea

• Two KPC isolates from CT hospitals confirmed by CDC

• One NDM• NHSN has reporting

capability• Laboratories report CREs

in some other states• Laboratory Reportable

Condition 2014

Clostridium difficile (CDI) Infections Toolkit Activity C: ELC Prevention Collaboratives

Last reviewed - 2/29/12 --- Disclaimer: The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Carolyn Gould, MD MSCR

Cliff McDonald, MD, FACP

Division of Healthcare Quality Promotion

Centers for Disease Control and Prevention

Prevention Strategies

• Core Strategies– High levels of scientific

evidence– Demonstrated

feasibility

• Supplemental Strategies– Some scientific

evidence– Variable levels of

feasibility

*The Collaborative should at a minimum include core prevention strategies. Supplemental prevention strategies also may be used. Most core and supplemental strategies are based on HICPAC guidelines. Strategies that are not included in HICPAC guidelines will be noted by an asterisk (*) after the strategy. HICPAC guidelines may be found at www.cdc.gov/hicpac

Summary of Prevention Measures

• Contact Precautions for duration of illness

• Hand hygiene in compliance with CDC/WHO

• Cleaning and disinfection of equipment and environment

• Laboratory-based alert system

• CDI surveillance• Education

• Prolonged duration of Contact Precautions*

• Presumptive isolation • Evaluate and optimize

testing• Soap and water for HH

upon exiting CDI room• Universal glove use on

units with high CDI rates*

• Bleach for environmental disinfection

• Antimicrobial stewardship program

Core Measures Supplemental Measures

* Not included in CDC/HICPAC 2007 Guideline for Isolation Precautions

National Center for Emerging and Zoonotic Infectious Diseases

Division of Healthcare Quality Promotion

Upcoming DPH activities• Commissioner’s Call to Action for antimicrobial

stewardship• Antimicrobial stewardship survey of acute care

hospitals, later follow with LTCFs• Posting of hospital-specific 2012 CLABSI, CAUTI,

and SSI (COLO, HYST) data on DPH website• Nursing Home HAI Prevalence and Antimicrobial

Use Survey pilot 2014, full survey 2016