CHAIN Collaborative Healthcare-associated Infection (HAI) Network September 7, 2012

Objective Describe the Collaborative for HAI network (CHAIN) goals and how the 10 th scope of work, hospital engagement network, MN HAI advisory committee fits in with these goals to provide an overall plan for reducing HAIs in Minnesota.

HAI Advisory Group Minnesota Statewide HAI Plan CUSP Culture Environmental Cleaning Antimicrobial Stewardship Hand Hygiene Transmission Precautions Injection Practices CLABSI- Central Line-associated Blood Stream Infections CAUTI- Catheter-associated Urinary Tract Infections SSI- Surgical Site Infections CDI- Clostridium Difficile VAP- Ventilator Associated Pneumonia MRSA- Methicillin-resistant Staphylococcus Aureus CRE- Carbapenem-resistant Enterobacteriaceae Other groups TCAB MAPS Reportable events Meaningful Use Quality reporting & Improvement Collaborative Healthcare-Associated Infection (HAI) Network HospitalLTACASC CHAIN Nursing Home Ambulatory CHAIN Home Care HDC

Stratis Health MDH MHA APIC CHAIN CHAIN Partners

CHAIN Partnership Panel Jane Harper, MDH Linell Santella, APIC-MN Julie Apold, MHA Vicki Tang Olson, Stratis Health

MDH American Recovery and Reinvestment Act (ARRA) Funding for HAI Prevention 9/2009 – 12/2011 Identified HAI Coordinator Developed MN State HAI Action Plan (HAI prevention across the continuum of care) Established multi-disciplinary HAI Advisory Group (ongoing) Led CDI, SSI prevention initiatives (9/2010 – 10/2011) Initiated NHSN User Group to promote participation in NHSN and provide a forum for case discussion HAI and antimicrobial use point prevalence survey (2011)

Ongoing MDH AR / HAI Prevention Unit Activities Outbreak investigation and consultation – Endoscope reprocessing – Product recalls – Unusual clusters Emerging pathogen surveillance – Invasive MRSA, Carbapenem-resistant Enterobacteriaceae (CRE), CDI, Influenza – Studies in collaboration with CDC Infection prevention and control recommendations to address emerging pathogens/infections or situations – MRSA, CRE (acute care and long term care), H1N1, etc.

Ongoing MDH AR / HAI Prevention Unit Activities (cont’d.) Antimicrobial Stewardship – Guide for Comprehensive Antimicrobial Stewardship Programs esistance/index.html esistance/index.html – Kick-off September 27, 2012 – Key audience: physicians and pharmacists Coordination with other MDH Sections /Divisions – Facility Provider Compliance – Health Policy and Health Reform – Immunization Program

CHAIN is an effort lead by the Association for Professionals in Infection Control and Epidemiology- Minnesota (APIC), Minnesota Department of Health, Minnesota Hospital Association, and Stratis Health. NHSN User Group Participate with Stratis Health and APIC-MN Content and surveillance expertise (infectious diseases, infection prevention and control) Possible future collaborative activities with MHA / Stratis Health / APIC-MN MDH AR/HAI Prevention Unit Role with CHAIN

APIC MN As chapter president in 2011, invited to participate on CHAIN Steering Committee APIC strategic plan: network with other organizations The Fit: – Subject: HAI collaboration across MN – Could it fit any better? – And who better to join forces with―Stratis Health, MHA, MDH

APIC MN After all, what is our work? – Combating HAIs in our facilities Researching evidence-based practices Developing strategies Educating our staff and patients Monitoring for compliance Measuring outcomes Reporting outcomes to the state…to NHSN Doing what we can to keep our facilities solvent-- reducing infections, CMS reporting for reimbursement

APIC MN With CHAIN we will now have – Support from other community leaders – A format to share tools, ideas, expertise My role with CHAIN – To represent APIC MN Infection Preventionists to the best of my ability – To share with CHAIN what we do, how we do it, and what we need – To share the work at APIC MN meetings and seek input from infection preventionists

CMS Partnerships for Patients National public/private partnership to improve the quality, safety and affordability of healthcare Center for Medicare and Medicaid Innovation (CMMI) allocated $1 billion in funding for Partnerships for Patients Initiatives Goals by the end of 2013: – Decrease preventable hospital-acquired conditions by 40% – Decrease preventable hospital readmissions by 20%

Hospital-Acquired Conditions 10 Hospital-acquired conditions – Pressure ulcers – Falls – Adverse drug events – Obstetrical adverse events – Catheter associated urinary tract infection (CAUTI) – Surgical site infection (SSI) – Central line associated blood stream infection (CLABSI) – Ventilator-associated pneumonia (VAP) – Venous thromboembolism (VTE) – Readmissions 2 Additional topics – Culture – TCAB

Culture All HC settings (MAPS) Calls-to-Action RARE Safe Tranistions Project Red CTI CHAIN Partnership for Patients HAI ADE & VTE Re- admissions Falls PU Safe Surgery Retained Objects OB TCAB AHRQ OAT

How does it fit together? Accountable Care Act Center for Medicare & Medicaid

Medicare QIO Promgram Protection Family Centered Care Beneficiary Hospital Associated Infections – CLABSI, CAUTI, SSI, CDI Nursing Home Pressure Ulcers/Restraints Adverse Drug Events Quality Reporting and Improvement/Value-Based Purchasing Individual Care Readmissions Integrating Care Immunizations/screenings – Influenza, pneumococcal, Breast cancer screening, colorectal cancer screening Cardiovascular screening – aspirin, blood pressure control, LDL control, smoking cessation Populations

Other focus areas Rural Health Health Disparities HIT

CAUTI/SSI initiative 12 Hospitals Monthly Reporting to NHSN CUSP Training Gap Analysis and Action Plan Group Calls – Best Practices

CDI/SSI 12 Hospitals recruited May 2012 – July 2014 Begin first with monthly entry into NHSN MDH is developing antimicrobial stewardship roadmap for release in fall Improvement cycles begin January 2013

MDH Antimicrobial Stewardship Program Survey CAH (n= 37) PPS (n=28) Total Yes10 (27%)18 (64%)28 No27 (73%)10 (36%)37 Does your hospital have an antimicrobial stewardship program in place?

CAUTI SSICDI Relationship between Roadmap and Initiatives

CHAIN Activities

HAI Advisory InitiativesEducationCommunication Roadmaps SSICDI CAUTI VAP HAI SAFE CLABSI MDRO Environmental Cleaning Hand hygiene Antimicrobial stewardship Transmission Precautions Injection Practices Chain Branding Website Listserv Measurement NHSN Outcome Measures MN infection SAFE from HAI Roadmap Process Measures SAFE from HAI CAUTI CDI SSI Group Calls Webinars Action Days 1:1 Support

Public Reporting CMS CLABSI SSI CAUTI CDI MRSA Healthcare Personnel Influenza Vaccination SQRMS State Infection Reporting Central Line Bundle SSI VAP Bundle

MN HAI Infrastructure MDH HAI Advisory Group – Oversee Overall Minnesota HAI Plan CHAIN – Support Minnesota HAI plan – Support SAFE from HAI – Identify infection prevention gaps and opportunities – Provide input and direction on implementation needs and reporting efforts across the state – Provide education and resources

CHAIN Operations Group Work together in partnership to provide seamless support to Minnesota Hospitals Coordinate implementation efforts between partnering organizations to maximize resources Identify funding sources as needs are identified Evaluate success of interventions and impact on outcomes

Consumer Feedback Stratis Health Consumer Group May 2012 Alcohol-based Disinfection Handwashing

MN NHSN Users Group Purpose: support infection preventionists with NHSN definitions, entry, and reporting Standard agenda – 1 st Thursday, 1-2p.m. – Updates from MDH/CDC – Updates from Stratis Health – Best practices sharing – Case studies/Troubleshooting/Networking APIC joining as co-leader Join NHSN/HAI distribution list for agenda/minutes

CHAIN Website Organized according to roadmap  SAFE  Building blocks/Prevention Strategies  Targeted Infections

HAI Roadmap SAFE = common across infection topics S = SAFE from HAI teams A = Accurate and concurrent reporting F = Facility expectations E = Education for patients and families

Safe from HAI Roadmap Building Blocks/Core Prevention - Handwashing - Antimicrobial Stewardship - Instituting environmental cleaning - Injection Practices - Transmission Precautions

Clinical Bundles CLABSI CAUTI CDI SSI VAP

What is on the Horizon? Support SAFE from HAI – Webinars Quarterly CHAIN webinars; additional on-going opportunities – In-person action days – Listserv – On-going advisory group review of data; identify and address gaps – Development of tools/resources as needed Continued support from NHSN Users Group Continued coordination of infection reporting Continued coordination and support for all Minnesota Infection Prevention activities

How do I get involved? Share tools/resources with colleagues via listserv or posting on CHAIN website Participate in educational opportunities Access website resources: Sign up for Safe from HAI: Sign up for listserv: Sign up for NHSN/HAI distribution list: Sign up for CAUTI and/or CDI initiative for targeted support:

Key Contacts CHAIN, or CAUTI/SSI/CDI-specific support Bruce Johnson, Program Manager, Stratis Health SAFE from HAI Mickey Reid, Manager, Patient Safety/Quality, Minnesota Hospital Association Statewide HAI Plan Jean Rainbow, Nurse Specialist, Minnesota Department of Health