Illinois Healthcare-Associated Infections (HAI) Plan Mary Fornek January 21, 2010 Metropolitan Chicago Healthcare Council

American Recovery and Reinvestment Act of 2009 (ARRA)

Four Components of the HAI Plan HAI Program Infrastructure Surveillance, Detection, Reporting and Response Prevention Evaluation, Oversight, and Communication

HAI Program Infrastructure

Key Points Illinois has created a HAI Prevention Advisory Council Specific HAI targets have been identified –Clostridium difficile (C. difficile) –Methicillin-resistant Staphylococcus aureus (MRSA) –Central line Associated Bloodstream Infections (CLABSIs) –Surgical Site Infections (SSIs)

Surveillance, Detection, Reporting and Response

Central Line Associated Bloodstream Infections (CLA BSIs) Statewide reporting of CLABSIs in adult medical and/or surgical ICUs using National Healthcare Safety Network (NHSN) began January 1, Statewide reporting of CLABSIs in Pediatric and Neonatal ICUs began October 1, 2009.

CLABSI continued Baseline CLABSI standardized infection ratios (SIRs) for various ICU types for the first twelve months of NHSN surveillance will be available by March 1, The IHA is a participant in John Hopkins University’s nationally recognized multistate “Stop BSI” initiative, in which forty-one Illinois hospitals are enrolled.

Clostridium difficile Collaborative Implementation in March hospitals will be asked to participate –10 hospitals from the Chicago area –10 hospitals from Southern Illinois Hospitals participating in the C. difficile collaborative will be required to use the NHSN (C. difficile Associated Disease) CDAD module for reporting.

Methicillin Resistant Staphylococcus aureus (MRSA) October 1, 2007 – hospitals identify patients colonized and/or infected with MRSA. MRSA data available on the IDPH website in an annual report and on the Hospital Report Card. IFMC-IL MRSA Collaborative – Includes 8 hospitals, all reporting MRSA through the NHSN MDRO module

Surgical Site Infections (SSIs) Statewide Reporting will be required in APRIL Procedures ― Total Knee Arthroplasty (TKA) ―Coronary Artery Bypass Graft (CABG)

SSI Workshops Mary Andrus presenting SSI Module of NSHN –February 5, 2010 MCHC –February 12, 2010 Elmhurst Health Center –March 5, 2010 New Sherman Hospital Two 4 hour sessions each day (8am – 12pm) and (1pm – 5pm) 30 participants per session IT Webinar – date to be determined

Patient IDGender Date of Birth NHSN Procedure Code Date of ProcedureOutpt. Duration Hours Duration Minutes Wound Class ASA ClassEndoscope Surgeon Code NHSN SSI Denominator Data

Electronic Lab Reporting (ELR) Surveillance Automated reporting of reportable diseases to public health agencies Development of software modules to increase the efficiency and reliability of reporting to CDC’s National Healthcare Safety Network Linking together hospitals to identify transfers of patients for whom a multi-drug resistant organism (MDRO) has been detected

Key Points Two priority prevention targets for surveillance have been identified (e.g. CLABSI and SSI). Illinois hospitals with adult, pediatric, and/or neonatal ICUs are required to report CLABSIs through NHSN. Illinois hospitals are required to report TKA and CABG SSIs through NHSN beginning April 1, 2010.

Prevention

Development of 5 Workgroups MDRO Workgroup –Will explore making all or some of the specific emerging multidrug-resistant gram negative organisms of epidemiologic importance reportable in the State of Illinois. HAI Workgroup –Establish outbreak reporting requirements –Explore methods to electronically achieve notification of HAI outbreaks –Explore developing a separate module for reporting HAI clusters within the current reporting systems

Workgroups continued Outbreak/Breaches of IC Practices Workgroup – Explore developing processes and tiered response criteria to handle increase reports of serious infection control breaches or suspect cases/clusters, and outbreaks –Decide on actions that will be taken when serious infection control breaches have been identified Surveillance Workgroup –Explore developing legislation to mandate use of qualified electronic surveillance system and minimum Infection Preventionist staffing levels

Workgroups continued Long Term Care Workgroup – Assist in developing a statewide needs assessment and profile – Establish educational standards for LTC and LTACH healthcare workers – Develop standardized educational tools – Implement the educational sessions – Explore current and future collaboratives between local health departments and LTCF, LTACHs and hospitals

Evaluation and Communication

Key Points IDPH will be measuring progress towards targets through NHSN data. Validation activities will be implemented throughout the year. Consumers have access to healthcare quality measures through the Illinois Hospital Report Card Web Site

ActivitiesTimeline Medical/Surgical ICU CLABSI ReportingJanuary 1, 2009 Pediatric/Neonatal ICU CLABSI ReportingOctober 1, 2009 SSI NHSN TrainingFebruary 2010 Initial Outbreak/Breaches of IC Practices Workgroup Meeting February 2010 Training and launch of Chicago area C. difficile Collaborative March 2010 SSI Reporting for TKA and CABGApril 1, 2010 MDRO Workgroup Meeting2010 Long Term Care Workgroup Meeting2010 SSI TKA and CABG Data AvailableJanuary 2011 HAI Workgroup MeetingFebruary 2011 MRSA and C. difficile Reporting Through NHSN Statewide 2011 Surveillance Workgroup Meeting2011

Questions