William B. Munier, MD Director, Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality National Advisory Council for Healthcare Research and Quality 8 April 2011 Healthcare-Associated Infections and AHRQ’s Role in their Prevention

2 Magnitude of the Problem Previous HAI estimates (based on Klevens et al., 2007) Previous HAI estimates (based on Klevens et al., 2007) 2002 – Hospital only – 1.7 million HAIs – 99,000 deaths – ~$30 billion in excess healthcare costs Overall HAI figures to be updated in light of new lower CDC estimates for CLABSI, CAUTI, SSI, and VAP Overall HAI figures to be updated in light of new lower CDC estimates for CLABSI, CAUTI, SSI, and VAP

3 New CLABSI Estimates MMWR, March 1, 2011 MMWR, March 1, 2011 – CLABSIs in ICUs: 2001 – 43, – 43, – 18, – 18,000 Current estimates for CAUTI, SSI, VAP likewise lower Current estimates for CAUTI, SSI, VAP likewise lower Best current overall estimates Best current overall estimates – At any one time, HAIs affect 1 out of every 20 hospital patients – HAIs are costly, deadly, and largely preventable } 58%

4 AHRQ’s Central Role Promote the wide-scale application of evidence-based approaches to prevent healthcare-associated infections (HAIs) Promote the wide-scale application of evidence-based approaches to prevent healthcare-associated infections (HAIs)

5 AHRQ’s Role in the National Effort 1. Participates in coordinated, Department- level activities to reduce HAIs – Serves on HHS Steering Committee for Prevention of HAIs – Chairs the Committee’s Research Working Group – Facilitates overall HHS evaluation efforts

6 AHRQ’s Role in the National Effort 2. Supports research and demonstration a) Epidemiology b) Infection control interventions c) Implementation & impact 3. Supports projects to spread evidence- based methods and proven techniques

7 Five Phases of Translational Research 1 T0 - discovery of opportunities to address health problems through technologic advances, surveillance, outbreak investigation, and epidemiologic studies T1 - move discovery into first application of candidate intervention(s) T2 - assess the value of the candidate interventions, leading to the development of evidence-based recommendations T3 - move evidence-based recommendations into health practice, through delivery, dissemination, and diffusion research T4 - evaluate the “real world” health impact of population-level health practice 1 Adapted from: Genet Med 2007:9(10): and

8 Michigan Keystone ICU Project first major HAI project: $454, first major HAI project: $454,000 Led by Dr. Peter Pronovost, JHU, in conjunction with Michigan Hospital Association & Blue Cross/Blue Shield Led by Dr. Peter Pronovost, JHU, in conjunction with Michigan Hospital Association & Blue Cross/Blue Shield Enormously successful in reducing CR-BSI in Michigan ICUs Enormously successful in reducing CR-BSI in Michigan ICUs Based on streamlining CDC protocols, addressing teamwork/human factors, and fostering a culture of safety Based on streamlining CDC protocols, addressing teamwork/human factors, and fostering a culture of safety

9 AHRQ HAI Investments

10 Infection Types – Major Focus Areas CLABSI CLABSI CAUTI CAUTI SSI SSI VAP VAP MRSA MRSA C. difficile C. difficile

11 Healthcare Settings Hospitals (Phase I) Hospitals (Phase I) Ambulatory settings (Phase II) Ambulatory settings (Phase II) – Ambulatory surgery centers – ESRD facilities – Outpatient clinics & offices Long-term care facilities (Phase III) Long-term care facilities (Phase III)

12 AHRQ HAI Projects – FY 2010 Contracts (including IAAs) 18$19 million Grants 15$15 million Total$34 million

13 Illustrative HAI Projects Assess the value of candidate interventions Assess the value of candidate interventions – Cluster randomized trial of hospitals to assess the impact of targeted vs. universal strategies to reduce MRSA in ICUs Move evidence-based recommendations into health practice Move evidence-based recommendations into health practice – Nationwide implementation of CUSP to reduce CLABSI

14 Nationwide Implementation of CUSP for CLABSI – Interim Report Recruitment Recruitment – 45 State hospital associations – 700 hospitals – 1,100 hospital teams Interim results – 350 hospitals Interim results – 350 hospitals Average CLABSI rate/1000 central line days: – Baseline: 1.8 – CUSP for CLABSI:1.17 } 35%

15 Expanding the Impact of CUSP Beyond CLABSI CUSP for CAUTI CUSP for CAUTI CUSP for SSI/Safe Surgery CUSP for SSI/Safe Surgery CUSP for VAP CUSP for VAP

16 Facing Forward Build on prior-year activities to increase effectiveness of AHRQ’s HAI investments Build on prior-year activities to increase effectiveness of AHRQ’s HAI investments Expand research projects in high-priority areas Expand research projects in high-priority areas Enhance synergy within HHS & with the private sector to strengthen nationwide efforts to reduce HAIs Enhance synergy within HHS & with the private sector to strengthen nationwide efforts to reduce HAIs

17 AHRQ HAI Investments Next up! Peter Pronovost, MD, Peter Pronovost, MD, AHRQ’s partner in reducing HAIs