1. Welcome to the GHA Infection Prevention Power Hour December 19, 2013

2. Brief Agenda GHA/HEN Update Review of CMS, Georgia HAI Reporting for 2014 Georgia DPH Update – Antibiotic Stewardship Program GMCF, QIO Update – NHSN Reporting: CDI

3. How Are We doing at Preventing Infection Harm?

4. CAUTI Still A Challenge

5. SSI: Colon

6. SSI Abdominal Hysterectomy

7. Coming Hospital wide CLABSI and CAUTI Additional SSI: Hip and knee prosthesis VAE: IVAC, Possible, probable VAP

8. LEAPT to GAPP Innovation for rapid safety improvement Sepsis C. diff with antimicrobial stewardship

9. Stepping up to Antibiotic Stewardship in Georgia Jeanne Negley, MBA Georgia HAI Coordinator Georgia Department of Public Health Georgia Hospital Association Infection Prevention Power Hour December 19, 2013

10. Impetus to Engage in Stewardship  Awareness of stewardship work conducted in Oregon  New to Georgia (with no program for stewardship)  Need for state to engage with providers in prevention activities

11. Activities  Convened subcommittee  Recommended: Create statewide strategic plan  Conducted research on resources and evidence of resistant disease in the state: Within the State HD: Emerging Infections Program, Gonococcal Isolate Surveillance Project, Vaccine Preventable Disease, Evaluation Resources Outside the State HD: Centers for Disease Control and Prevention (subject matter and evaluation experts), South Dakota, and Maryland

12. Initial Results  Developed statewide strategic plan  Initial focus on acute care  Logic Model  Adapted from CDC DHQP logic model  Policy implementation through partnerships  Phased-in approach  Recognition Program for Antibiotic Stewardship

13. Association of State and Territorial Health Officials (ASTHO) Grant Opportunity  Applied for and received ASTHO HAI Capacity Grant  “Changed Gears” to focus on training for acute care pharmacists and physicians  Grant Activities:  Developed ASP assessment tool with CDC  October 9, 2013 training for pharmacists  Conducted post-training focus group with pharmacists  Physician webinars scheduled for December 2013

15. October 9, 2013  A lot of people in one room  Challenge of partial government shutdown  Georgia Antibiotic Stewardship Subcommittee members step up to the challenge  Jeanne conducts focus group  Meeting runs over time; extended Q&A session

17. Focus Group Questions What did you like most/least about training? What is one most useful idea of technique you learned today? What are the barriers to antimicrobial stewardship programs (ASP)? What can the State Health Department do to help promote enhance … ASP? Initial thoughts on Honor Roll? Anything we have not discussed?

18. Physician Training  One-hour webinar offered on three dates  Dec. 9, 11, and 12 (noon and 5 pm)  Program highlights need, hospitalist/community program, ASP for larger facility  Live Q&A session for each broadcast  CMEs through Emory

19. Preliminary Assessment Data  26 of 50 facilities had a multidisciplinary committee focused on antimicrobial use 19 (73.1%) reported physician or pharmacist leader for stewardship activities 4 (15.4%) have neither physician nor pharmacist leaders 3 (11.5%) did not meet regularly

20. Preliminary Focus Group Data  Participants like the training: speakers, content, format  Wanted more education:  Supported for pharmacists and physicians  Partner with pharmacy and medical schools  Supported Honor Roll program  Need to be sensitive of resources at smaller facilities

21. Existing Partners to Support our Work  HAI Advisory Committee and Antibiotic Stewardship Subcommittee  Development of Honor Roll; Created Toolkit; Speakers Bureau; Development of new partnerships  Georgia Hospital Association, Quality Improvement Organization, Georgia Infection Prevention Network  Marketing training; Development of new partnerships  Centers for Disease Control and Prevention  Assessment tool  Focus group questions  Subject matter consultation

22. New Partnerships Developed  Georgia Society of Health System Pharmacists and Emory School of Medicine  Marketing, continuing education, sustainability (pharmacy association)  Medical Association of Georgia, Atlanta Infectious Disease Society, Atlanta Chapter of Hospital Medicine  Marketing training  Potential Future Partners: state pharmacy and medical schools  To offer antimicrobial stewardship training to pharmacists and physicians

23. The Georgia HAI Advisory Committee and Antibiotic Stewardship Subcommittee are developing an honor roll to recognize facilities engaged in stewardship. The requirements of the Honor Roll support the stewardship principles and tools provided in pharmacists and physician training programs. Georgia Honor Roll for Antibiotic Stewardship S TEPPING UP TO A NTIMICROBIAL S TEWARDSHIP IN G EORGIA

24. Phase 1- Engagement: 1.Letter of Commitment from Leadership 2.Antibiotic Stewardship Team 3.Educational Event Phase 2- Implementation 4.Antibiotic Stewardship Programs 5.Measurement of Impact of Program Elements of Honor Roll S TEPPING UP TO A NTIMICROBIAL S TEWARDSHIP IN G EORGIA

25. Acknowledgements Georgia Department of Public Health Matthew Crist Stephanie Lambert (former intern) Lauren Lorentzson Michele Mindlin Ashley Moore Melissa Tobin D’Angelo Nadine Oosmanally Georgia Antibiotic Stewardship Subcommittee Jesse Jacob, MD, MS, Emory University Hospital, co-chair Renee Watson, RN, CIC, Children’s Healthcare of Atlanta, co-chair Angelina Davis, PharmD, MS, BCPS (AQ-ID) WellStar Health System Denise Flook, RN, CIC, Georgia Hospital Association Kimberly Hazelwood, PharmD, Georgia Department of Public Health Sheena Kandiah, MD, Emory University Hospital Armando Nahum, SafeCare Campaign Cindy Prosnak, RN, CIC, Georgia Medical Care Foundation Craig Smith, MD, University Health System, Augusta Centers for Disease Control and Prevention Loria Pollack Ronda Sinkowitz-Cochran Heidi Gruhler Arjun Srinivasan Susan Fuller Turquoise Griffith ASTHO Catherine Cairns Virginia Dolen

26. Kathryn Arnold, MD, Centers for Disease Control and Prevention Ryan Deal, Georgia Department of Public Health Marcia L. Delk, MD, MBA, WellStar Health System Denise Flook, RN, MPH, CIC, Georgia Hospital Association Jesse T. Jacob, MD, MSc, Emory University Hospital Midtown Robert C. Jerris, PhD, D (ABMM), Children’s Healthcare of Atlanta/Emory School of Medicine Mary Key, BSN, CIC, Tift Regional Medical Center Denise Leaptrot, BSMT(ASCP), RN, CIC, MBA, Coliseum Medical Centers Peggy McGee, RN, CIC, Liberty Hospital Armando Nahum, SafeCare Campaign Cindy Prosnak, RN, CIC, Alliant/Georgia Medical Care Foundation Susan M. Ray, MD, Emory School of Medicine Lynn A. Reynolds, RN, CIC, Southeast Georgia Health System Craig E. Smith, MD, MS, CTropMed, FACP, FIDSA, University Health Care System James P. Steinberg, MD, Emory University School of Medicine Nimalie Stone, MD, Centers for Disease Control and Prevention Robert Thornton, MPH, Georgia Department of Public Health (District 9-1) Renee Watson, BSN, RN, CIC, Children’s Healthcare of Atlanta Rebecca Walker, RN, CIC, Georgia Regents University Georgia HAI Advisory Committee

27. Thank you! Jeanne Negley, MBA Georgia Department of Public Health 2 Peachtree Street, NW, #14-225 Atlanta, GA 30303 404-657-2593 jenegley@dhr.state.ga.us

28. Alliant/GMCF/QIO Update Cindy Prosnak

29. Contact Information Denise M. Flook, RN, MPH, CIC Georgia Hospital Association 770-249-4518, dflook@gha.org.dflook@gha.org Jeanne Negley, HAI Coordinator Georgia Dept. of Public Health (404) 657-2593 | jenegley@dhr.state.ga.us.jenegley@dhr.state.ga.us Cindy Prosnak, RN, BSN, CIC Alliant GMCF 706.836.8361 | CProsnak@gaqio.sdps.org.CProsnak@gaqio.sdps.org