1. Population- based Surveillance of Reportable Diseases in Nursing Home Facilities in Nebraska Manjiri Joshi, MPH + Alison Keyser Metobo, MPH + + Epidemiology Surveillance Response Coordinator

2. Overview Background – Nursing home increased risk for infection – Health outcomes in nursing home residents – Baseline for Nebraska cases Objective Methods – Estimated incidence rates in nursing home residents – Comparing estimated incidence rates in nursing home residents and non-nursing home cases Results Next Steps

3. Background

4. Nursing Home residents are at increased risk for infection – Advanced Age – Group Living – Comorbidities – Compromised Immunity – Need for hospitalization

5. Health outcomes for nursing home residents Clostridium Difficile infections Influenza Methicillin Resistance Staphylococcus Aureus Vancomycin resistance Enterococci

6. Compared Nebraska incidence rates with national incidence rates – Establish baseline in Nebraska population

11. 2010 - revised reportable disease regulations implemented in Nebraska Conditions added for laboratories reporting via Automated Electronic Laboratory Reporting (ELR) Acinetobacter spp. Streptococcus pneumoniae Enterococcus spp. Influenza Klebsiella spp. Clostridium difficile Staphylococcus aureus Meningococcal disease, invasive (Neisseria meningitidis)

12. Objectives Calculate estimated incidence rates among nursing home residents for selected agents for 2010 ̶ 2011 Compare estimated incidence rates for nursing home residents and non-nursing home cases who are 65 years and older

13. METHODS

14. ELR (All Reportable Conditions) Nebraska’s Electronic Diseases Surveillance System (NEDSS) Different line lists with selected variables are created and exported as excel files HL-7 SAS Codes

15. Nursing home data “Nursing home associated case”- –any lab report where patient address = Nursing home address Obtained addresses of all 231 licensed Nursing home facilities Nursing home line list - 2010 and 2011 Selected agents –Clostridium Difficile –Enterococcus Sp. –Influenza –Methicillin Resistant Staphylococcus Aureus (MRSA) –Non MRSA Staph –Streptococcus Pneumonia ** For influenza only positive cases were included

16. Non-nursing home data Lab report data (ELR) for 2010 ̶ 2011 Selected agents –Clostridium Difficile –Enterococcus Sp. –Influenza –Methicillin Resistant Staphylococcus Aureus (MRSA) –Non MRSA Staph –Streptococcus Pneumonia ** For influenza only positive cases were included

17. Estimated incidence rates for nursing home residents 2010 ̶ 2011 Total number of licensed beds in Nebraska were used as proxy for convenience as population at risk to calculate the estimated incidence rates in nursing home facilities * Proxy for population at risk Incidence Rate = Number of cases Number of licensed beds*

18. Compare estimated incidence rates for nursing home residents and non-nursing home cases Nursing home cases – Assumption : Majority of the population in nursing home was 65 years and above – All the licensed beds in Nebraska were used by this population Incidence Rate = Number of cases in nursing home who are 65 yrs and older Total number of licensed beds Non-nursing home cases – Number of cases for 65 years and above was included – Age specific population for Nebraska was used to calculate the incidence (Denominator) Incidence Rate = Number of cases who are 65 yrs and older Population at risk who are 65 yrs and older

19. RESULTS

20. Number and proportion of lab reports for which patient address was available YearTotalCount (n) % of available address 20102660239490% 20117136631588.49%

21. Number and proportion for Nursing homes in Nebraska identified in the Lab reports for 2010 and 2011 Total Number of Beds – 16,975 Median: 62 Range: 4 -329 Total # of Nursing homes in Nebraska # identified in 2010, 2011 Percentage % 2314820.77

22. Nursing home associated cases by age and gender -2010 and 2011 Total20102011 Statewide incidence Male Total % Female Total % % Missing gender inform. Age Median Age Range Clostridium Difficile7132394.1859.236.64.227930-97 Enterococcus Sp.131120.7738.530.830.766766-91 Influenza240 1.4158.341.707930-99 MRSA7430.4171.428.607466-81 Non MRSA - Staphylococcus Aureus 4400.2425.0 5078.572-81 Streptococcus Pneumonia 10640.5960.040.0058.526-104

23. Estimated incidence rates for nursing home residents using total number of licensed beds (16,975) in Nebraska

24. Estimated incidence rates: nursing home residents vs. non nursing cases (65 years and above)

25. Evaluation Chart Review – Validate number of nursing home cases

26. Next Steps Add question to the investigation: “ If you are a nursing home resident?” Nursing home survey – To get number of residents in each nursing home – Age and gender information

27. Limitation Total population in nursing homes Age specific information for nursing home cases Address information – No consideration for missing address

28. Acknowledgement Bryan Buss *, DVM, MPH, DACVPM Eryn Murphy ᴪ MS Tom Safranek **, MD * CDC Career Epidemiology Field Officer (CEFO), Nebraska Department of Health and Human Services ** State Epidemiologist, Nebraska Department of Health and Human Services ᴪ Epidemiology Syndromic surveillance Coordinator