1. CDC Winnable Battles: Preventing Healthcare-Associated Infections (HAIs) National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion

2. Healthcare-associated Infections (HAIs)  Infections that patients acquire during the course of receiving treatment for other conditions within a healthcare setting  HAIs increase cost: $26-33 billion annually  CDC estimates 1 in 25 hospital patients has an infection, including Central-line associated bloodstream infections Catheter-associated urinary tract infections Surgical site infections Pneumonias - ventilator-associated and others Clostridium difficile infections  HAIs occur across healthcare settings (e.g., long-term care, outpatient)  Many infections are caused by resistant microorganisms Carbapenem-resistant Enterobacteriaceae (CRE) Methicillin-resistant Staphylococcus aureus (MRSA)

3. Healthcare-associated Infections (HAIs)

4. Eliminating Healthcare Associated Infections Strengthening public health-healthcare collaboration

5. Federal and State Alignment of HAI-AR Programs  CDC Winnable Battle  National Plans and Goals HHS HAI Action Plan and HHS Agency Priority Goal National Strategy and Action Plan for Combating Antibiotic-Resistant Bacteria (CARB) CMS Value-based Purchasing  State Legislation and HAI-AR programs

6. States with Mandatory Public Reporting Policies for Healthcare-Associated Infections (HAIs) DC* 2004 2015 States required to publicly report some healthcare-associated infections

7. CDC’s National Healthcare Safety Network (NHSN)  NHSN: Tracking infections in over 15,000 healthcare facilities nationwide  NHSN is used by Facilities across healthcare to track HAIs and antimicrobial resistance, and direct prevention activities States for public reporting and regional prevention CMS for quality reporting and prevention initiatives HHS to measure national progress

8. Progress reducing healthcare-associated infections: 2008-2013 *CLABSI: Central line-associated bloodstream infections; † MRSA: Methicillin-resistant Staphylococcus aureus HAI National Action Plan 2013 Goals: 50% reduction for CLABSI and MRSA; 25% reduction for SSI

9. HAI Progress Report Based on 2013 data; published January 2015  National summaries of healthcare-associated infections  46% decrease in CLABSI between 2008 and 2013  19% decrease in SSIs related to the 10 select procedures tracked in the report between 2008 and 2013  6% increase in CAUTI between 2009 and 2013, mostly in ICUs; although initial data from 2014 seem to indicate that these infections have started to decrease  8% decrease in hospital-onset MRSA bacteremia between 2011 and 2013  10% decrease in hospital-onset C. difficile infections between 2011 and 2013

10. HAI Progress Report Based on 2013 data; published January 2015  State-by-state summaries of healthcare-associated infections  26 states performed better than the national SIR on at least 2 infection types  16 states performed better than the national SIR on at least 3 infection types  6 states performed better than the national SIR on at least 4 infection types  22 states performed worse than the national SIR on at least 2 infection types  13 states performed worse than the national SIR on at least 3 infection types  State-by-state summaries available at http://www.cdc.gov/hai/progress-report/index.html http://www.cdc.gov/hai/progress-report/index.html

11. CDC’s NHSN Data For Action Targeted Assessment For Prevention (TAP) CDC funded health departments AHRQ funded networks CMS funded networks Other partners CDC funded health departments AHRQ funded networks CMS funded networks Other partners Target Partnering for Prevention Target hospitals with highest number of excess infections CDC’s NHSN Data Over 4,800 hospitals currently reporting CAUTI, CLABSI, and C. difficile data CDC’s NHSN Data Over 4,800 hospitals currently reporting CAUTI, CLABSI, and C. difficile data

12. Using CDC’s NHSN Data for Action: Targeted Assessment for Prevention (TAP) Strategy Targeting → Assessment → Implementation  Identify healthcare facilities with excess infections  Assess gaps in infection prevention in targeted facilities/units using CDC tools  Implement interventions to address gaps in infection prevention using CDC Implementation Guidance  Partner among health departments and hospital networks with CDC and clinical expertise to prevent infections

13. Healthcare, infections, and antibiotic resistance have moved beyond hospitals Hospitals Ambulatory Facilities Long-term Care Dialysis Facilities

14. State HAI Prevention Programs  CDC supports at least one HAI coordinator in every state through the Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Cooperative Agreement  State health departments work with state hospital associations, CMS-funded networks, and hospital networks to: Track infections in healthcare facilities Focus HAI prevention efforts using CDC’s NHSN data Implement prevention strategies across healthcare settings using CDC’s tools and evidence-based guidelines

15. Innovations to improve patient safety CDC Prevention Epicenters Program  CDC collaborates with academic investigators to conduct innovative infection control and prevention research  Fills prevention knowledge gaps identified by CDC’s outbreak response and surveillance data

16. Emerging Infections Program (EIP) Early warning system for new and changing threats  CDC funded network of 10 state health departments collaborating with local health departments, academic institutions, other federal agencies, laboratories, infection preventionists, and healthcare providers  Conducts surveillance and special studies on HAIs and AR to assess overall burden and prevention impact across all healthcare facilities  Recently released 2011 HAI and Antimicrobial Use Prevalence Survey Estimated 722,000 HAIs in US hospitals in 2011, or 1 in 25 patients Estimated 75,000 patients with HAIs died during hospitalization

17. CDC’s Clinical and Environmental Microbiology Laboratory  Serves as national and an international reference laboratory for testing and diagnostic capacity of pathogens causing HAIs and antibiotic resistant infections  Develops and evaluates methods to reliably detect emerging antimicrobial resistance  Conducts applied research on improved detection methods for HAIs  Provides environmental microbiology methods for measuring contamination of healthcare environment  Assists in healthcare-associated outbreak investigations

18. Antibiotic resistance in the United States  Sickens >2 million people/year  Kills at least 23,000 people/year, plus 15,000–29,000/year from C. difficile  >$20B/year in health care costs  Threat to economic stability  Need to act now or even drugs of last resort will soon be ineffective

19. Modern medicine at risk  Loss of effective antibiotic treatment could make routine infections deadly Pneumonia Urinary tract infections Wound infections  Patients who receive specialized care will be at highest risk Cancer chemotherapy Complex surgery Joint replacements Organ transplants Chronic conditions (e.g., rheumatoid arthritis) Dialysis Cancer Treatment >600,000 patients will receive chemotherapy in 2014 1 ~60,000 cancer patients will be hospitalized with neutropenia and infections 2 1 in 14 of these will die from this complication 2 1 Kantar Health, Cancer Impact 2 Caggiano et al, 2005, Cancer

20. Antibiotic Resistant Threats in the U.S.  CDC’s AR Report ranked 18 drug-resistant threats: Urgent, Serious, and Concerning  Urgent threats include Carbapenem-resistant Enterobacteriaceae (CRE) Clostridium difficile  Serious threats include Drug-resistant Pseudomonas Methicillin-resistant Staphylococcus aureus Access CDC’s AR Report at http://www.cdc.gov/drugresistance/threat-report-2013/http://www.cdc.gov/drugresistance/threat-report-2013/

21. State HAI-AR Prevention Programs: Detect, Prevent, Respond  Prevention of AR transmission needs to be across healthcare and community settings  Networks of healthcare facilities in communities around the country working together with health departments to: Better detect and respond to outbreaks Prevent infections Improve prescribing

22. CDC Recommends All Hospitals Implement Antibiotic Stewardship Programs  Leadership commitment  Accountability  Drug expertise  Action  Tracking  Reporting  Education Access CDC Vital Signs at http://www.cdc.gov/vitalsigns/issues.htmlhttp://www.cdc.gov/vitalsigns/issues.html

23. Actions State Health Departments Can Take to Advance Antibiotic Stewardship  Gain an understanding of antibiotic stewardship activities in the state or area  Facilitate efforts to improve antibiotic prescribing and prevent antibiotic resistance  Provide educational tools to facilities to help prescribers improve practices

24. CDC’s FY 16 AR Solutions Initiative Online http://www.cdc.gov/drugresistance/solutions-initiative

25. For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. For more information: www.cdc.gov/winnablebattles National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion