11/12/2015 2 Objectives After this presentation, participants will be able to: Explain the importance of reporting HAIs Describe the characteristics of HAI outbreaks historically reported in Kentucky Conference For Understand changes in disease reporting Healthcare Transparency & Patient Safety in Kentucky Kraig Humbaugh, MD, MPH Identify antibiotic stewardship as a strategy Lexington, KY in the fight against antibiotic resistance November 13, 2015 No disclosures of conflicts of interest 3 4 Population Health Surveillance Ultimate Goal for Communicable Diseases From the French: “to watch over” Surveillance helps to call attention to unusual Control and reduce diseases of events or numbers of events. Awareness of a potential public health problem from public health importance and the outset allows more time for a thoughtful, impact considered response and more strategic use of limited resources. Surveillance also helps us understand the depth and breadth of a health event: the “who,” “what,” “where,” “when,” and possibly “why” and “how.” 5 6 Reportable Disease Laws Traditional Passive Surveillance Kentucky Revised Statute 214.010 Relies on timely recognition and “Every physician and advanced practice reporting of certain types of disease or registered nurse shall report all diseases clusters of illness. designated by administrative regulation of Presumes thorough knowledge and the Cabinet for Health and Family Services correct diagnosis of illness by clinician as reportable” 902 Kentucky Administrative Regulation 2:020 Presumes that all reportable diseases or unusual disease groupings will be Delineates who should report, the diseases and outbreaks to be reported, and how they reported to the health department are to be reported Presumes reporting will occur promptly 5 1
11/12/2015 7 8 Reportable Disease Investigations, What does Public Health do with the reports? 2012-2014 *†‡ Assists in determining whether outbreak is 2012 2013 2014 occurring, case investigation, and 8,466 total investigations 9,689 total investigations 9,330 total investigations Lab report Lab report Lab report prevention/control of other cases Morbidity report from Morbidity report from Morbidity report from hospital hospital hospital In the case of healthcare facilities, can Faxed EPID 200 Form Faxed EPID 200 Form Faxed EPID 200 Form Campylobacteriosis= 552 Campylobacteriosis= 683 Campylobacteriosis= 679 assist in providing guidance for control Salmonellosis = 757 Salmonellosis = 562 Salmonellosis = 645 STEC = 120 STEC = 177 STEC = 182 and with more detailed testing HAV, acute = 83 HAV, acute = 84 HAV, acute = 125 HBV, acute = 275 (509 HBV, acute = 289 (589 HBV, acute = 232 (616 Can help determine if facility outbreaks chronic ‡ ) chronic ‡ ) chronic ‡ ) HCV, acute = 344 (2,573 HCV, acute = 321 (3,222 HCV, acute = 322 (3,092 are interrelated across county and state chronic or resolved ‡ ) chronic or resolved ‡ ) chronic or resolved ‡ ) Pertussis = 741 Pertussis = 499 Pertussis = 530 lines * Data retrieved from the National Electronic Disease Surveillance System (NEDSS) † Investigations of Chlamydia, Gonorrhea, HIV/AIDS, Influenza, and Tuberculosis are not included. ‡ Reporting of Chronic Hepatitis B and Chronic Hepatitis C is voluntary. Investigations created for Chronic Hepatitis do not represent the true burden of chronic hepatitis. 10 Reported Disease Outbreak Settings, Kentucky, 2006 - 2015 †‡§ Reported Disease Outbreaks by Organism, Kentucky, 2006 - 450 2015 †‡§ 250 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 400 200 350 2015 2014 300 2013 2012 150 2011 Count 250 Count 2010 2009 100 200 2008 2007 150 2006 50 100 50 0 0 Setting Organism † Data retrieved from Kentucky Outbreak Report Database † Data retrieved from Kentucky Outbreak Report Database ‡ 2015 data only includes outbreaks reported between January 1, 2015 and August 31, 2015. ‡ 2015 data only includes outbreaks reported between January 1, 2015 and August 31, 2015. § Data on Influenza outbreaks includes reports in two calendar years and therefore has been § Data on Influenza outbreaks includes reports in two calendar years and therefore has been excluded from excluded from this figure. this figure 11 12 Healthcare Facility Disease Outbreaks by Organism, Kentucky, Number of Influenza-Like Illness Outbreaks in 2006 - 2015* †‡§ Long Term Care Facilities by Influenza 250 Season in Kentucky, 2010-2015 100 92 200 90 No. LTCF Outbreaks 80 150 2014 Count 70 2013 2012 59 100 60 2011 2010 50 2009 50 2008 40 2007 2006 30 0 20 11 9 6 10 0 2010-2011 2011-2012 2012-2013 2013-2014 2014-2015 Influenza Season Organism * Outbreak considered for count if setting listed as “acute care,“ “hospital,” “long term care facility,” “outpatient setting,” “personal care hospital,” or “personal care facility.” † Data retrieved from Kentucky Outbreak Report Database ‡ 2015 data only includes outbreaks reported between January 1, 2015 and August 31, 2015. § Data on Influenza outbreaks includes reports in two calendar years and therefore has been excluded from this figure. 2
11/12/2015 13 14 Influenza Vaccination Coverage in Summary of New Regulation U.S., Healthcare Personnel, 2014- 2015 Season Defines HAIs and HAI outbreaks Mandates simultaneous reporting of HAI data to both Centers for Medicare and Medicaid Pharmacists 95.3% Services (CMS) and the Kentucky Nurses 89.0% Department for Public Health (KDPH) after regulation goes into effect Physicians 88.9% Mandates electronic reporting of positive Assistants/Aides 64.4% laboratory tests for certain Multidrug Resistant Organisms (MDROs) via the Kentucky Health Information Exchange beginning in October Reference: 2016 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6436 a1.htm 15 16 New Definitions and Reporting New Definitions Requirements Healthcare-Associated Infection (HAI): An Healthcare-Associated Infection (HAI) infection acquired by a person while receiving Outbreak: treatment for a separate condition in a two or more HAIs that are epidemiologically healthcare setting linked or connected by person, place or time Under the new regulation, certain HAIs are now reportable by facility through the National OR Healthcare Safety Network (NHSN) a single case of an HAI not commonly Cases of specific multidrug resistant diagnosed (for example, legionellosis organisms will be reported electronically acquired in a healthcare facility) beginning in October 2016. 17 18 National Healthcare Safety Network NHSN (Continued) (NHSN) NHSN provides medical facilities, states, regions, and the nation with data CDC’s National Healthcare Safety Network collection and reporting capabilities (NHSN) is the nation’s most widely used needed to: • Identify infection prevention problems by healthcare-associated infection tracking facility, state, or specific quality system. NHSN provides facilities, states, improvement project • Benchmark progress of infection regions, and the nation with data needed to prevention efforts identify problem areas, measure progress of • Comply with state and federal public prevention efforts, and ultimately eliminate reporting mandates, and • Ultimately, drive national progress toward healthcare-associated infections. elimination of HAIs. http://www.cdc.gov/nhsn/about.html http://www.cdc.gov/nhsn/about.html 3
11/12/2015 19 Simultaneous Reporting to Both CMS and KDPH HAIs are mandated to be reported routinely for hospitals that participate in the Centers for Medicare and Medicaid Services (CMS) Hospital Inpatient Quality Review (IQR) Program. Similar requirements exist for long term care facilities, outpatient dialysis centers, rehabilitation centers and others. Under new regulation, data submitted to CMS through NHSN are required to be submitted at same time to the KDPH. 21 22 Electronic Multidrug Resistant Organism (MDRO) Reporting Officially begins October 2016 Can be used be facilities to demonstrate “meaningful use,” in order for facilities to continue to receive meaningful use payments Involves electronic reporting of positive laboratory results of certain MDROs as defined in the regulation, via the Kentucky Health Information Exchange 23 24 Kentucky Health Information State Mandate for HAI Reporting Exchange (KHIE) NHSN Surveillance data Allows KDPH to see how facilities are doing Enables safe, secure electronic exchange based on national benchmarks and in of patient health information among comparison with each other participating providers and organizations Facilities that report in the highest or lowest throughout the state tertiles may be highlighted for data validation or Participation fulfills meaningful use consultation objectives of the Medicare and Medicaid Individual patient level data is protected Electronic Health Record Incentive Hospital level data may be reported once Program finalized http://khie.ky.gov Also available on https://data.medicare.gov/data/hospital- compare 4
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