Chasing Zero Infections - Connecting the Dots Thursday, May 25, 2017 to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship The Big Picture: Statewide Program Targeting Clostridium difficile Infection and Establishing a Strong Antibiotic Stewardship Program Nychie Q. Dotson, MPH, CIC, CPHQ Health Care-Associated Infection Prevention Program Manager May 25, 2017 Florida Hospital Association Chasing Zero Event Division of Disease Control and Health Protection To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. 5/22/2017 1 Objectives • Introducing the Florida Department of Health’s Health Care-Associated Infection (DOH HAI) Prevention Program • Review past initiatives • Present current and future initiatives • Antibiotic stewardship Division of Disease Control and Health Protection To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. 5/22/2017 2 Mission to Care FHA HIIN 1
Chasing Zero Infections - Connecting the Dots Thursday, May 25, 2017 to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship DOH HAI Program Mission: Use surveillance guided, evidence- based prevention strategies through collaboration among public and private entities to reduce health care-associated infections in people who interact with Florida’s health care system. Division of Disease Control and Health Protection To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. 5/22/2017 3 HAI Advisory Board Florida Florida Agency for Florida Hospital Professionals in Infectious Health Care Association Infection Control Disease Society Administration SME in Quality Hospital Florida Health Improvement & Corporation of Care Hospital America Association Epidemiology Division of Disease Control and Health Protection To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. 5/22/2017 4 Mission to Care FHA HIIN 2
Chasing Zero Infections - Connecting the Dots Thursday, May 25, 2017 to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Team Introduction Nychie Dotson , MPH, CIC, CPHQ ─ Program Manager Tammy Jernigan , ARNP, MSN, CIC ─ Senior Health Care -Associated Infection Preventionist Wayne Higgins ─ Government Operations Consultant I Melani Dickenson , MPH, CPH ─ HAI Prevention Epidemiologist Soundarya Soma , MPH ─ HAI Data Specialist Frances Vaughn , MPH, MLS (ASCP) CM ─ HAI Epidemiologist Luz Caicedo ─ HAI Epidemiologist Sebastian Arenas ─ Biological Scientist IV Division of Disease Control and Health Protection To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. 5/22/2017 5 Florida 67 Counties Population of 20,271,272 Per 2015 Census 223 Acute-Care Hospitals 28 Long-Term Acute-Care Hospitals (LTACHs) 20 Rehab Hospitals Division of Disease Control and Health Protection To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. 5/22/2017 6 Mission to Care FHA HIIN 3
Chasing Zero Infections - Connecting the Dots Thursday, May 25, 2017 to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Florida’s Clostridium difficile Infection (CDI) Rates 2015 Standard Infection Ratio 0.00-0.69 0.70-0.90 0.91-1.06 1.07-1.18 1.18-1.85 CMS data is unavailable Data from Hospital Compare 2016 Division of Disease Control and Health Protection To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. 5/22/2017 7 Past Initiatives State CDI Carpabenem- Electronic Jacksonville Asymptomatic Orlando Collaborative Metro CDI Bacteriuria Regional Resistant Laboratory 2010- Prevention (ASB) CDI Enterobacteriaceae Reporting for Collaborative - Klebsiella Antimicrobial Antibiotic Collaborative November Stewardship Surveillance Resistance Collaborative Surveillance 2011- in Nursing October Homes Statewide 2013 Hospital Antibiogram Division of Disease Control and Health Protection To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. 5/22/2017 8 Mission to Care FHA HIIN 4
Chasing Zero Infections - Connecting the Dots Thursday, May 25, 2017 to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Statewide CDI Collaborative Division of Disease Control and Health Protection To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. 5/22/2017 9 Jacksonville Regional Collaborative • Help health care facilities to evaluate current practices for preventing CDI and identify opportunities for process improvements • 21 facilities including acute care, long-term care, rehabilitation facilities, and skilled nursing facilities and nursing homes • Monthly meetings and one-on-one trainings Division of Disease Control and Health Protection To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. 5/22/2017 10 Mission to Care FHA HIIN 5
Chasing Zero Infections - Connecting the Dots Thursday, May 25, 2017 to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Jacksonville Regional Collaborative, Continued Progress made in acute-care facilities: • 83% always educate patients and their families about contact precautions for CDI. • 83% provide clinicians with instructions regarding recommended testing practices for the CDI test used in the facility. • 67% use contact precautions for patients with CDI for the duration of the hospitalization. Division of Disease Control and Health Protection To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. 5/22/2017 11 Jacksonville Regional Collaborative, Continued Progress made in long-term care: • 100% review antibiotic usage and formulate goals for promoting judicious use of antimicrobial agents. • 100% use sporicidal or bleach-based solutions for daily and terminal cleaning of CDI rooms. • 100% always use dedicated, noncritical medical items. Division of Disease Control and Health Protection To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. 5/22/2017 12 Mission to Care FHA HIIN 6
Chasing Zero Infections - Connecting the Dots Thursday, May 25, 2017 to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Orlando Regional Collaborative • Reduce health care onset and total CDI by 25% and have 90% compliance with adherence to isolation precautions and cleaning of high-touch surfaces • 11 health care facilities, including 10 acute-care hospitals and one rehabilitation hospital • Monthly meetings alternating between webinars and face-to-face Division of Disease Control and Health Protection To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. 5/22/2017 13 Statewide Asymptomatic Bacteriuria (ASB) Antibiotic Stewardship Project in Nursing Homes • Reduce inappropriate use of antibiotics for the treatment of asymptomatic bacteriuria in at least 4 out of the 8 participating nursing homes • Completed pre- and post-assessment questionnaires • Participated in 1-2 site visits Division of Disease Control and Health Protection To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. 5/22/2017 14 Mission to Care FHA HIIN 7
Chasing Zero Infections - Connecting the Dots Thursday, May 25, 2017 to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Statewide ASB Antibiotic Stewardship in Nursing Homes Goals and objectives achieved: • 88% (7/8) participating facilities implemented 3-5 strategies to support antibiotic stewardship for ASB. • 31 ASB antibiotic stewardship strategies were implemented in 7 nursing homes. • 88% (7/8) educated staff on proper procedures for sterile specimen collection. • 88 % (7/8) educated appropriate staff on the indications for treatment of ASB. Division of Disease Control and Health Protection To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. 5/22/2017 15 ASB Antibiotic Stewardship Projects in a Corporate Nursing Home Group • To help health care facilities evaluate the current practice of antibiotics used for the treatment of urinary tract infections and ASB and to identify opportunities for process improvements • 11 care centers participated • Completed a pre- and post-assessment, implemented training, and used tools to support best practices Division of Disease Control and Health Protection To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. 5/22/2017 16 Mission to Care FHA HIIN 8
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