Topics Current regulations and reporting of outbreaks Major changes - PDF document

Conference For Humbaugh 11/07/2014 Healthcare Transparency & Patient Safety 2 Topics  Current regulations and reporting of outbreaks  Major changes to regulations  Definitions  Simultaneous reporting of data to both National Healthcare Safety Network (NHSN) and Kentucky Conference for Department for Public Health (DPH) Healthcare Transparency & Patient Safety  Electronic laboratory reporting of multidrug Kraig E. Humbaugh, M.D., M.P.H. resistant organisms beginning in October 2016 Kentucky Department for Public Health November 7, 2014  Advantages of reporting 2 3 4 Population Health Surveillance for Ultimate Goal Communicable Diseases  From the French: “to watch over”  Surveillance helps to call attention to unusual events or Control and reduce diseases of numbers of events.  Gaining awareness of a potential public health problem public health importance and from 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 Remember!  Kentucky Revised Statute 214.010  “Every physician and advanced practice registered nurse shall report all diseases HIPAA Privacy Rules do not change the state designated by administrative regulation of requirement for reporting diseases to the the Cabinet for Health and Family Services state or local health department. However, as reportable” an additional notation should be made in  902 Kentucky Administrative Regulation 2:020 the patient’s record that the information  Delineates who should report, the diseases was shared with the health department. and outbreaks to be reported, and how they are to be reported 5 1

Conference For Humbaugh 11/07/2014 Healthcare Transparency & Patient Safety 7 8 Who is responsible for infectious What’s Reportable to Public Health in KY Now?  Certain specific illnesses, or disease surveillance?  State Level:  Unexpected patterns of cases or deaths  Examples:  State Epidemiologist  Medical Epidemiologists  Large numbers ill with similar syndrome  Infectious Disease Epidemiologists  Failure of common disease to respond to usual therapy  Nurse Consultants  Unusual geographic or seasonal distribution  Other DPH staff  Atypical aerosol, food or water transmission  Local Level:  Healthcare Associated Infections are only reportable as “outbreaks”  Regional Epidemiologists  Reports can be made to either the state or local health  Public Health Nurses department  Environmental Health Specialists (occasionally) 9 10 Traditional Passive Surveillance What does Public Health do with the reports?  Assists in determining whether outbreak is Relies on timely recognition and reporting of certain types of disease or clusters of illness. occurring, case investigation, and prevention/control of other cases  Presumes thorough knowledge and correct diagnosis of illness by clinician  In the case of healthcare facilities, can assist in providing guidance for control and  Presumes that all reportable diseases or with more detailed testing unusual disease groupings will be reported to the health department  Can help determine if facility outbreaks are interrelated across county and state lines  Presumes reporting will occur promptly 11 Reported Disease Outbreaks by Organism, Kentucky, 2006 ‐ 2014 2012 Investigations 2013 Investigations 250  8,466 total investigations  9,689 total investigations 200  Lab report  Lab report 2014  Morbidity report from hospital  Morbidity report from hospital 2013 150 2012  Faxed EPID 200 Form  Faxed EPID 200 Form 2011 Count 2010  Campylobacteriosis= 552  Campylobacteriosis= 683 2009  Salmonellosis = 757  Salmonellosis = 562 2008 100 2007  STEC = 120  STEC = 177 2006  HAV, acute = 83  HAV, acute = 84 50  HBV, acute = 275 (509 chronic)  HBV, acute = 289 (589 chronic)  HCV, acute = 344 (2,573 chronic or  HCV, acute = 321 (3,222 chronic or resolved) resolved) 0  Influenza isolates = 516  Influenza isolates = 1,195  Pertussis = 741  Pertussis = 499 Organism Source: Kentucky NEDSS Data Source: Kentucky Outbreak Report Database 2

Conference For Humbaugh 11/07/2014 Healthcare Transparency & Patient Safety 14 Disease Outbreaks by Year by Organism, Kentucky, 2006 ‐ 2014 Reported Disease Outbreak Settings, Kentucky, 2006 ‐ 2014 160 VRE 400 Varicella Unknown etiology STEC 350 Shigella 140 Scabies Salmonella Rhinovirus 300 Respiratory Unknown 120 Pseudomonas Pertussis Nontuberculosis mycobacterium 250 Norovirus 2014 100 MRSA 2013 Count Mycobacterium wolinskyi 2012 200 Listeria 2011 Legionella Count 2010 80 Hepatitis A 2009 Hand, Foot, and Mouth 150 Giardia 2008 GI Unknown 2007 60 ESBL 2006 100 Enterovirus/Rhinovirus Cryptosporidium C. perfringens 40 CRE 50 C. difficile Chlorine Exposure Campylobacter 0 Botulism 20 B. cereus B. cepacia Aseptic Meningitis Acinetobacter 0 2006 2007 2008 2009 2010 2011 2012 2013 2014 Year Setting Source: Kentucky Outbreak Report Database Source: Kentucky Outbreak Report Database 15 Reported Disease Outbreaks, Kentucky, 2006 ‐ 2014 Organism 2006 2007 2008 2009 2010 2011 2012 2013 2014 Acinetobacter 0 0 0 0 1 1 0 0 1 Aseptic Meningitis 0 0 0 0 0 1 0 0 0 B. cepacia 0 0 0 0 0 0 0 1 0 B. cereus 1 0 0 0 0 1 0 0 0 Healthcare Facility Disease Outbreaks by Organism, Kentucky, 2006 ‐ 2014 Botulism 0 0 0 0 1 0 0 0 0 Campylobacter 0 0 1 1 0 0 2 1 1 200 Chlorine Exposure 0 0 0 0 1 0 0 0 0 C. difficile 0 0 0 0 1 2 1 3 0 180 CRE 0 0 0 0 0 0 1 1 0 C. perfringens 0 0 0 0 0 0 1 0 0 Cryptosporidium 0 1 0 0 1 1 1 2 0 160 Enterovirus/Rhinovirus 0 0 0 0 0 0 0 0 1 ESBL 0 0 0 0 0 0 0 0 2 140 GI Unknown 0 0 0 0 38 20 57 24 25 Giardia 0 0 0 0 0 0 0 1 0 Hand, Foot, and Mouth 0 0 0 0 0 0 0 1 1 120 Hepatitis A 2 1 1 0 1 0 0 0 0 Count 2014 Legionella 0 0 0 0 0 0 1 0 2 100 Listeria 0 0 0 0 0 0 0 2 0 2013 Mycobacterium wolinskyi 0 0 0 0 0 0 0 1 0 2012 MRSA 0 0 1 0 0 1 1 3 0 80 Norovirus 6 8 6 20 27 33 36 50 30 2011 Nontuberculosis mycobacterium 0 0 0 0 0 0 0 1 1 60 2010 Pertussis 0 0 0 0 0 1 5 2 1 Pseudomonas 0 0 0 0 0 0 0 2 0 2009 40 Respiratory Unknown 0 0 0 0 0 0 4 1 3 2008 Rhinovirus 0 0 0 0 0 0 0 1 0 Salmonella 11 3 2 10 18 14 17 18 25 20 2007 Scabies 0 0 0 0 1 0 0 4 3 2006 Shigella 1 1 0 3 2 4 5 4 4 0 STEC 2 4 0 5 1 2 6 7 5 Unknown etiology 11 9 18 10 0 0 0 0 0 Varicella 0 0 0 0 0 0 1 0 1 VRE 0 0 0 0 0 0 0 0 2 Total 34 27 29 49 93 81 139 130 108 Organism Source: Kentucky Outbreak Report Database Source: Kentucky Outbreak Report Database 17 18 New Definitions New Definitions  Healthcare ‐ Associated Infection (HAI):  Healthcare ‐ Associated Infection (HAI) Outbreak:  An infection acquired by a person while  two or more HAIs that are epidemiologically receiving treatment for a separate condition linked or connected by person, place or time in a healthcare setting  Under the new regulation, certain HAIs would OR be reportable when the law goes into effect  a single case of an HAI not commonly through NHSN diagnosed (for example, legionellosis acquired  Cases of multidrug resistant organisms in a healthcare facility) would be reported electronically beginning in October 2016. 3