clifford mcdonald, m.d. senior adviser for science and integrity division of healthcare quality...
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Clifford McDonald, M.D.Senior Adviser for Science and IntegrityDivision of Healthcare Quality Promotion
Centers for Disease Control and Prevention
National Center for Emerging and Zoonotic Infectious Diseases
Division of Healthcare Quality Promotion
Healthcare-associated Infections and Antibiotic
Resistance
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
Many infections are caused by resistant microorganisms Carbapenem-resistant Enterobacteriaceae (CRE) Methicillin-resistant Staphylococcus aureus (MRSA)
National Healthcare Safety Network (NHSN): real-time data system
Evidence-based guidelines; the standard of care to prevent HAIs
CDC supports healthcare facilities and health departmentsto investigate and control outbreaks
CDC implements prevention strategies with public and private partners
CDC provides national and international laboratory expertise
CDC conducts applied research to inform prevention
CDC: Science and Data for Action
State Health Departments CDC assists in outbreak responses CDC releases state-specific progress
reports CDC serves as a reference laboratory CDC guides prevention collaboratives
Eliminating Healthcare Associated Infections
Strengthening public health- healthcare collaboration
CDC’s National Healthcare Safety Network is used to report infection data to CMS under pay for performance requirements
CDC infection prevention expertise helps populate surveyor checklists
CDC infection prevention expertise providing guidance on content and data collection
CDC outbreak investigations guide FDA product recalls
CDC infection prevention guidelines serve as the basis for checklists
CDC provides expertise for HHS HAI Action Plans
CDC provides data for tracking national progress
Healthcare Facilities CDC guidelines drive the standard of
care CDC’s NHSN provides data for local
improvement (e.g. HAI, antibiotic use)
NHSN is a national surveillance and quality improvement system 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
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CDC’s National Healthcare Safety Network (NHSN)
NHSN: Tracking infections in over 16,000 healthcare facilities nationwide*
HAI Event Number of Facilities Enrolled In NHSN
Initial Target Number of Facilities
ACUTE CARE HOSPITALS 5,900 5,000CLABSI - ICU† 3,450
3,400CAUTI - ICU 3,400
CLABSI – Non-ICU 1,700
4,000CAUTI – Non-ICU 2,250
SSI 3,900MRSA Bacteremia 4,550
C. difficile LabID Event 4,600
DIALYSIS FACILITIES 6,750 5,600
LONG TERM ACUTE CARE FACILITIES (LTAC) 575 430
INPATIENT REHABILITATION FACILITIES (IRF) 1,250 1,200
AMBULATORY SURGICAL CENTERS (ASC) 3,150 5,300
NURSING HOMES/SKILLED NURSING FACILITIES 280 15,000
* - Data as of February 19, 2015
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Target hospitals with highest number of
excess infections • AHRQ funded networks
• CMS funded networks
• Health Departments
• Other partners
NHSN DataOver 4,800
hospitals currently reporting CAUTI, CLABSI, and C. difficile data
Target
Partnering for Prevention
NHSN Data For ActionTargeted Assessment For Prevention (TAP)
Progress reducing healthcare-associated infections: 2008-2013
-50%
-40%
-30%
-20%
-10%
0%
-46%
-32%
-19%
*CLABSI: Central line-associated bloodstream infections†MRSA: Methicillin-resistant Staphylococcus aureus
Healthcare and HAIs have moved beyond hospitals….
Hospitals
Ambulatory facilities
Long-term care
Dialysis facilities
~5,000
~5,000
~16,000
~6,000
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Detect and Protect Regional prevention collaborative
H
HL L
Healthcare Facilities
Health Department
CRE surveillance(reporting of outbreaks)
Provide situational awarenessLab
supportProvide expertise, build capacity
Outbreak response, technical guidanceEducation and training
Facilitateinter-facility communication
Detect and ProtectAntibiotic Use and Resistance (AUR) Module
FY2015 proposed President’s budget will support developing AUR Module of NHSN: Collect data from healthcare facilities and improve antibiotic prescribing Use real-time electronic AU and AR data from healthcare facilities allowing rapid analysis Provide national benchmarks to compare antibiotic use and antibiotic resistance across facilities
Antibiotic Use Module Provides data to assess and improve
local and national appropriate antibiotic use
Lab, pharmacy data captured electronically
Addresses the need for standardized and accurate antibiotic use data
Provides essential data to prevent C.difficile through controlled antibiotic use
Antibiotic Resistance Module Monitoring of local, regional, national Resistance patterns in healthcare
settings Tracking of resistance patterns across
and between facilities and within communities
Innovations to improve patient safety
CDC prevention epicenters program
Unique research program in which CDC collaborates with academic investigators to conduct innovative infection control and prevention research
This collaboration protects patients by filling prevention knowledge gaps identified by CDC’s outbreak response and surveillance data
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
Conduct surveillance on infectious disease, foodborne disease, influenza, HAIs, and antibiotic resistance to estimate national burden numbers
Conduct applied research, e.g. risk factors and prevention strategies
EIP population (~44 million) representative of the U.S. (e.g. age, gender, race, population density, percent at or below poverty level)
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
CDC’s Clinical and Environmental Microbiology Laboratory
Assist EIP surveillance by providing reference testing and diagnostic capacity of pathogens causing HAIs and antibiotic resistant infections
Serve as national and an international reference laboratory for antimicrobial susceptibility testing
Develop and evaluate methods to reliably detect emerging antimicrobial resistance
Conduct applied research on improved detection methods for HAIs
Provide environmental microbiology methods for measuring contamination of healthcare environment
Assist in Healthcare-associated outbreak investigations Various settings, infection sources, and organisms Culture medical devices, medications, environmental samples Conduct typing of organisms
Additional Slides
Antibiotic Resistance
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In 2013, CDC identified four core actions to help fight antibiotic resistance:
Antimicrobial Resistance: The strategy
• Threat to economic stability
• Modern medicine is at risk
• Loss of effective antibiotic treatment could make routine infections deadly
Antibiotic resistance in the US
• Patients who receive specialized care will be at highest risk
• Need to act now or even drugs of last resort will soon be ineffective
Detect and Protect – FY16 proposal
A down payment to improve our country’s abilityto start tackling our biggest drug-resistant threats The FY 2016 President’s Budget requests
$264M to• Slow development of resistant bacteria
and prevent spread of resistant infections
• Strengthen surveillance to track AR threats and measure impact
• Advance development and use of rapid and innovative diagnostic tests
• Accelerate research and development for new antibiotics, other therapies, and vaccines
• Support partnerships for prevention, detection, control, and research
AR Initiative: key activities
CDC plans to award more than 85% of its FY 2016 AR initiative funding to States, communities, health care providers, universities, and other groups to: • Establish a “Detect” network of 7
regional labs to characterize emerging resistance and rapidly identify outbreaks of dangerous drug-resistant threats
• Double number of Emerging Infection Program sites from 10 to 20 to expand our ability to track all urgent and serious threats for focused prevention
• Establish State AR Prevention “Protect” Programs in 50 states and 10 large cities for health care to better track outbreaks, improve prescribing, and prevent infections
• Improve antibiotic prescribing in hospitals and across health care settings and target community AR threats
• Track how antibiotics affect the human microbiome and how the microbiome might protect humans from AR infections
• Greatly scale up rapid detection of AR infections transmitted to humans through food and other pathways
• Enhance collaboration and capacities to combat AR internationally
Antibiotic Resistance Initiative could reduce many infections
Substantial Cost Savings from Aggressive AR Intervention
Projected burden of healthcare-associated invasive MRSA,healthcare-associated CDI, healthcare-associated CRE,
and hospital-onset MDR Pseudomonas infections
2011 2012 2013 2014 2015 2016 2017 2018 20190
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
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Over 5 years prevention will result in:> 1/2 million AR infections avertedThousands of AR infection attributable deaths avertedBillions in medical costs averted
Maintaining status quo
Aggressive multisectoral intervention
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