Objectives Introducing the Florida Department of Healths Health - - PDF document

Chasing Zero Infections - Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Thursday, May 25, 2017 Mission to Care FHA HIIN 1

To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Division of Disease Control and Health Protection

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

5/22/2017 1

To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Division of Disease Control and Health Protection

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

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Chasing Zero Infections - Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Thursday, May 25, 2017 Mission to Care FHA HIIN 2

To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Division of Disease Control and Health Protection

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.

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To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Division of Disease Control and Health Protection

HAI Advisory Board

Florida Professionals in Infection Control Florida Infectious Disease Society Florida Hospital Association Agency for Health Care Administration Hospital Corporation of America Florida Health Care Association SME in Quality Improvement & Hospital Epidemiology

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Chasing Zero Infections - Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Thursday, May 25, 2017 Mission to Care FHA HIIN 3

To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Division of Disease Control and Health Protection

Team Introduction

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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

To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Division of Disease Control and Health Protection

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

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Chasing Zero Infections - Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Thursday, May 25, 2017 Mission to Care FHA HIIN 4

To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Division of Disease Control and Health Protection

Florida’s Clostridium difficile Infection (CDI) Rates 2015

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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

To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Division of Disease Control and Health Protection

Past Initiatives

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Jacksonville Metro CDI Prevention Collaborative November 2011- October 2013 State CDI Collaborative 2010- Asymptomatic Bacteriuria (ASB) Antibiotic Stewardship in Nursing Homes Orlando Regional CDI Collaborative Statewide Hospital Antibiogram Electronic Laboratory Reporting for Antimicrobial Resistance Surveillance Carpabenem- Resistant Enterobacteriaceae

• Klebsiella

Surveillance Collaborative

Chasing Zero Infections - Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Thursday, May 25, 2017 Mission to Care FHA HIIN 5

To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Division of Disease Control and Health Protection 5/22/2017 9

Statewide CDI Collaborative

To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Division of Disease Control and Health Protection

Jacksonville Regional Collaborative

• Help health care facilities to evaluate current

practices for preventing CDI and identify

• pportunities 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

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Chasing Zero Infections - Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Thursday, May 25, 2017 Mission to Care FHA HIIN 6

To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Division of Disease Control and Health Protection

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.

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To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Division of Disease Control and Health Protection

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.

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Chasing Zero Infections - Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Thursday, May 25, 2017 Mission to Care FHA HIIN 7

To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Division of Disease Control and Health Protection

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

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To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Division of Disease Control and Health Protection

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

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Chasing Zero Infections - Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Thursday, May 25, 2017 Mission to Care FHA HIIN 8

To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Division of Disease Control and Health Protection

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.

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To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Division of Disease Control and Health Protection

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

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Chasing Zero Infections - Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Thursday, May 25, 2017 Mission to Care FHA HIIN 9

To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Division of Disease Control and Health Protection

ASB Antibiotic Stewardship Projects in a Corporate Nursing Home Group

• 23% decrease in culture rate from baseline to
• utcome measurement time period
• Fewer cultures collected from residents without

symptoms of urinary tract infections

• Recommended designating staff to specialize in

urine collection to decrease urine specimen contamination

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To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Division of Disease Control and Health Protection

Statewide Hospital Antibiogram

• Project to create first state-level antibiogram
• Began in 2014 and entailed the process of creating a

collective antibiogram

• Total of 60 facilities participated in the pilot project
• DOH decided to create an antibiogram analysis function

in Merlin

• Merlin is able to produce regional/statewide

antibiograms but is dependent on facilities reporting through electronic laboratory reporting (ELR)

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Chasing Zero Infections - Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Thursday, May 25, 2017 Mission to Care FHA HIIN 10

To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Division of Disease Control and Health Protection

Electronic Laboratory Reporting for Antimicrobial Resistance Surveillance

• Preliminary data are available from enrolled facilities in 2015.
• In 2013 there were approximately 70 acute-care hospital labs

in FL enrolled and submitting susceptibility data.

• Advantages in Florida: State statute mandates reporting and

standard reporting format for those labs enrolled in ELR.

• Florida is also at risk due to the pronounced domestic and

international travel that occurs in the state.

• Electronic surveillance increases the ability to detect patterns

quickly.

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To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Division of Disease Control and Health Protection

Antibiotic Stewardship Education

• Six quarterly webinars have been completed with 900+ in

attendance.

• The presenters have included pharmacists, advanced

registered nurse practitioners, and infectious disease physicians.

• The next webinar will be held the first week of June 2017.
• The speaker will be Dr. Florian Daragjati, Pharm. D., BCPS.,

Pharmacy Coordinator at Ascension Health Center for Antimicrobial Stewardship.

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Chasing Zero Infections - Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Thursday, May 25, 2017 Mission to Care FHA HIIN 11

To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Division of Disease Control and Health Protection

National Health and Safety Network (NHSN) Antimicrobial Use and Resistance (AUR) Module

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Reporting into the AUR Module at this time is voluntary

• Not a part of CMS Quality Reporting
• Included as one of the options for Public Health

Registry reporting for Meaningful Use Stage 3

• Requires data from both the antibiotic use (AU) and

antibiotic resistance (AR) options in order to receive credit

To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Division of Disease Control and Health Protection

NHSN AUR Module

• Antibiotic Resistance
• Purpose: Facilitate evaluation of antimicrobial

resistance data using a standardized approach and improve awareness of a variety of AR issues to aid in clinical decision making and prioritize transmission prevention efforts.

• Antibiotic Usage
• Purpose: Provide a mechanism for facilities to report

and analyze antimicrobial usage as part of antimicrobial stewardship efforts at their facility.

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Chasing Zero Infections - Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Thursday, May 25, 2017 Mission to Care FHA HIIN 12

To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Division of Disease Control and Health Protection

Participation Requirements

Who can participate in the AR Modules?

• Hospitals that have:
• Electronic Laboratory Information System (LIS)
• Admission Discharge Transfer (ADT) System
• Ability to collect and package data using HL7

standardized format: Clinical Document Architecture

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To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Division of Disease Control and Health Protection

Participation Requirements, Continued

Who can participate in the AU Modules?

• Hospitals that have:
• Electronic Medication Administration Record (eMAR)
• Bar Coding Medication Administration (BCMA) systems
• Ability to collect and package data using HL7

standardized format: Clinical Document Architecture

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Chasing Zero Infections - Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Thursday, May 25, 2017 Mission to Care FHA HIIN 13

To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Division of Disease Control and Health Protection

NHSN AUR Module Reporting In Florida

• Currently 2 general acute care facilities submitting data

into the AUR module

• Facility stats:
• 300 – 442 licensed beds
• Pharmacy is leading the reporting for these hospitals

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To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Division of Disease Control and Health Protection

Interested in participating in the NHSN AUR Module?

• DOH HAI Program is currently recruiting 5

facilities to participate in the NHSN AUR Module.

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Chasing Zero Infections - Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Thursday, May 25, 2017 Mission to Care FHA HIIN 14

To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Division of Disease Control and Health Protection

The DOH HAI Program is able to facilitate participation in the NHSN AUR module via provision of technical assistance and identification of appropriate vendors.

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Further questions?

To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

Division of Disease Control and Health Protection

Questions

Nychie Dotson, MPH, CIC, CPHQ Florida Department of Health Division of Disease Control and Health Protection Bureau of Epidemiology Phone: 850-408-0756 Email: Nychie.Dotson@flhealth.gov

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