State Update NHICEP Meeting March 17, 2015

Transcription

1 State Update NHICEP Meeting March 17, 2015

2 State Update Agenda: General Infectious Disease Update Healthcare-Associated Infections Update CRE and duodendoscopes

3 Reported Outbreaks, NH, YTD YTD: Jan Mar 12, 2014

4 State Flu Activity Week 9 March 1, March 7, 2015 Outpatient ED and private provider visits for ILI still elevated but decreasing Still seeing increased influenza and pneumoniarelated deaths but decreasing 41 influenza deaths this influenza season identified; no children Current lab evidence in 2 of the 10 counties Hillsborough and Rockingham There were 8 counties that had increased ARI or ILI outbreaks and recent lab evidence. Activity reported as Widespread

5 Influenza Season Updates season to date, 785 specimens tested 454 positive (58 %) AH3, 2 H1N1, 10 B Last year, 219/438 (50%) of the total specimens submitted were positive for flu, and most (96%) of positive specimens were 2009 A (H1N1) ~%70 of AH3 specimens in US are not the same strain that is in the vaccine

6 State Influenza Activity

7 State ARI Activity

8 Influenza-like Illness Outbreaks Typically ILI outbreaks each flu season Since Jan 1, 2015: 64 ILI outbreaks Most in LTCF and some schools Please report suspected outbreaks to NH DHHS Follow NH DHHS prevention recommendations Please let us know if you have a problem getting large volumes of oseltamivir for prophylaxis during a facility outbreak

9 Vaccination CDC released interim Influenza vaccination effectiveness estimates Flu vaccine this season reduced risk of having to go to the doctor because of flu by 23 % among people of all ages. Likely reflects that circulating H3N2 viruses are genetically different from the H3N2 vaccine virus Vaccine can still prevent some infections and lessen related complications Hospitalized, severely ill, or high-risk suspect flu patients should be treated with antiviral medications Do not wait for confirmation prior to initiating treatment

10 Influenza? or Measles? or Mumps? Cases of parotitis have been identified in persons with lab-confirmed influenza NH participating in a case control study Persons with lab-confirmed influenza B infections presenting with a maculopapular rash Providers should be aware and consider appropriate lab testing Report lab-confirmed flu cases with parotitis or maculopapular rash to NH DHHS

11 Ebola 24,000 reported cases of EVD in Guinea, Liberia and Sierra Leone ~10,000 reported deaths Declining since Dec, still some pockets in G and SL No new cases in 2 weeks in Liberia

12 Ebola Continuing to monitor returning travelers in NH Most low risk but a few some risk No suspect cases in NH to date New funding available in May to support hospital preparedness to be awarded Hospitals and healthcare coalitions (EMS) NH DHHS working with NHHA and partners to plan for these funds

13 For More Information: Beth Daly, MPH Chief, Infectious Disease Surveillance Section

14 HAI Program Update Katrina Hansen, MPH HAI Program Manager Roza Tammer, MPH HAI Surveillance Coordinator

15 Updates: Program staffing HAI funding HAI activities HAI in the news

16 Program Staffing In addition to two full-time staffed positions, HAI has two interns this Spring/Summer Two new interns HCP vaccination reporting Oral health quality improvement project

17 Legislation Two proposed HAI related legislative additions/changes: Study commission on regulation of healthcare quality issues Additions to RSA 151 (HAI law)

18 Legislation Proposed study commission on regulation of healthcare quality issues Recent infection control investigations revealed gaps and/or lack of specific regulatory oversight Aim to assess oversight, regulation and reporting of patient safety and healthcare quality issues A clear understanding of roles/responsibilities of all regulatory and oversight entities will improve response to reported patient safety and healthcare quality concerns

19 Legislation Proposed additions to RSA 151 (HAI law) End stage renal dialysis (ESRD) centers Reasons: Increased risk of infection (~37,000 BSIs in 2009) CMS collects this information through ESRD QIP CSTE position statement encouraging state health departments to include ESRD facilities in reporting requirements Measures: Positive blood culture and vascular access site infection IV antimicrobial start time HCP Flu vaccination

20 Legislation Proposed additions to RSA 151 (HAI law), continued Assisted living and long-term care facilities Reasons: NH DPHS collects data for some healthcare facilities Coverage rates for these facilities remains low Typically report more influenza related clusters and outbreaks than other healthcare settings Experience with these clusters and outbreaks have depicted poor HCP influenza vaccination rates Measures: HCP Flu vaccination

21 Funding Awarded $107,679 federal funds last August Grant funds: 1 position Total HAI budget: $214,377 Total for fees: $84,832 Applied unspent funds from prior year ($21,866) Facilities billed January Following up with facilities that still haven t paid Fees cover additional program costs One HAI position, supplies, some travel, resources for workshops, data validation

22 Funding New application pending for federal funds Supplemental ELC Ebola Preparedness Funds 3 year grant period Wish list: 1 nurse position Work to assess Ebola readiness and assist with HAI investigations Conduct infection control assessments At urgent care centers Build program and state IC infrastructure Bring APIC trainings to NH

23 HAI Activities Annual NHSN workshops Data validation Annual reports Investigations and outbreak response Protocols/guidelines Lean Process and Quality Improvement Healthcare personnel influenza vaccination

24 HAI Activities Annual NHSN workshops for hospitals and ASCs Day-long workshops to share HAI program updates, NHSN protocol changes, training, and other HAI surveillance topics Data validation for NHSN reported data Selected vendor and currently in negotiations Includes plan to validate data at hospitals and ASCs Two-year contract with option to renew Will facilities once vendor approved by Governor and Council (approx. mid/late April)

25 HAI Activities Annual reports Data reconciliation in progress Iterative, collaborative process to confirm data with reporting facilities prior to publication Timeline ed to facilities February 13, 2015 Deadlines are firm Process expected to be more efficient New report template Previous review of quarterly reports Plans to update format of annual report to align with other Division documents

26 HAI Activities Outbreak response/investigations as-needed Infection control breaches or concerns Building partnerships with NH licensing boards Drug diversion Protocol, presentations, EMS group New investigations Fungal infections following cornea transplant procedures S. maltophilia in patients following bronchoscopy

27 HAI Activities Common/recurring themes from investigations ICP turnover and administrative support Drug diversion, reporting, and determining public health role Infection control oversight Single-dose vials vs. multi-dose vials Federal involvement (i.e., FDA) Infection vs. colonization Staffing time and resources (facilities and HAI Program)

28 HAI Activities MDRO CDECC document Complete and posted to DPHS website ns.htm Thank you to our workgroup members and other contributors! Lynda Caine, Anne Nolan, Margaret Crowley, Margaret Franckhauser, Steve Crawford, Terri Kangas-Feller, Jill Drouin, HAI Program staff Distribution Presentations throughout fall 2014 and others scheduled for spring 2015

29 HAI Activities LEAN Process Improvement Techniques: Quarterly report process Significantly reduced staff time and improved data quality by reducing potential for transposing errors Quality improvement: Oral health infection prevention Surveyed oral healthcare personnel about educational interests regarding infection control Will be engaging a summer intern and assembling a workgroup to plan how to provide these services Continuing activities Roza will take a Lean Green Belt Training in March Taking part in IDSS quality improvement project around data requests

30 HAI Activities HCP influenza vaccination reporting Hospitals, ASCs, assisted living/adult day care/adult residential facilities (ALFs) required to report Transition from web-based survey to NHSN Most hospitals and some ASCs already report this data into NHSN Hospitals may submit HCP data via NHSN ASCs and ALFs will continue to report via web-based survey Hospitals to report policy and patient data (where applicable) to HAI Program via web-based survey Regardless of method of reporting, NHSN protocols must be used

31 HAI Activities HCP Influenza vaccination reports Published data brief on HAI website 4-page document including facility group data and comparison data enza-vaccination pdf Next year (14-15 season), HAI program will publish a separate data report for ALFs and present data by individual facility Same format as hospital and ASC reports

32 HAI Activities HCP Influenza vaccination report example

33 HAI in the News CRE and duodenoscopes

34 CRE and duodenoscopes Food and Drug Administration (FDA) released safety alert on Feb 19th Notices/ucm htm FDA is aware of and closely monitoring the association between reprocessed endoscopes and multidrugresistant bacterial infections caused by CRE, such as Klebsiella species and Escherichia coli In total, from January 2013 through December 2014, the FDA received reports of 75 MDRs encompassing approximately 135 patients in the United States relating to possible microbial transmission from reprocessed duodenoscopes

35 CRE and duodenoscopes Recommendations for facilities/providers Follow all manufacturer instructions for cleaning and processing closely Report problems with reprocessing the device to the manufacturer and to the FDA, as described below Implement comprehensive quality control program for reprocessing duodenoscopes Inform patients of the benefits and risks associated with ERCP procedures Discuss with patients what they should expect following the ERCP procedure and symptoms that should prompt additional follow-up

36 CRE and duodenoscopes Recommendations for patients Discuss the benefits and risks of procedures using duodenoscopes For most patients, the benefits of ERCP outweigh the risks of infection ERCP often treats life-threatening conditions that can lead to serious health consequences if not addressed Understand what symptoms would require prompt evaluation and follow-up

37 Interim CDC Surveillance Protocol 3/12: CDC released a new protocol offering hospitals an option for detecting bacterial contamination of duodenoscopes Facilities wishing to test duodenoscopes for bacterial contamination after cleaning and disinfection may follow these protocols Step by step approach, including Suggestions for how scopes should be sampled Options for frequency and types of sampling How to test samples in the lab How to interpret lab results

38 For More Information: Katrina Hansen, MPH HAI Program Manager (603) Roza Tammer, MPH HAI Surveillance Coordinator (603)

39 CRE and duodenoscopes: Survey Lynda Caine, ICP at Concord Hospital, surveyed 13 hospitals Some preliminary information: 9 (69.2%) of hospital ICPs surveyed perform ERCP procedures Of those 9 hospitals, 4 have Pentax ED and 4 have Olympus scopes None of those 9 hospitals culture scopes routinely Use other quality measures such as channel checks, culture only if suspicious, or use ATP to test following disinfection No standardized protocol

40 CRE and duodenoscopes: Survey Preliminary information, continued: 7 (77.8%) require competencies for endoscope cleaning, 1 is in the process and the other facility plans to work with surgical services Mixed approach to training Once annually to four times a year 8 (88.9%) not changing practices since FDA safety communication Reviewing current practices, gap analysis, or are planning some changes