Transcription
The Targeted Assessment forPrevention (TAP) StrategyVirgie S. Fields, MS, CPHHealthcare-Associated Infections EpidemiologistHealthcare-Associated Infections and Antimicrobial Resistance ProgramVirginia Department of HealthMay 11, 20181
What is the TAP Strategy?Slide adapted from CDC.www.cdc.gov/hai/prevent/tap.html2
Previous Work 2016 - Health Quality Innovators (HQI) – MVHIN Project Maryland-Virginia HAI Improvement Network 36 Virginia hospitals voluntarily participated Monthly reporting 2016 – VDH TAP Letter sent to Hospital Administrators Included 2015 NHSN data for CAUTI and C. difficile Current: Virginia Hospital and Healthcare Association(VHHA) / Agency for Healthcare Research and Quality(AHRQ) Safety Program for ICUs Project 20 ICUs participating3
TARGET4
Target TAP Reports! Data from National Healthcare Safety Network(NHSN) Cumulative attributable difference (CAD) CAD # Observed – (# Predicted * SIRgoal) Positive CAD number of excess infections afacility would have needed to prevent to achievean HAI reduction goal during a specified timeperiod Negative CAD facility has reached the HAIreduction goal5
Example TAP Report for 2017Q3. Fictitious data.6
What HAI data are included? Virginia Reporting Regulations Central line-associated bloodstreaminfections (CLABSI) Adult, pediatric, and neonatal intensive careunitsAdult and pediatric medical, surgical,medical/surgical wards Catheter-associated urinary tractinfections (CAUTI) Adult and pediatric intensive care unitsAdult and pediatric medical, surgical,medical/surgical wards Surgical Site Infections (SSI) Colon proceduresAbdominal hysterectomies Laboratory-identified Events (LabID) MRSA bacteremiaClostridium difficile Total number of Virginia hospitalsreported data for HAI Type/Unit forspecified time periodExample TAP Report for 2017Q3. Fictitious -investigation/hai/reporting/
Standardized Infection Ratio (SIR) # Observed / # PredictedSIR Interpretation: If the SIR interpretation is Same, thenthe number of observed infections didnot significantly differ from the numberpredicted. If the SIR interpretation is Sig Higher,then the number of observed infectionswas significantly higher than thenumber predicted. If the SIR interpretation is Sig Lower,then the number of observed infectionswas significantly lower than thenumber predicted. If the SIR interpretation is N/A, then theSIR was not calculated because thenumber of predicted infections was lessthan 1.Example TAP Report for 2017Q3. Fictitious data.8
2020 Department of Healthand Human Services (HHS)National Targets (from 2015baseline) CLABSI: 50% Reduction(SIR 0.50) CAUTI: 25% Reduction(SIR 0.75) SSI: 30% Reduction(SIR 0.70) MRSA: 50% Reduction(SIR 0.50) CDI: 30% Reduction(SIR spExample TAP Report for 2017Q3. Fictitious data.9
Cumulative attributable difference(CAD) # Observed – (# Predicted * SIRgoal)Example: 8 – (4 * 0.5) 6 excess CLABSIs Positive CADs have been rounded up tothe next whole number Negative CADs are represented by ‘.’ Ranked by CAD among total number ofhospitals reporting for HAI Type/Unit Highlighted if hospital is ranked in theTop 5 Ranking of CADs is not intended to bepunitive nor indicative of performanceExample TAP Report for 2017Q3. Fictitious data.10
Example TAP Report for 2017Q3. Fictitious data.11
ASSESS12
Assessment Tools CDI, CLABSI, CAUTI assessment tools developed by CDCare available MRSA coming in late summer PDF Fillable version Save and email Print paper copy Scan and email VDH – REDCap versions of tools are available13
Assessment ToolsCDI TAP Facility Assessment f14
Assessment ToolsCDI TAP Facility Assessment Tool Assessment Tool may be done at the facility and/orunit-specific level Administer to variety of staff and healthcare personnel Frontline staff (e.g., Nurses, Certified NurseAssistants, Physicians) Mid-level staff (e.g., Director of InfectionPrevention, Unit/Nurse Managers) Facility’s senior leadership (e.g., CEO, CMO, COO) Environmental Services personnel Aims to capture awareness and perceptions related toCDI prevention policies and practices15
Assessment ToolsCDI TAP Facility Assessment Tool – Lab SectionOnly need tocompleted onceper facility byclinical lab abled.pdf16
Assessment ToolsCDI TAP Facility Assessment Tool – Antibiotic Stewardship PracticesOnly need tocompleted onceper facility bystewardship p-Section-Reader-Enabled.pdf17
Assessment Tools Partnering with District Epidemiologists REDCap links can be shared VDH HAI/AR Program will aggregate data to createfeedback report for facilities Individual responses are anonymous Assessments by infection type for individual hospitalswill take place at most annually, if needed18
Feedback ReportSlide adapted from CDC.19
Feedback ReportSlide adapted from CDC.20
Feedback Report Scoring methodologycreated to helpfurther targetprevention and trackprogressScoring is notintended to compareperformance acrossfacilitiesSlide adapted from CDC.21
PREVENT22
Prevent Use feedback report to drive action Work with District Epi and HAI/AR Program tointerpret results and highlight identified gaps Explore results by Respondent Role and/or Unit Identify resources Outline next steps23
TAP Implementation GuidesDomainsalign tap/cdiff.html24
123Feedback Report – Implementation Guide – Partner ff.htmlVanderbilt University Medical Center25
Data Reports – Anticipated Schedule26VDH ReportFrequencyAnticipatedReleaseWho receivesreport?NHSN DataCleaning ReportsQuarterlyTwo weeks beforeCMS deadlineIPsTAP ReportsQuarterlyTwo weeks afterCMS deadlineIPs District/RegionalEpidemiologistsHAI AnnualReportAnnually2016 data –June/July 2018Public - Website
Feedback Received Include number of predicted infections in TAP Reports Historical data Aggregating to half-years or last 4 quarters27
Final Thoughts National framework – data for action Grant metric for VDH Rankings are not meant to be punitive or comparative Assessments are not meant to be done more than oncea year, if necessary Encourage communication between hospitals and localhealth departments The reports and the strategy are adaptive Feedback is appreciated We are here to support you!28
Key ResourcesNew NHSNMRSA TAPReport!CDC TAP Strategy nning TAP Reports in NHSN (Individual -Guide-forIndividual-Facility-User.pdfNHSN Training Videos and gedu/trainingvideos.htmlCDI TAP Facility Assessment Tool inInstructions.pdf29
homehttp://www.vhha.com/30
THANK YOU!ANY QUESTIONS/COMMENTS?31
CRE/CRPA Surveillance in Virginia:UpdatesTisha Mitsunaga, DrPH, ScMCDC/CSTE Applied Epidemiology FellowHealthcare-Associated Infections and Antimicrobial Resistance ProgramVirginia Department of HealthMay 11, 201832
Updates to GuidancePreviouslyGoing forwardPublic health contacting ordering Public health contacting orderingfacility for any CRE/CRPA isolate facility for any CP-CRE/CP-CRPA/pansubmission to DCLSresistant result from DCLS33DCLS calling submitting lab withall results within 2 daysDCLS calling submitting lab withpositive results only within 2 daysRecommendation for privateroom for all CPO patientsRecommendation for private room forall CPO patients in hospitals, withpatient or staff cohorting for LTCFresidentsMid-Atlantic Regional Laboffering colonization screeningthrough DCLS/VDHMid-Atlantic Regional Lab offeringcolonization screening plus admissionscreening through DCLS/VDH
CRE/CRPA Testing To Date(from 3/26/18) Volume: 1 isolate/day received Sentinel labs: 10 (Fairfax County Health Department funnelingspecimens from Fairfax County labs) Date of collection to Date received by DCLS: 6 days average (2-10days range) Healthcare exposure: hospital, long-term care, outpatient, none Gender: 50/50 males/females Average age: 62 years (22 – 96 years age range) Specimen source: 70% urine, 20% respiratory/sputum Organisms: P. aeruginosa (17), K. pneumoniae (10), E. cloacae (9),E. coli (5), S. marcescens/E. aerogenes (4), P. mirabilis (3) Pre-surveillance: 1 NDM, 1 KPC reported in January 201834
DCLS Isolate Submission and Results(current as of May 10, 2018, almost 7 weeks in)Total # isolates tested52CRETotal # CRE isolates (% of total isolates)35 (67%)Total # CP-CRE isolates (% of total CRE)14 (40%)CRPATotal # CRPA isolates (% of total isolates)17 (33%)Total # CP-CRPA isolates (% of total CRPA)0 (0%)PatientsTotal # individual patients46Total # CPO patients (% of total patients)11 (24%) All CP-CRE to date has been KPC (24% of all patientstested)35
Future Considerations Patients are coming from different settings Follow-up also occurring across settings Different education needs for patients and providers Clinician letter in development Strongly encourage interfacility communication! Understand regional endemicity of KPC Strongly encourage labs to submit isolates (only 20% ofsentinel labs are currently submitting)! Practical recommendations for long-term care settings36
THANK YOU!ANY QUESTIONS/COMMENTS?37
VDH HAI/AR ProgramSeth Levine, Epidemiology Program ManagerSarah Lineberger, HAI Program ManagerShaina Bernard, AR CoordinatorCarol Jamerson, Nurse EpidemiologistVirgie Fields, HAI EpidemiologistEmily Valencia, AR EpidemiologistTisha Mitsunaga, CDC/CSTE Applied Epidemiology FellowAshley Rose, HAI Program AssistantThank you – any questions?Email us at:HAI@vdh.virginia.gov38
The Targeted Assessment for Prevention (TAP) Strategy Virgie S. Fields, MS, CPH Healthcare-Associated Infections Epidemiologist. Healthcare-Associated Infections and Antimicrobial Resistance Program. Virginia Department of Health. May 11, 2018
