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Engaging long-term care facilities in HAI prevention: Assessing current practices and developing new resources Nimalie D. Stone, MD/MS Ambulatory and Long Term Care Team Division of Healthcare Quality Promotion CSTE Annual Conference June 13, 2011 *Nothing to disclose National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion Session Objectives • Provide examples of state projects that are raising awareness, developing resources, and engaging long-term care facilities (LTCF) in infection prevention and control activities. – Understand the current challenges facing infection control programs in LTCF – Describe approaches to developing resources to improve infection prevention and control activities in the LTC setting – Understand the opportunities and challenges to engaging and sustaining HAI prevention programs for LTCF Acute care has a shrinking role in healthcare delivery Acute Care Facility Home Care Tranquil Gardens Nursing Home Long Term Care Facility Outpatient/ Ambulatory Facility What is “long term care”? • Long-term care is a variety of services that includes medical and non-medical care to people who have a chronic illness or disability. – Long-term acute care hospitals, chronic ventilator care – Skilled nursing facilities/ Rehabilitation facilities – Nursing homes (custodial care / dementia care) – Assisted-living facilities – Hospice – Home-based care / Senior day care services http://www.medicare.gov/longTermCare/static/home.asp Changing population in NHs • 3.2 million residents received care in 15, 956 certified NH/SNF in the US in 2008 – Acute care hospitals are the primary source of new admissions (90% of facilities take post-acute care) • From 1999 to 2008 – 10% increase in the number of residents cared for in NHs – Increasing proportion of individuals under the age of 65 are receiving care in NHs (13.6% in 2008) • Custodial care has shifted to assisted-living facilities (ALFs) – Fastest growing segment of LTC – 975,000 beds in 2004 (>2x the numbers in the 1990’s) Nursing Home Compendium 2009, CMS Growing complexity in the NH resident population Increasing post-acute care population Growing medical complexity and care needs Increasing exposure to Community-based devices, wounds and care antibiotics High prevalence of multidrugresistant organisms Dynamic movement across healthcare settings Impacts where healthcareassociated infections manifest Acute care Tranquil Gardens Nursing Home Long-term care Burden of HAIs in US NHs* Very limited data on national incidence of HAIs Estimated 1.6-3.8 million infections annually Account for ~30-50% of hospital transfers Including costs from hospitalization, likely results in >1 billion $ in additional health costs annually Rate of deaths from infections ranges from 0.04 to 0.71 per 1000 resident-days >100,000 deaths/year *Extrapolated from small studies over 10 years old in Strausbaugh LJ et al. ICHE 2000. 21(10): 674--679 Updated NH regulations for Infection Control - 2009 • Collapsed F441, F442, F443, F444, F445 into a single tag • Expanded from 8 pages in 1995 to 38 pages and including an investigative protocol • Incorporates/references many CDC guidelines for IC in healthcare settings CMS Manual System, Pub 100-07, Transmittal 51 “Interpretive Guidelines for Long-Term Care Facilities, Tag F441”, 7-2009 National NH IC Citation Trends, 2000-2010 Data courtesy of Ed Mortimer, CMS Survey&Cert., March2011 Challenges for LTC infection prevention programs Lack of trained/dedicated infection prevention staff Limited guidance for infection surveillance methodology in LTC Absence of national benchmarks Limited ability to relate to clinical practices such as antibiotic utilization Limited evidence-based prevention practices which have been evaluated in LTC settings Communication barriers of HAI risks and exposures made available at transitions of care between acute and LTC facilities Promoting state HAI prevention work in LTC • 14 state plans mentioned specific interest in including or expanding prevention work into LTC – Most anticipated work starting in 2011 – Some already had active programs for LTC or plans to include them in initial collaboratives • LTC Prevention Collaborative Calls – 20 -25 states participating on a given call – Calls facilitate for state progress updates, information and resource sharing, highlighting successes State Initiatives for Engaging LTC • Implement needs assessments for longterm care facilities • Develop infection control resources and/or training programs • Include long-term care facilities in specific HAI prevention collaboratives LTC Baseline Prevention Practices Assessment Tool • Completed by the primary person responsible for coordinating day-to-day infection prevention and control activities for the facility • Primary domains about the program – Personnel resources – Policies/ specific activities – Sufficiency of program resources Highlighting State HAI Prevention Activities in LTC Introductions to LTC issues (5/2010) LTC Needs assessments/ IC training (7/2010) CDI/CA-UTI data and metrics for LTC (7/2010) LTC needs assessment tool implementation, featuring VT and GA (9/2010) Developing/sustaining IC training for LTC, featuring NE (1/2011) Prevention collaboratives for LTC, featuring VT and IN (3/2011) Regional MDRO prevention, featuring WA (5/2011) Take Home Points Changes in the LTC resident population has increased the risk of HAI in this setting Infection prevention in LTCF has taken greater priority nationally LTCF have many resource challenges to overcome to meet the goals of infection prevention CDC has developed programs and resources to promote expansion of state HAI prevention efforts in LTC Thank you!! Email: [email protected] with questions/comments For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: [email protected] Web: www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion