State Update NHICEP Meeting March 17, 2015

(1)

New Hampshire Department of Health & Human Services

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, 2006-2015 YTD

(4)

State Flu Activity Week 9

March 1, 2015 - March 7, 2015

Outpatient ED and private provider visits for ILI still

elevated but decreasing

Still seeing increased influenza and

pneumonia-related 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.

(5)

Influenza Season Updates

2014-15 season to date, 785 specimens tested

454 positive (58 %) - 442 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)

(7)

(8)

Influenza-like Illness Outbreaks

Typically 10-30 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

(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

(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)

Beth Daly, MPH

Chief, Infectious Disease Surveillance Section 603-271-4927

erdaly@dhhs.state.nh.us

(14)

Katrina Hansen, MPH

HAI Program Manager

Roza Tammer, MPH

HAI Surveillance Coordinator

HAI Program Update

(15)

Updates

:

Program staffing

HAI funding

HAI activities

(16)

Program Staffing

In addition to two full-time staffed positions,

HAI has two interns this Spring/Summer

Two new interns

HCP vaccination reporting

(17)

Legislation

Two proposed HAI related legislative

additions/changes:

Study commission on regulation of healthcare

quality issues

(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

(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:

(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

(23)

HAI Activities

Annual NHSN workshops

Data validation

Annual reports

Investigations and outbreak response

Protocols/guidelines

Lean Process and Quality Improvement

(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 email 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 emailed 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

http://www.dhhs.nh.gov/dphs/cdcs/hai/publicatio

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

http://www.dhhs.nh.gov/dphs/cdcs/hai/documents/influ enza-vaccination-2013-14.pdf

Next year (14-15 season), HAI program will publish

a separate data report for ALFs and present data by

individual facility

(32)

HAI Activities

(33)

HAI in the News

(34)

CRE and duodenoscopes

Food and Drug Administration (FDA) released safety

alert on Feb 19th

http://www.fda.gov/MedicalDevices/Safety/Alertsand

Notices/ucm434871.htm

FDA is aware of and closely monitoring the association

between reprocessed endoscopes and

multidrug-resistant 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

(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

(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

(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

http://www.cdc.gov/hai/organisms/cre/cre-duodenoscope-surveillance-protocol.html

(38)

Katrina Hansen, MPH HAI Program Manager (603) 271-8325

Katrina.hansen@dhhs.state.nh.us

Roza Tammer, MPH

HAI Surveillance Coordinator (603) 271-5927

Roza.tammer@dhhs.state.nh.us

(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

(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

http://www.dhhs.nh.gov/dphs/cdcs/hai/publications.htm

http://www.dhhs.nh.gov/dphs/cdcs/hai/documents/influenza-vaccination-2013-14.pdf

http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm434871.htm

http://www.cdc.gov/hai/organisms/cre/cre-duodenoscope-surveillance-protocol.html