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What It Is

The Healthcare-Associated Infection/Antibiotic Resistance (HAI/AR) Prevention Program aims to eliminate and prevent HAIs and AR organisms.

Program Goals

  • Identify and contain AR organisms
  • Promote appropriate  use of antimicrobials
  • Submit data submission to healthcare facilities for targeted intervention to decrease HAIs
  • Promote sustainable prevention infrastructure in healthcare facilities across the state

Objectives

  1. Identify and contain emerging pathogens and antibiotic resistant organisms of interest
  2. Improve outbreak identification, investigation and reporting
  3. Use the CDC National Healthcare Safety Network for surveillance of HAIs
  4. Support implementation of antimicrobial stewardship in healthcare facilities
  5. Provide education, mentorship and support to infection preventionist in all healthcare settings
  6. Facilitate evidence-based practices for infection prevention and control in healthcare settings through education and training, consultation and access to resource materials.

Required Reporting

HAIs and MDROs reporting regulation - 902 KAR 2:020 Reportable disease surveillance.

What is an HAI?

HAIs are infections patients develop while receiving healthcare. HAIs can occur in all health settings including, but not limited to, hospitals, ambulatory surgical centers, dialysis facilities, outpatient clinics (e.g., physicians' offices, health care clinics), rehabilitation centers and nursing homes. HAIs can be associated with procedures and the devices used in medical care and treatment.

Common HAIs include: central line associated bloodstream infection, catheter-associated urinary tract infection, surgical site infection, Clostridioides difficile and methicillin-resistant Staphylococcus aureus infections.  

What is Antimicrobial Resistance?

Antimicrobial/antibiotic resistance occurs when germs like bacteria and fungi have or develop the ability to defeat the drugs designed to kill them. Infections caused by antibiotic-resistant germs are difficult, and sometimes impossible, to treat. Consequently, antibiotic-resistant infections can extend hospital stays and require additional follow-up doctor visits and costly, toxic alternative therapies.

Antibiotic resistance does not mean a person is resistant to antibiotics, but, rather, bacteria have become resistant to antibiotics designed to kill them. To survive, germs are constantly finding new defense strategies to survive the effects of antibiotics.

Bacteria develop resistance through traits in their DNA. Often, resistance genes are found in DNA that carry genetic instructions from one germ to another. Some bacteria can share their DNA and make other germs resistant. More in-depth information can be found

Browse more in-depth information about bacteria antibiotic resistance

Kentucky State-Regional Infection Prevention and Epidemiology

Kentucky-State Regional Infection Prevention and Epidemiology advises the HAI/AR Prevention Program. Membership includes The Quality Improvement Organization for Kentucky, Kentucky Association for Healthcare Facilities, Kentucky Office of Inspector General, University of Kentucky, University of Louisville, Association of Professionals in Infection Control and Epidemiology, Kentucky Department for Public Health, Kentucky Hospital Association, Lexington-Fayette County Health Department, Kentucky Division of Laboratory Services, Friedell Committee, Leading Age and Public Health Preparedness Branch.  

More information about the program can be found in the State HAI Plan.

MDRO

Multi-drug resistant organisms (MDROs) are common germs, usually  bacteria, resistant to multiple antibiotics. MDROs can cause active infections with or without symptoms.

MDROs commonly spread by direct contact between people or with contaminated surfaces in the environment. MDROs can be difficult to treat, depending on the antibiotics to which the bacteria are resistant.

MDRO Reporting

MDRO reporting has been required since 2016 and involves completing the multidrug-resistant reporting form EPID 250  and providing the associated laboratory results. Instructions for filling out the EPID 250 are provided, as are more in-depth definitions for carbapenem-resistant organisms.

The MDRO report for 2018 is expected to be available by October 2019.

New Recognized Infectious Agents, HAI Outbreaks, Emerging Pathogens and Pathogens of Public Health Importance

An outbreak of a disease or condition that resulted in multiple hospitalizations or death is expected to be reported immediately by phone to the Kentucky Department for Public Health.  

An unexpected pattern of cases, suspected cases or deaths which may indicate a newly-recognized infectious agent; an outbreak or epidemic; an emerging pathogen posing a public health danger;  or a non-infectious chemical, biological or radiological agent. These events are to be reported to the Kentucky Department for Public Health by phone.  

Outbreaks and Investigations

As reports are processed the HAI/AR Prevention Program will conduct outbreak investigations when indicated. An HAI outbreak is defined as: the occurrence of two or more HAIs or MDROs epidemiologically linked or connected by person, place or time; or a single case of an HAI not commonly diagnosed. An investigation may also occur if a specific HAI or MDRO is found in a location for the first time.

Response

Investigations are traditionally focused on outbreaks of MDROs and emerging pathogens. Additionally, there have been investigations related to infections occurring related to devices (e.g., intrathecal pain pumps) and outpatient procedures (intra-articular joint injections). Site visits are conducted when possible. We engage CDC when emerging pathogens/mechanisms are identified. We utilize the Kentucky Division of Laboratory Services (DLS) and CDC lab for pulsed field gel electrophoresis (PFGE) and whole-genome sequencing (WGS) when needed. 

Point Prevalence Survey

A point prevalence survey (PPS) involves screening of at-risk individuals when there is concern for potential horizontal transmission of MDROs between patients either directly or via healthcare providers. The Antibiotic Resistance Laboratory Network provides assistance when point prevalence surveys are performed.  The AR Lab Network is funded through CDC grant funding and is a national initiative. 

If within-facility transmission is identified or suspected, PPS will be continued until transmission has been halted. Additionally, a targeted onsite assessment will be performed if possible and assistance will be provided to the facility regarding mitigation of infection prevention and control breaches. Re-emphasis on facility infection prevention and control activities is always a part of the response.

Target Infections Control Assessment and Response

Infection Control Assessment Tools were developed by CDC under the Epidemiology and Laboratory Capacity Infection Control Assessment and Response Program to help health departments assess infection prevention practices and to guide quality improvement activities, such as addressing identified gaps. These tools may also be used by healthcare facilities to conduct internal quality improvement audits.

NHSN

What is NHSN?

The Center for Disease Control and Prevention National Healthcare Safety Network is a national HAI tracking system that provides data needed to identify problem areas, measure progress of prevention efforts and ultimately eliminate healthcare-associated infections.

The network allows healthcare facilities to track HAIs, as well as blood safety errors and important healthcare process measures such as healthcare personnel influenza vaccine status and infection control adherence rates.

Target, Assess and Prevent

The Targeted Assessment for Prevention (TAP) Strategy is a framework for quality improvement developed by the CDC to use data for action to prevent HAIs. The TAP Strategy consists of three components: 1) running TAP Reports in the National Healthcare Safety Network (NHSN) to target healthcare facilities and specific units with an excess burden of HAIs; 2) administering TAP Facility Assessment Tools to identify gaps in infection prevention in the targeted locations; and 3) accessing infection prevention resources within the TAP Implementation Guides to address those gaps. The TAP Assessment is a survey that is administered to a variety of people within the hospital to identify breaches in knowledge for specific infection control practices and activities.

The Statewide Annual TAP Report is available for the years 2015-2017  and the year 2018 (estimated September 2019).

Extensively Drug Resistant Organism Registry

The XDRO registry is populated with patient information and laboratory data for all carbapenem-resistant Enterobacteriaceae (CRE) identified in Kentucky facilities or identified in Kentucky residents. The registry can be queried by facility infection Preventionists so that appropriate transmission-based precautions can be taken when patients have healthcare contact. Initial entry into the XDRO registry will be done manually by the HAI/AR Prevention Program staff, although eventually the registry will be populated automatically from electronic laboratory reporting through the Kentucky Health Information Exchange (KHIE).  Additionally, an alert feature is planned that would allow real-time use of admission, transfer, and discharge (ADT) data in KHIE to alert the facility about the patient's history of CRE. This would provide for more timely initiation of appropriate transmission-based precautions and should limit opportunities for spread of the organism within the facility.

If you are interested in gaining access to the database please contact Brittany Corley.  

Antimicrobial Stewardship

According to SHEA, antibiotic stewardship is a set of coordinated strategies to improve use of antimicrobial medications to enhance patient health outcomes, reduce resistance to antibiotics and decrease unnecessary costs.

Antimicrobial stewardship includes a systematic effort to educate and persuade prescribers of antimicrobials to follow evidence-based prescribing.

Statewide antimicrobial stewardship report 2013-14

Collaborative

 Activities include:

  • The Louisville-Metropolitan Antimicrobial Resistance/Antibiotic Stewardship Collaborative, which serves as a vehicle for discussion of issues related to infection prevention and control, antimicrobial resistance, and antibiotic stewardship. Participants include physicians, infection preventionists, microbiologists, and others from acute and long-term care facilities in the Louisville metropolitan area. Goals include strengthening inter-facility communication and improving consistency of response to antimicrobial resistance threats.  
  • Work with QSource, the Quality Improvement Organization (QIO) for Kentucky, in their efforts to improve rates of outpatient antibiotic prescribing in the state. 
  • The hospital-onset (HO) MRSA Bloodstream Infection (BSI) Collaborative with CDC and Tennessee, which is an effort to reduce rates of MRSA bacteremia in facilities with historical higher rates through targeted evidence-based interventions. 
  • Work with the Child and Adolescent Health Research Design and Support Unit (CAHRDS Antibiotic Team), Department of Pediatrics, University of Louisville School of Medicine. This group analyzes Medicaid prescribing and claims data related to antibiotic prescribing in pediatrics with a goal of improving outpatient antibiotic prescribing for pediatric patients across the state. More generally, they are actively involved in increasing public and provider knowledge about antibiotic use and antimicrobial resistance as public health issues of critical importance. 

Frequently Asked Questions

What is the difference between an active infection and colonization with an organism?

Active infection indicates that an organism (bacteria, virus, etc.) is found in or on the body and is associated with signs and/or symptoms of illness. Colonization indicates that an organism is found in or on the body, but is not producing any signs or symptoms of illness.

Are contact precautions necessary in long-term care?

According to the CDC place CRE colonized or infected residents that are high-risk for transmission on CP; for patients at lower risk for transmission use precautions based on type of care provided.

Documentation