Prioritization of surveillance and infection prevention activities to reduce healthcare associated infections [HAI] in Tennessee [TN]

Background: About 1.7 million HAI occur each year among patients while receiving treatment for medical or surgical conditions; these result in significant morbidity, mortality and cost. Implementing what is known for prevention can lead to ≥70% reduction in HAI. The U.S. department of health and human services [HHS] steering committee recently developed an action plan to reduce, prevent and ultimately eliminate HAI.

Objective: In alignment with HHS action plan, Tennessee department of health [TDH] led an effort to prioritize surveillance and infection prevention activities and incorporate into the state action plan.

Methods: In working toward the state HAI plan, the multidisciplinary advisory group [MDAG] was formed and members included infection preventionists [IP] (representing all 4 APIC chapters, large, small, academic, non-academic, rural and urban hospitals), healthcare epidemiologists, quality improvement staff, hospital leadership, consumers, representatives from TN hospital association, Quality Improvement Organizations, and TN Healthcare Association (representing nursing homes). Before the MDAG meeting, TDH conducted a statewide survey of IP to document important issues (surveillance, infection prevention) in their facilities. The MDAG meeting was held on October 7, 2009 to review existing prevention collaborative [PC] efforts to reduce HAI in TN and discuss a possible coordinated, statewide surveillance and PC effort by thoroughly examining over survey findings.

Results: The survey showed that IP prioritized in descending order, surveillance of CLABSI beyond intensive care units [ICU], Methicillin resistant Staphylococcus aureus [MRSA] (lab-identified event), surgical site infections [SSI] (hip prosthesis [HPRO], knee prosthesis [KPRO], spinal fusion), ventilator-associated pneumonia, Clostridium difficile (lab-identified event). Regarding establishing PC, IPs ranked in descending order, MRSA, surgical care improvement project, catheter-associated urinary tract infection [CAUTI], CLABSI beyond ICUs, Clostridium difficile. There was clearly a disagreement of priorities between surveillance purpose and infection PC among IP. MDAG members played a significant role in readjusting priorities that resulted in alignment between surveillance and PC. The final recommendations from the MDAG were: to expand surveillance on CLABSI beyond ICUs, MRSA and Clostridium difficle (lab identified event only), SSI (HPRO, KPRO) and to launch new PC on central line insertion practices adherence, Clostridium difficle and CAUTI in addition to existing PC.

Conclusions: The engagement of stakeholders as part of the MDAG was found critical to their buy-in. The MDAG members helped ensure that the state HAI plan align with HHS action plan and surveillance activities be implemented in parallel with PC to measure the impact of the collaboratives.