Healthy Chicago's Focus on Communicable Diseases, Healthcare-associated infections
Healthy Chicago: Focus on Communicable Diseases, Healthcare-associated infections Stephanie R. Black, MD, MScMedical Director, Acute Disease Surveillance Chicago Board of Health July 18, 2012 Chicago Department of Public Health @ChiPublicHealth on
OverviewGoal:Reduce morbidity and mortality related to communicable diseases.Target:Coordinate infection control education of healthcare providers in long-term care facilities.Discussion topics: Introduce multi-drug resistance and significance Review local epidemiology of KPCs (MRDO of concern) Review Communicable Diseases program response
Tracking emerging MDROs• Multi-drug resistant organisms are typically pathogens that are resistant to ≥ 3 drug classes• To date, multi-drug resistant organisms (MDROs) have not been reportable, though clusters of unusual pathogens are reportable• New proposed IDPH rule: 690.387 – Extensively drug-resistant organisms of public health importance (reportable within 7 days)
What are CRE?• Carbapenem-resistant enterobacteriaceae (usually K. pneumoniae, E. coli) – Resistance to any 3rd generation cephalosporin antibiotic and non- susceptibility to a carbapenem – Molecular test (PCR) specific for resistance gene – Phenotypic test positive for production of a resistance gene
Why are CRE epidemiologically important?• CRE have been associated with high mortality rates (up to 40 to 50% in some studies).• In addition to β-lactam/carbapenem resistance, CRE often carry genes that confer high levels of resistance to many other antimicrobials, often leaving very limited therapeutic options. “Pan-resistant” KPC-producing strains have been reported.• CRE have spread throughout many parts of the United States and have the potential to spread more widely.
Healthcare Surveillance Needed in 2012Long term carefacility withventilator andpsychiatric patientsS. Gerber 2011 Long term acute care hospital
Prevalence of KPC colonization among LTACH patients 60 50 40 Average = 30% Percent 30 20 10 KPC positive 0 G E A F D B C LTACHLin MY et al, IDSA Meeting 2011, abstract 396.
Communicable Disease program initiatives• Long Term Care Roundtable• MDRO infection control survey
Long-term care facility roundtable• Contact list for skilled nursing facilities in Chicago (n=82)• Monthly meetings to facilitate education and allow problems solving with peers• Address the IDPH regulation • 201 ILCS 45/2-213 A skilled nursing facility shall designate a person or persons as Infection Prevention and Control Professionals to develop and implement policies governing control of infections and communicable diseases. The Infection Prevention and Control Professionals shall be qualified through education, training, experience, or certification or a combination of such qualifications. The Infection Prevention and Control Professional’s qualifications shall be documented and shall be made available for inspection by the Department.
LTC Roundtable curriculum excerpt Hand Hygiene Surveillance for infections• Transmission based precautions• HAI and device-associated infections• Outbreak prevention and management• Vaccination/employee health• Antimicrobial stewardship
The MDRO infection control survey• Infection control surveillance and practices• Establish regional guidance for sensible control of MDROs• Is the media influencing MDRO priorities?
MDRO information exchange project• MDRO registry• Provide point-of-care clinicians ability to check the registry for the presence of CRE in their patient – Surveillance – Communication – Hand hygiene• Advantages/disadvantages
Acknowledgments• Sue Gerber• Margaret Okodua• Kingsley Weaver• Shamika Smith• Deb Burdsall• Bob Weinstein• Mary Hayden• Mike Lin• CJ Thurlow• Monica Sikka• Don Blom• Mary Alice Lavin• Craig Conover