July Board of Health Meeting

1. Healthy Chicago:
Focus on Communicable Diseases,
Healthcare-associated infections
Stephanie R. Black, MD, MSc
Medical Director, Acute Disease Surveillance
Chicago Board of Health
July 18, 2012
Chicago Department of Public Health
@ChiPublicHealth on

2. Overview
Goal:
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

3. 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)

6. 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

7. 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.

8. Healthcare Surveillance Needed
in 2012
Long term care
facility with
ventilator and
psychiatric patients
S. Gerber 2011 Long term acute care
hospital

9. Exposure network graph demonstrating the relationships of cases to long-term acute care
hospitals (LTACHs), acute care hospitals, and nursing homes during the entire 12-month
study period.
Won S Y et al. Clin Infect Dis. 2011;53:532-540
© The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases
Society of America. All rights reserved. For Permissions, please e-mail:
journals.permissions@oup.com.

10. Prevalence of KPC colonization
among adult ICU patients
5
4 Average = 3.3%
3
Percent
2
1 KPC positive
0
5 6 7 8 9 10
Survey
2010 2011 2012 2013

11. 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
LTACH
Lin MY et al, IDSA Meeting 2011, abstract 396.

12. Communicable Disease program
initiatives
• Long Term Care Roundtable
• MDRO infection control survey

13. 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.

15. 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

16. The MDRO infection control survey
• Infection control surveillance and
practices
• Establish regional guidance for sensible
control of MDROs
• Is the media influencing MDRO priorities?

18. http://www.akg-images.co.uk/_customer/london/gallery/science/medicine.html

19. Locally variable factors that may influence the likelihood of benefit of contact isolation.
Kirkland K B , Clin Infect Dis. 2009;48:766-771
© 2009 by the Infectious Diseases Society of America

20. 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

21. 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