HHS Action Plan to Prevent Healthcare-Associated Infections

• Action Plan Development
• Phase 1: Acute-Care Hospitals
• Phase 2: Ambulatory Surgical Centers, End-Stage Renal Disease Facilities, and Increasing Influenza Vaccination Among Healthcare Personnel
• Final list of Action Plan Target and Metrics
• Public Comment
• State HAI Prevention Plans

Action Plan Development

In recognition of healthcare-associated infections (HAIs) as an important public health and patient safety issue, the U.S. Department of Health and Human Services (HHS) convened the HHS Steering Committee for the Prevention of Healthcare-Associated Infections. The Committee's charge is to improve coordination and maximize the efficiency of prevention efforts across HHS.  Members of the Steering Committee include clinicians, scientists, and public health leaders representing:

• Agency for Healthcare Research and Quality (AHRQ)
• Administration on Aging (AOA)
• Centers for Disease Control and Prevention (CDC)
• Centers for Medicare & Medicaid Services (CMS)
• Food and Drug Administration (FDA)
• Health Resources and Services Administration (HRSA)
• Indian Health Service (IHS)
• National Institutes of Health (NIH)
• Office of the Assistant Secretary for Health (OASH)
  • National Vaccine Program Office
  • Office of Healthcare Quality
• Office of the Assistant Secretary for Planning and Evaluation (ASPE)
• Office of the Assistant Secretary for Public Affairs (ASPA)
• Office of the National Coordinator for Health Information Technology (ONC)
• U.S. Department of Defense (DoD)
• U.S. Department of Labor (DOL)
• U.S. Department of Veterans Affairs (VA)

The Steering Committee marshaled the extensive and diverse resources of the Department, formed public and private partnerships, and initiated discussions that identified new approaches to HAI prevention and collaborations. In 2009, the Office of Healthcare Quality was created by the Assistant Secretary for Health to support and carry out the Steering Committee's mandate to improve healthcare quality by preventing and eventually eliminating HAIs.

The Steering Committee, along with scientists and program officials across HHS, released the HHS Action Plan to Prevent Healthcare-Associated Infections in 2009, providing a roadmap for HAI prevention in acute care hospitals. In this first iteration of the Action Plan, the Committee focused on acute care hospitals where the scientific information on prevention and the capacity to measure improvement was most complete and where the associated morbidity and mortality was greatest. Thus, prevention of HAIs in acute care hospitals became the first phase - Phase One - of the Action Plan.

Phase 1: Acute-Care Hospitals

Phase 1 of the Action Plan addressed the most common infections in acute care inpatient settings and outlined specific recommended optimum clinical practices, a prioritized research agenda, an integrated information systems strategy,  policy options for linking payment incentives or disincentives to quality of care and enhancing regulatory oversight of hospitals, and a national messaging and communications plan to raise awareness of HAIs among the general public and prevention strategies among healthcare workers:

• HHS Action Plan to Prevent Healthcare-Associated Infections (complete document, printable PDF - 424 KB)
• HHS Action Plan to Prevent Healthcare-Associated Infections (in sections)
• Action Plan Targets and Metrics lists the nine metrics with corresponding five-year goals to focus efforts in reducing healthcare-associated infections.

This Action Plan includes five-year goals for nine specific measures of improvement in HAI prevention. The plan was initially released in January 2009 for public comment; a final version that incorporated additional content and responses to comments was released in June 2009.

Phase 2: Ambulatory Surgical Centers, End-Stage Renal Disease Facilities, and Increasing Influenza Vaccination Among Healthcare Personnel

The healthcare and public health communities are increasingly challenged to identify, respond to, and prevent HAIs across the continuum of settings where healthcare is delivered. The public health model’s population-based perspective can increasingly be deployed to enhance the prevention of HAIs, particularly given the shifts in healthcare delivery from acute care settings to ambulatory and long-term care settings. The Steering Committee clearly articulated the need to maintain the Action Plan as a “living document,” developing successor plans in collaboration with key public and private stakeholders to incorporate advances in science and technology, shifts in the ways healthcare is delivered, changes in healthcare system processes and cultural norms, and other factors.

In late 2009, the Steering Committee approved an expansion of the Action Plan, and through this expansion three new draft modules were released in September 2010:

• Ambulatory Surgical Centers (September 2010 Draft) [PDF - 89 KB]
• End-Stage Renal Disease Facilities (September 2010 Draft) [PDF - 402 KB]
• Influenza Vaccination of Healthcare Personnel (September 2010 Draft) [PDF - 113 KB]

These modules comprised the second phase – Phase 2 – of the Action Plan, extending its scope to the outpatient environment and addressing the health and safety of healthcare workers, as well as the risks of transmission of influenza from healthcare personnel to patients.

Public Comment

In Fall 2010, the Office of Healthcare Quality solicited public comment on the draft Phase 2 modules. The updated and revised HAI Action Plan, including Phases 1 and 2, will be released for public comment in 2012.

State Healthcare-Associated Infection Prevention Plans

The 2009 Omnibus Bill required states receiving Preventive Health and Health Services (PHHS) Block Grant funds to certify that they will submit a plan to reduce HAIs to the Secretary of Health and Human Services by January 2010. HHS received plans from all 50 states, the District of Columbia, and Puerto Rico.

HHS Report to Congress: Healthcare-Associated Infections: FY 2010 State Action Plans

The report addresses the adequacy of State Healthcare-Associated Infection (HAI) Action Plans for achieving state and national goals for reducing HAIs. It responds to the joint explanatory statement to accompany H.R. 1105, the Omnibus Appropriations Act, 2009 (Public Law 111-8):

"…[E]ach State plan shall be consistent with the Department of Health and Human Services' national action plan for reducing healthcare-associated infections and include measurable 5-year goals and interim milestones for reducing such infections: Provided further, That the Secretary shall conduct a review of the State plans submitted pursuant to the preceding proviso and report to the Committees on Appropriations of the House of Representatives and the Senate…"

The State-Specific HAI Summary Data Report (May 2010) represents the first time CDC has reported state-specific infection information. The report includes both national central line-associated bloodstream infection (CLABSI) data and state-specific data for states mandated by state law to report CLABSIs.