The HHS Office of the Assistant Secretary for Health supports a number of projects to advance the elimination of healthcare-associated infections by promoting science, recognizing significant achievement at the bedside, and promoting national partnerships and development of infrastructure. These projects include:
- HAI Longitudinal Program Evaluation of the Health Care-Associated Infections (HAI) HHS Action Plan Year 1 Report
- HHS-APIC-SHEA Partnership in Prevention Award
- HHS-Critical Care Collaborative Societies (CCSC) Awards Program
- Technological Innovations for Hand Hygiene Monitoring and Feedback
- Flu Vaccination of Healthcare Personnel: Legal Environmental Review and State Legislative Models
- Environmental Monitoring and Disinfection of Emerging Resistant Healthcare Pathogens
- Regional Projects
- Healthy People 2020
- HAI Initiatives Evaluation
- Evaluation of the Medicare Hospital-Acquired Conditions—Present on Admission Program
Longitudinal Program Evaluation of the Health Care-Associated Infections (HAI) HHS Action Plan Year 1 Report
The Office of Disease Promotion and Health Promotion (ODPHP), Division of Healthcare Quality, the Agency for Healthcare Research and Quality (AHRQ), and the Centers for Disease Control and Prevention (CDC) contracted with IMPAQ International (IMPAQ) and the RAND Corporation (RAND) to produce iterative and comprehensive evaluations of HHS programs related to the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination.
Longitudinal Program Evaluation of the Health Care-Associated Infections HHS Action Plan-Year 1 Report (September 2011) [PDF – 1760 KB], the first report of the evaluation, examined initial progress toward achieving Action Plan targets. The evaluation found that measurable progress has been made in reducing health care-associated infections (HAIs) and specifically aimed to:
- Record current and future design, content, and progress of the HAI Action Plan.
- Provide feedback on how to strengthen monitoring capabilities
- Offer insights to identify prospective high-yield opportunities to reduce HAIs.
In addition to the successes noted to date, the evaluation also identified several areas for improved coordination and outreach. For the Federal Steering Committee for the Prevention of Health Care-Associated Infections response to the report, view the cover letter [PDF – 315 KB].
Now Accepting Nominations for the 2013 HHS-APIC-SHEA Partnership in Prevention Award
The U.S. Department of Health and Human Services (HHS) has partnered with the Association for Professionals in Infection Control and Epidemiology (APIC) and the Society for Healthcare Epidemiology of America (SHEA) to create the Partnership in Prevention Award.
The award will highlight the work of a hospital that achieved sustainable improvements based on the concepts of the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination. The award winner will be announced during International Infection Prevention Week (October 20-26, 2013).
This is an opportunity to recognize the outstanding efforts of multidisciplinary teams that have improved clinical practice and patient safety through the utilization of evidence-based guidelines, achieved and maintained superior prevention results, and advanced best practices.
Nominations for the award will be accepted through July 15, 2013. Eligibility criteria and application instructions [PDF 130 KB].
We invite you to nominate your team. If you have any questions about the awards, please email the Partnership in Prevention Award team at email@example.com.
We look forward to seeing the great nominations highlighting the important work you do to prevent HAIs.
HHS-Critical Care Societies Collaborative (CCSC) Awards Recognizes Achievements in Eliminating Healthcare-Associated Infections
For the third year, the U.S. Department of Health and Human Services (HHS) and the Critical Care Societies Collaborative (CCSC)* called for applications from teams of critical care professionals and health care institutions with demonstrated systems of excellence for reducing and eventually eliminating targeted health care-associated infections (HAIs).
Targeted HAIs for the 2013 awards cycle are as follows:
- catheter-associated urinary tract infections (CAUTI);
- central line-associated bloodstream infections (CLABSI); and,
- ventilator-associated pneumonia (VAP).
Awards for reducing CAUTI, the most prevalent HAI, are new this year. Hospitals, units, and teams demonstrating sustained reduction or elimination of the targeted HAIs for a minimum of 25 months combined with national leadership in disseminating information about their success were eligible.
Winners were announced May 20, 2013 during the Super Session at the American Association of Critical-Care Nurses (AACN) 2013 National Teaching Institute & Critical Care Exposition in Boston, Massachusetts. Award recipients (alphabetized by state) are:
- Intensive Care Unit, Franciscan St. Francis Health, Mooresville, Ind. (CAUTI)
- Surgical ICU and Trauma Burn ICU, University of Michigan Health System, Ann Arbor (VAP)
- Medical Surgical ICU, HealthEast St. John’s Hospital, Maplewood, Minn. (CLABSI)
- Beth Israel Medical Center, New York City (CAUTI)
- ICU, Novant Health Presbyterian Medical Center, Charlotte, N.C.; ICU,Novant Health Matthews Medical Center, Matthews, N.C.; and ICU,Novant Health Huntersville Medical Center, Huntersville, N.C. (VAP)
- Cardiac Intermediate Unit, East Carolina Heart Institute at Vidant Medical Center, Greenville, N.C. (CLABSI)
- Medical Intermediate Unit, Vidant Medical Center, Greenville, N.C., (VAP)
- Medical University of South Carolina, Charleston (CLABSI)
In addition to the eight awardees, 11 health care organizations received honorable mentions for their efforts toward eliminating HAIs within their facilities. Facilities receiving honorable mention in this year’s awards program are listed at www.aacn.org/haiawards.
*CCSC member organizations include AACN, American College of Chest Physicians, American Thoracic Society, and Society of Critical Care Medicine.
Adherence to recommended hand hygiene practices by health care personnel is the most effective way to reduce health care-associated infections. Yet adherence remains low and many hand hygiene improvement initiatives are neither sustainable nor standardized.
The human capital required for thorough and regular hand hygiene monitoring can be overwhelming in terms of time spent monitoring and data entry. Existing technologies such as radio frequency identification (RFID) are appealing alternatives since they offer objectivity, can be more anonymous than direct observation, and obviate the need for time-consuming audits and data entry.
However RFID is very expensive to implement even in a single hospital ward. Development and validation of less expensive technologies for non-human hand hygiene adherence monitoring, such as low-power sensor contact tracing, is needed.
The HHS Office of the Assistant Secretary for Health, in partnership with CDC worked on a project to expand efforts to develop and validate low-cost methods for measuring hand hygiene adherence via electronic contact tracing. Contact tracing involves the use of wireless devices placed on hand hygiene dispensers, employee badges, and inside patient rooms.
The project aimed to:
- Validate sensor contact tracing technology in a variety of healthcare settings, including intensive care units (ICUs), non-ICU acute care settings, ambulatory care centers, long-term care settings, and outpatient clinics.
- Develop and test the impact of various data feedback mechanisms on improvement in individual and ward-level hand hygiene adherence
- Develop an implementation plan for use of sensor contact tracing technology in various health care settings that could accompany current guidelines for hand hygiene in healthcare settings, and
- Assess the acceptability of this technology among hospital staff.
The results of the project are summarized in the following paper:
Ellingson K, Polgreen PM, Schneider A, et al. Healthcare Personnel Perceptions of Automated Hand Hygiene Adherence Monitoring Technology. Infect Control Hosp Epidemiol. 2011 Nov;32(11):1091-6.
The Influenza Vaccination of Health Care Personnel (HCP) Working Group of the Steering Committee sponsored a project to develop, synthesize, and/or enhance evidence and tools for improving influenza vaccination of HCP.
The purpose of the project was to examine the effect that various policy changes may have on influenza vaccination coverage for HCP. The intended outcome of the project was to have a comprehensive report that identifies the existing policies in each State, allowing for comparisons between and among States, as well as comparisons to model state and federal statutes that may be useful in drafting future state and federal statutes. Collaborations with state and local policymakers, facility leadership, workforce representatives, professional associations, patient advocates, and others were an integral component of this project.
The project developed educational materials intended to encourage voluntary influenza vaccination of all HCP. Materials will be disseminated to stakeholders interested in increasing influenza vaccination coverage rates of HCP. The materials will include:
- A common definition of health care personnel,
- Describe the strategies that facilities have implemented to encourage voluntary vaccination, and
- Outline the current coverage rates among HCP.
- A review of evidence-based practice of seasonal influenza vaccination of HCP as it relates to transmission of illness to patients
- Summarize the literature that addresses the relationship between influenza vaccination of HCP, and influenza disease rates among patients.
The project also reviewed the legal environment surrounding requirements for influenza vaccination of HCPs, such as requirements for employers to offer vaccination to HCP, to obtain declination forms from those HCP who decline vaccination, or to mandate that vaccination be performed. Federal and state laws, individual facilities’ policies, and judicial decisions will be reviewed.
The health care environment serves as a reservoir for acquisition of certain of infections by emerging multi-drug resistant (MDR) pathogens such as:
- C. difficile,
- Methicillin-resistant Staphylococcus aureus,
- A. baumannii, and
- Vancomycin-resistant enterococci,
There is an increasing need to understand the role of the environment in the spread of these pathogens and to develop infection control measures to minimize transmission of these pathogens in healthcare facilities. This project assesses the dynamics of contamination of the health care environment and to assess cleaning and disinfection methods to reduce environmental contamination.
Current infection control recommendations are hampered by a lack of data regarding the :
- Bioburden of environmental surfaces,
- Relative importance of certain surfaces/practices in transmission,
- Effectiveness of cleaning and disinfection strategies employed in health care settings and
- Appropriate methodologies for sampling the environment and monitoring cleaning effectiveness.
The goals of the project were to:
- Establish bioburden of MDR pathogens on healthcare environmental surfaces
- Establish effectiveness of current cleaning/disinfection methods at reducing bioburden
- Develop standard sampling, culture, and non-culture methods for assessing bioburden reductions
- Understand the relationship between environmental contamination and patient population characteristics (e.g. prevalence of colonization, presence of wounds, presence of indwelling urinary or respiratory catheters, etc.).
The data will be used to inform the development of future prevention studies designed to establish the optimal methods for preventing transmission of MDR and other pathogens from the environment.
This project was a collaborative effort between the HHS Office of the Assistant Secretary for Health, CDC, and State Health Departments.
Regional Projects 2011-2012
Over the last year, the HHS Office of the Assistant Secretary for Health has seen Regional HAI Projects achieve successes in addressing gaps in HAI prevention and develop increased coordination at the state and regional levels in a way is helping to move the prevention needle at the national level. These projects were selected for 2011-12 funding:
Region I - Using Pilot Project NHSN Data to Direct Infection Prevention/Control Interventions in Dialysis Settings
Region I will build on their Year 1 work that focuses on surveillance in dialysis centers. In Year 2, the Region will generate and execute preventive and mitigating HAI interventions in a variety of dialysis settings, based on facility data from Year 1.
Region VI - Toolkit to Support States in the Development of Consumer-Friendly HAI Websites
Based on formative research conducted in Year 1, Region VI will create and pilot a toolkit designed to assist state agencies in the process of implementing a consumer-friendly HAI website to encourage smart healthcare decisionmaking.
Regions VII & VIII - HAI Prevention Training for Healthcare Personnel in Critical Access Hospitals and Long-Term Care Facilities
The two regions will partner to bring an infection prevention training to the area's infection preventionists.
Region IX - Building on Efforts to Strengthen HAI Prevention in Small and Rural Hospitals
In Year 2, Region XI will promote widespread dissemination at the local level of communication tools developed in Year 1 that target infection prevention in California's small, rural, and critical access hospitals.
Regional Projects 2010-2011
In May 2010, awarded regional HAI Prevention Project. Proposals selected for funding used information and data from the national and regional state HAI plans, the CDC review of state plans, the expertise of HAI state advisory councils, and identified activities that could be implemented to address the HAI state/regional gaps.
Projects cascade from one or more specific goals identified in the HAI Action Plan, and address at least one HAI activity areas: 1) capacity building, 2) reporting, 3) prevention, 4) evaluation and 5) communication).
Region I: A New England Collaborative: Tackling Healthcare-Associated Infections (HAIs) in Non-Acute Settings
Key Project Elements: Addressed HAI prevention in dialysis facilities through generating partnerships between state health departments, hospitals and non-acute care settings, and leveraging these partnerships to assess training needs and identifying training resources to address these needs.
Region II:Education and Outreach to Healthcare Providers in Ambulatory Surgical Centers for the Prevention and Reduction of Healthcare Associated Infections: A Pilot Project
Key Project Elements: Assessed and developed educational outreach materials for preventing in HAIs for Ambulatory Surgery Centers.
Region III: HAI Prevention Collaborative
Key Project Elements: Convened a multidisciplinary group of public health and medical partners to address common gaps in surveillance and prevention of healthcare-associated infections, focusing on multidrug-resistant organisms and C. difficile. Addressed capacity building, prevention, and communication through the project activities.
Region VI: Formative research for the development of a consumer friendly website to help decrease HAIs
Key Project Elements: Conducted formative research on the effect of public reporting on decision making, with a focus on consumer decision making. Also examined security, privacy and legal aspects inherent to healthcare communications.
Region VIII: State Based Training to Implement Healthcare-Associated Infections Prevention Activities
Key Project Elements: Identified communication and training needs and opportunities across this region, which has substantial variability in healthcare-associated infrastructure. Three training meetings were held to address these needs and leverage these opportunities.
Region IX: Strengthening HAI Prevention Efforts in Small and Rural Hospitals
Key Project Elements: Disseminated best practices and improved communication between federal, state, and local public health agencies engaged in healthcare-associated prevention. This project focused on small, rural and critical access hospitals, and will aim to understand and disseminate best practices among this demographic of providers.
Healthy People 2020
Complementing efforts to reduce health care-associated infections, Healthy People 2020 includes Health Care-Associated Infections as a new topic area, including two objectives on health care-associated infections:
- Reduce central line-associated bloodstream infections
- Reduce invasive healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA) infections.
Health Care-Associated Infections Webinar
A webinar was held on August 16, 2011 to outline the public health burden of health care-associated infections to the Healthy People community. Successful prevention initiatives and tools at both the national and local levels were highlighted by various speakers. View the webinar.
What Is Healthy People?
Healthy People provides science-based, 10-year national objectives for promoting health and preventing disease. Since 1979, Healthy People has set and monitored national health objectives to meet a broad range of health needs, encourage collaborations across sectors, guide individuals toward making informed health decisions, and measure the impact of our prevention activity.
Designing Healthy People for the Next Decade
Every 10 years, HHS leverages scientific insights and lessons learned from the past decade, along with new knowledge of current data, trends, and innovations. Healthy People 2020 will reflect assessments of major risks to health and wellness, changing public health priorities, and emerging issues related to our nation's health preparedness and prevention.
Evaluation of the Medicare Hospital-Acquired Conditions—of the Present on Admission Program
The Deficit Reduction Act of 2005 (the Act) modified payment for acute care hospitalizations of Medicare fee-for-service beneficiaries if a complicating condition that could have reasonably been prevented occurred during the hospitalization. Section 5001(c) of the Act requires the Secretary of the U.S. Department of Health and Human Services (HHS) to identify complications of care that meet the following three conditions:
- Are high cost, high volume, or both;
- Are assigned to a higher-paying Medicare severity diagnosis-related group (MS-DRG) when present as a secondary diagnosis; and
- Could reasonably have been prevented through application of evidence-based guidelines.
In response to the Act, the Centers for Medicare & Medicaid Services (CMS) developed the Hospital-Acquired Conditions (HAC) —Present on Admission (POA) program, whereby inpatient prospective payment system cases can no longer be assigned to higher-paying MS-DRGs on the basis of preventable complicating conditions that are acquired during the hospital stay.
To implement this payment change, beginning in April 2008, CMS began requiring hospitals participating in the inpatient prospective payment system (IPPS) to code all International Classification of Diseases, Ninth Revision (ICD-9) diagnoses on the inpatient claim as either POA or HAC. After extensive federal and public input, CMS identified ten HACs as being preventable under accepted guideline-consistent care and targeted these for application of the HAC-POA payment policy. The evaluation will seek to answer a broad set of research questions to assess the outcomes of the program.
For more information, please see: