Health Care Quality Projects
ODPHP supports a number of HHS Office of the Assistant Secretary for Health (OASH) projects to advance the elimination of health care-associated infections by promoting science, recognizing significant achievement at the bedside, and promoting national partnerships and development of infrastructure. These projects include:
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.
ODPHP 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
- 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
- Outline the current coverage rates among HCP
- Review 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
- 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
- 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 OASH, ODPHP, CDC, and State Health Departments.
Over the last year, OASH 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 decision making.
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 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, OSAH awarded regional HAI Prevention Project. Proposals selected for funding used information and data from the national and regional state HAI Action 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 [PDF - 29 KB]
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 [PDF - 12 KB]
Key Project Elements: Assessed and developed educational outreach materials for preventing in HAIs for Ambulatory Surgery Centers.
Region III: HAI Prevention Collaborative [PDF - 33 KB]
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 [PDF - 12 KB]
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 [PDF - 12 KB]
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 [PDF - 12 KB]
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.
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 reflects assessment of major risks to health and wellness, changing public health priorities, and emerging issues related to our nation's health preparedness and prevention.
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
- 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:
- Evidence-Based Guidelines for Selected and Previously Considered Hospital-Acquired Conditions (January 2012 Report Update) [PDF - 651 KB]
- Additional Tables and Reports from the Evaluation
- Information on CMS Quality Initiatives
- Information on the CMS FY2013 Final Rule for HAC-POA
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