Public Health Collaboration Models for Infection Prevention in Licensed Healthcare Settings

A Focus on Ambulatory Surgical Centers (ASCs) – October 20, 2010 – Meeting Overview

Healthcare delivery in the United States continues to transition to settings outside the hospital. Ambulatory surgery, in particular, has been an area of immense growth. Despite this shift in healthcare delivery, attention to infection control in ASCs and other non-hospital settings (e.g., hemodialysis, long-term care, outpatient clinics) might be lacking as evidenced by increased identification of outbreaks of healthcare-associated infections (HAIs) and infection control lapses in these settings [1, 2].

Ensuring the safety of healthcare for patients in all settings is a priority for the Department of Health and Human Services (HHS) and its’ Operating Divisions, requiring collaboration at the state and federal levels amongst government agencies and other organizations that share responsibility for HAI prevention and oversight and inspection activities in these settings.
The Centers for Disease Control and Prevention (CDC), in conjunction with the Office of the Assistant Secretary for Health in the HHS Office of the Secretary hosted a meeting on Wednesday, October 20 in Atlanta to discuss HAI prevention needs and ongoing activities in these settings. The meeting objectives were to identify novel approaches and best practices for collaboration regarding the promotion of infection control training and HAI prevention, surveillance, and oversight activities in ASCs and other licensed healthcare settings.

The participants included representatives from HHS, the Center for Medicare and Medicaid Services (CMS), state health departments, state survey agencies, and quality improvement organizations (QIOs). Facilitated discussion centered on improving the inspection process and using inspection data for action, current and planned educational outreach, and identifying areas for improved stakeholder collaboration.

The following discussion points were emphasized by attendees:

• States need a mechanism to track and summarize infection control deficiencies identified during surveys to better target infection prevention outreach at the local level
• Effective communication channels between health departments, survey agencies and QIOs are currently lacking in many states, and are necessary to optimize prevention activities and outreach

Feedback gathered during discussion has been used to inform modifications to the HHS Action Plan to Prevent HAIs in ASCs [3] and will be used in ongoing work involving CMS, CDC, and other partners to improve the infection control survey process in ASCs and other licensed healthcare settings.

Meeting Participants

Organizations:

Department of Health and Human Services
Centers for Medicare and Medicaid Services
CDC Foundation
American Hospital Association
Association for Professionals in Infection Control and Epidemiology
University of Nevada Las Vegas
University of North Carolina School of Medicine
Tulane University
National Association for City and County Health Officials
Los Angeles County Public Health Department

State Health Departments:

California, Colorado, Georgia, Illinois, Kansas, Massachusetts, Maryland, Minnesota, Missouri, Montana, Nevada, New Jersey, New York, North Carolina, Oklahoma, Tennessee, Texas, Virginia, Washington

State Survey Agencies:

California, Colorado, Georgia, Indiana, Massachusetts, Maryland, Minnesota, Missouri, Nevada, New York, North Carolina, Oklahoma, Tennessee, Texas

Quality Improvement Organizations:

Colorado Foundation for Medical Care (Colorado), Georgia Medical Care Foundation (Georgia), IFMC-IL (Illinois), EMMC (Maine), Masspro (Massachusetts), Delmarva Foundation for Medical Care (Maryland), Stratis Healh (Minnesota), Primaris (Missouri), HealthInsight (Nevada), Healthcare Quality Strategies, Inc (New Jersey), IPRO (New York), Carolinas Center for Medical Excellence (North Carolina); Oklahoma Foundation for Medical Quality (Oklahoma), QSource (Tennessee), TMF Health Quality Institute (Texas).

References

1. Schaefer MK, Jhung M, Dahl M, et al. Infection Control Assessment of Ambulatory Surgical Centers. JAMA 2010;303:2273-2279.
2. Thompson ND, Perz JF, Moorman AC, Holmberg SD. Nonhospital Health Care-Associated Hepatitis B and C Virus Transmission: United States, 1998-2008. Annals of Internal Medicine 2009;150:33-39.
3. HHS Action Plan to Prevent Healthcare-Associated Infections: Ambulatory Surgery Centers. Accessed December 9, 2010.