Hospital Outreach Unit:Local public health and HAIs

Dawn Terashita MD, MPH

Acute Communicable Disease Control

Los Angeles County Department of Public Health

dterashita@ph.lacounty.gov

November 2012

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Background History

• In 2002, healthcare-associated infections consisted of– Investigation of hospital outbreaks – Outreach & surveillance for antimicrobial

resistance & blood borne pathogens.

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Background History

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Background History

• In early 2003, during the SARS situation, BT LPHNs assisted in infection control and prevention in the hospital setting

• In November 2003, ACDC created the new Hospital Outreach Unit

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Hospital Outreach Unit (HOU) Mission

• To enhance emerging infectious disease preparedness and response efforts and improve hospital disease reporting by hospitals in LAC through strengthened communications, collaboration, and consolidations of resources

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Summary

• 102 licensed acute care hospitals

• 174 infection preventionists

• HOU divided the county into 5 areas

• Each area is assigned a Liaison Public Health Nurse

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Hospital Outreach Unit: Objectives

• Collaboration and communications between Public Health and hospitals

• Bioterrorism and pandemic disease preparedness and response

• Hospital outbreak investigations• Healthcare-associated infection prevention and

surveillance• Mandatory disease reporting• Identify and respond to new and emerging threats

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GOAL 1: Prevent

• Infection Control Education– Visit every hospital at least annually– Attend infection control committee meetings– Promote WEBvCMR– Distribute educational materials– Distribute disease alerts such as measles alerts– Review the pandemic flu plan– Attend training, table-tops and exercises– Give presentations

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Goal 1: PreventInfection Control Education2006 - 2010 2006 2007 2008 2009 2010

Infection control meetings (31)

59 60 55 71 55

Trainings, table tops, and exercises

63 87 20 1 2

Web-based disease reporting system training

70 88 47 55 55

APIC chapter meeting 30 41 30

Educational materials distributed

79,233 95,931 35,987 79534 51.584

HAI hospital visits 459

GOAL 2: Detect and Report

• 100% LAC hospitals now using NHSN

• 100% LAC hospitals have conferred rights to LADPH

• Validation of CLABSI, MRSA and VRE BSI, C. diff NHSN data completed on 20 LAC hospitals

• CRKP surveillance June 1, 2010 to July 31, 2012

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GOAL 3: Investigate • Hospital Outbreak Investigation

– Site visits & chart review– Collect specimens from patients & environmental

areas– Interview staff, etc.

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Goal 3: Investigate 2008 – 2010

Year # Investigated

Hospital Visits 2008 366

2009 331

2010 339

Hospital Phone Contacts

2008 643

2009 1518

2010 1122

Hospital Email Contacts

2008 3399

2009 4913

2010 4764

Outbreak Investigation

2008 23

2009 16

2010 2712

Other Hospital Outreach Unit Activities• Liaison between ACDC/Public Health and

non-acute healthcare settings such as:– Hospital based SNF and dialysis centers– Acute psychiatric hospitals– Large clinics– Jail medical services

• Keep key hospital contact information up-to-date, including email, fax, and phone numbers – IP, ICC, ED, Lab, Pharmacy, ID, etc.

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Other HAI Activities• California Healthcare-Associated Infections

Advisory Working Group

• Hospital Association of Southern California HAI Taskforce

• National Healthcare Safety Network (NHSN) State User Group

• CSTE Nosocomial Infections Workgroup

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CDPH HAI Program Collaboration

• ARRA funded collaboration with CDPH

• 1 HAI field staff assigned to Los Angeles County (Feb 2010 to Dec 2011)

• HAI and HOU staff will visit every hospital– Ensure enrollment into NHSN with rights

conferred to CDPH and LACDPH– Serve as consultant for HAI issues– Evaluate data collection and reporting methods

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Future Direction

• Increase outreach to hospitals to alleviate infection control deficits

• Continue expansion of HAI activities to non-acute care settings (SNFs, dialysis centers, ambulatory surgery centers)

• Initiate analysis of NHSN data

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