Kelly McCormick

Enhancement of Health Department Capacity for Health Care–Associated Infection Prevention Through Recovery Act–Funded Programs

OBJECTIVES We evaluated capacity built and outcomes achieved from September 1, 2009, to December 31, 2011, by 51 health departments (HDs) funded through the American Recovery and Reinvestment Act (ARRA) for health care-associated infection (HAI) program development. METHODS We defined capacity for HAI prevention at HDs by 25 indicators of activity in 6 categories: staffing, partnerships, training, technical assistance, surveillance, and prevention. We assessed state-level infection outcomes by modeling quarterly standardized infection ratios (SIRs) for device- and procedure-associated infections with longitudinal regression models. RESULTS With ARRA funds, HDs created 188 HAI-related positions and supported 1042 training programs, 53 surveillance data validation projects, and 60 prevention collaboratives. All states demonstrated significant declines in central line-associated bloodstream and surgical site infections. States that implemented ARRA-funded catheter-associated urinary tract infection prevention collaboratives showed significantly greater SIR reductions over time than states that did not (P = .02). CONCLUSIONS ARRA-HAI funding substantially improved HD capacity to reduce HAIs not targeted by other national efforts, suggesting that HDs can play a critical role in addressing emerging or neglected HAIs.

Surveillance for respiratory health care–associated infections among inpatients in 3 Kenyan hospitals, 2010-2012

BACKGROUND Although health care-associated infections are an important cause of morbidity and mortality worldwide, the epidemiology and etiology of respiratory health care-associated infections (rHAIs) have not been documented in Kenya. In 2010, the Ministry of Health, Kenya Medical Research Institute, and Centers for Disease Control and Prevention initiated surveillance for rHAIs at 3 hospitals. METHODS At each hospital, we surveyed intensive care units (ICUs), pediatric wards, and medical wards to identify patients with rHAIs, defined as any hospital-onset (≥3 days after admission) fever (≥38°C) or hypothermia (<35°C) with concurrent signs or symptoms of acute respiratory infection. Nasopharyngeal and oropharyngeal specimens were collected from these patients and tested by real-time reverse transcription polymerase chain reaction for influenza and 7 other viruses. RESULTS From April 2010-September 2012, of the 379 rHAI cases, 60.7% were men and 57.3% were children <18 years old. The overall incidence of rHAIs was 9.2 per 10,000 patient days, with the highest incidence in the ICUs. Of all specimens analyzed, 45.7% had at least 1 respiratory virus detected; 92.2% of all positive viral specimens were identified in patients <18 years old. CONCLUSION We identified rHAIs in all ward types under surveillance in Kenyan hospitals. Viruses may have a substantial role in these infections, particularly among pediatric populations. Further research is needed to refine case definitions and understand rHAIs in ICUs.

The role of the public health analyst in the delivery of technical assistance to state health departments for healthcare-associated infection prevention.

Introduction:Aligned with the goals of the DHHS Action Plan to Prevent Healthcare Associated Infections (HAIs), in 2009 the Centers for Disease Control and Prevention (CDC) awarded cooperative agreements to 51 state and territorial health departments for purposes of developing and implementing strategies to reduce HAIs. These cooperative agreements through the Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) were supported by the American Recovery and Reinvestment Act (ARRA). Objectives:To systematically describe the perceptions of CDC public health analysts who delivered technical assistance (TA) to state health departments as part of the ELC cooperative agreement supported by ARRA to develop, implement, and/or expand HAI prevention programs. Research Design:Eight semistructured interviews using a standardized script were administered. Interviews were audio recorded; responses were transcribed, thematically coded, and analyzed using a qualitative immersion approach. Subjects:This study included CDC staff who provided TA to grantees of the ELC cooperative agreement supported by ARRA from September 2009 to December 2011. Results:Four convergent themes were identified, creating a framework of activities for the delivery of TA: acting as a liaison, facilitating training, providing administrative and program management support, and sharing/disseminating information to states. Having a liaison and providing informational resources to states were perceived as critical components of TA for HAI program sustainability. Conclusions:Findings provide a framework of core TA activities required to build and sustain capacity in state HAI prevention programs through the cooperative agreement structure. This categorization of themes can be used to assist other agencies and entities in planning for and provision of TA when utilizing cooperative agreements.

Perspectives on Federal Funding for State Health Care–Associated Infection Programs Achievements, Barriers, and Implications for Sustainability

In September 2009, federal funding for health care–associated infection (HAI) program development was dispersed through a cooperative agreement to 51 state and territorial health departments. From July to September 2011, 69 stakeholders from six states—including state health department employees, representatives from partner organizations, and health care facility employees—were interviewed to assess state HAI program achievements, implementation barriers, and strategies for sustainability. Respondents most frequently cited enhanced HAI surveillance as a program achievement and resource constraints as an implementation barrier. To sustain programs, respondents recommended ongoing support for HAI prevention activities, improved surveillance processes, and maintenance of partnerships. Findings suggest that state-level HAI program growth was achieved during the cooperative agreement but that maintenance of programs faces challenges.