Organizational Structure of the HHS Initiative for the Prevention of Health Care-Associated Infections

The U.S. Department of Health and Human Services (HHS) has undertaken several inter-agency initiatives to improve and expand health care-associated infection (HAI) prevention efforts. One of these initiatives was the establishment of the Federal Steering Committee for the Prevention of Health Care-Associated Infections. The Division of Health Care Quality in the Office of Disease Prevention and Health Promotion coordinates the activities of the Steering Committee.

The Steering Committee includes senior-level representatives from the Operating and Staff Divisions of HHS and is chaired by a Deputy Assistant Secretary for Health. The Deputy Assistant Secretary for Health charged the Steering Committee with developing and implementing the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination.

The Steering Committee uses a phased working group structure to accomplish its charge. Each of the ten working groups enumerated strategies for accomplishing a portion of the HAI Action Plan. The diagram below shows the organization of the working groups by phase:

Phase One focuses on addressing six high priority HAI-related areas within the acute care hospital setting - surgical site infections, central line-associated bloodstream infections, ventilator-associated events formely ventilator-associated pneumonia, catheter-associated urinary tract infections,Clostridium difficile infections, and methicillin-resistant Staphylococcus aureus (MRSA) infections.
Phase Two expands efforts outside of the acute care setting into outpatient facilities. It includes strategies to reduce HAIs in ambulatory surgical centers (ASCs) and end-stage renal disease facilities (ESRDs), as well as a strategy to increase influenza vaccination coverage among healthcare personnel (HCP).
Phase Three expands efforts into long-term care facilities, specifically skilled-nursing facilities (SNFs) and nursing facilities (NFs).

Working Groups of the Federal Steering Committee for the Prevention of Health Care-Associated Infections

1. Prevention and Implementation

Roles:

Identify prioritized clinical practices or evidence-based unit-level or facility-specific interventions to prevent HAIs
Promote implementation of priority clinical practices (i.e., CDC guidelines) or proven effective interventions

Agency Lead: Centers for Disease Control and Prevention (CDC)

2. Research

Roles:

Identify gaps in the existing knowledge base of the effectiveness of HAI prevention practices, epidemiology of HAIs, and pathogenesis, transmission and colonization of health care-associated pathogens
Develop and implement a coordinated, complementary research agenda

Agency Lead: Agency for Healthcare Research and Quality (AHRQ)

3. Information Systems and Technology

Roles:

Develop and implement a coordinated strategy to integrate HAI-related surveillance and reporting systems
Align data definitions and standardize data measures needed to measure the burden of HAIs

Agency Leads: Office of the National Coordinator for Health Information Technology (ONC) & CDC

4. Incentive and Oversight

Role:

Identify options for and leverage payment policies and incentives to prevent HAIs
Identify policy and programmatic options for assuring compliance with HAI prevention practices in health care facilities

Agency Lead: Centers for Medicare & Medicaid Services (CMS)

5. Outreach and Messaging

Role:

Develop and implement a national messaging strategy for HAI prevention to raise awareness of the issue among various stakeholder groups, including patients or consumers

Agency Lead: Office of Disease Prevention and Health Promotion (ODPHP)

6. Evaluation

Roles:

Develop the metrics and targets associated with the initiative in partnership with non-government stakeholders.
Develop and refine a framework for evaluating the Department’s activities related to the HAI Action Plan.

Agency Lead: ODPHP

7. Influenza Vaccination of Health Care Personnel

Role:

Develop benchmarks for measuring short term, mid-term and long-term progress objectives which will be aligned with the Healthy People 2020 objective for increasing seasonal influenza vaccination coverage of health care personnel (HCP).

Background:

Because most HCP provide care to, or are in frequent contact with, patients at high risk for complications of influenza, HCP are a high priority for expanding vaccine use. Achieving and sustaining high vaccination coverage among HCP will protect staff and their patients and reduce disease burden and health care costs.

Although it is a high priority for reducing morbidity associated with influenza in health care settings, preliminary data for the 2010-11 flu season suggest 63.5% of HCP reported receiving seasonal influenza vaccine.

Agency Lead: CDC

8. Ambulatory Surgical Centers

Role:

Identify comprehensive strategies to reduce the incidence of HAIs in this healthcare setting

Background:

ASCs are defined by CMS as distinct entities that operate exclusively to provide surgical services to patients who do not require hospitalization and are not expected to need to stay in a surgical facility longer than 24 hours. Many of the services performed in these facilities extend beyond procedures traditionally thought of as surgery, including endoscopy, injections to treat chronic pain, and dental care. Currently, there are over 5,300 Medicare-certified ASCs in the U.S., which represents a greater than 50% increase since 2001. In 2007 more than six million surgeries were performed in these facilities and paid for by Medicare at a cost of nearly $3 billion. Over the last decade, ASCs have demonstrated tremendous growth both in the volume and complexity of procedures being performed.

Agency Leads: CDC & Indian Health Service (IHS)

9. End-Stage Renal Disease Facilities

Role: Identifies comprehensive strategies to reduce the incidence of HAIs in this health care setting

Background:

Infection is a leading cause of morbidity and is second only to cardiovascular disease as the leading cause of death in the chronic uremic patient on hemodialysis. According to the United States Renal Data System, the total death rate due to infection is 76 per 1,000 patient-days with sepsis responsible for three quarters of these infection-related deaths. In comparison to the general population, the incidence of sepsis in patients with ESRD can be up to 100 times higher. Infections are a major reason for hospitalizations in this population, estimated to be responsible for as many as 20% of all inpatient admissions. It has been predicted that the number of ESRD patients will increase approximately 1.5-fold by the year 2020, underscoring the importance for prevention efforts in this population to reduce the physical, emotional, and financial cost of infections.

Agency Lead: CMS

10. Long-Term Care Facilities

Role: Identifies comprehensive strategies to reduce the incidence of HAIs in this health care setting

Background: Current HAI burden estimates in SNFs and NFs, the two types of settings that the HAI Action Plan will initially focus on, show that between 1.6 and 3.8 million infections each year, with an estimated 150,000 additional hospitalizations and 380,000 additional deaths among nursing home (NH) residents, while adding an estimated $673 million in additional health care costs.

Currently, data sources for HAIs in long-term care facilities (LTCF) are limited. Most data collection systems currently in place are not designed as HAI surveillance systems, nor are they deemed adequate for HAI surveillance, which serves to highlight the need to develop the LTCF strategy in the HAI Action Plan.

Most common HAIs in NHs include: Urinary tract infections (UTIs), which includes both catheter-associated and non-catheter associated UTIs; Lower respiratory tract Infections, primarily influenza and pneumonia; gastroenteritis, primarily caused by Clostridium difficile or Norovirus infection; and skin and soft tissue infections.

Agency Leads: CDC & ODPHP