# Presentation: 102559

## Surveillance for Healthcare - Associated Infections in VHA: A Status Report

**	****      ****Ronald O. Valdiserri M.D., M.P.H.**
-                   Chief Consultant
-                         Public Health Strategic Healthcare Group
-                   February 2, 2007

## Missions of the Veterans Health Administration (VHA)

- Medical care
- Graduate medical education
- Research
- Emergency preparedness

## Facts about the Department of Veterans Affairs

**24.3 M veterans currently alive in U.S.**
**In 2005, 5.3 M persons received care in VA health facilities**
**Largest integrated health care system in U.S.**
**155 medical centers**
**135 nursing homes**
**45 residential rehab rx. programs**
**Serves > 100,000 homeless vets each year**
**Largest single provider of HIV care (22,903 in FY05)**

## In FY 2005, VHA health care system provided:

- 57.5 M outpatient visits
- 5.0 M bed-days of inpatient hospital care
- 231.1 M prescriptions
- 219 M inpatient and outpatient lab tests

## Who Are VA Patients?

- Older - Median 59y, 49% over age 65, 278,000 > 85y
- Sicker - Compared to Age-Matched Americans
- 3 Additional Non-Mental Health Diagnoses
- 1 Additional Mental Health Diagnosis
- Poorer
- 70% with annual incomes < $26,000
- 40% with annual incomes < $16,000
- 31% have no health insurance
- Changing Demographics -7% female overall and 10%
- female by 2010
- 22.5% of outpatients less than 50 years of age are women veterans

## Implementation of CPRS

- July 1996 : Installed at first VA site
- Aug.- Dec.1997 : 3 additional sites
- June 1998 : Installed in lead site in each of VA’s      		          22 regions
- Dec. 1999 : Implementation complete at all
-                     VA Medical Centers

## Vista / CPRS (Computerized Patient Record System)

**VistA/CPRS supports the largest integrated**
**health system in the United States serving over **
**5 million veterans**
-  Delivers an integrated record covering all aspects of
-      patient care and treatment
-  Includes electronic order entry and management,
-      narrative notes entry, laboratory results, consultation
-      requests and reports, alerts of abnormal results,
-      imaging, clinical reminders, and much more
-  VistA Web allows clinicians to see health data from any  other VA facility where the veteran has received care

## Clinical                       VA                  HEDIS                  HEDIS Performance            FY 05            Commercial       Medicare Indicator                                            2005                      2005

| 
Colorectal cancer screening | 
76% | 
52% | 
54% |
| --- | --- | --- | --- |
| 
Beta blocker
on discharge after AMI | 
98% | 
97% | 
94% |
| 
Diabetes: Eye Exam | 
79% | 
55% | 
67% |

## Hospital Associated Infections & Syndromic Surveillance (HAISS) Program

- Leverage VHS’s advanced electronic
- medical record and national, integrated
- healthcare system to establish a
- comprehensive electronic surveillance
- system to monitor:
- Healthcare-associated infections
- Influenza and other emerging infectious diseases or syndromes associated with bioterrorist activity

## Category 1: NHSN Infections

- End Users:
- VHA HAISS program
- CDC National Healthcare Safety Network (NHSN)
- Infection Control Practitioners at local sites
- Purpose: to allow all appropriate VHA facilities to actively participate in NHSN surveillance, with electronic data collection and NHSN infection determination, and transmittal to CDC via the NHSN web-based application.

## Category 1: NHSN Infections

- NHSN Infections includes surveillance for ICU device-associated and surgical site infections using established NHSN criteria:
- Central line-associated bloodstream infection (CLABSI)
- Catheter-associated urinary tract infection (CAUTI)
- Ventilator-associated pneumonia (VAP)
- Surgical site infection (SSI)

## Category 2: Syndromic Surveillance

- End Users:
- VHA HAISS program
- Local and State health departments
- Authorized users at local sites
- Federal Partners
- Purpose: to provide situational awareness to VHA to allow early event detection and monitoring of disease outbreaks:
- Magnitude, location, and rate of spread

## Category 2: Syndromic Surveillance

**Syndromic Surveillance includes surveillance for influenza-like illness (ILI) and others from 7 syndrome groups characteristic of illnesses potentially caused by Category A bioterrorist agents:**
- -  Respiratory - cough, pneumonia, ILI, URI
-        -  Gastrointestinal - vomiting, diarrhea
-        -  Neurological - meningitis, botulism-like
-        -  Dermatologic - hemorrhagic
-        -  Dermatologic - vesicular (smallpox-like)
-        -  Fever, Malaise, Sepsis
-        -  Coma/Sudden death

## Category 3: Organisms/Infections of Epidemiologic Significance

- End Users:
- VHA HAISS program
- Local and State health departments
- infection Control Practitioners at local sites
- Purpose:
-       - To allow users to monitor and detect trends in
-        transmission of multi-drug resistant organisms
-        (MDRO), local clustering of organisms, and non-ICU
-        bloodstream infections,
-     - To allow local VHA facilities to identify and report
-        infections/conditions that require notification to public
-        health authorities via electronic auto-populating of
-        reporting forms.

## Category 3: Organisms/Infections of Epidemiologic Significance

- Includes surveillance for multi-drug resistant organisms (MDRO)
-      - MRSA, VRE, multi-resistant gram negatives
- Clustering of organisms of epidemiologic significance
- - C.difficile, Group A Streptococcus, Legionella, MTB
- Non-ICU bloodstream infections
- Infectious Diseases/conditions reportable to the local, state, and national public health authorities

## Category 3: Organisms/Infections of Epidemiologic Significance

- End Users:
- VHA HAISS program
- Infection Control Practitioners, Infectious Disease Physicians, and Pharmacists at local sites
**Purpose: to promote appropriate antimicrobial usage by allowing facilities to:**
-     - monitor antimicrobial usage and resistance trends,
-     - recognize antimicrobial misuse,
-     - suggest alternative therapies to clinicians.

## Category 4: Antibiotic Usage and Decision Support

- Antimicrobial usage trends, by drug, facility and location
- Antimicrobial resistance patterns, by organism, facility and location
- Drug/bug mismatch identification (antibiotic prescribed does not correlate with resistance pattern of organism isolated)
- Alternative antimicrobial recommendations related to effectiveness as well as cost considerations

## Timeline

- Fall 06 : Solicit vendor proposals
- Mid Feb 07 : Identify successful vendor(s)
- ~ 6 months : Develop prototype
- ~ Sept 07 : Install and test prototype @ 1-2 facilities
- Early 08 : System “live” @ 16 VA Hospitals (NHSN)
- 2011 : System-wide implementation

**Surveillance **
**	****	****	****    ****is information for **
**                                                               ****public health action.**