Antimicrobial Resistance Coordinator Antimicrobial Stewardship Collaborative New Jersey Hospital Association July 25 2018 Updates on Stewardship and Resistance Infrastructure Response Various Roles of Public Health ID: 930112
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Patricia M. Barrett, MSDAntimicrobial Resistance CoordinatorAntimicrobial Stewardship CollaborativeNew Jersey Hospital AssociationJuly 25, 2018
Updates on Stewardship and Resistance
Slide2Infrastructure
Response
Various Roles of Public Health
Slide3Slide4Promote best practices to prevent drug resistance and transmission
Prevention
Slide5Introductory resources for long-term care facilities developing their stewardship programBound copy of the CDC Core Elements of Antibiotic Stewardship for Nursing HomesExample stewardship policySlide deck for staff educationCommunications strategies for providers
Patient factsheets on antibiotics and common infections
Physical and digital copies available soon
Long-term Care Stewardship Toolkit
Slide6New program under development to recognize facility stewardship programs
Feature on the NJDOH HAI webpage
Digital media kit for each ASP
Focus-group scheduled on August 28, 2018
Determine program requirements
Incentives and benefits for enrollment
Email patricia.barrett@doh.nj.gov for more information or to join focus group
Stewardship Recognition Program
Slide7U.S. and World Antibiotic Awareness Week is November 12-18, 2018CDC resources and updates available at: www.cdc.gov/antibiotic-use/week/index.htmlPlease share your activities and ideas for the week with NJDOH!
Reminder: Antibiotic Awareness Week
Slide8Guide includes:Understanding your roleInternal, external, and state partnersPolicies and proceduresData and surveillanceUnderstanding your IT needs
Reportable communicable diseases
HAI prevention
Professional development
Will soon be posted on the NJDOH HAI WebsiteNew IP Guide and Resources
Slide9CDC stewardship training available at: www.train.org/cdctrain/course/1075730
Four online modules released throughout 2018
Free registration with 8 contact hours
Clinicians
Physician AssistantsNurses
Health EducatorsPharmacistsPublic Health Practitioners
CDC Antibiotic Stewardship Training
Slide10Updated policy memorandum from CMS (July 2018)QSO-17-30Previously S&C 17-30Facilities must have
water management plans and documentation, including:
Risk assessment for pathogens growth in the facility water system.
Water management program, testing protocols with ranges, and control measures.
ASHRAE industry standard and the CDC toolkit. Requirement for all Hospitals, Critical Access Hospitals, and Long-Term Care Facilities
CMS Legionella and Water Management
Slide11CMS Legionella and Water Management
www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-And-Cert-Letter-17-30-.html
www.cdc.gov/legionella/wmp/toolkit/index.html
www.ashrae.org/technical-resources/bookstore/ansi-ashrae-standard-188-2015-legionellosis-risk-management-for-building-water-systems
Slide12Monitor antibiotic use and resistance to understand trends and identify resistant threats
Surveillance
Slide13CDC has added MRSA TAP reports in NHSN for acute care hospitalsAvailable as of April 2018Baseline MRSA LabID data from 2015MRSA TAP report includes:SIR (Standardized Infection Ratio) CAD (Cumulative Attributable Difference)
New TAP Report in NHSN
Slide14Factsheets on select MDROsLaboratory protocolsSampling recommendationsBest practicesLaboratory safety for MDROs
www.cdc.gov/hai/settings/lab/lab_settings.html
CDC Resources for Laboratorians
Slide15NJDOH is accepting Carbapenem-resistant Klebsiella spp. and
E. coli
isolates for Carbapenemase testing
ID, AST, mCIM
RT-PCR for: IMP, KPC, NDM, OXA-48, VIMRegular submission is encouragedResults sent electronicallyFedEx shipping and testing free
CRE Lab Surveillance Program
Slide16Novel Resistance Lab SurveillanceIsolates accepted at the Northeast AR Laboratory:
Carbapenem-resistant
Acinetobacter
Third-generation cephalosporin-resistant
E. coli and
Klebsiella spp.Pan non-susceptible isolates (I or R)Isolates with other concerning resistance patterns
Prior notification is required
Regular submissions can be set-up
FedEx shipping and testing free
Slide17Patients who report international healthcare exposure in the past 365 days are considered high-risk for CP-CRE colonizationThe AR Lab Network supports admission screening for these high-risk patientsRectal swab coordinated through NJDOHSwabs, FedEx shipping, and testing free
CRE Admission Screening
Slide18Implement control measures to contain and prevent transmission of resistant threats
Response
Slide19Candida auris is nationally notifiableClinical isolates onlyPassed by the Council of State and Territorial Epidemiologists in June 2018C. auris
and
Candida haemulonii
complex
are expected to be added with the next update of the Communicable Diseases Regulations (N.J.A.C. 8:57)Timeline TBDGuidance will be shared once timeline established
Candida auris Reporting
Slide20Diversion of injectable medications can lead to viral or bacterial infections.NJDOH resources include:Template policiesTabletop exercise tool for healthcare facilities to work through scenarios of diversionPublic health reporting algorithm
Drug Diversion Conferences
(recent conference June 2018)
Drug Diversion Resources
Sources: Maki et al., JAMA 1991; Hellinger et al., Ann Intern Med 2012
www.oneandonlycampaign.org/partner/new-jersey
Slide21CDC has identified possible transmission of Acinetobacter calcoaceticus-Acinetobacter baumannii (ACB) via
platelet transfusion
2 cases identified in other states
Please report any cases where patients developed
ACB sepsis within 24 hours of platelet transfusions to local health departmentPlease report any cases since January 2018 and onwardOrganisms include:
A. baumannii, A. pittii, A. nosocomialis, and A. seifertii
Call for Cases
Slide22Build and maintain capacity for prevention, surveillance, and response across New Jersey
Infrastructure
Slide23Resistance Testing in ELR
NJDOH is beginning to assess the antibiotic susceptibility testing data sent through electronic lab reporting (
ELR
)
Goal: Integrate resistance data into Communicable Disease Reporting Surveillance System (CDRSS)
Slide24[Enter HM Slides on AUR Module]
Slide25Thank you!Patricia M. Barrett, MSD
Antimicrobial Resistance Coordinator
📞
609-826-5964
📩
patricia.barrett@doh.nj.gov
Slide26Maki D.G., Klein B.S., McCormick R.D. Nosocomial Pseudomonas pickettii bacteremias traced to narcotic tampering: a case for selective drug screening of health care personnel. JAMA. 1991;265(8):981–986. [
PubMed
]
Hellinger W.C.,
Bacalis L.P., Kay R.S. Health care-associated hepatitis C virus infections attributed to narcotic diversion. Ann Intern Med. 2012;156:477–482. [PubMed]
References