Healthcare Infection Control Practices Advisory Committee (HICPAC)

Slide 1
HHS Efforts to Reduce Healthcare-associated Infections

Anand Parekh, MD MPH
Deputy Assistant Secretary for Health (Science and Medicine)

Health Care Infection Control Practices Advisory Committee
November 13, 2008

Slide 2
Overview of Presentation

  • Background on Development of Draft Plan
  • Working Group Structure
  • Progress of Working Groups
  • Influenza Vaccination of Health-care Personnel Initiative

Slide 3
Impact of Healthcare Associated Infections Nationally

  • HAIs account for an:
    • estimated 1.7 million infections and
    • 99,000 associated deaths each year.,
  • HAIs affect 5-10% of hospitalized patients annually
  • HAIs add nearly $20 billion to healthcare costs each year

Slide 4
Estimated Annual Hospital Cost of HAI by Site of Infection


Major Site of Infection
Total infections
Hospital Cost per
Infection (2002 $)
Total annual hospital cost
(in millions $)
Deaths Per year
Surgical Site Infection
Central line associated-Bloodstream Infection
Ventilator-associated Pneumonia
Catheter associated-Urinary Tract Infection

Klevens RM, Edwards JR, Richards CL, Horan T, Gaynes R, Pollock D, Cardo D. Estimating healthcare-associated infections in U.S. hospitals, 2002. Public Health Reviews (in press)

Stone PW, Braccia D, Larson E. Systematic review of economic analysis of health care-associated infections. Am J Infect Control 2005;33:501-9.

Roberts RR, Scott RD, Cordell R, Solomon SL, Steele L, Kampe LM, Trick WE, Weinstein RA. The use of economic modeling to determine the hospital costs associated with nosocomial infections. Clin Infect Dis 2003;36:1424-32.

Slide 5
Leading Types of Healthcare Associated Infections

Bloodstream Infections,14
Surgical Site Infections, 17
Urinary Tract Infections, 34

% HAIs nationally

Slide 6
GAO Report: HHS specific Recommendations

  1. Improve central coordination of HHS-supported HAI prevention and surveillance activities
  2. Identify priorities among CDC’s recommended practices to:
    Promote implementation of high priority practices
    Consider inclusion into CMS’s Conditions for Participation
  3. Establish greater consistency and compatibility of data collected across HHS to:
    Increase reliable national estimates

Slide 7
HHS Steering Committee on HAI Reduction

CHARGE: Develop a National Action Plan for Reducing HAIs. Plan will:

  • Establish national goals for reducing HAIs
  • Include short-term and long-term benchmarks
  • Outline opportunities for collaboration with external stakeholders
  • Coordinate and Leverage HHS resources to accelerate and maximize impact

Slide 8
Tier One Priorities

  • HAI Priority Areas
    • Catheter associated-Urinary Tract Infection
    • Central Line Associated Blood Stream Infection
    • Surgical Site Infections
    • Ventilator Associated Pneumonia
    • MRSA
    • Clostridium difficile
  • Implementation Focus
    • Hospitals

**Tier Two will address additional HAI areas and other types of healthcare facilities

Slide 9
Steering Committee Working Group Structure

org chart

Slide 10
Prevention and Implementation Working Group Objectives

  • Partner with the Healthcare Infection Control Practices Advisory Committee to prioritize existing recommended infection control clinical practices.
  • Establish a “top 10” list for existing recommended guidelines.
  • Identify opportunities to share best practices that result in successful HAI reductions and prevention.
  • Enumerate strategies to translate prioritized guidelines into bedside care.

Working Group Lead: CDC

Slide 11
Research Working Group Objectives

  • Identify gaps in existing knowledge base
  • Prioritize research needs to fill knowledge gaps identified
  • Develop and test interventions that utilize technology to promote HAI prevention
  • Develop a coordinated research agenda to strengthen the science for infection control prevention

Working Group Lead: AHRQ

Slide 12
Incentive and Oversight Working Group Objectives

  • Explore with CMS the inclusion of specific infection control practices in their Conditions for Participation
  • Explore financial incentives to enhance hospital compliance with prioritized infection control practices
  • Partner with the Joint Commission, CMS, and the American Osteopathic Organization to ensure that compliance with infection control practices is evaluated in the required certification process

Working Group Lead: CMS

Slide 13
Information Systems and Technology Working Group Objectives

  • Establish definitional alignment and standardize measures for HAIs across agencies
  • Provide guidance for developing a robust database that will measure HAIs and enable HHS to accurately benchmark progress toward HAI elimination.
  • Mobilize health information systems to help reinforce appropriate patient safety practices
  • Seek strategic opportunities to make varied HHS data systems interoperable

Working Group Leads: ONC and CDC

Slide 14
Outreach and Messaging Working Group Objectives

  • Develop national initiative focused on reducing HAIs
  • Explore opportunities to link HAI rates to the Secretary’s Value Driven Healthcare Initiative.
  • Disseminate information on HAI prevention to consumer groups to raise awareness to the issue

Working Group Lead: OPHS

Slide 15
Next Steps………

  • Please share your comments and ideas….send to or
  • Plan is undergoing Departmental Clearance
  • After clearance, will be posted in the FR for public comment
  • Plan to be Revised based on Comments Received
  • Planned Release- Late January 2009

Slide 16
Influenza Vaccination of Health-care Personnel:
An HHS Initiative to Improve a Serious Public Health Problem

Only 45 percent of U.S. health-care personnel were vaccinated in 2007

Slide 17
Impact of Influenza Vaccination of Health Care Personnel on patients

  • Over 12 years in one hospital, vaccination coverage increased from 4% to 67%
    • Laboratory-confirmed influenza cases among HCP decreased from 42% to 9%
    • Nosocomial cases among hospitalized patients decreased 32% to 0 (p<0.0001)1
  • Three randomized controlled trials evaluated impact of HCP influenza vaccination on residents in nursing homes2,3,4
    • They estimated 5%- 40% decrease in overall mortality among residents in the setting of high employee vaccination levels, regardless of patient vaccination levels.

1Salgado et al., Inf Cont Hosp Epi 2004;25:923-8
2Carman et al., Lancet 2000;355(9198): 93--7
3Potter, et al., J Infect Dis 1997;175:1—6
4Hayward, et al, BMJ 2006;333:1241-6

Slide 18
HHS Initiative for Influenza Vaccination of Health Care Personnel: Components

Two components

  • Improving HHS health care employee influenza vaccination, with focus on
    • Federal Occupational Health
    • Indian Health Service
    • U.S. Public Health Service Commissioned Officers
    • NIH Clinical Center
    • CDC
  • Promoting influenza vaccination to non-federal health care organizations and HCP

Slide 19
HHS Initiative for Influenza Vaccination of Health Care Personnel: HHS Employees

Three focus areas

  • Developing office and agency specific strategies to improve HCP vaccination levels
  • Measuring employee vaccination rates
  • Disseminating a toolkit containing
    • Standard presentation
    • Relevant articles
    • Posters
    • Fact sheets, questions and answers
    • Vaccine information statements
    • Links to other resources
    • Toolkit is available on HHS OPHS website

Slide 20
HHS HCP Vaccination Toolkit

[Screen capture of, HCP initiative to improve ful vaccination toolkit web site.
Over 5,500 views to the website since it went live in mid-July.]

Slide 21
Other HHS Activities

  • CDC developed a measure on HCP influenza vaccination adopted by the National Quality Forum (limited to 12 months and evaluation thereafter)
  • CDC’s National Influenza Vaccination Week (Dec 8-14) will feature HCP vaccination on Dec 12 in a webcast
  • HRSA sent letter to all grantee Federally Qualified Health Centers encouraging HCP vaccination

Slide 22
HHS Initiative for Influenza Vaccination of Health Care Personnel: Outreach

HHS will also promote Influenza Vaccination of Health Care Personnel (HCP) nationwide

Healthy People 2010 target: 60% of all HHS HCP will be vaccinated annually By 2010

HHS plans to partner with many other organizations to promote HCP influenza vaccination

Selected Partners include:

  • American Academy of Family Physicians
  • American Academy of Pediatrics
  • American College of Obstetricians and Gynecologists
  • American College of Physicians
  • American Hospital Association
  • American Medical Association
  • American Nurses Association
  • American Society of Health-System Pharmacists
  • Association for Professionals in Infection Control and Epidemiology, Inc.
  • National Black Nurses Association
  • National Hispanic Nurses Association
  • National Foundation for Infectious Diseases
  • National Influenza Vaccine Summit
  • National Medical Association
  • National Hispanic Medical Association


Date last modified: January 12, 2009
Division of Healthcare Quality Promotion (DHQP)
National Center for Preparedness, Detection, and Control of Infectious Diseases