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

摘要

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. Health care–associated infections (HAIs) are an increasingly recognized cause of preventable morbidity and mortality. 1,2 Since 2008, the Department of Health and Human Services (DHHS) has committed substantial resources toward prevention of HAIs. This commitment resulted in the DHHS Action Plan to Prevent HAIs, which identified key strategies to achieve and sustain progress in protecting patients from infections. 3 Funding to health departments to carry out this plan came from the American Recovery and Reinvestment Act (ARRA) of 2009. The Epidemiology and Laboratory Capacity Program of the Centers for Disease Control and Prevention (CDC) distributed these funds, granting approximately $35.8 million for state-level capacity building for HAI prevention programs (ARRA–HAI) to 51 health departments in 49 states, the District of Columbia, and Puerto Rico. 4 The DHHS Action Plan emphasized aligning and coordinating HAI stakeholder efforts, promoting standardized metrics for HAI surveillance, and targeting reduction of device-associated, procedure-associated, and multidrug-resistant HAIs. The goal of ARRA–HAI funding was to enhance the role of state and territorial health departments in executing the Action Plan goals through allocation of funds in 3 domains: infrastructure, surveillance, and prevention. The CDC reviewed applications and distributed funds competitively. Health departments applied for a total of $66?230?990 and received $35?800?000 in Epidemiology and Laboratory Capacity funding; all health departments that applied received some funding. The average award was $210?000 for the 17 health departments that received funding only for infrastructure, $630?000 for the 12 health departments that received funding for 2 of the 3 domains, and $1.1 million for the 22 health departments that received funding for all 3 domains. Most health departments with little to no engagement in HAI activities at the time applications were filed (July 2009) received funds only for infrastructure. Conversely, health departments with more active HAI programs applied to enhance existing infrastructure in addition to proposing surveillance and prevention activities ( Figure 1 ). Open in a separate window FIGURE 1— Distribution of American Recovery and Reinvestment Act funding to 51 state and territorial health departments among infrastructure, surveillance, and prevention funding domains, 2009–2011. The CDC developed a conceptual program model that guided the evaluation and served as the basis for expectations related to health department performance. 5 Health departments awarded funding for infrastructure (n?=?48) were expected to dedicate staff time to HAI activities, promote strategic partnerships through regular assembly of a multidisciplinary advisory group of HAI stakeholders, and provide training and technical assistance to health care facilities regarding HAIs. Those awarded funding for surveillance (n?=?31) were expected to enhance the quality of HAI surveillance through the National Healthcare Safety Network (NHSN) Surveillance System and to work toward active use of NHSN data to inform decision-making and motivate prevention. The 28 health departments awarded funds for prevention collaborative implementation were expected to lead or support multifacility prevention initiatives targeting HAI reductions through systematic implementation of evidence-based practices, data feedback, and culture change strategies. 6 We assessed capacity built (i.e., breadth of engagement in key HAI activities) and outcomes achieved (i.e., statewide HAI reductions) from September 1, 2009, to December 31, 2011, by the 51 health d