The National Association of County and City Health Officials (NACCHO), the voice of the country’s nearly 3,000 local health departments, with support from the Centers for Disease Control and Prevention (CDC), Division of Healthcare Quality and Promotion, awarded eleven local health departments with funding to support the Local Health Department Healthcare-Associated Infections and Antimicrobial Resistance (HAI/AR) project. These funds supported their ability to pilot and implement the CDC (Interim) Local Health Department Strategy for HAI/AR.

HAIs are among the leading causes of preventable deaths in the United States. The CDC estimates that one in 31 hospital patients are infected with at least one HAI, and AR is a major public health threat that compounds the challenge of HAIs. Antimicrobial-resistant infections cause more than 35,000 deaths each year, and nine of the top 18 infections considered to be the highest AR threats are often associated with healthcare settings.

The selected local health departments used the CDC (Interim) Local Health Department Strategy for HAI/AR to enhance the capacity of HAI/AR prevention and response, including through conducting infection control assessments, strengthening antimicrobial stewardship efforts, improving laboratory coordination, and enhancing HAI/AR data reporting and access. They also coordinated with stakeholders at the local and state levels to advance these efforts.

We asked our HAI/AR pilot project sites to reflect on their experiences and lessons learned since joining our project. Here is what one of our sites, the Kern County Public Health Department, shared with us. A standalone version of their blog post can be found here.

Enhancing HAI/AR Strategy at Kern County’s Public Health Department

“Since being accepted into the National Association of County and City Health Officials (NACCHO) Local Health Department Healthcare-Associated Infections/ Antimicrobial Resistance (HAI/AR) Project, Kern County’s Public Health Department (KCPH) has made significant progress towards implementing its HAI/AR strategy. The work done throughout the COVID-19 pandemic with healthcare facilities helped pave the way for the development of the HAI/AR work plan. The progress has been gradual since KCPH needed to shift from a responsive to a preventive approach. Key partners, like the California Department of Public Health’s (CDPH) HAI/AR program, made the transition easier by providing trainings and educational resources for KCPH staff to build HAI/AR capacity.

“The effects of the COVID-19 pandemic laid the groundwork for the HAI/AR program activities. During the COVID-19 pandemic, healthcare facilities turned to KCPH for resources and guidance. The increased communication between KCPH and healthcare facilities established a collaborative environment that strengthened their relationship.”

For instance, a monthly call with skilled nursing facilities (SNFs) was created at the start of the COVID-19 pandemic to check-in with facilities regarding their staffing levels, resources, and COVID-19 cases. This call continues to be held but has now transitioned to serving as a check-in call to provide KCPH with an update regarding any changes in management and to address any concerns among the SNFs. The relationships established throughout the COVID-19 pandemic have made it easier to create buy-in among healthcare facilities to participate in new initiatives KCPH is launching as part of the HAI/AR program.”

Shifting to a Preventive Approach through a Sustainable Workforce

“KCPH took a gradual approach to implementing the HAI/AR strategy and leaned into the NACCHO HAI/AR project for technical assistance to build HAI/AR capacity. A gradual approach was taken due to the transition needed to shift from a responsive to a preventive approach. The COVID-19 pandemic created a growing need for KCPH to respond to HAI concerns in the healthcare setting. KCPH temporarily hired a contracted staff at the beginning of the COVID-19 pandemic to respond to outbreaks and provide guidance to healthcare facilities. Later, a plan was made to ensure the contracted staff’s work would be continued once their contract expired. The work that the contracted staff established, like the monthly check-in calls with SNFs was added to the preventive approach workplan. The NACCHO monthly peer-to-peer sharing and capacity-building assistance calls helped to keep KCPH accountable with its new workplan and provided an opportunity for NACCHO staff to provide feedback on the progress being made. During these calls, KCPH would share challenges faced in executing its workplan and NACCHO would share resources to address the challenges.”

Enhancing Partnerships through Shared Goals

“The main key partner in KCPH’s HAI/AR program is the California Department of Public Health’s HAI/AR program. Significant progress has been made in engaging CDPH during the strategy plan development and implementation, mainly because KCPH’s goal of preventing the spread of HAI/AR organisms is in alignment with CDPH’s goal. During the initial planning stages of the project, they provided KCPH staff with assistance to incoming HAI/AR case investigations. CDPH HAI continues to provide KCPH with support in the form of training and involvement in each of the all-facility calls Kern County holds with healthcare facilities. One of the trainings that CDPH HAI provided to KCPH staff was on preparing to conduct site assessments to SNFs using the Centers for Disease Control and Prevention (CDC) Infection Control Assessment Response (ICAR) tool. They allowed KCPH staff to shadow them on site assessments, which laid the groundwork for Kern County to be able to establish yearly site assessments with all 17 SNFs. Since CDPH HAI has IPs assigned to different regions, the Central Valley IP is able to be involved with each of KCPH’s educational calls. They assist KCPH with recruitment of subject matter experts to present on the all-facility calls with healthcare facilities.”

Concluding Thoughts

“KCPH’s progress in increasing staff’s capacity, and expertise can be attributed to the grant awarded by NACCHO for the HAI/AR Project. Through this grant KCPH’s HAI/AR program staff have been able to attend two conferences, the Council of State and Territorial Epidemiologists (CSTE) 2022 Conference, and the 2023 Society for Healthcare Epidemiology of America (SHEA), to expand their expertise. Through these conferences, KCPH staff were able to get ideas to expand its work plan. For example, KCPH began implementing yearly site assessments to skilled nursing facilities (SNFs) using the CDC ICAR tool. Additionally, two of KCPH’s staff are in the process of becoming CIC certified. Apart from the grant that NACCHO provided KCPH for its HAI/AR program, they were able to accept KCPH for the NACCHO Infection Prevention and Control Assessment Training (IPC-AT) project. This project allowed KCPH staff to enhance its infection prevention and control (IPC) capacity. KCPH was paired with a board-certified Infection Preventionist (IP) to conduct remotely held standardized IPC assessments at SNFs. KCPH had previously conducted in-person ICAR site assessments, but this project helped provide staff with further resources when conducting remotely held site assessments. The board-certified IP provided KCPH staff with further guidance on how to respond to identified deficiencies/ gaps in the infection control practices of SNFs.”