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, West Hartford-Bloomfield Health District, shared with us. A standalone version of their blog post can be found here.

Partner Engagement to Strengthen HAI/AR Capacity

“The West Hartford-Bloomfield Health District (WHBHD) has engaged multiple partners throughout the BLOC COVID, BLOC COVID+, and HAI/AR Strategy projects; most notably, these include long-term care facilities (LTCFs), other local health departments, and the state of Connecticut’s HAI/AR program. Communication has been central to successful partner engagement.

Best practices for communication with facilities included outreach to introduce the BLOC COVID+ projects and associated goals and staff. Facilities were also provided with direct contacts for local health department staff. The Health District increased the frequency of communication with all facilities in the jurisdiction, with persistent outreach to facilities that they had trouble contacting on the first try.

“The Health District emphasized that they are a resource and support tool for IPC-related efforts when communicating with facilities through introductions, when conducting Infection Control and Response Assessments (ICARs), and during both in-person and virtual educational sessions, which assisted in building trust.”

Partnerships with LTCFs strengthened mutual efforts to build HAI/AR capacity through strengthened IPC programs, sharing of knowledge and resources, providing guidance and recommendations in outbreaks, conducting ICARs, and providing educational training sessions for facility staff. Educational sessions were provided in-person, tailored to each facility’s needs based upon ICARs or in response to an outbreak, and included staff in multiple roles (i.e. nurses, CNAs, IPC roles, environmental, and dining staff) to relieve burden from administration.

WHBHD partnered with two other local health departments in the state to develop the Connecticut Coalition Against HAIs. The coalition’s goal is to improve IPC response in LTCFs and other congregate settings to decrease rates of negative health outcomes associated with HAIs. The coalition hosts quarterly meetings to deliver timely updates, provide education, and allow for peer sharing and feedback. As a result, the collaboration fostered by the coalition bolstered HAI/AR capacity within our jurisdiction through expanding and standardizing IPC efforts. The state of Connecticut HAI/AR program team is also included in quarterly coalition meetings. This partnership has further assisted in building trust and addressing hesitancy in facilities due to lack of time, staff turnover, and lack of knowledge of local health roles. The coalition and bi-directional information sharing between the Health District and facilities has effectively established and maintained regular communication over time.

The Health District has regularly engaged with the state HAI/AR program throughout the strategy plan development and implementation phases. Early in the LHD HAI/AR Strategy project, a meeting was held with the WHBHD team and state Department of Public Health (DPH) HAI/AR team for formal introductions, sharing of roles and responsibilities associated with IPC, discussion of department HAI activities, and establishment of a communication plan. The strategy plan was shared with the state program for feedback and to ensure Health District goals align with state HAI/AR goals. The Health District regularly attend DPH HAI/AR program monthly meetings for shared updates, resources, and information in support of WHBHD efforts to build HAI/AR capacity.

The time dedicated to these projects, especially in-person, has allowed the WHBHD team to become familiar, friendly faces within facilities. In-person interactions in particular bolstered efforts to address the challenges associated with high staff turnover at facilities, building trust, and lack of time that were barriers throughout the pandemic and prior to the expansion of HAI/AR activities.”

Building Capacity with the BLOC COVID Project

“The West Hartford-Bloomfield Health District began working on HAI/AR activities through the BLOC COVID project in 2020, which focused primarily on the prevention of COVID transmission within facilities. A round of funding through NACCHO for 2022 through June 2023 supported the BLOC COVID+ project, which shifted focus to prevention of HAIs and AR with a continued emphasis on COVID. These projects paved the way for building the District’s HAI/AR program. The Health District then began the LHD HAI/AR Strategy Project in March 2023. Throughout this period, relationships were formed with other LHDs, emergency preparedness groups, including ESF-8 Region 3, and the Coalition of HAIs, which further contributed to WHBHD’s HAI/AR programmatic efforts.

The Health District partnered with a local IPC consultant for the BLOC COVID project in 2020 and has continued contracting them to date. This partnership was strengthened through the coordination of ICAR assessments and educational training sessions, development and sharing of IPC resources, and CT Coalition Against HAIs meetings. The IPC consultant supports the Health District’s program by providing expertise, experience, updates, resources, and educational opportunities. They assisted IPC activities by providing support and recommendations, which in turn increased engagement and strengthened relationships with facility partners.”

Strengthening Beyond BLOC COVID+

“Building upon the groundwork of the BLOC COVID and BLOC COVID+ projects, implementing activities through the LHD HAI/AR Strategy project established the foundation of the Health District’s HAI/AR program through the development of an HAI/AR Implementation Strategy Plan. The Implementation Strategy Plan includes training opportunities to increase staff knowledge and skills to effectively respond to cases or outbreaks of MDROs or infectious diseases, update internal outbreak and emergency preparedness plans, and engage with the state HAI/AR program. The Health District regularly attends state HAI/AR meetings for LHDs interested in IPC activities and for IPC nurses across the state of CT. The Health District plans to participate in a tabletop exercise with CT DPH HAI/AR program in August to put their outbreak response skills to the test!

Internal collaboration and coordination among staff is essential to successful implementation of HAI/AR activities. The Health District’s environmental health team has regular communication with facilities during dining inspections, which includes being a resource and providing guidance in the event of an outbreak. The Public Health Nurses and Epidemiologist coordinate outbreak response efforts and provide IPC guidance. The Emergency Preparedness Specialist leads emergency planning efforts including infectious disease threats. Previous coordination with facilities throughout the COVID-19 pandemic further prepared staff for expanding HAI/AR activities.”