Local Health Departments (LHDs) are routinely involved in HAI prevention activities because they:

• Serve as the frontline of public health and facilitators of community healthcare.
• Help strengthen prevention and response by identifying gaps and needs, advancing healthcare knowledge, and sharing best practices and resources with community partners.

• Improve regional infection control infrastructure and coordination to minimize the spread of HAIs through partnerships, surveillance, and prevention.
• Transform local knowledge and data into action to better prevent infections and foster judicious use of antibiotics.

Check out this 2:00 minute video on Addressing Healthcare-Associated Infections: The Role of Local Health Departments for more information on LHD engagement in HAI prevention.

NACCHO’s Exploratory Survey
In April 2022, NACCHO conducted an exploratory survey of Rural, Frontier, and Small LHDs to understand their engagement in Healthcare Associated Infections (HAI), Antimicrobial Resistance (AMR), and/or Antimicrobial Stewardship (AMS) activities or initiatives. Forty-four (44) health departments answered the call and responded to the exploratory online survey. The goals of the survey were to:

1. Assess performance for Rural, Frontier, and Small LHDs & their partnership collaborations engaged or not engaged in HAI, AMR, and AMS initiatives.
2. Inform on workforce development and capacity building in LHDs and their partnerships engaged or not engaged in HAI, AMR, and AMS initiatives.

Key Findings

Rural, Frontier, and Small LHDs Engaged in HAI, AMR, and AMS Initiatives
Over one-third (44%) of the survey respondents indicated that their health department does engage in initiatives/activities around HAI, AMR and/or AMS. Of these survey respondents:

• Nearly half (47%) indicated they decided to engage in activities or initiatives around HAI, AMR, and/or AMS because it was part of their Medicare Rural Hospital Flexibility (Flex) Program and/or Centers for Disease Control and Prevention (CDC) program.

• More than two-thirds (70%) provided activities or initiatives they have implemented for HAI, AMR and/or AMS including outbreak investigations, response to COVID-19, work with hospital infection control/prevention, and partnering with local and state agencies.
• Nearly three-quarters (70%) provided the name and contact information for partner organizations/facilities which they have collaborated with on initiatives for HAI, AMR, and AMS. The most common responses were CDC, local hospital infection control/prevention, and other local and state agencies.
  

Rural, Frontier, and Small LHDs Not Engaged in HAI, AMR, and AMS Initiatives
Slightly over half (55%) of the survey respondents indicated that their health department does not currently engage in initiatives/activities around HAI, AMR, and/or AMS. Of these survey respondents:

• Slightly less than three-fourths (72%) identified barriers which prevented their LHD from engaging with HAI, AMR, and AMS with the majority indicating lack of funding, lack of staff time, and lack of training.
• Over half (56%) provided a list of agencies they would like to work with for HAI, AMR, and AMS which included hospitals, long-term care facilities, and local healthcare providers.

• Slightly less than two-thirds (64%) identified activities and/or initiatives they would like to engage in for HAI, AMR, and/or AMS; the majority focused on communications/messaging to the public and community partners.

Training & Competencies

• Over two-thirds (67%) of the survey respondents indicated they did not have staff trained in activities or competencies in HAI, AMR, and AMS.
• Centers for Disease Control and Prevention (CDC), Association for Professionals in Infection Control Epidemiology (APIC), Certification Board of Infection Control and Epidemiology (CBIC), National Association of County and City Health Officials (NACCHO), TRAIN, and state DOH websites were the most frequently cited training and/or HAI, AMS, and AMR resources.

What does this mean to me?

HAIs and AMRs are infections that patients can get while receiving treatment for medical or surgical conditions. Many HAIs and AMRs are preventable. At any one time in the United States, 1 out of every 25 hospitalized patients are affected by an HAI.1

Studies suggest that implementing existing prevention practices can lead to up to a 70 percent reduction in certain HAIs.2 Modeling data suggests that substantial reductions in resistant bacteria, like MRSA, can be achieved through coordinated activities between health care facilities in a given region.3 The financial benefit of using these prevention practices is estimated to be $25 billion to $31.5 billion in medical cost savings.4

What can Rural, Frontier, and Small LHDs do about HAIs, AMRs, and AMS?

HAIs and AMRs are a threat to patient, and subsequently, public health safety. These kinds of infections are a significant cause of illness and death; they can have serious emotional, financial, and medical consequences. Rural, Frontier, and Small LHDs can provide leadership in surveillance, outbreak investigations, and prevention by collaborating with healthcare and community partners. The development and implementation of an AMS plan can improve antibiotic prescribing and use in order to effectively treat infections, protect patients from unnecessary antibiotic use, and combat antibiotic resistance.

The complete report can be found here: Rural Partnership in HAI, AMR, AMS (naccho.org) Exploratory Survey Report.

This infographic also illustrates the major findings of the survey.

Resources

• State-based HAI Prevention Activities – https://www.cdc.gov/hai/state-based/index.html
• National Action Plan to Prevent Health Care-Associated Infections – https://health.gov/about-odphp/previous-initiatives
• Healthcare Associated Infection Toolkits – https://www.cdc.gov/hai/prevent/prevention_tools.html
• Actions to Fight Antimicrobial Resistance – https://www.cdc.gov/drugresist...;
• AMR Communication Resources – https://www.cdc.gov/drugresistance/resources.html

• AMS Resources – https://apic.org/professional-practice/practice-resources/antimicrobial-stewardship/
• Core Elements of Hospital Antibiotic Stewardship Programs Tools & Resources – https://www.cdc.gov/antibiotic...;

References

1. Magill SS, Edwards JR, Bamberg W, et al. Multistate Point-Prevalence Survey of Health Care–Associated Infections. New England Journal of Medicine 2014; 370:1198-208.
2. Pronovost P, Needham D, Berenholtz S, et al.  An intervention to decrease catheter- related bloodstream infections in the ICU.  New England Journal of Medicine. 2006;355:2725-32.
3. Vital Signs: Estimated Effects of a Coordinated Approach for Action to Reduce Antibiotic-Resistant Infections in Health Care Facilities — United States; MMWR August 4, 2015; 64; 1-7 Retrieved from http://www.cdc.gov/mmwr/previe... 0804a1_w
4. Scott RD. The direct medical costs of healthcare-associated infections in US hospitals and the benefits of prevention. Atlanta: Centers for Disease Control and Prevention; 2009.