NACCHO projects support and build workforce capacity for Local Health Departments (LHDs) and recognize that opportunities and challenges in rural, frontier, and small settings may be unique.  Rural, Frontier, and Small LHDs frequently report that they are overlooked or not invited to participate in projects. As a result, NACCHO carved out specific places via the Rural Café, Rural-Frontier LHD Projects, or the small LHD Virtual Community for Rural, Frontier, and Small LHDs to share knowledge and collaborate.

What is HAI, AMR, and AMS?
NACCHO recognizes that Healthcare Associated Infections (HAIs) are among the leading causes of preventable deaths in the United States. HAIs are infections that develop during, or soon after, receiving a healthcare service or from being in a healthcare setting (e.g., hospital, clinic, doctor’s offices, surgery center, nursing home, or home-care visits by a health professional)1. Antimicrobial Resistance (AMR) occurs when bacteria or fungi develop the ability to defeat the drugs designed to kill them1. Antimicrobial Stewardship (AMS) is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics)2.

Why are HAIs, AMRs, and AMSs important to Public Health?
HAI, AMR, and AMS activities or initiatives include, but are not limited to, implementing infection prevention and control efforts, improving the use of antibiotics, identifying antibiotic-resistant infections, and reducing the transmission of resistant organisms. Antimicrobial Resistance is an urgent global public health threat, killing at least 1.27 million people worldwide and associated with nearly 5 million deaths in 2019. In the U.S., more than 2.8 million antimicrobial-resistant infections occur each year. More than 35,000 people die as a result, according to CDC’s 2019 Antibiotic Resistance (AR) Threats Report3. CDC estimates that one in 25 hospital patients is infected with at least one HAI4. CDC also released a new report finding that much of the progress made in the United States in previous years combating AMR was lost, in large part, due to the effects of the COVID-19 pandemic. This report concludes that the threat of AMR infections is not only still present but has gotten worse, with resistant hospital-onset infections and deaths both increasing at least 15% during the first year of the pandemic5.

NACCHO’s Exploratory Survey of Rural, Frontier, and Small LHDs
Understanding this growing threat, in April 2022, NACCHO conducted an exploratory survey of Rural, Frontier, and Small LHDs to understand their engagement in HAI, AMR and/or AMS activities or initiatives. Forty-four (44) health departments answered the call and responded to the exploratory online survey. We would like to extend a huge thank you to these health departments for their time and insight. From the exploratory survey responses and more in-depth interviews with 11 Rural LHDs, a series of blogs will be posted along with HAI, AMR, and AMS resources and information which will emphasize the key findings from these survey and interview reports.

This infographic also illustrates the major findings of the survey.

Who Participated in the NACCHO Exploratory Survey?
Thank you again to the 44 LHDs who participated in this exploratory survey on HAI, AMR, and/or AMS activities or initiatives, because of your involvement and contribution, NACCHO was able to get a better understanding of the current efforts and challenges Rural, Frontier, and Small LHDs face.

• Bismarck - Burleigh Public Health
• Cavalier County Health District
• Chambers County Public Health
• Cook County Public Health and Human Services
• Coshocton City Health Department
• Douglas County Dept of HHS
• Elbert County Public Health
• Florida Department of Health in Polk County
• GCHD (Kansas)
• Georgia State Office of Rural Health
• Grafton City Hospital
• Henry & Stark County Health Departments
• Idaho Bureau of Rural Health & Primary Care
• Jackson County Public Health
• Kent County Health Department
• Lane County Health Department
• Langlade County Health Department
• Logan County Health District
• Logan Health - Cut Bank
• Marietta/Belpre Health Department
• Milam County Health Department
• Mississippi State Office of Rural Health
• Moffat County Public Health
• Monroe County Health Department
• Montana Hospital Association
• Montana Department of Public Health and Human Services
• Ohio State Office of Rural Health
• Pierce County Public Health Department
• Pima County Health Department
• Portsmouth City Health Department
• Rural Health and Primary Care for the State of New Hampshire
• Schuyler County Health Department
• Scotland County Health Department
• Shelby County Health Department
• Siskiyou County Public health
• Stark County Health Department
• Sullivan County Department of Public Health
• The Critical Access Hospital Network
• Towner County Public Health
• Union County Health Department
• University of Arizona
• Vermont Department of Health
• Whitley County Health Department
• Williamson County & Cities Health District

If you are a Rural, Frontier or Small LHD, please join the Rural Café, Rural-Frontier LHD Projects or NACCHO’s Small LHD Virtual Community to receive information specific to your unique needs. LHD’s may sign up directly for the Rural Café with Victoria Freire at [email protected].

References

1. Centers for Disease Control and Prevention. (2021). About Antibiotic Resistance. Retrieved from https://www.cdc.gov/drugresist...;
2. Association for Professionals in Infection Control and Epidemiology. Antimicrobial Stewardship. Retrieved from https://apic.org/professional-...;
3. Centers for Disease Control and Prevention. (2014). Types of Healthcare-associated Infections. Retrieved from https://www.cdc.gov/hai/infect...;
4. Centers for Disease Control and Prevention. (2021). About Antimicrobial Resistance. Retrieved from https://www.cdc.gov/drugresist...;
5. Centers for Disease Control and Prevention. (2016). CDC Winnable Battles Final Report. Retrieved from https://www.cdc.gov/winnableba...;
6. Centers for Disease Control and Prevention. (2022). COVID 19: U.S. Impact on Antimicrobial Resistance. Retrieved from https://www.cdc.gov/drugresist...;