Infection Control Today

OCT 2018

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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32 ICT October 2018 www.infectioncontroltoday.com In this 15-year review, the three programs that support infectious diseases emergency preparedness saw a net decrease in federal investments that were course corrected through supplemental funding when an outbreak occurred. Additionally, HHS officials and non-federal stakeholders noted in the report that the timing of supplemental awards limited the public health response since funding took an average of four months to be received. The lag often resulted in removing resources from routine activities and personnel hires to remedy the gap between the outbreak onset and receipt of the funding. This causes public health departments to decrease their normal functions to address the outbreak, which leaves the locality or region vulnerable to other outbreaks unrelated to the emergency. Evidence of this issue was highlighted in a study published in the journal Infection Control and Hospital Epidemiology titled, "Lessons Learned from Hospital Ebola Preparation." The study found that hospital Ebola preparations required extraordinary resources, which were diverted from routine infection prevention activities. During a sample week of preparations, 80 percent of hospital epidemiology time was reported as committed to Ebola, amounting to a median of 160 hours of staff time per hospital. During the time that such effort was focused on Ebola, only 30 percent of routine infection prevention activities were completed. "This report demonstrates the need to increase funding overall for emergency preparedness, and the importance of fully funding programs such as the Prevention and Public Health Fund," says Kaye. "Doing so will help ensure healthcare epidemiologists and other infection prevention and control professionals have the resources available to support critical ongoing infection prevention and response efforts, as well as the ability to respond quickly during an unexpected outbreak. This will ultimately save lives and reduce the burden of infectious diseases on the healthcare system." HHS has three key preparedness and capacity-building programs—Epidemiology and Laboratory Capacity for Infectious Diseases (ELC), the Hospital Preparedness Program (HPP), and Public Health Emergency Preparedness (PHEP). These three programs awarded about $21.2 billion to states and other jurisdictions from 2002 through 2017 to carry out public health preparedness and response efforts, including those related to infectious diseases, natural disasters, or terrorist events. Of this amount, $18.4 billion were awards funded from annual appropriations. The remaining was funded from supplemental appropriations to respond to specifc infectious disease threats, including Zika, Ebola, and H1N1 pandemic infuenza. HHS offcials and non-federal stakeholders told GAO that supplemental appropriations were important for supporting necessary surges in capacity, but the timing of additional awards can limit response. HHS's three key preparedness and capaci- ty-building programs measure performance in four areas that directly relate to infectious disease preparedness capacity—electronic lab reporting, epidemiology capacity, laboratory capacity, and responder protection. Most awardees (states and other jurisdictions) met targets for all nine measures in the responder protection area, which measures activities related to safety and coordination for responders. However, awardee performance in the other three areas was mixed: • Electronic lab reporting. One of two measures were met. This area relates to the sending of laboratory reports to public health agencies via electronic means (as opposed to traditional, paper reports). • Epidemiology capacity. One of three measures were met. This area relates to awardees' ability to identify and respond to infectious disease outbreaks. • Laboratory capacity. Five of six measures were met. This area relates to both laboratory testing of certain pathogens, and communication between laboratories and other public entities. With a key provision supporting the development of a trained and ready public health workforce, and new efforts to combat antimicrobial resistance, the Pandemic and All Hazards Preparedness Act reauthorization bill approved by the House Energy and Commerce Committee in July addresses issues that are essential to ensuring the U.S. will have the resources and capacities necessary to confront emerging threats to public health. The Infectious Diseases Society of America (IDSA), which has led efforts to make lawmakers aware of needs to strengthen the workforce of expert responders, and to address the growing threat of antimicrobial resistance, including in this legislation, urged the full House and Senate to move forward with a strong reauthorization that contains these critical provisions along with increased resources for public health emergency preparedness programs. As the IDSA noted in a statement, "While physicians trained to detect, prevent, treat and contain infectious diseases are our frontline of defense against public health emergencies that can include outbreaks, natural disasters and bioterror attacks, support for training, including through medical education loan repayment, to enter a specialty that provides relatively low economic compensation for physicians has been notably lacking. The bill released by the committee today takes an important step toward bolstering our preparedness by providing loan repayment opportunities for individuals serving in Centers for Disease Control and Prevention Epidemic Intelligence Service, a program that provides expert responders and trains future public health leaders. In addition, while infections resistant to existing antibiotics pose increasing threats, with slow return on investments in antibiotic research and development, efforts to build the needed arsenal of new drugs have languished. The bill released by the committee today supports additional initiatives through the Department of Health and Human Services Biomedical Advanced Research and Development Authority to address antimicrobial resistance including with strategies to drive the development of new drugs. Importantly, the bill also codifes the expert council advising the federal government on AMR solutions. The Epidemiologist's Role During an epidemic, how well prepared a facility is for an outbreak can mean the difference between lives saved or lives lost. Prevention of and preparedness for disease outbreaks require a commitment of resources so that healthcare epidemiologists and other healthcare professionals are equipped to prevent, identify, manage, and contain any outbreak at any time. In a disease outbreak, it is important to have a leader in place to coordinate the response by the healthcare team. With their exceptional command of data and unique analytical and investigative skills, healthcare epidemiologists are responsible for investigating the outbreak, containing further spread of the disease, and communicating with the community and health offcials at a local, state, and national level. Late last year, SHEA, with the support of the CDC, issued a new expert guidance document for hospitals to use in preparing for and containing outbreaks. "This guidance details the role of the healthcare epidemiologist as an expert and leader supporting hospitals in preparing for, stopping, and recovering from infectious diseases crises," says David Banach, MD, co-chair of the writing panel and Assistant Professor of Medicine at the University of Connecticut and Hospital Epidemiologist at UConn Health. "Armed with the resources to develop and support key activities, healthcare epidemiologists can utilize their skills and expertise in investigation and response to infectious disease outbreaks within a hospital's incident command system." SHEA and CDC collaborated in 2016 to form the Outbreak Response Training Program to guide healthcare epidemiologists in how to maximize their facilities' preparedness and response efforts to combat outbreaks such as Ebola, Zika, pandemic infuenza, and other infectious diseases. The new document, Outbreak Response and Incident Management: SHEA Guidance and Resources for Healthcare

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