Interim Local Health Department (LHD) HAI/AR Strategy

• Designate at least one staff member who is the primary point of contact for HAI outbreaks and/or HAI/AR activities.
• Increase LHD awareness of key roles in the state HAI/AR program (see also Goal 1, Objective 1.1).
• Increase local jurisdiction’s awareness of AR Lab Network activities in the state.
• Leverage existing trainings, such as Project Firstline, Nursing Home Infection Preventionist Training, and NACCHO HAI Resources, to improve health department staff awareness of IPC practices (refer the appendix of training resources for a list of available trainings).
• Identify regular touch points with the state HAI/AR coordinator for updates and knowledge sharing.
• Offer trainings that build foundational IPC skills for newer staff.
• Increase LHD staff awareness of the Core Competencies for Public Health Professionals

this formNACCHO Virtual CommunitiesProject Firstline

• Identify, add, and/or establish routine communication with the Project Firstline Lead at the state HAI/AR program to identify training opportunities.
• Designate a staff member as the HAI/AR lead who regularly participates in facility engagement, including but not limited to, assisting with ICAR and tele-ICAR assessments.
• Support ongoing training of LHD staff in infection prevention and control through NACCHO HAI Resources, Project Firstline and other existing trainings (refer the appendix of training resources for a list of available trainings).
• Provide training to LHD staff on National Healthcare Safety Network (NHSN) through CDC’s NHSN Training and other existing trainings.
• Support at least one LHD staff member in becoming Certified in Infection Control (CIC), if eligible, or to pursue available IPC trainings.
• Improve communication skills of LHD staff by encouraging training that includes best practices for skills such as communicating critical feedback, discussing sensitive topics, and setting the tone for collaborative and co-learning relationships.
• Identify opportunities for LHD staff to shadow the state HAI/AR program or other partners on ICAR visits.

• Establish a mentor-mentee arrangement with the state HAI/AR coordinator or other state or local HAI/AR program staff lead; periodically shadow that person in day-to-day activities for ongoing training and knowledge.
• Develop an HAI/AR team or program to ensure staff are trained to adequately support a variety of HAI/AR activities.
• Collaborate with state HAI/AR program or other partners for cross-awareness and shared knowledge (i.e., conduct joint training opportunities).
• Leverage existing trainings to increase LHD staff awareness on modalities used to deliver information (e.g., committees, e-mail distribution lists, in-person trainings, symposiums, etc.), the types of facilities that LHD supports, and best practices for communicating IPC guidance and education (e.g., through role play and sample script trainings).
• Leverage existing trainings to increase LHD staff knowledge of the ICAR tool, ICAR process, and associated skills with conducting ICARs, such as communicating challenging or sensitive feedback (refer the appendix of training resources for relevant trainings).
• Leverage existing trainings to increase LHD staff ability to use NHSN data to identify areas for priority prevention actions (refer the appendix of training resources for relevant trainings)

• Discuss and clarify state and local HAI/AR data sources with state HAI/AR program.
• Work to clarify and communicate HAI/AR reporting policies and procedures for the different types of healthcare facilities.
• Identify LHD knowledge gaps in HAI/AR policies and guidance.
• Ensure staff have solid understanding of the components of Project Firstline tools and materials.

• Engage with state HAI/AR program and other key partners (e.g., NACCHO, other LHDs within the state) to examine and identify existing HAI/AR policies, such as state and local requirements for HAI/AR reporting.
• Identify necessary steps for accessing HAI/AR data sources at the local level.
• Determine how available data are being used or could be used to meet the state’s prevention and health equity goals, including identifying underserved or high-risk areas within the local jurisdiction.
• Engage with state HAI/AR program to ensure that communications about local data to facilities are coordinated across the local and state HAI/AR activities (see also Goal 1, Objective 1.1).

• Use local information and data on infections, outbreaks, antimicrobial resistance, and antibiotic use to guide activities and responses to HAI/AR threats.
• Ensure LHD staff awareness of the processes in place for accessing HAI/AR data, such as through NHSN or other county level data.
• Ensure that areas of high social vulnerability are included in the local and state HAI/AR program strategies.
• Establish regular communications and two-way knowledge sharing with partners that develop and implement policies (e.g., regulatory agencies, boards of health, etc.).

• Connect with bordering local jurisdictions for introductions, orientation to HAI/AR activities, and knowledge sharing.
• Identify existing local or regional structures such as regional emergency preparedness, regional healthcare coalitions, or other regional collaboratives.
• Develop a regular cadence for interjurisdictional situational awareness related to HAI/AR outbreaks or emerging issues.

• Communicate with healthcare systems that operate within the jurisdiction and neighboring jurisdictions at the system or administrative level (see also Goal 1, Objective 1.2).
• Identify opportunities for sharing resources, staffing, and funding opportunities that will support priorities around HAI/AR activities.
• Establish ongoing communications or workgroups for regional goal setting.
• Share interjurisdictional plans, goals, and knowledge with state HAI/AR program.
• Review the HAI/AR and Accreditation Crosswalk for Public Health Accreditation Board (PHAB) accreditation as the health department is considering or renewing accreditation.

• Discuss and develop a plan for resource sharing with key partners (e.g., multiple LHDs meet with state HAI/AR Advisory Committee for regional approaches to address priorities).
• Develop an ongoing communications plan for sharing and feedback on interjurisdictional information with state HAI/AR program.
• Consider using a social network analysis to determine where patient transfers between facilities are occurring and develop a plan for sharing resources and communication between those facilities.
• Work with the LHD quality improvement officer or program lead and use the HAI/AR and Accreditation Crosswalk as the health department is considering or renewing accreditation.

• Review current local and state preparedness and response plans for elements related to infectious diseases, outbreak responses, and healthcare coordination.
• Meet with LHD preparedness staff regarding their local healthcare preparedness plans for infectious disease outbreaks.
• Discuss role of local public health for addressing healthcare outbreak responses as part of emergency preparedness with the state HAI/AR program.
• Review available preparedness and response resources, (e.g., CDC Public Health Emergency Preparedness Programs (PHEP), NACCHO, and Assistant Secretary for Preparedness and Response’s (ASPR) Hospital Preparedness Programs (HPP).

• Engage with the state HAI/AR program and key preparedness or emergency management partners (e.g., healthcare coalitions) to inform local preparedness activities.
• Engage with local healthcare coalitions and emergency preparedness groups to ensure alignment of efforts and activities.
• Conduct healthcare emergency response trainings and tabletop exercises as part of the local or regional emergency preparedness and response plans.

• Regularly engage with state HAI/AR or Public Health Emergency Preparedness programs to align on preparedness and response strategies, policies, and identify elements related to HAI/AR activities.
• Develop an evaluation plan to monitor and track progress of preparedness and response activities.

• Revisit roles and responsibilities with state HAI/AR program to improve understanding of case data, outbreak detection, response roles and activities.
• Identify how LHD will be informed of HAIs, multi-drug resistant organisms (MDROs), and other possible outbreaks.
• Identify the facilities and provider types for which prevention and outbreak support will be provided, in coordination with the state HAI/AR program.
• Familiarize LHD staff with the Council for Outbreak Response: Healthcare-Associated Infections and Antimicrobial-Resistant Pathogens (CORHA) Principles and Practices for Outbreak Response
• Subscribe to the CORHA newsletter for regular updates on HAI/AR outbreak activities.
• Familiarize LHD staff with Targeted Assessment Prevention (TAP) strategies through CDC trainings and resources, such as the Targeted Assessment for Prevention (TAP) Strategy, including the TAP Strategy Learning Series videos, the TAP Facility Assessment Deployment Packet [PDF – 5 Pages], and the TAP Strategy Gap Prioritization Worksheet.
• Increase local jurisdictions awareness of state AR Lab Coordinator.
• Increase local jurisdictions awareness of AR Lab Network activities in the state.

• Coordinate with the state HAI/AR program to review relevant HAI/AR data and reports.
• Coordinate with the state HAI/AR program on clear roles and responsibilities during outbreak response, including coordination and reporting expectations.
• Use available data sources to support facilities within the jurisdictions to target outbreaks, determine prevention program needs, and identify HAI/AR priorities and available resources.
• Facilitate frequent communication with affected facilities to share guidance and address needs during outbreak responses.
• Develop a communications plan for patient notification of adverse events (e.g., CORHA Resources and Products).
• Promote detection and reporting of HAIs, MDROs, and other possible outbreaks from facilities in coordination with local or state laboratories and clinical laboratories.

• Increase LHD utilization of the Interim Guidance for a Public Health Response to Contain Novel or Target Multidrug-Resistant Organisms (MDROs) [PDF – 16 Pages] and resources available from CORHA.
• Conduct trainings to facility staff and other health department staff on MDRO containment and other forms of healthcare outbreak responses.
• Develop an outbreak and response communication plan to include engagement with the media and public on disclosure. Refer to CDC’s Patient Notification Toolkit for guidance and examples.
• Develop or use a tracking system and protocols for actively monitoring outbreak response activities. Refer to the CORHA Principles and Practices for Outbreak Response for guidance.
• Develop and disseminate standards for inter-facility patient transfers.
• Map ongoing cases of an outbreak to determine which facilities and regions were affected.
• Conduct a social networking analysis to identify patterns of patient transfers between healthcare systems and jurisdictions.
• Actively conduct prevention and response activities with facilities to do tabletop exercises, ICARs, Targeted Assessment for Prevention (TAP) Strategy reports, and education and outreach on preventing HAI/AR infections and outbreaks (see Goal 1 for activities related to facility relationships).
• Conduct timely reporting of emerging HAI/AR threats and outbreaks.
• Promote infection control guidance to other groups (e.g., assisted living, adult homes, long term acute care centers, community health centers, etc.).

• Discuss HAI/AR prevention activities with state HAI/AR program including HAI/AR data, reports, and prevention goals.
• Identify LHD roles and responsibilities as a component of the state’s HAI/AR prevention activities and strategy.
• Review CDC’s Infection Control Assessment and Response (ICAR) tools.

• Review available data to identify local outbreaks, surveillance trends and priority areas to focus prevention work, in coordination with state HAI/AR program.
• Identify prevention opportunities or collaboratives with state and local partners, in coordination with state HAI/AR program.
• Pursue training opportunities, such as shadowing the State HAI/AR program.
• Begin to conduct ICAR assessments at facilities in the jurisdiction to systematically assess a healthcare facility’s IPC practices and guide quality improvement activities.
• Become familiar with NHSN data and how it is used in your state/jurisdiction, through communication with the state HAI/AR program or state NHSN lead if needed.

• If local data is available, analyze surveillance data for trends across facilities within jurisdiction and leverage available HAI/AR data to intervene. For example, if the LHD utilizes NHSN, regularly generate TAP reports to determine priority areas.
• If local data is available, conduct data validation to inform prevention and analysis of available NHSN data to identify HAIs priority needs for external validation.
• In collaboration with partners and facilities, organize trainings in infection prevention and control for facility staff (e.g., tabletop exercises to establish protocols, programs to improve hand hygiene in LTCFs, practice in environmental cleaning and disinfection, etc.).
• Participate in local, regional, or state prevention collaboratives.
• Survey local health care facility HAI policies, programs, and staff to conduct facility capacity assessments.
• Establish and/or update data use agreements (DUAs) with NHSN, including but not limited to Antimicrobial Use and Antimicrobial Resistance (AU/AR) data reported by facilities.
• Share relevant local data to facilities and assist in developing facilities’ skills in NHSN, such as through data entry.
• Conduct ICAR assessments at facilities within the jurisdiction to systematically assess a healthcare facility’s IPC practices and guide quality improvement activities.
• Coordinate with state health department to leverage Project Firstline training to train frontline healthcare workers on infectious diseases and emerging threats.
• Partner with local academic institutions to educate and train rising healthcare workers on infection control, tailoring the Project Firstline curriculum to local threats that rising healthcare workers may be more likely to encounter. See Objective 2.1, Level 2 for more information about joining NACCHO’s New Infection Prevention and Control Living Learning Network.

• Discuss LHD roles and responsibilities for antimicrobial stewardship activities with state HAI/AR program.
• Increase awareness of stewardship tools and resources:
  • CDC Core Elements of Antibiotic Stewardship
  • Antibiotic Stewardship Implementation Framework for Health Departments [PDF – 2 Pages]
  • Core Elements of Hospital Antibiotic Stewardship Programs

• Designate a staff member who has responsibility for stewardship activities.
• Identify and establish routine communication with state health department’s Antibiotic Stewardship Lead.
• Utilize CDC Core Elements of Antibiotic Stewardship, Antibiotic Stewardship Implementation Framework for Health Departments [PDF – 2 Pages], and Core Elements of Hospital Antibiotic Stewardship Programs to improve stewardship programs in facilities across the jurisdiction.
• Identify and facilitate appropriate training opportunities for facility staff and providers based on their settings, patients, and needs (training can be conducted in partnership with state HAI/AR program or other partners for cross-training, maximizing uptake, and awareness).
• Provide training to providers and facility staff on stewardship tools and resources:
  • CDC Training on Antibiotic Stewardship
  • CDC Core Elements of Antibiotic Stewardship
  • NHSN Antimicrobial Use (AU) Option (if using NHSN)
• Collaborate with partners on a communications plan to reach providers, healthcare facilities, and organizations to share stewardship guidance and best practices.

• Work with the Antibiotic Stewardship Coordinator at the state HAI/AR program to identify and engage antibiotic stewards, clinicians, facilities, or health systems within the jurisdiction that need additional support to improve implementation of antibiotic stewardship Core Elements.
• Participate in stewardship collaboratives with key partners, such as academic institutions and facilities, to implement and evaluate evidence-based, local-level interventions informed by antibiotic use data in different healthcare settings.
• Leverage NHSN AUR/AS and other data such as CDC’s Antibiotic Resistance & Patient Safety Portal, Medicaid data, etc. to track antibiotic use within the jurisdiction to inform and assess the implementation of focused stewardship interventions in different healthcare settings.
• Implement or promote local-level initiatives to increase adherence to appropriate prescribing practices.
• Enhance stewardship by connecting facilities to share data and effective stewardship methods.
• Provide feedback with peer comparison to prescribers (potential partners may include state Medicaid office or local health plans).
• In partnership with local health systems, support the dissemination of communication training modules to prescribers.

• Discuss health equity goals with state HAI/AR program for understanding and awareness.
• Identify how the state’s HAI/AR-related health equity goals can best be addressed locally.

• Develop local level HAI/AR health equity goals that are aligned with state equity goals based on priority populations, infection rates, and other factors.
• Provide local perspective on where health disparities exist in the community to inform and direct local and state HAI/AR activities.
• Increase awareness on partners’ existing efforts to advance health equity in underserved populations.

• Promote Project Firstline materials with healthcare facilities to meet infection control and patient safety educational and training needs of diverse groups of healthcare personnel and patients.
• Collaborate with partners to align health equity approaches for maximum impact.
• Improve demographic or social determinants of health data collection and quality.
• Assess data sources for availability of equity-related variables that identify disparities (e.g., socioeconomic, insurance status, social vulnerability index, race/ethnicity, geographic, etc.), and incorporate in surveillance and analyses.
• Analyze data with a health equity lens.
• Work with the state health department on prevention projects focused specifically on health equity, which can include activities to better understand health disparities and health equity through collection, analysis, and reporting of data, paired with targeted prevention or response interventions to improve reach and benefit the population(s) or setting(s) identified as disproportionally affected or historically underserved.