HAI/AR and Accreditation Crosswalk
Alignment between Activities Related to HAI and AR and Public Health Accreditation
The Centers for Disease Control and Prevention (CDC) Division of Healthcare Quality Promotion (DHQP) and Center for State, Tribal, Local and Territorial Support (CSTLTS), in collaboration with Public Health Foundation (PHF)external icon, developed a crosswalk to highlight potential linkages between healthcare-associated infection (HAI) and antibiotic resistance (AR) program activities and the population-based accreditation standards and measures for health departments, established through the Public Health Accreditation Board (PHAB). The crosswalk can aid health departments’ HAI/AR Programs and accreditation staff demonstrate specific examples of HAI/AR activities that help fulfill accreditation objectives and strengthen crosscutting health department performance improvement efforts.
Developing and Vetting the Crosswalk
“The crosswalk reiterates that everybody in this agency has a part in accreditation”
– State Health Department Accreditation Coordinator
Starting in 2013, CDC staff from DHQP and CSTLTS have collaborated to identify alignments and areas of connection between HAI/AR activities and accreditation requirements. Using this collective experience, the crosswalk was updated in late 2017. In early 2018, CDC engaged PHF to conduct interviews with seven health departments (four state, three local) to obtain input and perspectives on the crosswalk. PHF captured perspectives from both HAI/AR Programs and accreditation/performance improvement staff. Overall, health department staff felt the crosswalk was helpful in promoting collaboration, new ideas, and conversations across the two programs and offered suggestions for changes and improvements to the crosswalk. CDC used the feedback to refine the crosswalk and welcomes additional input as health departments begin to use it in practice.
About the Content of the Crosswalk
What is Public Health Accreditation?
Many health-related entities have accreditation programs, but until 2011, there was no national accreditation program for public health departments. Accreditation through PHAB is a voluntary process that measures the performance of state, tribal, local, and territorial health departments against a national set of evidence-based standards focusing on population-based public health services. Health departments report that accreditation helps them better identify strengths and weaknesses, document their capacity to deliver the core functions and 10 Essential Public Health Services, increase their accountability to community members, stakeholders, and policymakers, and improve their communication with the governing entities/boards of health.
Since exploratory work on accreditation began in 2004, CDC has served as a co-funder (along with the Robert Wood Johnson Foundation) and partner in developing, establishing, and improving the national accreditation program. CDC’s CSTLTS supports accreditation as a means to enhance accountability and quality across the public health enterprise. Given CDC’s many programmatic areas of interest, the agency plays an ongoing role in identifying connections and highlighting where accreditation standards bolster or reinforce programmatic efforts. [Footnote 1].
The crosswalk uses the PHAB Standards and Measures Version 1.5 pdf icon[PDF – 264 pages]external icon, which were released in 2014 and are used by sites currently seeking initial accreditation. While the measures for reaccreditation are different, the domains and standards are the same and those seeking reaccreditation should find the crosswalk valuable as well. (See Guide to National Public Health Department Reaccreditation: Process and Requirements pdf icon[PDF – 90 pages]external icon).
What is the focus of health department HAI/AR Programs?
HAIs are infections caused by a wide variety of bacteria, fungi, and viruses during the course of receiving medical care. The most serious infections are caused by antibiotic resistant organisms, which can be difficult or impossible to treat. HAI/AR Programs use a multi-factorial approach to prevent and respond to infectious disease threats in healthcare settings including:
- Surveillance/Data for Action: HAI/AR Programs use available data sources to understand the HAI/AR burden in their communities
- Containment/Response: HAI/AR Programs monitor and assist healthcare facilities with responding to HAI/AR outbreaks and new and emerging threats.
- Prevention: HAI/AR Programs facilitate activities to prevent outbreaks and new and emerging HAIs.
- Laboratory: state labs provide test and investigation results and may provide HAI/AR surveillance data.
- Policy: HAI/AR Programs may participate in the implementation of policy and strategy related to HAI prevention.
- Partnerships: HAI/AR Programs may participate in partnerships to build capacity or facilitate HAI/AR prevention.
- Communications: HAI/AR Programs may communicate about data, policy, legislation or activities to state, local, tribal or territorial health departments.
CDC supports HAI/AR activities through dedicated funding in the Epidemiology and Laboratory Capacity (ELC) Cooperative Agreement. Much of the crosswalk content draws from expectations of ELC grantees and the evidence-based interventions advanced through the CDC HAI/AR Program, although the crosswalk can be helpful for health departments that are not grantees as well.
How to Use the Crosswalk
The crosswalk provides content in three columns.
- Column 1 cites PHAB’s Standards and Measures (Version 1.5) for each of the 12 Domains.
- Column 2, “HAI/AR-specific Programs or Activities” describes relevant HAI/AR Programs and activities drawn largely from ELC guidance for grantees.
- Column 3, “Opportunities/Considerations for Connections between HAI/AR and Accreditation.”
The crosswalk can be used to foster engagement between HAI/AR programmatic work and cross-cutting health department accreditation efforts. More concretely, it can aid staff in identifying or highlighting opportunities for documentation or activities that align with accreditation requirements, and/or identifying areas for improving health department activities. Accreditation coordinators can use this to clarify how HAI/AR staff can participate in accreditation documentation efforts.
Conversely, HAI/AR staff can use this crosswalk to consider aspects of their work in categories that align with PHAB Domains. Although the crosswalk is structured around the PHAB Domains, Standards and Measures, it may be more useful for HAI/AR staff to consider categories of their program that align with PHAB standards, such as surveillance, response, partnerships, and communications. The following section includes highlights of connections across areas of activity in HAI/AR Programs. HAI/AR staff may find this useful as they participate in accreditation or agency-wide performance improvement efforts.
Accredited health departments should also find the crosswalk valuable, as it can highlight HAI/AR activities that may not have been previously considered across the PHAB domains (which remain the same for reaccreditation). In particular, the crosswalk can prompt ideas for areas for improvement that can be used as additional examples within annual reports or reaccreditation efforts.
This document is not intended to provide definitive information on all possible linkages between PHAB Standards and Measures and HAI/AR programmatic activities, nor is it a guarantee of conformity to PHAB documentation requirements. The crosswalk is intended to support accreditation coordinators and health department HAI/AR program staff as they identify important points of connection, emphasizing collaboration across the health department and in population-based efforts.
Key Areas of Connection between PHAB Standards and HAI/AR Programs
Crosswalk results and health department staff indicate that while there are connections across almost all PHAB Domains, PHAB Domains 1 and 2 contain the most relevant and robust opportunities to demonstrate where HAI/AR activities can contribute to accreditation documentation requirements. Potential documentation examples may include reports of HAI surveillance data; MOUs and other arrangements with other agencies; demonstration of laboratory resources; communications regarding antimicrobial resistance; and coordination with other areas of public health such as preparedness. The tables below provide a snapshot of areas for collaboration and coordination opportunities.
Health departments’ HAI/AR Programs reported that PHAB Domains 1 and 2 contained the most relevant and robust opportunities to demonstrate where HAI/AR activities can contribute to accreditation documentation requirements. Potential documentation examples may include reports of HAI surveillance data; MOUs and other arrangements with other agencies; demonstration of laboratory resources; communications regarding antimicrobial resistance; and coordination with other areas of public health such as preparedness. The table below provides a snapshot of the areas with the strongest potential for collaboration and coordination.
Most Relevant Connections between PHAB Domains and HAI/AR Programs
= stronger connection;
= weaker connection
|PHAB Domain||Surveillance / Data for Action||Containment / Response||Prevention||Lab||Policy||Partnerships||Communication|
|1 – Assess|
|2 – Investigate|
|3 – Inform and Educate|
|4 – Community Engagement|
|5 – Policies and Plans|
|6 – Public Health Laws|
|7 – Access to Care|
|8 – Workforce|
|9 – Quality Improvement|
|10 – Evidence-based Practices|
|11 -Administration and Management|
|12 – Governance|
|AAR||After Action Report|
|AR||Antimicrobial Resistance or Antibiotic Resistant Infections|
|ARLN||Antibiotic Resistance Laboratory Network|
|AUR||Antibiotic Use and Resistance|
|CMS||Centers for Medicare and Medicaid|
|EIP||Emerging Infections Program|
|ELC||Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases|
|EOP||Emergency Operations Plan|
|HAN||Health Alert Network|
|HIP||Health Improvement Plan|
|L or LHD||Local Health Department|
|MOA||Memorandum of Agreement|
|MOU||Memorandum of Understanding|
|NHSN||National Healthcare Safety Network|
|NNDSS||Nationally Notifiable Data Detection System|
|PMS||Performance Management System|
|PHAB||Public Health Accreditation Board|
|PHF||Public Health Foundation|
|S||State Health Department|
|S/T||State/Tribal Health Department|
|T||Tribal Health Department|
|T/L||Tribal/Local Health Department|
PHAB Domains/Standards/Measures Column
(S) = State HD
(T) = Tribal HD
(L) = Local HD
(S/T) = State/Tribal HD
(T/L) = Tribal/Local HD
Language in this column is extracted exactly from the PHAB Standards and Measures, V 1.5, at the Domain, Standard and Measure levels.
HAI/AR Specific Programs or Activities Column
Programs and activities reflect relevant HAI/AR activities. While they are drawn largely, but not exclusively, from ELC guidance for Recipients, they may be applicable to health departments that do not receive ELC funds.
Opportunities / Considerations
For Connections Between HAI/AR and Accreditation Column
This column represents both conceptual and concrete opportunities that can prompt new collaborations between HAI/AR and accreditation efforts and/or possibilities for accreditation documentation that can be drawn from HAI/AR work.
Context statements are provided paraphrasing all or some elements of the PHAB expectations with follow up statements about where HAI/AR connections can be made.
- DOMAIN 1: Conduct and disseminate assessments focused on population health status and public health issues facing the community
- Standard 1.1: Participate in or lead a collaborative process resulting in a comprehensive community health assessment
- Standard 1.2: Collect and maintain reliable, comparable, and valid data that provide information on conditions of public health importance and on the health status of the population
- Standard 1.3: Analyze public health data to identify trends in health problems, environmental public health hazards, and social and economic factors that affect the public’s health
- Standard 1.4: Provide and use the results of health data analysis to develop recommendations regarding public health policy, processes, programs or interventions
- DOMAIN 2: Investigate health problems and environmental public health hazards to protect the community
- Standard 2.1: Conduct timely investigations of health problems and environmental public health hazards
- Standard 2.2: Contain/mitigate health problems and environmental public health hazards
- Standard 2.3: Ensure access to laboratory and epidemiological / environmental public health expertise and capacity to investigate and contain/mitigate public health problems and environmental public health hazards
- Standard 2.4: Maintain a plan with policies and procedures for urgent and non-urgent communications.
- DOMAIN 3: Inform and educate about public health issues and functions
- Standard 3.1: Provide health education and health promotion policies, programs, processes, and interventions to support prevention and wellness
- Standard 3.2: Provide information on public health issues and public health functions through multiple methods to a variety of audiences.
- DOMAIN 4: Engage with the community to identify and address health problems
- Standard 4.1: Engage with the public health system and the community in identifying and addressing public health problems through collaborative processes.
- Standard 4.2: Promote the community’s understanding of and support for policies and strategies that will improve the public’s health
- DOMAIN 5: Develop public health policies and plans
- Standard 5.1: Serve as primary and expert resource for establishing and maintaining public health policies, practices, and capacity
- Standard 5.2: Conduct a comprehensive planning process resulting in a Tribal / State / community health improvement plan
- Standard 5.3: Develop and implement a health department organizational strategic plan
- Standard 5.4: Maintain all hazards emergency operations plan
- DOMAIN 6: Enforce public health laws
- Standard 6.1: Review existing laws and work with governing entities and elected/appointed officials to update as needed.
- Standard 6.2: Educate individuals and organizations on the meaning, purpose, and benefit of public health laws and how to comply.
- Standard 6.3: Conduct and monitor public health enforcement activities and coordinate notification of violations among appropriate agencies
- DOMAIN 7: Promote strategies to improve access to health care
- Standard 7.1: Assess health care service capacity and access to health care services
- Standard 7.2: Identify and implement strategies to improve access to health care services
- DOMAIN 8: Maintain a competent public health workforce
- Standard 8.1: Encourage the development of a sufficient number of qualified public health workers
- Standard 8.2: Assess staff competencies and address gaps by enabling organizational and individual training and development opportunities.
- DOMAIN 9: Evaluate and continuously improve health department processes, programs, and interventions
- Standard 9.1: Use a performance management system to monitor achievement of organizational objectives
- Standard 9.2: Develop and implement quality improvement processes integrated into organizational practice, processes, and interventions
- DOMAIN 10: Contribute to and apply the evidence base of public health
- Standard 10.1: Identify and use the best available evidence for making informed public health practice decisions
- Standard 10.2: Promote understanding and use of the current body of research results, evaluations, and evidence-based practices with appropriate audiences
- DOMAIN 11: Maintain Administrative and Management Capacity
- Standard 11.1: Develop and maintain an operational infrastructure to support the performance of public health functions
- Standard 11.2: Establish effective financial management system
- DOMAIN 12: Maintain Capacity to engage the public health governing entity
- Standard 12.1: Maintain current operational definitions and statements of public health roles, responsibilities, and authorities
- Standard 12.2: Provide information to the governing entity regarding public health and the official responsibilities of the health department and of the governing entity
- Standard 12.3: Encourage the governing entity’s engagement in the public health department’s overall obligations and responsibilities