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

PHAB Measures

HAI/AR Specific Programs or Activities

Opportunities / Considerations For Connections Between HAI/AR and Accreditation

PHAB Measures

Measure 2.1.1:

(All) Protocols for investigation process

HAI/AR Specific Programs or Activities

HAI/AR Programs work with a variety of healthcare facilities to investigate and respond to HAI/AR outbreaks (including addressing new or emerging AR threats). Programs promote the use of evidence based guidance, protocols and tools and provide training for state and local HD staff to investigate outbreaks, clusters or unusual cases of HAIs, especially those caused by emerging AR pathogens. HAI/AR Programs may use CDC’s protocols and toolkits and recommendations for systematically collecting data to detect and investigate suspected or identified HAI/AR outbreaks. HAI/AR Programs work to develop standard reporting criteria including number, size and type of HAI/AR outbreaks a part of performance measurement reporting.

Opportunities / Considerations For Connections Between HAI/AR and Accreditation

Context: HDs must demonstrate capacity to conduct investigations using standardized procedures.

Opportunity: HAI/AR Programs may cite the use of CDC’s protocols and toolkits for outbreak response. HAI/AR Programs may have developed their own state-specific protocols based on CDC guidance or evidence based practices and may cite their own tailored processes used for tracking and follow up of HAI/AR outbreak responses and investigations.

PHAB Measures

Measure 2.1.2:

(S) Capacity to conduct and/or support investigations of infectious diseases simultaneously.

(T/L) Capacity to conduct an investigation of an infectious disease.

HAI/AR Specific Programs or Activities

HAI/AR Programs are expected to quickly respond to and investigate reports of HAIs and new or emerging AR threats in healthcare settings, by working with affected facilities, across healthcare settings (e.g., hospitals and long term care) as well as with other programs in state and local public health (e.g., emergency preparedness, mycotics, influenza, hepatitis, etc.). Programs are also improving protocols, procedures and response time for HAI/AR outbreak investigations and enhancing laboratory capacity to quickly detect and respond to AR pathogens, including an efficient and effective process for outbreak tracking.

Opportunities / Considerations For Connections Between HAI/AR and Accreditation

Context: State HD must provide written procedures demonstrating it has the capacity to address multiple, simultaneous investigations (local and Tribal health departments must document the capacity for an investigation). HDs must provide written procedures as well as reviews against procedures, which can include AARs, programmatic evaluations or audit reports

Opportunity: HAI/AR Programs can provide audits/programmatic evaluations, AARs, or case reviews of investigation reports, to demonstrate capacity to support investigations.

PHAB Measures

Measure 2.1.3:

(All) Capacity to conduct investigations of non-infectious health problems, environmental, and/or occupational health hazards

HAI/AR Specific Programs or Activities

n/a

Opportunities / Considerations For Connections Between HAI/AR and Accreditation

n/a

PHAB Measures

Measure 2.1.4:

(All) Collaborative work through established governmental and community partnerships on investigations of reportable diseases, disease outbreaks and environmental public health issues

HAI/AR Specific Programs or Activities

HAI/AR Programs work to enhance HAI and AR outbreak investigations by sharing information and making connections among facilities (in the case of multi-facility outbreak) and with public health authorities for outbreak responses and investigations as appropriate. HAI/AR Programs coordinate among government agencies or organizations responsible for assuring and overseeing HAI/AR surveillance, prevention and control. Many programs have established processes and protocols for exchanging information about outbreaks among state and local government partners (e.g. State Survey agencies, Communicable Disease Control and state licensing boards).

Opportunities / Considerations For Connections Between HAI/AR and Accreditation

Context: HDs must provide two examples of agreements that demonstrate how they work with established partners on investigation of an outbreak/environmental public health issue. HDs must also provide documentation of working with partners on investigations (meeting minutes, AARs), and a list of lab services provided, which includes testing for notifiable / reportable diseases.

Opportunity: HAI/AR Programs may have developed MOUs or protocols that demonstrate how they work with other agencies or organizations during an outbreak investigation.

PHAB Measures

Measure 2.1.5:

(All) Monitored timely reporting of notifiable/reportable diseases, lab test results, and investigation results

HAI/AR Specific Programs or Activities

HAI/AR Programs are expected to rapidly respond to reports of outbreaks or breaches in infection control and assist facilities in responding to them. Programs should work to develop a process for monitoring timely laboratory reporting from state and clinical labs and work to improve the use of surveillance data to identify and prevent HAI outbreaks or transmissions in healthcare settings (e.g. hepatitis B, hepatitis C, MDROs, and other reportable HAIs).

Opportunities / Considerations For Connections Between HAI/AR and Accreditation

Context: Jurisdictions routinely track outbreaks and monitor notifiable disease activities. HDs must provide a tracking log or audit of reports, including test and investigation results. HDs must provide copy of laws/regulations related to reporting of notifiable diseases/conditions.

Opportunity: HAI/AR Programs that have a tracking system or audit of investigations conducted around HAI/AR can consider these as examples.

PHAB Measures

Measure 2.1.6:

(S) Consultation, technical assistance, and/or information provided to Tribal and local HDs in the state regarding disease outbreaks and environmental public health hazards

HAI/AR Specific Programs or Activities

State HAI/AR Programs are expected to work with local HDs or Tribes as needed for maximally effective and efficient response to HAI/AR outbreaks and reports of infection control lapses in healthcare.

Opportunities / Considerations For Connections Between HAI/AR and Accreditation

Context: States must document how they provide assistance to Tribal or local HDs in this area. This may be at the request of the locals/Tribes or at the initiation of the state and may be done through a variety of formats or channels.

Opportunity: HAI/AR Programs may provide technical assistance to locals or Tribes on HAI/AR outbreak investigations. Examples of documentation illustrating this assistance can include training sessions and presentations, onsite or phone consultation, webinars, or email communication.

Standard 2.2: Contain/mitigate health problems and environmental public health hazards

PHAB Measures

HAI/AR Specific Programs or Activities

Opportunities / Considerations For Connections Between HAI/AR and Accreditation

PHAB Measures

Measure 2.2.1:

(All) Protocols for containment/mitigation of public health problems and environmental public health hazards

HAI/AR Specific Programs or Activities

Some HAI/AR programs are working with partners to enhance outbreak investigations, detection, containment response and investigation of emerging or unusual antibiotic resistant pathogens in their jurisdiction. HAI/AR Programs develop regional strategies to prevent transmission of these emerging threats, and also address antibiotic overuse and misuse across healthcare and the community (environment).

Opportunities / Considerations For Connections Between HAI/AR and Accreditation

Context: HDs must provide written protocols or a set of protocols to contain /mitigate health problems. This includes disease-specific procedures for follow-up and reporting during outbreaks.

Opportunity: Documentation may include a written protocol or set of protocols, demonstrating a program’s capacity for detecting, responding to, and containing an HAI or emerging antibiotic resistant threat. Protocols for addressing HAI/AR outbreaks can also be considered.

PHAB Measures

Measure 2.2.2:

(All) A process for determining when the All Hazards Emergency Operations Plan (EOP) will be implemented

HAI/AR Specific Programs or Activities

HAI/AR Programs communicate regularly and collaborate with the state and local preparedness programs to improve coordinated responses to HAI and AR outbreaks that may warrant an emergency activation or incident command type of response. HAI/AR Programs often have regular periodic meetings with emergency preparedness programs in their jurisdiction to ensure alignment. In some states, preparedness program representatives are members of the HAI/AR Multidisciplinary Advisory Group.

Opportunities / Considerations For Connections Between HAI/AR and Accreditation

Context: HDs must provide all infectious disease outbreak protocols. The HD must highlight the description of the process for determining when the EOP will be implemented. The HD must provide protocols that include cluster evaluation protocols.

Opportunity: HAI/AR Programs that have developed protocols or procedures for emergency HAI/AR responses or for working with the state or local preparedness programs on such responses can consider these as examples. HAI are specifically mentioned in the PHAB guidance as an example for cluster evaluation protocols.

PHAB Measures

Measure 2.2.3:

(All) Complete After Action Reports (AAR)

HAI/AR Specific Programs or Activities

HAI/AR Programs have developed protocols and procedures for outbreak investigation recommendations, follow up and tracking tools to capture the data that result from HAI/AR investigations. Programs may develop reports that summarize the investigations and follow up steps.

Opportunities / Considerations For Connections Between HAI/AR and Accreditation

Context: The HD must provide a protocol describing when events rise to significance for development and review of an AAR, a list of all events that did and did not meet the level of significance to require an AAR, and provide two examples of AARs for separate events. The list must include all outbreaks that threaten the public’s health.

Opportunity: HAI/AR outbreaks should be included in the list of all outbreaks within the last five years. If they rose to the level of significance requiring an AAR they could be considered an example for that requirement.

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

PHAB Measures

HAI/AR Specific Programs or Activities

Opportunities / Considerations For Connections Between HAI/AR and Accreditation

PHAB Measures

Measure 2.3.1:

(All) Provisions for the HD’s 24/7 emergency access to epidemiological and environmental public health resources capable of providing rapid detection, investigation, and containment / mitigation of public health problems and environmental public health hazards

HAI/AR Specific Programs or Activities

HAI/AR Programs have access to laboratory results for HAI and AR pathogens, specifically CRE, since laboratories are expected to report susceptibility results and percentage of samples tested. Programs work with clinical laboratories for timely and appropriate testing and reporting of AR pathogens and consult with HAI/AR Program epidemiologists for investigations and containment responses.

Opportunities / Considerations For Connections Between HAI/AR and Accreditation

Context: HDs must provide comprehensive policies and procedures outlining how the HD maintains 24/7 access to support services in emergencies. The HD should also have a process (i.e., call down list) to contact epidemiological and environmental health resources and contracts/MOAs/MOUs that define access to needed resources in an emergency.

Opportunity: HAI/AR Programs may have developed policies, protocols, operating procedures, or local guidance that can be used to document how they work with partners and access expertise to ensure timely and effective response to new, unusual, or emerging AR threats. Also, HAI/AR staff with particular expertise may be part of the resources that HDs may want to leverage in an emergency situation.

PHAB Measures

Measure 2.3.2:

(All) 24/7 access to laboratory resources capable of providing rapid detection, investigation and containment of health problems and environmental public health hazards.

HAI/AR Specific Programs or Activities

HAI/AR Programs are enhancing laboratory capacity for state and local detection, reporting, and epidemiologic response to new and emerging HAI/AR threats.

Opportunities / Considerations For Connections Between HAI/AR and Accreditation

Context: HDs must provide examples of how they have the needed laboratory capacities for state and local detection and response to new and emerging issues.

Opportunity: HAI/AR Programs can provide documentation of laboratory testing capacities for AR pathogens, protocols for reporting results, and responding to signals or alerts of unusual resistance, and communication with epidemiologists for investigations/response.

PHAB Measures

Measure 2.3.3:

(All) Access to laboratory and other support personnel and infrastructure capable of providing surge capacity

HAI/AR Specific Programs or Activities

HAI/AR Programs collaborate with partners and other programs to build HAI/AR expertise and infrastructure including laboratory capacity.

Opportunities / Considerations For Connections Between HAI/AR and Accreditation

Context: HDs must provide documentation of how they have access to additional personnel and infrastructure, in situations requiring surge capacity.

Opportunity: HAI/AR Programs may consider collaborations with partners that can provide surge capacity in the event of a significant or ongoing AR response or investigation as examples.

PHAB Measures

Measure 2.3.4:

(All) Collaboration among Tribal, state and local HDs to build capacity and share resources to address Tribal, state, and local efforts to provide for rapid detection, investigation, and containment / mitigation of public health problems and environmental public health hazards

HAI/AR Specific Programs or Activities

HAI/AR Programs collaborate with other state, local, or tribal public health partners to share resources, trainings, and protocols which build capacity and enhance coordinated public health detection and response capabilities for HAI/AR.

Opportunities / Considerations For Connections Between HAI/AR and Accreditation

Context: HDs must provide documentation, such as policies and procedures that demonstrate communication and collaboration in addressing public health problems and environmental public health hazards. Documentation addressing joint exercises is also required.

Opportunity: HAI/AR Programs may have examples such as protocols, policies, or training activities that demonstrate coordination and communication among public health partners for detection and response to HAI outbreaks, or new or unusual AR pathogens.

Standard 2.4: Maintain a plan with policies and procedures for urgent and non-urgent communications

PHAB Measures

HAI/AR Specific Programs or Activities

Opportunities / Considerations For Connections Between HAI/AR and Accreditation

PHAB Measures

Measure 2.4.1:

(All) Written protocols for urgent 24/7 communications

HAI/AR Specific Programs or Activities

HAI/AR Programs develop and implement plans for communication of outbreaks, infection control breaches, and/or new or unusual resistance through standard reporting criteria or algorithms. Plans include coordination with communication experts, media and other public health and healthcare partners.

Opportunities / Considerations For Connections Between HAI/AR and Accreditation

Context: HDs must provide documentation of the written protocols for urgent 24/7 communication and information on how the HD can be reached.

Opportunity: HAI/AR Programs may have documentation that can serve as an example to demonstrate how communication can occur with partners (such as hospitals) in the event of an HAI/AR outbreak.

PHAB Measures

Measure 2.4.2:

(All) A system to receive and provide urgent and non-urgent health alerts and to coordinate an appropriate public health response

HAI/AR Specific Programs or Activities

HAI/AR Programs use resources and templates including but not limited to the Patient Notification Toolkit to notify patients of potential exposure to infectious pathogens due to unsafe practices or infection control breaches. Response to new or emerging HAI/AR threats in healthcare facilities should be included in a program’s communications and response plan.

Opportunities / Considerations For Connections Between HAI/AR and Accreditation

Context: HDs must provide one example within 5 years of how it established or participated in a HAN or similar system that receives and issues alerts 24/7. HDs must also provide reports of testing the 24/7 contact procedure.

Opportunity: HAI/AR –related alerts may be included in communications that occur via a HAN or similar system.

PHAB Measures

Measure 2.4.3:

(All) Timely communication provided to the general public during public health emergencies

HAI/AR Specific Programs or Activities

HAI/AR Programs use resources including but not limited to the CDC Patient Notification Toolkit to implement effective risk communication and help guide media and communication strategies to inform the public about a significant HAI or AR threat.

Communication around HAI/AR outbreaks or new or emerging AR threats in healthcare facilities should be considered for inclusion in a program’s emergency response plan, in coordination with the HD preparedness program.

Opportunities / Considerations For Connections Between HAI/AR and Accreditation

Context: HDs must provide two examples within 5 years of how it communicates with and provides information to the public. HDs must also demonstrate how it uses the media to communicate information to the public during a public health emergency.

Opportunity: Examples could include those related to HAI/AR.

PHAB Measures

Measure 2.4.4:

(S) Consultation and technical assistance provided to Tribal and local HDs on the accuracy and clarity of public health information associated with a public health emergency

HAI/AR Specific Programs or Activities

State HAI/AR programs coordinate with and provide technical assistance and training to local and tribal HDs for a regional communications approach about HAI outbreaks and new or emergent AR threats

Opportunities / Considerations For Connections Between HAI/AR and Accreditation

Context: The State HD serves as a resource to local and Tribal HDs in their efforts to inform the public concerning an outbreak or an environmental or other public health emergency. Two examples of consultation, technical assistance, or guidance must be provided.

Opportunity: Examples of provision of consultation or technical assistance could include those related to HAI/AR.