Framework for Implementing the Interim Local Health Department Strategy for Response, Control, and Prevention of Healthcare Associated Infections (HAI) and Antibiotic Resistance (AR)

Download the LHD HAI/AR Strategy Action Planning Worksheet Template [Excel – 457 KB] to plan and track your list of prioritized goals, objectives, and activities.

View the Guide for Facilitating Conversations with the state HAI/AR programs pdf icon[PDF – 3 Pages] for guidance on engaging your state HAI/AR program and other partners that have a role in HAI/AR across your jurisdiction.

Follow these three steps when your health department is ready to assess and strengthen your HAI/AR capacity.

  • Step 1: Familiarize yourself with the goals, objectives, and activities
  • Step 2: Assess your current capacity
  • Step 3: Develop an action plan 
Step 1. Familiarize yourself with the LHD HAI/AR Strategy

First, read through the Interim Local Health Department (LHD) Strategy for Response, Control, and Prevention of Healthcare-Associated Infections (HAI) and Antibiotic Resistance (AR).  The strategy describes the goals, objectives, and activities for HAI/AR work. Each goal area has designated objectives, and each objective has key activities that span 3 levels based on existing HAI/AR infrastructure.

The strategy uses three levels of activities for each objective.

  • Level 1 activities form the foundational components for each objective and may be more suited for LHDs with little to no experience leading HAI/AR activities.
  • Level 2 activities build upon level 1 and may be more suited for LHDs with previous experience leading HAI/AR activities.
  • Level 3 activities build upon levels 1 and 2 and may be more suited for LHDs with extensive experience leading HAI/AR activities.

These objectives and activities are inherently interrelated and while activities have been separated out across objective areas, there may be overlap between activities and in some cases, replication of types of activities across different goal areas.  When creating an action plan, activities can be viewed as supporting multiple objective or goals.

Note that you may choose to tackle the entire set of goals or focus on one goal or a few objectives at a time. LHDs may choose to work through the activities across all goals and objectives, or they may choose to focus on priority areas. For example, if a LHD is eager to grow partner networks and collaboration, they may choose to focus on Goal 1 as a starting point. If a LHD has already addressed the primary objectives under Goal 1 (i.e., State HAI/AR program engagement) and is ready to expand operational capacity, they may choose to focus on Goal 2 and revisit Goal 1 (or 3) at a later date.

Step 2. Assess your current capacity

In step 2, you’ll assess your key characteristics, current capacity, existing activities, and consider gaps and areas of desired focus. Start by reflecting on the questions listed below and reviewing the expected outcomes for the levels that strategy activities span.

Assessment Questions and Considerations:

  1. How would you characterize your public health governance? Visit the Health Department Governance Classification Map if you are unsure.
    • Centralized Governance / State Governed
    • Decentralized Governance / Locally Governed
    • Mixed Governance
    • Shared Governance
    • Other
  1. What is the size of the population served by your LHD?
    • Small (<50,000)
    • Medium (50,000 to 499,000)
    • Large (500,000+)
  1. How many LHD staff are currently dedicated to HAI/AR work?
  1. What types and numbers of healthcare facilities are in your jurisdiction (e.g., 20 nursing homes and 2 acute care hospitals)?
  1. What is the HAI/AR landscape in your jurisdiction?
    • What are the most urgent pathogens affecting your jurisdiction?
    • Does your LHD have access to infection rates for pathogens of concern? If so, what data do you use to know what pathogens are priority for your jurisdiction?
  1. Who are the LHD partners and what HAI/AR activities are they conducting or engaged in?
  1. What is the capacity at the LHD to initiate or enhance HAI/AR activities?
  1. What activities, if any, do LHDs currently conduct to address HAI/AR priorities?
    • How do those activities fit into the state HAI/AR priorities and the LHD priorities?
    • Are there unique local level priorities that should be considered?

To help determine priorities, roles, and responsibilities that state HAI/AR programs and LHDs will work on together, explore the Guide for Facilitating Conversations with the State HAI/AR Program pdf icon[PDF – 3 Pages].

Determining your Level  

Use the expected outcomes for each goal area below determine which level you would fall into based on what you are currently working on, what you plan to work on, and what best aligns with your priorities.

  • Level 1 activities form the foundational components for each objective and may be more suited for LHDs with little to no experience leading HAI/AR activities.
  • Level 2 activities build upon level 1 and may be more suited for LHDs with previous experience leading HAI/AR activities.
  • Level 3 activities build upon level 1 and 2 and may be more suited for LHDS with more extensive experience leading HAI/AR activities.

You may choose different levels for different goals or objectives. For example, if your LHD is more focused on growing and building HAI/AR awareness, Level 1 might be the best fit for you. After determining the appropriate level for your LHD, familiarize yourself with the activities outlined for that level. The activities provide a catalog of recommended actions and competencies for each objective.

Goal 1: Expected Outcomes, by Level
Goal 1: Grow and expand networks across state, regional, and local levels through increased LHD communication and collaboration within the public health sector and among public-private sector partners.

Level 1

Level 1

Level 2

Level 2

Level 3

Level 3

Level 1 activities should result in: 

Level 1 activities should result in: 

Level 2 activities should result in: 

Level 2 activities should result in: 

Level 3 activities should result in: 

Level 3 activities should result in: 

  • Robust awareness of the key players in the HAI/AR landscape including contacts at the state HAI/AR program, healthcare facilities, public health organizations, and academic and community partners.
  • Knowledge of local, state, and regional partners’ priorities.
  • Robust awareness of the key players in the HAI/AR landscape including contacts at the state HAI/AR program, healthcare facilities, public health organizations, and academic and community partners.
  • Knowledge of local, state, and regional partners’ priorities.
  • Developing, leading, and implementing plans for addressing shared priorities with key partners.
  • Increasing engagement and communication channels with facilities.
  • Developing, leading, and implementing plans for addressing shared priorities with key partners.
  • Increasing engagement and communication channels with facilities.
  • Implementing initiatives on behalf of partner network priorities.
  • Growing partner networks, either through increased partners or increased frequency.
  • Implementing initiatives on behalf of partner network priorities.
  • Growing partner networks, either through increased partners or increased frequency.

Level 1

Level 1 activities should result in: 

  • Robust awareness of the key players in the HAI/AR landscape including contacts at the state HAI/AR program, healthcare facilities, public health organizations, and academic and community partners.
  • Knowledge of local, state, and regional partners’ priorities.

Level 2

Level 2 activities should result in: 

  • Developing, leading, and implementing plans for addressing shared priorities with key partners.
  • Increasing engagement and communication channels with facilities.

Level 3

Level 3 activities should result in: 

  • Implementing initiatives on behalf of partner network priorities.
  • Growing partner networks, either through increased partners or increased frequency.
Goal 2: Expected Outcomes, by Level
Goal 2: Build LHD operational capacity to conduct and promote sustainable HAI/AR infection prevention and control activities.

Level 1

Level 1

Level 2

Level 2

Level 3

Level 3

Level 1 activities should result in: 

Level 1 activities should result in: 

Level 2 activities should result in: 

Level 2 activities should result in: 

Level 3 activities should result in: 

Level 3 activities should result in: 

  • Robust awareness of available IPC trainings and resources, available HAI/AR data sources, interjurisdictional partners, and local preparedness plans.
  • Robust awareness of available IPC trainings and resources, available HAI/AR data sources, interjurisdictional partners, and local preparedness plans.
  • Increased LHD staff trained on IPC.
  • Understanding of the latest HAI/AR policies, science, and guidance.
  • Communication strategies consistent with state messaging.
  • Plans for interjurisdictional collaboration.
  • Increased understanding of local preparedness.
  • Increased LHD staff trained on IPC.
  • Understanding of the latest HAI/AR policies, science, and guidance.
  • Communication strategies consistent with state messaging.
  • Plans for interjurisdictional collaboration.
  • Increased understanding of local preparedness.
  • Robust training opportunities for LHD staff that cover IPC, related topics, and mentorship opportunities.
  • Strategies for bi-directional knowledge sharing between LHDs and other partners.
  • Leading prevention, preparedness, and response efforts.
  • Robust training opportunities for LHD staff that cover IPC, related topics, and mentorship opportunities.
  • Strategies for bi-directional knowledge sharing between LHDs and other partners.
  • Leading prevention, preparedness, and response efforts.

Level 1

Level 1 activities should result in: 

  • Robust awareness of available IPC trainings and resources, available HAI/AR data sources, interjurisdictional partners, and local preparedness plans.

Level 2

Level 2 activities should result in: 

  • Increased LHD staff trained on IPC.
  • Understanding of the latest HAI/AR policies, science, and guidance.
  • Communication strategies consistent with state messaging.
  • Plans for interjurisdictional collaboration.
  • Increased understanding of local preparedness.

Level 3

Level 3 activities should result in: 

  • Robust training opportunities for LHD staff that cover IPC, related topics, and mentorship opportunities.
  • Strategies for bi-directional knowledge sharing between LHDs and other partners.
  • Leading prevention, preparedness, and response efforts.
Goal 3: Expected Outcomes, by Level
Goal 3: Expand LHD HAI/AR infection prevention, outbreak response, and stewardship activities using data for action and prioritizing activities that increase impact on health equity.

Level 1

Level 1

Level 2

Level 2

Level 3

Level 3

Level 1 activities should result in: 

Level 1 activities should result in: 

Level 2 activities should result in: 

Level 2 activities should result in: 

Level 3 activities should result in: 

Level 3 activities should result in: 

  • Robust awareness of the roles of the LHD in outbreak and response activities.
  • Knowledge of state HAI/AR prevention strategies, stewardship activities, health equity goals, and resources.
  • Coordination and communication with the state during outbreaks.
  • Robust awareness of the roles of the LHD in outbreak and response activities.
  • Knowledge of state HAI/AR prevention strategies, stewardship activities, health equity goals, and resources.
  • Coordination and communication with the state during outbreaks.
  • LHD playing an active role in outbreak response as defined with SHD, whether in shadowing, leading, or being updated.
  • Using data for action at the local level.
  • Designated stewardship activities at the local level.
  • Local health equity goals.
  • LHD playing an active role in outbreak response as defined with SHD, whether in shadowing, leading, or being updated.
  • Using data for action at the local level.
  • Designated stewardship activities at the local level.
  • Local health equity goals.
  • Leading trainings to educate facilities on prevention, containment, and stewardship.
  • Data assessment to determine trends.
  • Using data to implement prevention strategies.
  • Leading local health equity work.
  • Leading trainings to educate facilities on prevention, containment, and stewardship.
  • Data assessment to determine trends.
  • Using data to implement prevention strategies.
  • Leading local health equity work.

Level 1

Level 1 activities should result in: 

  • Robust awareness of the roles of the LHD in outbreak and response activities.
  • Knowledge of state HAI/AR prevention strategies, stewardship activities, health equity goals, and resources.
  • Coordination and communication with the state during outbreaks.

Level 2

Level 2 activities should result in: 

  • LHD playing an active role in outbreak response as defined with SHD, whether in shadowing, leading, or being updated.
  • Using data for action at the local level.
  • Designated stewardship activities at the local level.
  • Local health equity goals.

Level 3

Level 3 activities should result in: 

  • Leading trainings to educate facilities on prevention, containment, and stewardship.
  • Data assessment to determine trends.
  • Using data to implement prevention strategies.
  • Leading local health equity work.

Now that you have determined your capacity, priorities, and level, you will use this information to move to the action planning phase.

Step 3. Develop an Action Plan

In the Action Plan phase, you’ll find tools for developing action plans to implement activities. Use the worksheet templates provided to track your list of prioritized activities and determine what support you would need to conduct those activities. Once you have completed an action plan, you can use the plan for discussions with your partners.

Click here to download the LHD HAI/AR Strategy Action Planning Worksheet Template [Excel – 457 KB]. A video demo of how to use the tool will be coming soon.

As you fill out the action planning worksheet, consider the following:

  • Resources: What additional support or resources would help you achieve desired activities?
    • Have you reviewed available data and policies (e.g., reporting requirements) for your jurisdiction?
    • Are there funding opportunities to consider?
  • Leaders: Who will serve as the lead(s)for HAI/AR activities at your LHD? Who will lead the activities among your partner networks?
  • Partners: Which partners in your network should be informed of or engaged in the desired activities?
    • Does your partner network include the right partners and people to implement activities?
    • Does your partner network have an established structure for coordination, accountability, and decision making? Refer to the Success Framework for HAI/AR Partner Networks for recommendations on building, strengthening, sustaining, and evolving your partner networks.
  • Timeline: What are the steps required and when will you aim to achieve them?
  • Monitoring: What are the milestones of progress and how will you measure them?
    • What available data will you analyze to determine progress?
  • Results: If the desired activities are successfully implemented, what specific, measurable changes would you like to see in the community?

Use these tools and worksheets for discussions with your partners, as you engage them. We recommend sharing them with your state HAI/AR program.