mandatory cre reporting and the xdro registry in illinois · mandatory cre reporting and the xdro...
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Mandatory CRE Reporting and the XDRO Registry in Illinois
Angela Tang, MPHCRE Project Director/Epidemiologist
Hektoen Institute
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Topics
1. History of CRE in IL
2. Mandatory CRE reporting
3. XDRO registry
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First 2 CRE cases, Chicago area, 2007-2008
3Slide Credit: Mike Lin
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KPC Outbreak: IL & IN Facilities, 2008
4Credit: Mike Lin
Won SY et al. CID 2011
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CRE Point Prevalence Surveys, Chicago area, 2010-2011
Facility type CRE colonization prevalence
Short stay acute care hospitals(adult ICUs) 3%
Long term acute care hospitals (LTACHs) 30%
Lin MY, et al. CID, 2013
Credit: Mike Lin
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Need for more CRE data & inter-facility communication
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Facility type CRE colonization prevalence
Short stay acute care hospitals (adult ICUs) 3%
Long term acute care hospitals (LTACHs) 30%
•CRE were relatively common in some Chicago healthcare facilities, particularly LTACHs
•Few CRE data from hospital non-ICU wards, nursing homes, and regions outside of Chicago
•Possibility of mandatory reporting discussed with HAI Advisory Council
Adapted from: Mike Lin
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Start Date: November 1, 2013
Required Reporters: acute care hospitals long-term acute care hospitalslong-term care facilitieslaboratories
How to report: Extensively Drug-Resistant Organism (XDRO) Registry
When to report: Within 7 days of test confirmation
Amendment to the Control of Communicable Diseases Code (77 Ill. Adm. Code 690)
Mandatory CRE Reporting in Illinois
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Enterobacteriaceae with one of the following test results:
1. Molecular test (e.g., PCR) specific for carbapenemase,
2. Phenotypic test (e.g., Modified Hodge) specific for carbapenemase production, OR
3. Susceptibility test (for E. coli and Klebsiella species only): non-susceptible to ONE of the carbapenems (doripenem, meropenem, or imipenem) AND resistant to ALL third generation cephalosporins tested (ceftriaxone, cefotaxime, and ceftazidime). Note: Ignore ertapenem.
Report 1st positive culture per patient encounter.
Illinois CRE Surveillance Definition
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XDRO registry, 20131. Mandatory CRE reporting
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All Illinois Facilities
Facility A
Query XDRO status
2. Information exchange
Adapted from: Trick, WE et al., EID 2015
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XDRO Architecture
Healthcare facility,
Laboratory
IDPH Web
PortalLog in
• Collaboration among IDPH, CDC Chicago Epicenter, Medical Research Analytics and Informatics Alliance (MRAIA)
• Built from scratch with input from end user
Authentication
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IDPH Web Portal
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IDPH Web Portal
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XDRO registry interface
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Submit report page
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Culture info
Facility info
Patient demographics
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CRE reported to XDRO registry, 2014-15n (%)
Organism1
K. pneumoniae 2567 (84)E. coli 180 (6)Enterobacter spp. 170 (6)
Other 142 (4)Mechanism of Resistance2
KPC 636 (90)NDM 29 (4)OXA-48-like 6 (<1)IMP 1 (<1) 16
2Out of 709 isolates with molecular testing
1Out of 3059 reports
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CRE by IDPH Region, 2014-15
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Unique patients reported to the XDRO registry, by quarter of earliest CRE clinical culture,
11/2013 – 12/2016 (N=2920)
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0
50
100
150
200
250
300
2013Q4 2014Q4 2015Q4 2016Q4
Uni
que
patie
nts (
n)
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Adding emerging organisms
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All Illinois Facilities IDPH
Facility A
Query XDRO status
3. Information exchange
2. Emerging pathogens1. Mandatory CRE reporting
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Candida auris
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Carbapenemase-producing Pseudomonas aeruginosa
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• VIM–PA outbreak detected in Chicago area• KPC and IMP later identified
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Inter-facility communication
All Illinois Facilities IDPH
Facility A
ADT Feed/Manual query
XDRO status
3. Information exchange
2. C. auris, CP-PA1. Mandatory CRE reporting
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Manual searches
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Need last name and DOB to conduct query
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Patient Match
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XDRO Auto Alerts
Hospital ADT feed
(Last name, First name, DOB)
IP logs in to XDRO
Email,
page, text
• Inpatient Admission Feed: Every 15-30 min• Pager/SMS texts (optional feature): Real-time alerts from 8 am-8 pm; Off-hours alerts queued until 8 am next day
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Sample XDRO alert email
Subject: Alert notification from XDRO registry (AID 123)
The XDRO registry has identified that a patient recently admitted to <hospital name> may carry an organism that is highly resistant to antibiotics. Please log in to the XDRO registry (dph.partner.illinois.gov) for details.
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Sample alert text message
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Log in to the registry to view alerts
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Facility Alert Page
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Tracking Alert Outcomes
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CRE Alert Outcomes, 1/7/15 – 5/28/17
763 alerts at 18 hospitals
Missing data: 17 (2%)
Complete data: 746 (98%)
Incorrect pt: 5 (1%)
Correct pt: 741 (99%)
Notes: - 2 C. auris alerts were sent. Data not
shown here- 1 hospital has not received an alert yet
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741 alerts
Yes561 (76%)
Yes459 (82%)
No102 (18%)
No180 (24%)
Yes72 (40%)
No108 (60%)
Known CRE at time of alert?
In contact precautions at time of alert?
Alert Outcomes: All correct inpatient CRE alerts, 1/7/15 – 5/28/17
Adapted from: Mike Lin
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Auto alerts - Additional benefits
Saves time
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Manual Searches, 1.5 years
Auto Alert Searches, 1 month
5,744 28,661
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Auto alerts - Additional benefits
Saves time
Provides data for quality improvement
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Manual Searches, 1.5 years
Auto Alert Searches, 1 month
5,744 28,661
Alerts(n)
Alerts/month
Correct person?n (%)
Known CRE?n (%)
Contact Precautions?n (%)
47 2.8 44 (94) 19 (43) 9 (20)
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Additional benefits
Timely infection control action saves resources
This…..
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Not That…
Contact Precautions
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XDRO auto alert progress (statewide)
Credit: Emily Augustini
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Select Challenges & Solutions
Challenge Solution
Understanding CRE definition Educational campaign
Testing capacity at local labs Lab validation, testing at IDPH Laboratory
Onboarding facilities (esp. long-term care)
Educational campaign, individual assistance
XDRO data quality Lab validation,Future data validation
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Common Questions
• Why didn’t you use NEDSS or NHSN for
reporting?
• How did you address HIPAA issues?
• Why doesn’t IL follow the CDC 2015 CRE
definition?
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XDRO registry developments
2013 2014 2015 2016 2017 2018+
Registry opens
for CRE
Auto alert pilot
Auto alert expansion
Syndromic surveillance feed
for alerting
C. aurisELR
CP-PA
Manual reporting
& querying
Pager & text alerts
CP-PA= Carbapenemase-producing Pseudomonas aeruginosa; ELR= Electronic Laboratory Reporting
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www.xdro.org 44
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Acknowledgments
IDPH
• Erica Runningdeer• Chinyere Alu• Stacey Hoferka• Emily Augustini
BD/MedMined• Vikas Gupta• Autumn Langford
MRAIA
Hospital IPs
CDC Epicenter
• Bill Trick• Mike Lin• Vicky Gao• Shawn Xiang• Helen Zhang• George Markovski
For more information:[email protected]