So far in this blog series, NACCHO has explored how disease surveillance can combat antimicrobial resistance and highlighted how local health departments can play a role in protecting communities from this public health threat. In this final post, we provide additional cases of how local public health can serve as a key partner in the fight to contain and prevent this global public health issue.
The information systems world asserts that getting the right data to the right people at the right time supports informed decision-making. Antimicrobial surveillance is no exception. Ensuring local health departments (LHDs) get the information they need in the time they need it will advance their ability to detect, prevent, and control antimicrobial resistance. Access by itself is not a solution, however, as it must be accompanied by the training, expertise, and support needed to develop, maintain, and utilize antimicrobial resistance surveillance systems and data. Further, there is a need to more clearly identify the roles, responsibilities, and investments of facilities and organizations who are stakeholders in the fight against antimicrobial resistance. This includes outlining the roles and responsibilities of local public health, particularly in relation to state public health and other local healthcare facilities, and better defining processes for reporting and investigating healthcare-associated infections (HAIs) and antimicrobial resistance.
While national and state agencies have cited the critical role of local public health, health departments continue to have varying levels of engagement in developing and implementing antimicrobial resistance prevention, surveillance, and reporting programs and policies. This variation in engagement is attributed to many reasons, such as availability of funding, capacity, and challenges in collaborating across levels of government, sectors of public health and health care, facilities, and organizations. Below, we explore how several LHDs are navigating such factors of engagement to address antimicrobial resistance.
Assessing Provider Practices and Needs to Prevent Infections in DuPage County (IL)
In 2010, the DuPage County Health Department (DCHD), which serves a population of more than 900,000 residents, engaged in a strategic planning process to advance the health and well-being of county residents. One of the four areas of public health importance identified in the community plan was infectious disease, including the prevention of HAIs and multidrug-resistant organisms (MDROs). MDROs are bacteria resistant to one or more classes of antimicrobials, making them very difficult and more expensive to treat. They are most often found in hospitals and long-term care facility (LTCF) settings, transmitted through direct contact with an infected person or indirect contact with a contaminated surface.
In order to address this priority area, the health department conducted a needs assessment with LTCFs in the county to better understand the current knowledge, attitudes, and practices related to the prevalence and prevention of HAIs and MDROs. Multiple projects were subsequently launched to address the gaps identified in the needs assessment, including regional workshops focused on HAI and MDRO prevention and control, delivered in partnership with state and local public health agencies; outreach and education opportunities for healthcare professionals and the general public; and meetings with LTCFs to establish and/or expand antimicrobial stewardship efforts. DCHD continues to support these projects, inform statewide HAI and MDRO strategic planning efforts, and strengthen partnerships with local healthcare facilities.
Creating a Forum for Infection Prevention Education in Philadelphia (PA)
It wasn’t long ago when the Philadelphia Department of Public Health (PDPH), which serves 1.5 million residents, had a limited role in the prevention and surveillance of HAIs. In 2012, however, reports of carbepenem-resistant Enterobacteriaceae (CRE) clusters in local LTCFs marked the beginning of steadily increasing involvement in preventing, investigating, and responding to outbreaks of HAIs. CRE are a family of germs that have become resistant to most antibiotics, making them difficult to treat. Usually occurring in healthcare settings, this bacteria is responsible for at least 9,300 infections and 610 deaths annually.
In 2013, after surveying local skilled nursing facilities and identifying a desire for the agency to facilitate inter-facility communication and education, PDPH hosted the Infection Prevention Symposium on CRE prevention and antimicrobial stewardship. This event brought together 150 healthcare professionals, helped spread the word about the threat of CRE, and increased voluntary reporting of CRE. The health department continues to facilitate community collaborations to promote discussion and exchange of ideas within the region and better understand local needs related to antimicrobial resistance and stewardship.
Partnering to Promote Antibiotic Stewardship in Los Angeles (CA)
In 2003, the Los Angeles County Department of Public Health (LACDPH) created a hospital outreach unit to partner actively with the California Department of Public Health to foster collaboration and communication between public health and hospitals, and assist with hospital outbreak investigations. These investigations include activities like conducting site visits, reviewing charts, collecting patient and environmental samples, and interviewing staff.
Between 2003 and 2010, LACDPH conducted 207 outbreak investigations across its 101 licensed acute care hospitals. Now that HAI reporting and oversight of antibiotic use by hospitals are mandated in California – the first and only state to pass such legislation advancing antibiotic stewardship – this partnership continues to provide a mutual understanding of public health needs and hospital capabilities, enhance local access to surveillance data for HAI prevention efforts, and advance collaborative approaches to HAI prevention.
This model of state and local partnership demonstrates the benefits of defining roles and responsibilities between agencies to advance efforts to combat antimicrobial resistance. Enhanced local access to surveillance data – in combination with funding and technical expertise – enables LACDPH to play the integral role they do in supporting implementation of their state’s antibiotic stewardship legislation.
Kickstarting Antimicrobial Stewardship Efforts in Your County
Although many LHDs are engaged in antimicrobial resistance and stewardship efforts, challenges and barriers persist, including lack of resources, limited involvement in reporting and data collection activities, and a need for increased coordination with state health departments and other stakeholders. For many of the LHDs spotlighted in this blog series, success was made possible by several necessary factors, including availability of funding, expertise, and community support. Thus, with adequate resources, more robust and interoperable public health information systems, and increased collaboration, more LHDs can provide proactive leadership, coordination, and participation in antimicrobial resistance and stewardship efforts. Globally emerging infectious disease threats, such as antimicrobial resistance, highlight the importance of early detection and action on the local level. LHDs are uniquely equipped to contribute to the reduction of the health and economic burden associated with antimicrobial resistance. Enhancing such surveillance at a local level will be critical to slowing the development and spread of antimicrobial resistance in the U.S. and worldwide.
To share how your LHD is working against antimicrobial resistance, or to connect with one of the LHDs showcased in this blog series, contact NACCHO’s Infectious Diseases team.