Local Health Department (LHD) HAI/AR Strategy

The Strategy's basic structure revolves around three broad, long-term goals for effective LHD HAI/AR programs:

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.
2. Build LHD operational capacity to conduct and promote sustainable HAI/AR infection prevention and control activities.
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.

Each goal includes up to four specific objectives. Objectives are concrete, shorter-term actions LHDs can take to accomplish a goal.

Objectives for goal 1

• Objective 1.1: Engage with the state HAI/AR program to determine priorities, state and local roles and responsibilities when working together, and to maintain coordination between the LHD and the state.
• Objective 1.2: Grow and sustain relationships between health care and public health at the local level tailored to meet the LHD's, healthcare facilities' and providers' needs.
• Objective 1.3: Engage public health, healthcare, academic and community partners in growing the partnership network to prevent HAI/AR in all patient populations within the local jurisdiction.

Objectives for goal 2

• Objective 2.1: Increase local public health staff capacity, expertise and confidence to conduct HAI/AR activities, in alignment with the overall state HAI/AR program strategy.
• Objective 2.2: Increase local public health awareness of the latest HAI/AR guidance, data, programs and policies that impact their community.
• Objective 2.3: Increase interjurisdictional infrastructure and sustainability of local HAI/AR infection prevention and control activities, in alignment with the overall state or regional strategy.
• Objective 2.4: Develop and/or update local healthcare preparedness and response plans to have capacity for responding to emerging HAI/AR threats and outbreaks.

Objectives for goal 3

• Objective 3.1: Implement HAI/AR outbreak and response strategies using data to identify appropriate participation in local, regional and state-wide approaches.
• Objective 3.2: Implement infection prevention activities using available data to tailor and focus efforts.
• Objective 3.3: Implement antibiotic stewardship activities using data to tailor and focus efforts.
• Objective 3.4: Support HAI/AR activities that promote health equity and are aligned with state health equity priorities.

Each objective includes recommended activities that are specific and measurable. As they complete recommended activities, LHDs get closer to accomplishing objectives and, ultimately, achieving their goals.

Given that LHDs can vary widely in infrastructure, resources, workforce capacity and more, activities are organized into three levels. LHDs may choose different levels for different goals or objectives. For example, if the LHD is more focused on growing and building HAI/AR awareness, Level 1 might be the best fit.

• 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.

It is worth noting that some activities may be applicable to – and help LHDs achieve – more than one objective and/or goal. Download the Strategy tool to see all activities.

Expected outcomes are things LHDs can expect to experience or observe once they successfully achieve an objective. Every objective has at least one expected outcome, which LHDs can reference to gauge progress.

Expected outcomes for goal 1

• Level 1 activities:
  • 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 activities:
  • Developing, leading, and implementing plans for addressing shared priorities with key partners.
  • Increasing engagement and communication channels with facilities.
• Level 3 activities:
  • Implementing initiatives on behalf of partner network priorities.
  • Growing partner networks, either through increased partners or increased frequency.

Expected outcomes for goal 2

• Level 1 activities:
  • Robust awareness of available IPC trainings and resources, available HAI/AR data sources, interjurisdictional partners, and local preparedness plans.
• Level 2 activities:
  • 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 activities:
  • 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.

Expected outcomes for goal 3

• Level 1 activities:
  • 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 activities:
  • 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 activities:
  • 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.