ARRA PREVENTING HEALTHCARE-ASSOCIATED INFECTIONS

This funding was appropriated under the American Recovery and Reinvestment Act of 2009 (Public Law 111-5).  The ARRA funds are intended to reduce preventable healthcare-associated infections through State
health department efforts to prevent HAIs including leveraging the National Health Care Safety Network to support the dissemination of HHS evidence-based practices within hospitals ($40 million).

Specific goals include: (1) progress towards prevention targets (e.g., 50-70% reduction in bloodstream infections); (2) use of the metrics and supporting systems to assess progress towards meeting the targets; (3) broad implementation of current evidence-based prevention guideline recommendations; (4) develop and implement state public health-healthcare HAI prevention collaboratives to implement prioritized HAI prevention recommendations using CDC s NHSN as the measurement system; (5) enhance and expand participation by hospitals and other healthcare facilities in the NHSN to facilitate reporting of appropriate HAI metrics and progress toward five-year prevention targets to state health departments and CDC, HHS, and other HHS OPDIVs; (6) build a public health workforce in health departments who can coordinate state-wide initiatives to ensure progress towards five-year national prevention targets; (7) assist States in the development and submission of state HAI prevention plans; (8) quickly expand its infrastructure to address a broader array of HAI epidemiology; (9) provide additional training for EIP state staff on HAI epidemiology and surveillance; (10) develop and implement enhanced surveillance tools and methods, and add staff for targeted two year projects.

Agency - Department of Health and Human Services

The Department of Health and Human Services is the Federal government's principal agency for protecting the health of all Americans and providing essential human services, especially to those who are least able to help themselves.



Program Accomplishments

Fiscal Year 2008: The Epidemiology and Laboratory Capacity (ELC) for Infectious Disease program plays a critical role in strengthening our nation s infrastructure for preventing and controlling infectious diseases. The program builds epidemiology, laboratory, and information systems capacity in all 50 states to assist frontline state programs respond to infectious disease outbreaks, address the increasing threat of antimicrobial resistance, and detect and respond to new and emerging infectious diseases. As states are in different stages of implementing HAI monitoring and prevention programs, ELC funding would be flexible in its applications; however monies would be directed specifically toward the goals of preventing healthcare associated infections.

The Emerging Infections Programs (EIPs) are a critical part of our nation s infrastructure for public health work in infectious diseases. Established in 1995, the EIPs consist of 10 centers of excellence across the US that are collaborations among state health agencies, academic institutions, CDC, and other federal agencies. Collectively, they form a specialized network of research centers for infectious disease work that goes beyond the routine functions of health departments. The EIP network s unique strength and contribution lies in its ability to quickly translate surveillance and research activities into informed policy and public health practice.

CDC has supported and been an active participant in the collaborative effort led by HHS to develop the HHS Action Plan to Prevent Healthcare Associated Infections. The HHS Action Plan sets specific targets for monitoring and preventing HAIs nationally and represents a national blueprint for prevention. CDC has played an integral role in the development and implementation of the HHS Action Plan, including chairing the Prevention and Implementation working group and co-chairing the Information Systems and Technology working group, while actively participating in the three other workgroups. In September 2008, CDC hosted a meeting of experts to help define prevention targets and metrics for the Action Plan. CDC continues to work closely with HHS and the other agencies to implement the plan. CDC has a broad range of activities that are crucial to successfully implement the HHS plan. These activities can be categorized as: 1) tracking and monitoring HAIs; 2) developing guidelines for prevention; 3) implementation of prevention strategies; 4) developing new strategies for prevention; 5) identifying and responding to new and emerging threats.

CDC s NHSN is a tool for tracking and prevention of HAIs that incorporates HICPAC practice guidelines, uses validated standardized definitions and protocols, and allows facilities to analyze, share, and compare their data with that of others. NHSN is used by over 2000 healthcare facilities in all 50 states, and continues to expand. Since 1990, facilities reporting to NHSN have seen significant reductions of up to 70% in rates of catheter associated urinary tract infections (CAUTI) in ICUs. From 1997 to 2007, hospitals participating in CDC s NHSN have decreased bloodstream infections by up to 50%. A total of 10,600 device-associated infections are estimated to have been prevented, and at least 1,300 lives are estimated to have been saved.
CDC has demonstrated dramatic success in preventing and reducing HAIs through implementation of CDC guidelines. Through CDC supported efforts in Southwestern Pennsylvania, local hospitals have successfully reduced bloodstream infections by as much as 70 percent by fully implementing CDC prevention recommendations. Similar success was observed when Michigan fully implemented CDC guidelines in more than 100 ICUs. CDC funded and collaborated with the Pittsburgh VA Medical Center to prevent MRSA infections using CDC recommendations. These efforts led to greater than 60% reductions in MRSA rates, and to collaboration among healthcare facilities in southwestern Pennsylvania on a regional MRSA initiative. The Veterans Health Administration launched a national MRSA prevention initiative involving every Veterans Health Administration hospital in the country modeled after Pennsylvania s success. These and other prevention implementation examples demonstrate the savings in lives and healthcare costs that can result from national implementation of evidence-based HAI prevention programs. Fiscal Year 2009: No Current Data Available Fiscal Year 2010: No Current Data Available

Uses and Use Restrictions

CDC will provide 99.5% of the funds to eligible states using the following existing Cooperative Agreements: the Epidemiology and Laboratory Capacity for Infectious Disease program, and the Emerging Infections Program.

Project funds may be used for costs associated with planning, organizing, conducting and supporting programs directed toward preventing healthcare associated infections, and for the implementation of other program elements as described in Section ":050:" above.

These funds may be used for the preservation of jobs necessary to build capacity in state and local health departments related to healthcare associated infection prevention.

See above.

Eligibility Requirements

Applicant Eligibility

State (includes District of Columbia, public institutions of higher education and hospitals): Health/Medical

Beneficiary Eligibility

State; Local; Public nonprofit institution/organization; Other public institution/organization

Credentials/Documentation

Applicants should document the need for assistance, state the objectives of the project, outline the method of operation, describe the evaluation procedures, describe plans for sustaining the impact of ARRA investments beyond the federal funding provided in the next two years and provide a budget with justification of funds requested. Costs will be determined in accordance with OMB Circular No. A-87 for State and local governments. For nonprofit recipients, costs will be determined in accordance with HHS Regulations 45 CFR 74, Subpart Q. This program is excluded from coverage under OMB Circular No. A-87.

Aplication and Award Process

Preapplication Coordination

Preapplication coordination is not required.

This program is eligible for coverage under E.O.

12372, "Intergovernmental Review of Federal Programs." An applicant should consult the office or official designated as the single point of contact in his or her State for more information on the process the State requires to be followed in applying for assistance, if the State has selected the program for review.

Environmental impact information is not required for this program.

This program is eligible for coverage under E.O.

12372, "Intergovernmental Review of Federal Programs." An applicant should consult the office or official designated as the single point of contact in his or her State for more information on the process the State requires to be followed in applying for assistance, if the State has selected the program for review.

Application Procedures

This program is excluded from coverage under OMB Circular No. A-102. This program is excluded from coverage under OMB Circular No. A-110. Applicants must download the SF424 (R&R) application forms and SF424 (R&R) Application Guide for this requirement through Grants.gov/Apply.
Only the forms package directly attached to a specific Funding Opportunity Announcement (FOA) can be used. Applicants will not be able to use any other SF424 (R&R) forms (e.g., sample forms, forms from another FOA) although some of the "Attachment" files may be useable for more than one FOA.

If an applicant does not have access to the Internet, or if they have difficulty accessing the forms online, contact the CDC Procurement and Grants Office Technical Information Management Section (PGOTIMS) staff. For this, or further assistance, contact PGO TIMS: Telephone (770) 488-2700, Email: PGOTIM@cdc.gov.

HHS/CDC Telecommunications for the hearing impaired: TTY 770-488-2783.

The standard application forms must be used for this program, as furnished by CDC and required by 45 CFR 92 for State and local governmental agencies, and by OMB Circular No. A-110 for nongovernmental applicants. This program is subject to the provisions of 45 CFR 92 for State and local governments and OMB Circular No. A-110 for nonprofit organizations.

Award Procedures

All applications that are complete and responsive to non-competitive supplemental grant announcements will be evaluated for scientific and technical merit and receive support. Support will be need based and may be formula driven. Applications that are complete and responsive to competitive supplemental grant and cooperative agreement announcements will undergo an objective review process, receive a written critique and be scored according to published review criteria. Successful applicants will receive a Notice of Award (NOA) from the CDC Procurement and Grants Office. The NOA shall be the only binding, authorizing document between the recipient and CDC. The NOA will be signed by an authorized Grants Management Officer.

Deadlines

Contact the headquarters or regional office, as appropriate, for application deadlines.

Authorization

Health Service Act Sections 301(a)[42 U.S.C. 241(a)] American Recovery and Reinvestment Act of 2009, Public Law 111-5, Public Law 111-5, 42 U.S.C 241(a).

Range of Approval/Disapproval Time

Not Applicable.

Appeals

Not Applicable.

Renewals

Renewals will be based upon availability of funding under the American Recovery and Reinvestment Act.

Assistance Considerations

Formula and Matching Requirements

This program has no statutory formula.This program has no matching requirements. This program does not have MOE requirements.

Length and Time Phasing of Assistance

Project Period: until December 29, 2011. Budget Period: variable. See the following for information on how assistance is awarded/released: No information provided.

Post Assistance Requirements

Reports

Recipients of Federal awards from funds authorized under Division A of the ARRA must comply with all requirements specified in Division A of the ARRA (Public Law 111-5), including reporting requirements outlined in Section 1512 of the Act.

For purposes of reporting, ARRA recipients must report on ARRA sub-recipient (sub-grantee and sub-contractor) activities as specified below.

Not later than 10 days after the end of each calendar quarter, starting with the quarter ending June 30, 2009 and reporting by July 10, 2009, the recipient must submit quarterly reports to HHS that will be posted to Recovery.gov, containing the following information:
(a) The total amount of ARRA funds under this award; (b) The amount of ARRA funds received under this award that were obligated and expended to projects or activities; (c) The amount of unobligated award balances; (d) A detailed list of all projects or activities for which ARRA funds under this award were obligated and expended, including: (1) the name of the project or activity; (2) a description of the project or activity; (3) an evaluation of the completion status of the project or activity; (4) an estimate of the number of jobs created and the number of jobs retained by the project or activity; and (5) for infrastructure investments made by State and local governments, the purpose, total cost, and rationale of the agency for funding the infrastructure investment with funds made available under this Act, and the name of the person to contact at the agency if there are concerns with the infrastructure investment.

( e) Detailed information on any sub-awards (sub-contracts or sub-grants) made by the grant recipient to include the data elements required to comply with the Federal Funding Accountability and Transparency Act of 2006 (Public Law 109-282).

For any sub-award equal to or larger than $25,000, the following information will be required: (1) the name of the entity receiving the sub-award; (2) the amount of the sub-award; (3) the transaction type; (4) the North American Industry Classification System code or Catalog of Federal Domestic Assistance (CFDA) number; (5) program source; (6) an award title descriptive of the purpose of each funding action; (7) the location of the entity receiving the award; (8) the primary location of performance under the award, including the city, State, congressional district, and country; and (9) a unique identifier of the entity receiving the award and of the parent entity of the recipient, should the entity be owned by another entity.
(f) All sub-awards less than $25,000 or to individuals may be reported in the aggregate, as prescribed by HHS.
(g) Recipients must account for each ARRA award and sub-award (sub-grant and sub-contract) separately.

Recipients will draw down ARRA funds on an award-specific basis.

Pooling of ARRA award funds with other funds for drawdown or other purposes is not permitted.

(h) Recipients must account for each ARRA award separately by referencing the assigned CFDA number for each award.

Additional reporting requirements will detailed in Funding Opportunity Announcements and included in award notices.

Final financial status and performance reports are required 90 days after the end of the project period.

No cash reports are required.

No progress reports are required.

No expenditure reports are required.

No performance monitoring is required.

Audits

In accordance with the provisions of OMB Circular No. A-133 (Revised, June 27, 2003), "Audits of States, Local Governments, and Non-Profit Organizations," nonfederal entities that expend financial assistance of $500,000 or more in Federal awards will have a single or a program-specific audit conducted for that year. Nonfederal entities that expend less than $500,000 a year in Federal awards are exempt from Federal audit requirements for that year, except as noted in Circular No. A-133. An organization that expends $500,000 or more in a year in Federal awards shall have a single or program-specific audit conducted for that year in accordance with the provisions of OMB Circular A-133, Audit of States, Local Governments, and Non-Profit Org

Records

Financial records, supporting documents, statistical records, and all other records pertinent to the grant program shall be retained for a minimum of 3 years, or until completion and resolution of any audit in process or pending resolution. In all cases records must be retained until resolution of any audit questions. Property records must be retained in accordance with 45 CFR 92.42 requirements.

Financial Information

Account Identification

75-0144-0-1-550 - TAFS 75 9/10 0144.

Obigations

(Cooperative Agreements) FY 08 $0; FY 09 est $40,000,000; FY 10 est $0

Range and Average of Financial Assistance

From $100,000 to $1,600,000.

Regulations, Guidelines, and Literature

Regulations governing this program are published under 42 CFR 55 b. 45 CFR 92, DHHS Publication No. (OASH) 94-50,000, (Rev.) April 1, 1994, is available.

Information Contacts

Regional or Local Office

None.

Headquarters Office

Joni Young National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Department of Health and Human Services, 1600 Clifton Road, NE., Mailstop A07, Atlanta 30333 Email: JYoung@cdc.gov Phone: (404) 639-4025

Criteria for Selecting Proposals

Funding would be specifically directed to state health departments for HAI activities and would not be available for other non-related infectious disease activities. For state applicants to be eligible they will have to outline a plan for reporting progress toward HHS Action Plan Prevention Targets using specified metrics, either by participating in NHSN or by using NHSN definitions and surveillance methods in systems compatible with NHSN.
CDC will require state applicants to specifically address in their applications state plans for sustaining the impact of ARRA investments beyond the federal funding provided in the next two years. Specifically, states will need to demonstrate a continued plan for progress toward meeting HHS Action Plan prevention targets as demonstrated through reporting metrics outlined in the Plan. Other criteria will be listed in individual funding opportunity announcements.
[ts1]This Program requires Congressional Notification. Not Approved.



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