MDH HAI Update - August 2017

Minnesota Department of Health

Healthcare-Associated Infections (HAI) Update

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August 17, 2017

Survey link still live – Tell us about yourself!

Thank you to those who have filled out our quick survey! We want to know a bit more about our readers: who you are, why you’re here, and especially, what you’d like to see in these updates. Please take a couple minutes to answer this short HAI Update Reader Survey to help us make these emails more useful to you.


Think Fungus: Fungal Disease Awareness Week

This week is the first annual Fungal Disease Awareness Week! CDC and partners are highlighting the importance of recognizing serious fungal diseases early enough in the course of a patient’s illness to provide life-saving treatment. Visit the Think Fungus webpage for more information about fungal diseases and why they pose a public health problem.

The HAI unit at MDH conducts surveillance in Hennepin and Ramsey Counties for candidemia (bloodstream infections with Candida species), which is one type of serious fungal disease. We conduct surveillance for candidemia to track disease incidence, monitor trends, and identify areas where prevention and intervention strategies can be focused. Candida is a type of yeast that is normally found on the skin and in the gastrointestinal tract of healthy people, but in people with certain underlying conditions, Candida can cause serious invasive infections. Most cases of candidemia are HAIs, and candidemia is among the most common types of HAI bloodstream infections. These infections can be difficult to treat due to the growing threat of antifungal resistance in Candida species.


Safe vaccine preparation

August is National Immunization Month and with students coming in for back-to-school vaccinations, it’s a great time to review safe vaccine preparation technique. Always follow these guidelines:

  • Use aseptic technique, starting with hand hygiene, even if you are going to wear gloves.
  • Inspect the vial to verify you have the correct vaccine and the correct age-appropriate formulation.
  • Examine the vaccine for discoloration and precipitate. Do not use if you notice either.
  • Use a new sterile needle and new sterile syringe for each patient.
  • Disinfect the rubber septum with alcohol before entering the vial.
  • Dispose of a single-dose vial immediately after withdrawing a dose, even if there is serum left in the vial.
  • Enter a multi-dose vial with a new sterile needle and a new sterile syringe. Never re-enter the vial with a used needle and syringe, even if it is for the same patient.

Learn more from the MDH How to Administer Injections factsheets.


Zoster transmission in LTC

Since 2013, nine cases of varicella have been reported in persons who worked at LTC or assisted living facilities. Four of these cases are known to have had contact with residents who had shingles.

One case involved a 25-year-old man who was previously healthy. He was out of work for three weeks and hospitalized twice during that period due to complications. He had no history of disease or vaccination.

CMS does not require LTC facilities to have proof of immunity to varicella, but does recommend that health care workers be protected against varicella. Find out more at CDC’s Recommended Vaccines for Health Care Workers webpage. If health care personnel are exposed to varicella or zoster, follow the steps outlined on the Preventing Varicalla-Zoster Virus Transmission in Health Care Settings webpage.

If insurance does not cover vaccine for these workers, there are sites throughout the state that provide free or low cost vaccines for qualifying adults. You can find a list of these locations at the Vaccination Clinics Serving Uninsured and Underinsured Adults webpage.


Educational opportunities

The Minnesota 2017 CHAIN Fall Conference will be held on Wednesday, Sept. 27 from 1:00-4:30PM at the Earle Brown Heritage Center in Brooklyn Center. Learn about the latest evidence-based approaches for reducing and preventing healthcare-associated infections (HAIs) in Minnesota. Winners of the CHAIN Award for Excellence will be recognized at the conference.  

The Wisconsin Surgical Site Infection Prevention Summit V: Collaboration as a Pathway to Improving Patient Outcomes is Friday, Sept. 29 in Madison, Wisconsin. Dr. Darrell A. Campbell, Jr., director of the Michigan Surgical Quality Collaborative and professor emeritus at the University of Michigan Medical School, will be the keynote speaker. Registration closes Sept. 15. Contact Heidi Brittnacher at surgeryevents@mcw.edu or 414-805-9427 for more information.

The South Dakota Infection Control Council will be hosting the Hunting for New Ways to Prevent Infections Conference Oct. 5-6 in Sioux Falls, South Dakota. Registration to the conference is free this year.


New antimicrobial stewardship resources

Have you been struggling with how to implement an antimicrobial stewardship program in a small or critical access hospital? Do you feel like CDC’s Core Elements for Acute Care Hospitals are nice, but not realistic for your facility? If so, CDC recently published a document that might help you: Implementation of Antimicrobial Stewardship Core Elements at Small and Critical Access Hospitals.

If you are interested in a plain-language description of why antimicrobial stewardship is important; current antimicrobial use in the U.S. and how it varies by region or setting; or if you would like a comprehensive summary of activities geared to improving antimicrobial use, you might like CDC’s recent Antibiotic Use in the United States, 2017: Progress and Opportunities report.


Diagnostic stewardship resource

An opinion piece recently published in JAMA, titled Diagnostic Stewardship—Leveraging the Laboratory to Improve Antimicrobial Use, describes a strategy aimed at improving appropriate use of antimicrobials. Diagnostic stewardship strategies designed to reduce false-positive infection diagnoses include modifications to test ordering, specimen collection and processing, and result reporting. These false-positives may lead to unneeded antibiotic treatment but could also serve to obscure or delay a correct diagnosis for symptoms like delirium due to a non-infectious cause. Therefore, these practice changes could improve health care quality more generally.

The article includes an informative table summarizing possible interventions for commonly ordered diagnostic tests for infections, e.g., urine cultures, blood cultures and certain molecular detection tests. It also includes a description of potential limitations and the necessity of monitoring for unintended consequences of diagnostic stewardship interventions.

Minnesota Antibiotic Stewardship Honor Roll for Hospitals now open for applications!

In collaboration with Minnesota Hospital Association, Stratis Health, APIC Minnesota, and Minnesota CHAIN, the Antibiotic Stewardship Collaborative is pleased to introduce the Minnesota Antibiotic Stewardship Honor Roll for Hospitals! Objectives for this honor roll are to encourage hospital commitment to antibiotic stewardship, share stewardship activities happening across the state, provide incentive for program improvement, and publicize the importance of antibiotic responsibility.

Visit the Minnesota Antibiotic Stewardship Honor Roll website for more information and to apply for this three-tiered recognition program.