Healthcare-Associated Infections (HAI) Update - Nov. 2018

Minnesota Department of Health

Healthcare-Associated Infections (HAI) Update

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November 2018

Participate in U.S. Antibiotic Awareness Week

Be antibiotics aware. U.S. Antibitiocs Awareness Week - November 12-18, 2018


U.S. Antibiotic Awareness Week aims to raise awareness of the threat of antibiotic resistance and the importance of appropriate antibiotic prescribing. This year, U.S. Antibiotic Awareness Week is November 12–18, 2018. The observance is a key component of the Centers for Disease Control and Prevention's (CDC) efforts to support antibiotic stewardship, the process of improving how we use antibiotics. Antibiotic Awareness Week hopes to advance antibiotic stewardship in communities, health care facilities, and on the farm in collaboration with state-based programs, non-profit partners, and for-profit partners.

Although antibiotics are life-saving tools for preventing and treating infections, widespread use and misuse of antibiotics has led to increases in antibiotic-resistant infections. Antibiotic resistance is one of the most urgent threats to the public's health. Each year in the U.S., more than 2 million people develop an antibiotic-resistant infection, and more than 23,000 people die as a result.

Up to 50 percent of all antibiotics prescribed in health care settings are not necessary or are inappropriately prescribed. A concerted effort to eliminate inappropriate antibiotic use is necessary. It is crucial for everyone to take part in antibiotic stewardship to help reduce the emergence and impact of antibiotic-resistant superbugs.

Utilize these resources and tips to help prevent antibiotic resistance:

  • Follow clinical guidelines when prescribing antibiotics.
  • Help your facility establish processes that enable prescribers to know when antibiotic use is needed and to use the right antibiotics, at the right dose, and for the right duration.
  • Prevent infections by hand washing, vaccination, and using safe food handling practices.
  • Communicate with patients as to why antibiotics are unnecessary for viral infections and what alternatives they can use for symptom relief. Use materials like the cough and cold care guides and viral prescription pad from the new Minnesota Antimicrobial Stewardship Program Toolkit for Outpatient Clinics.
  • Use One Health Antibiotic Stewardship Print Materials to increase knowledge on appropriate antibiotic use. Provide fact sheets to patients.
  • Talk to patients about possible harmful side effects from antibiotics, such as allergic reaction, Clostridioides difficile infection, and antibiotic-resistant infection.
  • Publicly display your facility's commitment to antibiotic stewardship by using Minnesota Antibiotic Stewardship Commitment Materials for Partners.
  • Hospitals and long-term care facilities can achieve statewide recognition for antibiotic stewardship by applying for the Minnesota Antibiotic Stewardship Honor Roll for Hospitals and Long-term Care.

Visit the Minnesota Department of Health website for more resources or to learn more about antibiotic resistance and One Health stewardship.


CDC and Choosing Wisely host antibiotic stewardship webinars

The Centers for Disease Control and Prevention (CDC) will host a free webinar for pharmacists to highlight ways they can best practice antibiotic stewardship.

The webinar is on Tuesday, Nov. 13, from 12 – 1 p.m. Central Time.

Register for CDC's 5 Ways Pharmacists Can Be Antibiotics Aware webinar.


Choosing Wisely
will host Dr. Katherine Fleming-Dutra from CDC to discuss the Core Elements of Outpatient Antibiotic Stewardship. This webinar will discuss if the U.S. is effectively reducing antibiotic use, lessons learned from current efforts, and practical case studies. 

The webinar is on Tuesday, Nov. 13, from 3 – 4 p.m. Central Time.

Register for Choosing Wisely's Core Elements of Outpatient Antibiotic Stewardship webinar.


Webinar: Infections, Antibiotic Use, and Infection Control Practices in Minnesota Nursing Homes

Please join us on Thursday, November 15 at 12 p.m. as we discuss Infections, Antibiotic Use, and Infection Control Practices in Minnesota Nursing Homes. Dr. Nicola Thompson from CDC and J.P. Mahoehney from MDH will share the results of the Nursing Home Prevalence Survey (NHPS). The NHPS assessed healthcare-associated infections and the use of antimicrobial drugs from a random sample of nursing homes from 10 states including Minnesota. The aim of this webinar is to share the results of the NHPS with long-term care facilities throughout the state. One hour of general CE credit will be available to all professionals that attend the call.

Register for Infections, Antibiotic Use, and Infection Control Practices in Minnesota Nursing Homes.


Long-term Care Infection and Antibiotic Use Tracking Tool: Newly Revised, Now Available!

The Minnesota Department of Health Healthcare-Associated Infections/Antimicrobial Resistance Unit has created a free, computer-based tool to assist with tracking infection rates and antibiotic use within long-term care facilities. The tool was created using Microsoft Excel 2016 and follows a linelist format. Data captured by the linelist includes but is not limited to the following:

  • Infection type and body system of infection
  • Medical devices currently in use
  • Diagnostic information
  • Antibiotic/antimicrobial information such as antibiotic name, class, dose, route, frequency, and name of prescribing provider
  • Antibiotic start date, end date, and total days of therapy

The revised linelist also includes a summary page that provides summarized data using a variety of different tables and graphs. The tables and graphs are automatically generated as data is entered into the monthly tracking sheets providing staff with real-time, easy to follow summaries of data. See the screenshot below for an example of the Days of Therapy (DOT) Rate per 1,000 Resident Days. ​

To download the tracking tool and accompanying instruction sheet, visit the Minnesota Antimicrobial Stewardship Program Toolkit for Long-term Care Facilities. Refer to Appendix L: Infection and Antibiotic Use Tracking Tool Instructions (PDF) | (Excel) in the "Frequently requested items" section at the top of the page. Click (Excel) ​to download a copy of the tracking tool spreadsheet. If you have any questions or concerns regarding the tracking tool, feel free to contact Cody Schardin directly using the contact information below.

Cody Schardin
Health Program Representative
HAI/AR Unit
cody.schardin@state.mn.us
651-201-5141

Days of Therapy (DOT) Rate per 1,000 Resident Days example graph

2018-2019 Influenza Resources for Long-term Care

In efforts to assist our long-term care partners prepare for the 2018-2019 influenza season, the Infection Control Assessment and Response (ICAR) team and the Vaccine Preventable Disease unit would like to provide the following resources:

  1. WEEKLY INFLUENZA ALERT: Subscribe to Weekly Influenza Activity to receive an email alert every week during the flu season.
  2. GENERAL GUIDANCE: For general resources regarding the control of influenza or RSV in long-term care, refer to the MDH Long-Term Care: Influenza website.
  3. OUTBREAK DEFINITION: In long-term care, an outbreak is one laboratory-confirmed influenza or RSV positive case along with other cases of respiratory illness in a unit. For more information please review the Interim Guidance for Influenza Outbreak Management in Long-Term Care Facilities.
  4. REPORTING: Influenza cases must be reported to the Minnesota Department of Health using the Long-Term Care Facility Influenza and RSV Report Form. Reaching out to the ICAR team is not “reporting”. 
    Submit this report when an influenza or RSV outbreak is suspected in your long-term care facility. Email to karen.martin@state.mn.us or fax to 651-201-4820.
  5. ANTIVIRAL TREATMENT AND CHEMOPROPHYLAXIS: Antiviral recommendations can be found in the Interim Guidance for Influenza Outbreak Management in Long-Term Care Facilities or call 651-201-5414 and ask to speak to someone about flu antivirals.

If the resources listed do not answer your concern, let us know at health.HAI@state.mn.us and we will address the question individually. Thank you.


Webinar: How Well Are You Protected?

The Minnesota Department of Health invites you to participate in the following online training:

Topic: How Well Are You Protected? What healthcare workers need to know about gown standards and selection considerations
Date: Tuesday, November 20, 2018
Time: 11:00 am - 12:00 pm, Central Standard Time

Register for the How Well Are You Protected? webinar.
**Space is limited so registration is required.

The National Personal Protective Technology Laboratory (NPPTL) recognizes healthcare workers can be exposed to body fluids that are capable of transmitting diseases and recommends these healthcare workers wear protective clothing to protect both the patient and themselves from the transfer of microorganisms by blood and body fluids. Translating disease-specific infection control recommendations into personal protective equipment (PPE) specifications can be challenging.

Learning objectives of this webinar include:

  • Summarize the protective clothing selection process
  • Explain CDC Ebola PPE recommendations
  • Identify performance requirements and standard test methods for healthcare worker clothing
  • Describe ongoing NPPTL research projects with gowns  

This information is important for occupational health practitioners as they consider the potentially increased occupational risk for infectious diseases.

Biography of the speaker:

Dr. Selcen Kilinc-Balci

Dr. Selcen Kilinc-Balci has been working for National Personal Protective Technology Laboratory (NPPTL) of the National Institute for Occupational Safety and Health (NIOSH) at the Centers for Disease Control and Prevention (CDC) for over 8 years in the area of protective clothing and equipment. At NIOSH, Dr. Kilinc-Balci has been leading and executing research in personal protective clothing and equipment focused in surgical/isolation gowns, aprons, head covers, footwear covers, and mine rescue ensembles in the area of bringing science to the standards. She also works on the development of standard test methods and guidance documents for PPE interfaces (glove/protective clothing area), and participates in the studies on development of improved test methods for assessing liquid and viral penetration through healthcare worker clothing and investigation of the impact of stockpiling conditions on the performance of PPE.

For questions or concerns about the upcoming webinar, please contact 651-201-5414.


Advisory Group Opportunity for Minnesota Ambulatory Care Professionals

Do you work in a medical or dental ambulatory care setting? Are you interested in improving antibiotic stewardship?

In late fall or early winter 2018, Minnesota Department of Health will gather an advisory group to share insights on stewardship needs in ambulatory care, identify priorities for resource and tool development, and help promote awareness of stewardship resources.

If you are interested in joining us, please contact health.stewardship@state.mn.us.​


Quick Observation Tools (QUOTs) for Infection Control

The CDC and APIC have developed a new set of Infection Prevention Observation Tools designed to help health care facilities quickly identify infection prevention deficiencies and take corrective action to protect patients from healthcare-associated infections (HAIs).

These Quick Observation Tools (QUOTs) include assessment forms and observation worksheets that enable frontline health care personnel in hospitals, ambulatory settings, and critical access hospitals to perform infection prevention checks at the patient-care level quickly.


Healthcare-Associated Infections Progress Report Released

The Centers for Disease Control and Prevention's (CDC) National Healthcare Safety Network (NHSN) is the nation's healthcare-associated infection tracking system. The infection data are reported to the NHSN. Each year CDC publishes a progress report that is used to identify problem areas, measure progress of prevention efforts, and identify target areas that need improvement. 

The 2016 National and State Healthcare-Associated Infections Progress Report shows how Minnesota hospitals compare with the nation in central-line associated bloodstream infections (CLABSI), catheter-associated urinary tract infections, lab identified hospital onset methicillin-resistant Staphylococcus aureus (MRSA), lab identified C. difficile events, and surgical site infections. The 2016 HAI Progress Report is the first report to measure HAI prevention progress using the updated 2015 baseline, or reference point.

The standardized infection ratio (SIR) is a summary statistic that is used to track HAI prevention progress over time. Lower SIRs are better. HAI data for nearly all U.S. hospitals are published on the Hospital Compare website. This report is based on 2016 data, published in 2018, and uses the 2015 Baseline and risk-adjusted models.

Nationally, for acute care hospitals, the 2016 HAI Progress Report highlights include: 

  • About 11% decrease in central line-associated bloodstream infections (CLABSIs)
  • About 7% decrease in catheter-associated urinary tract infections (CAUTIs)
  • About 13% decrease in abdominal hysterectomy surgical site infections (SSIs)
  • About 7% decrease in colon surgery SSIs
  • About 7% decrease in methicillin-resistant Staphylococcus aureus (MRSA) bacteremia
  • About 8% decrease in Clostridioides difficile (C. difficile) infections

Highlights from Minnesota acute care hospitals:

  • Minnesota hospitals reported no significant change in CLABSIs, CAUTIs, SSIs,

    C. difficile, and MRSA between 2015 and 2016

  • Minnesota was 14% lower than the national baseline in central line-associated bloodstream infections (CLABSIs) in 2016
  • Minnesota SIR was 17% higher than the national SIR for catheter-associated urinary tract infections (CAUTIs) in 2016
  • Minnesota SIR was 45% lower than the national SIR for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in 2016

For more information on the 2016 HAI Progress Report, view the data tables, technical appendix, or FAQs about HAI Progress Report.

CHAIN Award for Excellence: Abbott Northwestern Hospital

The Minnesota Collaborative Healthcare-Associated Infection Network (CHAIN) Award for Excellence commends the infection prevention and antibiotic stewardship efforts of health care teams working to build safer health care environments. The awards are presented annually by CHAIN. We had many great initiatives submitted and we will be featuring a brief summary of each nomination in the coming months. This month we are featuring the Antibiotic Stewardship Committee for Abbott Northwestern Hospital. We hope the lessons learned will provide you with innovative ideas that are useful to you regarding patient safety and quality of care. 

Abbott Northwestern Hospital received the CHAIN Award for its Central Line-Associated Bloodstream Infection (CLABSI) Prevention Team.

The hospital has a multidisciplinary CLABSI team comprised of key stakeholders including nursing leaders, anesthesiologists, hospitalists, intensivists, cardiologists, nurses, and an infection preventionist. With strong support from hospital leaders, the team meets monthly to review data, update policies, and implement central line practice changes. Under new leadership in 2017, the team implemented new CLABSI reduction practices.

The hospital's previous work related to CLABSI reduction had not achieved substantial decreases in infections, with rates decreasing from 2015 to 2016 by approximately 10 percent. Data suggested that a majority of CLABSIs were related to central line maintenance lapses. Infection preventionists conducted central line maintenance audits and confirmed gaps in compliance with central line maintenance best practice recommendations.

With a data-driven approach from the maintenance practice concern, the team implemented five new approaches to improve central line maintenance practices: rounding on patients with a central line on the ICU, medical oncology, and telemetry units; creating an all-inclusive central line dressing change kit along with a 21-step dressing change procedure; modifying central line patient education; forming Clinical Action Teams with CLABSI nurse champions; and conducting mandatory central line dressing return demonstrations for all nurses.

Central line standard rounding was initiated in 2017. Rounding focused on increasing CLABSI awareness; educating patients, families, nursing staff, and providers; discussing ownership of central line care for patients transferred internally or from an outside facility; and changing culture. Rounding consisted of central line dressing assessment, chart review, antimicrobial disk placement and compliance, dressing date compliance and number of dressing changes requested during rounding, and appropriate central line indication.

Central line rounding involved an infection preventionist rounding on units alone or with a nursing leader, a clinical nurse specialist, or a circulating nurse. This collaborative rounding allowed timely feedback to staff, daily updates to unit leaders and staff, and the ability to escalate concerns quickly. Rounding occurred weekly on the telemetry unit, biweekly on the medical oncology unit, and multiple times throughout the week on ICUs depending on rounding results.

In 2017, rounding occurred on over 2,000 central lines, with a leading focus on tracking the percentage of central line dressings that needed to be changed. After implementing the interventions, the percentage of dressings that needed to be changed decreased 67 percent from the first month of rounding to December 2017. CLABSI rates decreased by 20 percent from 2016 to 2017 and the number of CLABSIs hospital-wide decreased by 23 percent. Through the first two quarters of 2018, over 2,200 central lines have been rounded on. CLABSI rates in 2018 have decreased 20 percent compared to 2017. In total, the interventions implemented resulted in a 36 percent reduction in CLABSI at Abbott Northwestern Hospital.

CHAIN represents a partnership formed in 2011 between the Minnesota Chapter of the Association for Professionals in Infection Control and Epidemiology (APIC-Minnesota), the Minnesota Department of Health, the Minnesota Hospital Association, and Stratis Health. In early 2017, CHAIN expanded membership to include organizations representing providers across care settings. CHAIN coordinates across the continuum of health care delivery and supports patients, individuals, and their families to prevent harm from infections acquired in the process of care and combat antibiotic resistance. By leveraging collective capacity and resources, integrating and aligning related initiatives, and breaking down silos and barriers to implementation of best practices, CHAIN serves as a resource to its members and the health care community.