Healthcare-Associated Infections (HAI) Update - June 2019

Minnesota Department of Health

Healthcare-Associated Infections (HAI) Update

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June 2019

In This Edition

ICAR Expanding to Include Ambulance Services

The Minnesota Infection Control Assessment and Response (ICAR) Program is expanding to include ambulance services. Since 2016, the ICAR team has conducted nearly 400 on-site visits with acute care, long-term care, outpatient and dialysis settings, and is now seeking partnerships with ambulance services.

Free, non-regulatory on-site ICAR assessments assist ambulance services with unique infection prevention and control challenges for their setting. The ICAR team will provide technical assistance and resources to help services strengthen infection prevention and control programs. Components of the ICAR assessment include ten domains such as health care personnel safety, hand hygiene, personal protective equipment, injection safety, cleaning, and disinfection.

All Minnesota ambulance services are eligible to enroll in ICAR.

If you are interested in learning more about having an ICAR visit with your ambulance service, please contact the ICAR team at

New Tools Available: Long-term Care Antibiotic Stewardship

Antibiotic stewardship is a team effort that requires continual communication within any long-term care facility. NEW tools are available to help explain antibiotic stewardship practices to members of your team and stakeholders. Check out these and other tools in the Minnesota Antimicrobial Stewardship Program Toolkit for Long-term Care Facilities.

  • 72-Hour Antibiotic Time-Out Sample Template
    Customizable tool that incorporates facility antibiotic time-out policies.
  • Template Feedback Form for Prescribers: Long-term Care Prescribing
    Customizable tool that can be used to inform prescribers of antibiotic stewardship protocol for your long-term care facility.
  • Sample Letter to Providers: Communicate Antibiotic Stewardship Priorities

    Inform prescribers of your facility’s commitment to antibiotic stewardship with examples of antibiotic "time-out," prescription record keeping, and clinical criteria to initiate antibiotics for urinary tract infections.

  • Sample Letter to Obtain an Antibiogram from a Laboratory
    Request antibiogram reports to improve appropriate antibiotic use.
  • Loeb and McGeer Criteria: A Practical Guide for Use in Long-term Care Information on when to use Loeb, McGeer, and NHSN criteria.

Apply for the Minnesota Antibiotic Stewardship Long-term Care Honor Roll

Have you developed an antibiotic stewardship program for your facility? Share your story! 

The Minnesota Department of Health encourages progress in the development of antibiotic stewardship programs through our Minnesota Antibiotic Stewardship Long-term Care Honor Roll. In this past year, 25 facilities have reported progress in reaching the goals of the program.

This three-tiered program provides the opportunity for LTC facilities to demonstrate commitment and facilitate the implementation of the CDC’s core elements of antibiotic stewardship annually. Highlights of your stewardship activities will be recognized on the MDH website! Check out what others in Minnesota are doing to improve antibiotic use!

For more information on how to enroll, visit the Minnesota Antibiotic Stewardship Long-term Care Honor Roll.

MN Antibiotic Stwardship Honor Rolls

Call for Nominations: 2019 CHAIN Award for Excellence

Are you part of, or do you know a health care team that is doing great work to reduce the incidence of healthcare-associated infections or combat antibiotic resistance? If you have done any of the following or something else to improve your work in this area, CHAIN would like to hear about it and recognize the excellent work being done! 

  • Involving patients or residents and their families in your work to reduce healthcare-associated infections or enhance antibiotic stewardship 
  • Launching an antibiotic stewardship program, with early successes to share  
  • Ramping up your infection control program by enhancing surveillance, improving testing practices, or finding creative ways to promote best practices for prevention 
  • Establishing a team focused on this work either within your facility or across settings of care 
  • Developing a new protocol or resource to support staff  

The 2019 CHAIN Award for Excellence commends infection prevention and antibiotic stewardship efforts of health care teams working hard to build a safer health care environment. We encourage health care leaders and staff from across care settings to submit nominations. CHAIN members will review all nominations for key lessons learned and innovative strategies that contribute to infection prevention and antibiotic stewardship. Strong nominations will describe the full project lifecycle and specific strategies tested through the intervention, highlight the ways in which multidisciplinary staff were engaged in the project, and provide both process and outcome measures demonstrating the tangible impact of their improvement work. Visit CHAIN Award for Excellence for to view past winners and nominations.

Submit a 2019 CHAIN Award Nomination by August 2, 2019! Award winners from both hospital and long-term care settings will be recognized on September 27 at the 2019 APIC Minnesota Fall Conference. A virtual presentation to industry colleagues regarding the award winners' essential contributions to patient safety and quality of care will be scheduled at a later date. Promising practices and findings will be shared through a variety of venues to promote learning and improve health care across the state.

We look forward to recognizing the outstanding accomplishments of health care teams in reducing infections and antibiotic resistance throughout Minnesota. Thank you for your participation! Please email any questions to

MOHASC 2019 Annual Meeting Summary

In February, the Minnesota One Health Antibiotic Stewardship Collaborative (MOHASC) gathered to discuss 2018 progress and to chart the course for 2019.

A summary of progress and next steps from the 2019 Annual Meeting is now available at One Health Minnesota Antibiotic Stewardship Strategic Plan.

TAP Strategy Support Available to Target HAI Prevention Efforts

The Minnesota Department of Health (MDH) and the Minnesota Hospital Association (MHA) are partnering to offer individualized support to facilities interested in deploying the Targeted Assessment for Prevention (TAP) Strategy. TAP was developed by CDC to use National Healthcare Safety Network (NHSN) data for action to prevent healthcare-associated infections (HAIs). TAP reports also allow health departments and quality improvement partners to prioritize facilities with high HAI burdens.

Upon facility request, MHA and MDH can provide a TAP report and interpretation of results, help develop an action plan for improvement, and support deployment of the TAP facility assessment to capture staff awareness and perceptions of policies and practices related to HAI prevention.

Is your facility ready to employ the TAP strategy to target prevention efforts? For more information or to request a TAP report for your facility, contact

The Targeted Assessment for Prevention (TAP) Strategy

Minnesota Centers for Enhanced Response

The Minnesota Department of Health (MDH) recently launched the Minnesota Centers for Enhanced Response (PDF) program. This program intends to establish a partnership between the MDH Infection Control Assessment and Response (ICAR) Program and hospitals to identify high consequence infectious disease (HCID) preparedness gaps.

MDH recognizes that preparing for HCIDs can be a daunting task for frontline facilities. The Centers for Enhanced Response (CER) program offers frontline hospitals the opportunity to self-assess their hospital's overall readiness. The CER assessment can be found in the High Consequence Infectious Disease (HCID) Toolbox for Frontline Health Care Facilities.

Once an assessment is completed, MDH will provide facilities with free HCID resources and follow-up to provide guidance on how to mitigate gaps. There is no specific time commitment required, and MDH will use trends in assessment finding to assist with further resource development.

For questions or comments, email or contact a member of the MDH ICAR team at 651-201-5414.

Injection Safety Still Making Headlines

The One & Only Campaign – One Needle, One Syringe, Only One Time – is reaching its tenth year of existence. Yet, unsafe injection practices still occur and even make headlines.

Just last year in Washington, routine surveillance detected acute hepatitis C virus (HCV) infections in two hospital emergency department patients. This led to the discovery of an outbreak involving 13 patients. One nurse who cared for all of these patients admitted to diverting drugs (self-injecting, then replacing an injectable medication with another fluid for patient use). The potential harm it can pose in exposing patients to bloodborne or bacterial pathogens is a big concern nationally and in Minnesota.

For more information on the case, you can read MMWR– Hepatitis C Virus Potentially Transmitted by Opioid Drug Diversion from a Nurse. This underscores the importance of frequent monitoring of staff access to drug dispensing systems.

One Needle, One Syringe, Only One Time is an easy way to prevent transmission of bloodborne pathogens to patients. Use the resources below and include injection safety training in your infection prevention and control program.

CHAIN Award for Excellence

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 hope the lessons learned will provide you with innovative ideas that are useful to you.

University of Minnesota Medical Center – MHealth
Two 2018 Nominations:

Intermediate Care Unit:
Catheter-Associated Urinary Tract Infection (CAUTI) Prevention

Following a site visit to assess best practices and compliance with CAUTI prevention bundles, there was a facility-wide push at University of Minnesota Medical Center to implement strategies to improve adherence to best practice. Focus areas included identification of a unit CAUTI champion to assist in quarterly rounding and frontline staff education, increased emphasis on the importance of early catheter removal, increased rounding to assess for adherence to the maintenance bundle, and standardized checklists and audit tools. The CAUTI Standardized Infection Ratio (SIR) for 6B in 2016 and 2017 was 1.118 and 1.969 respectively. After implementation, the SIR for 2018 was 0.000 at the time the nomination was submitted.

Antimicrobial Stewardship Team

Penicillin allergy assessment and skin testing have been shown to support antibiotic stewardship efforts, leading to improved antibiotic efficacy, reduced resistance, decreased adverse events (e.g., C. difficile), and lower costs. A two-step penicillin allergy testing protocol was developed by the Antimicrobial Stewardship Team (AST), and standard training was completed by infectious disease physicians, pharmacy residents, and pharmacists. Of the 26 allergy assessments conducted, AST deemed eight patients to have true IgE-mediated reactions; the remaining 18 were unclear or not an allergy. In the end, 16 patients had their penicillin allergy removed and 12 received a preferred beta-lactam regimen within six months after the protocol. Patients received education both before and after about penicillin allergies and their results, and a wallet card was provided to the patient at completion.

What is CHAIN?

The Collaborative Healthcare-Associated Infections Network (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.