Healthcare-Associated Infections (HAI) Update - Oct. 2019

Minnesota Department of Health

Healthcare-Associated Infections (HAI) Update

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October 2019

In This Edition

Why Infection Prevention Matters

mother holding baby's hand in hospital

"In April 2019, our 1-year-old daughter was admitted to the pediatric intensive care unit after having surgery. Due to complications with her recovery, she had already been hospitalized for 6 weeks when her condition unexpectedly deteriorated. At our urging, her doctor ran tests and we learned the culprit was influenza. Despite having received the flu vaccine earlier that year, our daughter’s fragile immune system was not able to fight the infection. Although she still suffered with high fever, respiratory difficulties, a persistent cough, and lethargy, we are thankful she received the vaccine as her doctor said she might not have survived without it. This bump in the road prolonged our hospital stay another 3 weeks as she recovered.

Throughout the ordeal, we could not help but ask ourselves, ‘How could a baby that had been in the hospital for 6 weeks get influenza when none of her visitors were sick?’ Given the patients surrounding us who were already in precautions and the number of hospital staff coming in and out of her room throughout the day, it’s likely that someone who worked in the hospital passed the disease to her. Our plea is for everyone who works with sick patients get a flu vaccine, wash your hands often, stay home when sick, and follow protocols when entering and exiting patients rooms no matter how briefly you intend to stay."

This Minnesota family's story is a reminder that vaccines are a key part of protecting vulnerable patients from infections, and that health care professionals should make sure to always follow infection control precautions:

  • Wash your hands before and after providing care
  • Stay home if you're sick
  • Follow all posted precautions signs
  • Use appropriate personal protective equipment (PPE)
  • Get vaccinated
  • Use safe injection practices
  • Keep the patient's environment and equipment clean
  • Know if antibiotics are appropriate
  • Educate patients on infection prevention
  • Know your facility's infection preventionist(s)

Learn more: Infection Prevention and Control

Apply Now – Adult Sepsis Surveillance Project

The Healthcare-Associated Infections and Antimicrobial Resistance (HAI&AR) Section received $55,000 in funding from CDC to support one Minnesota hospital to implement and evaluate the CDC Hospital Toolkit for Adult Sepsis Surveillance (PDF).

The project starts on January 1, 2020, and ends on March 31, 2021. The funds that accompany participation in this project may be used to support the time and resources necessary for hospital staff to build programmable sepsis surveillance code into their electronic medical record. The code will be provided to the participating hospital and will allow infection preventionists (IPs) to generate reports using the most updated surveillance definitions. The computing code used for this project will be permanently given to the hospital and may be used to forward their future sepsis surveillance efforts.

Please visit the Adult Sepsis Surveillance Implementation and Feasibility Project page to apply. If you have any additional questions about the project or how to apply after reviewing the information online, you may contact J.P. Mahoehney at Applications are due by November 22, 2019.

Antibiotic Stewardship Honor Roll – Gold Level

Minnesota Antibiotic Stewardship Honor Roll - Gold Level

The Minnesota Department of Health Healthcare-Associated Infections/Antimicrobial Resistance Section and the Minnesota One Health Antibiotic Stewardship Collaborative would like to recognize Minnesota acute care hospitals, critical access hospitals, and long-term care facilities for their commitment to antibiotic stewardship by inviting you to apply for the Minnesota Antibiotic Stewardship Honor Roll.

The Minnesota Antibiotic Stewardship Honor Roll encourages commitment to antibiotic stewardship across the state. There are three levels of achievement, recognizing different levels of antibiotic stewardship programs. This month, we are highlighting the Gold level of achievement. Gold represents facility-wide commitment to antibiotic stewardship, dedicated and active actions to guide antibiotic stewardship, and a collaborative approach beyond your facility to practice antibiotic stewardship. In addition to the  bronze and silver-level criteria (highlighted in the MDH HAI Update - Sept. 2019), the following criteria must also be met to qualify for the gold level:

Submit a collaboration activity that describes how your hospital or long-term care facility engages in ongoing, formal collaboration beyond your facility to advance antibiotic stewardship. Some examples of how this requirement can be met are:

  • Formal mentorship of area hospitals, long-term care facilities, clinics, or dialysis centers where expertise is share in a structured, ongoing partnership.
  • Regional coordination of data, protocols, or best practices (e.g., sharing antibiotic use and resistance data with other hospitals, long-term care centers, or clinics in a benchmarking process) and using regularly scheduled meetings to facilitate information exchange.
  • Actively optimizing antibiotic stewardship during care transitions through regular meetings among facilities that share patients and development or improvement of protocols and communication practices.

It is important to note that requirements for long-term care facilities and hospitals may differ slightly.

Not currently part of the Minnesota Antibiotic Stewardship Honor Roll? Please consider applying!

Please send any questions or comments you may have regarding the Honor Roll to

FluSafe: Recognizing High Flu Vaccination Rates

Improving vaccination rates is a great way to prevent infections and show commitment to antibiotic stewardship. In addition to the Honor Roll, the MDH FluSafe program recognizes Minnesota hospitals and long-term care facilities for high flu vaccination rates among health care personnel.

Sixty-nine facilities (43 hospitals and 26 nursing homes) are being recognized for achieving 90% or higher employee flu vaccination rates during the 2018-19 flu season. Congratulations, FluSafe Facilities!

Registration for the 2019-20 flu season is open through November 1, 2019. Instructions for participating and registering are available on the FluSafe web page.​

2019-2020 Influenza Resources for LTCFs

Influenza season has officially begun. In efforts to assist Minnesota long-term care facilities (LTCFs) prepare and respond to the 2019-2020 influenza season, the Infection Control Assessment and Response (ICAR) team and the Vaccine Preventable Disease (VPD) section would like to provide the following resources:

NEW THIS YEAR: MDH will be following up by phone with facilities that have had residents hospitalized for influenza or RSV one to two months following the outbreak. This is to get information on the health status of residents post-hospitalization. The process for submitting an outbreak report form at the beginning of the outbreak has not changed.

If you have questions, please call MDH at 651-201-5414.

2019-2020 Norovirus Information for LTCFs

2019-2020 norovirus information for long-term care facilities is now available at Foodborne Outbreaks at Schools, Child Care, and Long-term Care Facilities. Unfortunately, that means norovirus season will soon be upon us.


  • Page 3 of the toolkit includes a section on outbreak prevention. Norovirus outbreaks are preventable and controllable. Take steps to help prevent an outbreak at your facility this season.
  • Save the date for a webinar on norovirus in LTCFs at 2 p.m. Thursday, Dec. 12. The MDH Foodborne Disease Unit will discuss the current outbreak season, common challenges, and other topics. More details will be sent closer to the date.

Remember to contact MDH immediately if an outbreak of acute gastroenteritis is suspected at your facility; these outbreaks are reportable by Minnesota law, and we can help provide direction and consultation. Call 1-877-FOOD-ILL or email

CDC STRIVE Infection Control Training

CDC has released the entire curriculum in the States Targeting Reduction in Infections via Engagement (STRIVE) learning module. The courses include the following foundational infection prevention strategies: competency-based training, audits, and feedback, hand hygiene, strategies for preventing healthcare-associated infections, environmental cleaning, personal protective equipment, patient and family engagement, and building a business case for infection prevention.

Targeted prevention strategy courses on CAUTI, MRSA, CLABSI, and CDI were also recently added to the STRIVE curriculum.

The courses are free and can be accessed at CDC/STRIVE Infection Control Training.

Order Free CDC Materials for USAAW

U.S. Antibiotic Awareness Week (USAAW) is Nov. 18-24. CDC provides free antibiotic stewardship materials for health care facilities, health departments, and individual clinicians. Fact sheets, pamphlets, posters, and educational materials can be ordered and mailed directly to your organization. Go to CDC-INFO On Demand and then select "Antibiotic Use" under "Programs."

The MDH Antimicrobial Resistance and Stewardship team will highlight USAAW through public messaging and social media promotion. Stay tuned for more information, and share the messages in your organization. Everyone plays an important role in using antibiotics appropriately and preventing antibiotic resistance!​

2019 AAAHC Quality Roadmap

The Accreditation Association for Ambulatory Health Care (AAAHC) has released its 2019 AAAHC Quality Roadmap (PDF). The roadmap provides a thorough analysis of 2018 data from more than 1,250 accreditation surveys conducted using the current Standards. Injection safety gets a number of mentions as being among the most common deficiencies cited in ambulatory quality studies. Please review the mentions of safe injection practices and resources on pages 8-10 and 16-18.

2019 CHAIN Award Winners

The 2019 CHAIN Award for Excellence winners were recognized by the Collaborative Healthcare-Associated Infection Network (CHAIN) at the APIC Minnesota Fall Conference on September 27. The award commends the infection prevention and antibiotic stewardship efforts of health care teams working to build safer health care environments. Park Nicollet Methodist Hospital in Saint Louis Park and Mayo Clinic Health System - Lake City Care Center received the award. Visit CHAIN Award for Excellence for photos and more information about the award.

Park Nicollet Methodist Hospital

Park Nicollet Methodist Hospital received the CHAIN award for its Partners Promoting Patient Hand Hygiene project. Through a partnership formed by the hospital's infection prevention, quality improvement, and nutrition and food service (NFS) departments using the "Plan, Do, Study, Act" cycle, a sustainable process was implemented for incorporating patient hand hygiene before meals into the Clostridioides difficile infection prevention bundle. Although patient hand hygiene had been a nursing responsibility in the facility, the team learned that NFS aides played a key role in promoting patient hand hygiene by being present at the point of meal delivery.

Beginning in January 2019, NFS aides delivered hand wipes to patients with meals, explained the importance of hand hygiene, and assisted with opening wipes as needed. Scripting was developed by NFS: "Please use this wipe to clean your hands before you eat to protect yourself from germs."

Observational data showed that at one month and six months following implementation, NFS aides provided hand wipes and instructions for hand wipe use during 100% of tray deliveries. Patients were observed to use hand wipes 61% of time at one month and 64% at six months. NFS aides and patients provided positive feedback on this process.

Mayo Clinic Health System – Lake City Care Center 

Mayo Clinic Health System – Lake City Care Center received the CHAIN award for its antibiotic stewardship program. In January 2018, the Antibiotic Stewardship Committee identified a need for improvement in facility-acquired Clostridioides difficile infection (CDI).

The committee implemented the following changes:

  • Probiotic use was standardized for all residents receiving antibiotics. To ensure all residents could receive the probiotic and for consistency of insurance coverage for residents, the probiotic was changed to a stock medication.
  • The committee developed a cleaning checklist for CDI. The cleaning checklist included daily cleaning of high-touch room surfaces such as resident beds, bathrooms, sinks, door knobs, light switches, and call lights.
  • The committee also developed an antibiotic time out checklist, which followed the "situation, background, assessment, recommendation" (SBAR) format. Nurses completed the checklist within 72 hours of an antibiotic start for the primary physician to review. The SBAR collected information about the antibiotic order, diagnostic results, signs and symptoms of illness, and any red flags such as antibiotic duration greater than seven days and lack of culture results; it served as a second check to ensure the residents were prescribed antibiotics appropriately.
  • Antibiotic stewardship education was provided by the infection preventionist at quarterly resident councils and was included in care conferences with residents and families. Staff also received antibiotic stewardship education.

Six months following the implementation of CDI prevention strategies, facility-acquired CDI decreased by 80%.