Healthcare-Associated Infections (HAI) Update - November 2019

Minnesota Department of Health

Healthcare-Associated Infections (HAI) Update

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November 2019

In This Edition

Participate in U.S. Antibiotic Awareness Week!

U.S. Antibiotic Awareness Week (USAAW), Nov. 18-24, 2019, aims to raise awareness of the threat of antibiotic resistance and the importance of appropriate antibiotic prescribing. 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. Up to 50% 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. The observance of USAAW is a key component of CDC's efforts to support antibiotic stewardship, the process of improving how we use antibiotics.

Utilize these resources and tips to help prevent antibiotic resistance:

Visit the Minnesota Department of Health website for more resources or to learn more about Antimicrobial Resistance and Stewardship and the Minnesota One Health Stewardship Collaborative.

LAST CALL: 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 for more information. Applications are due by November 22, 2019.

OVERVIEW: Antibiotic Stewardship Honor Roll

The Minnesota Department of Health HAI&AR Section and the Minnesota One Health Antibiotic Stewardship Collaborative continues to recognize Minnesota acute care hospitals, critical access hospitals, and long-term care facilities for their commitment to antibiotic stewardship. Over the past three months, we have highlighted what it takes to reach each level of the Minnesota Antibiotic Stewardship Honor Roll. If you are not currently part of the Honor Roll or you have not renewed your application, we highly encourage you to consider applying. Not only will your involvement in the Honor Roll further your commitment to antibiotic stewardship, you may inspire others throughout Minnesota through sharing unique interventions and collaboration activities. The three levels of recognition of the Honor Roll are as follows:

Honor Roll Logo


  • Applicants qualify for bronze-level recognition if they are able to demonstrate leadership commitment to antibiotic stewardship by submitting a letter of commitment from facility leadership, a copy of an active antibiotic stewardship policy, identified antibiotic stewardship leaders, and active antibiotic stewardship education or training to prescribing staff and caregivers. It is likely that many of you already qualify!

Silver: Action

  • In addition to all bronze-level requirements, a facility will qualify for silver-level recognition if actions and/or interventions are currently being taken to advance antibiotic stewardship. Required actions include education about antibiotic use for patients, residents, or the public, antibiotic use reporting (hospitals), and at least one additional action or intervention in place.

Gold: Collaboration

  • In addition to bronze and silver-level requirements, a facility will qualify for gold-level recognition if they can demonstrate how their facility engages in ongoing, formal collaboration beyond their facility to advance antibiotic stewardship. Collaboration among different facilities within the same health system is acceptable as long as collaboration occurs outside of the facility.

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

U.S. Antibiotic Awareness Week is Nov. 18-24 and provides an excellent opportunity to showcase what your facility is doing to address antibiotic stewardship! To apply for the Honor Roll or to view the current list of honorees, please visit Minnesota Antibiotic Stewardship Honor Roll. Send any questions or comments you may have about the Honor Roll to

New CDC Antibiotic Resistance Threats Report

CDC recently released the Antibiotic Resistance Threats in the United States, 2019. The report provides new national estimates of deaths and infections caused by antibiotic-resistant germs, and categorizes the top resistant germs based on level of concern to human health. More people in the United States are dying from antibiotic-resistant infections than previously estimated.

The new report shows that the scope and burden of antibiotic-resistant threats in the United States were greater than previously estimated in the 2013 AR Threats Report. According to the report, antibiotic-resistant bacteria and fungi cause more than 2.8 million infections and 35,000 deaths in the United States each year. When Clostridioides difficile infections are included in the burden estimate, the U.S. toll of all the threats exceeds 3 million infections and 48,000 deaths annually.

Since 2013, prevention efforts have reduced deaths from antibiotic-resistant infections by 18% overall and by nearly 30% in hospitals. Progress since 2013 could be lost without continued vigilance in preventing infections, slowing the development of resistance through improved antibiotic use, and containing the spread of resistance when it occurs.

Read the report at CDC: Biggest Threats and Data.

New CDC Infection Control Guidelines

The CDC Infection Control in Healthcare Personnel: Infrastructure and Routine Practices for Occupational Infection Prevention and Control Services document is an update of four sections of Part I of the Guideline for infection control in health care personnel, 1998 ("1998 Guideline") and their corresponding recommendations in Part II:

  • C. Infection Control Objectives for a Personnel Health Service
  • D. Elements of a Personnel Health Service for Infection Control
  • H. Emergency-Response Personnel
  • J. The Americans With Disabilities Act

Updates in Part I include: 

  • A broader range of elements necessary for providing occupational infection prevention and control (IPC) services to health care personnel (HCP);
  • Applicability to the wider range of health care settings where patient care is now delivered, including hospital-based, long-term care, and outpatient settings such as ambulatory and home health care; and
  • Expanded guidance on policies and procedures for occupational IPC services and strategies for delivering occupational IPC services to HCP.

The updated recommendations are aimed at the leaders and staff of Occupational Health Services and the administrators and leaders of health care organizations. They are intended to facilitate the provision of occupational infection prevention and control services to HCP and prevent the spread of infections between HCP and others.

Recommendations in other sections of the 1998 Guideline are current. Additional updates to the 1998 Guideline are underway and will be published in the future.

McKnight Heroes Award Nominations

Do you know someone who serves and protects patients or residents from harm in context of health care outbreak response?

The inaugural presentation of the McKnight Heroes Prize administered through the CDC Foundation: Evelyn and Thomas McKnight Family Fund for Patient Safety was recently announced. The purpose of the Fund is to honor and recognize important work to promote safe injection practices and patient safety and produce educational materials that raise awareness and highlight the work of the CDC One & Only Campaign.

Applications will be accepted through Jan. 17, 2020. Nominations will be accepted on behalf of candidates who come from a variety of professions, including but not limited to nurses, physicians, public health professionals, administrators, and advocates.

The recipient will receive a $1,000 travel scholarship, $1,000 honorarium, an award, and paid registration for attendance at the 6th Decennial International Conference on Healthcare Associated Infections in Atlanta from March 26-30, 2020. The awardee will be recognized during the conference by representatives from the McKnight family, the CDC Foundation, and CDC.

Submit a nomination: Evelyn and Thomas McKnight Prize for Healthcare Outbreak Heroes Nomination Form

Watch this video for more informationMcKnight Fund for Patient Safety (YouTube)

Health Observances

November is C. diff Awareness Month

Clostridioides difficile
 (C. diff) is estimated to cause almost half a million illnesses in the United States each year. C. diff is a germ that causes diarrhea and colitis (an inflammation of the colon) and can be life threatening. Most cases of C. diff occur when you’ve been taking antibiotics, and about one in five patients who get C. diff will get it again.

Together with our partners, CDC is working year-round to reduce C. diff infections and protect patients. This C. diff Awareness Month, we encourage you to check out and share C. diff resources to raise awareness about the importance of stopping the spread of this deadly bacteria:

National Influenza Vaccination Week and National Handwashing Awareness Week

CDC has designated December 1-7 as both National Influenza Vaccination Week and National Handwashing Awareness Week! Don’t worry, the CDC has developed tools to help you highlight both!

CDC offers a 2019 NIVW Digital Media Toolkit with resources, vaccination messages, and educational engagement with CDC subject matter experts. Take advantage of these resources to promote flu vaccination and prevent the spread of flu.

CDC also launched “Life is Better with Clean Hands,” a campaign and educational materials to promote handwashing throughout the day for adults. The “Clean Hands Count” Campaign aims to improve health care provider hand hygiene. Promotional materials, social media messaging, and a digital press kit all promote health care provider adherence to the CDC Hand Hygiene Guideline.

CHAIN Award for Excellence 2019 Nominations

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 Bethany on the Lake Infection Prevention Team. We hope the work others have done will provide you with innovative ideas that are useful to you regarding patient safety and quality of care.

Bethany on the Lake Infection Prevention Team

Bethany on the Lake has developed an antibiotic stewardship program that incorporates many of the One Health Antibiotic Stewardship (AS) resources and HAI prevention strategies by:

  • Tracking infections and outcomes using the AS tracking tool.
  • Analyzing data and presenting these data to the QUAPI team to discuss trends, outcomes, education, and opportunities for improvement.
  • Showing leadership and provider commitment to antibiotic safety in a letter for families and residents.
  • Reducing UTI rates from 12.82% to 1.7% by using Loeb criteria and antibiotic timeouts.
  • Continuing to do handwashing audits facility wide.
  • Applying for the One Health Antibiotic Stewardship Honor Roll gold-level recognition for commitment, implementation of evidence-based actions, and external collaboration.
  • Completing the CDC continuing education on nursing home infection preventionist training course
  • Developing a program in which visiting PAs see a resident in their own home for an infection like UTI, respiratory complications, or cellulitis. They initiate labs, diagnostics, and make assessments to provide timely information to care for these individuals

Quality Indicator Report shows the adjusted facility overall prevalence infection rate has gone down from 3.58% in 2018 to 0.94% in 2019.

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. 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.