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

Minnesota Department of Health

Healthcare-Associated Infections (HAI) Update

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December 2019

In This Edition

Save the Date: Antibiotic Stewardship Conference

2020 Minnesota Antibiotic Stewardship Conference

Accessible PDF: 2020 Minnesota Antibiotic Stewardship Conference (PDF)

Annual Report: HAIs in Acute Care Hospitals

MDH has released its second annual report, Healthcare-Associated Infections in Minnesota Acute Care Hospitals: 2018 Annual Report (PDF), summarizing statewide NHSN healthcare-associated infection data reported by Minnesota acute care hospitals participating in the Centers for Medicare and Medicaid Services Inpatient Prospective Payment System. This report also summarizes the progress of all Minnesota acute care hospitals towards implementing CDC's core elements of hospital antibiotic stewardship as reported to the National Healthcare Safety Network (NHSN).

Highlights from the 2018 report include meeting the U.S. Department of Health and Human Services HAI reduction targets for catheter-associated urinary tract infections (CAUTI) and hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) bacteremia infections. Minnesota hospitals also reported a significant decrease in hospital-onset C. difficile infections between 2017 and 2018. Minnesota acute care hospitals also reported significant advancement in institutional antibiotic stewardship, with 76% of all hospitals reporting implementation of all seven antibiotic stewardship program core elements. This is a 33% increase from 2017 (57%).

Network with ASC Peers and Discuss HAI Best Practices

MDH is committed to partnering with MN Ambulatory Surgery Centers (ASCs) to prevent healthcare-associated infections (HAIs). The MDH Healthcare-Associated Infections and Antimicrobial Resistance (HAI&AR) Section invites infection preventionists from ASCs throughout the state to come together to discuss the issues related to prevention, detection, monitoring, and control of healthcare-associated infections and antibiotic stewardship. The group has identified a wide range of topics of interest to learn more about prevention and control of HAIs and discuss best practices. Over the past couple years, experienced and knowledgeable leaders in the field have led discussions on topics ranging from airflow and humidity in the ASC to investigating an outbreak associated with surgery. We plan to continue bi-monthly meetings in 2020.

At the first meeting on January 8, 2020, we will review the science behind steam sterilization in the infection prevention process and national standards.

You are invited to join the conversation:

When: Bi-monthly on the second Wednesday of the month at 10:00 a.m.
How: Contact the MDH HAI&AR Section at 651-201-5414 or

Long-term Care Webinars

2019-2020 Influenza Update for LTC and Assisted Living Partners

MDH is hosting a webinar to provide updates on the 2019-2020 influenza season. Staff from long-term care/skilled nursing and assisted living facilities are encouraged to join. Updates will meet the following objectives:

  • Understand the current state of influenza activity in Minnesota.
  • Describe practices and strategies to deliver influenza vaccine to populations connected to long-term care. 
  • Identify facilities that were recognized by FluSafe in 2018-2019.
  • Describe how to recognize influenza and prevent its spread in a long-term care setting.

Participants must register for the session in order to be eligible for CEUs.

Register: 2019-2020 Influenza Update for LTC and Assisted Living Partners
Date: January 7, 2020
Time: 12:00-1:00 p.m. CST

Norovirus in Long-term Care Facilities Webinar Recording

If you were not able to join the Norovirus in Long-term Care Facilities Webinar on December 10, you can access the recording on the Outbreaks at Schools, Child Care, and Long-term Care Facilities page. Look under “Resources.”

The MDH Foodborne Diseases Unit would very much appreciate your feedback, so please fill out the Norovirus in Long-term Care Facilities Webinar Evaluation if you view the recording.

For questions or to report a possible outbreak, contact or 1-877-366-3455 (1-877-FOODILL).

Drug Diversion Planning and Response

Drug diversion is a risk in every organization and can harm a patient's safety, including potential exposure to infections through unsafe injections, reduced quality of care, and failure to receive essential medications, possibly resulting in pain and suffering. To learn more about the issues, patterns, and trends of potential diversion, view The Joint Commission: Quick Safety Issue 48: Drug diversion and impaired health care workers.

The Council of State and Territorial Epidemiologists (CSTE) has developed a Healthcare-Associated Infections (HAI) Drug Diversion Planning and Response Toolkit for State and Local Health Departments (PDF). The toolkit focuses on drug diversion response to define best practices, provides resources informed by past drug diversion investigations, and recommends the enhancement of collaborations among public health agencies and partners representing regulatory affairs: law enforcement and health care facility licensing, certification, and accreditation.

CMS Quality, Safety & Oversight Group Released a Memo for Nursing Homes

CDC's Division of Healthcare Quality Promotion (DHQP) Long-term Care Team would like to make you aware that the Centers for Medicare & Medicaid Services (CMS) Quality, Safety & Oversight Group has released a memo for nursing homes that clarifies several of the infection prevention expectations for nursing home providers, including the importance of access to alcohol-based hand rub, PPE, and EPA-registered disinfectants.  

CMS: Updates and Initiatives to Ensure Safety and Quality in Nursing Homes (PDF)

Appendix A of the memo includes an infection control surveyor worksheet that was developed during a CDC/CMS quality improvement project. Nursing homes should consider using this tool to perform infection prevention assessments.

Two MN Hospitals Recognized for Antimicrobial Stewardship Programs

The Infectious Diseases Society of America (IDSA) announced twelve institutions in the latest round of programs receiving the 2019-2021 Antimicrobial Stewardship Center of Excellence designation. Two Minnesota hospitals are among the twelve institutions honored: Mayo Clinic Hospital-Rochester and University of Minnesota Medical Center.

The CoE program recognizes institutions that have created stewardship programs led by infectious diseases physicians and ID-trained pharmacists that are of the highest quality and have achieved standards aligned with evidence-based national guidelines. A total of 78 programs have received the designation since its inception in 2017.

Congratulations Mayo Clinic Hospital-Rochester and University of Minnesota Medical Center!

IDSA: New Centers of Excellence Designees Announced

McKnight Heroes Award Nomination Reminder

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

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 this month we are summarizing two nominations submitted in pediatric care.

Gillette Children's Specialty Healthcare EVS/Infection Prevention

Gillette Children's Specialty Healthcare used quality improvement methods to determine how to implement an antibiotic timeout process. The purpose of the timeout was to determine if the patient was on the right antibiotics, cultures obtained were appropriate, there was an end date on the antibiotics, and there was an appropriate indication.

  • Gillette Children's Specialty Healthcare is small so they decided to review every patient in the hospital receiving antibiotics that were not for prophylactic purposes.
  • The antibiotic timeout review increased from one to two days a week to three days a week.
  • The antibiotic timeout is currently being performed three days a week with the ID physician, pediatric hospitalist, pharmacist, and infection prevention nurse.
  • This group continues to determine how to best document recommendations and how to approach different physician groups.
  • Antibiotic timeouts have improved the quality of patient care and communication; it has helped the infectious disease physician become involved early in patient care.

They reported this is an ever changing process, but a great start to improving antibiotic usage at Gillette Children's Specialty Healthcare. Next steps include data collection to track antibiotic use and EMR documentation of the team recommendations during ASP rounds.

Pediatric Home Service Infusion Team

The Pediatric Home Service Infusion Team completed a two-year observational study of complications associated with central venous catheters (CVCs) in pediatric home care patients, identifying the frequency of skin and other CVC complications that can play a role in central line infections.

The team analyzed data collected from the study to identify outcome measures, including central line-associated bloodstream infection (CLABSI) occurrences. They compared outcomes between CVCs managed by family caregivers versus nurses as a risk factor for catheter complications. This is a critical piece of data in the home care setting where care is frequently done by caregivers who have been trained, but are not health care professionals. Through the collection and analysis of this data, the team could identify the potential role of operator error in CVC outcomes. The study ultimately suggested that properly trained family caregivers accessing CVCs were not a risk factor, but skin complications were.

Following data analysis, the central line infusion team collaborated with local health care community members to develop standards in infusion care to help prevent infections, comparing CLABSI rates, protocols, procedures, and equipment to determine best practices, leading to safer care and infection prevention across the board. Determination that skin complications were a contributing factor to CLABSIs led to curriculum development and training for staff and family caregivers to ensure proper care for skin conditions.

Now, infection prevention training begins before discharge with emphasize in the importance of skin integrity. Additionally, caregivers receive ongoing training on skin care, infection prevention, and safety after discharge. Staff routinely assess for potential infection risks and educate caregivers to do the same so any issues can be caught early.

The most concrete evidence of the impact this team has had is shown through tracking CLABSI rates over time. Pediatric Home Service tracked 0.28 line infections per 1000 catheter days over a 12-month period. Infection rates decreased each quarter throughout the year, as staff and patients became more educated on safe care.

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.