HAI High Sign Newsletter MAR/APR 2021

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March/April 2021 · Volume 12, Issue 84

Antimicrobial Resistance (AR)   Healthcare-Associated Infection (HAI)
Virginia Department of Health (VDH)     United States (US)
Centers for Disease Control & Prevention (CDC)

In this Newsletter:

News in Virginia

Welcome New Team Member! We would like to welcome and introduce a VDH Regional Infection Preventionist (IP), Wendy Fariss, BSN, RN, CIC.  Wendy Fariss is one of many regional IPs positioned across Virginia to provide infection prevention and control consultation in healthcare and congregate settings.  We're thankful to have such amazing talent join our HAI/AR Program!

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Dear Frontline Healthcare Workers,
Infection prevention and control is a team effort and we need your help!
The Centers for Disease Control and Prevention (CDC) and the Virginia Department of Health (VDH) are collaborating on Project Firstline, an initiative aimed at providing innovative and effective infection prevention and control training for all frontline healthcare workers. 
VDH is asking all frontline healthcare workers to participate in a 10 minute survey designed to inform future CDC training materials and guide VDH training sessions. 
Please visit the VDH Project Firstline website for a full list of frontline worker types, including, but not limited to:
  • Non-clinical support staff & environmental services
  • Behavioral & mental health professionals & social services
  • Clinical professionals
  • Healthcare administrators
  • Laboratorians
  • Pharmacists
  • Public health personnel

Your valuable input will help shape Project Firstline!  If you have any questions, please reach out to the VDH Healthcare-Associated Infections and Antimicrobial Resistance (HAI/AR) Program at hai@vdh.virginia.gov.
Go to the Survey!

Please Share this Survey with all Frontline Healthcare Workers

Please Complete the Survey by March 31, 2021

Coming Soon: Call for Hospital Antibiograms. The Virginia Healthcare-Associated Infections Advisory Group will be sending out a request for hospitals to submit their 2019 antibiograms to be included in the next update of the Virginia State and Regional Cumulative Antibiogram project.  A representative from your antimicrobial stewardship program will be provided more details in the coming weeks.  The 2017 and 2018 Virginia State and Regional Antibiograms can be found here.

2020-21 Flu Season Update. As we draw towards what would normally be the end of the typical flu season in the Northern Hemisphere, influenza activity remains very low in all regions of Virginia. The most recent influenza activity report shows emergency department and urgent care visits for ILI (influenza-like illness) are below 1.5% for all regions in the Commonwealth, and have generally remained under 2% for the entirety of the season. This low level activity mirrors ILI levels on the national scale.

COVID-19 has played an integral role in this unusual flu season and has impacted decisions regarding future seasons. To date, Virginia was unable to identify the predominant strain of influenza due to low circulation in 2020-2021. Decreased specimen availability worldwide has impacted vaccine recommendations. The World Health Organization recently provided comment on the influence of the COVID-19 pandemic on their annual recommendation for the 2021-2022 northern hemisphere influenza vaccine, reporting that the “reduced number of viruses available for characterization raises uncertainties regarding the full extent of the genetic and antigenic diversity of circulating influenza viruses and those likely to pose a threat in forthcoming seasons.” Despite this unusual flu season, WHO provided this recommendation.

For the remainder of the flu season, influenza activity updates for the Commonwealth can be found in the VDH Weekly Influenza Activity Report, located here, or on the VDH Epidemiology webpage. Nationwide weekly flu updates can be found at the CDC FluView page, located here.

COVID-19 Vaccination and TB Testing.  The CDC has released guidance on COVID-19 vaccination and TB testing using the tuberculin skin test (TST) or an interferon gamma release assay (IGRA).  The most up to date guidance can be found on the CDC website here.  

CDC does not recommend delaying COVID-19 vaccination because of testing for TB infection.  TB testing can be completed during the same encounter for COVID-19 vaccination.  If TB testing cannot be completed at the same time, testing should be delayed >4 weeks after vaccination completion. Medical providers may not want to delay TB testing in cases where people are at high risk for progression to TB disease.  The VDH TB Program is happy to consult on these cases.  VDH does support retesting of such individuals with a negative result >4 weeks after COVID-19 vaccination completion.  For more information about TB testing for: policy requirements, patients being evaluated for active disease, or other medical care, refer to the CDC guidance.  

If you have additional questions please do not hesitate to contact the VDH TB Program at (804) 864-7906 or tuberculosis@vdh.virginia.gov.

Updated Latent Tuberculosis Testing and Treatment Recommendations.  The National Society of Tuberculosis Clinicians and the National Tuberculosis Controllers Association recently released the Testing and Treatment of Latent Tuberculosis Infection in the United States: Clinical Recommendations, patient-centered and practical state-of-the-art recommendations on latent tuberculosis infection (LTBI) as a companion reference to support health care providers in implementing the 2020 “Guidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from the National Tuberculosis Controllers Association and CDC.

Hiring Continues to Bolster Infection Prevention Resources in Virginia. The VDH Division of Clinical Epidemiology continues to seek Regional Infection Preventionists for the northern and eastern regions of Virginia to provide infection prevention and control consultation for healthcare-associated infections both proactively and in response to outbreaks in hospitals, long-term care facilities, and other healthcare and congregate settings. These positions will support implementation of numerous patient safety initiatives for COVID-19 and other emerging pathogens by performing on site infection prevention and control assessments, providing health education to public health staff, and serving as experts in infection control issues. To apply, send your cover letter and/or resume to lindsey.lambert@vdh.virginia.gov.

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Ebola. On February 24, 2021, CDC issued Level 3 travel warnings to avoid all nonessential travel to Democratic Republic of the Congo (DRC) and Guinea due to Ebola outbreaks in these countries.  Beginning March 5, 2021, VDH staff began monitoring the health of travelers arriving in Virginia who were in the DRC or Guinea in the previous 21 days. VDH will refer ill travelers who develop EVD-related symptoms for appropriate clinical evaluation.  Visit the VDH Ebola Virus Disease website for more resources.

One Health
One Health & Antimicrobial Resistance. One Health is a trans-disciplinary approach to health that recognizes the interconnections between people, animals and the environment. Changes such as human population growth into new geographic areas, close contact with animals, climate and environmental changes, and the increased movement of people and animals can lead to the spread of known, new and emerging diseases. Visit the CDC One Health website to learn more!
One Health Partners

  • The deadline to enter 2020Q3 data into NHSN for the CMS Quality Reporting Programs for participating acute care hospitals, long-term acute care facilities, inpatient rehabilitation facilities, and cancer hospitals has been extended to March 18, 2021. To ensure your data have been correctly entered into NHSN, please verify that: 1) your monthly reporting plans are complete, 2) you have entered appropriate summary and event data or checked the appropriate no events boxes, and 3) you have cleared all alerts from your NHSN facility homepage. Hospitals that have conferred rights to VDH will be receiving a quality assurance report in the second week of March, so please be sure to check your email and acknowledge receipt and review. Please remember to update the HAI/AR Program with any IP contact changes. For additional guidance on ensuring your data are accurately sent to CMS for Quality Reporting purposes, please visit the NHSN website and navigate to the appropriate section(s) for your facility type: http://www.cdc.gov/nhsn/cms/index.html.
  • Since NHSN will not hold an in-person annual training for 2021, NHSN subject matter experts created training videos covering several topics including LabID event reporting, CAUTI updates, SSI updates, facility-wide antibiogram report, and more. NHSN will also host follow-up Q&A sessions starting March 17, 2021. The 2021 NHSN Training videos, Q&A session registration, question form, and continuing education information can be accessed here.
  • In November 2020, CDC published the 2019 NHSN Antimicrobial Use Option Report. This report is the first national summary of SAAR distributions and percentages of use for adult, pediatric, and neonatal locations. It provides data for action for Antimicrobial Stewardship Programs (ASPs), helping inform stewardship efforts by enabling hospitals to see how their SAARs compare to the national distribution. Further, the percentage of antimicrobial use by class and drug within a SAAR antimicrobial agent category provides insight to prescribing practices across differing patient care locations. The data tables can be found here.
  • NHSN updated the Supplies and Personal Protective Equipment pathway in the LTCF COVID-19 Module to include the optimization strategies that LTCFs are using regarding their PPE supply items. Reporting for the updated data elements will begin the week of March 8, 2021. 
    • In addition, a new section called, Need for Government Support or Assistance was added to offer facilities a new option to indicate they would like outreach from state or local government to discuss COVID-19 assistance needs related to staffing shortages, personal protective equipment shortages, SARS-CoV-2 (COVID-19) testing supply shortages, infection control/outbreak management, staff training, and COVID-19 vaccination for residents and/or staff. VDH will use affirmative (“Yes”) responses to this question as another way to monitor assistance needs that facilities face and to prioritize outreach and response actions.

Research Corner

Hand Hygiene. A recent study in the American Journal of Infection Control identified that patients, visitors, and families at a hospital had low rates of performing hand hygiene. This group preferred washing hands with soap and water over using alcohol-based hand rub and reported higher hand hygiene rates than were actually observed. Acute healthcare settings should focus on communicating consequences of failing to perform hand hygiene and correcting misconceptions when designing interventions to improve hand hygiene.

Lessons Learned from Candida auris Outbreaks in the US. Interviews with healthcare facilities, organizations, and public health departments in New York, California and Illinois were conducted between 2019-2020.  Interviews of those who have responded to cases and outbreaks of C. auris found key lessons related to surveillance and laboratory capacity, communication, infection prevention and control, environmental cleaning, clinical management of cases, and media concerns. Read more here.

SARS-CoV-2 Air Contamination in Hospital Settings. A systematic review of 24 studies found that air close to and distant from patients with COVID-19 was sometimes contaminated with SARS-CoV-2 RNA, but few of these samples contained viable viruses. However, more attention may be needed in bathrooms, staff areas and public hallways, where higher viral loads were found. Read more here.

Prefer to Listen? Check out Infection Prevention Spotlight, a podcast from the American Journal of Infection Control. A recent episode highlights a conversation with infection prevention pioneer Dr. Elaine Larson, in which Dr. Larson discusses how far the field of infection prevention has come and what lies ahead. Other episodes have featured:  innovation in disinfection, care bundles to prevent SSIs, cost-effectiveness of infection prevention, hand hygiene best practices, and more.

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Save the Date for Upcoming Events & Recognition Weeks

National Patient Safety Awareness Week: March 14-20, 2021. This is an annual initiative sponsored by the Institute for Healthcare Improvement that highlights the need for improving the safety of patients and healthcare workers. Reducing the occurrence of HAIs by following adequate infection prevention and control practices is just one of the ways healthcare professionals can do so.

World Tuberculosis Day: March 24, 2021. A day to raise public awareness about the devastating health, social and economic consequences of TB, and to step up efforts to end the global TB epidemic. Click here for more information.

National Public Health Week: April 5-11, 2021. The 2021 theme for NPHW is “Building Bridges to Better Health.” Each day of National Public Health Week will focus on a specific public health topic. Click here for more information.

We Want To Hear From You!
We would like to thank all facilities across Virginia for their continued efforts to reduce antimicrobial resistance.  We know there are programs across Virginia doing great work to reduce antimicrobial resistance and we want to hear about it! If you would like to have your facility spotlighted in a future edition of the HAI High Sign, please email hai@vdh.virginia.gov.