HAI High Sign Newsletter JUL/AUG 2021

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July/August 2021 · Volume 12, Issue 86

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

In this Newsletter:

News in Virginia

Welcome New Team Members! We would like to welcome and introduce VDH Regional Infection Preventionists (IPs), Dana Chapman and Dee Winston.  Dana and Dee are among the many regional IPs that will be 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!

Tuberculosis Outbreak. VDH Tuberculosis (TB) and HAI Programs are working closely with the CDC to investigate a multistate outbreak of TB associated with a suspected contaminated bone allograft material used in surgical procedures.  Twenty states were notified of facilities within their state that received material from a single lot of bone allograft material.  Only one facility in Virginia received units from this contaminated lot.  VDH is working closely with that facility and the local health department to ensure prompt evaluation and treatment of the patients who received the contaminated material and to complete the contact investigation, including for exposed healthcare workers. For more information on this investigation, please visit the CDC Website.

Local Spotlight. The Virginia Beach Department of Health partnered with the VDH HAI team and the CDC to complete a vaccine effectiveness analysis in a local skilled nursing facility.  The Virginia Beach team worked diligently prior to CDC’s arrival and during data abstraction to ensure the project would run smoothly.  Many thanks to the facility for their partnership on this investigation and kudos to Virginia Beach for their fastidious work and continued excellence in public health!

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COVID-19 Vaccination Reporting Requirements. On May 11, 2021, the Centers for Medicare & Medicaid Services (CMS) provided clarification on the Interim Final Rule on COVID-19 Vaccine Requirements. CMS also published a QSO memo to state survey agencies on how to operationalize this new requirement. The rule, which went into effect on May 21, 2021, specifies that CMS-certified long-term care facilities must develop and implement policies and procedures to: 

CMS began reviewing compliance with the new vaccination reporting requirements starting Monday, June 14, 2021. Enforcement may result in penalties. Facilities should establish two designated NHSN reporting staff members with SAMS grid cards for NHSN Level 3 access reporting. As your dedicated Quality Innovation Network-Quality Improvement Organization (QIN-QIO), Health Quality Innovators (HQI) is available to support you and your facility with accessing NHSN and the required LTCF COVID-19 Module, including vaccine administration reporting. HQI can be reached at communications@hqin.org

NHSN Late-Onset Sepsis/Meningitis (LOS/MEN) Webinar. NHSN will offer a webinar on the soon to be released LOS/MEN module for NHSN reporting, August 4 at 1:00 p.m. (ET). This will be an opportunity to learn about the new electronic surveillance reporting option for Late Onset Sepsis and Meningitis targeting very low birth weight neonates during the first 120 days of life. Register in advance for this webinar HERE.

Upcoming CMS HAI Reporting Deadline. The deadline to enter 2021Q1 data into NHSN for the CMS Quality Reporting Programs for participating acute care hospitals, long-term acute care hospitals (LTACHs), inpatient rehabilitation facilities (IRFs), and cancer hospitals is August 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 August, 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

Training & Education

EPA List P for C. auris. The U.S. Environmental Protection Agency (EPA) now has a ‘List P’ for products effective against Candida auris.  Click here for more info.

Cleaning & Disinfection of Blood Glucose Monitors. Did you know that proper cleaning and disinfection of a blood glucose monitor (glucometer) is a very important step to prevent the transmission of bloodborne pathogens to residents and patients? According to the FDA, CMS and CDC, blood glucose meters (BGMs) can become contaminated with blood and, if used for multiple residents, must be cleaned and disinfected after each use according to manufacturer’s instructions for multi-patient use.

Failure to properly clean (removal of organic soil) and disinfect (microbicidal process) blood glucose devices between uses has been implicated in multiple outbreaks of viral illnesses in nursing homes, assisted living facilities, and in other healthcare  settings. A BGM should be cleaned and disinfected after each use following the manufacturer’s instructions using an EPA registered disinfectant that is effective against Human Immunodeficiency Virus (HIV), Hepatitis B, and Hepatitis C.  Note that 70% ethanol solutions are not effective against viral bloodborne pathogens, and the use of 10% bleach solutions may lead to physical degradation of the device. Healthcare personnel should consult with the manufacturer of the BGM to ensure the disinfectant is compatible with the meter/device.

Additionally, CDC recommends the use of single-use, auto-disabling fingerstick devices in settings where assisted blood glucose monitoring is performed. This practice prevents inadvertent reuse of fingerstick devices for more than one person. Reusable fingerstick devices must never be used for more than one resident or patient.

Earn CE with Project Firstline. Looking to earn additional continuing education (CE)?  Learn more about the “why” behind infection control and earn CE in the process with the Project Firstline course, Introduction to Infection Control and Virus Basics.  Learn how to safely use a multi-dose vial with Project Firstline’s course, Injection Safety or the important role that eye protection, gowns, and gloves play in infection control in PPE Basics.  Project Firstline will be releasing additional courses throughout the summer.

Prefer to Listen? The Association for Professionals in Infection Control and Epidemiology (APIC) hosts, 5 Second Rule, a podcast where infection preventionists discuss facts, myths and general tips to stay safe.  New episodes are released every second Tuesday.

One Health
Animal Reservoirs for Emerging Coronaviruses. Check out this podcast from CDC’s Emerging Infectious Diseases Journal to learn from Dr. Ria Ghai, an associate service fellow at CDC, and Sarah Gregory as they discuss how animals can serve as hosts for alpha- and betacoronaviruses.
Research Corner

Leveraging the Human Microbiome to Address Antimicrobial Resistance. A special issue of the Journal of Infectious Diseases entitled “The State of Microbiome Science at the Intersection of Infectious Diseases and Antimicrobial Resistance” was recently released. Within this edition, there are articles on how the microbiome and antimicrobial resistance interact, clinical and therapeutic pathways based on these interactions, and implications for diagnostics. This edition was made possible through the CDC Antibiotic Resistance Solutions Initiative

Prevalence of Antimicrobial Resistant Escherichia coli is Rising in the U.S. Among female outpatients with urinary tract infections (UTI) in the U.S., the prevalence of antimicrobial resistant Eschericia coli has increased nearly 8% each year from 2011-2019. This increase varied by region, with the East, South, Central and Pacific regions observing the highest prevalence of antimicrobial resistant E. coli isolates. Providers in outpatient settings should be aware of their regional antimicrobial resistant E. coli prevalence when treating UTIs in female patients.

Trends in U.S. Prescriptions During the COVID-19 Pandemic. Two articles published in Clinical Infectious Diseases examined trends in U.S. prescription practices during the COVID-19 pandemic.  A study comparing 2019 and 2020 prescribing found large numbers of nursing home residents were prescribed drugs investigated for COVID-19 treatment and there was an increase in prescribing of antibiotics commonly used for respiratory infections.  A separate study looked at trends in outpatient antibiotic prescriptions and found that from January 2020 to May 2020, the number of outpatients with antibiotic prescriptions decreased substantially more than would be expected due to seasonal trends alone; read the full article here, for more information.

ACP Releases Practice Advice for Short-Course Antibiotics in Common Infections. A Scientific Medical Policy Committee convened by the American College of Physicians (ACP) has published best-practice advice for the appropriate use of short-course antibiotics in the management of common infections, including acute bronchitis with chronic obstructive pulmonary disease (COPD) exacerbation, community-acquired pneumonia (CAP), urinary tract infections (UTIs), and cellulitis. The 4 evidence-based best-practice advice statements were outlined in the Annals of Internal Medicine; read more here.

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Save the Date for Upcoming Events & Recognition Weeks

World Hepatitis Day: July 28.  World Hepatitis Day is observed each year on 28 July to raise awareness of viral hepatitis, an inflammation of the liver that causes severe liver disease and hepatocellular cancer. This year’s theme is “Hepatitis can’t wait”, conveying the urgency of efforts needed to eliminate hepatitis as a public health threat by 2030. With a person dying every 30 seconds from a hepatitis related illness – even in the current COVID-19 crisis – we can’t wait to act on viral hepatitis.  Learn more about this year’s activities from the World Hepatitis Alliance and CDC.

National Immunization Awareness Month: August 2021. This August marks the annual observance of National Immunization Awareness Month, a time used to highlight the importance of vaccinations in the U.S. Resources for healthcare professionals, parents, and patients are available through the CDC. A webinar on increasing COVID-19 vaccine confidence for parents in pediatric offices will be offered on August 19, 2021 and an Instagram Q&A session on childhood vaccinations will be held on August 24, 2021.  Visit the VDH Immunization website to learn more about school and day care minimum immunization requirements in Virginia.

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.