HAI High Sign Newsletter NOV/DEC 2021

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November/December 2021 · Volume 12, Issue 88

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) Scott Baumgartner, BSN, RN, OCN  and Rashidat Odeyale, BSN, RN, who will be positioned in the Northern Region of Virginia to provide infection prevention and control consultation in healthcare and congregate settings. We would also like to welcome our new Regional Infection Prevention Coordinator, Andrea Chapman, MPH, CHOP, CIC.  We are thankful to have such amazing talent join our HAI/AR Program

VDH Tuberculosis (TB) Program Updates. On August 31, CDC updated their Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States regarding the timing of TB testing

  • COVID-19 vaccination should not be delayed because of testing for tuberculosis (TB) infection. Testing for TB infection with one of the immune-based methods, either the tuberculin skin test (TST) or an interferon release assay (IGRA), can be done before, after, or during the same encounter as COVID-19 vaccination.
  • TSTs and IGRAs were previously recommended to be administered > 4 weeks after completion of COVID-19 vaccination to minimize potential theoretical interference between vaccination and TB testing. This was out of an abundance of caution during a period when these vaccines were new. However, given logistical challenges faced in delaying TB infection testing, the recommendation has been updated so that these tests may now be administered without regard to timing of COVID-19 vaccination.

Tuberculosis has been added to the list of underlying conditions for CDC’s COVID-19 Vaccines for People with Underlying Medical Conditions.

2021-2022 Influenza Season. We are still fighting a pandemic, but the 2021-22 flu season is here! It is critical this year to get your flu vaccine; it’s never too late to vaccinate!

There is a large amount of uncertainty regarding how this year’s flu season will look, as we do not have sufficient data from last year’s season to make predictions for the coming year. Before the 2020-21 flu season, we generally observed one peak of Influenza A or B or a combination of both. Throughout 2020-21 we saw little to no activity during flu season (usually October-May). However, increased activity was observed during the off-season. 

Seasonal influenza surveillance data from the Southern Hemisphere showed a mild flu season, and influenza activity remains lower than expected for this time of year for a number of countries. Data from the Southern Hemisphere are critical for understanding how the flu season will look in the Northern Hemisphere. As a result, there is more uncertainty regarding the current flu season. Mitigation measures that were adopted due to concerns of spreading COVID-19, such as hand washing, social distancing, and mask wearing, may have helped reduce the spread of flu as well as other respiratory pathogens last flu season. How well these measures are followed this year may have an impact on how much activity we see during this flu season. 

VDH will continue to publish the Weekly Influenza Report every Thursday based on the previous week’s data and will keep evaluating other reports that may be helpful in measuring effects of currently circulating respiratory pathogens in Virginia. Visit the VDH Influenza website for weekly influenza updates. 

Follow these steps to prevent the spread of flu:

  1. Get vaccinated
  2. Practice good hand hygiene, respiratory etiquette, and stay home if you are feeling sick
  3. Take antivirals as prescribed

Measles Outbreak. VDH is working closely with local, state, and federal partners to respond to a measles outbreak among persons recently arriving from Afghanistan.  No community transmission has been identified at this time in Virginia.  Because measles is so contagious, it is likely that healthcare providers will find more cases; it is required to report measles cases to VDH.  Visit the measles web page to learn more about the current outbreak.

Norovirus Season. In Virginia, VDH is observing an increase in the number of patients with nausea, vomiting and diarrhea due to norovirus.  

  • Noroviruses are found in the feces and vomit of infected people and are highly contagious. Mitigation measures such as cleaning and disinfection and hand washing after using the bathroom, between seeing patients and prior to preparing or serving foods and medications prevents transmission via person-to-person or contaminated surfaces.
  • Norovirus infections are usually diagnosed based on symptoms, but during an outbreak, the state public health laboratory will test stool specimens to identify the virus and confirm the outbreak. 
  • Although individual cases of norovirus infection are not reportable to VDH, it is required to report suspected and confirmed outbreaks of norovirus to your local VDH health district.
  • During the last Norovirus Season (August 1, 2020- July 31, 2021) 48 norovirus or norovirus-like outbreaks were reported in Virginia, compared to 103 norovirus or norovirus-like outbreaks reported during the previous season (August 1, 2019- July 31, 2020). The majority of these outbreaks were spread through person-to-person transmission, and occurred in long-term care facilities. So far this season, 14 norovirus outbreaks have been reported in Virginia.
  • Norovirus Resources: Norovirus Infection Fact Sheet, Key Infection Control Recommendations for the Control of Norovirus Outbreaks in Healthcare Settings, Norovirus in Healthcare Facilities Fact Sheet 

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Requirements for Reporting HCP COVID-19 Vaccination Data to NHSN. Effective October 1, 2021, under the fiscal year 2022 payment rules, CMS requires acute care hospitals, long-term acute care hospitals, and inpatient rehabilitation facilities participating in Medicare quality reporting programs to report at least one self-selected week of data per month on healthcare personnel (HCP) COVID-19 vaccination to NHSN. The first reporting period is from October 1 - December 31, 2021. Each quarter, CDC will calculate a single quarterly COVID-19 HCP vaccination coverage rate. CMS will publicly report this quarterly rate on the Care Compare website. Please refer to the CMS Federal Register - Final Rule (pgs. 1604-1629) and the NHSN website for more information.

Upcoming CMS HAI Reporting Deadline. The deadline to enter 2021 Q2 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 November 15, 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 November, 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.  

Details of the Surgical Site Infections (SSI) Standardized Infection Ratio (SIR) Models are Available in SIR Guide Addendum. The SSI SIR, based on the 2015 baseline, is available for 3 main models/reports (i.e., All SSI, Complex Admission/Readmission, Complex 30-day). The details of the Complex 30-Day SSI risk adjusted model are available in the SSI section of the SIR Guide. The details of the model include: the risk factors included in the model and the parameter estimate that each factor contributes to the overall risk for infection following the specified procedure. This document includes the details of the SIR models for the All SSI SIR and Complex Admission/Readmission SSI SIR models by procedure category and patient population. The model details are in tables 1 through 6 of the SIR Guide Addendum: SSI SIR Models document.

Training & Education

Virginia Infection Prevention Training Center (VIPTC). VDH awarded a $6 million grant to Virginia Commonwealth University (VCU) Health System to establish a statewide infection prevention training center. The new Virginia Infection Prevention Training Center (VIPTC), to be designed and implemented by VCU will provide in-person and interactive online training to thousands of frontline healthcare workers across Virginia.  The training courses will include evidence-based infection prevention and control practices that can be applied across the healthcare continuum.  By establishing the Virginia Infection Prevention Training Center, VDH and VCU aim to create a sustainable resource for training and education for all frontline healthcare workers in the Commonwealth for years to come.  Learn more about VIPTC as well as past and upcoming training opportunities on the VIPTC website

Project Firstline Facilitator Toolkit. Do you want to host your own infection control training? Think that you can’t because you are not an infection control expert? Project Firstline has a facilitator toolkit to help you conduct an infection prevention and control training session. The training is made to fit your schedule with pre-scripted sessions from 10 to 60 minutes in length.

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NACCHO Report. CDC’s Project Firstline strives to equip public health and frontline healthcare workers with the infection prevention and control (IPC) knowledge they need to protect themselves, their patients, and their communities. To advance local health department engagement in IPC activities, NACCHO, in partnership with Project Firstline, released a new report highlighting the IPC activities conducted by local health departments, their training needs, and opportunities to bolster IPC capacity at the local level. 


Regional Containment Webinar Series led by CDC: C. auris and CPO Colonization Screening 101. The next webinar will take place Monday, November 15 from 1-2 PM. Register here to attend the webinar that will review  everything you need to know about colonization screening through the CDC’s AR Lab Network. Check out the MDRO Containment Webinar Series web page for more information.

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Get Ready for U.S. Antibiotic Awareness Week! Join VDH in observing this yearly event to promote optimal antibiotic use. Check out the CDC Partner Toolkit and additional resources on the VDH Antibiotic Awareness Week website for more information on how to get involved. 

The Virginia HAI Advisory Group will be hosting a webinar to provide critical updates about the Virginia Candida auris situation and have a guest speaker review treatment options for Candida auris. The webinar will take place on Tuesday, November 23rd from 12 - 1 PM. Register here.

  • Objectives: 
    • Define Candida auris epidemiology 
    • Explain state and regional Candida auris data 
    • Compare and contrast Candida auris treatment options
    • Review a Candida auris patient case 
  • Speakers: 
    • Shaina Bernard, PharmD
      • Antimicrobial Resistance Coordinator, Virginia Department of Health
    • Laura Cwengros, PharmD, BCIDP
      • Infectious Diseases Clinical Manager, CJW Medical Center 

Research Corner

Protecting Nursing Home Residents from COVID-19: Federal Strike Team Findings and Lessons Learned. A commentary from the June 2021 issue of the New England Journal of Medicine Catalyst focused on COVID-19’s toll in nursing homes by highlighting major shortcomings in how these facilities handle infection prevention and control. A federal strike team identified key challenges and promising practices to improve safety for residents and staff.  

Federal Action Needed to Address Antibiotic Resistance in Older Americans. According to the most recent antibiotic resistance report from the CDC, in 2017, six common antibiotic-resistant pathogens caused an estimated 30,000 deaths in the U.S. and resulted in $4.6 billion in health care costs. New research published by The Pew Charitable Trusts, University of Utah, and Infectious Diseases Society of America revealed that over one-third of those deaths and costs came from the Medicare-aged population (65 years and older)—a disproportionate figure given that Americans 65 and older made up 15% of the U.S. population that year.  Check out the full article for more data and a review of potential actions to combat antibiotic resistance. 

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Save the Date for Upcoming Events & Recognition Weeks


One Health Day: November 3, 2021. The COVID-19 pandemic is an example of a disease emerging as a result of close contact between animals and people.  One Health recognizes the close connection between the health of people, animals, and the environment and the role this connection plays in the emergence of new diseases.  A One Health approach can help address many kinds of public health threats, including zoonotic diseases, antibiotic resistance, vector-borne diseases, food safety and security, chronic disease, mental health, and more.  Celebrate One Health Day and learn more on the CDC One Health web page



Antibiotic Awareness Week: November 18-24, 2021. CDC is urging healthcare professionals to prescribe antibiotics only when necessary to help fight antibiotic resistance and to protect their patients from antibiotic-related adverse drug events. The Be Antibiotics Aware initiative provides resources to help improve antibiotic prescribing among healthcare professionals and use among consumers. Click here to view brief educational efforts you can use as healthcare professionals! 



National Influenza Vaccination Week: December 5-11, 2021. National Influenza Vaccination Week is a call to all Americans 6 months and older to get their annual flu vaccine if they have not already. Since COVID-19 and flu could spread simultaneously this winter, this week will serve to remind people that there is still time to get a flu vaccine to protect against flu illness and serious flu complications, such as worsening of chronic conditions or pneumonia. Check the CDC National Influenza Vaccination Week web page for more information and resources. To find a vaccination center near you click here

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.