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WA DOH urges hospitals to perform admission screening for Candida auris
The Washington State Department of Health (DOH) reminds healthcare providers and facilities that Candida auris, a highly resistant fungal pathogen, is circulating in Washington. Since July 2023 when the first locally acquired case of C. auris was reported to Public Health, more than 50 cases have been identified, the majority acquired through healthcare in Washington, and many identified through admission screening. When hospitals detect highly antibiotic-resistant organism colonization in patients at admission, they can select the best infection prevention precautions to prevent transmission to other patients.
The Public Health Laboratory (PHL) provides free collection kits, testing, and shipping for hospitals screening patients in the categories recommended by Public Health. Consider screening patients with:
- Close contact in a healthcare setting to someone diagnosed with auris. Close contact may include:
- Sharing a room, bathroom, or patient care equipment
- Being cared for by the same healthcare staff
- Staying in a room near that of a person with auris
- Admission of 24 hours or more in any healthcare facility during an outbreak of auris. Your local health jurisdiction can provide information about facilities with C. auris outbreaks.
- An overnight stay in the prior year in a healthcare facility
- Direct admission from a ventilator-capable skilled nursing facility or a long-term acute care hospital.
- In Washington, these facilities include Everett Center, Kindred Hospital, Park Rose Care Center, Rainier Rehabilitation, Regency at Northpointe, Seattle Medical Post Acute Care, Vancouver Specialty and Rehabilitative Care.
- Presence of a tracheostomy
- Known colonization or infection with a carbapenemase-producing organism
Hospitals that choose to perform admission screening through Public Health must work with their local health jurisdiction to plan the screening program in advance of submitting screening samples to PHL. Hospitals that want to perform screening of patients outside of these categories can seek commercial testing. For any questions that cannot be answered by the LHJ, please contact the MDRO Team.
Please review the Partners for Patient Safety webpage for additional information about proactive screening for targeted multidrug resistant organisms. Other resources about C. auris can be found on the DOH website.
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Infection Prevention and Control |
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 After 3 years of connecting with Skilled Nursing Facilities, it is time to retire IPChat. This program has been very popular over the years. We have connected 63 times, presented over 43 different infection prevention and control topics by 45 subject matter experts. Our presenters ranged from facility Infection Preventionists, local health jurisdictions and state level SMEs from DOH and DSHS across Washington. Each session featured engaging information, insightful questions that resulted in thoughtful conversations. In 2024, we have connected with 133 facilities and 12 local health jurisdictions with an average of 47 participants per session. Our highest participation rate was 65 attendees strong! We are so proud that our collaboration with DSHS and Puget Sound APIC has been so popular and successful. But as with all good things, it is time for us to retire IPChat.
Please join us for the last IPChat session on December 17 at 11am. We will be featuring two topics: “RSV/Flu/Covid Vaccine Schedules and Coverage Tips,” along with “Hand Hygiene – Back to Basics.”
Don’t despair, we still have you covered with Quarterly Long-Term Care Infection Prevention Calls and the upcoming PS-APIC/DOH LTC IP Education Series - coming in early spring 2025. You are always welcome to email our program, and/or schedule an IPC Support Service, including an ICAR!
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Antimicrobial Stewardship |
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Resources for All Antimicrobial Stewards
New! Penicillin Allergy Management Educational Module from The Society for Healthcare Epidemiology of America (SHEA)
Penicillin allergy labels present a barrier to optimal antibiotic prescribing. In this interactive course, learners will gain experience in penicillin allergy history taking, risk assessment using validated instruments, penicillin allergy testing, and delabeling.
CE credit is offered for physicians, pharmacists, and advanced practice providers. Register for this course today!
New! Urinary Tract Infections in Women Patient Education Video
This animated video answers some commonly asked questions about urinary tract infections in women in less than 3 minutes. Subtitles/closed captions are available in Spanish.
Acute Care Stewardship Resources
New in the New England Journal of Medicine: The BALANCE Trial
Bloodstream infections are associated with substantial morbidity and mortality. Early, appropriate antibiotic therapy is important, but the duration of treatment is uncertain. This study examines antibiotic treatment for 7 versus 14 days in patients with bloodstream infections.
Join the NHSN Antibiotic Use (AU) User’s Group
Acute Care Hospitals in Washington are invited to join DOH’s NHSN AU User's Group, which aims to support hospitals in utilizing their NHSN AU data effectively. Participants will gain valuable insights into generating reports in NHSN, analyzing and interpreting antimicrobial use data, and ultimately improving antimicrobial stewardship practices within their facilities. Facilities participating in the User’s Group are granted access to an interactive dashboard for benchmarking data against other hospitals, facilitating continuous quality improvement efforts. Register today!
Long-Term Care Stewardship Resources
New in JAMA Open: Urine Polymerase Chain Reaction Testing Study and Commentary
Multiplex molecular syndromic panels for diagnosis of urinary tract infection (UTI) lack clinical data supporting their use in routine clinical care. They also have the potential to exacerbate inappropriate antibiotic prescribing. This study assesses the frequency of claims for urine multiplex urine testing in the Medicare population.
A commentary calling for more oversight of this testing was also published in conjunction with this study.
Join the Skilled Nursing Facility Antimicrobial Stewardship (SNF AMS) Collaborative!
Enhance your antimicrobial stewardship expertise and skills through WA DOH’s SNF AMS Collaborative. The collaborative will run from September 2024 – May 2025, and will consist of monthly 45-min sessions. Each session will include a concise presentation, hands-on activities, and Q&A. Benefits of participation include improved antibiotic use and survey readiness. Earn a certificate upon completion, demonstrating your enhanced stewardship expertise. Learn more and register today!
Free Stewardship Resources for Consultant Pharmacists
WA DOH is offering to provide the American Society of Consultant Pharmacists' Antimicrobial Stewardship Toolkit for free to consultant pharmacists providing services at long-term care facilities in Washington State. The toolkit offers practical guidance for starting, growing, and maintaining an antimicrobial program, ensuring compliance with CMS Long-Term Care regulations. Learn more and register today!
Outpatient Stewardship Resources
New! Playbook for New Infection Preventionists in Outpatient Settings
The intent of this Playbook is to provide a quick reference for Infection Preventionists (IPs) in Washington state who are new to working in the outpatient setting. Chapter 7 offers practical suggestions for how new IPs can be involved in stewardship.
Penicillin Allergy Delabeling Resources for Pediatrics
Developed in partnership with Seattle Children’s, this patient education handout explains why it is important to have penicillin allergies assessed in children. Access this resource in English and Spanish.
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2023 HAI Rates in Washington
Acute Care Hospitals (ACHs) in Washington report five healthcare-associated infections (HAIs) to the National Healthcare Safety Network (NHSN):
- Catheter-associated urinary tract infection (CAUTI)
- Central-line associated bloodstream infections (CLABSI)
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Clostridioides difficile infections (CDI)
- Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia
- Surgical site infections (SSI) related to colon surgeries (COLO) and abdominal hysterectomies (HYST)
To better understand and compare HAI data between years, we utilize the standardized infection ratio (SIR). This compares the number of infections reported by a facility to the number that would be predicted, adjusting for several facility- and patient-level risk factors that influence infection incidence. If an SIR is less than 1, it means there were fewer infections than were predicted for that facility in the given time. The goal is for each HAI to have an SIR under 1, and for it to decrease annually as hospitals prevent more infections.
The data below compare the Washington SIRs for each HAI between 2021 and 202
Washington SIRs for each reportable HAI in 2023
 Most HAIs had an SIR under 1, meaning there were fewer infections than predicted during 2023. More improvement is needed to reduce surgical site infections, as the SIRs for both COLO and HYSTare greater than 1.
Percent Change in HAI SIRs, 2021-2023
The graph below shows the percent change in SIRs from the past two years.. A negative percent change (shown with a green downward arrow) means the SIR decreased, and a positive percent change (shown with a red upward arrow) means the SIR increased. The asterisks denote the percent change was statistically significant.
 Understanding the percent changes helps to demonstrate the HAI trends in Washington. Between 2021 and 2022, there was only a decrease in the CAUTI SIR, but between 2022 and 2023, there were decreases in three HAI SIRs, with two others remaining stable.
ACHs have made great strides decreasing CAUTI incidence, as the SIR decreased between both 2021-2022 and 2022-2023. Both CLABSI and MRSA also had decreases in 2023. Unfortunately, there have been large increases in SSIs for the past two years. More information and data are needed to understand the increase in SSIs in Washington hospitals.
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Check out these resources!
Project Firstline offers several training and education opportunities to help you out during onboarding, annual training, and continuing education! See how one of the following programs can help you out today!
Interactive online training modules: Available for CE/CNEs at no cost! Topics range from hand hygiene, respiratory droplets, to enhanced barrier precautions.
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NEW! The "Injection Safety" module will be released December 19th.
Text Messages: Short, weekly text messages on important infection prevention topics. Text “JoinWAIPC” to 59309.
Podcasts: Short podcast episodes ranging from basic infection prevention topics to IP in different settings to an antimicrobial stewardship mini-series.
Go to our website for more WA Project Firstline information and resources!
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National Healthcare and Safety Network (NHSN) |
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Bimonthly NHSN User Group for Hospitals
Join us for the NHSN Hospital User Group calls. We will host these calls every other month. Please register in advance for this call series. Upcoming meetings are as follows.
- Jan 14, 2025, at 10:30 AM
- Mar 11, 2025, at 10:30 AM
Please reach out to the NHSN Epi Team if you have any questions or have topic ideas for any of the calls.
Monthly Long-Term Care NHSN User Group
Please note there is a new Zoom Meeting registration link for 2025 monthly calls and previous registrants will need to re-register.
You are invited to register for the monthly NHSN skilled nursing facilities (SNFs) forum to share and, collaborate, improve reporting accuracy, and increase user knowledge. Calls are scheduled for the second Thursday of the month, 11:00 a.m. – noon. Upcoming meetings are as follows:
- Jan 9, 2025
- Feb 13, 2025
- Mar 13, 2025
Please reach out to the NHSN Epi Team for more information.
NHSN Support Services for SNFs
For a more comprehensive list of NHSN support options the HAI Epi Team can provide to skilled nursing facilities, see the NHSN Support and Technical Assistance for Skilled Nursing Facilities flyer.
NHSN Reporting Updates and Trainings
NHSN LTCF Component: Respiratory Pathogens and Vaccination Updates (replay)
NHSN is hosting a January 7 webinar to review important changes to reporting requirements for residents RPV and healthcare personnel vaccinations for long-term care facilities in 2025.
Effective January 1, 2025, LTCFs are required to report COVID-19, influenza, and RSV data weekly for residents.
Also, as of January 1, 2025 facilities will no longer be required to report COVID-19 vaccination data for HCP every week, although LTCFs are still required to report HCP COVID-19 vaccination data for one week per month, due on a quarterly basis, as part of a CMS Quality Reporting Program.
Finally, Up-to-Date definition changes for quarter 1 2025 now include: Individuals aged 65 years and older and those who are moderately or severely immunocompromised are up to date when they have received 2 doses of the 2024-2025 COVID-19 vaccine or received 1 dose of the 2024-2025 COVID-19 vaccine in the past 6 months. There is no change to the up-to-date definition for individuals younger than 65 years, so they are still considered up to date with 1 dose of the vaccine. The up-to-date definition for each quarter can be found here: Understanding Key Terms and Up to Date Vaccination.
When: Tuesday, January 7, 2025, at 10:00am PT
Register in advance for this webinar!
NHSN Epidemiology Email
The NHSN Epidemiology Team has a dedicated inbox. Please email the EPI team for any NHSN related questions, issues, or concerns. This will allow our team to respond to your message in a timely manner.
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Association for Professionals in Infection Control and Epidemiology (APIC) |
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Puget Sound Chapter
The Puget Sound Region APIC chapter meets on the fourth Thursday of every month from noon to 2:00 p.m.
- We review important legislative updates, IPC news, and educational opportunities.
- Journal club and round table discussions keep IPs up-to-date on recent activity in the IPC field, as well as connect with local IPs.
Register in advance for meetings. Links to registration sites can be found on our social media and website a few weeks prior.
APIC Podcasts:
AJIC Monthly Podcast
New Episode:
Recent Episodes:
Tune in the first Thursday of each month for new episodes.
APIC Monthly 5 Second Rule Podcast
Recent Episodes:
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WA DOH Influenza Update for Week 48 now available!
The weekly summary is available.
State Summary
- Influenza-like illness activity was low during week 48.
- To date, 1 lab-confirmed influenza death has been reported for the 2024-2025 season.
- To date, 4 influenza-like illness outbreaks in long term care facilities have been reported for the 2024-2025 season.
- During week 48, 2.1 percent of visits among Influenza-like Illness Network (ILINet) participants were for influenza-like illness, which was equal to the baseline of 2.1 percent.
- During week 48, 3.7 percent of specimens tested by WHO and NREVSS collaborating laboratories in Washington were positive for influenza.
- Influenza A and Influenza B were reported to the ILINet surveillance system during week 48.
Historic influenza reports
DOH creates influenza reports for healthcare providers and public health including:
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 Core Elements of Hospital Diagnostic Excellence (DxEx)
Actionable practices for hospitals to improve diagnoses including diagnostic reasoning, testing, and communication activities, thereby improving patient safety.
The Core Elements of Hospital Diagnostic Excellence were created in consultation with our federal partners, the Agency for Healthcare Research and Quality and the Centers for Medicare & Medicaid Services. The framework was also informed by expert knowledge within the clinical and patient community.
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You are subscribed to Healthcare-Associated Infections and Antimicrobial Resistance (HAI&AR) Newsletter for Washington State Department of Health. This information has recently been updated, and is now available. If you have not yet subscribed, you can use the button below.
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