Healthcare Associated Infections/Antimicrobial Resistance (HAI/AR) - HAN
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Overview
Chicago's HAI/AR Unit commits to continued detection and response to antibiotic-resistant infections in healthcare settings.
CDPH Healthcare Associated Infections / Antimicrobial Resistance (HAI/AR) Unit
The CDPH HAI/AR Unit conducts onsite investigations and provides technical assistance to Chicago healthcare facilities in order to mitigate gaps in infection prevention and control. The HAI/AR Unit leverages surveillance data for public health responses and trains healthcare staff across the continuum of care in core antimicrobial stewardship principles and appropriate antimicrobial use. The HAI/AR Unit commits to work with state, local, academic, and clinical partners to establish regional standards for infection control and antimicrobial stewardship best practices to reduce the emergence and spread of multi-drug resistant bacteria.
| HAI/AR Unit | Project Lead(s) | Contact Information |
|---|---|---|
| Medical Directors | Dr. Stephanie Black / Dr. Michelle Funk |
stephanie.black@cityofchicago.org michelle.funk@cityofchicago.org |
| Projects Administrator | Shane Zelencik | Phone: 312-746-6035 shane.zelencik@cityofchicago.org |
| Healthcare Associated Infections (HAI) Coordinator | Dr. Hira Adil | Phone: 312-743-0410 hira.adil@cityofchicago.org |
| Skilled Nursing Facilities and Assisted Living (SNFAL) | Liz Shane | Phone: 312-746-6122 elizabeth.shane@cityofchicago.org |
| Acute Care Hospital, Outpatient, and Other (ACHOO) | Maria Campos-Bovee | Phone 312-744-3269 maria.campos-bovee@cityofchicago.org |
| Epidemiology and Data Management | Dr. Hira Adil | Phone: 312-743-0410 hira.adil@cityofchicago.org |
| Antimicrobial Stewardship | Star Cervantes | Phone: 312-744-3376 estrella.cervantes@cityofchicago.org |
| Therapeutics and Testing | Christy Zelinski | Phone: 312-746-4023 christy.zelinski@cityofchicago.org |
| Project Firstline | Shane Zelencik | Phone: 312-744-3434 shane.zelencik@cityofchicago.org |
Types of HAIs
Below is some essential information from CDC on infections associated with invasive devices and procedures. Additionally, it is important to be aware of specific organisms and diseases often associated with healthcare settings.
- Central Line-associated Bloodstream Infection (CLABSI)
- Catheter-associated Urinary Tract Infections (CAUTI)
- Surgical Site Infection (SSI)
- Ventilator-associated Pneumonia (VAP)
- Multi- and Extensively-Drug Resistant Organisms are common in healthcare facilities. Please see below for more information about MDRO/XDROs
- Specific Diseases and Organisms
- Candida auris (C. auris)
- Clostridioides difficile (C. diff)
- Carbapenem-Resistant Enterobacterales (CRE)
- Carbapenem-Resistant Pseudomonas aeruginosa (CRPA)
- Carbapenem-Resistant Acinetobacter (CRAB)
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Vancomycin Intermediate/Resistant Staphylococcus aureus (VISA/VRSA)
Data Reports
Reporting
XDRO Reporting Criteria for Healthcare Facilities in Chicago
CDPH routinely monitors extensively resistant organisms (XDROs), specifically CRE, C. auris, CP-CRPA and CP-CRAB. For a list of XDRO reporting requirements for healthcare facilities and laboratories, please see table below.
CDPH routinely monitors extensively resistant organisms (XDROs), specifically CRE, C. auris, CP-CRPA and CP-CRAB. For a list of XDRO reporting requirements for healthcare facilities and laboratories, please see table below.
| Extensively resistant organism (XDRO) | Is this Reportable? | Report to INEDSS? | Report to XDRO | Is a CRF Required |
|---|---|---|---|---|
| Candida auris, clinical | Yes | Yes | Yes, First instance Only | Yes |
| Candida auris, screening | Yes | Yes | Yes, first instance only | CDPH will request, if necessary |
| CP-CRPA with any of the following mechanism(s): KPC, NDM, VIM, IMP, O | Not mandated by the state but CDPH would like this organism to be reported if a mechanismis found. | Yes | Yes | Yes |
| CP-CRAB | No | No | No | CDPH will request if necessary |
| CRPA or CP-CRPA with no mechanism or an unknown mechanism | No | No | No | No |
| CP-CRE: with a KPC mechanism or unknown mechanism | Yes | Yes | Yes | No |
| CP-CRE with any of the following mechanism(s): NDM,VIM,IMP,OXA |
Yes | Yes | Yes | Yes |
† If you do not have access to I-NEDSS please report via encrypted email to the XDRO Prevention Epidemiologist (Sidney.Thigpen@cityofchicago.org)
‡CP-CRAB is not reportable in Illinois, however, please report any clusters of CRAB or individual cases of CRAB with non-OXA mechanisms to CDPH either via INEDSS or email the XDRO Prevention Epidemiologist (Sidney.Thigpen@cityofchicago.org)
**In certain instances, additional information may be requested via a case report form in order to collect epidemiologic data as part of the public health investigation and response. If a case report form is needed, CDPH will reach out.
HAI Reporting Criteria for Healthcare Facilites in Chicago
Certain healthcare-associated infections are required to be reported to the National Healthcare Safety Network (NHSN) by CMS.
Acute care hospitals are required to report the following:
XDRO Registry
Extensively drug-resistant organisms (XDROs) are a major public health problem because there are no effective drugs currently available to treat infections caused by these bacteria. Detection of these organisms is possible as well as stopping the spread through Admission Screening coupled with consistent Point Prevalence Surveys at Long Term Care and Skilled Nursing facilities. To standardize the monitoring and reporting of these infections among facilities in Illinois, the XDRO registry was created. For access to the XDRO registry, click here.
Disease Reporting Criteria for Healthcare Facilities in Chicago
The table below shows reporting requirements for healthcare facilities. There may be a need to report cases and/or outbreaks to multiple entities. Reporting to CDPH does NOT satisfy the need to report to other required entities (e.g. IDPH, INEDSS, NHSN, etc.)
Certain healthcare-associated infections are required to be reported to the National Healthcare Safety Network (NHSN) by CMS.
Acute care hospitals are required to report the following:
-
CLABSI
-
CAUTI
-
SSI
-
C. difficile
-
MRSA Bacteremia (not required for long-term acute care hospitals)
XDRO Registry
Extensively drug-resistant organisms (XDROs) are a major public health problem because there are no effective drugs currently available to treat infections caused by these bacteria. Detection of these organisms is possible as well as stopping the spread through Admission Screening coupled with consistent Point Prevalence Surveys at Long Term Care and Skilled Nursing facilities. To standardize the monitoring and reporting of these infections among facilities in Illinois, the XDRO registry was created. For access to the XDRO registry, click here.
Disease Reporting Criteria for Healthcare Facilities in Chicago
The table below shows reporting requirements for healthcare facilities. There may be a need to report cases and/or outbreaks to multiple entities. Reporting to CDPH does NOT satisfy the need to report to other required entities (e.g. IDPH, INEDSS, NHSN, etc.)
| Facility Type | CDPH Reporting Requirements |
|---|---|
| Acute Care | COVID-19 outbreaks of staff and patients to your assigned IP iGAS cases to Invasive Group A Strep Case Report Form upon request Legionella cases to Legionnaires’ Disease Case Reporting Form upon request All other diseases/conditions email CDPHHAIAR@cityofchicago.org or your assigned IP |
| Skilled Nursing | COVID-19 staff and resident cases to SNF COVID-19 Case Reporting Form Influenza outbreaks to CDPH Influenza Outbreak Report Form iGAS cases to Invasive Group A Strep Case Report Form upon request Legionella cases to Legionnaires’ Disease Case Reporting Form upon request All other outbreaks email CDPHHAIAR@cityofchicago.org |
| Assisted Living | Influenza outbreaks to CDPH Influenza Outbreak Report Form All other diseases/conditions to Communicable Disease Reporting Form |
Infection Control Assessment and Response Tools
The Infection Prevention and Control Assessment and Response (ICAR) tools were developed to assist in assessing infection prevention practices and guide quality improvement activities (e.g., by addressing identified gaps). These tools may also be used by healthcare facilities to conduct internal quality improvement audits. Facilities can schedule an ICAR visit with CDPH, for more information contact the SNFAL project lead or the ACHOO project lead (see contact table in overview).
ICAR Section 1
Select one demographic form based on your individual healthcare setting:
ICAR Section 2
Below are various assessment modules that cover a variety of infection prevention practices. Modules can be selected based on facility-specific concerns:
ICAR Section 1
Select one demographic form based on your individual healthcare setting:
ICAR Section 2
Below are various assessment modules that cover a variety of infection prevention practices. Modules can be selected based on facility-specific concerns:
- Module 1 – Training, Audits, Feedback
- Module 2 – Hand Hygiene
- Module 3 – Transmission-Based Precautions (TBP)
- Module 4 – Environmental Services (EVS)
- Module 5 – High-level Disinfection and Sterilization
- Module 6 – Injection Safety
- Module 7 – Point of Care (POC) Blood Testing
- Module 8 – Wound Care
- Module 9 – Healthcare Laundry
- Module 10 – Antibiotic Stewardship
- Module 11 - Water Management
Infection Control and Prevention
Isolation Guidelines
Transmission-based precautions are an important tier of basic infection control and are to be used in addition to standard precautions to prevent transmission of infectious agents:
Multi-Drug Resistant Organisms (MDROs) Guidelines
Indwelling Devices
Environmental Cleaning
Seasonal Influenza Guidance
Hand Hygiene
Transmission-based precautions are an important tier of basic infection control and are to be used in addition to standard precautions to prevent transmission of infectious agents:
- Contact Precautions: Used for patients with known or suspected infections that represent an increased risk for contact transmission. Example Signage
- Droplet Precautions: Used for patients known or suspected to be infected with pathogens transmitted by respiratory droplets that are generated by a patient who is coughing, sneezing, or talking. Example Signage
- Airborne Precautions: Used for patients known or suspected to be infected with pathogens transmitted by the airborne route (e.g., tuberculosis, measles, chickenpox, disseminated herpes zoster). Example Signage
- Enhanced Barrier Precautions (For Skilled Nursing Facilities Only): Indicated when Contact Precautions do not otherwise apply for residents with any of the following wounds or indwelling medical devices (regardless of MDRO colonization status) and/or infection or colonization with an MDRO. Example Signage
- Appendix A: Type and Duration of Precautions Recommended for Selected Infections and Conditions (Updated 9/2018)
- Implementation of Personal Protective Equipment (PPE) Use in Nursing Homes to Prevent Spread of Multidrug-resistant Organisms (MDROs) (Updated 7/12/22)
- A Toolkit for Implementing PPE in Nursing Homes to Prevent the Spread of Multidrug and Extensively Drug-Resistant Organisms
- Summary of Personal Protective Equipment (PPE) Use and Room Restriction When Caring for Residents in Nursing Homes
Multi-Drug Resistant Organisms (MDROs) Guidelines
- Strategies for Prevention and Response to Novel & Targeted Multidrug-Resistant Organisms (MDROs) (Updated 3/13/23)
- Interim Guidance for a Public Health Response to Contain Novel or Targeted Multidrug-resistant Organisms (MDROs)
Indwelling Devices
- Guidelines for the Prevention of Intravascular Catheter-Related Infections
- Guidelines for Prevention of Catheter-Associated Urinary Tract Infections
Environmental Cleaning
- Best Practices for Environmental Cleaning in Healthcare Facilities
- List P: Antimicrobial Products Registered for use against Candida auris (C.auris)
- List K: Registered Antimicrobial Products Effective against Clostridium difficile Spores
- List N: Disinfectants for Coronavirus (COVID-19)
- Environmental Cleaning Audit Tool
Seasonal Influenza Guidance
- Prevention Strategies for Seasonal Influenza in Health Care Settings: Guidelines and Recommendations
- Interim Guidance for Influenza Outbreak Management in Long-Term Care and Post-Acute Care Facilities
- Guidelines for the Prevention and Control of Influenza Outbreaks in Illinois Long-term Care Facilities
- Influenza Toolkit for Long Term Care Employees
- Influenza Outbreak Report Form for Congregate Settings
Hand Hygiene
Tools and Resources
HAN Notifications
- The Chicago Health Alert Network (HAN) is CDPH's primary method of sharing information about urgent and emerging public health situations with Chicago healthcare facilities, clinicians, laboratories and partner agencies.
- Project Firstline is a CDC effort that aims to provide engaging, innovative, and effective infection control training for millions of frontline U.S. healthcare workers as well as members of the public health workforce.
- The purpose of the form is to convey information about a patient’s isolation precautions and the reason for their implementation to the receiving facility. The sending facility should record current infection and colonization information. This form is not intended to be a comprehensive documentation of microbiologic history and does not replace a review of medical records and communication between care providers. Please fill out this form and send it with all patients being transferred between healthcare facilities, regardless of whether or not they require isolation.
- The CDC report includes the latest national death and infection estimates for 18 antimicrobial-resistant bacteria and fungi. The germs are listed in three categories-urgent, serious, and concerning-based on level of concern to human health.
- The special report highlights the impact of COVID-19 on antimicrobial resistance in the U.S. the pandemic pushed healthcare facilities, health departments, and communities near their breaking points in 2020, making it very hard to maintain the progress in combating antimicrobial resistance.
- The CDC provides data on reporting general acute care, long term acute care, inpatient rehabilitation facilities, and critical access hospitals by state through the National Healthcare Safety Network (NHSN).
- NHSN’s HAI Pathogens and Antimicrobial Resistance Report provides a national snapshot of common HAI pathogens in U.S. inpatient healthcare facilities and includes national benchmark values for antimicrobial resistance (AR) across 8 urgent and serious drug-resistant phenotypes
- Notifiable diseases and conditions and control of notifiable diseases and conditions.
- Click this link to download the Illinois Department of Public Health's poster on diseases and conditions that must be reported to local health departments.
HAI Reporting
For questions related to Healthcare Associated Infection/Antibiotic Resistance, please contact the Chicago Department of Public Health:
Hira Adil
email: hira.adil@cityofchicago.org
Phone: 312-743-0410
or
CDPHHAIAR@cityofchicago.org