Communicable Disease Service

HAIs are infections people can develop as a result of receiving medical care.  HAIs can happen in any healthcare facility, including hospitals, ambulatory surgical centers, hemodialysis facilities, and long-term care facilities. A wide variety of bacteria, fungi, viruses, or other, less common pathogens can cause HAIs.

The COVID-19 pandemic has proven challenging nationally for overall healthcare infrastructure. The impact on HAIs showed a national increase in HAI incidence in 2020, based on CDC National Healthcare Safety Network data. These data highlight the need to return to conventional infection prevention and control practices and build resiliency in these programs to prepare for and withstand future pandemics. Additional information is available at CDC HAIs.

About Us

The ICAR Unit is part of the Infection Control, Healthcare, & Environmental Epidemiology Program within the Communicable Disease Service at the New Jersey Department of Health. The unit comprises subject matter experts specializing in the prevention and containment of healthcare-associated infections with an emphasis on patient/resident and healthcare personnel safety and quality improvement. This unit provides infection prevention and control-focused assessments and consultation to various healthcare facilities, including acute care, long-term care, hemodialysis, and other outpatient settings.  

Infection Prevention and Control Subject Matter Experts

The ICAR Unit consists of a wide variety of clinical and infection prevention and control expertise. Our subject matter experts include nurses, nurse practitioners, surgical technicians, data analysts, and epidemiologists with a wide range of specialties and expertise, including long-term care, acute care hospitals, hemodialysis, and outpatient settings such as corrections, operating rooms, home health, hospice, and pediatrics. Our primary focus is to ensure healthcare settings are up to date with infection prevention and control practices. Our subject matter experts undergo comprehensive infection prevention and control training with the goal of becoming certified in Infection Control (CIC®). The ICAR Unit includes individuals with CIC®. This certification requires participation in approved professional development and continuing education with recertification every five years.

Prevention Focused ICAR Consultations

The ICAR Unit seeks to partner with healthcare facilities of all types to participate in a non-regulatory assessment of their infection prevention program and practices. The ICAR prevention assessment is a collaboration between the facility team members and public health to improve infection prevention practices. This collaboration will have a positive impact on quality improvement efforts and infection prevention and control supporting better patient outcomes and safer work environments.

During the assessment, the ICAR Unit will:

• Provide infection prevention self-assessment tools and resources
• Facilitate discussions with participants to assess infection prevention practices and program activities using standardized tools
• Detect infection prevention gaps through remote or on-site assessment
• Stratify data to determine where prevention needs might be the greatest
• Share evidenced-based best practices identified nationally and locally
• Bolster outbreak preparedness and response
• Coordinate a post-assessment follow-up to provide additional resources
• Offer ongoing FREE consultation after the assessment is over
• Facilities interested in assessing their infection prevention programs and partnering with the ICAR Unit should review the General Guide to an ICAR Prevention Assessment by clicking here and the ICAR Prevention Assessment Frequently Asked Questions by clicking here. 

Facilities interested in assessing their infection prevention programs and partnering with the ICAR Team should review the General Guide to an ICAR Prevention Assessment by clicking here, and the ICAR Prevention Assessment Frequently Asked Questions by clicking here.

Prevention Focused ICAR Tools

Regardless of your facility’s active collaboration with the ICAR Unit, the NJDOH recommends that all healthcare facilities review the appropriate ICAR tool and perform a self-assessment for internal performance and quality improvement. The assessment tool can assist your facility in a systematic review of your various infection prevention and control policies and procedures. 

Acute Care (e.g., general hospital, specialty hospital, long-term acute care hospital, comprehensive rehabilitation hospital)

Long-term Care (e.g., nursing home, assisted living, short-term skilled nursing, behavioral health, group homes)

Hemodialysis (e.g., facilities that offer inpatient or outpatient hemodialysis services)

Outpatient (e.g., ambulatory surgical center, urgent care, private practice, federally qualified health center, program of all-inclusive care for the elderly, adult medical daycare)

HAIs are a significant threat to patient safety, yet frequently they are preventable. Although significant progress has been made to prevent some infection types, much work remains. On any given day, about one in 31 hospital patients have at least one HAI^{^}. 

The CDC HAI Progress Report is a snapshot of how each state and the country are eliminating HAIs. CDC, states, healthcare facilities, and other patient safety organizations use this data to identify problem areas, measure the progress of prevention efforts, and ultimately eliminate HAIs. Click here for more information on New Jersey reporting laws and the annual Hospital Performance Reports. Click here for more information from the U.S. Department of Health and Human Services on HAI prevention.

^{^}Centers for Disease Control and Prevention. HAI Data. U.S. Department of Health and Human Services. https://www.cdc.gov/hai/data/index.html

Long-term care (LTC) facilities provide medical and non-medical services to people with chronic diseases, disabilities, or transitional care needs. These settings may include but are not limited to nursing homes, skilled nursing, assisted living, hospice, and palliative care.

There are many special considerations for infection prevention in the LTC setting. An increasing number of individuals in the United States are receiving care in LTC facilities. These residents have growing medical complexity and care needs and increasing exposure to devices and antibiotics.

Patients/residents may transfer in and out of healthcare facilities with some frequency, so appropriate communication of medical history, including antibiotic use, devices, colonization with novel or targeted organisms, active infection, and risk factors, is critical. The New Jersey Universal Transfer form can be downloaded here. For individuals with novel or targeted multi-drug resistant organisms (MDROs), refer to the supplemental NJDOH MDRO Transfer Cover Sheet.

The scientific literature on HAI prevalence and evidence-based prevention practices in these settings is limited. No standardized system for HAI surveillance has been adopted nationally. McGeer Criteria are commonly used; however, NJ LTC facilities are required to begin reporting to CDC National Health and Safety Network, commonly referred to as NHSN. Refer to NJ Bill A4478 (approved P.L. 2021) Chapter 457 - C.26:2H-46.3 Review of reporting requirements; standardization, consolidation of reporting requirements https://pub.njleg.state.nj.us/Bills/2020/PL21/457_.PDF.

For more information from CDC on LTC HAI prevention and more, click here.

Patients who undergo hemodialysis have an increased risk of getting an HAI including waterborne pathogens. Adults on dialysis are 100 times more likely to have a staph bloodstream infection than adults not on dialysis^{^}. Hemodialysis patients are at a higher risk for infection because the process of hemodialysis requires frequent access to the bloodstream through a catheter or insertion of needles. Bloodborne pathogens, such as Hepatitis B and C viruses, are of particular concern in the hemodialysis setting. These viruses and other bacteria may live on surfaces like treatment chairs and machines and can be spread even with no visible blood or soil when not properly cleaned and disinfected. During an average week of hemodialysis, a patient can be exposed to 300-600 liters of water, providing multiple opportunities for potential patient exposure to waterborne pathogens. Understanding and implementing basic infection prevention and control in routine practice is imperative to reducing HAIs in all healthcare settings.

The CDC offers dialysis safety resources, including infection prevention tools explicitly intended for hemodialysis centers, available here.

^{^}Centers for Disease Control and Prevention. Preventing Bloodstream Infections in People on Dialysis. U.S. Department of Health and Human Services.

https://www.cdc.gov/vitalsigns/dialysis-infections/index.html 

Outpatient facilities provide a wide variety of healthcare services without an overnight stay. These settings may include but are not limited to physician offices, urgent care centers, ambulatory surgical centers, cancer clinics, imaging centers, endoscopy clinics, public health clinics, homecare and hospice, and emergency management services.

In the past, the risk of acquiring an HAI in the outpatient setting remained low as patients were generally healthier, visits were brief, procedures were less invasive, and the risk of environmental contamination was low. However, patients with a higher acuity are now cared for more often in the outpatient setting because of the increasing shift of care from hospital to outpatient settings.

For more information on outpatient settings, click here.