Healthcare-Associated Infections (HAIs) are among the top causes of unnecessary illnesses and deaths in the United States. HAIs are infections that patients get while staying in a hospital or other healthcare facility – infections that the patients did not have before being admitted.¹  Reducing preventable HAIs is a priority for the Department of Health and under state law, New Jersey hospitals are required to submit data on healthcare-associated infections to the Department. The Department is required to review and analyze the data, and report the results in New Jersey's annual Hospital Performance Report.²

2018-2023

Projects

• Project Firstline: CDC's national training collaborative for health care infection prevention and control for all health care workers. The NJDOH Communicable Disease Service's (CDS) Project Firstline Team is part of the Infection Control, Healthcare, & Environmental Epidemiology Program, which has developed and implemented culturally competent and inclusive novel and interactive trainings and health education tools for our diverse frontline health care workforce. Examples include, but are not limited to, an “Escape Room” challenge for infection prevention, a College Tour for prospective health care workers, and a suite of "micro-learn" handouts encompassing a diverse array of infection control topics. From October 2021 through September 2024, the NJDOH Project Firstline team conducted 121 trainings statewide at various health care setting types, local health departments, and academic institutions, training a total of 5,100 participants.
• Infection Control Assessment & Response (ICAR): The ICAR Unit, established in 2015, is part of the Infection Control, Healthcare, & Environmental Epidemiology Program within the NJDOH CDS. The team comprises subject matter experts specializing in preventing and containing health care-associated infections emphasizing patient/resident and health care personnel safety and quality improvement. The ICAR Unit collaboratives with health care facilities to provide focused consultation (e.g., COVID-19 containment, HAI prevention, multidrug-resistant organism) using structured infection prevention tools. ICAR consultations include an educational component focused on hand hygiene and environmental cleaning. Relationships with each facility are maintained through a listserv where facilities receive infection prevention and control-related communication.

Policies and Legislation

• NJ Rev Stat §26:2H-46.3 (P.L.2021, c.457) called for a review, standardization, and consolidation of infection reporting requirements for long-term care facilities in the state.
• NJ Rev Stat § 26:2H-12.87 (P.L.2021, c.190) requires certain long-term care facilities to develop and maintain an outbreak response plans

Outreach

• NJDOH’s Office of Health Care Quality Assessment publishes annual Hospital Performance Reports for public consumption, including HAI data for New Jersey hospitals.
  • The report can provide consumers with a picture of how well individual hospitals deliver quality health care so that they can make informed decisions about choosing a hospital.
  • The goal is to improve the quality of care delivered in New Jersey by promoting healthy competition among hospitals to improve their performance in health care delivery.
  • The report promotes self-awareness among hospitals on how they are performing compared to their New Jersey peers and the rest of the nation so that they can identify areas that need improvement to deliver the best care to their patients.
• NJDOH’s Communicable Disease Service (CDS) conducts HAI prevention outreach through social media messages on Instagram, LinkedIn, Facebook, Threads, and X (formerly Twitter) to promote infection prevention and control (IPC) best practices. The campaign is called IPC Tips of the Week and focuses on a new subject area each month. Outreach via social media has reached over 1.5 million individuals, with 135,416 individuals engaging (e.g., post reactions, shares, comments) with the campaign.

Grants given by NJDOH

• As part of COVID-19 supplemental funding, CDS has awarded a total of eight health service grants to bolster infection prevention and the reduction of HAIs.
  • The grants were intended to train frontline health care staff on the basics of infection prevention. Grantees were required to attend monthly grantee meetings, provide quarterly programmatic and fiscal reports, participate in quarterly site visits, provide required CDC performance measures biannually, and provide final performance reports.
  • Grant recipients included the New Jersey Association of County and City Health Officials (NJACCHO), New Jersey Hospital Association (NJHA), and Health Care Association of New Jersey (HCANJ).
  • Total grant funds awarded from 2021 through 2023 = $1.8 million
  • As a result, a total of 14,565 health care workers received infection prevention and control training from our grant recipients between 2021 and 2024.

Grants and funding received by NJDOH

• Epidemiology and Laboratory Capacity (ELC) Cooperative Agreement:  Annual competitive grant received by Communicable Disease Service (CDS) funds the base HAI response and prevention activities within the Infection Control, Healthcare, & Environmental Epidemiology Program. Activities include National Healthcare Safety Network (NHSN) surveillance, infection prevention assessments, HAI response, and antimicrobial stewardship.
• American Rescue Plan Act of 2021 – Project E: Emerging Issues (COVID-19 Supplemental Funding):
  • Strengthening Healthcare Associated Infection Response and Prevention (SHARP) Capacity: Received in 2021 and extended through July 2026, the SHARP grant was meant to bolster and expand HAI programs in each state because of the COVID-19 pandemic. Funded areas include HAI prevention and response, multi-drug resistant organism surveillance, NHSN surveillance, antimicrobial stewardship, and Project Firstline.
  • Nursing Home & Long-Term Care Facility STRIKE Team and Infrastructure Project: 
    • CDS contracted with APIC Consulting Services, LLC., a subsidiary of the Association for Professionals in Infection Control and Epidemiology (APIC), to provide day-to-day leadership and oversight of infection prevention practices, education of staff, auditing staff, and creation and revision of policies and procedures in long-term care facilities experiencing a recent outbreak of COVID-19 or other emerging pathogens. The initiative was named “Enhanced Infection Control Support” (EICS).
    • Forty-six skilled and non-skilled long-term care facilities (LTCFs) participated in the EICS project for infection prevention placement across 16 of 21 (76%) New Jersey counties.
    • Among the 46 LTCFs, the project impacted 5,181 facility residents, with facilities having an average census of 162 residents. 
    • Consultants were on-site at facilities for a range of 2 to 6 weeks during both normal working hours and nights/weekends. In total, consultants spent 7,588 hours working with skilled facilities and 2,089 hours working with non-skilled facilities. 
    • During this time, consultants performed a total of 6,146 staff audits and provided 7,493 staff trainings and on the spot education.
• Infection Control Assessment & Response (ICAR): Annual state funding supports the ICAR Unit’s provision of remote and on-site infection prevention and control-focused assessments and consultation to various health care facilities, including acute care, long-term care, hemodialysis, and other outpatient settings.

Assets/resources

• NJDOH applies a non-punitive approach when providing HAI prevention and infection control technical assistance to facilities or investigating outbreaks. This encourages reporting and leaves facilities more open to suggestions and prevention strategies.
• New Jersey is one of only six states that collect and publicly report HAIs related to Coronary Artery Bypass Graft (CABG) procedures and is one of only eight states that collect and publicly report HAIs related to knee arthroplasty procedures.
• The CDC National Healthcare Safety Network (NHSN) is the nation’s most widely used HAI tracking system. NHSN provides facilities, states, regions, and the nation with data needed to identify problem areas, measure the progress of prevention efforts, and ultimately eliminate HAIs.

Challenges

• Patient demographics are not required fields when reporting in the National Healthcare Safety Network (NHSN) database, thus limiting the utility of these data to identify health disparities.
• NHSN data is self-reported and verified by hospitals, but there is a lack of staffing and funding to conduct data audits to assess accuracy.
• The COVID-19 pandemic exposed high staff turnover in all health care settings, which negatively affects patient care and the reporting of infections through NHSN. Training for NHSN is time-consuming, and every new staff member who onboards needs to receive CDC clearance, which can take months for each person.

Disparities/inequities

• Immunocompromised and elderly individuals are most often affected by HAIs because of their opportunistic nature. 
• Because COVID-19 exposed health inequities, CDC is now asking states to collect and analyze demographic information for HAIs moving forward.
• In 2023, the Infection Control, Healthcare, and Environmental Epidemiology (ICHEE) Program started a Health Equity Taskforce representing staff among each of the Program’s four units. The mission of the heath equity taskforce is to enhance the well-being of all individuals by implementing comprehensive strategies that effectively prevent and reduce the burden of health care-associated infections in the state of New Jersey. Through targeted education, innovative interventions, and inclusive community engagement, we aim to reduce disparities in health care outcomes and create a safe and equitable environment for patient, health care providers, and the community at large. 

Final Assessment

Three of the six Healthcare-Associated Infections targets were achieved by 2020. 

• Targets were achieved for:
  • Catheter-associated urinary tract infections (CAUTI)
  • Colon surgical site infections
  • Abdominal hysterectomy surgical site infections 
• Targets were not achieved for:
  • Central line-associated bloodstream infections (CLABSI)
  • Coronary artery bypass graft (CABG) surgical site infections
  • Knee arthroplasty surgical site infections

For more information, please refer to these resources:

• NJDOH Healthy Care Quality Assessment 
• CDC National Healthcare Safety Network
• Healthy People 2030

References:

1. Healthcare-Associated Infections. Health Care Quality Assessment, NJDOH. 2/4/21.
2. Report Healthcare-Associated Infections (HAIs). Health Care Quality Assessment, NJDOH. 12/13/16.