November/December 2022 · Volume 13, Issue 94

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Antimicrobial Resistance (AR)   Healthcare-Associated Infection (HAI)
Virginia Department of Health (VDH)   United States (U.S.)
Centers for Disease Control & Prevention (CDC)

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• New VDH HAI/AR Program Members
• Spotlight on Regional Infection Preventionists
• Respiratory Diseases
  
• Monkeypox Updates
• Ebola
• COVID-19 Updates
• Tuberculosis
• Norovirus
• Virginia Long-Term Care Infrastructure Pilot Projects (VLIPP)
• NHSN Updates
• Training & Education
  
  • 2022 Updates to Enhanced Barrier Precautions for Nursing Homes
  • CDC & CMS COVID-19 Infection Prevention & Control Recommendations Update
  • U.S. Pharmacopeia Compounding Standards Update
• Research
  • Changes in Health and Quality of Life in U.S. Skilled Nursing Facilities by COVID-19 Exposure Status in 2020
  • Interhospital Outbreak of Burkholderia cepacia Complex Ventilator-Associated Pneumonia caused by Contaminated Mouthwash in Coronavirus Disease 2019 Patients
• Awareness Events
  • November: National Family Caregivers Month; National Hospice and Palliative Care Month; C. diff Awareness Month
  • U.S. Antibiotic Awareness Week - November 18-24, 2022
  • National Influenza Vaccination Week - December 6-12, 2022

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News in Virginia

New VDH HAI/AR Program Members. The VDH HAI/AR program would like to welcome Laura Robertson as our team administrative assistant. We would also like to welcome Kamel Frozanfar as the Multidrug Resistant Organisms Prevention Coordinator. 

Spotlight on Regional Infection Preventionists, Eastern Region. In October for International Infection Prevention Week (October 16-22), we celebrated our Regional Infection Preventionists (IPs) and their efforts to protect patients/residents, staff, and visitors in healthcare facilities across the Commonwealth.
What other VDH team members are saying about our Regional IPs:

• “They have all been incredibly helpful and responsive when I reach out to them! They are essential to the work that we do with investigations and they are the front line in keeping multidrug-resistant organisms contained. I really couldn't do my job effectively without them and they have always been such great people to work with!”
• “[Our health district] is grateful and thankful for the support received, and continues to receive, by the Southwest IPs. We highly appreciate working with a group of IPs that has so much knowledge and helped us with long-term care facilities and assisted living facilities that were challenging at times. We value your insights and guidance. You are the best!"
• “[The Northwest Regional IPs] have been an invaluable resource for our outbreak team. They've been incredibly helpful in answering complex questions and in providing direction around new or updated guidance, even while on the road to and from their other meetings/site visits. I really appreciate their willingness to help out by sending resources or providing presentations to facilities in our district. It's really helped to ease the burden of the workload by being able to reach out to them and to tap into their practical knowledge and experience around infection control practices. I can't sing their praises enough!” 

Interested in learning more about who are Infection Preventionists and how to become one? Check out this infographic from the Association for Professionals in Infection Control and Epidemiology (APIC).

Respiratory Diseases.

• Early Increases in Seasonal Flu Activity: The beginning of October marked the official launch of the 2022-2023 flu season. CDC’s first FluView report of the season showed an early increase in flu activity happening in most parts of the country, especially in the southeast and south central U.S regions; Virginia is showing the same pattern. The CDC recommends that everyone 6 months and older get vaccinated each year.  Now is the best time to get your flu vaccine!  For the 2022-23 flu season, CDC preferentially recommends 3 flu vaccines for people 65 years and older. To find a flu vaccine near you visit CDC’s vaccines.gov. 
• Surge in Cases of Respiratory Syncytial Virus (RSV): There is a current national surge of RSV, a common respiratory virus that usually causes mild, cold-like symptoms. While the CDC does not keep a national count of RSV cases, hospitalization, or deaths, it does however, track changes in the virus’ spread. A CDC spokesperson reported an observed rise in RSV in multiple U.S. regions. There is no specific treatment for RSV infection, though researchers are working to develop vaccines and antivirals. The CDC recommends managing fever and pain with over-the-counter medicine, drinking enough fluids, and talking to your healthcare provider to relieve symptoms. 

Monkeypox Updates. In the U.S., at least three healthcare personnel have acquired monkeypox infection from sampling lesions while using a sharp instrument.  Recommendations for safe monkeypox specimen collection and infection control:

• Adhere to all recommended infection prevention and control measures, including using proper personal protective equipment (PPE) to reduce the risk of monkeypox virus transmission in healthcare settings. 
• Practice methods to safely collect monkeypox specimens using swabs. 
• Vigorously swab lesion specimens to maximize the probability of achieving accurate diagnostic results, safely.
• Do not unroof or aspirate lesions using sharp instruments during monkeypox lesion specimen collection. It is dangerous and not necessary for diagnostic accuracy.
• For more information, refer to CDC’s Clinician Outreach and Communication Activity on monkeypox issued on October 18, 2022.

Ebola. Healthcare facilities are encouraged to maintain situational awareness regarding the Ebola virus disease outbreak in Uganda caused by Sudan virus. As of 11/09/2022, no confirmed, probable, or suspected cases have been reported outside Uganda or in the U.S. Recommendations for healthcare professionals:

• Ensure you know how to contact your local health department in the event that a patient presents to your facility with concern for Ebola.
• Ensure awareness of CDC’s infection prevention and control recommendations.
• Keep up to date with VDH’s Ebola website for healthcare professionals and review resources appropriate to your setting, such as the VDH Ebola evaluation algorithm for hospitals.

COVID-19 Updates. In September, CDC published updated COVID-19 healthcare infection prevention and control (IPC) recommendations. VDH endorses these recommendations. 

• CDC COVID-19 IPC Recommendations for Healthcare Personnel (9/23/2022)
• Vaccination status is no longer used to inform source control, screening testing, or post-exposure recommendations.
• Community transmission levels continue to be used to inform application of IPC strategies.
• In general, empiric transmission-based precautions are not indicated for asymptomatic residents following close contact to SARS-CoV-2 or asymptomatic healthcare personnel following a higher-risk exposure; considerations are outlined in the guidance.
• Updated recommendations address when to use source control, universal use of PPE, testing frequency after a close contact or higher-risk exposure, screening testing of asymptomatic healthcare personnel, and screening testing for nursing home admissions.
• Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2 (9/23/2022)
• Strategies for Mitigating Healthcare Personnel Staffing Shortages (9/23/2022)

The Centers for Medicare and Medicaid Services (CMS) published updated guidance in alignment with CDC recommendations:

• CMS memo on nursing home visitation (9/23/2022)
• Updated guidance for face coverings and masks during visits; updated visitation FAQs.
• CMS memo on LTC facility testing requirements for staff and residents (9/23/2022)
• Routine testing of asymptomatic staff is no longer recommended but may be performed at the discretion of the facility.
• Updated recommendations for testing individuals who have recovered from COVID-19.

Tuberculosis. The VDH Tuberculosis (TB) Program would like to remind providers to “Think TB”. Management of both active TB disease and latent TB infection (LTBI) are critical in order to make progress toward TB elimination.

• The VDH TB Program has created a variety of resources that address both TB disease and LTBI, including a recently released LTBI toolkit with materials for both patients and providers. Please remember to report all suspected cases of active TB disease to your local health department and follow your facility policies and procedures to ensure all suspected and confirmed active TB cases are properly isolated. To report LTBI cases, please use the LTBI Case Report Form or the Confidential Morbidity Report, making sure to provide information on chest x-ray results and treatments in the 'Comments' section. 
• Nontuberculous Mycobacteria: On October 31, 2022, CDC issued a Health Alert Network Health Advisory to emphasize the importance of following existing recommendations for maintaining and monitoring dental waterlines. Multiple outbreaks of nontuberculous Mycobacteria infections have occurred in children who received pulpotomies in pediatric dental clinics where the dental treatment water contained high levels of bacteria. The CDC communication provides infection prevention recommendations that dental providers should follow properly to maintain and monitor equipment to ensure that dental treatment water is safe for patient care.  

Norovirus Season is Approaching! An increase in the number of patients with nausea, vomiting and diarrhea due to norovirus is beginning to be observed in Virginia. Noroviruses are extremely contagious and are found in the feces and vomitus of infected people. These viruses can spread rapidly through congregated facilities such as long-term care, day care and school environments. Mitigation measures such as cleaning, 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. It is recommended to wash your hands with soap and warm water for at least 20 seconds and stay home from work or school if ill.

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 important to report all suspected and confirmed outbreaks of norovirus to your local VDH health district.

During the last Norovirus Season (August 1, 2021- July 31, 2022) 148 norovirus or norovirus-like outbreaks were reported in Virginia. The majority of these outbreaks were spread through person to person transmission, and occurred in long-term care facilities and schools. So far this season, there have been 15 norovirus outbreaks 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 

Virginia Long-Term Care Infrastructure Pilot Projects (VLIPP): VDH was awarded $9.9 million in funds under the CDC Epidemiology and Laboratory Capacity (ELC) Cooperative Agreement for the Nursing Home & Long-Term Care Facility Strike Team and Infrastructure Project. This Virginia Long-Term Care Infrastructure Pilot Project (VLIPP) funding will be utilized in nursing homes and long-term care facilities to assist with the ongoing COVID-19 response and to bolster preparedness for emerging infections. The projects are based on identified needs that align with funding objectives; access to a complete overview of the VLIPP funding can be found on the CDC website. 

The following Virginia healthcare stakeholders are the subrecipients of these funds and are executing projects from late 2022 through July 2024. Targeted facilities include skilled nursing homes (SNFs), assisted living facilities (ALFs), adult day care centers (ADCCs), as well as programming that will benefit all long-term care facilities. For more detailed information on specific projects in Virginia, please visit the VLIPP website. 

Carilion Medical Center Eastern Virginia Medical School (EVMS)  Health Quality Innovators (HQI)  LeadingAge Virginia  University of Virginia (UVA) Virginia Commonwealth University (VCU)  Virginia Department of Health, Division of Pharmacy Services Virginia Department of Social Services (VDSS) Virginia Health Care Association/Virginia Center for Assisted Living (VHCA-VCAL)

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