Healthcare Associated Infections (HAIs)

About ICAR

The New Jersey Department of Health, Communicable Disease Service (CDS) was awarded funds by the U.S. Centers for Disease Control and Prevention (CDC) as part of a three-year nationwide program to reduce healthcare associated infections (HAIs). With this cooperative agreement, CDS established the Infection Control Assessment and Response (ICAR) team to assist healthcare facilities(HCFs) in reducing the number of HAIs by assessing their infection prevention programs, providing educational resources, and sharing best practices.

The ICAR team is comprised of epidemiologists and infection preventionists specializing in the prevention of HAIs. This team will assess a variety of patient care facilities including acute care, long term care, hemodialysis, and other outpatient settings.

ICAR Assessments

The ICAR team is currently seeking HCFs of all types to participate in a non-regulatory assessment of their infection prevention program and practices. The ICAR team will not share individual assessment documentation with the Division of Health Facility Survey & Field Operations unless an egregious violation is observed. The visit is a collaboration between the ICAR team, local health department, and your facility team members to improve infection prevention practices. Your participation will make invaluable contributions towards the health and safety of the residents of New Jersey.

icar FlyerDuring the visit, ICAR team will:

  • Provide infection prevention self-assessment tools and resources to HCFs
  • Facilitate discussions with facility leadership to assess infection prevention practices and program activities using CDC’s standardized tool
  • Detect infection prevention gaps through on-site observations
  • Share best practices identified nationally and locally
  • Bolster outbreak response and reporting preparedness
  • Coordinate a post-assessment follow-up to provide additional resources

Facilities interested in assessing their infection prevention programs and partnering with the ICAR team can contact ICAR Infection Preventionist, Jessica Felix, BSN, RN, CIC at 609-826-5964 or Jessica.Felix@doh.nj.gov for more information.

For questions or concerns regarding the ICAR initiative or any other healthcare associated infections program please contact Healthcare Associated Infections Coordinator, Jason Mehr, MPH, CIC at 609-826-5964 or Jason.Mehr@doh.nj.gov.

The general guide to an ICAR assessment

Frequently asked questions

Please direct any further questions to ICAR Infection Preventionist, Jessica Felix, BSN, RN, CIC at 609-826-5964 or by email at Jessica.Felix@doh.nj.gov for more information.


Acute Care Hospitals

HAIs are infections patients can get while receiving medical treatment in a healthcare facility. HAIs are a major threat to patient safety, yet often times they are preventable. Together with healthcare and public health partners, the CDC is working to bring increased attention to HAI prevention.

 Vital SignsAlthough significant progress has been made in preventing some infection types, much work remains to be done. On any given day, about one in 25 hospital patients has at least one healthcare associated infection. 1

CDC’s HAI Progress Report is a snapshot of how each state and the country are doing in eliminating HAIs. CDC, states, healthcare facilities, and other patient safety organizations use this data to identify problem areas, measure progress of prevention efforts, and ultimately eliminate HAIs. From 2013 to 2014, among New Jersey acute care hospitals, the most recent HAI Progress Report (2014 data, published 2016) found:

  • 4% decrease in central line-associated bloodstream infections (CLABSI)
  • 6% increase in overall catheter-associated urinary tract infections (CAUTI)
  • 19% increase in abdominal hysterectomy (HYST) surgical site infections (SSI)
  • 10% decrease in colon surgery (COLO) SSI
  • 5% decrease in laboratory identified hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections
  • 3% decrease in hospital-onset Clostridium difficile (C. difficile) infections

For additional information on New Jersey reporting laws and the annual Hospital Performance Reports click here.

It is recommended that at a minimum, all acute care hospitals review the appropriate ICAR assessment tool and perform a self-assessment for internal performance improvement.

For more information from the U.S. Department of Health and Human Services on HAI prevention click here.

(1) Centers for Disease Control and Prevention (CDC). HAI Data and Statistics. CDC website 2016. Available at http://www.cdc.gov/hai/surveillance/

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Long Term Care Facilities

imageLong term care (LTC) facilities provide a variety of medical and non-medical services to people who have a chronic disease or disability. These settings may include but are not limited to: nursing homes, skilled nursing, inpatient rehabilitation, assisted living, hospice, senior day care services, and long term acute care hospitals.

There are many special considerations for infection prevention in the LTC setting. These include:

  • 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 long term care with some frequency, so appropriate communication of medical history, including antibiotic use, devices, past infections, and risk factors is critical. The New Jersey Universal Transfer form can be downloaded here.
  • Scientific literature on the prevalence of HAI and evidence-based prevention practices in these settings is limited.

It is recommended that at a minimum, all LTC facilities review the appropriate ICAR assessment tool and perform a self-assessment for internal performance improvement.

For more information from CDC on LTC HAI prevention click here. Additional information on control measures can be reviewed

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Hemodialysis Centers

Patients who undergo hemodialysis have an increased risk of getting a HAIs. Of particular concern in the hemodialysis setting is the fact that Hepatitis B and C viruses can live on surfaces like hemodialysis chairs and machines and can be spread even with no visible blood. The understanding and implementation of basic infection control in routine practice is imperative to reducing HAIs in the hemodialysis setting.

The CDC has released new infection prevention tools on injectable medication preparation and administration intended specifically for hemodialysis centers. These new tools expand the set of existing audit tools and checklists to help outpatient hemodialysis healthcare workers adhere to CDCs recommended practices.

Centers for Disease Control and Prevention's Dialysis Infection Prevention Tools.Available prevention tools from CDC include:

  • CDC’s Core Interventions for Dialysis BSI Prevention
  • Hemodialysis Task Specific Audit Tools and Checklists
  • Hemodialysis Central Venous Catheter Scrub-the-Hub Protocol
  • Hemodialysis Station Routine Disinfection Audit Tool, Checklist, and Notes for Clinical Managers
  • Training Video and Print Resources for Preventing Bloodstream and Other Infections in Outpatient Hemodialysis Patients
  • Key areas for Patient Education
  • Recommended Staff Competencies

It is recommended that, at a minimum, all hemodialysis centers review the appropriate ICAR assessment tool and perform a self-assessment for internal performance improvement.

For more information from CDC on dialysis safety, click here.

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Outpatient Facilities

Outpatient Care ProvidersOutpatient facilities provide a wide variety of healthcare services without an overnight stay. The term "outpatient", which may also be used interchangeably with the term “ambulatory care”, encompasses a large variety of healthcare settings that include but are not limited to physician offices, urgent care centers, hemodialysis centers, ambulatory surgical centers, cancer clinics, imaging centers, endoscopy clinics, and public health clinics.

In the past, the risk of acquiring HAIs 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 the hospital setting to the outpatient settings. An increasing frequency of invasive procedures and advanced technology further increases the risk of HAIs.1,2

It is recommended that at a minimum, all outpatient settings review the appropriate ICAR assessment tool and perform a self-assessment for internal performance improvement.

For more information on outpatient settings, click here.

(1) Centers for Disease Control and Prevention (CDC). Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care. CDC website. 2011. Available at http:/www.cdc.gov/hai/pdfs/guidelines/ambulatory-care-04-2011pdf and
(2) Friedman C, Petersen K, Infection Control in Ambulatory Care (APIC). Boston. Jones and Bartlett, 2004.

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Last Reviewed: 10/13/2017