Master's Project Title:

Surveillance and Infection Prevention in Minnesota Healthcare Facilities (Executive Summary)

MCH Student:

Jason Foss

Date of Defense:

April 26, 2019


Introduction: Healthcare-associated infections (HAIs) and antibiotic resistance are public health problems that can affect all people, especially the most vulnerable populations. Healthcare-associated infections are infections that are acquired while receiving healthcare. These include, but are not limited to, central line-associated blood infections, catheter-associated urinary tract infections, ventilator-associated infections, and surgical site infections (CDC, 2019). The elderly, immunocompromised, and children are especially at risk for acquiring these infections during stays at inpatient settings or visits to outpatient clinics. Minnesota is known to have high quality healthcare systems and remarkable state and local health departments, but Minnesotans are still at risk of acquiring antibiotic resistant infections from healthcare facilities as well as their communities. On any given day, about one in 31 hospital patients will have at least one healthcare-associated infection (CDC, 2019) and the United States experiences about 2 million hospital-acquired infections each year (CIDRAP, 2019). Of those younger than one year, children residing in neonatal or pediatric intensive care units have higher rates of healthcare-acquired infections than those that are not (Revelas, 2012). These statistics fail to include infections from skilled nursing facilities and outpatient clinics, which would elevate the total number of healthcare-associated infections. With this public health concern in mind, it is important for healthcare professionals, hospital administrators, and other medical personnel to take proper precaution when treating and working alongside healthy children and those with antibiotic resistant infections.

Organization: As a part of the Healthcare-Associated Infections and Antibiotic Resistance (HAIAR) team at the Minnesota Department of Health, I was given the opportunity to assist in the Multi-site Gram-negative Surveillance Initiative (MuGSI). MuGSI is an epidemiological surveillance service, funded in eight states, that aims to evaluate population-based incidence of certain carbapenem-resistant organisms (CROs). The program also seeks to understand characteristics and risk-factors related to CROs and describe resistance mechanisms among the CRO isolates (CDC, 2018). There are many healthcare-associated infections, but our team specifically focuses on six species of bacteria: Pseudomonas aeruginosa, Enterobacter Cloacae, Enterobacter aerogenes, Klebsiella pneumoniae, Klebsiella oxytoca, Escherichia coli, and Acinetobacter baumannii. I participated in this by reviewing intake from local hospital laboratories to determine whether gram-negative bacteria would be considered resistant to carbapenems, a type of last-resort antibiotic, based on guidelines from the Centers for Disease Control and Prevention. If an organism was determined to be resistant, and fit the criteria for a MuGSI case, I would look over patient medical records to find certain healthcare characteristics and underlying conditions that may have led them to acquire the infection. This information is used by the Centers for Disease Control and Prevention to discover the causes of antibiotic resistant infections, and to formulate protocols to reduce these infections in the future.

Experience: Throughout my time with the HAIAR team, I’ve been able to review information from all populations, including pediatric cases. Although children are generally very healthy, pediatric antibiotic resistant infections still arise in Hennepin and Ramsey counties. Pseudomonas aeruginosa infections can occur in children that have tracheostomies or are reliant on invasive devices like mechanical ventilators (MDH, 2019). These infections can lead to pneumonia and become resistant as children receive more antibiotics. After learning about the risks associated with contracting carbapenem-resistant organisms through reviewing medical records, I was able to communicate with infection preventionists, typically registered nurses experienced in infectious disease, and review literature about how to prevent healthcare-associated infections. Working with an interdisciplinary public health team provided me insight into how policies can be formed to help educate healthcare personnel in the most efficient ways to prevent antibiotic resistant infections from spreading.

The Minnesota Department of Health is a large, state-level government organization with the mission to improve the health of all Minnesotans. The health department has a few goals that resonate with the HAIAR team: “Individuals and organizations in Minnesota understand how to prevent disease”, “Individuals and organizations in Minnesota practice disease prevention”, and “Disease threats are quickly detected and contained.” I was able to assist in these goals by communicating with healthcare facilities about carbapenem-resistant infections and explaining the information that is necessary to report. I worked alongside epidemiologists to acquire the information and data necessary to assess outbreaks and provide healthcare facilities with resources to prevent future infections.

This position with the HAIAR team has taught me about healthcare systems and their interactions with the government. There needs to be a strong relationship between healthcare faculty and state health departments in order to keep communities not only safe from disease, but allow people to interact without the worry that they or their children will become ill. After speaking with infection preventionists and reviewing literature, there needs to be a fine balance between preventing infections in children and letting them interact in healthcare settings. Healthcare facilities must allow children to socialize in clinics and hospitals in order for them to develop, especially when they are chronically ill (Moore, 2018). Healthcare professionals must be well-educated on infection prevention so they can allow children to learn from and interact with other children, but can also identify a child that needs to be separated immediately to stop the spread of disease. This important job is for healthcare professionals, the health department, and parents, so all must be educated to save the lives of others.

Conclusion: Overall, the HAIAR unit does a tremendous job of acquiring information and helping to prevent the spread of disease in Minnesota facilities. I believe that they should seek more information from pediatric patients when reviewing medical records, and this burden falls on both the health department and the healthcare providers. Medical records should hold as much information as possible, but there are time constraints for both parties. The Minnesota Department of Health should ask additional questions about family health history to determine whether there are more risk factors for carbapenem resistant organisms than is known. Although this suggestion may be far from becoming a reality, I believe individuals should have their microbiomes mapped during healthcare appointments to determine other risk factors that may be related to acquiring disease.

Surveillance of infectious disease is an important sector of public health that is often overlooked in the United States because of the mass increase in chronic diseases. Many antibiotic resistant organisms can be deadly for vulnerable populations, and it is the duty of health departments and healthcare providers to work together to create healthier communities and provide safer facilities for patients. Children must be protected, so it is vital that we continue to search for risk factors for carbapenem-resistant infections and study how to prevent them.



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CDC. (2018). MuGSI | HAIC | HAI. Retrieved from

CIDRAP. (2019). Overuse and overprescribing of antibiotics. Retrieved from

Minnesota Department of Health. (2019). About Carbapenem-resistant Pseudomonas

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Moore, D. L. (2018). Infection prevention and control in paediatric office settings. Paediatrics &

Child Health, 23(8). doi: 10.1093/pch/pxy117

Revelas, A. (2012). Healthcare – associated infections: a public health problem. Nigerian

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