healthcare-Associated Infections (HAI) program
Outbreak Investigation & Response
The CDPH HAI Program has assembled a list of resources to assist LHDs and healthcare facilities (HCF) conducting an HAI Investigation. These resources have been developed by the Centers for Diseases Control and Prevention (CDC), the California Department of Public Health’s Healthcare-Associated Infections (CDPH HAI) Program, national professional societies (e.g., the Society for Healthcare Epidemiology of America (SHEA), and the Council for Outbreak Response: Healthcare-Associated Infections and Antimicrobial-Resistant (AR) Pathogens (CORHA).
These resources can be used by health departments and healthcare facilities working to build, standardize or improve capacities and practices related to HAI/AR outbreak detection, reporting, investigation, and control and prevention activities. The CDPH HAI Program is available to provide technical assistance and consult on HAI infections and outbreaks.
Resources
Public health authority
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AFL 23-08. Requirements to Report Outbreaks and Unusual Infectious Disease Occurrences Includes definitions, examples, and links to CORHA definitions.
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Title 42 Code of Federal Regulations (CFR) section 482.42: Condition of Participation: Infection prevention and control and antibiotic stewardship programs
- Title 17 California Code of Regulations (CCR) sections 2500-2502: Healthcare Providers and Laboratories must report to LHD
- Title 22 CCR sections 70737,70739, 72523, 72539, and 72541: Healthcare Facilities must report to LHD and their CDPH L&C District Office
- CDPH Reportable Diseases and Conditions
General approach to HAI investigations: Sentinel Cases, Clusters, Outbreaks, Infection Control Breaches
- CDC TRAIN Healthcare Outbreak Response Training Course
- CDC Steps for Evaluating an Infection Control Breach
- CORHA Principles and Practices of Outbreak Response; Suppl B: Infection Control Breach Investigations (PDF); Toolkits for HAI Investigations
- SHEA Outbreak Response and Incident Management: SHEA Guidance and Resources for Healthcare Epidemiologists in United States Acute-Care Hospitals. Infect Control Hosp Epidemiol. 2017 Dec; 38(12): 1393–1419.doi: 10.1017/ice.2017.212
CDPH HAI Program Quicksheets and Guidance
- C. auris Investigation and Response Quicksheet (PDF) Printable Version (PDF)
- Carbapenemase-Producing Organisms Quicksheet (PDF)
- C. difficile Infection (CDI) Quicksheet (PDF)
- Healthcare-Associated Hepatitis B and C (HBV/HCV) Investigation Quicksheet Algorithm (PDF)
- Healthcare-Associated Legionnaires’ Disease Investigation Quicksheet (PDF)
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CDPH Recommendations for Prevention and Control of COVID-19, Influenza, and Other Respiratory Viral Infections in California Skilled Nursing Facilities - 2023-24 (PDF)
- Guidance for Face Coverings as Source Control in Healthcare Settings
- Please visit
CDPH Immunization Branch for more Disease Information and Report
Healthcare-Associated Pathogens, Clusters, and Outbreaks
- CDC Diseases and Organisms in Healthcare Settings
- CORHA Resources and Products; Toolkits for HAI Investigations
CDPH AR pathogens
Acute Viral Respiratory Outbreaks (influenza, SARS CoV-2, RSV)
- CDPH Recommendations for Prevention and Control of COVID-19, Influenza, and Other Respiratory Viral Infections in California Skilled Nursing Facilities- 2023-24 (PDF)
- CDC Preventing Transmission of Viral Respiratory Pathogens in Healthcare Settings | Infection Control
- CDC Interim Guidance for Influenza Outbreak Management in Long-Term Care and Post-Acute Care Facilities
- CDC Testing and Management Considerations for Nursing Home Residents with Acute Respiratory Illness Symptoms when SARS-CoV-2 and Influenza Viruses are Co-circulating
- CDC Viral Respiratory Pathogens Toolkit for Nursing Homes
- CDPH Influenza and Respiratory Illness Outbreak Quicksheet (PDF)
Acute Gastrointestinal Outbreaks (norovirus)
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CDC Norovirus Prevention and Control Guidelines for Healthcare Settings, 2011 and
2017 Updates
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Key Infection Control for Norovirus in Healthcare Settings (PDF)
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LA County Norovirus toolkit for SNF 2023 (PDF)
Acute Gastrointestinal (GI) - Illness and Outbreaks in healthcare (not norovirus)
- CDC C. difficile
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CDPHC. difficile Infection (CDI) Quicksheet (PDF)
- SHEA Strategies to prevent C. difficile infections in acute-care hospitals: 2022 Update
Acute Viral Hepatitis B and C: Healthcare-Associated Outbreak Investigations
Scabies
- CDPH Prevention and Control of Scabies in California Health Care Settings, August 2020 (PDF)
- CDPH Scabies
- CDC Scabies in Institutional Settings
- LA County Scabies Toolkit: Healthcare Settings
- For other ectoparasites infections refer to CDPH Vector-Born Disease Branch
Invasive Group A Streptococcal Disease (iGAS) Post-Partum, Post-Surgical, and in Long-Term Care
- CDPH Invasive Group A Streptococcus (iGAS) (PDF)
- CDC Invasive Group A Streptococcus Infection in Long-Term Care Facilities
- Prevention of Invasive Group A Streptococcal Disease Among Household Contact of Case Patients and among Postpartum and Postsurgical Patients: Recommendations from the Centers for Disease Control and Prevention. Clin Infect Dis 2002; 35(8): 950-59.
Water-Associated Pathogens in Healthcare (Legionella, Pseudomonas, Non-Tuberculous Mycobacterium (NTM), and others)
- Healthcare-Associated Legionnaires’ Disease Investigation Quicksheet (PDF)
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Legionella - Healthcare Investigation Resources
- CDC HAI Reduce Risk from Water (See links to tools including: Water Infection Control Risk Assessment (WICRA), Water Management Plan checklists)
- CORHA Water Associated Organisms, including Burkholderia and Nontuberculous Mycobacteria (NTM)
Environmental Fungi in Healthcare Settings
- CDC Investigating Fungal Disease Outbreaks
- CDC Healthcare-Associated Mold Outbreaks
- Sample line list for
investigating healthcare-associated mold outbreaks (Excel)
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A Guide to Investigating Suspected Outbreaks of Mucormycosis in Healthcare
- Targeted Environmental Investigation Checklist for Environmental Molds (e.g., Aspergillus, Mucormycetes) (PDF)
- Keeping health care linens clean: Underrecognized hazards and critical control points to avoid contamination of laundered health care textiles.
- CORHA Environmental Molds
Occupational Health Resources
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CDC Infection Control in Healthcare Personnel
- Infrastructure and Routine Practices for Occupational Infection Prevention and Control Services
- Epidemiology and Control of Selected Infections Transmitted Among Healthcare Personnel and Patients
- Healthcare Provider Vaccinations
- ACIP recommendations: Immunization of Healthcare Personnel
- CDPH Immunization Recommendations for Healthcare Personnel (PDF)
- Occupationally Acquired Infections in Healthcare Settings
- Cal-OSHA, Title 8, Section 5193, California Code of Regulations
- Cal-OSHA, Title 8, Section 5199, California Code of Regulations
- Management of HCP Occupational Exposures to HIV, HBV, and HCV: National Clinician Consultation Center: Post-Exposure Prophylaxis
Other HAI Investigation Resources
- CDPH Core Infection Prevention Strategies and SHEA Compendium
- CDPH resources and tools for investigating HAI outbreaks in different healthcare settings
- Medical products - CORHA Considerations for Medical Product-Related Infections
- Patient notification resources from CDC and CORHA
- CDC-led Outbreak Investigations in Healthcare Settings: Recent examples and Safety Alerts
Other Communicable Diseases in Healthcare Settings
Tuberculosis
- CDPH Tuberculosis
- CDC Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, MMWR 2005 (PDF)
Measles
- CDC Interim Infection Prevention and Control Recommendations for Measles in Healthcare Settings
- Please visit CDPH Immunization Branch Disease Information and Report
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