Healthcare Associated Infections and Antimicrobial Resistance

Dashboards

The Healthcare-Associated Infections (HAI) Program provides interactive dashboards to support infection prevention, reporting transparency, and quality improvement efforts statewide. These dashboards display selected HAI and related data reported by healthcare facilities to the National Healthcare Safety Network (NHSN), enabling comparison across facilities and alignment with public health goals.

Dashboards help healthcare professionals, facility leadership, policymakers, researchers, and members of the public better understand and act on key performance indicators for infection prevention and control.

HAI/Antimicrobial Resistance (HAI/AR) Dashboard

The HAI/AR Dashboard provides an annual overview of how individual healthcare facilities in Tennessee compare to national standards for selected healthcare-associated infections and antimicrobial resistance indicators.

This dashboard may be used to:

• Compare facility performance to national benchmarks
• Review trends in HAI and antimicrobial resistance
• Support infection prevention and quality improvement planning
• Increase transparency in healthcare performance reporting

Data are based on facility submissions to NHSN and are typically updated annually in late November.

Healthcare Personnel Influenza Vaccination Dashboard

The Healthcare Personnel (HCP) Influenza Vaccination Dashboard displays facility-level influenza vaccination coverage among healthcare personnel in Tennessee acute care hospitals.

Healthcare personnel are at increased risk of contracting and transmitting influenza. Annual influenza vaccination is recommended to protect healthcare staff, patients, and communities.

This dashboard compares facility vaccination rates to the Healthy People target of 90 percent coverage.

Facilities are categorized as:

• Met – Vaccination coverage is 90 percent or higher
• Not Met – Vaccination coverage is below 90 percent

Data reflect the most recent available reporting period submitted through NHSN.

Candida auris Dashboard

The Candida auris Dashboard provides statewide surveillance data on Candida auris (C. auris), an emerging multidrug-resistant fungal pathogen that spreads in healthcare settings.

This dashboard displays:

• Combined clinical and screening C. auris case counts
• Regional distribution of cases across Tennessee
• Recent surveillance year trends

Monitoring C. auris supports infection prevention planning, containment strategies, and antimicrobial resistance response efforts.

Reporting & Compliance

Certain Tennessee healthcare facilities are required to report healthcare-associated infections (HAIs) and related events to the Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network (NHSN).

Reporting requirements vary by facility type and event. All required data must be submitted using the NHSN web application and follow CDC/NHSN case definitions and protocols.

For assistance with reporting requirements or NHSN enrollment, contact HAI.Health@tn.gov.

Reporting Requirements by Facility Type

Acute Care Hospitals

(Excludes Critical Access Hospitals unless otherwise specified)

Acute care hospitals must report the following:

Central Line-Associated Bloodstream Infections (CLABSI)

Report from:

• Adult and pediatric ICUs (including burn and trauma units)
• Neonatal ICUs (Level 2/3 and Level 3)
• Adult and pediatric medical, surgical, and medical-surgical wards

Data Required:

• Numerator: CLABSIs meeting CDC/NHSN case definition
• Denominator: Patient days and central line days

Resources:

NHSN Surveillance Reporting Overview

CLABSI NHSN Protocol

CLABSI Protocol Training

CLABSI Numerator Form

CLASBI Numerator Form Instructions

CLABSI Denominator Form (NICU)

CLASBI Denominator Form Instructions (NICU)

CLASBI Denominator Form (not NICU or SCA)

CLASBI Denominator Form Instructions (not NICU or SCA)

CDC Location Descriptions

Catheter-Associated Urinary Tract Infections (CAUTI)

Report from:

• Adult and pediatric ICUs
• Adult and pediatric medical, surgical, and medical-surgical wards

Data Required:

• Numerator: CAUTIs meeting CDC/NHSN definition
• Denominator: Patient days and urinary catheter days

Resources:

NHSN Surveillance Reporting Overview

CAUTI NHSN Protocol

CAUTI Protocol Training

CAUTI Numerator Form

CAUTI Numerator Form Instructions

CAUTI Denominator Form

CAUTI Denominator Form Instructions

CDC Location Descriptions

Surgical Site Infections (SSI)

Procedures Required for Reporting:

• Coronary artery bypass graft (CBGB/CBGC)
• Colon procedures
• Abdominal hysterectomy procedures

Data Required:

• Procedure numerator data
• Procedure denominator data

Resources:

NHSN Surveillance Reporting

SSI NHSN Protocol

SSI Protocol Training

SSI Numerator Form

SSI Numerator Form Instructions

SSI Denominator Form

SSI Denominator Form Instructions

ICD-10-PCS/CPT Code Reference File

Importing Procedures Into NHSN

MRSA Bacteremia (Laboratory-Identified Events)

Report from:

• Facility-wide inpatient locations
• Emergency departments
• 24-hour observation locations

Data Required:

• Non-duplicate MRSA-positive blood cultures
• Denominator: Patient days, admissions, ED/observation encounters

Resources:

NHSN Surveillance Reporting

MDRO NHSN Protocol

MDRO Protocol Training

MRSA Numerator Form

MRSA Numerator Form Instructions

MRSA Denominator Form

MRSA Denominator Form Instructions

Clostridioides difficile Infection (CDI)

Report from:

• Facility-wide inpatient locations (excluding NICUs, well baby nurseries, and well baby clinics)
• Emergency departments
• 24-hour observation locations

Data Required:

• Non-duplicate positive laboratory assays (LabID events)
• Denominator: Patient days, admissions, ED/observation encounters

Resources:

NHSN Surveillance Reporting

MDRO/CDI NHSN Protocol

MDRO/CDI Protocol Training

CDI Numerator Form

CDI Numerator Form Instructions

CDI Denominator Form

CDI Denominator Form Instructions

Healthcare Personnel Influenza Vaccination

Acute care hospitals must report healthcare personnel (HCP) influenza vaccination data through the NHSN Healthcare Personnel Safety (HPS) Component.

Reporting Period:

• July 1 – March 31
• Submission deadline: May 15

Facilities Required to Report:

• Acute care hospitals
• Long-term acute care hospitals
• Inpatient rehabilitation facilities
• Outpatient hemodialysis facilities
• Inpatient psychiatric facilities

Personnel Groups:

• Employees
• Licensed independent practitioners
• Adult students, trainees, and volunteers
• Optional: Other contract personnel

Vaccination Status Categories:

• Vaccinated at facility
• Vaccinated elsewhere
• Medical contraindication
• Declination
• Unknown

Resources:

NHSN Surveillance Reporting Overview

HCP Influenza Vaccination NHSN Protocol

HCP Influenza Vaccination Protocol Training

Healthcare Personnel Influenza Reporting Plan

Influenza Vaccination Summary Form

Long-Term Acute Care (LTAC) Hospitals

Required to report:

• CLABSI (all inpatient locations)
• CAUTI (all inpatient locations)
• Ventilator-Associated Events (VAE) – adult inpatient locations
• MRSA bacteremia (facility-wide)
• CDI (facility-wide, with standard exclusions)
• Healthcare Personnel Influenza Vaccination

Ventilator-Associated Events (VAE)

Mechanical ventilation is an essential, life-saving therapy for patients with critical illness and respiratory failure. However, patients receiving mechanical ventilation are at increased risk for complications and poor outcomes, including death.

In Tennessee, Ventilator-Associated Events (VAE) have been reportable since January 1, 2016, from all adult inpatient locations within long-term acute care hospitals (LTACs).

Facilities Required to Report

• All long-term acute care facilities (LTACs)

Units Required to Report

• All adult inpatient locations

Required Data

Numerator:

• Ventilator-associated events meeting CDC/NHSN case definitions

Denominator:

• Patient days

• Ventilator days

Reporting Method

All VAE data must be submitted through the CDC National Healthcare Safety Network (NHSN) web application.

VAE Reporting Resources

NHSN Surveillance Reporting Overview

VAE NHSN Protocol

VAE NHSN Protocol Training

Forms

VAE Numerator Form

Numerator Form Instructions

VAE Denominator Form

ICU and Other Locations (not NICU or SCA) Form Instructions

CDC Location Descriptions

Inpatient Rehabilitation Facilities (IRFs)

Required to report:

• CAUTI (all inpatient locations)
• MRSA bacteremia (facility-wide)
• CDI (facility-wide, with standard exclusions)
• Healthcare Personnel Influenza Vaccination

Outpatient Hemodialysis Facilities

All outpatient hemodialysis facilities in Tennessee, including hospital-based and freestanding centers, are required to report specific events through the CDC’s National Healthcare Safety Network (NHSN).

Dialysis Events

Outpatient hemodialysis facilities must report Dialysis Events monthly through NHSN.

Required Numerator Data

• Intravenous antimicrobial starts
• Positive blood cultures
• Signs of vascular access infection (e.g., redness, swelling, drainage)

Required Denominator Data

• Number of dialysis outpatients (first two working days of the month)
• Stratified by vascular access type

Reporting Resources

Facilities should use the following NHSN guidance and materials to ensure accurate reporting:

NHSN Surveillance Reporting Overview

Dialysis Event NHSN Protocol

Dialysis Event NHSN Protocol Training

Dialysis Event Forms

Numerator Reporting

Dialysis Event Numerator Form

Numerator Form Instructions

Denominator Reporting

Dialysis Event Denominator Form

Denominator Form Instructions

Healthcare Personnel Influenza Vaccination for Outpatient Hemodialysis Facilities

Outpatient hemodialysis facilities are required to report healthcare personnel (HCP) influenza vaccination data through the NHSN Healthcare Personnel Safety (HPS) Component beginning with the 2015–2016 influenza season.

Reporting Period

• July 1 – March 31
• Submission deadline: May 15

Report the Following Personnel Groups

• Employees
• Licensed independent practitioners
• Adult students, trainees, and volunteers

Vaccination Status Categories

• Vaccinated at the facility
• Vaccinated elsewhere
• Medical contraindication
• Declination
• Unknown

Reporting Resources

Facilities should use the following NHSN guidance and materials to ensure accurate reporting:

NHSN Surveillance Reporting Overview

HCP Influenza Vaccination NHSN Protocol

HCP Influenza Vaccination NHSN Protocol Training

Healthcare Personnel Influenza Reporting Plan

Healthcare Personnel Influenza Vaccination Summary Form

How to Report

All required events must be reported through the CDC National Healthcare Safety Network (NHSN) web application.

Facilities must follow CDC/NHSN case definitions, reporting protocols, and submission timelines for each event type.

Need Assistance?

For questions regarding:

• NHSN enrollment
• Reporting requirements
• Event definitions
• Form completion
• Submission deadlines

Contact the TDH HAI Program:

Email: HAI.Health@tn.gov

Please include your facility name and the event type in your message.

Surveillance & NHSN

The TDH Healthcare-Associated Infections (HAI) Program supports healthcare facilities in reporting and surveillance activities through the Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network (NHSN). Educational opportunities, user calls, and annual training sessions are offered to assist facilities in accurate reporting, data interpretation, and infection prevention efforts.

NHSN User Calls - 2025

Monthly NHSN User Calls provide updates, reporting guidance, and time for questions related to surveillance and NHSN submission.

• October 2025 - [slides] [video]
• September 2025 - [slides] [video]
• August 2025 - [slides] [video] [CDC Line List Template]
• July 2025 - [slides] [video]
• June 2025 - [slides] [video]
• May 2025 - [slides] [video]
• April 2025 - [slides] [video]
• March 2025 - [slides] [video]
• February 2025 - [slides] [video]
• January 2025 - [slides] [video recording not available]

NHSN Annual Training – 2025

The 2025 NHSN Annual Training sessions provide in-depth review of event definitions, reporting expectations, and data analysis guidance.

• CLABSI & CAUTI Events - [slides] [recording]
• MRSA & CDI Events - [slides] [recording]
• SSI Events - [slides] [recording]
• AUR Module - [slides] [recording]
• VAE & PedVAE - [slides] [recording]
• Data Analysis - [slides] [recording]

Archived Materials

Archived NHSN User Calls and Annual Training materials from prior years are available upon request.

To request archived materials, please contact:

Email: HAI.Health@tn.gov

Please include the year and topic in your request.

Stewardship & Antibiogram

The Tennessee Healthcare-Associated Infections and Antimicrobial Resistance (HAI/AR) Program supports antimicrobial stewardship efforts across healthcare settings. These initiatives promote responsible antibiotic use, reduce antimicrobial resistance, and improve patient outcomes through data-driven tools, education, and collaboration.

Antimicrobial Stewardship

Antimicrobial stewardship programs help ensure antibiotics are used appropriately—prescribing the right medication, at the right dose, for the right duration. Effective stewardship reduces unnecessary antibiotic use, prevents resistance, and improves patient safety.

The HAI/AR Program supports stewardship efforts through surveys, educational webinars, toolkits, and statewide data reporting.

Antimicrobial Use Survey

The Antimicrobial Use Survey was developed by the Tennessee Department of Health to collect data on antimicrobial usage in:

• Acute care hospitals
• Long-term care facilities

The survey gathers information on the number of residents or patients who received at least one dose of specified antimicrobials during the 24 hours before the survey date. Data are standardized using the facility census on the survey day.

Participation Details

• Facilities submit data monthly through a secure survey link.
• Data collection typically takes 10–30 minutes to generate and 5–10 minutes to enter.
• Each quarter, participating facilities receive a personalized report showing:
  • Trends in antibiotic use over time
  • Comparison with other participating facilities
  • Simple tables and graphs for interpretation

These quarterly reports are provided at no cost.

Long-Term Care Antimicrobial Use Survey:
https://redcap.health.tn.gov/redcap/surveys/?s=93YTLTDMDL

For questions about participation, contact HAI.Health@tn.gov.

Tennessee Antimicrobial Steward Call

The Tennessee Antimicrobial Steward Call is held on the second Tuesday of every other month via webinar (one hour).

The call provides:

• Practical guidance on stewardship interventions
• Discussion of statewide antimicrobial use data
• Peer learning opportunities
• A forum for stewardship pharmacists and healthcare professionals

To suggest a topic, volunteer to present, or request webinar details, contact HAI.Health@tn.gov.

2025 Steward Call Materials

• February – Slides | Video
• April – Slides | Video
• June – Slides | Video
• August – Slides | Video

Archived slides and recordings from previous years are available upon request.

Dialogue Around Respiratory Illness Treatment (DART)

The Dialogue Around Respiratory Illness Treatment (DART) program provides evidence-based communication strategies to help healthcare providers discuss respiratory illness treatment with patients. These tools support providers in explaining when antibiotics are not appropriate while maintaining patient satisfaction and trust.

DART focuses on improving patient-provider conversations and reducing unnecessary antibiotic prescribing in outpatient settings.

Learn more about the DART program:
https://www.uwimtr.org/dart/

(External website. Accessibility and content are managed by the University of Wisconsin–Madison Institute for Medical Research.)

Centers for Disease Control and Prevention (CDC) Resources

(External links – accessibility and content managed by the CDC)

CDC Core Elements of Antibiotic Stewardship (Outpatient)

Be Antibiotics Aware Partner Toolkit

CDC Trainings on Antibiotic Stewardship (10 hours of free continuing education credit)

Agency for Healthcare Research and Quality (AHRQ) Resource

(External link – accessibility and content managed by AHRQ)

4 Moments of Antibiotic Decision Making

Tennessee Statewide Antibiogram

An antibiogram is a report that shows how bacteria and fungi respond to specific antibiotics and antifungal medications. It helps clinicians choose the most effective treatment for infections by showing which medications are most likely to work.

The Tennessee HAI/AR Program publishes statewide and regionwide antibiograms to support empirical treatment decisions—particularly when facility-specific antibiograms are unavailable.

This antibiogram:

• Follows Clinical and Laboratory Standards Institute (CLSI) M39, 5th Edition guidelines
• Was developed by the HAI/AR antimicrobial stewardship team
• Includes antimicrobial susceptibility data reported as final interpretations:
  • Susceptible
  • Intermediate
  • Resistant
  • Non-susceptible
  • Not tested

• Uses data submitted to the NHSN Antimicrobial Resistance (AR) Option from 2017 to 2023
• Allows users to visualize trends in antimicrobial resistance over time

Antibiograms are essential tools for guiding empirical antimicrobial therapy and supporting data-driven clinical decision-making.

View the Tennessee Statewide Antibiogram:
https://healthdata.tn.gov/stories/s/pz92-gr5r

Candida auris (C. auris)

Candida auris (C. auris) is an emerging fungal pathogen that spreads in healthcare settings and is often multidrug-resistant. The Centers for Disease Control and Prevention (CDC) considers C. auris an urgent public health threat due to its ability to cause serious infections and outbreaks in healthcare facilities.

The TDH Healthcare-Associated Infections (HAI) Program provides guidance for facilities, providers, patients, and families to support prevention, screening, and reporting.

Guidance for Healthcare Facilities and Providers

Healthcare facilities play a critical role in identifying, preventing, and reporting Candida auris.

• LTCF Acceptance of Candida auris (C. auris) Colonized Residents (2023)
• Information for Facilities Considering Colonization Screening (2023)

Resources for Facilities and Providers

External link disclaimer: Some links in this section take you to websites outside the Tennessee Department of Health. The department is not responsible for the content of external websites.

CDC Candida auris Resource Page

Candida auris – Managing Patients and Residents (2022)

Infection Prevention: A CDC Message to Infection Preventionists

Candida auris 2023 Case Definition

CSTE: Update to the Standardized Case Definition and National Notification for Candida auris

Candida auris: A Guide for Healthcare Facilities (2022)

EPA Disinfection Products Effective Against C. auris (List P)

Information for Patients and Families

The following resources provide plain-language information about Candida auris:

External link disclaimer: The links in this section take you to websites outside the Tennessee Department of Health. The department is not responsible for the content of external websites.

CDC Candida auris Fact Sheet

Candida auris Colonization: Information for Patients and Family Members

Candida auris Testing: What to Expect if You Need to Be Tested

Additional Educational Resources

Archived content notice: Materials listed below are archived. Archived materials are provided for historical and educational purposes and may not reflect current guidance.

• Think Fungus: Candida auris (2022)
• What Is Fungal Disease? (2022)

Reporting Candida auris in Tennessee

Timely reporting helps prevent transmission and supports public health response efforts.

When Should I Report C. auris?

Healthcare facilities should report cases in accordance with Tennessee reportable disease requirements.

For additional reporting details, refer to the Reportable Disease Reference Guide.

How to Report

Cases may be reported using one of the following methods:

• Online reporting system
• Fax submission (2025)

Submitting a Specimen for Laboratory Testing

Facilities should follow the Tennessee Department of Health guidance for specimen submission and laboratory testing.

For reporting support or specimen submission questions, contact the HAI Program.

HAI Prevention Calculator

The HAI Prevention Calculator is a planning tool designed to help healthcare facilities prioritize healthcare-associated infection (HAI) prevention activities. It estimates how many infections would have needed to be prevented during a selected time period to reach a specified Standardized Infection Ratio (SIR).

This tool supports data-driven quality improvement efforts and helps facilities set realistic prevention goals.

Purpose of the Calculator

The HAI Prevention Calculator helps facilities:

• Evaluate infection prevention performance
• Identify improvement targets
• Estimate prevention impact
• Support strategic planning

Results are based on NHSN data entered by the user.

How to Use the HAI Prevention Calculator

Follow the steps below:

Step 1: Select a Time Period and HAI

Choose the time period you would like to evaluate (for example, a quarter or calendar year).

Select the HAI from the dropdown menu, or choose “Custom Target” to enter a target SIR.

Step 2: Retrieve Required Data from NHSN

Log into the CDC’s National Healthcare Safety Network (NHSN) and obtain the following information for the selected time period:

• Number of observed infections
• Number of predicted infections or the Standardized Infection Ratio (SIR)

Step 3: Review Data Retrieval Instructions (If Needed)

For assistance in obtaining your NHSN data, refer to:

• CLABSI and CAUTI guidance
• Surgical Site Infection (SSI) guidance (COLO, HYST, CABG)
• LabID Event guidance (MRSA, CDI)

Step 4: Enter Data into the Calculator

Enter the required values into the calculator fields.

Step 5: Compute Results

Click “Compute” to determine how many infections would have needed to be prevented to reach the selected or target SIR during the specified time period.

HAI Prevention Calculator

Important Information

• This calculator is provided for reference purposes only.
• Data entered into the calculator is not stored or shared with the Tennessee Department of Health.
• The accuracy of the results depends on the accuracy of the data entered.
• Facilities should ensure NHSN data are finalized and validated before using this tool.

Need Assistance?

For questions about using the HAI Prevention Calculator or retrieving NHSN data, contact:

Email: HAI.Health@tn.gov

Please include your facility name and the HAI type in your message.

Workforce & Resources

The TDH Healthcare-Associated Infections and Antimicrobial Resistance (HAI/AR) Program supports healthcare facilities across Tennessee through infection prevention expertise, workforce education, and practical tools. This section provides Infection Prevention team information, newsletters, and curated resources that support patient safety and infection control practices.

Infection Prevention Team

The HAI/AR Infection Prevention (IP) team helps minimize risk to patients and healthcare personnel across all types of healthcare settings. The team includes registered nurses, epidemiologists, and dialysis subject matter experts. Most Infection Preventionists hold Certification in Infection Control and Epidemiology (CIC).

What the Infection Prevention Team Does

Key responsibilities include:

• Investigating potential outbreaks
• Providing infection prevention guidance and consultation
• Delivering education and training
• Responding to inquiries submitted to HAI.Health@tn.gov
• Supporting facilities statewide as needed

Contact the Infection Prevention Team: HAI.Health@tn.gov

IP Insight Newsletter

The IP Insight Newsletter provides updates, education, and infection prevention guidance for healthcare professionals in Tennessee.

Archived content notice: Newsletter issues may be archived. Archived materials are provided for historical and educational purposes and may not reflect current guidance.

2025 Issues

• Issue 5: October [PDF]
• Issue 4: July [PDF]
• Issue 3: March [PDF]
• Issue 2: January [PDF]

2024 Issues

• Issue 1: October [PDF]

Workforce Recognition and Education

Environmental Services Week

September 14–20, 2025

Environmental Services Week is a time to recognize and thank environmental services (EVS) personnel for keeping healthcare facilities clean and safe for patients, families, and staff. EVS teams play an essential role in infection prevention by supporting effective cleaning and disinfection practices in healthcare environments.

EVS Week Resources (AHE)

External link disclaimer: You are now leaving the Tennessee Department of Health website. The department is not responsible for the content of external websites.

Environmental Services Week (AHE)

Clorox Healthcare: EVS Training Videos and Education Sheets

EVS Infection Prevention Podcast: Why EVS is the First Line of Defense in Infection Prevention (YouTube video)

Project Firstline EVS Cleaning & Disinfecting Job Aids

CDC Project Firstline Training Materials

Infection Prevention Practice Resources

Artificial Fingernails and Infection Risk

Artificial fingernails have been associated with outbreaks and transmission of pathogens in healthcare settings. The resources below provide education and research related to infection risks.

Education and Research

External link disclaimer: You are now leaving the Tennessee Department of Health website. The department is not responsible for the content of external websites.

Educate: Developing Knowledge and Skill in Hand Hygiene (YouTube)

Hemodialysis-related bacteremia cluster linked to artificial fingernails – PubMed

NICU outbreak of Pseudomonas aeruginosa and staff fingernails – PubMed

NICU outbreak of ESBL-producing Klebsiella pneumoniae linked to artificial nails – PubMed

Pathogenic organisms associated with artificial fingernails worn by healthcare workers – PubMed

CDC Clean Hands: Hand Hygiene for Healthcare Workers

WHO Guidelines on Hand Hygiene in Health Care

TDH Resource

• Artificial Nails Poster from TDH and THA (2023) [PDF]

Toolkits and Reference Materials

This section includes tools and resources that support infection prevention assessment and patient safety practices.

Drug Diversion Risk (CDC Collaboration)

• Drug Diversion Risk (2025) [PDF]

Perioperative Observation Toolkit (AORN)

Perioperative Observation Toolkit [PDF]

Additional Resources

External link disclaimer: You are now leaving the Tennessee Department of Health website. The department is not responsible for the content of external websites.

CDC Patient Safety – Clean Hands Count!