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MDPH Infection Control Assessment and Response (ICAR) Program

What is an ICAR?

The Massachusetts Department of Public Health (MDPH) has partnered with the Centers for Disease Control and Prevention (CDC) to offer healthcare facilities in Massachusetts onsite infection prevention and control (IPC) assessments. An Infection Control Assessment and Response (ICAR) visit consists of an on-site, collaborative, non-regulatory visit from a Public Health Nurse and an Epidemiologist to assess and strengthen current infection prevention and control practices in Massachusetts health care facilities.

The site visit includes verbal feedback and a written report. During the site visit we will review the responses to the assessment tool (questionnaire) and conduct direct observations of the facility's IPC practices. The assessment tool includes a series of modules that individuals performing the assessment may use depending on the focus of the assessment. Modules can be selected based on allotted time, facility-specific concerns, or applicability to an organism of concern. ICAR visits can be either prevention-based or responsive.

The visit offers a "fresh set of eyes" and a no-cost, consultative review of a facility's IPC program.

Proactive ICARs

Proactive ICARs are for facilities not currently experiencing an outbreak that are interested in improving their IPC practices. ICARs are non-regulatory and are designed to identify a facility's IPC program strengths and areas for opportunity.

During the onsite visits, MDPH staff assist healthcare facilities in reviewing current infection prevention practices and provide recommendations for improvement. The proactive assessments are conducted using a standardized set of ICAR tools developed by CDC. These tools may also be used by healthcare facilities as self-assessments to conduct internal quality improvement after the visit.

Request a Proactive ICAR

Email infectioncontrolma@mass.gov
(Please include your Name, Role, Email, Phone, Facility Type, Facility Name and Facility Address)

Responsive ICARs

A Responsive ICAR may be needed when a facility is experiencing an outbreak or after an infection control breach has been identified. As with proactive ICARs, responsive ICAR visits are non-regulatory and are designed to identify a facility's IPC program strengths and areas for opportunity.

Request a Responsive ICAR

If your facility is experiencing an outbreak of illness or has a known infection prevention concern or breach, please contact MDPH HAI/AR Program.

Call: 617-983-6800 (24/7 Epidemiology Line)


How do I schedule a proactive ICAR visit?

Please email infectioncontrolma@mass.gov and include your Name, Role, Email, Phone, Facility Type, Facility Name and Facility Address. MDPH staff will contact you to schedule a visit. If you are experiencing an outbreak or have identified an infection control breach, please contact MDPH via the 24/7 Epidemiology Line: 617-983-6800.

How much does an ICAR cost?

MDPH ICAR visits are free. There is no cost for participating in the MDPH ICAR Program.

How long is an ICAR visit?

The length of the visit is generally three to four hours but can vary depending on the facility type, facility size and areas of concern. During the first half of the visit, MDPH staff will sit down with key staff from the facility to review the ICAR assessment tool. The second half of the visit will be the observation portion, during which MDPH and key staff tour the facility to identify areas for improvement. During both the assessment and the observation portions, recommendations and best practices will be shared. There is ample time for discussion and questions.

Which facility types can request an ICAR?

Currently, we are conducting both proactive and responsive ICARs at Long Term Care Facilities. We conduct responsive ICARs at all facility types.

Who from the facility staff should be present during the visit?

Facility staff present for the ICAR visit should include the Infection Preventionist (IP), Director of Nursing (DON/DNS), Assistant Director of Nursing (ADON) and the Administrator. It is also helpful to have the Environmental Services (EVS)/Housekeeping Supervisor and Maintenance Supervisor available for questions during the visit.

What are the IPC focus areas?

The MDPH ICAR tool uses the CDC ICAR Modules which are available here: Infection Control Assessment and Response (ICAR) Tool for General Infection Prevention and Control (IPC) Across Settings | HAIs | CDC

The IPC focus areas include: Hand Hygiene, Transmission-Based Precautions, Environmental Services, Water Exposure, Continuous Quality improvement (Training, Audits and Feedback), Injection Safety, Antibiotic Stewardship, MDRO Infection Prevention, Ventilator/Respiratory Infection Prevention, Vaccine Storage and Handling Practice, Wound Dressing Changes and Point of Care Blood Testing.

Do I need to prepare anything for the visit?

Please ensure the appropriate leadership staff are available for the visit. Additionally, please ensure access to all areas of the building including EVS closets, carts and storage.

What do the direct observations include?

While onsite we conduct observations throughout the facility including resident/patient units, nursing stations, communal shower/tub rooms, nourishment kitchens, clean and dirty utility rooms, clean storage rooms, laundry services, medication preparation areas, therapy gyms, staff breakrooms, beauty salons, activity rooms, dining rooms, entry screening stations, EVS closets and carts, and any other areas of concern.

Additionally, the facility should plan for the Public Health Nurse to observe Point of Care Blood Testing and a Wound Dressing Change.

Will there be a written report?

Yes, the facility will be provided a written report within two weeks of the visit. The report includes observations and customized IPC recommendations for the facility. The report will include links to references and resources.

Who can I contact if I have questions?

Please email infectioncontrolma@mass.gov with questions.