spreading knowledge. preventing infection.™ · 2015. 2. 11. · september 14, 2014 page 3 with...
TRANSCRIPT
September 2014
Inside this issue
Notes From the President by Sonya Mauzey……..…...…..page 2
APIC Indiana Fall Conference by Anna Roe….......…..….page 3
Kari’s Korner by Kari Kuebler……………………….……page 3
Updates from the Communication Committee Chairman:
Diana Korpal……………………………………………….page 4
APIC National Trip 2014 by Loretta Marsh ………….….page 4
APIC National 2014 Anaheim, California
by Connie Simpson…………………………………………page 6
Data, Data, and More Data by Mona Wenger………….…page 9
Keep the Information Coming by Michael Grow……..…page 11
Federal HAI Reporting to NHSN by Susan Kraska…….page 12
Infe
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Spreading knowledge. Preventing infection.™
Newsletter published in March, May,
September, and November.
Please send articles, questions, comments, or
suggestions to:
Michael Grow, MBA, MT (ASCP), CIC
Franciscan St. Elizabeth Health
1701 S. Creasy Lane
Lafayette, Indiana 47905
Office: (765)502-4373
Cell: (765) 761-8047
Email: [email protected]
September 14, 2014 Page 2
Notes From the President
By Sonya Mauzey
Greetings APIC Indiana Members!
It is hard to believe summer is winding
down and our fall conference is just around
the corner. This issue of our newsletter is
traditionally devoted to articles provided by
our scholarship recipients to share with you
some of the things learned while at the APIC
national conference. Read through to see
what great opportunities the national
conference offers for networking,
implementing science to practice etc.
Sonya with Dr. Pittet
Didn’t get to go this year due to needing
financial assistance? Please apply for
chapter scholarship funds; even if you did
this year and weren’t selected, I encourage
all to apply. Additionally, there are
scholarship funds available from generous
vendors and APIC support partners. One of
our members, Michele Daum from
Evansville, IN, was too new to be eligible to
apply for a chapter scholarship. So she
applied for one, she found on the APIC
national website and won a scholarship from
Diversey to attend and do a poster
presentation. So, look for ways to make it to
the next national conference scheduled in
Nashville, TN, you won’t be disappointed!
Speaking of Tennessee, one of the many
take away resources from the conference
was the HAI calculator that was presented
during the closing plenary by the Tennessee
Department of Health. It is available online
and free to any facility/state. This free
interactive tool allows you to enter your SIR
score, and number of infections for a
specified timeframe and then what you
would like your SIR score goal to be. So for
example, if your current SIR is 1.25 and you
would like to reach 0.75, you just plug in the
requested numbers, hit compute and it will
tell you how many infections you need to
prevent in order for you to reach your target
SIR goal. The direct link is:
http://health.state.tn.us/ceds/HAI/calculator.
shtml .There are several other resources
available from Tennessee and you can find
them simply by typing “TN HAI” in the
your internet search box (Google, Bing, etc).
Susan Kraska, President-elect, and I
attended the Chapter Leadership luncheon.
We learned about a great idea for pursuing
and developing a journal club using the
framework of implementation science to
analyze research articles. What are the
benefits of this? It will keep you current
September 14, 2014 Page 3
with new infection prevention knowledge,
improve your literature evaluation skills and
understanding of statistical methods, help to
engage with other IPs in lively discussion
about the implications and findings, and
hopefully then translate and integrate the
findings into infection prevention practice!
Lastly, this year was extra special for our
chapter, because we received one of the
Chapter of Excellence awards. It was truly a
privilege and honor to represent our chapter
at the Leadership luncheon to accept our
recognition which included a $500
certificate to spend toward APIC products.
We are excited about being able to use these
funds to share with the membership. Watch
for some of the items we are purchasing for
giveaways and for promoting more
scholarship fundraising monies at the fall
conference.
Opening Reception
APIC Indiana’s 2014 Fall Program: Understanding Infection Prevention in
2014
By Anna Roe
APIC Indiana’s Fall Conference will be
held at the Indianapolis Marriott North,
3645 River Crossing Parkway 1180,
Indianapolis, IN 46240 on October 10, 2014
from 7:30 AM - 4:00 PM.
Topics include:
The first MERS case in the US
How to figure a SIR for your
healthcare institution
Who needs what report in your
healthcare institution
Updates on perioperative cleaning
Management of Legionella
Please find the registration form on the
APIC website or e-mail [email protected]
By Kari L. Kuebler RN, BSN
Indiana University Health System
APIC Indiana’s website is under-
construction. While we work hard to deliver
our membership the best possible product,
September 14, 2014 Page 4
we will have a temporary site coming soon
to provide membership with needed
information in the interim. On this website
you will find a Resources and Forms Tab.
Under this Tab is a NHSN Information link.
Here I have included vital NHSN links to
criteria, newsletters, and more. I have also
included my contact information. Please
contact me with questions concerning
NHSN HAI events. If I don’t know the
answer, we will find it together. I have had
the pleasure to speak with many of our
members over the last several months and
hope to hear from more of you soon!
For questions concerning NHSN criteria,
please contact me at:
317-964-9598
Updates from the
Communication Committee
Chairman: Diana Korpal
Attention Indiana Chapter: Please go to
“APIC Indiana” on your face book and like
us to get up to date information regarding
APIC Indiana and participate on discussions
among our members.
Note also that our new APIC Indiana
website is under construction and will be
ready as soon as our new communications
team is able to transfer all documents to the
new site. Check out the new temporary site
http://new.apicin.org that is now more than
90% full of the content pages contained on
http://apicin.org . Thanks in advance for
your patience in this endeavor. Should you
have any questions please contact: Kari
Kuebler or Jennifer Spivey – co
administrators for both sites.
APIC National Trip 2014
By Loretta Marsh, MSN, RN, CIC
Indiana University Health Ball Memorial
Hospital
My first APIC National Convention will
be hard to top! The venue was perfect, the
weather, the company, the speakers and
presentations all perfect. “Thank you” to
APIC Indiana for making this conference a
reality for me! I would like to discuss my
favorite presentation and the one I used the
quickest after returning home!
There are some individuals in the
Infection Prevention world that I would not
miss a chance to see speak if I have the
opportunity. I enjoy and respect them so
much that I will look for anything they will
be presenting at , thus my favorite
presentation was chalk full of the IP world’s
September 14, 2014 Page 5
“best in class”. Ruth Carrico, in particular is
a speaker I enjoy immensely. The session
was 1402, The SHEA /IDSA Compendium
of Strategies to Prevent HAI’S: Update on
Prevention Measures. The room for this
session was full to the gills. I guess others
feel the way I do and it was the new SHEA
Compendium updates. I took the picture
below after the session which was amazing.
The energy in the room after these ladies
completed their presentations was
electrifying to put it mildly. The personal
additions to their specific sessions were so
insightful. It was very clear that each of
them had been there done that!! If this
group does not get you energized in
Infection Prevention it is not going to
happen, just saying!!
Ruth Carrico, PhD, FSHEA, RN, CIC, Linda Greene,
RN, MPS, CIC, Lynn Hadaway, M.Ed., RN-BC,
CRNI, Janet Haas, PhD, RN, CIC, Lisa Maragakis,
MD, MPH, FSHEA, Ann Marie Pettis, RN, BSN, CIC,
Julia Moody, MS, SM(ASCP), and Deborah Yokoe,
MD, MPH (missing one from the picture)
The session that I used almost
immediately after returning home from
Nationals was Conducting an Infection
Control Tracer Round (ICRA) for
Renovation and Construction Projects. My
hospital was starting some large scale
projects which had prompted me to attend
this session as a priority. I was very
impressed with the presenter, Mr. Lewis
Johnson and felt a connection with him as he
worked at Lee Memorial Health System in
Fort Myers, Florida which was where I had
my first nursing job fresh out of college. The
presentation had a lot of great pictures of
containment devices and new pressure
monitoring devices. Visually you could
follow exactly what he was talking about
because of his illustrations. The presentation
was well worth my time.
My story starts after my return from
California and my first few days back at
work. The Ball team was introduced to a
project manager who was to be the liaison
between the construction team and the
hospital. He represents the system and at
first blush seemed really on the ball. The
pre-ICRA walk through had occurred in my
absence and the Infection Prevention
barriers were in place for a couple different
projects. I set out to round on the projects
that week with the project manager and at
the first project found that there was a hepa
equipped air filtration unit running and a
monitor in place in the anteroom showing
appropriate negative pressure. The
construction space had no HEPA filtration
units and no monitors indicating negative
pressure to adjacent hallways. I asked about
this oversight and was told this was too big
of a space to make negative and that the ante
room was the important part as that is where
workers entered and exited. I was made to
feel like I was being very uncooperative for
even asking about this. I was told that
another hospital in our system was O.K.
with doing projects this way. I advised the
project manager that I could not speak to
what other hospitals were doing but that
here this is what we required and it was a
requirement on our ICRA form. I could get
no support from my maintenance director.
This concept seemed to be new to everyone.
I really began to question that I knew what I
was talking about and then I remembered
the presentation I had attended at APIC.
September 14, 2014 Page 6
Thanks to the Covidien group that gave
us cards with access to all slides and
presentations, I was able to download the
presentation. The end of the presentation
gave a contact phone number and I decided
to use it and make a call. Mr. Johnson
became my champion that day. Lewis
picked up the phone on the second ring. He
listened to specifics of the project and
advised me on how to language what I
needed so there was no communication
barrier with the project manager. He gave
me page numbers for specific supporting
evidence from the, Guidelines for Design
and Construction of Hospitals and
Outpatient Facilities, 2014 Edition. (See
excerpt below) Mr. Johnson gave me the
confidence and tools to confront the project
manager and defend best practice for the
safety of our patients. I was not alone
anymore and believe me his help was a
game changer. I went to our next rounds
armed with guidelines and I countered every
excuse with how the work could be done.
The barriers in our hospital now reflect what
the ICRA requires for a Class 4 project. If I
had not attended the National Conference I
would not have had the contact information
for Mr. Johnson and would not have felt
comfortable to reach out to him. Knowledge
is power!!! Experts do not hurt either!!!
Example of a pressure monitoring device.
See you in Nashville 2015!
APIC National 2014
Anaheim, California
By Connie Simpson, RN, BSN
Perry County Memorial Hospital
Tell City, IN
I want to acknowledge APIC Indiana for
having the vision to provide funding for
scholarships for APIC IN members to
further their education by attendance at the
State and National APIC Conferences. I
began my job as an ICP in 1987 by
implementing Universal Precautions and the
Hepatitis B Vaccine, and educating staff on
HIV/AIDS. The first APIC National
Conference that I attended was in Nashville
in 1991, although I have not been able to
attend the conference every year. Perry
County Memorial Hospital (PCMH) is a 25
September 14, 2014 Page 7
bed critical access hospital without an
epidemiologist, making it even more
important that I stay current in the field, as
Infection Control is constantly changing.
Not only are the educational sessions and
speakers valuable to keep up with the latest
CDC recommendations and emerging issues
in Infection Control, but networking with
colleagues, (both national and international),
to maintain professional development is also
a valuable experience.
PCMH is building a new 25 bed facility
with the move expected early in 2015, so the
construction sessions were a focus. I am
also responsible for Employee Health and
Patient Education, so I have selected a few
conference sessions to review, but all of the
sessions are always very informative and
educational.
Opening Plenary: How Genome
Sequencing is Changing Medical
Microbiology (Jennifer Gardy)
The Opening Plenary was thought
provoking and shows the future of
surveillance with genome sequencing and
that it is becoming less costly.
Opening Plenary: Why HC Professionals
Inhibit Medical Advances: Historical Role
and the Role of Cognitive Biases in
Judgment and Decision Making (Gregory
Poland). I first heard Dr. Poland several
years ago when he spoke of mandatory flu
vaccinations for HCW, and this session
focused on behavioral measures to
implement change.
Disinfection and Sterilization:
What’s New – Dr. Rutala is a well known expert in his
field and always gives an excellent
presentation with evidence-based
information. Comparison of a rapid readout
biological indicator for steam sterilization
now requires a 30 minute to 1 hour readout,
compared to 24-48 hours to 7 days in the
past. A new accelerated hydrogen peroxide
HLD was reviewed and of importance to me
as a department in our facility had recently
been approved to use this for cystoscopies.
Accelerated hydrogen peroxide was used in
a study to treat privacy curtains to reduce
risk of infection. Thoroughness of
environmental cleaning should be monitored
(e.g., fluorescence). GI endoscope
contamination was reviewed along with a
study recently published in the MMWR
regarding NDM-Producing E. coli
Associated ERCP. Recommendations in the
publication included education/adherence
monitoring, enforcement of best practices,
improved definition of the scope of the issue
and contributing factors, and perform
periodic microbiologic surveillance of
duodenoscopes to assess whether bacteria
have survived the reprocessing procedure.
Due to the difficulty of cleaning endoscope
lumens and contamination of colonoscopes,
endoscopes represent a nosocomial hazard.
Manufacturers should be encouraged to
develop practical sterilization technology for
endoscopes. For cleaning of instruments for
CJD, check recommendations published in
ICHE 2014;34:1272. EPA has registered
antimicrobial products effective against C.
difficile spores, April 2014.
The SHEA/IDSA Compendium of
Strategies to Prevent HAIs: Update on Prevention Measures This was
recently published in AJIC and was a very
good presentation by several speakers
including Ruth Carrico from Louisville.
Hand Hygiene “Tour d Monde” :
Partnership, Innovation, Leadership –
The Infection Prevention Mantra –
(Didier Pittet MD, MS, CBE, University
of Geneva Hospitals, WHO Collaborating
Centre on Patient Safety)
This was a very motivational and
inspirational session by Dr. Pittet, the lead
September 14, 2014 Page 8
advisor to the WHO Global Patient Safety
Challenge which aims to reduce HCAI
worldwide. Dr. Pittet started using one of
the first alcohol hand gels at his facility in
Geneva in 1995, and promotes hand hygiene
worldwide with the Clean Your Hands
campaign. Clips were shown of different
countries using alcohol hand gel, the barriers
to use of hand gel in different countries, and
Dr. Pittet’s visits to those countries. I had
the privilege to meet Dr. Pittett at his book
signing, “Clean Hands Save Lives”, the
story of his campaign.
Draft Guidelines for the Prevention of
Surgical Site Infection, 2014
The take away for this session is that
some recommendations could not be made
due to lack of evidence based practice and
research. HICPAC is considering revisions
to the process of evidence evaluation for
future guidelines. No recommendation
could be made regarding optimal timing of
preoperative parenteral prophylactic
antimicrobial agent for prevention of SSI,
although the speaker said that 1 hour was
used. A preoperative antibiotic was
recommended prior to skin incision in all
cesarean sections. In clean and clean-
contaminated procedures, do not administer
additional prophylactic antimicrobial agent
doses after the surgical incision is closed in
the operating room, even in the presence of
a drain. The final guidelines may not be
released until 2015.
NHSN Surveillance and Prevention:
CAUTI
The new CAUTI definition will not be
ready for use until 2015. It is important that
the definition be accurate as the data is being
used broadly for public reporting. January
1, 2015-added data will need to be reported
for Adult and pediatric medical, surgical and
medical/surgical wards for CMS
participation. 2015 is to be a baseline year
for CAUTI data for subsequent years. A
new algorithm was reviewed along with the
potential removal of yeast from ABUTI.
Facilities Guideline Institute 2014
Guidelines for the Design and
Construction of HCF
Clarifications addressed location of hand
hygiene stations, scrub sinks, decorative
water features, hot water, and airborne
infection isolation room, along with a
comparison with AORN recommendations
and FGI.
Environmental Cleaning Roles and
Responsibilities…going where we’ve
never gone before
Marti Craighead from Barnes-Jewish
Hospital described a process to assign roles
and responsibilities for cleaning the patient
and work environment. Her facility took a
picture of every single item in the patient
environment and met with representatives
from each department to determine primary
users and owners of each item. They then
implemented a binder describing when and
who would clean those items.
Closing Plenary-Federal HAI Initiatives:
Where we Have Come from, Where We
Are Going, and the Importance of
Inspiring Collaboration along the Way
Speakers included Donald Wright, MD,
MPH, Deputy Assistant Secretary for
Health, Office of Disease Prevention and
Health Promotion, U.S. Department of
Health and Human Services; Denise Cardo,
MD, Director, Division of Healthcare
Quality Promotion, National Center for
Emerging and Zoonotic Infectious Diseases,
CDC; and Marion Kainer, MD, MPH,
Director, Healthcare Associated Infections
and Antimicrobial Resistance Program,
Tennessee Department of Health.
Don Wright reviewed the proposed 2020
HCAI targets timeline, starting with a new
September 14, 2014 Page 9
baseline in 2015, and this was published
recently in the Federal Register for
comments.
The highlight of Denise Cardo’s
presentation was the TAP report, referring to
Targeted Assessment for Prevention, which
ranks facilities by excessive numbers of
infections above a set benchmark. The TAP
report function will be built into NHSN
application for 2015. Denise also referred to
the recent CDC Vital Signs that focused on:
Improving Antibiotic Prescribing Practices
in Hospitals. The CDC recommends that all
hospitals in U.S. have a program with those
7 Key Elements, and focus on antibiotic
stewardship.
Marion Kainer – The fungal meningitis
outbreak of 2012 was the largest healthcare
associated outbreak in U.S. history. Marion
described how the cause had been
determined in 8 days in TN. Discussion
included the importance of regional
collaboration and what TN is doing,
including the HAI prevention calculator, and
HAI definition checklist available on the TN
Department of Health website. TN is
proactive in public reporting, and has a
website that can be accessed for information
by searching for TN HAI.
Data, Data, and More Data
By Mona Wenger, MS
Elkhart General Hospital
Data, data, and more data. What does an
APIC Conference have to do with assisting
Infection Preventionists (IPs) with data
collection? Everything!!
An APIC Conference provides the means
for IPs to connect with vendors that have
developed electronic data mining programs.
These programs have the capability to
collect, report, and analyze infectious
disease data and with one stroke of a key on
the computer board, an IP can “Run a
Report” and within a matter of minutes have
all positive isolate results that have been
identified within the past 24 hours or 2 years
or 5 years. One can run a report on data
such as drug resistant organisms (DROs)
and sensitivities, nosocomials, patterns,
create spreadsheets and unit or time specific
graphs.
Since the federal government has
mandated the reporting of specific
healthcare acquired infections (HAIs), the
data mining program has become a tool by
which we are able to quickly identify not
only HAIs, but organisms that are
circulating in the community too. Another
program feature is the readmission
notifications for DROs. Transmission based
September 14, 2014 Page 10
precautions are implemented faster because
IP is notified via email alerts. The IP
department is not the only department
utilizing the program. Pharmacy, in consult
with healthcare providers, is able to identify
and address unnecessary or inappropriate
treatment, thus promoting antibiotic
stewardship.
Electronic reporting can make the work
load of an IP much more manageable and
much less stressful. We know this first hand
because one day our reference laboratory
(LAB) notified us that their electronic
reporting system would be going down for
an upgrade. That was almost 3 months ago.
However, the LAB upgrade caused a failure
in the electronic data mining program.
Therefore, we can tell you personally how
this affects one’s work day because we have
not had our mining program since May 10th.
Our IP world went from electronic data
mining to reviewing by hand hundreds of
LAB reports daily for the local/state health
department reportable conditions and
hospital/community acquired infections. So,
now our work load has gone from 2.5 hours
of active surveillance to basically an all-day
affair. One also has to keep in mind that the
rest of the duties of an IP, such as phone
calls, faxes, emails, research, meetings, the
data reports, and the federal reporting that
now has to be inputted manually, continues
non-stop.
Without an electronic data mining
program, the work load of an IP
dramatically increases. The identifying and
reporting of infectious disease organisms
rapidly at our facility is enhanced by having
an electronic data mining program. The job
duties of an IP become a great deal more
balanced. The APIC Conference provides IP
with the necessary connections to vendors
that developed and made the electronic data
mining program more easily accessible and
our workload lighter.
Data, data, and more data. What does the
APIC Conference have to do with data
collection and a healthcare facility?
Everything!!
Note: As of September 4th, our electronic
data mining program is up and running.
Yes, we celebrated!!
September 14, 2014 Page 11
Keep the Information Coming
By Michael Grow
I am thankful for the contributions of
so many of you that help to make this
newsletter what it is. I could not publish this
newsletter without all your contributions.
Since the last newsletter I have
changed employers and am now at
Franciscan St. Elizabeth Health. So please
send any news, articles, pictures, etc. to me
What you share could just be what
someone else needs.
I am looking forward to seeing what
this newsletter will become because of your
efforts.
Thank you!
"What's New in Infection
Prevention in 2014?"
October 10, 2014
Indianapolis Marriott North
Topics will include:
The first MERS case in the US
How to figure a SIR for your healthcare institution
Who needs what report in your in your healthcare institution
Updates on perioperative cleaning
Management of Legionella
See you soon!
September 14, 2014 Page 12
Federal HAI Reporting to NHSN
By Susan Kraska, APIC Indiana Public Policy Chair
Below is a slide that I hope all our members are accustomed to seeing with the dates and
HAI's that are reportable now and will be in 2015 and 2016.
There has been much activity at the Federal level via APIC's Public Policy Committee.
Submission of multiple comments on legislative proposals and also member support submitted
for monies for CDC/NHSN when asked. Many thanks to all APIC Indiana members who
respond when asked to send letters via the APIC web site. It remains one place we do have a
voice that directly affects the work we do.