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Departmental role and scope in infection control: Use of a generic template that meets new JCAHO requirements
AJIC
I 14
Abstracts
April
1994
RBCllL COLONIZATIC)N WlTH VANCOMYCIN-RESISTANT Bm FhBCIUMlPAECALlS (VRBF) IN THB CARDBYI’HORACIC SURGICAL PATIENT. D. Dakney, RN; H.C. NW, MD. llbz Pmsbytaian Hospital, New York, NY.
CONTINUOUS QUALITY IMPROVEMENT HOSPITALWJDE MONlTORING OF INFECTION CONTROL. I. Hunandez, RN, MSN,’ S. Honea, RN, MSN. Audie L. Murphy Memorial Vcmm Hospital, San Antonio, TX.
The emergence of ,Vp is due in pat to OVQ-use of oral vmcomycin for treatment of Clcwtridiumdrfficilc dimrba. Vancomycin tistance among atemcocci is inducibk and is plasm&mediated. Infections caused by VRFiF an difficult to treat and may be liie-w. use of vatbwmycln to h-cat the increasing numbers of OllOCOmiPlinfections caused by multi-resistant gram-positive organisms may soon be kdequate. In an imUb~ticm where MRSA and MRSE are common, short term puiopuaUve vacamycin prophylaxis for cardiway is a&lppiatc. Inorder to identify if use of parental vanmmycin for prophylaxis is a risk factor for the emergence of VREF, 79 cardiothmacic surgical patients were evaluated for VRBF colonizlltion by obtaining P rectal swab within 24 h of initiation of vancomycin prophykxis and 6-7 d following this initial dosage. Nom had previously rrcdved vancorny& during their hospital admission (which ranged from 1 day prior to surgery to several weeks prior). All remained cm vancomycin for 24-48 h poft-opwntivcly. Two of the 79 patients (2.5 a) devekQcd VRBF. Both patients also received gentamkin. One of these patknts hd been haspitaJizuJ 7 days before surgery and had vancomycinwceptibk E&&ttl on initial culhre. The other patknt had IX) cntemmcci isolated initially. We conclude that short term periopexative wcomycin prophylaxis for cardio~ukr surgery does not appear tn lead to a high VREF co1onixdic.n ratc. Rectal culturintt and utilizim selective media is heluful in identification of VREF coloniaion and &&lines kbo&ory identificatiiw. .
‘Ibe ~KW focus on haspitalwide infection amtrcd monitoring and surwilkw tkmcnds constsnt incrcmmti implemamtirm of an intadisciplinazy contia~ quality impmvemat (CQl) ~xoass. To achkvc this, the castnct of a pGpular quality managcmatvpauc dys.k tool, tk Igugw (‘fishboac’) diagmm, was utilized to lEcmamt tb hasvital* infL%tioll conhul monitoring syrtem. The fishbone diagram dt$icts CQI te& swwilkmx. monitaing. and w&i&~ componenta as the b&&e forthcinfenioncootrolindicptMBwhilcuLcnpnguofIhcdipBrpmreprcIQtthccrosrsection of dcpaments, pmgrams, and committee3 that pardcipate in tbi.3 pmcesa. Prevention and control measureajoin before tbe final outcome results in an unacceptable infection rate. Tha hc@alwide infection amIx indicators have ban set up to implement tw lcvcls of usage. Fii, the hospital will apply it3 own indiaor dam internally to assea and impmve its d4ivay of care. Secad, through the participation of Joint Commispioo on Adtathm of Healtbcare Or8anizaticas b..%i-testedinf&ion control indiamn, the Joint Commissica will feed back to tbe facility interhospital comparisons of peer institutions to help tbe facility identi@ fuaher oppntudtia for improvement which may not have been detect4 thmt@ the use of only the hospital’s infection control data. Impkmentation of this hos@alwide infection control mcmitotig and sweilknce system illurtrntcs the diversity of ways in which employees are cmpowezed, encouraged, and expected to become involved in daily impkmentation of CQI in a hospital seving.
A PROSFZCTIVB, RANDOMIZBD STUDY OF VBNTJLATOR-ASSOCL4TJ3D PNBUMONIA IN PATIBNTS WlT%I ONB VS. THRBB VBNTlLATOR CIRCUlT CHANGBS PBR WEBK. M. Loop, RN, MSN, CIC,* G. Wichtmm, RN, BSN, A. Grimf% RN, BS, MT(ASC!P), B. Bfkhu, RN, MSN, C. Bati, RN, MSN, MBA, A. Stsmm. MD. Univezsi~ of A@bama at Birmingham Hcdpital, Bin%ingham, AL.
DPPARTMBNTAL ROLE AND SCOPE IN INPBCTION COIWROLz USE OP A GBNBRIC TBMPLAETHATMBBTSNBWJCAHORBQ~. A.Parmn, RN, BSN, MPH, ‘XC,* L. B&m, RN, BSN, MPH, J. Almamz. RN, BA. Kaiser -te southern California Rqim, Pasadaq CA.
Km vauiktm days)‘of 7.35, &d wr thxxc timu per wal glv”P had=a late of S.-as. In the NICU the twu groups had rated of 12.15 and 12.58, respectively. chu smlysis rewakd that there was no significant d8fcml.x in vmdktorassocipted Fctemmk rates between the two gmups in cithu unit (?dIcu, P-value = 0.6; NICU, P-value = 0.9). Addawlly, when the gmups wen subdivided in order to ~shoaVrmvmtilPtedplt*nu(r7dPys)withloog-mmvatilatedpptinb(> Hence., OuI hospital-wide policy is 7 days). we pgpin found no sigdticant difkacc. now to chmge vaukbx circuiu once a week, with M estimstcd snnusl mst-ssvblgs in temls of equipmalt alone of 595,ooo.
InitklinputandfecdbnckfmmDepatmmtb%nagasindicawtbisnewformat It is also P useful tool in is bmcti&l in cdwating managea about their mk. aepprtmmepl miatation, &ff meetings, CWIUSJ updatea and for evaluatin8 and mlmltolingsmffcompctacy. AJCAHO~~~twarenthudarticsbwt(hicnewsppmachtoroleMdsmp and the ability of this format to be reviewed in conjunction with policks and pmcedures ewy two yeas.
I 14
Abstracts
April
1994
RBCllL COLONIZATIC)N WlTH VANCOMYCIN-RESISTANT Bm FhBCIUMlPAECALlS (VRBF) IN THB CARDBYI’HORACIC SURGICAL PATIENT. D. Dakney, RN; H.C. NW, MD. llbz Pmsbytaian Hospital, New York, NY.
CONTINUOUS QUALITY IMPROVEMENT HOSPITALWJDE MONlTORING OF INFECTION CONTROL. I. Hunandez, RN, MSN,’ S. Honea, RN, MSN. Audie L. Murphy Memorial Vcmm Hospital, San Antonio, TX.
The emergence of ,Vp is due in pat to OVQ-use of oral vmcomycin for treatment of Clcwtridiumdrfficilc dimrba. Vancomycin tistance among atemcocci is inducibk and is plasm&mediated. Infections caused by VRFiF an difficult to treat and may be liie-w. use of vatbwmycln to h-cat the increasing numbers of OllOCOmiPlinfections caused by multi-resistant gram-positive organisms may soon be kdequate. In an imUb~ticm where MRSA and MRSE are common, short term puiopuaUve vacamycin prophylaxis for cardiway is a&lppiatc. Inorder to identify if use of parental vanmmycin for prophylaxis is a risk factor for the emergence of VREF, 79 cardiothmacic surgical patients were evaluated for VRBF colonizlltion by obtaining P rectal swab within 24 h of initiation of vancomycin prophykxis and 6-7 d following this initial dosage. Nom had previously rrcdved vancorny& during their hospital admission (which ranged from 1 day prior to surgery to several weeks prior). All remained cm vancomycin for 24-48 h poft-opwntivcly. Two of the 79 patients (2.5 a) devekQcd VRBF. Both patients also received gentamkin. One of these patknts hd been haspitaJizuJ 7 days before surgery and had vancomycinwceptibk E&&ttl on initial culhre. The other patknt had IX) cntemmcci isolated initially. We conclude that short term periopexative wcomycin prophylaxis for cardio~ukr surgery does not appear tn lead to a high VREF co1onixdic.n ratc. Rectal culturintt and utilizim selective media is heluful in identification of VREF coloniaion and &&lines kbo&ory identificatiiw. .
‘Ibe ~KW focus on haspitalwide infection amtrcd monitoring and surwilkw tkmcnds constsnt incrcmmti implemamtirm of an intadisciplinazy contia~ quality impmvemat (CQl) ~xoass. To achkvc this, the castnct of a pGpular quality managcmatvpauc dys.k tool, tk Igugw (‘fishboac’) diagmm, was utilized to lEcmamt tb hasvital* infL%tioll conhul monitoring syrtem. The fishbone diagram dt$icts CQI te& swwilkmx. monitaing. and w&i&~ componenta as the b&&e forthcinfenioncootrolindicptMBwhilcuLcnpnguofIhcdipBrpmreprcIQtthccrosrsection of dcpaments, pmgrams, and committee3 that pardcipate in tbi.3 pmcesa. Prevention and control measureajoin before tbe final outcome results in an unacceptable infection rate. Tha hc@alwide infection amIx indicators have ban set up to implement tw lcvcls of usage. Fii, the hospital will apply it3 own indiaor dam internally to assea and impmve its d4ivay of care. Secad, through the participation of Joint Commispioo on Adtathm of Healtbcare Or8anizaticas b..%i-testedinf&ion control indiamn, the Joint Commissica will feed back to tbe facility interhospital comparisons of peer institutions to help tbe facility identi@ fuaher oppntudtia for improvement which may not have been detect4 thmt@ the use of only the hospital’s infection control data. Impkmentation of this hos@alwide infection control mcmitotig and sweilknce system illurtrntcs the diversity of ways in which employees are cmpowezed, encouraged, and expected to become involved in daily impkmentation of CQI in a hospital seving.
A PROSFZCTIVB, RANDOMIZBD STUDY OF VBNTJLATOR-ASSOCL4TJ3D PNBUMONIA IN PATIBNTS WlT%I ONB VS. THRBB VBNTlLATOR CIRCUlT CHANGBS PBR WEBK. M. Loop, RN, MSN, CIC,* G. Wichtmm, RN, BSN, A. Grimf% RN, BS, MT(ASC!P), B. Bfkhu, RN, MSN, C. Bati, RN, MSN, MBA, A. Stsmm. MD. Univezsi~ of A@bama at Birmingham Hcdpital, Bin%ingham, AL.
DPPARTMBNTAL ROLE AND SCOPE IN INPBCTION COIWROLz USE OP A GBNBRIC TBMPLAETHATMBBTSNBWJCAHORBQ~. A.Parmn, RN, BSN, MPH, ‘XC,* L. B&m, RN, BSN, MPH, J. Almamz. RN, BA. Kaiser -te southern California Rqim, Pasadaq CA.
Km vauiktm days)‘of 7.35, &d wr thxxc timu per wal glv”P had=a late of S.-as. In the NICU the twu groups had rated of 12.15 and 12.58, respectively. chu smlysis rewakd that there was no significant d8fcml.x in vmdktorassocipted Fctemmk rates between the two gmups in cithu unit (?dIcu, P-value = 0.6; NICU, P-value = 0.9). Addawlly, when the gmups wen subdivided in order to ~shoaVrmvmtilPtedplt*nu(r7dPys)withloog-mmvatilatedpptinb(> Hence., OuI hospital-wide policy is 7 days). we pgpin found no sigdticant difkacc. now to chmge vaukbx circuiu once a week, with M estimstcd snnusl mst-ssvblgs in temls of equipmalt alone of 595,ooo.
InitklinputandfecdbnckfmmDepatmmtb%nagasindicawtbisnewformat It is also P useful tool in is bmcti&l in cdwating managea about their mk. aepprtmmepl miatation, &ff meetings, CWIUSJ updatea and for evaluatin8 and mlmltolingsmffcompctacy. AJCAHO~~~twarenthudarticsbwt(hicnewsppmachtoroleMdsmp and the ability of this format to be reviewed in conjunction with policks and pmcedures ewy two yeas.