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Evaluation of an Inpatient Influenza Vaccination Program
www.ajicjournal.org Vol. 37 No. 5
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Presentation Number: 8-84
Epidemiology of Hospital-Acquired Infections in a Tertiary Care Center in Lebanon Lamia Alamuddin Jurdi, BBA, M.P.H., Infection Control Professional; Zeina A. Kanafani, MD, MS, CIC, Hospital Epidemiologist; Nisreen Sidani, RN, MSN, Infection Control Officer; Nada Zahreddine, MPH, CIC, Infection Control Professional; Souha S. Kanj, MD, Head, Infectious Diseases Division, American University of Beirut Medical Center, Beirut, Lebanon. Objective: To describe the epidemiology of hospital-acquired infections (HAI) and multi-drug resistant organisms (MDRO) in a tertiary care center in Lebanon for the period October 2007 to September 2008. Methods: The Infection Control and Prevention Program at the American University of Beirut Medical Center conducts prospective targeted surveillance of hospital-acquired infections. The surveillance program reports on device-associated infections in critical care areas (catheter-related bloodstream infections [CR-BSI], ventilatorassociated pneumonias [VAP], and catheter-associated urinary tract infections [CA-UTI]). Device-associated infections are benchmarked against the rates published by the National Healthcare Safety System (NHSN) and the International Nosocomial Infection Control Consortium (INICC). Data on primary bloodstream infections, surgical site infections, Clostridium difficile associated diarrhea, and infections caused by MDROs are collected from all hospital units. All hospital-acquired infections were identified using the Centers for Disease Control and Prevention (CDC) definitions. Results: Critical care areas: VAP rates were highest in the medical-surgical ICU (15.5/1,000 ventilator-days) and lowest in the Nursery Intensive Care (N-ICU), 1.5/1,000 ventilator-days. The most predominant organisms causing VAP were Acinetobacter baumannii and Pseudomonas aeruginosa. The Respiratory Care Unit (RCU) had the highest rate of CA-UTI, 16/1,000 catheter-days. Escherichia coli and Klebsiella pneumoniae were the most reported causative agents. Both RCU and ICU had the highest rates in CR-BSI (15.5/1000 catheter-days). Coagulase negative staphylococci (CoNS) were the most predominant organisms causing CR-BSI. In the ICU, rates of all deviceassociated infections were higher than the NHSN rates. On the other hand, VAP rates were lower whereas CR-BSI rates were higher than the INICC benchmark. CA-UTI rates were similar to the INICC benchmark. Hospital-wide rates: the primary BSI rate was 1.5/1,000 patient-days with CoNS (39%) being the predominant organism, followed by Escherichia coli (25%). RCU had the highest rate of bacteremia followed by ICU. Central-lines were the most commonly identified source of primary BSI followed by implanted vascular access devices. The rate of surgical site infections (SSI) correlated with the wound class (lowest for clean procedures, highest for contaminated/dirty procedures). The vast majority of MDRO were gram-negative bacilli. All the A. baumannii isolates, both hospital and community-acquired were MDRO. Conclusion: The rates of device associated infections were higher than those reported in by NHSN in the medical/ surgical ICU. Implementation of infection control measures should be reinforced through the use of various strategies, including educational activities, implementation of practice bundles, prospective audits, and performance feedback to healthcare workers.
Presentation Number: 8-85
Evaluation of an Inpatient Influenza Vaccination Program Kathleen Wroten, RN, BSN, CIC, Manager, Infection Control; Leslie Freeman, RN, CIC.; Kellianne Riches, RN, BSN, Infection Control Nurse; Kimberly A. Couch, PharmD., MA, PharmD., Christiana Care Health System, Newark, DE. Issue: The influenza vaccination standing order by exception (IVSOE) was implemented in 2002 to increase compliance with inpatient screening and administration of influenza vaccine to eligible patients in our acute care setting. Additionally, prefilled individual dose syringes of influenza vaccine were placed in an automated dispensing cabinet on each nursing unit to allow easy access to vaccine after pharmacist review of orders and decrease the time for the vaccine to reach the patient. Lastly, electronic medication administration records (eMAR)
E74
American Journal of Infection Control June 2009
were implemented this year in part to increase compliance and documentation of influenza vaccine administration (among other medications). Project: Education of the experienced and new nursing staff early each fall prior to the beginning of the influenza season regarding the need for and use of the IVSOE has been essential to the program. We evaluated the number of doses of vaccine that were available for inpatient administration as a percentage of those allotted for inpatient use. We also tracked the absolute number of influenza vaccines administered to determine the success of our program. Results: Because of the success of the program, in 2006 our number of vaccines allotted increased from 1600 to 4000. In 2002, 302 (20%) doses of vaccine were administered. In 2003, 392 (26%) doses were administered. In 2004, 1179 (74%) were administered. In 2005, 3178 (100%1) doses were administered. In 2006, 2439 (61%) doses were administered. In 2007, 2264 (57%) doses were administered. Lastly, from October 13, 2008 through December 15, 2008, 1109 doses were administered. Lessons Learned: An IVSOE can assist in increasing inpatient influenza vaccination rates; however it takes coordinated efforts of infection control, nursing, pharmacy, and information technology to maintain success. In addition, eMAR can assist in tracking when a vaccine information sheet (VIS) is given, what version of the VIS is given, and the manufacturer and lot number of the vaccine administered. The IVSOE also contains the reasons why a patient is not eligible for the influenza vaccine. This may be an area for further exploration and may give us a better understanding of outpatient vaccine administration rates. Presentation Number: 8-86
Fecal Containment Using Indwelling Bowel Catheters to Potentially Prevent Multidrug-Resistant Organism Nosocomial Infections Barbara Barnett, RN, Clinical Nurse Specialist, University of Virginia Health Systems, Charlottesville, VA; Jan Powers, PhD, RN, CCRN, CCNS, Director Clinical Nurse Specialists, St. Vincent Indianapolis Hospital, Indianapolis, IN; Michael Koenig, RN, Burn/ICU Nurse, University of California, San Diego Medical Center, San Diego, CA; Elizabeth Stokes, RN, BSN, Director of Research Services, Sisters of Charity Providence Hospitals, Columbia, SC; Linda Morris, PhD, APN, CCWS, Clinical Nurse Specialist, Northwestern Memorial Hospital, Chicago, IL; Stathis Poulakidas, MD, Director of Burn Services, John H. Stroger Jr. Hospital of Cook County, Chicago, IL; Elizabeth C. Konz, PhD, RD, Global Clinical Research, Hollister Incorporated, Libertyville, IL. Issue: In an acute or critical care setting 18% to 33% of patients have fecal incontinence (1). Multidrug-resistant organisms which are spread by direct or indirect contact, such as C. difficile and vancomycin-resistant enterococcus (VRE) both contribute to the prevalence of diarrhea-associated enteric nosocomial infections (2). A practical method for containment of the diarrhea is needed to reduce the risk of exposure to these organisms. Project: A study was conducted to assess and compare the impact of fecal containment with use of indwelling bowel catheters in the acute/ICU setting. The study was conducted at 12 sites using either catheter A or catheter B (A, 7; B, 5). An analysis of 146 patients (A, 76; B, 70) on the number of bedding and dressing change visits per day with catheter A or catheter B in place was conducted. Bedding and dressing change visits per patient day (frequency of nursing visits per day spent changing bedding/dressing due to fecal contamination) were used an indirect measure of catheter leakage and fecal containment. Routine daily bedding/dressing changes were not included, only catheter-related bedding/dressing changes were recorded. Results: The rate of bedding/dressing changes per patient day for catheter A was 1.2 and for catheter B was 1.7 (p50.0035). For catheter A sites, 735 bedding/dressing change visits occurred over 612 patient days and for catheter B sites, 705 bedding/dressing change visits occurred over 413 patient days. Although non-significant, lower observed rates of device leakage (A, 1.1; B, 1.4), repositions due to leakage (A, 0.25; B, 0.39), and devices expelled (A, 0.02; B, 0.07) may have contributed to the significant reduction in bedding/dressing changes associated with the use of catheter A compared to catheter B. Lessons Learned: Indwelling bowel catheters that divert, collect, and contain liquid stool from bedridden patients help to control and reduce exposure to fecal contaminates. These catheters should be studied against other
E73
Presentation Number: 8-84
Epidemiology of Hospital-Acquired Infections in a Tertiary Care Center in Lebanon Lamia Alamuddin Jurdi, BBA, M.P.H., Infection Control Professional; Zeina A. Kanafani, MD, MS, CIC, Hospital Epidemiologist; Nisreen Sidani, RN, MSN, Infection Control Officer; Nada Zahreddine, MPH, CIC, Infection Control Professional; Souha S. Kanj, MD, Head, Infectious Diseases Division, American University of Beirut Medical Center, Beirut, Lebanon. Objective: To describe the epidemiology of hospital-acquired infections (HAI) and multi-drug resistant organisms (MDRO) in a tertiary care center in Lebanon for the period October 2007 to September 2008. Methods: The Infection Control and Prevention Program at the American University of Beirut Medical Center conducts prospective targeted surveillance of hospital-acquired infections. The surveillance program reports on device-associated infections in critical care areas (catheter-related bloodstream infections [CR-BSI], ventilatorassociated pneumonias [VAP], and catheter-associated urinary tract infections [CA-UTI]). Device-associated infections are benchmarked against the rates published by the National Healthcare Safety System (NHSN) and the International Nosocomial Infection Control Consortium (INICC). Data on primary bloodstream infections, surgical site infections, Clostridium difficile associated diarrhea, and infections caused by MDROs are collected from all hospital units. All hospital-acquired infections were identified using the Centers for Disease Control and Prevention (CDC) definitions. Results: Critical care areas: VAP rates were highest in the medical-surgical ICU (15.5/1,000 ventilator-days) and lowest in the Nursery Intensive Care (N-ICU), 1.5/1,000 ventilator-days. The most predominant organisms causing VAP were Acinetobacter baumannii and Pseudomonas aeruginosa. The Respiratory Care Unit (RCU) had the highest rate of CA-UTI, 16/1,000 catheter-days. Escherichia coli and Klebsiella pneumoniae were the most reported causative agents. Both RCU and ICU had the highest rates in CR-BSI (15.5/1000 catheter-days). Coagulase negative staphylococci (CoNS) were the most predominant organisms causing CR-BSI. In the ICU, rates of all deviceassociated infections were higher than the NHSN rates. On the other hand, VAP rates were lower whereas CR-BSI rates were higher than the INICC benchmark. CA-UTI rates were similar to the INICC benchmark. Hospital-wide rates: the primary BSI rate was 1.5/1,000 patient-days with CoNS (39%) being the predominant organism, followed by Escherichia coli (25%). RCU had the highest rate of bacteremia followed by ICU. Central-lines were the most commonly identified source of primary BSI followed by implanted vascular access devices. The rate of surgical site infections (SSI) correlated with the wound class (lowest for clean procedures, highest for contaminated/dirty procedures). The vast majority of MDRO were gram-negative bacilli. All the A. baumannii isolates, both hospital and community-acquired were MDRO. Conclusion: The rates of device associated infections were higher than those reported in by NHSN in the medical/ surgical ICU. Implementation of infection control measures should be reinforced through the use of various strategies, including educational activities, implementation of practice bundles, prospective audits, and performance feedback to healthcare workers.
Presentation Number: 8-85
Evaluation of an Inpatient Influenza Vaccination Program Kathleen Wroten, RN, BSN, CIC, Manager, Infection Control; Leslie Freeman, RN, CIC.; Kellianne Riches, RN, BSN, Infection Control Nurse; Kimberly A. Couch, PharmD., MA, PharmD., Christiana Care Health System, Newark, DE. Issue: The influenza vaccination standing order by exception (IVSOE) was implemented in 2002 to increase compliance with inpatient screening and administration of influenza vaccine to eligible patients in our acute care setting. Additionally, prefilled individual dose syringes of influenza vaccine were placed in an automated dispensing cabinet on each nursing unit to allow easy access to vaccine after pharmacist review of orders and decrease the time for the vaccine to reach the patient. Lastly, electronic medication administration records (eMAR)
E74
American Journal of Infection Control June 2009
were implemented this year in part to increase compliance and documentation of influenza vaccine administration (among other medications). Project: Education of the experienced and new nursing staff early each fall prior to the beginning of the influenza season regarding the need for and use of the IVSOE has been essential to the program. We evaluated the number of doses of vaccine that were available for inpatient administration as a percentage of those allotted for inpatient use. We also tracked the absolute number of influenza vaccines administered to determine the success of our program. Results: Because of the success of the program, in 2006 our number of vaccines allotted increased from 1600 to 4000. In 2002, 302 (20%) doses of vaccine were administered. In 2003, 392 (26%) doses were administered. In 2004, 1179 (74%) were administered. In 2005, 3178 (100%1) doses were administered. In 2006, 2439 (61%) doses were administered. In 2007, 2264 (57%) doses were administered. Lastly, from October 13, 2008 through December 15, 2008, 1109 doses were administered. Lessons Learned: An IVSOE can assist in increasing inpatient influenza vaccination rates; however it takes coordinated efforts of infection control, nursing, pharmacy, and information technology to maintain success. In addition, eMAR can assist in tracking when a vaccine information sheet (VIS) is given, what version of the VIS is given, and the manufacturer and lot number of the vaccine administered. The IVSOE also contains the reasons why a patient is not eligible for the influenza vaccine. This may be an area for further exploration and may give us a better understanding of outpatient vaccine administration rates. Presentation Number: 8-86
Fecal Containment Using Indwelling Bowel Catheters to Potentially Prevent Multidrug-Resistant Organism Nosocomial Infections Barbara Barnett, RN, Clinical Nurse Specialist, University of Virginia Health Systems, Charlottesville, VA; Jan Powers, PhD, RN, CCRN, CCNS, Director Clinical Nurse Specialists, St. Vincent Indianapolis Hospital, Indianapolis, IN; Michael Koenig, RN, Burn/ICU Nurse, University of California, San Diego Medical Center, San Diego, CA; Elizabeth Stokes, RN, BSN, Director of Research Services, Sisters of Charity Providence Hospitals, Columbia, SC; Linda Morris, PhD, APN, CCWS, Clinical Nurse Specialist, Northwestern Memorial Hospital, Chicago, IL; Stathis Poulakidas, MD, Director of Burn Services, John H. Stroger Jr. Hospital of Cook County, Chicago, IL; Elizabeth C. Konz, PhD, RD, Global Clinical Research, Hollister Incorporated, Libertyville, IL. Issue: In an acute or critical care setting 18% to 33% of patients have fecal incontinence (1). Multidrug-resistant organisms which are spread by direct or indirect contact, such as C. difficile and vancomycin-resistant enterococcus (VRE) both contribute to the prevalence of diarrhea-associated enteric nosocomial infections (2). A practical method for containment of the diarrhea is needed to reduce the risk of exposure to these organisms. Project: A study was conducted to assess and compare the impact of fecal containment with use of indwelling bowel catheters in the acute/ICU setting. The study was conducted at 12 sites using either catheter A or catheter B (A, 7; B, 5). An analysis of 146 patients (A, 76; B, 70) on the number of bedding and dressing change visits per day with catheter A or catheter B in place was conducted. Bedding and dressing change visits per patient day (frequency of nursing visits per day spent changing bedding/dressing due to fecal contamination) were used an indirect measure of catheter leakage and fecal containment. Routine daily bedding/dressing changes were not included, only catheter-related bedding/dressing changes were recorded. Results: The rate of bedding/dressing changes per patient day for catheter A was 1.2 and for catheter B was 1.7 (p50.0035). For catheter A sites, 735 bedding/dressing change visits occurred over 612 patient days and for catheter B sites, 705 bedding/dressing change visits occurred over 413 patient days. Although non-significant, lower observed rates of device leakage (A, 1.1; B, 1.4), repositions due to leakage (A, 0.25; B, 0.39), and devices expelled (A, 0.02; B, 0.07) may have contributed to the significant reduction in bedding/dressing changes associated with the use of catheter A compared to catheter B. Lessons Learned: Indwelling bowel catheters that divert, collect, and contain liquid stool from bedridden patients help to control and reduce exposure to fecal contaminates. These catheters should be studied against other