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Isolation Precautions: Active Surveillance and Multidisciplinary Management Save Costs
American Journal of Infection Control 45 (2017) S2-S15
Contents lists available at ScienceDirect
American Journal of Infection Control
American Journal of Infection Control
j o u r n a l h o m e p a g e : w w w. a j i c j o u r n a l . o r g
Oral Abstracts
Decision Tools
Stephen Derman, FAIHA, President, MediSHARE Environmental Health & Safety Services
Session: DT-209 Presentation Number: 1200 Analysis and Modeling of Sociodemographic Factors Contributing to Hospital Acquired Infection Incidence Margaret C. Cullather, BS, Safety Specialist, Amazon.com BACKGROUND: Each year 90,000 people will die from a hospital acquired infection (HAI). Currently, there are many studies looking at HAI surveillance within the hospital but few look at surveillance within a community and sociodemographic factors that may influence these infection rates. This study discerns a significant relationship between the two. A statistical regression was used to develop infection risk analysis using sociodemographic factors such as income, citizenship, minority, and veteran status. METHODS: The research conducted a Geographic Information Systems (GIS) analysis of twenty hospitals and interviews with chief medical officers (CMOs) selected by use of a random number generator from the Medicare database of 4,000 + US hospitals. This included a statistical stepwise regression comparing Medicare infection data with sociodemographic data obtained from the US Census Bureau American Community Survey. Interviews were used as supplemental data to better understand interactions between communities and infections. RESULTS: Results show that HAI incidence was higher in counties with high minority, uninsured, non citizen populations. These results are substantiated by studies that found atrial fibrillation, vitamin D deficiency, malnutrition, cancer, and dialysis treatments as independent risk factors of HAIs—conditions more frequent in populations of high minority and low income. Research also suggests that a population’s ability to move and travel resulted in differences in adaptive immunity influencing HAI rates as well. CONCLUSIONS: The results of this experiment indicate that the spread of HAIs can be distinctly influenced by the patients environment outside of the hospital. It then becomes important to consider issues of social justice, economics, and structural violence when developing public health systems to prevent the spread of HAIs.
Session: DT-210 Presentation Number: 1200 AIHA Guidelines for Selection and Use of Environmental Surface Disinfectants in Healthcare Roberta Smith, RN, MSPH, CIC, CIH, Occupational Health Program Manager, Colorado Department of Public Health & Environment; John Martinelli, Director, Healthcare Practice Director, Forensic Analytical Consulting Services;
BACKGROUND: The selection of chemical disinfectants and disinfection technologies such as ultraviolet often do not consider the occupational health risks to healthcare workers and environmental services staff. When new products or modalities are used, questions generally arise for occupational health and safety professionals on the worker exposure considerations of these products. To this end, a subcommittee of the American Industrial Hygienists Association (AIHA) came together to create a guideline that could be used by Industrial Hygienists, Occupational Health Professionals, and Safety Professionals to help understand the concepts of disinfection and potential worker safety considerations when using different chemicals or processes. METHODS: The guideline created by AIHA has put together information for the practicing industrial hygienist and health and safety professional working in healthcare settings to be able to understand the complex ecology of opportunistic pathogens of interest, provide practical guidance on how to select appropriate disinfectants given a product’s efficacy, effectiveness, efficiency and safety, and how to assess actual cleanliness and estimate occupational exposure to housekeeping staff and other healthcare workers working with disinfecting products. RESULTS: The publishing of this guideline has the intention to bring infection preventionists, industrial hygienists, occupational health and safety professionals together to build a comprehensive cleaning and disinfection program that takes into account the appropriate selection of disinfection agents with the consideration of healthcare worker safety. In addition, the document addresses the appropriate administrative, engineering, and personal protection controls for disinfectants and disinfection processes that could potentially be implemented in healthcare. CONCLUSIONS: The AIHA Infection Control subcommittee that authored this guideline anticipates that this document will enhance the knowledge and partnership of industrial hygienists and infection preventionist on potential exposures to healthcare workers in the cleaning and disinfection processes.
Session: DT-211 Presentation Number: 1200 Isolation Precautions: Active Surveillance and Multidisciplinary Management Save Costs Daiane Patricia Cais, MSN, Nurse Coordinator, Infection Control Team, Hospital Samaritano de São Paulo/Brazil; Juliana Almeida-Nunes Sr., RN, Nurse, Infection Control Team, Hospital Samaritano de São Paulo; Bianca Miranda, MD, Infectious Diseases Chief, Infection Control Team, Hospital Samaritano de São Paulo/Brazil; Maria Luisa Moura, MD, Infectious Disease Doctor, Infection Control Team, Hospital
APIC 44th Annual Educational Conference & International Meeting | Portland, OR | June 14-16, 2017
Oral Abstracts / American Journal of Infection Control 45 (2017) S2-S15
Samaritano de São Paulo/Brazil; Lanuza Duarte, RN, Nurse, Infection Control Team, Hospital Samaritano de São Paulo/Brazil; Analu Mancini, RN, Nurse, Infection Control Team, Hospital Samaritano de São Paulo/Brazil; Gabriela Coito, Nurse student, Infection Control Team, Hospital Samaritano de São Paulo/Brazil; Sarita Lessa, RN, Nurse, Infection Control Team, Hospital Samaritano de São Paulo BACKGROUND: One of the main activities of the Infection Control Team (ICT) is to minimize the risk of transmission of multi-drug resistant organisms from colonized and/or infected patients to other patients or healthcare workers, by installing and monitoring compliance with precautions and isolations recommendations. Transmission-based precautions (TBP)—contact, droplets and airbone infection isolation—when not properly indicated, can increase costs and cause problems to patients. We aimed to evaluate the adequacy of TBP prescription in a 300-bed private hospital in Sao PauloBrazil, focusing on costs. METHODS: From May 2016 to November 2016, ICT performed active weekly surveillance and evaluate the indication of TBP prescribed to all patients in intensive care units (ICU) and general floors (GF), through electronic data system. Nurses and physicians are empowered to install and suspend TBP as recommended by institutional protocol, available electronically for the entire institution. Additional costs regarding to unnecessary TBP were analyzed, and data were converted from Brazilian Real to US dollar (quotation updated 12/13/2016). RESULTS: 1,418 patients were on TBP during study period, with an average of 60 patients evaluated per week. Of them, 181 (12.8%) were unnecessary, according to institutional protocol (91 in GF and 90 in ICU). The mean daily additional cost per patient in TBP was US$ 78.50 for GF and US$ 180.96 for ICU. For the period of study, the extra cost was US$ 6,435.60 for GF and US$ 16,286.49 for ICU. The total cost might be even higher since the evaluation by ICT is performed every seven days. CONCLUSIONS: Active surveillance and critical evaluation of isolation precautions is an essential task of ICT, however, for continuous success in preventing transmission of infection agents during patient care and unnecessary costs in healthcare settings, a multidisciplinary involvement is primordial to adequate management of isolation precautions.
SSI/HAI Prevention Session: SSIP-212 Presentation Number: 1201 Use of CHG Cloths and Nasal Iodine to Reduce Surgical Site Infections in Orthopedic Infections Debra A. Runyan, BS, MT(ASCP), CIC, Director, Infection Prevention, Pennsylvania Hospital; Claire Stango, RN, CIC, Infection Preventionist, Pennsylvania Hospital; Ida Macri, BSN, CIC, Infection Preventionist, Pennsylvania Hospital; Maria Vacca, BSN, RN, CIC, Infection Preventionist, Pennsylvania Hospital; John J. Stern, MD, Chief, Division Infectious Diseases, Pennsylvania Hospital BACKGROUND: To reduce total knee and hip arthroplasty surgical site infections by decolonizing patients prior to surgery.
S3
METHODS: Patients were provided/instructed to use 2% CHG (Chlorhexiidine Gluconate) cloths for a full body wipe the night before surgery. A full body wipe was done again by hospital staff the morning of surgery. A viscous iodine was also apply to both nostrils. This protocol was started in September 2014. Standardized Infection Ratios (SIR) were calculated and compared to data collected prior to the study. Compliance was monitored and feedback was given to both surgery and hospital providers when breaks in the protocol were noted. RESULTS: For the year prior to the intervention, there were 17 infections with an SIR or 1.46. Even though the protocol was started 10 weeks into the new fiscal year, there was a decrease in both the number of infections and the SIR. There were 11 infections with an SIR of 0.74. Of the 11 infections, 5 patients did not receive the full protocol. Given early success, the protocol continued from July 2015 through June 2016. During this interval, there were 13 infections with an SIR of 0.80. Of the 13, six did not receive the complete protocol. There were 1480 hip and knee surgeries during this period with a 85% protocol compliance rate. The overall rate for all these cases was 0.88 infections/100 surgeries . For patients who received the full protocol, the rate was 0.56 and for those who did not have the full protocol, the rate was 2.70 infections/ 100 surgeries. CONCLUSIONS: A protocol of 2% CHG wipes the night before and morning of surgery along with nasal iodine can reduce the incidence of surgical site infection. Compliance is key. The SSI rate for patients who did not receive the full protocol was 4.8 times higher than patients who did.
Session: SSIP-213 Presentation Number: 1201 Sustained Elimination of Immediate Use Steam Sterilization—Bridging the Implementation Gap Sharon K. Alexander, MPH, BSN, CIC, MT(ASCP), Infection Preventionist, Corporal Michael J. Crescenz Veterans Affairs Medical Center; Cheryl Ciocca, RN, MS, CRMST, Nurse Manager, Medical Intensive Care Unit, Corporal Michael J. Crescenz Veterans Affairs Medical Center; Lillian Santos, BSM, CST, CRCST, Chief Sterile Processing Service, Corporal Michael J. Crescenz Veteran Affairs Medical Center; Charmin Clavon-Surma, MSN, RN, CNOR, Operating Room Nurse Manager, Corporal Michael J. Crescenz Veterans Affairs Medical Center; Suzanne H. Fritz, RN, BSN, CIC, Infection Preventionist, Corporal Michael J. Crescenz Veterans Affairs Medical Center; Darren R. Linkin, MD, MSCE, Associate Professor (UPENN), ID Section Chief and Hospital Epidemiologist (VA), University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center BACKGROUND: Decreasing Immediate Use Steam Sterilization (IUSS) is an important component of the prevention of surgical site infections. Utilizing best practice guidelines, facility-specific challenges can be overcome by the systematic collection and analysis of data combined with the development, implementation and ongoing monitoring of the success or failure of targeted interventions by a team committed to zero tolerance. METHODS: A robust database was created in early Fiscal Year (FY) 2011 to enable our multi-disciplinary team to analyze the reason for each IUSS event. Front-line staff in our operative and sterile processing areas were engaged to review data, develop, validate, prioritize and implement interventions. Interventions that were systematically and consecutively implemented included trialing of
APIC 44th Annual Educational Conference & International Meeting | Portland, OR | June 14-16, 2017
Contents lists available at ScienceDirect
American Journal of Infection Control
American Journal of Infection Control
j o u r n a l h o m e p a g e : w w w. a j i c j o u r n a l . o r g
Oral Abstracts
Decision Tools
Stephen Derman, FAIHA, President, MediSHARE Environmental Health & Safety Services
Session: DT-209 Presentation Number: 1200 Analysis and Modeling of Sociodemographic Factors Contributing to Hospital Acquired Infection Incidence Margaret C. Cullather, BS, Safety Specialist, Amazon.com BACKGROUND: Each year 90,000 people will die from a hospital acquired infection (HAI). Currently, there are many studies looking at HAI surveillance within the hospital but few look at surveillance within a community and sociodemographic factors that may influence these infection rates. This study discerns a significant relationship between the two. A statistical regression was used to develop infection risk analysis using sociodemographic factors such as income, citizenship, minority, and veteran status. METHODS: The research conducted a Geographic Information Systems (GIS) analysis of twenty hospitals and interviews with chief medical officers (CMOs) selected by use of a random number generator from the Medicare database of 4,000 + US hospitals. This included a statistical stepwise regression comparing Medicare infection data with sociodemographic data obtained from the US Census Bureau American Community Survey. Interviews were used as supplemental data to better understand interactions between communities and infections. RESULTS: Results show that HAI incidence was higher in counties with high minority, uninsured, non citizen populations. These results are substantiated by studies that found atrial fibrillation, vitamin D deficiency, malnutrition, cancer, and dialysis treatments as independent risk factors of HAIs—conditions more frequent in populations of high minority and low income. Research also suggests that a population’s ability to move and travel resulted in differences in adaptive immunity influencing HAI rates as well. CONCLUSIONS: The results of this experiment indicate that the spread of HAIs can be distinctly influenced by the patients environment outside of the hospital. It then becomes important to consider issues of social justice, economics, and structural violence when developing public health systems to prevent the spread of HAIs.
Session: DT-210 Presentation Number: 1200 AIHA Guidelines for Selection and Use of Environmental Surface Disinfectants in Healthcare Roberta Smith, RN, MSPH, CIC, CIH, Occupational Health Program Manager, Colorado Department of Public Health & Environment; John Martinelli, Director, Healthcare Practice Director, Forensic Analytical Consulting Services;
BACKGROUND: The selection of chemical disinfectants and disinfection technologies such as ultraviolet often do not consider the occupational health risks to healthcare workers and environmental services staff. When new products or modalities are used, questions generally arise for occupational health and safety professionals on the worker exposure considerations of these products. To this end, a subcommittee of the American Industrial Hygienists Association (AIHA) came together to create a guideline that could be used by Industrial Hygienists, Occupational Health Professionals, and Safety Professionals to help understand the concepts of disinfection and potential worker safety considerations when using different chemicals or processes. METHODS: The guideline created by AIHA has put together information for the practicing industrial hygienist and health and safety professional working in healthcare settings to be able to understand the complex ecology of opportunistic pathogens of interest, provide practical guidance on how to select appropriate disinfectants given a product’s efficacy, effectiveness, efficiency and safety, and how to assess actual cleanliness and estimate occupational exposure to housekeeping staff and other healthcare workers working with disinfecting products. RESULTS: The publishing of this guideline has the intention to bring infection preventionists, industrial hygienists, occupational health and safety professionals together to build a comprehensive cleaning and disinfection program that takes into account the appropriate selection of disinfection agents with the consideration of healthcare worker safety. In addition, the document addresses the appropriate administrative, engineering, and personal protection controls for disinfectants and disinfection processes that could potentially be implemented in healthcare. CONCLUSIONS: The AIHA Infection Control subcommittee that authored this guideline anticipates that this document will enhance the knowledge and partnership of industrial hygienists and infection preventionist on potential exposures to healthcare workers in the cleaning and disinfection processes.
Session: DT-211 Presentation Number: 1200 Isolation Precautions: Active Surveillance and Multidisciplinary Management Save Costs Daiane Patricia Cais, MSN, Nurse Coordinator, Infection Control Team, Hospital Samaritano de São Paulo/Brazil; Juliana Almeida-Nunes Sr., RN, Nurse, Infection Control Team, Hospital Samaritano de São Paulo; Bianca Miranda, MD, Infectious Diseases Chief, Infection Control Team, Hospital Samaritano de São Paulo/Brazil; Maria Luisa Moura, MD, Infectious Disease Doctor, Infection Control Team, Hospital
APIC 44th Annual Educational Conference & International Meeting | Portland, OR | June 14-16, 2017
Oral Abstracts / American Journal of Infection Control 45 (2017) S2-S15
Samaritano de São Paulo/Brazil; Lanuza Duarte, RN, Nurse, Infection Control Team, Hospital Samaritano de São Paulo/Brazil; Analu Mancini, RN, Nurse, Infection Control Team, Hospital Samaritano de São Paulo/Brazil; Gabriela Coito, Nurse student, Infection Control Team, Hospital Samaritano de São Paulo/Brazil; Sarita Lessa, RN, Nurse, Infection Control Team, Hospital Samaritano de São Paulo BACKGROUND: One of the main activities of the Infection Control Team (ICT) is to minimize the risk of transmission of multi-drug resistant organisms from colonized and/or infected patients to other patients or healthcare workers, by installing and monitoring compliance with precautions and isolations recommendations. Transmission-based precautions (TBP)—contact, droplets and airbone infection isolation—when not properly indicated, can increase costs and cause problems to patients. We aimed to evaluate the adequacy of TBP prescription in a 300-bed private hospital in Sao PauloBrazil, focusing on costs. METHODS: From May 2016 to November 2016, ICT performed active weekly surveillance and evaluate the indication of TBP prescribed to all patients in intensive care units (ICU) and general floors (GF), through electronic data system. Nurses and physicians are empowered to install and suspend TBP as recommended by institutional protocol, available electronically for the entire institution. Additional costs regarding to unnecessary TBP were analyzed, and data were converted from Brazilian Real to US dollar (quotation updated 12/13/2016). RESULTS: 1,418 patients were on TBP during study period, with an average of 60 patients evaluated per week. Of them, 181 (12.8%) were unnecessary, according to institutional protocol (91 in GF and 90 in ICU). The mean daily additional cost per patient in TBP was US$ 78.50 for GF and US$ 180.96 for ICU. For the period of study, the extra cost was US$ 6,435.60 for GF and US$ 16,286.49 for ICU. The total cost might be even higher since the evaluation by ICT is performed every seven days. CONCLUSIONS: Active surveillance and critical evaluation of isolation precautions is an essential task of ICT, however, for continuous success in preventing transmission of infection agents during patient care and unnecessary costs in healthcare settings, a multidisciplinary involvement is primordial to adequate management of isolation precautions.
SSI/HAI Prevention Session: SSIP-212 Presentation Number: 1201 Use of CHG Cloths and Nasal Iodine to Reduce Surgical Site Infections in Orthopedic Infections Debra A. Runyan, BS, MT(ASCP), CIC, Director, Infection Prevention, Pennsylvania Hospital; Claire Stango, RN, CIC, Infection Preventionist, Pennsylvania Hospital; Ida Macri, BSN, CIC, Infection Preventionist, Pennsylvania Hospital; Maria Vacca, BSN, RN, CIC, Infection Preventionist, Pennsylvania Hospital; John J. Stern, MD, Chief, Division Infectious Diseases, Pennsylvania Hospital BACKGROUND: To reduce total knee and hip arthroplasty surgical site infections by decolonizing patients prior to surgery.
S3
METHODS: Patients were provided/instructed to use 2% CHG (Chlorhexiidine Gluconate) cloths for a full body wipe the night before surgery. A full body wipe was done again by hospital staff the morning of surgery. A viscous iodine was also apply to both nostrils. This protocol was started in September 2014. Standardized Infection Ratios (SIR) were calculated and compared to data collected prior to the study. Compliance was monitored and feedback was given to both surgery and hospital providers when breaks in the protocol were noted. RESULTS: For the year prior to the intervention, there were 17 infections with an SIR or 1.46. Even though the protocol was started 10 weeks into the new fiscal year, there was a decrease in both the number of infections and the SIR. There were 11 infections with an SIR of 0.74. Of the 11 infections, 5 patients did not receive the full protocol. Given early success, the protocol continued from July 2015 through June 2016. During this interval, there were 13 infections with an SIR of 0.80. Of the 13, six did not receive the complete protocol. There were 1480 hip and knee surgeries during this period with a 85% protocol compliance rate. The overall rate for all these cases was 0.88 infections/100 surgeries . For patients who received the full protocol, the rate was 0.56 and for those who did not have the full protocol, the rate was 2.70 infections/ 100 surgeries. CONCLUSIONS: A protocol of 2% CHG wipes the night before and morning of surgery along with nasal iodine can reduce the incidence of surgical site infection. Compliance is key. The SSI rate for patients who did not receive the full protocol was 4.8 times higher than patients who did.
Session: SSIP-213 Presentation Number: 1201 Sustained Elimination of Immediate Use Steam Sterilization—Bridging the Implementation Gap Sharon K. Alexander, MPH, BSN, CIC, MT(ASCP), Infection Preventionist, Corporal Michael J. Crescenz Veterans Affairs Medical Center; Cheryl Ciocca, RN, MS, CRMST, Nurse Manager, Medical Intensive Care Unit, Corporal Michael J. Crescenz Veterans Affairs Medical Center; Lillian Santos, BSM, CST, CRCST, Chief Sterile Processing Service, Corporal Michael J. Crescenz Veteran Affairs Medical Center; Charmin Clavon-Surma, MSN, RN, CNOR, Operating Room Nurse Manager, Corporal Michael J. Crescenz Veterans Affairs Medical Center; Suzanne H. Fritz, RN, BSN, CIC, Infection Preventionist, Corporal Michael J. Crescenz Veterans Affairs Medical Center; Darren R. Linkin, MD, MSCE, Associate Professor (UPENN), ID Section Chief and Hospital Epidemiologist (VA), University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center BACKGROUND: Decreasing Immediate Use Steam Sterilization (IUSS) is an important component of the prevention of surgical site infections. Utilizing best practice guidelines, facility-specific challenges can be overcome by the systematic collection and analysis of data combined with the development, implementation and ongoing monitoring of the success or failure of targeted interventions by a team committed to zero tolerance. METHODS: A robust database was created in early Fiscal Year (FY) 2011 to enable our multi-disciplinary team to analyze the reason for each IUSS event. Front-line staff in our operative and sterile processing areas were engaged to review data, develop, validate, prioritize and implement interventions. Interventions that were systematically and consecutively implemented included trialing of
APIC 44th Annual Educational Conference & International Meeting | Portland, OR | June 14-16, 2017