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Automated Surveillance Technology to Improve Surgical Site Infection (SSI) Workflow Efficiency: A Large Healthcare System Experience
Poster Abstracts / American Journal of Infection Control 44 (2016) S28-S82
CONCLUSIONS: The collaborative process promoted positive behavior changes in the Nursing staff on the LTC and Dialysis unit while reducing CLABSI & patient harm.
Data Standardization and Validation 4-130 A Case Study: Discordant Results in Mycobacterial Culturing of Cardiac Bypass Heater-Cooler Machines—Seek and You May Find Patricia Hnatuck, MT (ASCP), CIC, Infection Prevention Coordinator, Penn State Milton S. Hershey Medical Center; Arlene Brumbach, MS, CIC, Infection Prevention Coordinator, Penn State Hershey Medical Center; Dianne A. Stolberg, MPA, BSN, RN, CIC, Infection Prevention Coordinator, Penn State Hershey Medical Center; Rahn Snyder, RN, CIC, Infection Prevention Coordinator, Penn State Milton S. Hershey Medical Center; Larry Baer, CCP, LP, Certified Clinical Perfusionist, Penn State Milton S. Hershey Medical Center; Scott Mincemoyer, RN, MSN, Director of Clinical Quality, Penn State Milton S. Hershey Medical Center; Cynthia Whitener, MD, Infectious Disease Physician, Hospital Epidemiologist, Penn State Milton S. Hershey Medical Center; Kathleen G. Julian, MD, Infectious Disease Physician, Penn State Milton S. Hershey Medical Center BACKGROUND: Because of 3 cases of non-tuberculous mycobacterial (NTM) infections associated with cardiac surgery at our hospital and alerts released in 2015 implicating heater-cooler machines used during cardiopulmonary bypass, water sampling of our machines for NTM cultures is performed. While the first set of 6 water reservoir samples sent to Lab A are all negative for NTM, subsequent sampling performed 2 months later on the same machines and sent to Lab B are all positive for NTM. Do different collection and laboratory testing methods for NTM account for discordant results in organism recovery? Our experience of false-negative results from the first sampling session prompts a review of sampling and laboratory testing methods at Lab A and Lab B. METHODS: A literature search was performed to identify consensus NTM environmental testing methodology for heater-cooler machines. Conference calls were made to Lab A and Lab B to review the laboratory testing methods. RESULTS: Literature search yielded the European Centre for Disease Prevention and Control’s protocol, published in August 2015, for environmental testing of Mycobacterium chimaera potentially associated with heater-cooler units. These guidelines recommended concentration by filtration, decontamination by cetylpyridinium chloride, plating on selective solid agar (e.g., Middlebrook 7H11 or 7H10 agar or egg-based medium), and incubation on solid media at 35â °C for up to 8 weeks. CONCLUSIONS: While both laboratories that tested our samples are certified in environmental testing for NTM, this case study of discordant results from our heater-coolers identifies differences between lab methodologies and from published guidelines. Logistic issues inadvertently may also lead to differences in sampling methods, including time of water collection relative to prior disinfections. Sampling and laboratory methods may impact NTM recovery. There is a need for standardization of sampling methods and of environ-
S39
mental NTM testing for hospitals investigating heater-cooler machines and other potential sources of healthcare-associated NTM infections.
4-131 Automated Surveillance Technology to Improve Surgical Site Infection (SSI) Workflow Efficiency: A Large Healthcare System Experience Adebisi A. Adeyeye, DHA, RN, CIC, Infection Preventionist, Montefiore Medical Center–Weiler Division; Joan N. Hebden, MS., RN., CIC, Infection Prevention Clinical Development Manager, Wolters Kluwer Health; Audrey Adams, RN, MPH, CIC, Director, Infection Prevention & Control, Montefiore Medical Center BACKGROUND: A large Healthcare system implemented an electronic surveillance system (EES) to meet the demands of the mandated national and state public reporting requirements for healthcare – associated infections (HAI). Automated surveillance for HAIs has been accelerating over the last decade with the streamlining of these surveillance workflow processes as a desired outcome. Manually completing the National Healthcare Safety Network (NHSN) surgical denominator is time consuming and intensive, which involves many steps. METHODS: We looked at the time spent on surgical surveillance before and after the implementation of the EES. In July 2014, our 425-bed academic medical center implemented an automated surveillance application with a surgical procedure data feed sourced by the facility’s independent operating room (OR) system. A scheduled report was developed to generate information twice a month from the OR system. The parameters of the report were standardized utilizing the NHSN guidelines for Clinical Documentation Architecture (CDA) import. RESULTS: Using the EES takes approximately a third of the time of the manual process going from greater than 60 hours to less than 20 hours. Automating the process allows for capture of NHSN data elements from electronic data feeds and creates opportunities for efficient collection of denominator data, and the required NHSN data elements for SSI risk adjustments in timely manner. CONCLUSIONS: The benefits of utilizing the EES for Surgical Surveillance reduced the burden on Infection Prevention fulfilling the reporting mandate. EES results in time savings by eliminating the need to manually identify the operative cases and allows for timely intervention for identified infections. A timely data collection is actionable and leads to prompt identification of changes or patterns in real time.
4-132 Catheter Associated Urinary Tract Infection Algorithm Performance for ICU and Non-ICU Surveillance Carole Leone, RN, MSN, CIC, Infection Prevention Consultant, BJC Healthcare; Hilary Babcock, MD, MPH, Medical Director, BJC Infection Prevention and Epidemiology Consortium and Occupational Health, Barnes-Jewish and St. Louis Children’s Hospitals; Washington University School of Medicine BACKGROUND: Catheter-associated urinary tract infections (CAUTI) became publicly reportable in 2012 for certain intensive care unit (ICU) locations; this requirement expanded in 2015 to
APIC 43rd Annual Educational Conference & International Meeting I Charlotte, NC | June 11-13, 2016
CONCLUSIONS: The collaborative process promoted positive behavior changes in the Nursing staff on the LTC and Dialysis unit while reducing CLABSI & patient harm.
Data Standardization and Validation 4-130 A Case Study: Discordant Results in Mycobacterial Culturing of Cardiac Bypass Heater-Cooler Machines—Seek and You May Find Patricia Hnatuck, MT (ASCP), CIC, Infection Prevention Coordinator, Penn State Milton S. Hershey Medical Center; Arlene Brumbach, MS, CIC, Infection Prevention Coordinator, Penn State Hershey Medical Center; Dianne A. Stolberg, MPA, BSN, RN, CIC, Infection Prevention Coordinator, Penn State Hershey Medical Center; Rahn Snyder, RN, CIC, Infection Prevention Coordinator, Penn State Milton S. Hershey Medical Center; Larry Baer, CCP, LP, Certified Clinical Perfusionist, Penn State Milton S. Hershey Medical Center; Scott Mincemoyer, RN, MSN, Director of Clinical Quality, Penn State Milton S. Hershey Medical Center; Cynthia Whitener, MD, Infectious Disease Physician, Hospital Epidemiologist, Penn State Milton S. Hershey Medical Center; Kathleen G. Julian, MD, Infectious Disease Physician, Penn State Milton S. Hershey Medical Center BACKGROUND: Because of 3 cases of non-tuberculous mycobacterial (NTM) infections associated with cardiac surgery at our hospital and alerts released in 2015 implicating heater-cooler machines used during cardiopulmonary bypass, water sampling of our machines for NTM cultures is performed. While the first set of 6 water reservoir samples sent to Lab A are all negative for NTM, subsequent sampling performed 2 months later on the same machines and sent to Lab B are all positive for NTM. Do different collection and laboratory testing methods for NTM account for discordant results in organism recovery? Our experience of false-negative results from the first sampling session prompts a review of sampling and laboratory testing methods at Lab A and Lab B. METHODS: A literature search was performed to identify consensus NTM environmental testing methodology for heater-cooler machines. Conference calls were made to Lab A and Lab B to review the laboratory testing methods. RESULTS: Literature search yielded the European Centre for Disease Prevention and Control’s protocol, published in August 2015, for environmental testing of Mycobacterium chimaera potentially associated with heater-cooler units. These guidelines recommended concentration by filtration, decontamination by cetylpyridinium chloride, plating on selective solid agar (e.g., Middlebrook 7H11 or 7H10 agar or egg-based medium), and incubation on solid media at 35â °C for up to 8 weeks. CONCLUSIONS: While both laboratories that tested our samples are certified in environmental testing for NTM, this case study of discordant results from our heater-coolers identifies differences between lab methodologies and from published guidelines. Logistic issues inadvertently may also lead to differences in sampling methods, including time of water collection relative to prior disinfections. Sampling and laboratory methods may impact NTM recovery. There is a need for standardization of sampling methods and of environ-
S39
mental NTM testing for hospitals investigating heater-cooler machines and other potential sources of healthcare-associated NTM infections.
4-131 Automated Surveillance Technology to Improve Surgical Site Infection (SSI) Workflow Efficiency: A Large Healthcare System Experience Adebisi A. Adeyeye, DHA, RN, CIC, Infection Preventionist, Montefiore Medical Center–Weiler Division; Joan N. Hebden, MS., RN., CIC, Infection Prevention Clinical Development Manager, Wolters Kluwer Health; Audrey Adams, RN, MPH, CIC, Director, Infection Prevention & Control, Montefiore Medical Center BACKGROUND: A large Healthcare system implemented an electronic surveillance system (EES) to meet the demands of the mandated national and state public reporting requirements for healthcare – associated infections (HAI). Automated surveillance for HAIs has been accelerating over the last decade with the streamlining of these surveillance workflow processes as a desired outcome. Manually completing the National Healthcare Safety Network (NHSN) surgical denominator is time consuming and intensive, which involves many steps. METHODS: We looked at the time spent on surgical surveillance before and after the implementation of the EES. In July 2014, our 425-bed academic medical center implemented an automated surveillance application with a surgical procedure data feed sourced by the facility’s independent operating room (OR) system. A scheduled report was developed to generate information twice a month from the OR system. The parameters of the report were standardized utilizing the NHSN guidelines for Clinical Documentation Architecture (CDA) import. RESULTS: Using the EES takes approximately a third of the time of the manual process going from greater than 60 hours to less than 20 hours. Automating the process allows for capture of NHSN data elements from electronic data feeds and creates opportunities for efficient collection of denominator data, and the required NHSN data elements for SSI risk adjustments in timely manner. CONCLUSIONS: The benefits of utilizing the EES for Surgical Surveillance reduced the burden on Infection Prevention fulfilling the reporting mandate. EES results in time savings by eliminating the need to manually identify the operative cases and allows for timely intervention for identified infections. A timely data collection is actionable and leads to prompt identification of changes or patterns in real time.
4-132 Catheter Associated Urinary Tract Infection Algorithm Performance for ICU and Non-ICU Surveillance Carole Leone, RN, MSN, CIC, Infection Prevention Consultant, BJC Healthcare; Hilary Babcock, MD, MPH, Medical Director, BJC Infection Prevention and Epidemiology Consortium and Occupational Health, Barnes-Jewish and St. Louis Children’s Hospitals; Washington University School of Medicine BACKGROUND: Catheter-associated urinary tract infections (CAUTI) became publicly reportable in 2012 for certain intensive care unit (ICU) locations; this requirement expanded in 2015 to
APIC 43rd Annual Educational Conference & International Meeting I Charlotte, NC | June 11-13, 2016