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Centralization of Sterilization and High Level Disinfection from Multiple Outpatient Settings to a Centralized Sterile Processing Department Provides Consistent Process
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Oral Abstracts / American Journal of Infection Control 44 (2016) S3-S27
Alternate Care Settings Presentation Number 17 Centralization of Sterilization and High Level Disinfection from Multiple Outpatient Settings to a Centralized Sterile Processing Department Provides Consistent Process Linda Johnson, M.S.N. RN, CIC, Infection Control Manager, University of Missouri Health Care BACKGROUND: An academic medical center with 57 primary and specialty clinics within a four county area has 14 autoclaves and 17 areas using high level disinfection (HLD) in outpatient settings. Clinic staff are expected to remain competent in sterilization processes, though it is not a primary function in their busy work day. Ensuring each staff member’s competence in HLD or sterilization is an insurmountable task when there are multiple locations. Competency includes precleaning techniques, using biological monitors correctly, maintaining accurate records, performing preventative maintenance, and having and flowing failure recalls plans. METHODS: Infection control, Sterile Processing (SPD), and transport leaders met with clinic practice managers to discuss barriers in decentralization of autoclaves or HLD. Identified barriers included: not enough instruments, turn-around time, delivery schedules, and fear of not getting instruments back from sterile processing. Additional instruments were purchased by SPD in cases when couriers were limited in the amount of trips taken to outpatient settings. Procedures were developed for transporting instruments for central processing. Areas began with a trial period to assess for gaps in the process before eliminating the autoclave or HLD. Certified SPD staff provide training and assess competency for staff in remaining areas performing sterile processing or using HLD. RESULTS: Through consistent, planned coordination with infection control, SPD, transport and clinic leaders a 93% reduction in autoclaves and a 59% reduction in HLD usage was achieved. All staff that currently perform sterile processing or use HLD have received training and performed a competency. CONCLUSIONS: Centralization of instrument sterile processing improves the standardized process of instrument sterilization and reduces areas of concern related to maintaining quality processes in outpatient areas.
Presentation Number 18 Policies and Practices to Reduce Urinary Tract Infections in Nursing Homes Carolyn Herzig, PhD, MS, Project Director, Columbia University School of Nursing; Andrew Dick, PhD, Senior Economist, The RAND Corporation; Nicholas Castle, PhD, Professor, Department of Health Policy and Management, University of Pittsburgh; Patricia Stone, PhD, Professor, Center for Health Policy, Columbia University School of Nursing BACKGROUND: Urinary tract infections (UTIs) are the most common infections in nursing homes (NHs) and result in increased hospitalization and antibiotic use. Little is known about the effectiveness of UTI prevention strategies in NHs, particularly for infections not associated with catheter use. The objective of this study was to evaluate policies and practices associated with UTI prevalence.
METHODS: A survey of 2,550 randomly sampled US NHs was conducted to assess UTI prevention policies and practices. Responses were linked with 2013 Minimum Data Set assessments to measure UTI prevalence and catheter use and Certification and Survey Provider Enhanced Reporting data for NH characteristics. Descriptive statistics were computed and multivariable logistic regression analyses conducted controlling for bedsize, occupancy, payer mix, staffing levels, census region, and metropolitan setting. RESULTS: Data from 88,135 residents in 955 NHs were evaluated (n = 273,205 assessments). On average, the monthly prevalence of UTI and catheter-associated UTI (CAUTI) was 5.4% and 0.9%, respectively. The prevalence of indwelling and/or intermittent catheterization was 4.7%. Catheterization was associated with higher UTI (odds ratio (OR) = 4.4; P < .0001). Twenty-two percent of NHs had a policy for using portable bladder ultrasound scanners to determine post-void residual and it was associated with lower noncatheter-associated UTI (OR = 0.9; P = .04). Forty-four percent of facilities had a policy for leg bag cleaning and it was associated with lower CAUTI (OR = 0.8; P = .01). Finally, having an infection control professional who took a national course through the Association for Professionals in Infection Control and Epidemiology was associated with lower non-catheter-associated UTI (OR = 0.8; P = .003). CONCLUSIONS: UTI prevention policies are associated with infection prevalence and associations differ by catheter use. Furthermore, policies and practices vary across NHs. Because most UTIs in this setting are not catheter-associated, future studies should examine their severity and identify where increased attention on UTI prevention would best be focused.
Presentation Number 19 Non-ventilator Hospital Acquired Pneumonia in U.S. Hospitals: Incidence and Cost Karen K. Giuliano, PhD, RN, FAAN, Clinical Marketing, Sage Products; Dian Baker, PhD, RN, Professor of Nursing, California State University, Sacramento; Barbara Quinn, MSN, RN, ACNS-BC, Clinical Nurse Specialist, Sutter Medical Center, Sacramento BACKGROUND: Non-ventilator hospital acquired pneumonia (NVHAP) is an underreported and understudied disease. The purpose of our study was to use a large national sample to determine the U.S. incidence of NV-HAP. U.S. hospitals must monitor ventilatorassociated pneumonia (VAP), however there are no requirements to monitor NV-HAP. The limited studies available support that NV-HAP is an emerging factor in prolonged hospital stays and is associated with significant patient morbidity and mortality. Preventing 100 cases of NV-HAP may save up to $4 million, 700-900 hospital days, and the lives of 20-30 patients. METHODS: We used the 2012 Healthcare Utilization Project (HCUP) National Inpatient Sample (NIS) to determine the number of adult patients in U.S. hospitals who developed NV-HAP. The HCUP NIS is a sampling of inpatient records covering all participating hospitals for a given year. The HCUP data includes a range hospital attributes, diagnosis and procedure codes, billing information, and basic patient demographics. RESULTS: The total records in the HCUP database for 2012 were 7,296,968, with 6,567,271 adults 18 years or older. Using a list of 14 ICD-9 codes for a non-primary diagnosis of pneumonia and not associated with mechanical ventilation, we found an overall incidence of 0.8%, median LOS of 8 days, and median cost of $60,610. In a randomly generated comparison sample matched for acuity but
APIC 43rd Annual Educational Conference & International Meeting | Charlotte, NC | June 11-13, 2016
Oral Abstracts / American Journal of Infection Control 44 (2016) S3-S27
Alternate Care Settings Presentation Number 17 Centralization of Sterilization and High Level Disinfection from Multiple Outpatient Settings to a Centralized Sterile Processing Department Provides Consistent Process Linda Johnson, M.S.N. RN, CIC, Infection Control Manager, University of Missouri Health Care BACKGROUND: An academic medical center with 57 primary and specialty clinics within a four county area has 14 autoclaves and 17 areas using high level disinfection (HLD) in outpatient settings. Clinic staff are expected to remain competent in sterilization processes, though it is not a primary function in their busy work day. Ensuring each staff member’s competence in HLD or sterilization is an insurmountable task when there are multiple locations. Competency includes precleaning techniques, using biological monitors correctly, maintaining accurate records, performing preventative maintenance, and having and flowing failure recalls plans. METHODS: Infection control, Sterile Processing (SPD), and transport leaders met with clinic practice managers to discuss barriers in decentralization of autoclaves or HLD. Identified barriers included: not enough instruments, turn-around time, delivery schedules, and fear of not getting instruments back from sterile processing. Additional instruments were purchased by SPD in cases when couriers were limited in the amount of trips taken to outpatient settings. Procedures were developed for transporting instruments for central processing. Areas began with a trial period to assess for gaps in the process before eliminating the autoclave or HLD. Certified SPD staff provide training and assess competency for staff in remaining areas performing sterile processing or using HLD. RESULTS: Through consistent, planned coordination with infection control, SPD, transport and clinic leaders a 93% reduction in autoclaves and a 59% reduction in HLD usage was achieved. All staff that currently perform sterile processing or use HLD have received training and performed a competency. CONCLUSIONS: Centralization of instrument sterile processing improves the standardized process of instrument sterilization and reduces areas of concern related to maintaining quality processes in outpatient areas.
Presentation Number 18 Policies and Practices to Reduce Urinary Tract Infections in Nursing Homes Carolyn Herzig, PhD, MS, Project Director, Columbia University School of Nursing; Andrew Dick, PhD, Senior Economist, The RAND Corporation; Nicholas Castle, PhD, Professor, Department of Health Policy and Management, University of Pittsburgh; Patricia Stone, PhD, Professor, Center for Health Policy, Columbia University School of Nursing BACKGROUND: Urinary tract infections (UTIs) are the most common infections in nursing homes (NHs) and result in increased hospitalization and antibiotic use. Little is known about the effectiveness of UTI prevention strategies in NHs, particularly for infections not associated with catheter use. The objective of this study was to evaluate policies and practices associated with UTI prevalence.
METHODS: A survey of 2,550 randomly sampled US NHs was conducted to assess UTI prevention policies and practices. Responses were linked with 2013 Minimum Data Set assessments to measure UTI prevalence and catheter use and Certification and Survey Provider Enhanced Reporting data for NH characteristics. Descriptive statistics were computed and multivariable logistic regression analyses conducted controlling for bedsize, occupancy, payer mix, staffing levels, census region, and metropolitan setting. RESULTS: Data from 88,135 residents in 955 NHs were evaluated (n = 273,205 assessments). On average, the monthly prevalence of UTI and catheter-associated UTI (CAUTI) was 5.4% and 0.9%, respectively. The prevalence of indwelling and/or intermittent catheterization was 4.7%. Catheterization was associated with higher UTI (odds ratio (OR) = 4.4; P < .0001). Twenty-two percent of NHs had a policy for using portable bladder ultrasound scanners to determine post-void residual and it was associated with lower noncatheter-associated UTI (OR = 0.9; P = .04). Forty-four percent of facilities had a policy for leg bag cleaning and it was associated with lower CAUTI (OR = 0.8; P = .01). Finally, having an infection control professional who took a national course through the Association for Professionals in Infection Control and Epidemiology was associated with lower non-catheter-associated UTI (OR = 0.8; P = .003). CONCLUSIONS: UTI prevention policies are associated with infection prevalence and associations differ by catheter use. Furthermore, policies and practices vary across NHs. Because most UTIs in this setting are not catheter-associated, future studies should examine their severity and identify where increased attention on UTI prevention would best be focused.
Presentation Number 19 Non-ventilator Hospital Acquired Pneumonia in U.S. Hospitals: Incidence and Cost Karen K. Giuliano, PhD, RN, FAAN, Clinical Marketing, Sage Products; Dian Baker, PhD, RN, Professor of Nursing, California State University, Sacramento; Barbara Quinn, MSN, RN, ACNS-BC, Clinical Nurse Specialist, Sutter Medical Center, Sacramento BACKGROUND: Non-ventilator hospital acquired pneumonia (NVHAP) is an underreported and understudied disease. The purpose of our study was to use a large national sample to determine the U.S. incidence of NV-HAP. U.S. hospitals must monitor ventilatorassociated pneumonia (VAP), however there are no requirements to monitor NV-HAP. The limited studies available support that NV-HAP is an emerging factor in prolonged hospital stays and is associated with significant patient morbidity and mortality. Preventing 100 cases of NV-HAP may save up to $4 million, 700-900 hospital days, and the lives of 20-30 patients. METHODS: We used the 2012 Healthcare Utilization Project (HCUP) National Inpatient Sample (NIS) to determine the number of adult patients in U.S. hospitals who developed NV-HAP. The HCUP NIS is a sampling of inpatient records covering all participating hospitals for a given year. The HCUP data includes a range hospital attributes, diagnosis and procedure codes, billing information, and basic patient demographics. RESULTS: The total records in the HCUP database for 2012 were 7,296,968, with 6,567,271 adults 18 years or older. Using a list of 14 ICD-9 codes for a non-primary diagnosis of pneumonia and not associated with mechanical ventilation, we found an overall incidence of 0.8%, median LOS of 8 days, and median cost of $60,610. In a randomly generated comparison sample matched for acuity but
APIC 43rd Annual Educational Conference & International Meeting | Charlotte, NC | June 11-13, 2016