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Enhancing Infection Control Education through Collaborative University Partnerships
E76
Vol. 35 No. 5
A Herman, BSN, MPH, CIC1 L Sturm, MPH, CIC1 L Washer, MD1 C Chenoweth, MD1 1
Infection Control and Epidemiology, University of Michigan Hospitals and Health Centers, Ann Arbor, MI, USA 2 Infectious Diseases, University of Michigan Hospitals and Health Centers, Ann Arbor, MI, USA ISSUE: Sporadic episodes of Toxic Shock Syndrome (TSS) associated with infection of implantable breast tissue expanders placed after mastectomy have been infrequently described. Over a seven month period, we identified a cluster of three infections following breast tissue expansion that were associated with ICU admission and probable TSS caused by Staphylococcus aureus (SA). PROJECT: An outbreak investigation was conducted after a third case of SA breast tissue expander (TE) infection requiring ICU admission was identified. Each patient had undergone mastectomy with immediate placement of TE. In each case, infection developed approximately two days after an outpatient procedure for installation of saline into the TE. Surgical and clinic staff were notified and met with Infection Control to collect information, review practices, and discuss plans. Anterior nares cultures for SA were obtained from all clinic staff and surgeons. All tissue expansion procedures were halted temporarily. Patient isolates were only available from the third patient. Changes to practice after the second case, included pre-op showering with CHG, use of CHG with 70% alcohol prep, and ceasing of batch pre-filling of saline syringes used with the TE’s. Later changes included: Use of the manufacturer’s recommended closed fill system for filling the TE’s, Use of sterile gloves, a surgical drape and a mask during the filling procedure, Hand hygiene prior to stocking all supplies used during the procedure, Regular cleaning of a stocking tote, and Discontinuation of drains prior to filling TE’s in the clinic. Passive surveillance for infections after breast tissue expansion was changed to active surveillance. Anterior nares cultures were obtained from all clinic staff and surgeons. All TE procedures were halted until results from these cultures were available. DNA (PFGE) testing was performed on one staff isolate that matched the patient isolate in species and susceptibility pattern. The patient isolate was sent for TSS toxin testing. RESULTS: No trends were seen in surgical or clinic staff involved in the three possibile TSS infections. All patient isolates had different antibiotic susceptibility patterns. Two staff had positive cultures for SA. One staff isolate matched the third patient in susceptibility pattern but was not identical by DNA (PFGE) testing. TSS Toxin 1 was recovered from the patient SA isolate. All three patients recovered from the episodes of possible TSS. LESSONS LEARNED: Due to the serious nature of the infections seen after tissue expansion, we recommended a modified ‘‘sterile’’ procedure with a closed system be implemented. Due to passive surveillance and a higher threshold for action, we did not save patient isolates associated with the first two cases of possible TSS. This may have prevented us from identifying a point source for the toxin-producing SA. However, infections may have resulted from the patients’ endogenous flora. Thus, we are considering recommending surveillance and decolonization of SA culture positive patients undergoing breast TE procedures.
Staff Training/Competency/Compliance Publication Number 6-74
Enhancing Infection Control Education through Collaborative University Partnerships SP Applegarth, MSME1,2 DJ Haiduven, PhD, RN, CIC1,2 1
Patient Safety Research Center, James A. Haley V.A. Medical Center, Tampa, FL, USA
June 2007 2
E77
Department of Global Health, University of South Florida, College of Public Health, Tampa, FL, USA
ISSUE: The public health workforce is projected to decrease by 25% - 40% by the year 2010. This shortage of trained workers comes in an era when public health threats including emerging infectious diseases, natural disasters, pandemic influenza, and bioterrorism are greater than ever. With such a drastic workforce shortage on the horizon, it is imperative that new public health personnel are adequately trained not only through traditional educational methods but also through practical real-world experiences found only in the field. This need is exemplified in the infection control arena. PROJECT: A unique infection control training initiative has been established at the authors’ institutions. These facilities afford students from a local university in the Masters of Public Health (MPH) program, the experience of working in several different infection control settings as part of their course curriculum. Specifically, the student’s field experience, special project requirements, or both, are incorporated into these infection control settings under the mentorship of an infection control professional. The training settings include hospital infection control departments, alternative infection control programs, and research laboratories. The research labs are set-up with advanced equipment and measurement tools needed to perform experiments in the field of infection control and occupational safety. RESULTS: Since this initiative began in 2002, over 30 field experiences and special projects from MPH students have been completed. These students have majored in various fields including medicine, public health, epidemiology, nursing, communicable diseases, and global health. Projects have ranged from literature searches on current global infectious diseases to internships in infection control departments to designing and conducting infection control and occupational health-related experiments with experts in the field. These experts come from the fields of public health, medicine, nursing, engineering and ergonomics. Students also contribute to the development, writing and presentation of scientific abstracts and articles. Over 15 abstracts, posters, oral presentations and peer-reviewed scientific journal papers have been produced with these students as contributing authors. LESSONS LEARNED: This initiative has resulted in a mutually beneficial partnership for students and infection control professionals. Students gain invaluable knowledge by assisting with the design and implementation of infection control-related projects and experiments. In turn, infection control professionals receive assistance in day-day tasks, contributions to longer-term projects, and are able to help ‘‘shape’’ these interns for potential future infection control careers. It is important to obtain feedback from the students in order to enhance future projects. The implications of this initiative are to reverse the effects of a public health worker shortage by providing such programs to not only better prepare the workforce but also to instill a stimulating interest in the field of infection control and global health. Publication Number 6-75
National Tuberculosis Curriculum Consortium (NTCC): Active-Learning Teaching Tools for Your Staff M Jackson, PhD, RN S Harrity, MD, MSEd H Hoffman, PhD A Catanzaro, MD, et al. National Tuberculosis Curriculum Consortium, University of California San Diego School of Medicine, San Diego, CA, USA ISSUE: In 2003 the National Institutes of Health perceived a need to strengthen teaching about tuberculosis (TB) to health professions students. The National Tuberculosis Curriculum Consortium (NTCC) was funded to meet this need. PROJECT: The National Tuberculosis Curriculum Consortium (NTCC) was funded for 5 years (2003-2008) by the NIH/NHLBI to improve knowledge, attitudes, and confidence in caring for patients with LTBI/TB in students in health
Vol. 35 No. 5
A Herman, BSN, MPH, CIC1 L Sturm, MPH, CIC1 L Washer, MD1 C Chenoweth, MD1 1
Infection Control and Epidemiology, University of Michigan Hospitals and Health Centers, Ann Arbor, MI, USA 2 Infectious Diseases, University of Michigan Hospitals and Health Centers, Ann Arbor, MI, USA ISSUE: Sporadic episodes of Toxic Shock Syndrome (TSS) associated with infection of implantable breast tissue expanders placed after mastectomy have been infrequently described. Over a seven month period, we identified a cluster of three infections following breast tissue expansion that were associated with ICU admission and probable TSS caused by Staphylococcus aureus (SA). PROJECT: An outbreak investigation was conducted after a third case of SA breast tissue expander (TE) infection requiring ICU admission was identified. Each patient had undergone mastectomy with immediate placement of TE. In each case, infection developed approximately two days after an outpatient procedure for installation of saline into the TE. Surgical and clinic staff were notified and met with Infection Control to collect information, review practices, and discuss plans. Anterior nares cultures for SA were obtained from all clinic staff and surgeons. All tissue expansion procedures were halted temporarily. Patient isolates were only available from the third patient. Changes to practice after the second case, included pre-op showering with CHG, use of CHG with 70% alcohol prep, and ceasing of batch pre-filling of saline syringes used with the TE’s. Later changes included: Use of the manufacturer’s recommended closed fill system for filling the TE’s, Use of sterile gloves, a surgical drape and a mask during the filling procedure, Hand hygiene prior to stocking all supplies used during the procedure, Regular cleaning of a stocking tote, and Discontinuation of drains prior to filling TE’s in the clinic. Passive surveillance for infections after breast tissue expansion was changed to active surveillance. Anterior nares cultures were obtained from all clinic staff and surgeons. All TE procedures were halted until results from these cultures were available. DNA (PFGE) testing was performed on one staff isolate that matched the patient isolate in species and susceptibility pattern. The patient isolate was sent for TSS toxin testing. RESULTS: No trends were seen in surgical or clinic staff involved in the three possibile TSS infections. All patient isolates had different antibiotic susceptibility patterns. Two staff had positive cultures for SA. One staff isolate matched the third patient in susceptibility pattern but was not identical by DNA (PFGE) testing. TSS Toxin 1 was recovered from the patient SA isolate. All three patients recovered from the episodes of possible TSS. LESSONS LEARNED: Due to the serious nature of the infections seen after tissue expansion, we recommended a modified ‘‘sterile’’ procedure with a closed system be implemented. Due to passive surveillance and a higher threshold for action, we did not save patient isolates associated with the first two cases of possible TSS. This may have prevented us from identifying a point source for the toxin-producing SA. However, infections may have resulted from the patients’ endogenous flora. Thus, we are considering recommending surveillance and decolonization of SA culture positive patients undergoing breast TE procedures.
Staff Training/Competency/Compliance Publication Number 6-74
Enhancing Infection Control Education through Collaborative University Partnerships SP Applegarth, MSME1,2 DJ Haiduven, PhD, RN, CIC1,2 1
Patient Safety Research Center, James A. Haley V.A. Medical Center, Tampa, FL, USA
June 2007 2
E77
Department of Global Health, University of South Florida, College of Public Health, Tampa, FL, USA
ISSUE: The public health workforce is projected to decrease by 25% - 40% by the year 2010. This shortage of trained workers comes in an era when public health threats including emerging infectious diseases, natural disasters, pandemic influenza, and bioterrorism are greater than ever. With such a drastic workforce shortage on the horizon, it is imperative that new public health personnel are adequately trained not only through traditional educational methods but also through practical real-world experiences found only in the field. This need is exemplified in the infection control arena. PROJECT: A unique infection control training initiative has been established at the authors’ institutions. These facilities afford students from a local university in the Masters of Public Health (MPH) program, the experience of working in several different infection control settings as part of their course curriculum. Specifically, the student’s field experience, special project requirements, or both, are incorporated into these infection control settings under the mentorship of an infection control professional. The training settings include hospital infection control departments, alternative infection control programs, and research laboratories. The research labs are set-up with advanced equipment and measurement tools needed to perform experiments in the field of infection control and occupational safety. RESULTS: Since this initiative began in 2002, over 30 field experiences and special projects from MPH students have been completed. These students have majored in various fields including medicine, public health, epidemiology, nursing, communicable diseases, and global health. Projects have ranged from literature searches on current global infectious diseases to internships in infection control departments to designing and conducting infection control and occupational health-related experiments with experts in the field. These experts come from the fields of public health, medicine, nursing, engineering and ergonomics. Students also contribute to the development, writing and presentation of scientific abstracts and articles. Over 15 abstracts, posters, oral presentations and peer-reviewed scientific journal papers have been produced with these students as contributing authors. LESSONS LEARNED: This initiative has resulted in a mutually beneficial partnership for students and infection control professionals. Students gain invaluable knowledge by assisting with the design and implementation of infection control-related projects and experiments. In turn, infection control professionals receive assistance in day-day tasks, contributions to longer-term projects, and are able to help ‘‘shape’’ these interns for potential future infection control careers. It is important to obtain feedback from the students in order to enhance future projects. The implications of this initiative are to reverse the effects of a public health worker shortage by providing such programs to not only better prepare the workforce but also to instill a stimulating interest in the field of infection control and global health. Publication Number 6-75
National Tuberculosis Curriculum Consortium (NTCC): Active-Learning Teaching Tools for Your Staff M Jackson, PhD, RN S Harrity, MD, MSEd H Hoffman, PhD A Catanzaro, MD, et al. National Tuberculosis Curriculum Consortium, University of California San Diego School of Medicine, San Diego, CA, USA ISSUE: In 2003 the National Institutes of Health perceived a need to strengthen teaching about tuberculosis (TB) to health professions students. The National Tuberculosis Curriculum Consortium (NTCC) was funded to meet this need. PROJECT: The National Tuberculosis Curriculum Consortium (NTCC) was funded for 5 years (2003-2008) by the NIH/NHLBI to improve knowledge, attitudes, and confidence in caring for patients with LTBI/TB in students in health