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Infection Prevention and Control Programs in Nursing Homes: Results from a National Survey
Poster Abstracts / American Journal of Infection Control 43 (2015) S18-S73
Presentation Number 3-126 Infection Prevention and Control Programs in Nursing Homes: Results from a National Survey Carolyn Herzig MS, Project Director, Columbia University; Nicholas Castle, Professor, University of Pittsburgh; Monika Pogorzelska-Maziarz PhD, MPH, Assistant Professor, Thomas Jefferson University, Jefferson School of Nursing; John Engberg PhD, Senior Economist, RAND; Elaine L. Larson RN, PhD, CIC, Professor and Associate Dean for Research, Columbia University School of Nursing; Patricia W. Stone PhD, RN, FAAN, Centennial Professor in Health Policy, Center for Health Policy, Columbia University School of Nursing BACKGROUND: About 1.6 to 3.8 million nursing home (NH) infections are reported each year and this is expected to rise as the NH population increases. However, few studies have evaluated effective infection prevention and control (IPC) structures and processes in this setting. The objective of this study was to describe IPC programs in a national sample of NHs. METHODS: A cross-sectional survey of 2,550 randomly sampled US NHs was conducted from December 2013 to December 2014. Surveys were completed by the person in charge of IPC. Responses were linked to Online Survey, Certification, and Reporting (OSCAR) data, which contains information about NH characteristics, and descriptive statistics were computed. RESULTS: Completed surveys were received by 988 NHs (39% response) and 978 were linked with OSCAR data. Respondents had, on average, 116 beds, were predominantly for-profit (69%) and located in urban settings (68%). High staff turnover was reported during the previous 3 years: 41% of NHs employed at least 3 infection prevention specialists, 44% employed at least 3 Directors of Nursing, and 40% employed at least 3 Administrators. The 3 greatest infection challenges were ranked as urinary tract infections (96%), pneumonia/upper respiratory infections (84%), and skin and soft tissue infections (36%). On average, respondents spent 29% of their time on IPC activities; the most time-consuming were infection surveillance (76%), tracking antibiotic use (67%), and staff education (54%). One-third of respondents had at least 3 additional responsibilities, most frequently Staff Education/Development (45%), Director of Nursing (43%), Employee Health (29%), and/or Quality Coordinator/Manager (25%). Infection control certification was low (<3%) and most respondents (57%) reported no specific training in IPC. CONCLUSIONS: NH IPC structures and organization vary across the US, training is lacking, and individuals in charge of IPC often have multiple additional responsibilities. The identification of best practices related to IPC in this setting is critical.
Presentation Number 3-127 Cancer Center’s Experience Converting from Chlorhexidine Gluconate Impregnated Wipes to Chlorhexidine Gluconate Shower on Inpatient Blood & Marrow Transplant Unit Stephanie Carraway BS, Infection Prevention Specialist, H. Lee Moffitt Cancer Center; Stacy Martin RN, BSN, CIC, Infection Preventionist, H. Lee Moffitt Cancer Center; Kay Sams RN, BSN,
S29
MPH, CIC, Infection Preventionist, H. Lee Moffitt Cancer Center; Nicole Kahle RN, BSN, OCN, BMTCN, BMT Nursing Education Specialist, H. Lee Moffitt Cancer Center; Amy Patterson MSN, RN, AOCNS, BMTCN, BMT Clinical Nurse Specialist, H. Lee Moffitt Cancer Center; Theresa Papa-Rodriguez RN, BSN, OCN, Patient Care Manager of Inpatient BMT, H. Lee Moffitt Cancer Center BACKGROUND: In April 2012, Infection Prevention recommended a daily Chlorhexidine Gluconate (CHG) impregnated wipe protocol for Blood & Marrow Transplant (BMT) inpatients as an intervention to reduce hospital acquired Vancomycin-Resistant Enterococcus. Literature has supported this as effective in reducing multiple sites of hospital acquired infection as well as targeted organisms. Little data on the experience of patients with extensive lengths of stay, specifically BMT patients, was available. The protocol called for patients to apply CHG wipes daily, separate from showering. The “sticky” feeling and prolonged dry time patients reported following the use of the wipes led to poor compliance (59%). Despite additional teaching regarding the benefits of the wipes, patients remained reluctant to use. METHODS: Infection Prevention and BMT staff discussed methods to improve compliance. A study describing the benefits of a shower protocol with a CHG solution was reviewed. Several misconceptions, specifically that the shower protocol was not as effective and that the solution required a five minute skin dwell time, were addressed. It was also determined that significant cost savings could be realized by converting from the wipes to the shower protocol. In December 2013, the CHG shower protocol was implemented. RESULTS: Patients reported greater satisfaction and compliance rose to 84% by May 2014. The fear that the shower would not be as effective in decreasing VRE acquisition was alleviated as the rate continued to show a 39% reduction from baseline. A secondary benefit was the cost savings realized by the institution.
CONCLUSIONS: This Cancer Center’s experience demonstrates that benefits of a daily CHG regimen can be accomplished using either: a CHG shower protocol or CHG impregnated wipes. Our experience of converting to the less expensive CHG shower protocol for patients with long lengths of stay increased patient compliance and satisfaction without compromising the intended benefit of reducing hospital acquired VRE.
APIC 42nd Annual Educational Conference & International Meeting j Nashville, TN j June 27-29, 2015
Presentation Number 3-126 Infection Prevention and Control Programs in Nursing Homes: Results from a National Survey Carolyn Herzig MS, Project Director, Columbia University; Nicholas Castle, Professor, University of Pittsburgh; Monika Pogorzelska-Maziarz PhD, MPH, Assistant Professor, Thomas Jefferson University, Jefferson School of Nursing; John Engberg PhD, Senior Economist, RAND; Elaine L. Larson RN, PhD, CIC, Professor and Associate Dean for Research, Columbia University School of Nursing; Patricia W. Stone PhD, RN, FAAN, Centennial Professor in Health Policy, Center for Health Policy, Columbia University School of Nursing BACKGROUND: About 1.6 to 3.8 million nursing home (NH) infections are reported each year and this is expected to rise as the NH population increases. However, few studies have evaluated effective infection prevention and control (IPC) structures and processes in this setting. The objective of this study was to describe IPC programs in a national sample of NHs. METHODS: A cross-sectional survey of 2,550 randomly sampled US NHs was conducted from December 2013 to December 2014. Surveys were completed by the person in charge of IPC. Responses were linked to Online Survey, Certification, and Reporting (OSCAR) data, which contains information about NH characteristics, and descriptive statistics were computed. RESULTS: Completed surveys were received by 988 NHs (39% response) and 978 were linked with OSCAR data. Respondents had, on average, 116 beds, were predominantly for-profit (69%) and located in urban settings (68%). High staff turnover was reported during the previous 3 years: 41% of NHs employed at least 3 infection prevention specialists, 44% employed at least 3 Directors of Nursing, and 40% employed at least 3 Administrators. The 3 greatest infection challenges were ranked as urinary tract infections (96%), pneumonia/upper respiratory infections (84%), and skin and soft tissue infections (36%). On average, respondents spent 29% of their time on IPC activities; the most time-consuming were infection surveillance (76%), tracking antibiotic use (67%), and staff education (54%). One-third of respondents had at least 3 additional responsibilities, most frequently Staff Education/Development (45%), Director of Nursing (43%), Employee Health (29%), and/or Quality Coordinator/Manager (25%). Infection control certification was low (<3%) and most respondents (57%) reported no specific training in IPC. CONCLUSIONS: NH IPC structures and organization vary across the US, training is lacking, and individuals in charge of IPC often have multiple additional responsibilities. The identification of best practices related to IPC in this setting is critical.
Presentation Number 3-127 Cancer Center’s Experience Converting from Chlorhexidine Gluconate Impregnated Wipes to Chlorhexidine Gluconate Shower on Inpatient Blood & Marrow Transplant Unit Stephanie Carraway BS, Infection Prevention Specialist, H. Lee Moffitt Cancer Center; Stacy Martin RN, BSN, CIC, Infection Preventionist, H. Lee Moffitt Cancer Center; Kay Sams RN, BSN,
S29
MPH, CIC, Infection Preventionist, H. Lee Moffitt Cancer Center; Nicole Kahle RN, BSN, OCN, BMTCN, BMT Nursing Education Specialist, H. Lee Moffitt Cancer Center; Amy Patterson MSN, RN, AOCNS, BMTCN, BMT Clinical Nurse Specialist, H. Lee Moffitt Cancer Center; Theresa Papa-Rodriguez RN, BSN, OCN, Patient Care Manager of Inpatient BMT, H. Lee Moffitt Cancer Center BACKGROUND: In April 2012, Infection Prevention recommended a daily Chlorhexidine Gluconate (CHG) impregnated wipe protocol for Blood & Marrow Transplant (BMT) inpatients as an intervention to reduce hospital acquired Vancomycin-Resistant Enterococcus. Literature has supported this as effective in reducing multiple sites of hospital acquired infection as well as targeted organisms. Little data on the experience of patients with extensive lengths of stay, specifically BMT patients, was available. The protocol called for patients to apply CHG wipes daily, separate from showering. The “sticky” feeling and prolonged dry time patients reported following the use of the wipes led to poor compliance (59%). Despite additional teaching regarding the benefits of the wipes, patients remained reluctant to use. METHODS: Infection Prevention and BMT staff discussed methods to improve compliance. A study describing the benefits of a shower protocol with a CHG solution was reviewed. Several misconceptions, specifically that the shower protocol was not as effective and that the solution required a five minute skin dwell time, were addressed. It was also determined that significant cost savings could be realized by converting from the wipes to the shower protocol. In December 2013, the CHG shower protocol was implemented. RESULTS: Patients reported greater satisfaction and compliance rose to 84% by May 2014. The fear that the shower would not be as effective in decreasing VRE acquisition was alleviated as the rate continued to show a 39% reduction from baseline. A secondary benefit was the cost savings realized by the institution.
CONCLUSIONS: This Cancer Center’s experience demonstrates that benefits of a daily CHG regimen can be accomplished using either: a CHG shower protocol or CHG impregnated wipes. Our experience of converting to the less expensive CHG shower protocol for patients with long lengths of stay increased patient compliance and satisfaction without compromising the intended benefit of reducing hospital acquired VRE.
APIC 42nd Annual Educational Conference & International Meeting j Nashville, TN j June 27-29, 2015