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The Mucosal Barrier Injury Laboratory Confirmed Bloodstream Infection: What is the Impact in Central Line-Associated Bloodstream Infections in Oncohematologic Patients?
Poster Abstracts / American Journal of Infection Control 45 (2017) S16-S93
and Health Studies, The Open University of Hong Kong; Ka Ying Tong, Nurse, Division of Nursing and Health Studies, The Open University of Hong Kong; Ming Tat Lam, BN(Hons), Nurse, Division of Nursing and Health Studies, The Open University of Hong Kong; Fong Kiu Siu, BN(Hons), Nurse, Division of Nursing and Health Studies, The Open University of Hong Kong; Yi Ni Wong, BN(Hons), Nurse, Division of Nursing and Health Studies, The Open University of Hong Kong; Cho Yee Shum, BN(Hons), Nurse, Division of Nursing and Health Studies, The Open University of Hong Kong; Yat Man Mok, BN(Hons), Nurse, Division of Nursing and Health Studies, The Open University of Hong Kong; Man Man Chan, BN(Hons), Nurse, Division of Nursing and Health Studies, The Open University of Hong Kong; Oi Lee Chu, BN(Hons), Nurse, Division of Nursing and Health Studies, The Open University of Hong Kong BACKGROUND: Face mask use (FMU) is the most effective way to block the transmission of Influenza. However, many measurements of FMU practice have not yet been validated and those results are questionable. In 2012, H.S.W. Ho developed a 6-item FMU scale for assessing the FMU practice among the general public. Nevertheless, its psychometric properties are yet to be examined. Hence, this study aims to validate the FMU scale and investigate its factor structure. METHODS: This methodological study employed cross-sectional design. A panel of six experts and a convenient sample of 567 firstyear University students were used for psychometric testing. Internal consistency and stability were examined by Cronbach’s alpha statistics and Intra-class correlation coefficient (ICC), respectively. Content and construct validation were established by content validity index (CVI) and exploratory factor analysis (EFA). RESULTS: The CVI was 100%, indicating the good relevancy of this scale. Based on the 419 valid data (aged 17-37), the alpha was 0.81 and the ICC (checked by 2-week test-retest reliability of 111 volunteer respondents) was 0.79 (P < .001), indicating satisfactory reliability. The EFA results (KMO = 0.657, Significance of Bartlett’s Test <0.001, variance explained = 60.5%) revealed the two-factor structure of the scale. The first factor “cautious practice” (factor loading = 0.54-0.99, alpha = 0.78 for this subscale) reflected the cautious practice of FMU in perceived high-risk environment where is susceptible to be infected such as clinic or hospital. The second “negligent practice” (factor loading = 0.58-0.80, alpha = 0.78 for this subscale) reflected the negligent FMU practice in perceived safe environment where is not susceptible to be infected such as home. CONCLUSIONS: The current results indicated that the FMU scale is reliable and valid. The two factors also yield information about the dimensions of FMU practice among the general public. The FMU scale is ready to use in any epidemiological research.
Session DSV-049 12:30-1:30 p.m. The Journey to Improve Hand Hygiene Compliance Through Data Validation and the Evaluation of Compliance Barriers and Interventions Kelly Jolliff, BA, CIC, Coordinator of Epidemiology, Memorial Hospital of South Bend; Rhonda Reed, RN, BSN, CIC, Infection Prevention Nurse, Memorial Hospital BACKGROUND: Hand hygiene remains the single most important activity to prevent healthcare-associated infections (HAIs). However,
S33
despite extensive research there are variable hand hygiene data collection methods and knowledge deficits that impact compliance rates. This study is aimed at validating direct observation hand hygiene collection methods and the effectiveness of a multimodal hand hygiene performance improvement program. METHODS: This study took place over a two year period in a large acute care hospital and addressed accuracy of hand hygiene observation data and the impact of performance improvement initiatives. Statistical analysis utilizing a pooled Z test compared individuals collecting data in the unit of primary work; and trained individuals assigned to areas not considered the unit of primary work. The effect of several performance improvement strategies was measured by comparing pre and post intervention hand hygiene compliance. RESULTS: A total of 7,845 observations were collected by unit staff with hand hygiene compliance reported in 7,325 (93%). Secret shoppers made a total of 684 observations and compliance was reported in 200 (29%). The Z-Score was 49.9145 with P-value of 0. A total 2,768 observations were collected by secret shoppers during the performance improvement period with compliance in 1,438 (52%) which was a 79% increase from the pre-intervention period. CONCLUSIONS: This study found that there is a significant difference in reported hand hygiene compliance when there is observer bias and that data is more accurate when collected by trained anonymous individuals using a standardized approach. Many hospitals are now looking to change their method of measurement to electronic compliance monitoring. In addition, strategies focused on removing bias to heighten awareness, engaging staff in efforts, providing feedback on hand hygiene compliance, increasing product availability, and providing ongoing education are effective methods for improving hand hygiene compliance.
Session DSV-050 12:30-1:30 p.m. The Mucosal Barrier Injury Laboratory Confirmed Bloodstream Infection: What is the Impact in Central Line-Associated Bloodstream Infections in Oncohematologic Patients? 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; Maria Luisa Moura, MD, Infectious Disease Doctor, Infection Control Team, Hospital Samaritano de São Paulo, Brazil; Bianca Miranda, MD, Infectious Diseases Chief, Infection Control Team, Hospital Samaritano de São Paulo, Brazil; Duarte Lanuza, RN, Nurse, Infection Control Team, Hospital Samaritano de São Paulo, Brazil; Pereira Flávia, RN, Nurse Coordinator, Oncohematologic General Floor—Hospital Samaritano de São Paulo, Brazil; Analu Mancini, RN, Nurse, Infection Control Team, Hospital Samaritano de São Paulo, Brazil; Sarita Lessa, RN, Nurse, Infection Control Team, Hospital Samaritano de São Paulo BACKGROUND: Since 2013, to improve surveillance of central lineassociated bloodstream infections (CLABSI) and evaluate their impact on oncohematologic patients, the National Healthcare Safety Network (NHSN) implemented the definition of mucosal barrier injury associated laboratory-confirmed bloodstream infection (MBI-LCBI). We aimed to describe the rates of CLABSI in oncohematologic patients and its etiology after implementation of MBI-LCBI criteria in a 300bed private hospital in Sao Paulo.
APIC 44th Annual Educational Conference & International Meeting | Portland, OR | June 14-16, 2017
S34
Poster Abstracts / American Journal of Infection Control 45 (2017) S16-S93
METHODS: Cases of CLABSI were detected by active surveillance by Infection Control Team (ICT), according to NHSN recommendations. From January/2015 to November/2016, CLABSI rates were prospectively classified as MBI-LCBI and non-MBI-LCBI. CLABSI rates including MBI-LCBI were compared to rates excluding MBI-LCBI by Z-test. RESULTS: During the study period, ICT notified 18 CLABSI events, 88% of those met MBI-LCBI criteria. Mean incidence of CLABSI rate for that period was 1.39 infections/1,000 catheter-day including those that met MBI-LCBI criteria, compared to 0.69 in previous two years (2013 and 2014). After exclusion of infections that met MBI-LCBI criteria, mean CLABSI rate for the period was 0.15 infections/1,000 catheter-day (P = .0003). The most prevalent etiologic agents were Escherichia coli (44.4%), Klebsiella pneumonia (16.6%) and Enterobacter cloacae (11.1%). For MBI-LCBI, the most prevalent etiologic agent was Escherichia coli (60%), while there was none in nonMBI-LCBI group. CONCLUSIONS: CLABSI rate substantially decreases when MBILCBI cases are evaluated separately. Even though CLABSI definitions criteria include MBI-LCBI, the distinction is important, since CLABSI are preventable infections and the prevention actions must be directed to achieve target zero.
Session DSV-051 12:30-1:30 p.m. Use of Automated Surveillance System to Enhance Efficiency in Submitting Mandatory HealthcareAssociated Infection Data to National Healthcare Safety Network Abegail Pangan, MSN, RN, CIC, Infection Control Practitioner, Hospital for Special Surgery; Eileen A. Finerty, MS, RN, CIC, Nursing Director; Infection Control and Occupational Health Services, Hospital for Special Surgery BACKGROUND: A 200-bed orthopedic hospital utilized a new automated surveillance system to comply with submission of mandatory healthcare associated infection data to National Healthcare Safety Network (NHSN). The hospital performs an average of 10,728 hip and knee replacements per year. Manual abstraction of procedure denominator data and concurrent surveillance of surgical site infections (SSI) are labor intensive and unachievable for meeting submission deadlines. METHODS: Workflow and time spent by infection preventionists (IPs) using pre and post utilization of automated surveillance system were reviewed. Accuracy of detecting SSIs data was examined as well. All surgical procedure data from perioperative documentation feeds the system. The system also streamlined and flagged the detection of possible SSI using readmissions, laboratory results, key words (e.g., purulence, abscess, dehiscence) linked to a procedure that would indicate the presence of an SSI within surveillance window. Possible SSIs are reflected on the IP’s dashboard for review. Procedure denominator and SSI data are generated in a monthly report and then uploaded using a comma-separated file to NHSN. RESULTS: Pre-implementation, IPs spent greater than 40 hours a month to abstract and upload data to NHSN as compared to 3 hours spent post-implementation. With the new system, SSIs are sensitively captured using keywords for further investigation, therefore eliminating errors and missed possible SSIs using manual abstraction. CONCLUSIONS: The use automated electronic system improves workflow and efficiency in performing surveillance. It eases the burden of IPs’ compliance to mandatory reporting given the number of
procedures being performed in this hospital. It also reduces the time required for IPs to do manual abstraction and maximizes time spent on infection prevention initiatives and activities. Manual abstraction may not easily detect possible SSIs. Using the new system, possible SSIs are streamlined with the use of keywords, readmissions, laboratory results, etc. that eliminates underreporting of SSI events.
Session DSV-052 12:30-1:30 p.m. Using an in-Depth Analysis of Healthcare-Onset Clostridium difficile Cases to Drive Staged Interventions Jessica Strauch, PhD, Infection Prevention Specialist, Lutheran Medical Center BACKGROUND: Clostridium difficile Infection (CDI) is an infection of great concern in healthcare settings, leading to increased morbidity and mortality. There are known risk factors that can lead to an individual developing CDI in the hospital setting, yet it can be difficult to drive interventions based on the experience of other settings alone. This study aimed to take widespread risk factors from all CDI cases in a community hospital to drive targeted, staged interventions throughout the year. METHODS: All CDI cases from 2016 were reviewed to guide the each phase of targeted intervention. The interventions were rolled out monthly, with some interventions being rolled out simultaneously. Known risk factors from literature (length of hospitalization, antibiotic use) were considered, along with other factors such as laxative use and alcoholism were also reviewed. Additionally, cases were assessed for symptoms of active infection, such as increased white blood cells and abdominal pain. Cases were reviewed monthly and Results were analyzed using relative risk and correlation coefficients. RESULTS: Prior to interventions, there were 22 healthcare-onset (HO) CDI cases (rate 11.32/10,000 patient days). Interventions began in June and involved changes such as testing methodology, cleaning chemicals, a pilot of an automatic hand hygiene monitoring system, and EMR modifications for test orders. Since the interventions, there has been a 22% decrease in HO CDI cases (rate 8.69/10,000 patient days). The variables most significantly correlated with HO CDI were days in ICU (0.47) and laxative use (0.43). CONCLUSIONS: This study found that a thorough review of all CDI cases can be used to drive targeted interventions. While some interventions did see success, such as the testing methodology change, others were not successful. By taking the time to review the CDI cases, interventions specific to the healthcare facility can be created to lead to a successful reduction in HO cases.
Session DSV-053 12:30-1:30 p.m. Utilizing Negative Predictive Value of Blood Cultures to Audit CLABSI Detection Across a Health System Christina Silkaitis, MT, CIC, FAPIC, Director, Infection Prevention, Northwestern Medicine; Anessa Mikolajczak, RN, BSN, CIC, Manager, IP, Northwestern Medicine; Phillip Papirnik, Program Manager, Internal Audit, Northwestern Medicine; Florina Dekalo, Program Director, Internal Audit, Northwestern Medicine;
APIC 44th Annual Educational Conference & International Meeting | Portland, OR | June 14-16, 2017
and Health Studies, The Open University of Hong Kong; Ka Ying Tong, Nurse, Division of Nursing and Health Studies, The Open University of Hong Kong; Ming Tat Lam, BN(Hons), Nurse, Division of Nursing and Health Studies, The Open University of Hong Kong; Fong Kiu Siu, BN(Hons), Nurse, Division of Nursing and Health Studies, The Open University of Hong Kong; Yi Ni Wong, BN(Hons), Nurse, Division of Nursing and Health Studies, The Open University of Hong Kong; Cho Yee Shum, BN(Hons), Nurse, Division of Nursing and Health Studies, The Open University of Hong Kong; Yat Man Mok, BN(Hons), Nurse, Division of Nursing and Health Studies, The Open University of Hong Kong; Man Man Chan, BN(Hons), Nurse, Division of Nursing and Health Studies, The Open University of Hong Kong; Oi Lee Chu, BN(Hons), Nurse, Division of Nursing and Health Studies, The Open University of Hong Kong BACKGROUND: Face mask use (FMU) is the most effective way to block the transmission of Influenza. However, many measurements of FMU practice have not yet been validated and those results are questionable. In 2012, H.S.W. Ho developed a 6-item FMU scale for assessing the FMU practice among the general public. Nevertheless, its psychometric properties are yet to be examined. Hence, this study aims to validate the FMU scale and investigate its factor structure. METHODS: This methodological study employed cross-sectional design. A panel of six experts and a convenient sample of 567 firstyear University students were used for psychometric testing. Internal consistency and stability were examined by Cronbach’s alpha statistics and Intra-class correlation coefficient (ICC), respectively. Content and construct validation were established by content validity index (CVI) and exploratory factor analysis (EFA). RESULTS: The CVI was 100%, indicating the good relevancy of this scale. Based on the 419 valid data (aged 17-37), the alpha was 0.81 and the ICC (checked by 2-week test-retest reliability of 111 volunteer respondents) was 0.79 (P < .001), indicating satisfactory reliability. The EFA results (KMO = 0.657, Significance of Bartlett’s Test <0.001, variance explained = 60.5%) revealed the two-factor structure of the scale. The first factor “cautious practice” (factor loading = 0.54-0.99, alpha = 0.78 for this subscale) reflected the cautious practice of FMU in perceived high-risk environment where is susceptible to be infected such as clinic or hospital. The second “negligent practice” (factor loading = 0.58-0.80, alpha = 0.78 for this subscale) reflected the negligent FMU practice in perceived safe environment where is not susceptible to be infected such as home. CONCLUSIONS: The current results indicated that the FMU scale is reliable and valid. The two factors also yield information about the dimensions of FMU practice among the general public. The FMU scale is ready to use in any epidemiological research.
Session DSV-049 12:30-1:30 p.m. The Journey to Improve Hand Hygiene Compliance Through Data Validation and the Evaluation of Compliance Barriers and Interventions Kelly Jolliff, BA, CIC, Coordinator of Epidemiology, Memorial Hospital of South Bend; Rhonda Reed, RN, BSN, CIC, Infection Prevention Nurse, Memorial Hospital BACKGROUND: Hand hygiene remains the single most important activity to prevent healthcare-associated infections (HAIs). However,
S33
despite extensive research there are variable hand hygiene data collection methods and knowledge deficits that impact compliance rates. This study is aimed at validating direct observation hand hygiene collection methods and the effectiveness of a multimodal hand hygiene performance improvement program. METHODS: This study took place over a two year period in a large acute care hospital and addressed accuracy of hand hygiene observation data and the impact of performance improvement initiatives. Statistical analysis utilizing a pooled Z test compared individuals collecting data in the unit of primary work; and trained individuals assigned to areas not considered the unit of primary work. The effect of several performance improvement strategies was measured by comparing pre and post intervention hand hygiene compliance. RESULTS: A total of 7,845 observations were collected by unit staff with hand hygiene compliance reported in 7,325 (93%). Secret shoppers made a total of 684 observations and compliance was reported in 200 (29%). The Z-Score was 49.9145 with P-value of 0. A total 2,768 observations were collected by secret shoppers during the performance improvement period with compliance in 1,438 (52%) which was a 79% increase from the pre-intervention period. CONCLUSIONS: This study found that there is a significant difference in reported hand hygiene compliance when there is observer bias and that data is more accurate when collected by trained anonymous individuals using a standardized approach. Many hospitals are now looking to change their method of measurement to electronic compliance monitoring. In addition, strategies focused on removing bias to heighten awareness, engaging staff in efforts, providing feedback on hand hygiene compliance, increasing product availability, and providing ongoing education are effective methods for improving hand hygiene compliance.
Session DSV-050 12:30-1:30 p.m. The Mucosal Barrier Injury Laboratory Confirmed Bloodstream Infection: What is the Impact in Central Line-Associated Bloodstream Infections in Oncohematologic Patients? 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; Maria Luisa Moura, MD, Infectious Disease Doctor, Infection Control Team, Hospital Samaritano de São Paulo, Brazil; Bianca Miranda, MD, Infectious Diseases Chief, Infection Control Team, Hospital Samaritano de São Paulo, Brazil; Duarte Lanuza, RN, Nurse, Infection Control Team, Hospital Samaritano de São Paulo, Brazil; Pereira Flávia, RN, Nurse Coordinator, Oncohematologic General Floor—Hospital Samaritano de São Paulo, Brazil; Analu Mancini, RN, Nurse, Infection Control Team, Hospital Samaritano de São Paulo, Brazil; Sarita Lessa, RN, Nurse, Infection Control Team, Hospital Samaritano de São Paulo BACKGROUND: Since 2013, to improve surveillance of central lineassociated bloodstream infections (CLABSI) and evaluate their impact on oncohematologic patients, the National Healthcare Safety Network (NHSN) implemented the definition of mucosal barrier injury associated laboratory-confirmed bloodstream infection (MBI-LCBI). We aimed to describe the rates of CLABSI in oncohematologic patients and its etiology after implementation of MBI-LCBI criteria in a 300bed private hospital in Sao Paulo.
APIC 44th Annual Educational Conference & International Meeting | Portland, OR | June 14-16, 2017
S34
Poster Abstracts / American Journal of Infection Control 45 (2017) S16-S93
METHODS: Cases of CLABSI were detected by active surveillance by Infection Control Team (ICT), according to NHSN recommendations. From January/2015 to November/2016, CLABSI rates were prospectively classified as MBI-LCBI and non-MBI-LCBI. CLABSI rates including MBI-LCBI were compared to rates excluding MBI-LCBI by Z-test. RESULTS: During the study period, ICT notified 18 CLABSI events, 88% of those met MBI-LCBI criteria. Mean incidence of CLABSI rate for that period was 1.39 infections/1,000 catheter-day including those that met MBI-LCBI criteria, compared to 0.69 in previous two years (2013 and 2014). After exclusion of infections that met MBI-LCBI criteria, mean CLABSI rate for the period was 0.15 infections/1,000 catheter-day (P = .0003). The most prevalent etiologic agents were Escherichia coli (44.4%), Klebsiella pneumonia (16.6%) and Enterobacter cloacae (11.1%). For MBI-LCBI, the most prevalent etiologic agent was Escherichia coli (60%), while there was none in nonMBI-LCBI group. CONCLUSIONS: CLABSI rate substantially decreases when MBILCBI cases are evaluated separately. Even though CLABSI definitions criteria include MBI-LCBI, the distinction is important, since CLABSI are preventable infections and the prevention actions must be directed to achieve target zero.
Session DSV-051 12:30-1:30 p.m. Use of Automated Surveillance System to Enhance Efficiency in Submitting Mandatory HealthcareAssociated Infection Data to National Healthcare Safety Network Abegail Pangan, MSN, RN, CIC, Infection Control Practitioner, Hospital for Special Surgery; Eileen A. Finerty, MS, RN, CIC, Nursing Director; Infection Control and Occupational Health Services, Hospital for Special Surgery BACKGROUND: A 200-bed orthopedic hospital utilized a new automated surveillance system to comply with submission of mandatory healthcare associated infection data to National Healthcare Safety Network (NHSN). The hospital performs an average of 10,728 hip and knee replacements per year. Manual abstraction of procedure denominator data and concurrent surveillance of surgical site infections (SSI) are labor intensive and unachievable for meeting submission deadlines. METHODS: Workflow and time spent by infection preventionists (IPs) using pre and post utilization of automated surveillance system were reviewed. Accuracy of detecting SSIs data was examined as well. All surgical procedure data from perioperative documentation feeds the system. The system also streamlined and flagged the detection of possible SSI using readmissions, laboratory results, key words (e.g., purulence, abscess, dehiscence) linked to a procedure that would indicate the presence of an SSI within surveillance window. Possible SSIs are reflected on the IP’s dashboard for review. Procedure denominator and SSI data are generated in a monthly report and then uploaded using a comma-separated file to NHSN. RESULTS: Pre-implementation, IPs spent greater than 40 hours a month to abstract and upload data to NHSN as compared to 3 hours spent post-implementation. With the new system, SSIs are sensitively captured using keywords for further investigation, therefore eliminating errors and missed possible SSIs using manual abstraction. CONCLUSIONS: The use automated electronic system improves workflow and efficiency in performing surveillance. It eases the burden of IPs’ compliance to mandatory reporting given the number of
procedures being performed in this hospital. It also reduces the time required for IPs to do manual abstraction and maximizes time spent on infection prevention initiatives and activities. Manual abstraction may not easily detect possible SSIs. Using the new system, possible SSIs are streamlined with the use of keywords, readmissions, laboratory results, etc. that eliminates underreporting of SSI events.
Session DSV-052 12:30-1:30 p.m. Using an in-Depth Analysis of Healthcare-Onset Clostridium difficile Cases to Drive Staged Interventions Jessica Strauch, PhD, Infection Prevention Specialist, Lutheran Medical Center BACKGROUND: Clostridium difficile Infection (CDI) is an infection of great concern in healthcare settings, leading to increased morbidity and mortality. There are known risk factors that can lead to an individual developing CDI in the hospital setting, yet it can be difficult to drive interventions based on the experience of other settings alone. This study aimed to take widespread risk factors from all CDI cases in a community hospital to drive targeted, staged interventions throughout the year. METHODS: All CDI cases from 2016 were reviewed to guide the each phase of targeted intervention. The interventions were rolled out monthly, with some interventions being rolled out simultaneously. Known risk factors from literature (length of hospitalization, antibiotic use) were considered, along with other factors such as laxative use and alcoholism were also reviewed. Additionally, cases were assessed for symptoms of active infection, such as increased white blood cells and abdominal pain. Cases were reviewed monthly and Results were analyzed using relative risk and correlation coefficients. RESULTS: Prior to interventions, there were 22 healthcare-onset (HO) CDI cases (rate 11.32/10,000 patient days). Interventions began in June and involved changes such as testing methodology, cleaning chemicals, a pilot of an automatic hand hygiene monitoring system, and EMR modifications for test orders. Since the interventions, there has been a 22% decrease in HO CDI cases (rate 8.69/10,000 patient days). The variables most significantly correlated with HO CDI were days in ICU (0.47) and laxative use (0.43). CONCLUSIONS: This study found that a thorough review of all CDI cases can be used to drive targeted interventions. While some interventions did see success, such as the testing methodology change, others were not successful. By taking the time to review the CDI cases, interventions specific to the healthcare facility can be created to lead to a successful reduction in HO cases.
Session DSV-053 12:30-1:30 p.m. Utilizing Negative Predictive Value of Blood Cultures to Audit CLABSI Detection Across a Health System Christina Silkaitis, MT, CIC, FAPIC, Director, Infection Prevention, Northwestern Medicine; Anessa Mikolajczak, RN, BSN, CIC, Manager, IP, Northwestern Medicine; Phillip Papirnik, Program Manager, Internal Audit, Northwestern Medicine; Florina Dekalo, Program Director, Internal Audit, Northwestern Medicine;
APIC 44th Annual Educational Conference & International Meeting | Portland, OR | June 14-16, 2017