September 2014

Inside this issue

Notes From the President by Sonya Mauzey……..…...…..page 2

APIC Indiana Fall Conference by Anna Roe….......…..….page 3

Kari’s Korner by Kari Kuebler……………………….……page 3

Updates from the Communication Committee Chairman:

Diana Korpal……………………………………………….page 4

APIC National Trip 2014 by Loretta Marsh ………….….page 4

APIC National 2014 Anaheim, California

by Connie Simpson…………………………………………page 6

Data, Data, and More Data by Mona Wenger………….…page 9

Keep the Information Coming by Michael Grow……..…page 11

Federal HAI Reporting to NHSN by Susan Kraska…….page 12

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Spreading knowledge. Preventing infection.™

Newsletter published in March, May,

September, and November.

Please send articles, questions, comments, or

suggestions to:

Michael Grow, MBA, MT (ASCP), CIC

Franciscan St. Elizabeth Health

1701 S. Creasy Lane

Lafayette, Indiana 47905

Office: (765)502-4373

Cell: (765) 761-8047

Email: Michael.Grow@franciscanalliance.org

September 14, 2014 Page 2

Notes From the President

By Sonya Mauzey

Greetings APIC Indiana Members!

It is hard to believe summer is winding

down and our fall conference is just around

the corner. This issue of our newsletter is

traditionally devoted to articles provided by

our scholarship recipients to share with you

some of the things learned while at the APIC

national conference. Read through to see

what great opportunities the national

conference offers for networking,

implementing science to practice etc.

Sonya with Dr. Pittet

Didn’t get to go this year due to needing

financial assistance? Please apply for

chapter scholarship funds; even if you did

this year and weren’t selected, I encourage

all to apply. Additionally, there are

scholarship funds available from generous

vendors and APIC support partners. One of

our members, Michele Daum from

Evansville, IN, was too new to be eligible to

apply for a chapter scholarship. So she

applied for one, she found on the APIC

national website and won a scholarship from

Diversey to attend and do a poster

presentation. So, look for ways to make it to

the next national conference scheduled in

Nashville, TN, you won’t be disappointed!

Speaking of Tennessee, one of the many

take away resources from the conference

was the HAI calculator that was presented

during the closing plenary by the Tennessee

Department of Health. It is available online

and free to any facility/state. This free

interactive tool allows you to enter your SIR

score, and number of infections for a

specified timeframe and then what you

would like your SIR score goal to be. So for

example, if your current SIR is 1.25 and you

would like to reach 0.75, you just plug in the

requested numbers, hit compute and it will

tell you how many infections you need to

prevent in order for you to reach your target

SIR goal. The direct link is:

http://health.state.tn.us/ceds/HAI/calculator.

shtml .There are several other resources

available from Tennessee and you can find

them simply by typing “TN HAI” in the

your internet search box (Google, Bing, etc).

Susan Kraska, President-elect, and I

attended the Chapter Leadership luncheon.

We learned about a great idea for pursuing

and developing a journal club using the

framework of implementation science to

analyze research articles. What are the

benefits of this? It will keep you current

September 14, 2014 Page 3

with new infection prevention knowledge,

improve your literature evaluation skills and

understanding of statistical methods, help to

engage with other IPs in lively discussion

about the implications and findings, and

hopefully then translate and integrate the

findings into infection prevention practice!

Lastly, this year was extra special for our

chapter, because we received one of the

Chapter of Excellence awards. It was truly a

privilege and honor to represent our chapter

at the Leadership luncheon to accept our

recognition which included a $500

certificate to spend toward APIC products.

We are excited about being able to use these

funds to share with the membership. Watch

for some of the items we are purchasing for

giveaways and for promoting more

scholarship fundraising monies at the fall

conference.

Opening Reception

APIC Indiana’s 2014 Fall Program: Understanding Infection Prevention in

2014

By Anna Roe

APIC Indiana’s Fall Conference will be

held at the Indianapolis Marriott North,

3645 River Crossing Parkway 1180,

Indianapolis, IN 46240 on October 10, 2014

from 7:30 AM - 4:00 PM.

Topics include:

The first MERS case in the US

How to figure a SIR for your

healthcare institution

Who needs what report in your

healthcare institution

Updates on perioperative cleaning

Management of Legionella

Please find the registration form on the

APIC website or e-mail roeanm@sjrmc.com

By Kari L. Kuebler RN, BSN

Indiana University Health System

APIC Indiana’s website is under-

construction. While we work hard to deliver

our membership the best possible product,

September 14, 2014 Page 4

we will have a temporary site coming soon

to provide membership with needed

information in the interim. On this website

you will find a Resources and Forms Tab.

Under this Tab is a NHSN Information link.

Here I have included vital NHSN links to

criteria, newsletters, and more. I have also

included my contact information. Please

contact me with questions concerning

NHSN HAI events. If I don’t know the

answer, we will find it together. I have had

the pleasure to speak with many of our

members over the last several months and

hope to hear from more of you soon!

For questions concerning NHSN criteria,

please contact me at:

kkuebler@iuhealth.org

317-964-9598

Updates from the

Communication Committee

Chairman: Diana Korpal

Attention Indiana Chapter: Please go to

“APIC Indiana” on your face book and like

us to get up to date information regarding

APIC Indiana and participate on discussions

among our members.

Note also that our new APIC Indiana

website is under construction and will be

ready as soon as our new communications

team is able to transfer all documents to the

new site. Check out the new temporary site

http://new.apicin.org that is now more than

90% full of the content pages contained on

http://apicin.org . Thanks in advance for

your patience in this endeavor. Should you

have any questions please contact: Kari

Kuebler or Jennifer Spivey – co

administrators for both sites.

kkuebler@IUHealth.org or

jspivey@theheartcenter.com.

APIC National Trip 2014

By Loretta Marsh, MSN, RN, CIC

Indiana University Health Ball Memorial

Hospital

My first APIC National Convention will

be hard to top! The venue was perfect, the

weather, the company, the speakers and

presentations all perfect. “Thank you” to

APIC Indiana for making this conference a

reality for me! I would like to discuss my

favorite presentation and the one I used the

quickest after returning home!

There are some individuals in the

Infection Prevention world that I would not

miss a chance to see speak if I have the

opportunity. I enjoy and respect them so

much that I will look for anything they will

be presenting at , thus my favorite

presentation was chalk full of the IP world’s

September 14, 2014 Page 5

“best in class”. Ruth Carrico, in particular is

a speaker I enjoy immensely. The session

was 1402, The SHEA /IDSA Compendium

of Strategies to Prevent HAI’S: Update on

Prevention Measures. The room for this

session was full to the gills. I guess others

feel the way I do and it was the new SHEA

Compendium updates. I took the picture

below after the session which was amazing.

The energy in the room after these ladies

completed their presentations was

electrifying to put it mildly. The personal

additions to their specific sessions were so

insightful. It was very clear that each of

them had been there done that!! If this

group does not get you energized in

Infection Prevention it is not going to

happen, just saying!!

Ruth Carrico, PhD, FSHEA, RN, CIC, Linda Greene,

RN, MPS, CIC, Lynn Hadaway, M.Ed., RN-BC,

CRNI, Janet Haas, PhD, RN, CIC, Lisa Maragakis,

MD, MPH, FSHEA, Ann Marie Pettis, RN, BSN, CIC,

Julia Moody, MS, SM(ASCP), and Deborah Yokoe,

MD, MPH (missing one from the picture)

The session that I used almost

immediately after returning home from

Nationals was Conducting an Infection

Control Tracer Round (ICRA) for

Renovation and Construction Projects. My

hospital was starting some large scale

projects which had prompted me to attend

this session as a priority. I was very

impressed with the presenter, Mr. Lewis

Johnson and felt a connection with him as he

worked at Lee Memorial Health System in

Fort Myers, Florida which was where I had

my first nursing job fresh out of college. The

presentation had a lot of great pictures of

containment devices and new pressure

monitoring devices. Visually you could

follow exactly what he was talking about

because of his illustrations. The presentation

was well worth my time.

My story starts after my return from

California and my first few days back at

work. The Ball team was introduced to a

project manager who was to be the liaison

between the construction team and the

hospital. He represents the system and at

first blush seemed really on the ball. The

pre-ICRA walk through had occurred in my

absence and the Infection Prevention

barriers were in place for a couple different

projects. I set out to round on the projects

that week with the project manager and at

the first project found that there was a hepa

equipped air filtration unit running and a

monitor in place in the anteroom showing

appropriate negative pressure. The

construction space had no HEPA filtration

units and no monitors indicating negative

pressure to adjacent hallways. I asked about

this oversight and was told this was too big

of a space to make negative and that the ante

room was the important part as that is where

workers entered and exited. I was made to

feel like I was being very uncooperative for

even asking about this. I was told that

another hospital in our system was O.K.

with doing projects this way. I advised the

project manager that I could not speak to

what other hospitals were doing but that

here this is what we required and it was a

requirement on our ICRA form. I could get

no support from my maintenance director.

This concept seemed to be new to everyone.

I really began to question that I knew what I

was talking about and then I remembered

the presentation I had attended at APIC.

September 14, 2014 Page 6

Thanks to the Covidien group that gave

us cards with access to all slides and

presentations, I was able to download the

presentation. The end of the presentation

gave a contact phone number and I decided

to use it and make a call. Mr. Johnson

became my champion that day. Lewis

picked up the phone on the second ring. He

listened to specifics of the project and

advised me on how to language what I

needed so there was no communication

barrier with the project manager. He gave

me page numbers for specific supporting

evidence from the, Guidelines for Design

and Construction of Hospitals and

Outpatient Facilities, 2014 Edition. (See

excerpt below) Mr. Johnson gave me the

confidence and tools to confront the project

manager and defend best practice for the

safety of our patients. I was not alone

anymore and believe me his help was a

game changer. I went to our next rounds

armed with guidelines and I countered every

excuse with how the work could be done.

The barriers in our hospital now reflect what

the ICRA requires for a Class 4 project. If I

had not attended the National Conference I

would not have had the contact information

for Mr. Johnson and would not have felt

comfortable to reach out to him. Knowledge

is power!!! Experts do not hurt either!!!

Example of a pressure monitoring device.

See you in Nashville 2015!

APIC National 2014

Anaheim, California

By Connie Simpson, RN, BSN

Perry County Memorial Hospital

Tell City, IN

I want to acknowledge APIC Indiana for

having the vision to provide funding for

scholarships for APIC IN members to

further their education by attendance at the

State and National APIC Conferences. I

began my job as an ICP in 1987 by

implementing Universal Precautions and the

Hepatitis B Vaccine, and educating staff on

HIV/AIDS. The first APIC National

Conference that I attended was in Nashville

in 1991, although I have not been able to

attend the conference every year. Perry

County Memorial Hospital (PCMH) is a 25

September 14, 2014 Page 7

bed critical access hospital without an

epidemiologist, making it even more

important that I stay current in the field, as

Infection Control is constantly changing.

Not only are the educational sessions and

speakers valuable to keep up with the latest

CDC recommendations and emerging issues

in Infection Control, but networking with

colleagues, (both national and international),

to maintain professional development is also

a valuable experience.

PCMH is building a new 25 bed facility

with the move expected early in 2015, so the

construction sessions were a focus. I am

also responsible for Employee Health and

Patient Education, so I have selected a few

conference sessions to review, but all of the

sessions are always very informative and

educational.

Opening Plenary: How Genome

Sequencing is Changing Medical

Microbiology (Jennifer Gardy)

The Opening Plenary was thought

provoking and shows the future of

surveillance with genome sequencing and

that it is becoming less costly.

Opening Plenary: Why HC Professionals

Inhibit Medical Advances: Historical Role

and the Role of Cognitive Biases in

Judgment and Decision Making (Gregory

Poland). I first heard Dr. Poland several

years ago when he spoke of mandatory flu

vaccinations for HCW, and this session

focused on behavioral measures to

implement change.

Disinfection and Sterilization:

What’s New – Dr. Rutala is a well known expert in his

field and always gives an excellent

presentation with evidence-based

information. Comparison of a rapid readout

biological indicator for steam sterilization

now requires a 30 minute to 1 hour readout,

compared to 24-48 hours to 7 days in the

past. A new accelerated hydrogen peroxide

HLD was reviewed and of importance to me

as a department in our facility had recently

been approved to use this for cystoscopies.

Accelerated hydrogen peroxide was used in

a study to treat privacy curtains to reduce

risk of infection. Thoroughness of

environmental cleaning should be monitored

(e.g., fluorescence). GI endoscope

contamination was reviewed along with a

study recently published in the MMWR

regarding NDM-Producing E. coli

Associated ERCP. Recommendations in the

publication included education/adherence

monitoring, enforcement of best practices,

improved definition of the scope of the issue

and contributing factors, and perform

periodic microbiologic surveillance of

duodenoscopes to assess whether bacteria

have survived the reprocessing procedure.

Due to the difficulty of cleaning endoscope

lumens and contamination of colonoscopes,

endoscopes represent a nosocomial hazard.

Manufacturers should be encouraged to

develop practical sterilization technology for

endoscopes. For cleaning of instruments for

CJD, check recommendations published in

ICHE 2014;34:1272. EPA has registered

antimicrobial products effective against C.

difficile spores, April 2014.

The SHEA/IDSA Compendium of

Strategies to Prevent HAIs: Update on Prevention Measures This was

recently published in AJIC and was a very

good presentation by several speakers

including Ruth Carrico from Louisville.

Hand Hygiene “Tour d Monde” :

Partnership, Innovation, Leadership –

The Infection Prevention Mantra –

(Didier Pittet MD, MS, CBE, University

of Geneva Hospitals, WHO Collaborating

Centre on Patient Safety)

This was a very motivational and

inspirational session by Dr. Pittet, the lead

September 14, 2014 Page 8

advisor to the WHO Global Patient Safety

Challenge which aims to reduce HCAI

worldwide. Dr. Pittet started using one of

the first alcohol hand gels at his facility in

Geneva in 1995, and promotes hand hygiene

worldwide with the Clean Your Hands

campaign. Clips were shown of different

countries using alcohol hand gel, the barriers

to use of hand gel in different countries, and

Dr. Pittet’s visits to those countries. I had

the privilege to meet Dr. Pittett at his book

signing, “Clean Hands Save Lives”, the

story of his campaign.

Draft Guidelines for the Prevention of

Surgical Site Infection, 2014

The take away for this session is that

some recommendations could not be made

due to lack of evidence based practice and

research. HICPAC is considering revisions

to the process of evidence evaluation for

future guidelines. No recommendation

could be made regarding optimal timing of

preoperative parenteral prophylactic

antimicrobial agent for prevention of SSI,

although the speaker said that 1 hour was

used. A preoperative antibiotic was

recommended prior to skin incision in all

cesarean sections. In clean and clean-

contaminated procedures, do not administer

additional prophylactic antimicrobial agent

doses after the surgical incision is closed in

the operating room, even in the presence of

a drain. The final guidelines may not be

released until 2015.

NHSN Surveillance and Prevention:

CAUTI

The new CAUTI definition will not be

ready for use until 2015. It is important that

the definition be accurate as the data is being

used broadly for public reporting. January

1, 2015-added data will need to be reported

for Adult and pediatric medical, surgical and

medical/surgical wards for CMS

participation. 2015 is to be a baseline year

for CAUTI data for subsequent years. A

new algorithm was reviewed along with the

potential removal of yeast from ABUTI.

Facilities Guideline Institute 2014

Guidelines for the Design and

Construction of HCF

Clarifications addressed location of hand

hygiene stations, scrub sinks, decorative

water features, hot water, and airborne

infection isolation room, along with a

comparison with AORN recommendations

and FGI.

Environmental Cleaning Roles and

Responsibilities…going where we’ve

never gone before

Marti Craighead from Barnes-Jewish

Hospital described a process to assign roles

and responsibilities for cleaning the patient

and work environment. Her facility took a

picture of every single item in the patient

environment and met with representatives

from each department to determine primary

users and owners of each item. They then

implemented a binder describing when and

who would clean those items.

Closing Plenary-Federal HAI Initiatives:

Where we Have Come from, Where We

Are Going, and the Importance of

Inspiring Collaboration along the Way

Speakers included Donald Wright, MD,

MPH, Deputy Assistant Secretary for

Health, Office of Disease Prevention and

Health Promotion, U.S. Department of

Health and Human Services; Denise Cardo,

MD, Director, Division of Healthcare

Quality Promotion, National Center for

Emerging and Zoonotic Infectious Diseases,

CDC; and Marion Kainer, MD, MPH,

Director, Healthcare Associated Infections

and Antimicrobial Resistance Program,

Tennessee Department of Health.

Don Wright reviewed the proposed 2020

HCAI targets timeline, starting with a new

September 14, 2014 Page 9

baseline in 2015, and this was published

recently in the Federal Register for

comments.

The highlight of Denise Cardo’s

presentation was the TAP report, referring to

Targeted Assessment for Prevention, which

ranks facilities by excessive numbers of

infections above a set benchmark. The TAP

report function will be built into NHSN

application for 2015. Denise also referred to

the recent CDC Vital Signs that focused on:

Improving Antibiotic Prescribing Practices

in Hospitals. The CDC recommends that all

hospitals in U.S. have a program with those

7 Key Elements, and focus on antibiotic

stewardship.

Marion Kainer – The fungal meningitis

outbreak of 2012 was the largest healthcare

associated outbreak in U.S. history. Marion

described how the cause had been

determined in 8 days in TN. Discussion

included the importance of regional

collaboration and what TN is doing,

including the HAI prevention calculator, and

HAI definition checklist available on the TN

Department of Health website. TN is

proactive in public reporting, and has a

website that can be accessed for information

by searching for TN HAI.

Data, Data, and More Data

By Mona Wenger, MS

Elkhart General Hospital

Data, data, and more data. What does an

APIC Conference have to do with assisting

Infection Preventionists (IPs) with data

collection? Everything!!

An APIC Conference provides the means

for IPs to connect with vendors that have

developed electronic data mining programs.

These programs have the capability to

collect, report, and analyze infectious

disease data and with one stroke of a key on

the computer board, an IP can “Run a

Report” and within a matter of minutes have

all positive isolate results that have been

identified within the past 24 hours or 2 years

or 5 years. One can run a report on data

such as drug resistant organisms (DROs)

and sensitivities, nosocomials, patterns,

create spreadsheets and unit or time specific

graphs.

Since the federal government has

mandated the reporting of specific

healthcare acquired infections (HAIs), the

data mining program has become a tool by

which we are able to quickly identify not

only HAIs, but organisms that are

circulating in the community too. Another

program feature is the readmission

notifications for DROs. Transmission based

September 14, 2014 Page 10

precautions are implemented faster because

IP is notified via email alerts. The IP

department is not the only department

utilizing the program. Pharmacy, in consult

with healthcare providers, is able to identify

and address unnecessary or inappropriate

treatment, thus promoting antibiotic

stewardship.

Electronic reporting can make the work

load of an IP much more manageable and

much less stressful. We know this first hand

because one day our reference laboratory

(LAB) notified us that their electronic

reporting system would be going down for

an upgrade. That was almost 3 months ago.

However, the LAB upgrade caused a failure

in the electronic data mining program.

Therefore, we can tell you personally how

this affects one’s work day because we have

not had our mining program since May 10th.

Our IP world went from electronic data

mining to reviewing by hand hundreds of

LAB reports daily for the local/state health

department reportable conditions and

hospital/community acquired infections. So,

now our work load has gone from 2.5 hours

of active surveillance to basically an all-day

affair. One also has to keep in mind that the

rest of the duties of an IP, such as phone

calls, faxes, emails, research, meetings, the

data reports, and the federal reporting that

now has to be inputted manually, continues

non-stop.

Without an electronic data mining

program, the work load of an IP

dramatically increases. The identifying and

reporting of infectious disease organisms

rapidly at our facility is enhanced by having

an electronic data mining program. The job

duties of an IP become a great deal more

balanced. The APIC Conference provides IP

with the necessary connections to vendors

that developed and made the electronic data

mining program more easily accessible and

our workload lighter.

Data, data, and more data. What does the

APIC Conference have to do with data

collection and a healthcare facility?

Everything!!

Note: As of September 4th, our electronic

data mining program is up and running.

Yes, we celebrated!!

September 14, 2014 Page 11

Keep the Information Coming

By Michael Grow

I am thankful for the contributions of

so many of you that help to make this

newsletter what it is. I could not publish this

newsletter without all your contributions.

Since the last newsletter I have

changed employers and am now at

Franciscan St. Elizabeth Health. So please

send any news, articles, pictures, etc. to me

at michael.grow@franciscanalliance.org.

What you share could just be what

someone else needs.

I am looking forward to seeing what

this newsletter will become because of your

efforts.

Thank you!

"What's New in Infection

Prevention in 2014?"

October 10, 2014

Indianapolis Marriott North

Topics will include:

The first MERS case in the US

How to figure a SIR for your healthcare institution

Who needs what report in your in your healthcare institution

Updates on perioperative cleaning

Management of Legionella

See you soon!

September 14, 2014 Page 12

Federal HAI Reporting to NHSN

By Susan Kraska, APIC Indiana Public Policy Chair

Below is a slide that I hope all our members are accustomed to seeing with the dates and

HAI's that are reportable now and will be in 2015 and 2016.

There has been much activity at the Federal level via APIC's Public Policy Committee.

Submission of multiple comments on legislative proposals and also member support submitted

for monies for CDC/NHSN when asked. Many thanks to all APIC Indiana members who

respond when asked to send letters via the APIC web site. It remains one place we do have a

voice that directly affects the work we do.