Kelley

Communications Committee Meeting Working group developing tools for IPs and community 2016 Infection Prevention Week resource planning Break the chain of infection APIC consumer alerts APIC Conference Podcast Twitter

Engineering Success: Successfully Implementing CAUTI Prevention Practices Kelley Boston & Cheryl Kirchner – Methodist Healthcare System Process Alignment to Reduce CAUTI PDCA Changing organizational culture Leadership support and engagement Daily accountability Consistency Targeting special populations and risk areas

Behavioral Modification: Jedi Mind Tricks to Create Change and Increase Compliance Jill Holdsworth, MS, CIC, NREMT - Sentara Northern Virginia Medical Center

Publishing Reasons for non publication: Don’t have the skill (28%) Have never written (22%) Don’t have anything publish worthy (33%) Don’t have the time (17%) Fear of rejection (99%)

APIC Hero Award

Call for Presentations Deadline August 5th Hot Topics: Antibiotic Stewardship Continuous Quality Improvement Pediatrics Long-Term Care International issues in Infection Prevention Call for Abstracts Posters& Oral August 15 - December 5 Film Festival October 24 - February 3

TINA

Disinfection and Sterilization: The Good, The Bad and the Ugly by William Rutala, PhD Modified Spaulding classification of Disinfection and Sterilization Critical Objects – or objects which directly or secondarily (i.e., via a mucous membrane such as duodenoscope, cystoscope, bronchoscope) enter normally sterile tissue or the vascular system or through which blood flows should be sterile. Semicritical – objects that touch mucous membranes or skin that is not intact require a disinfection process (high-level) disinfection [HLD] that kills all microorganisms but high numbers of bacterial spores. Noncritical – objects that touch only intact skin require low-level disinfection (or non-germicidal detergent).

Challenge with Endoscope-related Infections Endemic transmission of infections associated with GI Endoscopes likely go unrecognized. Flexible endoscopes are heat labile, only high level disinfection or low-temperature sterilization is possible. FDA Panel in 5/2015 recommended sterilization of duodenoscopes. Technology is not yet available.

Challenge to Eliminate Environmental Infections Monitoring the effectiveness of cleaning – ATP bioluminescence (measures organic debris) and Fluorescent marker. No Touch Cleaning – Hyrdrogen peroxide, UV-C. Visible Light Disinfection – uses blue light Research New Continuous room decontamination using dilute hydrogen peroxide Study of microbiomes New germicides

The Role of CMS in Assessing Infection Prevention and Control Compliance by K. Hoffmann Infection Prevention learning tools: https://learner.mlnlms.com Surveyors are moving from time spent on document review to the floor to assess basic infection control in all areas. Surveyors now observing patients and procedures where there is a high risk of infection transmission Survey process is on prevention efforts for HIAs Revised hospital Infection Control interpretative guidelines coming soon.

ANSI/AAMI ST91: 2015 Flexible Endoscope Reprocessing and the Importance of AAMI ST91 by A. Dronsnock AAMI ST91 – best practices for scope reprocessing Provides recommendations for techs performing reprocessing Must be certified and maintain competency Monitoring the manual cleaning process Utilize all cleaning stopes, use designated detergents, use a flushing system, rinse after cleaning, perform air purge of all channels, dry with lint-free cloth, keep detachable valves together with the same endoscope as a set Monitoring the automatic cleaning process Done PRIOR TO DISINFECTION, Includes visual inspection, testing, monitoring of cleaning parameters. Cultures should be done every 30 days or 60 cycles After cleaning, all detachable vales should be kept together as a set All staff must be certified and maintain certification

MICHELE

Flexible Endoscope Reprocessing and the importance of AAMI ST91. AAMI ST91 standard was developed by the AAMI Endoscope Reprocessing Working Group under the auspices of the AAMI Sterilization Standards Committee. These guidelines are intended to provide comprehensive information and direction for health care personnel in the processing of these devices and accessories. Specifically, this standard provides guidelines for pre-cleaning, leak testing, cleaning, packaging (where indicated), storage, high-level disinfection, and/or sterilizing of flexible gastrointestinal (GI) endoscopes, flexible bronchoscopes, surgical flexible endoscopes, and semi-rigid operative endoscopes in health care. Does not applies to probes and rigid endoscopes. Other topic discussed include functional and physical design criteria for endoscope processing areas, education, training, competency verification, and other personnel considerations, as well as specific processing recommendations. The spread of infection is related to endogenous and exogenous infections. Other risks involve chemical burns, death. Best practices for processing flexible endoscopes: 1) meticulous attention to all steps in processing endoscopes, their components and accessories is critical in making them safe for subsequent patient use, 2) steps are outlined in the document in details from leak testing to storage. Gives recommendation for certification of personnel, monitoring of manual cleaning and automatic cleaning process, monitoring of temperature and water quality.

Not all ambulatory sites are created equal: how a large tertiary hospital developed and utilized a specialized assessment tool, improving patient safety in more than 100 offsite locations. Donna Nucci, RN, MS, CIC. Infection Preventionist, Hospital Epidemiology Yale New Haven Hospital, Old Saybrook, Connecticut Background: Session analyze the key component of the ambulatory prevention risk assessment that assist to improve patient safety The ambulatory infection prevention risk assessment (A-IPRA) tool, modeled after the construction Infection Control Risk Assessment, was developed to categorize ambulatory sites at a 1,500-bed hospital with 122 off-site ambulatory sites covered by one full time equivalent IP. A hospital epidemiologist and 3 IPs with ambulatory infection prevention experience independently listed ambulatory setting risks based on personal risks based on personal experience and reports from the literature. Three major risk group areas/activities were identified as either low, medium, high. Categories were recorded by site in the hospital’s ambulatory database that is accessible to managers to see their designation, frequency of IP review, basic infection prevention practices/requirements for their designation, and access to relevant policies for their area. The A-IPRA identifies ambulatory areas for focused IP evaluation/review while giving managers tools to ensure basic infection prevention measures are in place. Focus points are formulated and disseminated to the managers. Ongoing annual education is provided through the hospital’s ambulatory work group to ensure each area is up to date on evolving policy and regulatory changes. When new sites are added, they undergo an IP assessment and risk categorization. The presentation will focus on tool components, utilization, and ongoing evaluation of offsite locations.

The Physical Environment's Critical Role in Infection Prevention: High-Risk Areas and Mitigation Strategies Bryan Connors, MS, CIH. Practice Director, Healthcare, Environmental Health & Engineering, Inc., Needham, Massachusetts There are four facility-related infection risks that are the most critical because they present the highest risk to patients, are the most common, and recently have received increased focus and scrutiny by regulatory agencies: 1.) HAIs that are the result of dust and other contaminants that may flow from construction sites to patient areas. 2.) Infection risks due to improper pressurization and ventilation of sensitive patient area, 3.) Infections due to the contamination of sterile compounds in hospital pharmacies. 4.) Legionellosis outbreaks caused by Legionella bacteria growth in sources such as cooling towers and potable water systems. Case studies were used to illustrate proven strategies and current best practices for compliance with regulations and to mitigate risks to patient health and safety including: 1.) Establishing internal audits to continually assess and improve the physical environment's role in infection prevention programs, 2.) Tools for assessing and prioritizing risks related to compliance with the Facility Guidelines Institute (FGI) pressurization and air exchange rates. 2010 Guidelines provide minimum requirements, project that entered the project phase prior to Jan 1 2011 can use the 2010 AIA Guideline. Maintain an inventory checklist of areas to be tested and use continuous monitoring. Traditional practice is to have in place: work practices, engineering controls and pressurization. A more robust system calls for: work practices, engineering control, pressurization 24/7 real time and environmental surveillance 3.) Strategies for preventing contamination in hospital pharmacies, implementing an environmental testing program and commissioning pharmacies to be USP 797 compliant. Need to comply with ISO 8,7 requirements by engaging with Pharmacy for design and testing and meet ISO Air Quality requirements. 4.) Legionella risk analysis methodology to develop an ASHRAE 188-compliant Legionella Management Plan. You need to perform a building survey (dead legs, cooling water and locations where high risk patients are located). A maintenance Program for the water must be in place (water supply temperature, have insulated water lines and a flushing program). A maintenance program must be in place as well for the cooling system. The Management Plan for Legionella must contain (responsibility, water system management, monitoring, disinfection practices, clinical screening/surveillances, response actions and new construction guidelines. Step to comply with ASHRAE 188P. Water management team with assigned responsibilities, process flow diagrams (potable /utility water), risk characterization & hazard analysis, and risk mitigation.

Professional Development Committee Committee purpose: Responsible for promoting professional development of APIC's members and diffusion of the APIC Competency Model. Recent Deliverable: Advanced Designation Program, Competency Assistance Program, Professional and Practice Standard. Long Term Initiatives: Pursue IP development in leadership from the competency model; continue diffusion of Competency Model to membership with focus on competent to advanced elements. Proficient Practitioner Roadmap and Competency Assistance Program Proficient Practitioner Roadmap/Bridge Reference to be used by IC practitioners to achieve the next level in their careers ( Expert IP) Goal is to present a draft of the document to the APIC National Board by the end of the year. Available to members in 2017