Pharmacy, Microbiology & Environmental Services: Engaging Critical Partners Ruth Carrico PhD RN FSHEA CIC Associate Professor Division of Infectious Diseases University of Louisville

Objectives Review aspects of critical partnerships in addressing the challenges of infection prevention Identify methods to engage those partners and capitalize on individual and combined strengths

Current Realities in Infection Prevention Emerging Infection Rapid Detection of organisms Impact on the Environment Response to Pathogens Staff Training and Education

Interdependence Preventing Infection

Interdependence Preventing Infection Pathogen Detection

Interdependence Preventing Infection Pathogen Detection Pathogen Treatment

Interdependence Preventing Infection Pathogen Detection Pathogen Eradication Pathogen Treatment

Interdependence Preventing Infection Pathogen Detection PathogenEradication Pathogen Treatment Rapid detection Rapid communication Reporting Feedback

Interdependence Preventing Infection Pathogen Detection PathogenEradication Pathogen Treatment Drug selection Drug use Investigation Feedback Rapid detection Rapid communication Reporting Feedback

Interdependence Preventing Infection Pathogen Detection PathogenEradication Pathogen Treatment Drug selection Drug use Investigation Feedback Rapid detection Rapid communication Reporting Feedback Product Use Staff performance Process efficacy Local engagement Feedback

Current Urgent Issue CRE – Emerging pathogen – Detection challenging – Treatment options are limited – Persistent in the environment – Rapid isolation necessary – Communication internally and externally – Staff performance critical

Collaborative Efforts Recognizing the interdependence Shared responsibilities Shared mission and vision Mutual respect Communication Support

Infection Control Committee Action or reporting function Premise should be “no free lunch” Every member or attendee has a specific purpose Provide information and develop interventions Evaluate effectiveness Determine course adjustments Enable the facility to be nimble in responses Feedback methods

How does your facility integrate infection control reporting of activities? A.We have a specific infection control committee B.Infection control included in the performance improvement committee C.Infection control included in the patient safety committee D.Do not know E.Other process used

How does your facility committee function? A.It is only a place for reporting B.It is only a place for developing action plans C.If is a combination of reporting and action D.Do not know E.Other

How is microbiology information shared ? A.In the committee B.Not part of the committee process C.Do not know D.Other process used

How is pharmacy information shared ? A.In the committee B.Not part of the committee process C.Do not know D.Other process used

How is environmental services information shared ? A.In the committee B.Not part of the committee process C.Do not know D.Other process used

Pharmacy Reports Antimicrobial utilization outside of guidelines – Dose, duration, timing Variation in antimicrobial use – Outside formulary, new additions, non-traditional use Pharmacy and Therapeutics Committee updates – Formulary updates/revisions – Discussion of new agents Performance improvement initiatives Antimicrobial utilization outside of guidelines – Dose, duration, timing Variation in antimicrobial use – Outside formulary, new additions, non-traditional use Pharmacy and Therapeutics Committee updates – Formulary updates/revisions – Discussion of new agents Performance improvement initiatives

Microbiology Reports Organisms of interest Emerging pathogens Antibiograms Report adjustments (e.g., susceptibilities) New/alterations in testing methods Performance improvement initiatives Organisms of interest Emerging pathogens Antibiograms Report adjustments (e.g., susceptibilities) New/alterations in testing methods Performance improvement initiatives

Environmental Reports Current environmental hygiene approaches Current disinfectants used Products under evaluation Employee health issues Environmental situations (e.g., construction, water damage) Performance improvement initiatives Current environmental hygiene approaches Current disinfectants used Products under evaluation Employee health issues Environmental situations (e.g., construction, water damage) Performance improvement initiatives

Active Engagement Case Scenario 64 year old female, identified with CRE in her urine. Patient is symptomatic with elevated temperature and CRE was identified in a urine culture. How can we expect that pharmacy, microbiology, and environmental services will be working together with infection prevention and control on this issue?

Active Engagement Carbapenem-resistant Enterobacteriaceae (CRE) – Pharmacy Current treatment options Obtaining medication Ensuring appropriate use of the selected agents Intervening when treatment outside guidelines Feedback of results of appropriate use and interventions Identification of treatment failures

Active Engagement Carbapenem-resistant Enterobacteriaceae (CRE) – Pharmacy – Why is this important to infection control? Additional way to identify cases Overall adherence with infection prevention activities Opportunity to heighten impact of infection prevention Identification of educational needs – New drug, new methods for administration? – What will administering staff need to know? – Who else needs to be involved (e.g., IV therapy team?)

Active Engagement Carbapenem-resistant Enterobacteriaceae (CRE) – Microbiology Current detection methods New methods or improvements Ensuring appropriate sample collection Feedback of results Feedback of results and how collection methods impacted results Identification of trends

Active Engagement Carbapenem-resistant Enterobacteriaceae (CRE) – Microbiology – Why is this important to infection control? Additional way to identify cases Overall adherence with infection prevention activities Opportunity to heighten impact of infection prevention Identification of educational needs – Specimen collection – Recognition of the abnormal – Responding to the abnormal – Reflexive implementation of control and containment methods

Active Engagement Carbapenem-resistant Enterobacteriaceae (CRE) – Environmental Services Current cleaning and disinfection methods Current disinfectants used Changing methods or agents Staff performance Feedback of results Identification of trends

Active Engagement Carbapenem-resistant Enterobacteriaceae (CRE) – Environmental Services – Why is this important to infection control? Staff performance Who else assists with environmental hygiene Overall adherence with infection prevention activities Opportunity to heighten impact of infection prevention Identification of educational needs – Cleaning and disinfection processes – Who else can help – Barriers to environmental hygiene – Understanding the impact of current pathogens – Transmission issues – Patient and family involvement

Objectives Review aspects of critical partnerships in addressing the challenges of infection prevention Identify methods to engage those partners and capitalize on individual and combined strengths