Welcome to the GHA Infection Prevention Power Hour September 18, 2014

Agenda Infection Prevention Updates – APIC NHSN Updates – CMS Reporting Updates – CMS Memorandum Regarding IUSS in Surgical Settings Georgia Department of Public Health Updates – Antimicrobial Stewardship Successes – Ebola and Enterovirus D 58 Updates – Influenza Season – Georgia Emerging Infections Program Update QIN : 11 th Scope of Work Shared Learning Offers and Requests

APIC call NHSN Updates

PDFs/Summary_of_FY_2015_IPPS_Rule_FINAL__9_3_14.pdf PDFs/Summary_of_FY_2015_IPPS_Rule_FINAL__9_3_14.pdf

Position Statement: Immediate-Use Steam Sterilization AAMI, AAAHC, AORN, APIC, ASC Quality Collaboration, AST, IAHCSMM

Summary: “Flash sterilization” has traditionally been used to describe steam sterilization cycles where unwrapped medical instruments are subjected to an abbreviated steam exposure time and then used promptly after cycles completion without being stored. This is in contrast to traditional “terminal sterilization” cycles, where instruments are sterilized within containers, wrappers, or primary packaging designed to maintain the instruments’ sterility and allow the devices to be stored for later use. The term “flash” arose out of the abbreviated time of exposure of the unwrapped device. Today, however, “flash sterilization” is an antiquated term that does not fully describe the various steam sterilization cycles now used to process items not intended to be stored for later use. The term “immediate-use steam sterilization” more accurately reflects the current use of these processes. The same critical reprocessing steps (cleaning, decontaminating, and transporting sterilized items) must be followed regardless of the specific sterilization cycle employed; a safe process does not include short-cuts or work-arounds.

Summary: “Immediate use” is broadly defined as the shortest possible time between a sterilized item’s removal from the sterilizer and its aseptic transfer to the sterile field. Immediacy implies that a sterilized item is used during the procedure for which it was sterilized and in a manner that minimizes its exposure to air and other environmental contaminants.

We agree that: Personnel involved in reprocessing should be knowledgeable and capable of exercising critical thinking and judgment, and should implement standardized practices. The supervising organization is responsible for ensuring appropriate training, education, and competency of staff and ensuring necessary related resources are provided: – Examples: (CBSPD) Certification Board for Sterile Processing and Distribution and (IAHCSMM) International Association of Healthcare Central Service Materiel Management. – Examples of standards and practices can be found with Association for the Advancement of Medical Instrumentation (AAMI), the Association of periOperative Registered Nurses (AORN), and the CDC Prevention- Healthcare Infection Control Practices Advisory Committee (HICPAC)

We agree that: Sterilization personnel should be educated regarding the different types of steam sterilizers and different types of steam sterilization cycles used in healthcare. Sterilization cycles with little or no dry time are efficacious when used in compliance with validated written instructions provided by the device manufacturers, sterilization equipment manufacturers, and container manufacturers and when done in accordance with professional guidelines Cleaning, decontam, and rinsing are critical and users must follow and complete all required processing steps regardless of the sterilization exposure parameters being used. Aseptic transfer from sterilizer to the point of use is critical to protect from contamination. Only items sterilized and packaged in materials cleared by the FDA for maintenance of sterility can be stored.

We agree that: Device manufacturer’s written instructions for reprocessing any reusable device must be followed. Cycle parameters required to achieve sterilization are determined by the design of an instrument, the characteristics of the load, the sterilizer capabilities, and the packing (if used) Survey personnel statement

DPH Influenza Coordinator Seasonal Influenza Guidelines

Jeanne Neagley Peggy Kirkland Coffee Regional Medical Center Pharmacist Antimicrobial Stewardship Program Update

Dr. Cherie Drensek, EBOLA and Enterovirus D 58 Updates

This material was prepared by GMCF, the Medicare Quality Improvement Organization for Georgia, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. 11SOW- GMCFQIN-C

September 11, 2014

 Thank you very much for your participation in the 2011 Prevalence Survey.  Your data yielded important results that were published in the New England Journal of Medicine available at:

Data Summary : A total of 183 hospitals (22 facilities in metro Atlanta) > 93 (51%) were small, >68 (37%) were medium-sized, >22 (12%) were large Patients Surveyed > 11,290 patients (1395 in Atlanta) were included in surveys (between May and September 2011). > Median patient age was 58 years (range 32 to 74). > Approximately 51.9% of patients were receiving or were scheduled to receive antimicrobial agents. > 4.0% of patients had at least 1 health care–associated infection Source: N Engl J Med 2014; 370: March 27, 2014

Title: Evaluation of Antibiotic Prescribing Quality in Hospitalized Patients Overview: This project will assess U.S. acute care hospital antibiotic prescribing quality in a sample of inpatients from participating facilities in 10 Emerging Infections Program (EIP) states for 4 different prescribing event types: 1) intravenous (IV) vancomycin administration 2) fluoroquinolone (ciprofloxacin, levofloxacin, or moxifloxacin) administration 3) urinary tract infection (UTI) 4) community-acquired pneumonia (CAP)

Objectives: 1) Evaluate antibiotic prescribing quality. 2) Determine the proportion of inappropriate antimicrobial use in 4 specified prescribing scenarios, including UTI, ) community- acquired pneumonia (CAP), IV vancomycin and fluoroquinolone use.

Data Sources: 1. Discharge Data  Will be obtained from the 2013 GHA discharge database at the state.  Lists of ICD-9 codes for pneumonias and UTIs will be used to identify cases for sampling from the d/c database. 2. Pharmacy Data  GA EIP will request electronic pharmacy order data to identify patient prescribed vancomycin or fluoroquinolones.  May need IP support to identify the appropriate pharmacy contacts in selected facilities. ###

Timeline:  The Georgia Department of Public Health has approved this project, and EIP staff will act as agents of the state conducting a public health assessment.  EIP will work with participating hospitals to obtain pharmacy data in the fall of  All medical record reviewswill be performed by EIP staff.  CDC plans to analyze and present results in ###

QIN / QIO Updates 11 th Scope of Work Nancy Fendler

This material was prepared by GMCF, the Medicare Quality Improvement Organization for Georgia, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. 11SOW- GMCFQIN-C

NHSN UPDATES NHSN Update – – NHSN guidance and definitions for reporting HCP influenza vaccination summary data can be found in the NHSN Influenza Vaccination Summary Protocol: care-hospital/hcp-vaccination/index.html#pro. care-hospital/hcp-vaccination/index.html#pro – Operational Guidance for Acute Care Hospitals to Report Healthcare Personnel (HCP) Influenza Vaccination Data to CDC’s National Healthcare Safety Network (NHSN) for the Purpose of Fulfilling CMS’s Hospital Inpatient Quality Reporting (IQR) Program Requirements and CMS’s Hospital Outpatient Quality Reporting (OQR) Program Requirements – CMS also published on December 10, 2013 the CY 2014 OPPS/ASC final rule that finalized for the Hospital Outpatient Quality Reporting Program (OQR) the HCP influenza vaccination measure and its summary reported data from hospital outpatient departments via CDC’s NHSN beginning with the influenza season.2 The CY 2014 OPPS/ASC final rule stated that hospital outpatient departments would start reporting HCP influenza vaccination summary data on October 1, 2014, and clarified that beginning with the influenza season, hospital outpatient departments must submit data for the entire influenza vaccination season (October 1 through March 31) to NHSN.

Thoughts / Suggestion Future Topics Discussion by all

Contact Information Jan Ratterree, RN, BSN, CIC Georgia Hospital Association | Jeanne Negley, HAI Coordinator Georgia Department of Public Health (404) |