1. APIC Greater NY Chapter 13 Q & A Session January 20, 2016 by Steve Bock RN BSN CIC Infection Prevention and Control Department 212-263-5454 / 212-598-6767

2. Question #1 A patient with Cystic Fibrosis (CF) is admitted to a medical unit at your hospital. A diagnosis of “rule-out active Mycobacterium tuberculosis” infection is made and plans are made to transfer the patient to a negative pressure room. As the IP, you a. advise against the move because the patient will be placed at increased risk of infection in the negative pressure room due to having CF. b. agree with the move. c. agree with the move but insist the patient wear a surgical mask while in the room, except when eating. d. advise against the move; CF patients never get TB.

3. Answer #1 A patient with Cystic Fibrosis (CF) is admitted to a medical unit at your hospital. A diagnosis of “rule-out active Mycobacterium tuberculosis” infection is made and plans are made to transfer the patient to a negative pressure room. As the IP, you a. advise against the move because the patient will be placed at increased risk of infection in the negative pressure room due to having CF. b. agree with the move. c. agree with the move but insist the patient wear a surgical mask while in the room, except when eating. d. advise against the move; CF patients never get TB.

4. Answer #1 - continued B – Agree with the move Rational: CF patients can get TB but they are not immunocompromised, so being placed in a negative pressure room will not increase their risk of infection (unlike the case with an immunocompromised patient). Therefore, once in the negative pressure room, the patient does not need to wear a mask.

5. Question #2 A patient is admitted through your Emergency Department to the surgical floor with a diagnosis of UC (ulcerative colitis)/Crohn’s disease exacerbation with complaints of diarrhea and severe abdominal pain. This is the patient’s third hospitalization for his irritable bowel flare-up in the past 6 months. A C. difficile test is ordered in the workup process. As the IP, you a. advise against testing for C. difficile; Patients with diagnosed UC/Crohn’s disease have a known reason for the diarrhea already. b. recommend a negative pressure room. c. put the patient on Contact Precautions pending the outcome of the C. difficile testing. d. advise Contact Precautions be started if the C. difficile test is positive.

6. Answer #2 A patient is admitted through your Emergency Department to the surgical floor with a diagnosis of UC (ulcerative colitis)/Crohn’s disease exacerbation with complaints of diarrhea and severe abdominal pain. This is the patient’s third hospitalization for his irritable bowel flare-up in the past 6 months. A C. difficile test is ordered in the workup process. As the IP, you a. advise against testing for C. difficile; Patients with diagnosed UC/Crohn’s disease have a known reason for the diarrhea already. b. recommend a negative pressure room. c. put the patient on Contact Precautions pending the outcome of the C. difficile testing. d. advise Contact Precautions be started if the C. difficile test is positive.

7. Answer #2 - continued C - put the patient on Contact Precautions pending the outcome of the C. difficile testing Rationale: Patients with UC/Crohn’s disease can have C. difficile infection. Waiting for a test to be collected and result as positive is not practicing safely. And with this being the patient’s third admission in 6 months, you might argue that the patient has an increased risk of C. difficile infection given multiple exposures to the hospital environment (even though your hospital is “clean”).

8. Question #3 Your hospital has made improving hand hygiene compliance a corporate goal for 2016. Which of the following education and training approaches should you as an IP recommend as a priority? a. Identify human factors that may present unrecognized obstacles for compliance. b. Ask staff leaders (department/unit champions) to attend local and/or state health department educational programs on hand hygiene. c. Intensify disciplinary actions for employees who do not follow hand hygiene practices. d. Implement a mentoring program based on peer-to-peer instruction and coaching.

9. Answer #3 Your hospital has made improving hand hygiene compliance a corporate goal for 2016. Which of the following education and training approaches should you as an IP recommend as a priority? a. Identify human factors that may present unrecognized obstacles for compliance. b. Ask staff leaders (department/unit champions) to attend local and/or state health department educational programs on hand hygiene. c. Intensify disciplinary actions for employees who do not follow hand hygiene practices. d. Implement a mentoring program based on peer-to-peer instruction and coaching.

10. Answer #3 - continued D - Implement a mentoring program based on peer-to-peer instruction and coaching. Rationale: HH is among the simplest and most effective preventive measures to reduce healthcare-associated infections. However, compliance with HH among HCWs is consistently suboptimal. Numerous studies suggest that HCWs’ compliance is influenced significantly by the behavior of other healthcare personnel. The IP should emphasize the importance of role modeling to set high standards and to contribute to a culture of safety within a healthcare environment. Incidentally, it wouldn’t hurt to analyze the human factors that may impede good HH behavior. We all already have enough education about HH! Beating staff with a stick…not so good!

11. Question #4 Which of the following statements best describes human factors? a. Environmental, organizational, and job elements and human and individual characteristics that influence behavior at work that can affect health and safety. b. Prevention of errors and adverse effects to patients associated with healthcare use. c. Ability to identify the many and various factors that impact upon a complex situation or event. d. The attitudes, beliefs, perceptions, and values that employees share in relation to safety.

12. Answer #4 Which of the following statements best describes human factors? a. Environmental, organizational, and job elements and human and individual characteristics that influence behavior at work that can affect health and safety. b. Prevention of errors and adverse effects to patients associated with healthcare use. c. Ability to identify the many and various factors that impact upon a complex situation or event. d. The attitudes, beliefs, perceptions, and values that employees share in relation to safety.

13. Answer #4 - continued A - Environmental, organizational, and job elements and human and individual characteristics that influence behavior at work that can affect health and safety. Rationale: Human factors examine the relationship between people, the tools and equipment they use in the workplace, and the systems with which they interact. The goal of human factors is to minimize errors by focusing on improving efficiency, creativity, productivity, and job satisfaction. The application of human factors knowledge to healthcare can help design processes to improve patient safety.

14. BONUS Question #5 As the IP, you are asked to recommend the length of time a staff member who has developed influenza should be excluded (furloughed) from work duties. The staff member was diagnosed with flu on January 15. You consult the CDC guidelines and recommend that the employee: a. remain off work until January 20. b. remain off work until January 21. c. remain off work until January 20 or until symptoms have resolved, whichever is longer. d. remain off work for the duration of her illness. e. remain off work until she has taken Tamiflu for 24 hours.

15. BONUS Answer #5 As the IP, you are asked to recommend the length of time a staff member who has developed influenza should be excluded (furloughed) from work duties. The staff member was diagnosed with flu on January 15. You consult the CDC guidelines and recommend that the employee: a. remain off work until January 20. b. remain off work until January 21. c. remain off work until January 20 or until symptoms have resolved, whichever is longer. d. remain off work for the duration of her illness. e. remain off work until she has taken Tamiflu for 24 hours.

16. BONUS Answer #5 - continued C - remain off work until January 20 or until symptoms have resolved, whichever is longer. Rationale: Influenza is primarily spread between individuals via respiratory secretions (droplet spread). Viral shedding starts 24-48 hours after infection and typically 24 hours before the onset of symptoms. Shedding normally persists less than 5 days but can be longer in children and in immunocompromised persons. Thus, adults are typically infectious from the day before symptoms begin until approximately 5 days after the onset of illness. Staff members who develop influenza illness should be furloughed for 5 days after the diagnosis or the duration of illness, whichever is longer.