1. Increasing Your Infection Prevention Capacity Ruth Carrico PhD RN FSHEA CIC Associate Professor Division of Infectious Diseases University of Louisville

2. Objectives Review the changing practices involved in infection prevention and control Explore strategies to increase your capacity and impact applicable to any healthcare setting

3. Increasing Capacity and Capability Your skills Skills you can obtain from other departments Skills you can develop in others

4. Evolution of Infection Prevention: 1960s Era of Exploration – Advances in knowledge regarding relationships between microbes, people and the environment – Field of public health focused on patients in hospitals – Hospital epidemiologists – Nurses involved in case finding and surveillance – Basic CDC course Garcia R, Bernard B, Kennedy V. The fifth evolutionary era in infection control: Interventional epidemiology. AJIC 2000;28:30-43.

5. Evolution of Infection Prevention: 1970s Era of Expansion – Medical devices – Research regarding risks of nosocomial infection – Focus on institutional capabilities for providing and delivering quality care – Process evaluations began – Design of supplies and materials and their relationships to infection – SENIC

6. Evolution of Infection Prevention: 1980s Era of Reaction and Response – HIV – Universal precautions – Antibiotic resistance recognized as major problem – Cost control and containment – JCAHO [TJC] Agenda for Change – Little focus on necessary resources

7. Evolution of Infection Prevention: 1990s Era of Regulation – HAI rates had been relatively “steady” from 1975 to 1990 – JCAHO [TJC] introduces quality assurance/performance improvement to Infection Control – ABHRs hit the scene (culture change starting) – IOM To Err is Human – NNIS in 285 hospitals in 42 states – HICPAC

8. Evolution of Infection Prevention: 2000 Era of Interventional Epidemiology – Patient safety movement (Root Cause Analysis, Failure Modes and Effects Analysis, Sentinel Events) – AHRQ funds research – Advocacy – Bundles – NNIS becomes NHSN in 2005 – NHSN- 3000 hospitals in all 50 states. 22 states require use of NHSN to report HAIs (2011) – Surveillance guiding interventions

9. Infection Prevention in 2010 and Beyond Era of Transformation – Transparency and legislation – Approaches and initiatives questioned (e.g., MRSA) – CMS value based purchasing – Successes in elimination of HAI is now the expected – Getting to zero VS. Zero tolerance – Infection control continues its transformation to Infection prevention – Links with quality and patient safety more evident

10. Existing Skill Set for the Function of Infection Prevention Clinical expertise Knowledge of surveillance fundamentals Identification of infectious disease processes Preventing and controlling transmission Employee/occupational health Management and communication Education Feltovich F, Fabrey L. The current practice of infection prevention as demonstrated by the practice analysis survey of the Certification Board of Infection Control and Epidemiology, Inc. AJIC 2010;38:784-788.

11. New Skill Set for the Function of Infection Prevention Surveillance fundamentals Epidemiology Health behavior Health promotion Environmental sciences Biostatistics Collaborative practices Educational techniques for instruction and design Leadership

12. Increasing Capacity and Capability Include needs in risk assessment Perform an inventory of your current skills and the skills within your department Clearly outline your weaknesses so you can develop a plan to address them Identify departments with similar responsibilities Recruit unit-based champions Develop an education plan for self and group Develop an evaluation plan to guide your process

13. Increasing Capacity and Capability Include needs in risk assessment – Begin the process by including the need for more capacity within the department in your risk assessment – Be clear about your need and the impact this gap is having on systems and outcomes – Make sure you share this information with your link to the facility executive team

14. Increasing Capacity and Capability Perform an inventory of your current skills and the skills within your department – This is difficult and humbling – Consider ‘grading’ yourself and your team in terms of knowledge v. proficient v. expert – Take into consideration present and well as future needs

15. Increasing Capacity and Capability Clearly outline your weaknesses so you can develop a plan to address them – Can keep this personal or ask for input from others – Outside opinion can be valuable from those you trust. Also solicit feedback from those with whom you do not have a good working relationship – Prioritize your weaknesses in terms of importance to you and your job roles

16. Increasing Capacity and Capability Identify departments with similar responsibilities – A first step in increasing your capacity is to identify departments with shared interests and/or responsibilities – Identify resources that may be able to be shared – Identify training that can be obtained from these departments

17. Increasing Capacity and Capability Recruit unit-based champions – Liaison program – Individuals self-select based upon interest – Training provided to this group – Engagement in problem identification and response – “Nobody knows the work better that those who do the work” (Toyota production- Gemba: the place of the work)

18. Increasing Capacity and Capability Develop an education plan for self and group – Once you have identified strengths, weaknesses, areas for assistance, begun the building of your liaison program, you must have a parallel education plan – Prioritize topics according to need (look back at risk assessment) – Develop the workers – Develop yourself

19. Increasing Capacity and Capability Develop an evaluation plan to guide your process – With your improvement plan, identify metrics for success – Must evaluate your progress, the impact of new resources (e.g., liaison program), and your interventions – What is not working should be stopped or changed – Keep adequate evaluation records to justify activities

20. Increasing Capacity and Capability Include needs in risk assessment Perform an inventory of your current skills and the skills within your department Clearly outline your weaknesses so you can develop a plan to address them Identify departments with similar responsibilities Recruit unit-based champions Develop an education plan for self and group Develop an evaluation plan to guide your process

21. Objectives Review the changing practices involved in infection prevention and control Explore strategies to increase your capacity and impact applicable to any healthcare setting