2. The Value of Infection Control Can Companies Help Bolster Value? Copyright 2002, Robert Garcia, BS, MMT(ASCP), CIC

3. IC Responsibilities Range: all depts. Nosocomial infection surveillance Communicable diseases Employee health Sterilization assurance Medical devices Sanitation Antisepsis Engineering & Construction Patient Safety Regulatory requirements Bio-terrorism planning

4. The IC Profession at a Crossroads 12,000 ICPs and dwindling Responsibilities up 75% in acute care and 81% in LTC Staffing has not changed for 60% of IC departments or decreased nearly 25% 75% over 45 years of age Most nurses, but where are the nurses? Jackson MM, Soule B, Tweetn SS. APIC Strategic Planning Member Survey, 1997. The Emerging Healthcare Delivery Systems Task Force. APIC. AJIC AM J Infec Control 1998;26:113-25.

5. Lack of Nurses and Infection >15 studies and reports equate decreased RN nursing staff with increasing nosocomial infections Needleman J, Buerhaus P, Mattke S, et al. Nurse-staffing levels and quality of care in hospitals. N Eng J Med 2002;346:1715-22 Jackson M, Chiarello L, Gaynes R, et al. Nurse staffing and health care – associated infections: Proceedings from a working group meeting. AJIC AM J Infec Control 2002;30:199-206.

6. Nosocomial Infections 4 th leading cause of death in U.S. >$4 billion dollar cost to hospitals LTC, Ambulatory, others $ = unknown Resistant organisms IOM Report Media reports

7. ECONOMIC PRESSURE HEALTHCARE INFLATION MANAGED CARE COST OF TECHNOLOGY MEDICAID CUTS

8. Prophetic Insight on Future Paths “ …Because we do not provide direct care to patients, the value of our practice must be demonstrated in other ways. We must translate infection control activities into proposals and systems that gain priority by stressing quality and economy. ” Pantelick EL. Hospital infection control: Dinosaur or Dynasty. Am J Infect Control 1989;17:56-61.

9. APIC Research Foundation Priorities Project A review of the world’s literature on IC and ID over the last 20 years Identified 65 of most published authors 43 responded to survey #1 top priority: Cost-effectiveness/financial impact studies Report from the Research Foundation, APIC Educational Conference & International Meeting, June 2000, Minneapolis, MN.

10. What is at Stake? For infection control professionals: –A necessary increase in institutional value attained by sustained decease in infections and demonstration of cost reductions For Industry: –The confirmation that a proven and high quality product does make a difference –Enhanced market position

11. An Emerging Methodology Interventional Epidemiology “…IE examines all functions from a global health care viewpoint; that is, it takes into consideration the potent changes outside of a healthcare organization and in response integrates this knowledge into the internal process systems of the facility.” Garcia R, Barnard B, Kennedy V. The Fifth Evolutionary Era in Infection Control: Interventional Epidemiology. AJIC Am J Infect Control 2000;28:30-43

12. Communication Between Providers People Procedures VAP PoliciesEquipment & Devices VAP surveillance rounds (observational periods between IC and nurses) Physicians Nurses Intubation/Extubation Cleaning & maintenance of ventilator & components Definition of VAP Oral & Dental Care Cleaning of ventilator & devices Closed suction system, oral suction catheters, water, other suction devices, suction canisters/tubing Mechanical ventilator (Heated humidifier or HME) Tracheostomy devices Closed suctioning Use of H2 antagonists/sucralfate Handwashing Filters Pharmacists Intubation/Extubation Analysis of System Components Influencing the Occurrence of Ventilator-Associated Pneumonia Nutritional Specialists Nasogastric tubes Placement & maintenance of nasogastric tube Respiratory Therapists Handwashing Suctioning (closed/oral) Oral Care Vent circuits, filters Nebulizer s Multidose vials Laryngoscopes Resuscitation bags Barrier equipment Ventilator circuits Tracheostomy care Cleaning of laryngoscopesNebulizers Suction canistersResuscitation bags Placement and care of nasogastric tubes Enteral feedingWeaning Self-extubation Semi-recumbent positioning Relay surveillance data to healthcare providers Feedback from healthcare providers

13. The Practice Arena of Interventional Epidemiologists ClinicalFinancial Customer Satisfaction

14. Can Companies Help Bolster IC Value? Provide a fresh perspective on infection transmission Provide economic and clinical rationale Provide viable interventional methodologies Provide effective education Provide support for the span of the partnership