Agenda

Issue: Patients and residents are frequently transferred between acute care and long-term care facilities. During interfacility transfers, an individual’s MDRO status may be inconsistently communicated which can lead to increased risk of MDRO transmission within the receiving facility. In July 2022, carbapenemase-producing organisms and Candida auris became reportable communicable disease conditions in Wisconsin. Since this time, cases continue to rise across the state. The Wisconsin Healthcare-Associated Infections (HAI) Prevention Program’s surveillance has identified communication of an individual’s MDRO status between health care facilities as an infection prevention and control gap leading to transmission.

Project: This quality improvement project included representation from long-term care, acute care, local and Tribal health departments, and the Wisconsin HAI Prevention Program. The team completed a gap analysis of the communication processes and tools used at their health care facilities. In addition, the team reviewed a tool available from the CDC (Centers of Disease Control and Prevention) that is often used but found to be cumbersome and too in-depth for practical application. This group used the Plan-Do-Study-Act (PDSA) process improvement approach to rework the CDC tool, structuring the content for improved utility and application. 

Results: The project team was successful in creating a streamlined transfer form that is published on the Wisconsin HAI Prevention Program’s webpage. This form is easily accessible and may be used by health care facilities to help streamline communication of patient and resident MDRO status.

Lessons Learned: It was important to have a diverse representation of care team members from different health care settings to outline communication workflows, identify barriers, and pinpoint where breakdowns commonly occur. Barriers and breakdowns identified include lack of electronic health record interoperability, staffing pressures, and the use of emergency transport services. As a result, the team was able to create a tool that is clear, relevant, and easy to integrate within a health care facility to support transfer communications and prevent the spread of MDROs.

Issue: Infection preventionists (IPs) in healthcare settings frequently shift between priorities and tasks.  Tools have been implemented within the electronic health record (EHR) to support some of the largest priorities; such as identifying and reporting communicable diseases, implementing appropriate precautions, and healthcare associated infection (HAI) surveillance.  

Less commonly performed tasks, such as exposure investigation, have been completed in various places outside of the EHR.  We found variation in how investigations were conducted, confusion regarding expectations, and difficulty collecting information after the work was done.  

Project: We developed a tool within our EHR to support standardizing IPs’ work around exposure investigations.  We expected IPs competency in completing exposure investigations to be lower than other tasks that are performed more often, so this tool would facilitate compliance with the expectations of their role.  

The tool, called an “exposure case,” is a part of the infection control module in our EHR, not part of the legal medical record.  The link to patients’ records is a benefit, facilitating easier review and ability to link relevant information to the case.  The tool prompts the IP to enter potentially relevant information into discrete fields that can later be used to assess trends; for example, symptoms, isolation, locations and dates of exposure, outcome of the event, and more.  A free text field is included for additional notes, such as communication regarding the event.  

Lessons Learned: “We don’t know what we don’t know.”  When work and documentation is decentralized, it is challenging to identify patterns.  For us, IPs from multiple hospitals formed an enterprise department, individual investigations were conducted as needed, and discrepancies between IPs work were not identified.  It was nearly impossible to conduct retrospective review of past investigations to draw conclusions regarding trends in exposures.  

By standardizing the documentation to a centralized location, we are now able to easily run reports on the investigations to try to recognize trends, such as location, disease, or outcome of the event.  We now know, for example, exposure was ruled out in 70% (30/43) of the investigations conducted over the last year, or that pertussis exposures increased in ambulatory areas.

Issue: During an accreditation survey we were consistently asked to provide the instructions for use (IFU) from the manufacturer for equipment and supplies. Some departments struggled to find and provide the IFU. Upon detailed review of many IFUs gaps in our practices were noted.

Project: Infection prevention worked with administration, quality and department managers, supply chain, and vendors to make plans of correction. It was discovered that staff access to IFUs was a large issue. A third-party vendor was contracted with, and an icon was placed on every computer that provides access to an online searchable database of IFUs. After correcting the gaps noted through the survey all IFUs were reviewed. Many IFUs have problematic steps, such as washing the patient bed frame with soap and water first and then disinfecting it. Risk assessments were completed to tailor the steps to something more workable for departments and a question was sent to the accreditation group to verify that was acceptable. The response was “no”, that the IFU had to be followed unless we had a letter from the manufacturer modifying the IFU. We are now in the process of working with manufacturers to obtain letters modifying their IFUs to practices that better align with workflows. 

Results: Gaps in following the cleaning and disinfection steps in IFUs were identified and resolved, or if not able to fit into the workflow the manufacturer is being contacted to outline acceptable alternative steps.

Lessons Learned: Obtain the IFU and review it in detail prior to purchasing a product and work with the vendor and manufacturer to resolve any concerns about the IFU.

Issue: Two consecutive years of a high rate of healthcare associated infection (HAIs) leading to increased health care cost and negative patient outcomes.

Project: A collaborative approach among infection prevention, quality and operations was critical in understanding and addressing our problem. Providing ongoing data analysis was necessary for operations teams to support the necessary changes. Daily audits were conducted by quality to collect information and provide bundle adherence data. Daily discussions with physicians and clinicians and nursing staff on use of indwelling devices was completed through care coordination rounds. Tactics used included the encouragement of alternative use for and prompt removal of devices. The external catheter was introduced as an alternative solution to the indwelling foley catheter. Physicians and clinicians were educated on the Clostridioides difficile (C-Diff) testing algorithm and daily surveillance continues to help avoid hospital-acquired C-Diff. Furthermore, an interdisciplinary team meets for Daily Engagement System huddles and one day per week is devoted to reviewing maintenance of CAUTI/CLABSI bundles and C-Diff testing. Each step outlined was critical to the success of achieving zero HAIs. After six months, the daily audits were reduced to weekly quality maintenance audits shared with department leaders. Infection prevention and quality departments continue to collaborate on efforts to mitigate infections. Team member and physician/clinician education is recurring.

Results: Our focus was engaging leaders early on, which elevated awareness of patient outcomes and implications caused by infections in the hospital. Providing knowledge and the “Why” behind the work resulted in improved patient outcomes. 

Froedtert Holy Family Memorial Hospital has more than 2 years without CLABSI, CAUTI & Healthcare-onset Clostridioides difficile Infections.

Lessons Learned: Evidence-based practice guidelines and algorithms standardized workflows providing informed discussions and decision-making around patient care, which required leadership engagement and support. Continued data collection and analysis involving staff engagement encouraged the utilization of practice guidelines. Instituting staff workflows resulted in sustained improvement.

The CDC Hospital Healthcare Infection Control Advisory Committee (HICPAC) is reviewing and updating the 2007 Transmission-basedPrecautions  guidelines to incorporate the latest science and lessons learned from the COVID-19 response. This presentation will provide an overview of the status and work of the CDC Isolation Work Group appointed by HICPAC with the goal to provide insight into potential guidelines change(s).This update is intended to prepare infection preventionists for the impact of guidelines revisions on current practice. 

Objectives:
 1. Identify the goals of the Isolation Work Group and guideline development process.
 2. Describe the structure and approach to the Transmission-Based Precautions Guidelines review and revisions.
 3. Communicate work group activities and status of guideline revision and approval.
 4. Discuss the potential impact on healthcare infection prevention and control programs.

Occupational / Employee Health programs designed to protect the healthcare workforce begin with prevention but must also include recognizing situations where exposure may or have occurred and ensuring there is a rapid response process. This session will provide case scenarios and take  learners through algorithmic responses. 

Objectives:
1. Discuss healthcare personnel illness reporting and its important role in the health and safety of healthcare personnel, patients, and communities
2. Using scenario-based learning, healthcare and patient care situations will be used to explore preventive and response actions germane to occupational/Employee Health programs
3.  Review specific disease algorithms outlining approaches that may be used in pre- and post exposure responses 

Abstract Presentations Group B

The meet the author session provides an opportunity for open dialogue with the authors to discuss the process of writing and presenting an abstract along with the focus of the abstract.

Join the zoom link to chat with the abstract presenters for: 

• Katelyn Harms - Got the I.T.C.H.? Instrument Transport, Cleaning and Handling - Sustained Compliance with Soiled Instrument Management on Inpatient Units
• Lydia Zabel - Capitalizing on Evidence-based Practice to Reduce the Three Cs (CAUTI, CLABSI & CDI)
• Valerie Thomas - Implementing a New Tool to Standardize and Monitor Exposure Investigations

It is highly recommended to view the abstract presentations, found in the abstract hall, prior to attending this session. 

Attendees will be asked to participate in a round table application of the EIPAC decision making framework based on current guidelines and research findings while navigating through competing values. Through applications of the EIPAC framework and its principles, it is hoped that infection preventionists will become more comfortable with ethics-based decision making. 

Breakout sessions

Check out the mock construction site. How many things can you find wrong? Are you familiar with the ICRA 2.0? Has the correct risk class been assigned to this project? Are the necessary barriers and precautions in place? What corrective actions need to be taken before they begin this project? 

Breakout session

Certification is just one of the phases of moving from novice to expert. There is an increased emphasis on credentialing and competency by key stakeholders along with an increasing focus on health care  infection (HAI) prevention. Considering the pressures of the current health care environment, have you been thinking about becoming certified?

Anna is certified in both CIC and LTC-CIP and will be able to talk about how the LTC-CIP focuses specifically on the knowledge base and practices directly relevant to long-term care. 

Homelessness in the United States is an urgent public health issue and humanitarian crisis. Nationally there is an increasing number of people experiencing homelessness, with a sharp rise in the percentage of older adults. Housing is a key social determinant of health. Lack of affordable housing 
limited shelter space exacerbates the issue. Most shelters are congregate settings with limited ventilation. Resources and capacity to serve this population are strained leaving more people unsheltered and exposed. Being homeless not only increases the risk for community based infectious and non-infectious diseases but also healthcare associated infections (HAIs). Patients experiencing homelessness are at a high risk of infection and often lack access to health care resources for the management of chronic infection. Learn about the challenges facing this vulnerable population and strategies to address their health care needs.    

Breakout sessions

Infection preventionists face unique challenges in the long-term care setting. Often the infection preventionist in the long-term care setting wears many hats and works alone. Plus, they assume the role of the infection preventionist with minimal training and have a long list of questions but limited access to recognized experts in the field. This is your opportunity to bring your questions and concerns to a nationally recognized expert.