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April 27, 2011

Quality and Patient Safety Lunch and Learn VUMC Department of Infection Control and Prevention: Who We Are & What We Do. April 27, 2011. Healthcare Epidemiology/ Infection Control.

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April 27, 2011

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  1. Quality and Patient Safety Lunch and LearnVUMC Department of Infection Control and Prevention: Who We Are & What We Do April 27, 2011

  2. Healthcare Epidemiology/Infection Control • Focuses on a variety of disciplines and activities directed at preventing and controlling infections and adverse outcomes and enhancing the quality-of-care: • Surveillance • Epidemiologic and laboratory investigation • Risk reduction programs • Policy development and implementation • Education and information dissemination “Public health in the hospital”

  3. History: Infection Control Programs • 1959: AHA establishes advisory committee for nosocomial infection control • 1962: AHA publishes 1st monograph on hospital infections • 1969: JCAHO requires infection control committee & a “sanitary environment” • 1970: CDC establishes NNIS system (19  300 hospitals) • 1972: APIC founded • 1974: SENIC project • 1975: Half of US hospitals had IC programs/ICPs

  4. Infection surveillance and control programs strongly associated with: • Reduced UTI, SSI, pneumonia, BSI • Adjusted for hospital and pt characteristics • Essential components of program: • Organized surveillance - Trained MD • 1 ICP per 250 beds - System to report SSI rates to surgeons HAI with IC programs:  32% HAI without HAI programs  18% Haley RW et al Am J Epidemiol 1985;121:182-205

  5. History: Infection Control Programs • 1980: SHEA established • 1981: CDC Guidelines for Prevention and Control of Nosocomial Infections • 1981: CIC established • 1987: Infection control is one of key JCAHO “critical indicators” • 1992: HICPAC established • 1990s: Era of guidelines • 2000s: Era of QI • 2006: NNIS  NHSN system • 2008: CMS and nonpayment for HACs • 2011: HAIs added to IPPS

  6. Healthcare Epidemiology • Often paired with Infection Control & Prevention programs • MD Epidemiologist (usually ID certified) • Nurse specialists – Infection Preventionists • Database analysts • Collaboration with many groups

  7. Healthcare Facility =

  8. VUMC IC Structure Pre-2000 Hospital Epidemiologist Administrative Liaison IC Nursing Coordinator ICPs (2) Secretarial Support

  9. VUMC IC&P Structure: 2011 Chief Hospital Epidemiologist Administrative Liaison Associate Hospital Epidemiologists (2) VCH Hospital Epidemiologist IC Director Database Analysts (2) ICPs (8) Secretarial Support

  10. Evolution of IC Programs THEN NOW Cover multiple hospitals Chair IC Committee Develop policies Extinguish fires QI/Prevention focus Act as well as track Growing regulatory needs Prevent fires

  11. Evolution of HE THEN NOW Quality improvement Implementation science Leadership/management Communication skills Teamwork Negotiation Organizational behavior and group psychology • Surveillance and epidemiological principles • Outbreak investigation • Transmission and control of nosocomial infections • Disinfection and sterilization • Employee health

  12. IC&P: Who We Are • Vicki Brinsko RN CIC • Director • Yrs of IC Experience: 28; 25 years at VUMC • Member of HICPAC • Past President, Mid-TN APIC • APIC Chapter Legislative Representative

  13. IC&P: Who We Are • Kathie Wilkerson RN CIC • Yrs of IC Experience: 18 • Past President, Mid-TN APIC • CDC Blue Ribbon Abstract award at APIC 2005 • THA Safety Award Abstract 2005 • 33 years at VUMC • Jan Syzchowski RN CIC • Yrs of IC Experience: 18 • President, Mid-TN APIC • Past President Western KY APIC • Gold Medal winner poster presentation 2008 APIC International Conference

  14. IC&P: Who We Are • Tracy Louis RN MSN CIC • Yrs of IC Experience: 7 • Past President, Mid-TN APIC • Presented 3 posters at APIC • Lorrie Ingram RN BSN CIC • Yrs of IC Experience: 6 • Presented poster at APIC • Vast nursing experience

  15. IC&P: Who We Are • Amy Dzewior RN BSN • Yrs of IC Experience: 3 • APIC secretary Med-TN chapter • Presented poster at APIC 2010 • Beth Hodge MS RN • Yrs of IC Experience: 1 • Co-authored poster for APIC 2011 International Conference • Featured in “Do No Harm” conference in May 2011

  16. IC&P: Who We Are • Jackie Smith RN MSN • Yrs of IC Experience: 3 • IPC for MCJCHV • Tanya Boswell RN MSN • Yrs of IC Experience: 1.5 • IPC for MCJCHV

  17. IC&P: Who We Are • Brian Nelsen BGS CISSP • Data analyst and IC&P software developer • Gale Woodland BBA • Newest member of IC&P Team • Focus on analysis/trends

  18. IC&P: Who We Are • Peggy Connolly Administrative Assistant • 25 years in IC&P and at VUMC • Jonelle Williams - Chart abstraction and assitant to IPCs • I year with IC&P

  19. IC&P: Who We Are • Tom Talbot MD MPH • Yrs of IC Experience: 10 • Member, HICPAC • Chair, SHEA Education Cmtee • William Schaffner MD • Assoc Hosp Epidemiologist • Chief Hosp Epidemiologist for 32 years • Yrs of IC Experience: 45 • Past President, SHEA • Secretary, IDSA • President, NFID

  20. IC&P: Who We Are • Titus Daniels MD MPH • Assoc Hosp Epidemiologist • Chair, Health Records Exec Cmtee • Co-Director, Vanderbilt Antibiotic Stewardship Program (VASP) • Yrs of IC Experience: 6 • APIC Annual Conf Cmtee • Greg Wilson MD • MCJCHV Hosp Epidemiologist • Yrs of IC Experience: 4

  21. IC&P: Who We Are • Jim Johnson MD MPH • Yrs of IC Experience: 1 • Joining team as Associate Hosp Epidemiologist at VUMC • Williamson Medical Center Hospital Epidemiologist starting July 2011 • Fellows: • Jennie Esbenshade MD • James Crowe MD • Kyle Widmer MD

  22. A Day with the Infection Preventionist’s Beeper

  23. 8:19am Monday • The Chairman of Surgery calls you wanting to know the “infection rate” for the surgeons in his department for a presentation he is giving to the unit. • No worry . . . He needs the data before tomorrow at 6am.

  24. Role of Healthcare Epidemiology I: Surveillance • Tracking outcomes in a regular, standardized manner to assess for trends • The cornerstone of healthcare epidemiology • How do you know you have a problem w/o data?

  25. The Problem: Healthcare Associated Infections Central Line-Associated Bloodstream Infections Ventilator-Associated Pneumonia Cather-Associated Urinary Tract Infections Surgical Site Infections

  26. Surveillance • Routine collection of data • Utilize standardized definitions for cases • Utilize common denominator populations • Allows for assessment and comparison of rates • e.g. Bloodstream infection rates patients with a central venous catheter – BSI per 1000 central line days

  27. 9:45am Monday • You receive an email from the Director of Infection Control & Prevention asking you to review the institution’s current policy on isolation of patients with suspected or confirmed contagious infections.

  28. Role of Healthcare Epidemiology II: Prevent Transmission of Infections • Many patients may be infected with or colonized with contagious infections • These may be spread by direct contact with the patient or their environment or through the air • Must minimize transmission of such pathogens

  29. CDC Transmission-Based Precautions

  30. 10:30am Monday • Meeting with the Central Line Bloodstream Infection Task Force

  31. Role of Healthcare Epidemiology III: Prevention Initiatives • Develop and implement programs that are designed to prevent infections using evidenced-based practices • Synergize skills with those of QCs • Collaborate w/key stakeholders • Make sure have representation of frontline AND leadership • Decide how you’ll measure the impact BEFORE implementing the measure

  32. 11:07am Monday • A reporter from the Tennessean contacts you after the release of the first state report on healthcare-associated infection rates. • She wants a comment as to why your hospital has a higher rate of surgical site infection in cardiac surgical patients than other hospitals in the city. “Why are you guys so bad?”

  33. Role of Healthcare Epidemiology IV: Communicating a Message/Education • May be within the hospital • May be outside of the hospital • Key = simplifying the message

  34. Nosickfolks Hospital The Lowest Infection Rates in TN!!! (Much Lower Than Vanderbilt)

  35. 1:07pm Monday • Nurse from an inpatient unit contacts one of the infection control nurses re: 3 patients in the hospital who developed bloodstream infections with a highly resistant strain of Acinetobacter baumannii. She’s wants to know if you think there is an outbreak in the ICUs.

  36. Function of Healthcare Epidemiology V: Outbreak Investigation • Identify increased incidence of events above the baseline rate • ? How many cases = “increased” • Create a case definition • Find all potential cases • Save isolates • Determine if cases related • Identify risk factors • Implement control measures

  37. Are the Strains Related? Pt A Pt B All isolates clonally the same Pt C Both isolates clonally the same Pt E Pt D Pt F Saline Flush Pulse-Field Gel Electrophoresis

  38. 2:53pm Monday • Notified by pediatric unit that 3 yr old diagnosed with pertussis (whooping cough). Pt was not placed in isolation on arrival and has been here for 4 days.

  39. Function of Healthcare Epidemiology VI: Contagious Disease Exposures • Confirm exposure event occurred • Identify exposed patients and healthcare workers • Evaluate need for post-exposure prophylaxis

  40. 4:03pm Monday • Called by an ED attending physician • Just examined a 38yr-old corporate lawyer for Saturn who presented with 5 days of progressive cough, malaise, and fatigue. • PE: febrile, hypoxic, Ill-appearing

  41. 4:03pm Monday • At the end of your conversation, the MD recalls that the patient stated he felt “great” before leaving for China 10 days ago. • Pt had been touring areas of China to investigate prospective new factory location for his work. Enjoyed walking through the markets, where there were plenty of chickens loose. Illness began 1 day prior to return.

  42. Function of Healthcare Epidemiology VII: Biopreparedness

  43. Function of Healthcare Epidemiology VII: Biopreparedness • Work with EP, leadership • Develop of institutional plans • Personal protection • Patient screening • Adequate supplies • Surge issues • Prioritization for limited resources • Development of stockpiles • Tabletop and real-time drills

  44. 7:23pm Monday • OR Administrator calls you frantic • Pt underwent brain biopsy last Thursday • Pathology compatible with vCJD (“Mad Cow Disease”) • Instruments used in case were sterilized through normal processes • [Which won’t kill the pathogen] • Have been reused since Friday morning

  45. Function of Healthcare Epidemiology VIII: Crisis Management • Selected VUMC IC&P Calls : • De facto OR in Cosmetic Surgery Clinic • This being used as surgical scrub  • Dirty bronch used on pt • VZV exposure in 7N, psych hospital • VU undergraduate with meningitis • State reporting data on CLABSI

  46. Key Code for IC&P “Speak” • IPC= Infection Prevention Consultant • CIC= Certified in Infection Control; this exam must be taken every 5 years to maintain certification • HICPAC= Health Infection Control Practices Advisory Committee; federal advisory committee made up of 14 infection control experts; serve a 3 year term.

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