Role Of The Infection Control And Prevention Program In .

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Role of the InfectionControl andPrevention Program inAntimicrobialStewardshipKate Tyner, RN, BSN, CICNebraska ASAP and ICAP

“Science is neat, but I’m afraid it’s not veryforgiving.”Mr. Clarke, Stranger Things

ObjectiveAttendees will describe the role of theinfection control and prevention program inantimicrobial stewardship.No disclosures to report

Classic role of infection preventionin reducing the demand forantimicrobial agents by: Preventing infectionsfrom occurring in thefirst place Make every effort toprevent transmissionwhen infections dooccurImage: Flickr, National Library of MedicineManning, M.L., et al. Antimicrobial stewardship and infectionprevention- leveraging the synergy: A position paper update.American Journal of Infection Control 46 (2018) 364-8

New hospital pressure:TJC Standard MM.09.01.01The hospital has an antimicrobial stewardshipmultidisciplinary team that includes the followingmembers, when available in the setting:- Infectious disease physician- Infection preventionist(s)- Pharmacist(s)- /1/6/AdHoc HAP ABX R3 20160822.pdf

New long-term care pressure:TJC Standard MM.09.01.01The organization has an antimicrobialstewardship multidisciplinary team that includesthe followingmembers, when available in the setting:- Infectious disease physician- Infection preventionist(s)- Pharmacist(s)- /1/6/AdHoc NCC ABX R3 20160822.pdf

Image: Goodfreephotos.comThe Butterfly EffectAntibiotic stewardship programs, when implementedalongside infection control measures, are more effectivethan implementation of antibiotic stewardship alone.Co-implementation with HandHygiene InterventionsAntibiotic Stewardship Alone66% reduction in antibiotic resistance17% reduction in antibiotic resistanceBaur, D. et al. Effect of antibiotic stewardship on the incidence of infection and colonization with antibiotic-resistantbacteria and Clostridium difficile infection: a systematic review and meta-analysis. Lancet Infect Dis 2017; 17: 9901001

CDC Core ElementIPC Synergistic ActivityLeadershipCommitmentIPC and ASP program leaders work to align programs. Reduceredundancy. Seize opportunity to benefit from shared expertise.Partner when making the case for resource allocation.AccountabilityLend support for strong, empowered leadership at the front-line ofhealthcare .Drug expertisePursue basic training specific to facility-type. Engage with the expert,whether they are on-site or remote.ActionInfluence and facilitate nursing role in initiation of antibiotic time-out,medication reconciliation during care transition, and patient educationabout safe antibiotic use.TrackingSurveillance for emerging pathogens and resistance patterns. Rapidresponse to transmission.ReportingProvide feedback of infection rates and audit data.EducationSingle, consistent message delivery to healthcare providers aboutpreventing infection and reducing MDROAdapted from Manning, M.L., et al. Antimicrobial stewardship and infection prevention- leveraging thesynergy: A position paper update. American Journal of Infection Control 46 (2018) 364-8

Perspective from the field Only 18% say that the IP role in antibioticstewardship is well defined. Most respondents indicated that they spend onaverage 5-10 hours per month on stewardshipactivities“To ensure role clarity and prevent Infection Preventionand Control resources from being stretched even thinner,these activities need to be identified, defined, quantified,and recognized.Manning, M. and Pogorzelska-Maziarz, M. Health care system leadersperspectives on infection preventionist and registered nurse engagement inantibiotic stewardship. American Journal of Infection Control 46 (2018) 498 502.

Action: Influence and support the nursingrole in antimicrobial stewardshipPerceptions of IPC leaders toward IP and bedsideRN ASP knowledge, engagement and educationThe bedside RN role in antibiotic stewardship is welldefinedWhen a patient has a positive culture, the bedsideRN can distinguish infection and colonizationBedside RNs know how to interpret microbiologyculture reportsManning, M. and Pogorzelska-Maziarz, M. Health care system leadersperspectives on infection preventionist and registered nurse engagement inantibiotic stewardship. American Journal of Infection Control 46 (2018) 498 502.StronglyAgree11%11%21%

Action: Influence and support the nursingrole in antimicrobial stewardshipPerceptions of IPC leaders toward IP and bedsideRN ASP knowledge, engagement and educationStronglyAgreeIPs provide AS education and training to bedsideRNsWhen a patient has a positive culture, IPs candistinguish colonization and contamination15%IPs know how to interpret microbiology culturereports100%Manning, M. and Pogorzelska-Maziarz, M. Health care system leadersperspectives on infection preventionist and registered nurse engagement inantibiotic stewardship. American Journal of Infection Control 46 (2018) 498 502.89%

CDC Core ElementIPC Synergistic ActivityLeadershipCommitmentIPC and ASP program leaders work to align programs. Reduceredundancy. Seize opportunity to benefit from shared expertise.Partner when making the case for resource allocation.AccountabilityLend support for strong, empowered leadership at the front-line ofhealthcare .Drug expertisePursue basic training specific to facility-type. Engage with the expert,whether they are on-site or remote.ActionInfluence and facilitate nursing role in initiation of antibiotic time-out,medication reconciliation during care transition, and patient educationabout safe antibiotic use.TrackingSurveillance for emerging pathogens and resistance patterns. Rapidresponse to transmission.ReportingProvide feedback of infection rates and audit data.EducationSingle, consistent message delivery to healthcare providers aboutpreventing infection and reducing MDROAdapted from Manning, M.L., et al. Antimicrobial stewardship and infection prevention- leveraging thesynergy: A position paper update. American Journal of Infection Control 46 (2018) 364-8

Surveillance Essential first step in identifyingpriority areas for managingantimicrobial use.Tracking patients who arefound by routine cultures with: New colonization InfectionMeasured per 100 admissionsor 1000 patient daysMinimum: MRSA, VRE, andC. difficileAPIC Text, 4th edition. Chapter 26 “Antimicrobials and Resistance.” Forest W. ArnoldWikimedia commonsAgricultural Research Service

IntakeproceduresPlan outlines the activities ofmonitoring and trackinginfectionSurveillanceplanNotificationof IPCComputer alerts toidentify previouslyinfected and colonizedpatientsIdentify potentially infectiouspeople at the time ofadmission. Infectious statusand isolation needs areobtained from transferringfacilitiesAlerts tofrontlineA system is in place to notify theinfection control and preventionteam/ coordinator whenantibiotic-resistant organisms orC. difficile are reported by aclinical laboratory

MDRO Tracking and ResponseSurveillanceTracking &ReportingRapidResponse toTransmissionIdentification, Isolation/Communication, and Containment

Audience participation:True or False?The recognition of the presence of multi-drug resistantorganisms in a facility (for example: CRE or VRSA) is thesole accountability of the medical laboratory scientists andthe prescribers.

Strategy for use of ContactPrecautions in acute careBanach, D., et al. Duration of Contact Precautions for Acute-Care Settings. ICHE, Feb 2018, Vol. 39, No. 2

Contact Precautions inLong Term Care Settings?Adopt a person-centered approach: “only when necessaryand as long as necessary” Use transmission-based precautions, anddiscontinue when no longer needed, based onevidence-based best practices and facility policy. Do not over-isolate residents. Consider transmission-based precautions on a caseby-case basis as an indicator to “gown and glove up”when providing direct personal care. If the resident cannot maintain clean hands, cleanclothes, and clean equipmentA Unit Guide To Infection Prevention for Long-Term Care Staff. Burdsdall, Schweon, Collier.AHRQ project contract number HHSA290201000025I, task order 8, from the Agency forHealthcare Research and Quality (AHRQ). March 2017

CDC Core ElementIPC Synergistic ActivityLeadershipCommitmentIPC and ASP program leaders work to align programs. Reduceredundancy. Seize opportunity to benefit from shared expertise.Partner when making the case for resource allocation.AccountabilityLend support for strong, empowered leadership at the front-line ofhealthcare .Drug expertisePursue basic training specific to facility-type. Engage with the expert,whether they are on-site or remote.ActionInfluence and facilitate nursing role in initiation of antibiotic time-out,medication reconciliation during care transition, and patient educationabout safe antibiotic use.TrackingSurveillance for emerging pathogens and resistance patterns. Rapidresponse to transmission.ReportingProvide feedback of infection rates and audit data.EducationSingle, consistent message delivery to healthcare providers aboutpreventing infection and reducing MDROAdapted from Manning, M.L., et al. Antimicrobial stewardship and infection prevention- leveraging thesynergy: A position paper update. American Journal of Infection Control 46 (2018) 364-8

Menu of synergistic activity andpartnershipHand HygienePersonal Protective EquipmentSpecific HAI prevention strategies (CA UTI, CL BSI, UTI/ASB)Injection SafetyPrevention of Surgical Site InfectionPrevention of Clostridium difficile Infection (CDI)Environmental CleaningDevice ReprocessingRespiratory Hygiene and Cough EtiquetteSystem to detect, prevent, and respond to HAI and MDROAdapted from CDC Infection Prevention and Control Assessment Tools for Acute Care and Long TermCare Facilities assessment-tools.html

Elements of implementationTraining is provided to all healthcare personnel, including allancillary personnelTraining is provided upon hire, prior to provision of careTraining is provided at least annuallyPersonnel are required to demonstrate competencyA defined process is used for practice auditsThe frequency of audit performance is definedA process is defined for improvement when non-adherence isobservedA process is defined for provision of feedbackThe frequency of feedback provision to frontline staff is definedAdapted from CDC Infection Prevention and Control Assessment Tools for Acute Care and Long TermCare Facilities assessment-tools.html

Reviewpublishedguidelines forMRSA control Calfee, D.P., et al. Strategies to Prevent MethicillinResistant Staphylococcus aureus Transmission andInfection in Acute Care Hospitals: 2014 Update.Infection Control and Hospital Epidemiology. July 2014,Vol. 35, No.7Institute BasicPractices Conduct MRSA risk assessment Educate healthcare personnel about MRSA Ensure compliance with HH recommendations Ensure proper cleaning and disinfection of environment Ensure compliance with contact precautions (colonized infected) Implement an MRSA monitoring programContinue tomonitorMRSA rates Develop system to report tostakeholders Hold appropriate individualsaccountable for implementingand complying with basicprevention measures

Calfee, D.P., et al. Strategies to Prevent MethicillinResistant Staphylococcus aureus Transmission andInfection in Acute CareHospitals: 2014 Update. Infection Control and HospitalEpidemiology. July 2014, Vol. 35, No.7Image: Pixabay

Audience Participation:True or False?Active surveillance testing for MRSA colonization shouldbe a key programmatic strategy for all infection preventionprograms that wish to reduce MRSA.

How? Ensure you are using the most recent evidence and guidelines available when strategizingabout infection prevention and control. Look for up-to-date guidance Branch out: try SHEA and IDSA guidance, as well as old favorites For example: McDonald, L.C., et al. Clinical Practice Guidelines forClostridium difficile Infection. Clinical Infectious Diseases, April 2018:66. For example: Calfee, D.P., et al. Strategies to Prevent MethicillinResistant Staphylococcus aureus Transmission and Infection in AcuteCare Hospitals: 2014 Update. Infection Control and Hospital Epidemiology.July 2014, Vol. 35, No.7 Connect with IP colleagues via professional societies APIC SHEA Continue your professional education Nebraska Infection Control Network Collaboratives Nebraska Hospital Association Great Plains Quality Innovation Network Nebraska ASAP

Summary Antibiotic stewardship programs, when implemented alongsideinfection control measures, are more effective than implementationof antibiotic stewardship alone. Recent guidance suggests specific, infection prevention synergisticactivities that relate to the CDC Core Elements of antibioticstewardship To ensure role clarity and prevent Infection Prevention and Controlresources from being stretched even thinner, these activities needto be identified, defined, quantified, and recognized

Questions?Image: Max Pixel

infection control measures, are more effective than implementation of antibiotic stewardship alone. Recent guidance suggests specific, infection prevention synergistic activities that relate to the CDC Core Elements of antibiotic stewardship To ensure role clarity and prevent Infection Prevention and Control

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