role of the infection control and prevention program in ... · role of the infection control and...

Role of the Infection Control and

Prevention Program in Antimicrobial Stewardship

Kate Tyner, RN, BSN, CICNebraska ASAP and ICAP

“Science is neat, but I’m afraid it’s not very forgiving.”

Mr. Clarke, Stranger Things

Objective

Attendees will describe the role of the infection control and prevention program in antimicrobial stewardship.

No disclosures to report

Classic role of infection prevention in reducing the demand for antimicrobial agents by:

• Preventing infections from occurring in the first place

• Make every effort to prevent transmission when infections do occur

Manning, M.L., et al. Antimicrobial stewardship and infection prevention- leveraging the synergy: A position paper update. American Journal of Infection Control 46 (2018) 364-8

Image: Flickr, National Library of Medicine

New hospital pressure: TJC Standard MM.09.01.01

The hospital has an antimicrobial stewardship multidisciplinary team that includes the following members, when available in the setting:

- Infectious disease physician

- Infection preventionist(s)

- Pharmacist(s)

- Practitioner

https://www.jointcommission.org/assets/1/6/AdHoc_HAP_ABX_R3_20160822.pdf

https://www.jointcommission.org/assets/1/6/AdHoc_HAP_ABX_R3_20160822.pdf

New long-term care pressure: TJC Standard MM.09.01.01The organization has an antimicrobial stewardship multidisciplinary team that includes the following

members, when available in the setting:

- Infectious disease physician

- Infection preventionist(s)

- Pharmacist(s)

- Practitioner

https://www.jointcommission.org/assets/1/6/AdHoc_NCC_ABX_R3_20160822.pdf

https://www.jointcommission.org/assets/1/6/AdHoc_NCC_ABX_R3_20160822.pdf

The Butterfly Effect

Image: Goodfreephotos.com

Antibiotic stewardship programs, when implemented alongside infection control measures, are more effective than implementation of antibiotic stewardship alone.

Co-implementation with Hand Hygiene Interventions

Antibiotic Stewardship Alone

66% reduction in antibiotic resistance 17% reduction in antibiotic resistance

Baur, D. et al. Effect of antibiotic stewardship on the incidence of infection and colonization with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis. Lancet Infect Dis 2017; 17: 990-1001

CDC Core Element IPC Synergistic Activity

Leadership Commitment

IPC and ASP program leaders work to align programs. Reduce redundancy. Seize opportunity to benefit from shared expertise. Partner when making the case for resource allocation.

Accountability Lend support for strong, empowered leadership at the front-line of healthcare .

Drug expertise Pursue basic training specific to facility-type. Engage with the expert, whether they are on-site or remote.

Action Influence and facilitate nursing role in initiation of antibiotic time-out, medication reconciliation during care transition, and patient education about safe antibiotic use.

Tracking Surveillance for emerging pathogens and resistance patterns. Rapid response to transmission.

Reporting Provide feedback of infection rates and audit data.

Education Single, consistent message delivery to healthcare providers about preventing infection and reducing MDRO

Adapted from Manning, M.L., et al. Antimicrobial stewardship and infection prevention- leveraging the synergy: 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 antibiotic stewardship is well defined.

• Most respondents indicated that they spend on average 5-10 hours per month on stewardship activities

“To ensure role clarity and prevent Infection Prevention and 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 leaders perspectives on infection preventionist and registered nurse engagement in antibiotic stewardship. American Journal of Infection Control 46 (2018) 498 -502.

Perceptions of IPC leaders toward IP and bedside RN ASP knowledge, engagement and education

StronglyAgree

The bedside RN role in antibiotic stewardship is well defined

11%

When a patient has a positive culture, the bedside RN can distinguish infection and colonization

11%

Bedside RNs know how to interpret microbiology culture reports

21%

Action: Influence and support the nursing role in antimicrobial stewardship


Action: Influence and support the nursing role in antimicrobial stewardship

Perceptions of IPC leaders toward IP and bedside RN ASP knowledge, engagement and education

Strongly Agree

IPs provide AS education and training to bedside RNs

15%

When a patient has a positive culture, IPs can distinguish colonization and contamination

89%

IPs know how to interpret microbiology culture reports

100%


Surveillance

• Essential first step in identifying priority areas for managing antimicrobial use.

• Tracking patients who are found by routine cultures with:

• New colonization • Infection

• Measured per 100 admissions or 1000 patient days

• Minimum: MRSA, VRE, and C. difficile

APIC Text, 4th edition. Chapter 26 “Antimicrobials and Resistance.” Forest W. Arnold

Wikimedia commons

Agricultural Research Service

Intake procedures

Identify potentially infectious people at the time of admission. Infectious status and isolation needs are obtained from transferring facilities

Surveillance plan

Notification of IPC

Alerts to frontline

Computer alerts to identify previously

infected and colonized patients

Plan outlines the activities of monitoring and tracking infection

A system is in place to notify the infection control and prevention team/ coordinator when antibiotic-resistant organisms or C. difficile are reported by a clinical laboratory

Rapid Response to Transmission

Tracking & Reporting

Surveillance

Identification, Isolation/Communication, and Containment

MDRO Tracking and Response

Audience participation:

True or False?

The recognition of the presence of multi-drug resistant organisms in a facility (for example: CRE or VRSA) is the sole accountability of the medical laboratory scientists and the prescribers.

Banach, D., et al. Duration of Contact Precautions for Acute-Care Settings. ICHE, Feb 2018, Vol. 39, No. 2

Strategy for use of Contact Precautions in acute care

Contact Precautions in Long Term Care Settings?Adopt a person-centered approach: “only when necessary and as long as necessary”

• Use transmission-based precautions, and discontinue when no longer needed, based on evidence-based best practices and facility policy.

• Do not over-isolate residents.

• Consider transmission-based precautions on a case-by-case basis as an indicator to “gown and glove up” when providing direct personal care.

• If the resident cannot maintain clean hands, clean clothes, and clean equipment

A Unit Guide To Infection Prevention for Long-Term Care Staff. Burdsdall, Schweon, Collier. AHRQ project contract number HHSA290201000025I, task order 8, from the Agency for Healthcare Research and Quality (AHRQ). March 2017

Menu of synergistic activity and partnership

Hand Hygiene

Personal Protective Equipment

Specific HAI prevention strategies (CA UTI, CL BSI, UTI/ASB)

Injection Safety

Prevention of Surgical Site Infection

Prevention of Clostridium difficile Infection (CDI)

Environmental Cleaning

Device Reprocessing

Respiratory Hygiene and Cough Etiquette

System to detect, prevent, and respond to HAI and MDRO

Adapted from CDC Infection Prevention and Control Assessment Tools for Acute Care and Long Term Care Facilities https://www.cdc.gov/hai/prevent/infection-control-assessment-tools.html

https://www.cdc.gov/hai/prevent/infection-control-assessment-tools.html

Training is provided to all healthcare personnel, including all ancillary personnel

Training is provided upon hire, prior to provision of care

Training is provided at least annually

Personnel are required to demonstrate competency

A defined process is used for practice audits

The frequency of audit performance is defined

A process is defined for improvement when non-adherence is observed

A process is defined for provision of feedback

The frequency of feedback provision to frontline staff is defined

Adapted from CDC Infection Prevention and Control Assessment Tools for Acute Care and Long Term Care Facilities https://www.cdc.gov/hai/prevent/infection-control-assessment-tools.html

Elements of implementation

https://www.cdc.gov/hai/prevent/infection-control-assessment-tools.html

Review published

guidelines for MRSA control

• Calfee, D.P., et al. Strategies to Prevent Methicillin-Resistant Staphylococcus aureus Transmission and Infection in Acute Care Hospitals: 2014 Update. Infection Control and Hospital Epidemiology. July 2014, Vol. 35, No.7

Institute Basic Practices

•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 program

Continue to monitor

MRSA rates

• Develop system to report to stakeholders

• Hold appropriate individuals accountable for implementing and complying with basic prevention measures

Calfee, D.P., et al. Strategies to Prevent Methicillin-Resistant Staphylococcus aureus Transmission and Infection in Acute CareHospitals: 2014 Update. Infection Control and Hospital Epidemiology. July 2014, Vol. 35, No.7

Image: Pixabay

Audience Participation:True or False?

Active surveillance testing for MRSA colonization should be a key programmatic strategy for all infection prevention programs that wish to reduce MRSA.

How?• Ensure you are using the most recent evidence and guidelines available when strategizing

about 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 for Clostridium difficile Infection. Clinical Infectious Diseases, April 2018:66.

• For example: Calfee, D.P., et al. Strategies to Prevent Methicillin-Resistant Staphylococcus aureus Transmission and Infection in Acute Care 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 alongside 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 resources from being stretched even thinner, these activities need to be identified, defined, quantified, and recognized

Questions?

Image: Max Pixel

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