welcome to the gha infection prevention power hour june 19, 2014

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Welcome to the GHA Infection Prevention Power Hour June 19, 2014

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Page 1: Welcome to the GHA Infection Prevention Power Hour June 19, 2014

Welcome to the GHA Infection Prevention Power Hour

June 19, 2014

Page 2: Welcome to the GHA Infection Prevention Power Hour June 19, 2014

GHA HEN Update

GHA/HEN Hospitals Update– Spread of C diff , Sepsis, and Worker Safety– LEAPT hospitals have implemented Rapid Cycle Change with great

success– Update on SUSP Cohort 5 Recruitment– Educational Opportunities:

Enhancing Caregiver Resilience: Burnout & Quality Improvement GHA Education Center, Marietta July 29, 2014 Team STEPPS Training (Team Strategies & Tools to Enhance Performance and Patient Safety) June 24 – 26 UGA Tifton Conference Center

Page 3: Welcome to the GHA Infection Prevention Power Hour June 19, 2014

SHEA 2014 UPDATEShttp://www.jstor.org/stable/10.10.1086/675819

SHEA has begun to publish updates to its Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals.

The original guidance documents were published in 2008 and focused on six HAIs: – CAUTI, SSI, CDI, CLA-BSI, MRSA, VAP

Page 4: Welcome to the GHA Infection Prevention Power Hour June 19, 2014

SHEA 2014 Updates

The new compendium updates the original guidance and adds a seventh document focused entirely on hand hygiene.

Updated literature review and graded recommendation strategies broken into 2 tiers: basic practices for all hospitals and special approaches which may be used when basic strategies not effective.

Guidance documents, not guidelines

Page 5: Welcome to the GHA Infection Prevention Power Hour June 19, 2014

SHEA 2014 Updates

May issue of Infection Control and Hospital Epidemiology includes a description of the process used to develop the compendium along with the CA-UTI document

June issue includes the SSI and CDI prevention updates

Page 6: Welcome to the GHA Infection Prevention Power Hour June 19, 2014

SHEA 2014 Updates

Some recommendations have remained unchanged Some brief observations are warranted

– CA-UTI document contains a table addressing problem solving in the implementation of CA-UTI prevention strategies

– CDI prevention guidance adds to the basic strategies that appropriate use of antimicrobials is an important component of CDI control.

– SSI prevention expanded to include: maintenance of normothermia, optimization of tissue oxygenation, use of alcohol-containing skin preps, and use of WHO based checklists.

Page 7: Welcome to the GHA Infection Prevention Power Hour June 19, 2014

SHEA 2014 Updates

Implementation strategies around the Four E’s framework is included:– Engagement of key stakeholders– Education regarding the intervention– Intervention is Executed by Embedding it in standard

processes and finally,– Evaluated to determine its impact

Page 8: Welcome to the GHA Infection Prevention Power Hour June 19, 2014

Georgia Department of Public Health Updates

Public Health HAI Update– Georgia Healthcare Advisory Committee

Policy Statement C difficile testing

GMCF/QIO Update: NHSN Updates

Page 9: Welcome to the GHA Infection Prevention Power Hour June 19, 2014

Georgia Healthcare Associated Infections Advisory CommitteePolicy Statement: Laboratory Diagnosis of Clostridium difficile for Healthcare FacilitiesIssued: April 22, 2014

Introduction:

The dramatic rise in Clostridium difficile infections over the last 10 years, its spread into the community, and the clinical and economic impact this disease stimulated an intensive review of all facets of the disease including a critical analysis of laboratory testing to diagnose infection.

Guidelines and position statements have been issued by:

The American Academy of Pediatrics 1

The American College of Gastroenterology 2

The American Society for Microbiology 3

The Association for Professionals in Infection Control and Epidemiology 4

The Centers for Disease Control and Prevention 5, and

The Society for Healthcare Epidemiology of America 6

Page 10: Welcome to the GHA Infection Prevention Power Hour June 19, 2014

Recommendations: Based on strength of evidence, the Georgia Healthcare Associated Infections Advisory Committee makes the following recommendations for laboratory testing when Clostridium difficile is suspected.

1. The preferred testing method is nucleic acid amplification assay (includes polymerase chain reaction [PCR]).

2. An alternative testing method is a 2-step algorithm to detect common glucose dehydrogenase antigen (GDH) and Toxin A/B, with reflex to nucleic acid amplification assay for discrepant results.

3. Diagnostic tests that ONLY detect TOXINS by EIA should NOT be performed (sensitivity 63-94%, specificity 75-100%).

4. Diagnostic tests should be performed ONLY on unformed, diarrheal stool specimens, except in the setting of ileus caused by Clostridium difficile7

5. Repeat testing during the same episode of diarrhea is discouraged, particularly when a nucleic acid amplification assay is used.

6. Test of cure should NOT be performed as the assay may be positive after clinical cure

Page 11: Welcome to the GHA Infection Prevention Power Hour June 19, 2014

Recommendations (continued)

We encourage all healthcare facilities to have a written policy regarding laboratory diagnosis of Clostridium difficile. When possible, we encourage healthcare facilities to have a multidisciplinary committee to address all aspects of Clostridium difficile disease; at a minimum, this committee should include representation from infectious diseases, infection control, gastroenterology, microbiology, pharmacy, building management, and hospital administration. 1 Pediatrics (2013) 131: 196-200

2 Am J Gastroenterology (2013) 108:478-498

3 www.asm.org

4 www.apic.org/implementationguides

5 www.cdc.gov/hai/organisms/cdiff/cdiff_infect.html

6 Infection Control and Hospital Epidemiology (2013) 5: 431-455

7 Brecher S, et al. 2013. Clin Infect Dis. 8 :1175-81

Page 12: Welcome to the GHA Infection Prevention Power Hour June 19, 2014

QIO/GMCF Updates

NHSN Update– Lab ID Outliers

Page 13: Welcome to the GHA Infection Prevention Power Hour June 19, 2014

Questions / Sharing of Successful Strategies

CAUTI– American Journal of Infection Control: June 2014: Nurse-directed catheter

removal protocols to prevent catheter-associated urinary tract infection: Strategies for implementation: Joan N. Hebden MS, RN, CIC

CLABSI SSI

– Success in obtaining new denominator requirements

C difficile / MRSA Blood Physician Office Practice Infection Prevention Programs

– American Journal of Infection Control: June 2014: A pragmatic approach to

infection prevention and control guidelines in an ambulatory care setting

Page 14: Welcome to the GHA Infection Prevention Power Hour June 19, 2014

Thoughts / Suggestion Future Topics

Discussion by all

Page 15: Welcome to the GHA Infection Prevention Power Hour June 19, 2014

Contact Information

Jan Ratterree, RN, BSN, CIC

Georgia Hospital Association

770-249-4518 | [email protected].

Jeanne Negley, HAI Coordinator

Georgia Dept. of Public Health

(404) 657-2593 | [email protected].

Cindy Prosnak, RN, BSN, CIC

Alliant GMCF

706.836.8361 | [email protected].