Author Archives: Mary Kundus, RN, BSN, MPH, CIC

Jun 1, 2016

It’s Time for APIC 2016!

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It’s Time for APIC 2016!

It’s Time for APIC 2016! And it’s time to get inspired – the APIC 43rd Annual Conference is almost here! From June 11-13, the infection prevention community – some 5,000 strong – will gather in beautiful, historic Charlotte, North Carolina to share and take in the latest breakthroughs and best practices from around the world. This three-day event is filled with opportunities to listen, learn and recharge with some of the industry’s most innovative thought leaders on infection prevention and control. We’ll be there, and we wanted you to know about some of the highlights:

What to see at APIC 2016 Conference

Disinfection and Sterilization: The Good, the Bad, and the Ugly

Start this conference right with this plenary session featuring Dr. William Rutala, a professor in the Division of Infectious Diseases at the University of North Carolina School of Medicine. Dr. Rutala presents a “good” classification scheme, improved data, and new technologies; the “bad” noncompliance, with guidelines for reprocessing medical/ surgical devices; and the “ugly” endoscope reprocessing and infection risks that may expose patients. Don’t miss it!

Integrating Infection Prevention Control Programs into the Ambulatory Care Setting: An Evolving Model 

Get a quick dose of ambulatory care expertise in this 30-minute session with Faith Skeete of NYU Medical Center and Natalie Fucito of NYU Langone.

Duodenoscopy

Hear the latest on a procedure that presents formidable challenges in infection control, presented by Maroya Walters of the Centers for Disease Control and Prevention.

International Infection Prevention and Control (IPC) in Resource-Limited Settings

Here is a rare chance to attend a workshop on a globally vital topic, hosted by experts from the Liberian and Kenyan Ministries of Health as well as the Infection Control Africa Network and the US CDC.

Best Practices for High-Level Disinfection and Reprocessing Programs at Large Academic Health Institutions

Take the Emerging Science, Research, and Application track – this Concurrent Education session features the very latest information from experts from the Medical Center, Medical School and Health Department at the University of Minnesota.

Infection Prevention and Surveillance in Primary Care 

Explore the latest with officials from Thomas Jefferson University, Jefferson College of Nursing and the Hospital of the University of Pennsylvania.

What to see in 3M Medical booth 1503

This year we are focusing on two topics that we get a considerable amount of questions on:

Endoscope reprocessing

Cleaning endoscopes is critical because residual organic material can inactivate disinfectants, allowing potentially deadly bacteria to remain on the surfaces. Facilities that achieve the highest standard of care proactively monitor manual cleaning protocols for flexible endoscopes. Read how routine endoscope cleaning monitoring can contribute to a higher standard of care.

Reducing the risk of surgical site infections

Patient safety is a primary concern for the perioperative team. A lot of attention is focused on skin preps and ways to reduce the patient’s bacterial load. One method is to use a nasal antiseptic before surgery. Before the conference, read a summary of clinical evidence about the efficacy of nasal antiseptics.

These are just a few examples of what’s inspiring us at this year’s APIC conference. We look forward to seeing you!

Feb 25, 2016

Nosocomial Infection: Reduce the Risk of a Surgical Site Infection

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Nosocomial-Infections-Reduce-the-Risk-of-a-Surgical-Site-Infection

Ways to help reduce the risk of a nosocomial infection during surgery

Prevention of nosocomial infections is critical. These infections are more commonly known as healthcare-associated infections (HAIs).

Healthcare facilities and operating rooms are fast moving places with many things to keep track of. But, there are four principles that can help reduce the risk of spreading a HAI during surgery to always keep top of mind:

  1. Diligent hand hygiene. Hand hygiene should be practiced by everyone in a healthcare facility. Patients, visitors, and healthcare professionals should understand and practice the World Health Organization (WHO) Five Moments for Hand Hygiene. The perioperative team uses more specific guidelines from the Association of perioperative Registered Nurses (AORN). The periop team should know and remind each other when to practice hand antisepsis.
  2. Reduce Bacteria on the Patient. Bacteria from the skin are the leading cause of surgical site infections. Microorganisms such as Staphylococcus aureus and Methicillin-resistant Staphylococcus aureus (MRSA) are serious threats that can cost a hospital as much as $60,000.1 The skin cannot be sterilized, but by using a surgical skin prep and an incise drape, a sterile operating field can be created. Evidence now suggests bacteria from the patient’s own nares can contribute to surgical site infections (SSIs). Clinical evidence demonstrates that using a nasal antiseptic helps reduce the risk of SSI when part of a comprehensive preoperative protocol.
  3. Maintain normothermia. Operating rooms are typically cold and patients are often exposed. Maintenance of normothermia is important to help reduce the risk of SSIs.2-5 Even a 1.6°C decrease in body temperature can produce inadvertent perioperative hypothermia.6-7 Forced-air warming is a technology that has been proven safe and effective for over 25 years. Maintaining normothermia is one of the easiest, least expensive, and most effective benefits you can offer to patients.
  4. Mitigate cross-contamination. In a clinical study, 77% of reusable ECG leadwires were found to be contaminated with antibiotic-resistant nosocomial pathogens even after being cleaned.8 This is one reason to use disposable leadwires. Disposable leadwires can also remain with the patient even while they are being transported.

Prevention and reduction of HAIs are a priority for the U.S. Department of Health and Human Services (HHS).

For more information on the HHS plan, visit the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination. There is no one way to stop HAIs, prevention relies on people. By practicing proper protocols and looking out for the patient, we can all work together to improve infection rates.

1 Anderson DJ, Kaye KS, Chen LF, et al. Clinical and financial outcomes due to methicillin resistant Staphylococcus aureus surgical site infection: a multi-center matched outcomes study. PLoS ONE. 2009; 4(12): doi: 10.1371/journal.pone.0008305
2Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med. 1996;334:1209-15.
3 Melling AC, Ali B, Scott EM, Leaper DJ. Effects of preoperative warming on the incidence of wound infection after clean surgery: A randomized controlled trial. Lancet. 2001;358:876-880.
4 Barie PS. Surgical site infections: epidemiology and prevention. Surg Infect. 2002;3:S9-S21.
5 Seamon, M.J., et. al. The effects of intraoperative hypothermia on surgical site infection: An analysis of 524 trauma laparotomies. Ann of Surg. 2012;255(4)
6 Sessler DI. Current concepts: mild perioperative hypothermia. N Engl J Med. 1997; 336:1730-1737.
7 Barie PS. Surgical site infections: Epidemiology and prevention. Surg Infect. 2002; 3: S-9 – S-21.
8 Jancin, Bruce. Antibiotic-resistant pathogens found on 77% of ECG lead wires. Cardiology News. 2004;2(3):14.
Feb 12, 2016

If You Struggle With Sterile Processing, Then Read This

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Sterile processing department

Sterile processing is an important function that is vital to every health care facility. Sterile processing technicians need up-to-date, helpful information about standards, guidelines, and recommended practices. To make it easy for technicians to learn best practices, 3MSM  Health Care Academy created a full catalog of free self-study and live continuing education (CE) courses presented by technical experts. Here is a list of some of the most popular 1 hour sterile processing CE courses over the past 12 months.

Sterilization & Disinfection in an ASC Setting

Learning Objectives:

  • Identify the latest requirements and guidelines from accrediting organizations specifically relating to reprocessing of medical devices.
  • Describe key published standards and recommended practices for safe and effective reprocessing of reusable patient care items.
  • List available resources that can help an ASC comply with best practice related to reprocessing of reusable medical devices.

ST79 Essentials for ASCs

Learning Objectives:

  • Discuss AAMI ST79 and the need for the recommended practice.
  • Discuss the different types of steam sterilization processes and cycle parameters.
  • Describe the different types of sterilization monitoring devices, including PCDs.
  • Describe routine load release for implants and non-implants.

What a Gas: A Review of Today’s Low Temperature Sterilization Options

Learning Objectives:

  • List the low temperature sterilization technologies that are available in the industry today.
  • Describe how each of the low temperature sterilization technologies work.
  • Recognize the benefits and limitations of each low temperature sterilization technology.
  • Identify the factors to be considered for choosing a low temperature sterilization technology.

IUSS – Follow the Standards or Get Cited!

Learning Objectives:

  • Review the most current AORN and AAMI standards and recommended practices relating to IUSS.
  • Explain CMS’s Update of Survey and Certification Memorandum Regarding IUSS.
  • Identify The Joint Commissions’ standards related to IUSS.

Steam Sterilization Qualification and Troubleshooting: Process Failures and Wet Packs

Learning Objectives:

  • Discuss steam sterilization qualification testing.
  • Describe available tools to help guide an investigational process on sterilization process failures and wet pack/load assessment.
  • Identify common reasons for steam sterilization process failures and wet packs/loads.

Are you following me? A Surgical Instrument Tray Tracer

Learning Objectives:

  • Understand how tracer methodology applies to sterile processing.
  • Discuss how IFU’s, competencies and processes may be observed by surveyors.
  • Understand the importance of following manufacturers’ IFU.

Duodenoscopes: Are Current Reprocessing Guidelines Adequate?

Learning Objectives:

  • Explain why duodenoscope reprocessing is currently under scrutiny.
  • Summarize the clinical literature describing outbreaks following exposure to duodenoscopes.
  • Discuss the reprocessing challenges that are unique to duodenoscopes.
  • Outline available and proposed options for improving duodenoscope reprocessing.

The Nuts and Bolts of Washers and Disinfectors

Learning Objectives:

  • Describe the steps in a washer/disinfector cycle and the purpose of each step
  • Discuss thermal disinfection and the A0 concept
  • Review means to optimize the effectiveness of your washer/disinfector
  • Identify potential root causes of washer / disinfector monitoring failures

The Science of Speed – The Evolution of Biological Indicators

Learning Objectives:

  • Describe the design and function of biological indicators
  • Discuss how biological indicator incubation time is determined
  • Understand how rapid readout biological indicators work

Sterile Processing in the ASC Environment – Are you ready for a survey?

Learning Objectives:

  • Identify sterile processing standards and guidelines relevant to the ambulatory surgery setting.
  • Describe best practices for instrument processing in the ambulatory surgery setting.
  • Develop a check off list to determine readiness for an accreditation survey.

Need more sterile processing CE learning? View the full course catalog.

Oct 13, 2015

Nosocomial Infections: Important Facts to Know

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Nosocomial infections, according to the World Health Organization (WHO), are “infections  acquired in hospital by a patient who was admitted for a reason other than that infection.”These infections are otherwise known as healthcare-associated infections (HAIs). HAIs can happen during a patient’s hospitalization or after discharge. Organisms from HAIs can also affect healthcare personnel and visitors.

HAIs are dangerous. Based on the 2011 U.S. CDC HAI prevalence survey, they found:

On any given day, 1 in 25 hospital patients has at least 1 HAI

An estimated 722,000 HAIs occurred in U.S. acute care hospitals in 2011

75,000 hospital patients with HAIs died during their hospitalization

Using the 2011 Data, the U.S. CDC Estimates of HAIs Occurring in Acute Care Hospitals in the United States

Major Site of Infection                                                Estimated Number of Infections

Surgical site infections from any inpatient surgery                  157,500

Pneumonia                                                                         157,500

Gastrointestinal Illness                                                        123,100

Urinary Tract Infections                                                         93,300

Primary Bloodstream Infections                                             71,900

Other types of infections                                                       18,500

Estimated total number of infections in hospitals            721,800

Important facts about nosocomial infections

  • Surgical site infections (SSIs) and pneumonia are tied as the number one type of HAI.
  • Surgical site infections on average can add 7-10 postoperative hospital days.1
  • Ventilator-associated pneumonia can be spread from bacteria on hands that is transferred to ventilator equipment.
  • 77% of reusable ECG leadwires were found to be contaminated with antibiotic-resistant nosocomial pathogens even after being cleaned.2
  • The greatest risk factor for developing a catheter-associated urinary tract infection (CAUTI) is prolonged use of a urinary catheter.
  • About 37,000 central line-associated blood stream infections (CLABSIs) happen each year to kidney dialysis patients with central lines.

The U.S. CDC’s National Healthcare Safety Network (NHSN) is an initiative to track and monitor HAI rates and prevention progress. The January 2015 National and State Healthcare-associated Infections Progress Report (based on 2013 data) gives national and state-by-state information for HAIs. The update shows significant progress, but more work around patient safety and infection prevention is needed. This helpful CDC infographic, 6 Ways to Be a Safe Patient, will help patients better understand what they can do to protect themselves from infection.

For more information about diseases and organisms that can be found in healthcare facilities, visit the US CDC definition and information page.

1 Anderson DJ, et al. Strategies to prevent surgical site infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29:S51-S61
2 Jancin, Bruce. Antibiotic-resistant pathogens found on 77% of ECG lead wires. Cardiology News. 2004;2(3):14.
May 18, 2015

Outbreak and Pandemic Preparedness

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common flu virus

Common influenza virus

The recent Ebola outbreak has caused approximately 10,000 deaths, most of which occurred in West Africa1. For years, people have worried about the possibility of war to bring the next big catastrophe. But, serious attention needs to be focused on microbiological threats. Bill Gates’ gave a recent TED Talk about one of the greatest threats currently facing the world. Gates believes if anything were to kill over 10 million people in the next few decades, it will likely be a pandemic. Here are some of my notes on the video and topic:

More Preparation is Needed

A lot of work has been done, but more work is needed. When the recent Ebola outbreak began to claim lives in West Africa, those in power did their best to contain it. In spite of their efforts, the disease continued to spread. The problem wasn’t that the system used to contain Ebola wasn’t working, but rather that no effective outbreak containment system existed. Gates identified three key components of a containment system that were not present:

  1. Surveillance and Data – There was no team of epidemiologists ready to go investigate the illness when the recent outbreak first began. Some of the first case reports came in on paper and were inaccurate, which caused significant delays.
  2. Personnel – There was no medical team on standby to deal with the outbreak when it first began to take hold. It took far too long to get workers into the countries affected.
  3. Treatment – There was no protocol in place for investigating or developing treatments, which hindered the ability to stop the spread of the disease and help those who were infected.

Prevention is Key

Gates says, we don’t need to panic about the possibility of a future epidemic, but we do need to plan accordingly. Since there is no way of knowing what the next microbial threat will be, we must focus on prevention. Fortunately, we have the benefit of advanced technology to help us prepare for this unknown threat. But, we need an effective system for putting these tools to work.

To prepare for the next outbreak, a containment system similar to systems used to respond to other threats needs to be created. Components of this system could include:

  • More research. – More research into creating effective treatments is necessary in order to expedite the process when the next superbug or microbial outbreak appears.
  • Better medical care in poor countries. – Having better medical care in poor countries may allow for better identification and containment of viruses. More education and tools to support healthcare professionals.
  • A medical reserve corps. – A medical reserve corps is a good idea. A team trained and equipped to go in the event of an epidemic.
  • “Germ games” to identify deficiencies in the system. – These table top scenario based exercises are used to help prepare for threats.  ‘What if’ scenarios can help identify problems with the system.

All of these ideas work at a high-level but, how can we prepare in  our day-to-day life? Healthcare workers (HCW) in a variety of healthcare settings can practice effective infection prevention strategies such as adhering to proper hand hygiene, cleaning, and monitoring in an effort to prevent the spread of pathogens. Prevention is key, and HCWs are a fundamental part of prevention strategies.

Source:

1 http://apps.who.int/ebola/current-situation/ebola-situation-report-8-april-2015