To assist in eliminating preventable hospitals-acquired infections, the N.C. Center for Hospital Quality and Patient Safety is developing a confidential, peer-review privileged database for the voluntary submission of infection measures. This initiative is also being supported by the Statewide Program for Infection Control and Epidemiology (SPICE). The NC Infection Reporting Workgroup was established as the advisory group for the NC System for Hospital Infections Measurement to determine the initial measures and the process for data collection. The Workgroup consists of Drs. Campione and Koeble (NC Quality Center), Kathy Cochran (Pitt Memorial Hospital), Evelyn Cook (DICON), Scott Whisnant (New Hanover Regional), Karen Hoffmann (SPICE), Dr. Jim Lederer (Novant Health System), and Dr. Jeff Engel (NC State Epidemiologist).
The objectives of the infections measurement system are:
- To estimate a N.C. rate of compliance with evidence based processes of care to prevent HAIs.
- To identify opportunities for the Quality Center and its partners to assist hospitals in preventing HAIs.
- To investigate and pioneer national infection rate definitions for consistency and accuracy.
- To prepare hospitals for potential public reporting of infection rates.
- To provide to hospitals information on best practices and to stimulate quality improvement
Phase One will include hospital voluntary reporting of these measures:
- Ventilator Process Measures / Bundle Compliance
- Central Line Insertion Process Measures / Bundle Compliance
- Central Line-Associated Bloodstream Infection Rate by ICU
Hospitals will electronically submit monthly statistics per quarter to the Quality Center's confidential, secure and peer-privileged infection measurement system. Future measures may include surgical site infection rates and MRSA rates.
When will hospitals start reporting?
In mid-July, six pilot hospitals will begin to test the database. They are also assisting the Quality Center by reviewing the tools
and the manuals for each measure. All hospitals in the state will be requested to sign a participation form by the end of the summer
with data submissions starting in mid-November for any of the 3rd quarter 2008 months.
Why should hospitals submit infection measures to the Quality Center?
- To receive confidential feedback that provides each hospital an opportunity to compare performance against benchmarks that will help guide a hospital's ongoing efforts to prevent HAIs.
- To be part of a standardization of surveillance methodology that yields reliable and accurate data.
We hope that all North Carolina infection control practitioners share our excitement in this proactive endeavor that will provide the necessary information to NC infection experts and hospital infection prevention leaders in determining where improvement is needed in fighting HAIs. We believe that if all hospitals participate in this database that this measurement system will provide reliable, useful information that is often not found in public reporting of hospital-level infection rates.
For more information or to comment, please contact Joanne Campione, PhD (jcampione@ncha.org) or Carol Koeble, MD (ckoeble@ncha.org).
APIC-NC has established a new scholarship for an APIC-NC member taking the certification review course. It is named for Eva Clontz, long-time SPICE Program Coordinator, in gratitude for her many years of service. The recipient will be expected attend the course within one year of receiving the award. The next review is scheduled for August 22, 2008.
The APIC-NC Board would like to express their gratitude to Eva Clontz for whom this Scholarship is named for her many years of service to APIC-NC.
Who is eligible: Any APIC-NC member who is currently seeking certification or re-certification in infection control and meets CBIC eligibility requirements for re-certification.
Application for scholarship and registration for CBIC review course can be downloaded from the SPICE website (scroll down to CBIC review course): www.unc.edu/depts/spice/apicnc.html
The following announcement comes from UNC News Services, 2/13/08 :
Every year, millions of people are infected with noroviruses - commonly called “stomach flu” – often resulting in up to 72 hours of vomiting and diarrhea. While most people recover in a few days, the symptoms can lead to dehydration and - in rare cases, especially among the elderly and infants - death.
Now, researchers at the University of North Carolina School of Public Health have discovered that the virus mutates genetically, similar to the virus that causes influenza. And, like flu, a vaccine could be possible.
“One of the mysteries of medicine has been why do they keep infecting people when you'd think we'd be developing immunity,” said Lisa Lindesmith, one of the lead authors of the study, “Mechanisms of GII.4 Norovirus Persistence in Human Populations,” published today in the online medical journal PLoS Medicine. “What we've found is that the GII.4 arm [of the noroviruses] keeps changing. Whenever we're seeing big outbreaks of norovirus, we're also seeing genetic changes in the virus.”
Noroviruses are the leading cause of viral acute gastroenteritis. They are highly contagious, often causing epidemic outbreaks in families and communities, on cruise ships, in hospitals and in assisted living facilities. The viruses are especially hard on the elderly – in 2006, 19 deaths were associated with norovirus acute gastroenteritis in long-term care facilities in the United States. Often, infection can mean many miserable hours, with time lost from work, school and other activities. There is no treatment to stop the infection.
Read the entire news release: http://uncnews.unc.edu/news/health-and-medicine/vaccine-for-stomach-flu-may-be-possible-unc-research-shows.html
PLoS Medicine is available at: www.plosmedicine.org
The following announcement comes from UNC News Services, 3/14/08 :
A new tuberculosis vaccine successfully tested at the University of North Carolina at Chapel Hill is easier to administer and store and just as effective as one commonly used worldwide.
Scientists at the UNC School of Pharmacy led by Tony Hickey, Ph.D., vetted a dry powder vaccine provided by Harvard University that is administered using an inhaler. The results of the vaccine test are being published this week in the Proceedings of the National Academy of Sciences.
“It is at least as good as the injectable vaccine,” said Hickey, a professor in the School's molecular pharmaceutics division. “The real advantage is that this vaccine does not need to be refrigerated. It also doesn't require needles, syringes and water like the injectable vaccine, and administering it is as easy as breathing in, making it ideal for use in developing countries.”
Read the entire news release:
http://uncnews.unc.edu/news/health-and-medicine/unc-harvard-develop-inhaled-tb-vaccine.html
The California Department of Education has translated the “Parent's Guide to
MRSA” booklet into 16 different languages. The title of the guide is: “A Parent's Guide to MRSA in California : What You Need to Know” includes information for parents regarding methicillin-resistant Staphylococcus aureus (MRSA).
The translations are available on the following page:
http://inet2.cde.ca.gov/cmd/translatedparentaldoc.aspx?docid=883-914
Languages include Arabic, Chinese, Farsi, German, Hebrew, Japanese, Khmer, Korean, Lao, Tagalog, Portuguese (Brazilian and continental), Russian, Spanish, and Vietnamese.
The following three announcements are taken from February 2008 Safety Share newsletter, Premier, Inc.
Diseases are spread by poor coughing and sneezing techniques. Most people put their hands in front of their mouths and noses to stop germs from getting into the air. Unfortunately, this technique puts the germs on their hands. The germs are then spread to telephones and doorknobs and many other surfaces, where the next user then acquires. This five-minute video was designed by three Maine hospitals to encourage people to cough and sneeze according to the infection control guidelines put forth by the Centers for Disease Control and Prevention (CDC). It is aimed at the common citizen. The message is serious, but it is presented with humor in such a way that it engages the viewer's attention for a full five minutes while the message is repeated in interesting new ways. The DVD, "Why Don't We Do It in Our Sleeves?" can be previewed at http://video.google.com/videoplay?docid=-8574515984097771637&q=ben+lounsbury and ordered at http://coughsafe.com .
A new website has been set up focusing on HAI's and related subjects. Included are definitions, tracking methods, prevention guidelines and links to CMS HAI Conditions, CDC guidelines, safety culture, hand hygiene, bundling, and SCIP.
URL: http://www.premierinc.com/quality-safety/tools-services/safety/topics/HAI/index.jsp
For complete article, see: http://www.premierinc.com/quality-safety/tools-services/safety/safety-share/02-08-full-txt.jsp#story-01"
A recent study found that daily cleaning of patients in a medical intensive care unit with chlorhexidine gluconate (CHG) impregnated cloths compared to soap and water baths was effective in reducing the rate of primary bloodstream infections (BSI). This clinical trial was a 52-week, two-arm, crossover design in a 22-bed medical intensive care unit (MICU), which is comprised of two geographically separate, similar 11-bed units of a public teaching hospital in Chicago . The study population included 836 MICU patients. During the first of two study periods (28 weeks), one hospital unit was randomly selected to serve as the intervention unit in which patients were bathed daily with 2 percent CHG-impregnated washcloths (Sage 2 percent CHG cloths; Sage Products Inc, Cary, IL); patients in the concurrent control unit were bathed daily with soap and water. After a two-week washout period at the end of the first period, cleansing methods were crossed over for 24 more weeks.
Patients in the CHG intervention arm were significantly less likely to acquire a primary BSI (4.1 versus 10.4 infections per 1,000 patient days; incidence difference, 6.3 [95% confidence interval, 1.2-11.0]). The incidences of other infections, including clinical sepsis, were similar between the units. Protection against primary BSI by CHG cleansing was found to be apparent after five or more days in the MICU.
Compared with soap and water, CHG cleaning resulted in a persistent, several log reduction in the density of microbial skin colonization, representing a low microbial load. This 12-month clinical trial, bathing MICU patients daily with a no rinse, 2 percent CHG-impregnated cloth, resulted in a 61 percent relative decline in the incidence of primary BSIs. The researchers note that primary BSIs were reduced by improving a required, routine patient care activity (i.e., patient bathing) without introduction of additional actions.
Downloads and links
- See Premier's Safety Share, April 2006, " Antimicrobial skin bathing reduces colonization from resistant organisms "
- Premier's Safety Institute; see Bundling intervention Web site
The following announcement is taken from the February 28, 2008 , edition of The Infection Control Monitor:
Following the lead of other organizations, including the University of Pennsylvania, the Washington State Hospital Association (WSHA) has seen a 35% improvement in hand hygiene compliance by asking its member hospitals to track hand sanitizer and soap use by counting discarded bottles, says Carol Wagner, RN, MBA, vice president of patient safety for the Seattle-based association.
The program began in 2005 when the association went looking for an evidence-based hand hygiene program and found it in the "Safe Table," a WSHA-sponsored forum where representatives from hospitals of all sizes gather to share best practices.
To learn more about how the bottle drive works in hospitals, go to www.hcpro.com/content/205425.cfm . The cost is $10.
A slide set that educates on proper injection practices is available on the CDC website. It was prepared in conjunction with an educational conference call on March 27. Specifically, these areas are covered:
1) Describe safe injection and other basic infection control practices, and be able to recognize and correct unsafe practices
2) Understand the need for monitoring healthcare personnel practices in your facility relating to injection safety and basic infection control
3) Describe the potential consequences of syringe reuse and other unsafe practices
4) Locate related CDC infection control guidance and educational materials
PowerPoint slides are available here: http://www.emergency.cdc.gov/coca/callinfo.asp
For a current list of FDA-cleared high-level disinfectants and chemical sterilants, please access http://www.fda.gov/cdrh/ode/germlab.html
RECOGNITIONS:
Congratulations to Johnsie Hubble of Chatham Hospital who passed the CBIC exam!
Contributors to Report of the Month: Karen K. Hoffmann, RN, MS, CIC; William A. Rutala, PhD, MPH; David J. Weber, MD, MPH; Eva P. Clontz, MEd, Debby Pyatt, BA
To subscribe to the Report of the Month, send email to spice@unc.edu
Report of the Month is also available on the home page of the Statewide Program for Infection Control and Epidemiology at http://www.unc.edu/depts/spice/.
The Statewide Program for Infection Control and Epidemiology (SPICE) is funded by the General Assembly of North Carolina to serve the State. The SPICE is not a regulatory agency but provides education and consultation to North Carolina healthcare facilities.
Copyright 2008 Statewide Infection Control Program
