2. Role of the Corporate Infection Preventionist in a Multi-Hospital System Maureen Spencer, RN, M.Ed., CIC Corporate Infection Preventionist Consultant Universal Health Services, a subsidiary of UHS of Delaware King of Prussia, PA www.workingtowardzero.com [Nothing to Disclose]

3. Universal Health Services 25 acute care facilities in  Wash DC, So Carolina, Florida, Oklahoma, Texas, Nevada, California A for-profit system with corporate offices in King of Prussia, PA Infection Prevention is in the Quality and Patient Safety Department

4. Corporate Infection Preventionist An emerging role for Infection Preventionist (IP) in multi-hospital systems Corporate Infection Preventionist is an adjunct to the facility IPs Provides consultative and educational services Analyze facility-wide HAI data Implement infection prevention measures and standardize practices, policies, IC Plans, risk assessments Standardize IP Job Descriptions and pay scales

5. Key Role: Networking and Consulting Due to the high workload of IPs today, it can prevent them from networking and attending local and national conferences They can feel isolated and lack a peer support group The Corporate Infection Preventionist serves as a facilitator to develop a cohesive relationship with Quality and Patient Safety at corporate office

6. Responsibilities Standardization of surveillance systems: UHS corporate dashboard and NHSN data analysis Development of educational programs: webinar, infection control training course and CIC prep course, annual infection prevention summit Facilitate communication with monthly IP teleconferences, frequent phone calls and consistent email communication Development and standardization of policies and procedures Collaboration with corporate Value Analysis Team on products Collaboration with corporate Process Improvement team Collaboration and participation with corporate Accreditation and Regulatory team on Full Book Surveys (evaluate continued readiness for TJC and CMS requirements) Consultation with Infection Preventionists, Quality Directors, OR Directors, Chief Nursing Officers, C Suite (CEO/COO/CMO/CFO) and medical staff in the development of a structured national infection prevention program

7. Webinar Topics 2011-2012  Overview of Rapid Molecular Technology and Cost Effective Outcomes  Working Toward Zero SSIs: “7 S Bundle”  Overview of Dialysis and IC Issues  Overview of Sterilization and Disinfection  Overview of Antiseptics  Statistics and Epidemiology: Beyond the 2 x 2 Table  Overview of MRSA and Prevention Measures  Overview of C. difficile and Prevention Measures  2013 NHSN and UHS Requirements for Surveillance

8. Continued Readiness: TJC and CMS Corporate Infection Preventionist participates in monthly Full Book Surveys where both The Joint Commission (TJC) and CMS standards are reviewed at the selected hospital The team is comprised of IC, Quality, Risk Management, Environment of Care and Emergency Management, Medication Safety Officer, Facilities and Life Safety Surveys are completed over a three day period for preparation of the facility

9. Standards CMS: Condition of Participation for Infection Control –CFR 482.42 (a)(1), (b)(1), etc –Medicare standards – TAG A-0747 - 0756 Joint Commission Standards National Patient Safety Goals

10. A Picture Speaks Louder Than Words  Photos of deficiencies are prepared in a PowerPoint presentation  Photos illustrate the citations in the final report  Allows the IP and other managerial staff to use the presentation in staff meetings to correct deficiencies and educate staff

11. Serve as a Resource for the Infection Preventionists The Joint Commission (TJC) Association for Professionals in Infection Control and Epidemiology (APIC) Centers for Disease Control (CDC) National Health and Safety Network (NHSN) Centers for Medicaid and Medicare Services (CMS) HICPAC, EPA, FDA, AAMI, ASHE, AII, IHI, AORN

12. How To Keep Up With New Knowledge? Resources for Daily Research: www.infectioncontroltoday.com www.sciencedaily.comwww.sciencedaily.com (health – daily update) www.hpnonline.comwww.hpnonline.com (daily update) www.apic.org www.ajicjournal.org/ http://www.cdc.gov/Other/emailupdates/ www.cdc.gov/hai/ www.jointcommission.org www.shea-online.org www.sentri7.com www.pharmacyonesource.com

13. How To Keep Up With New Knowledge? Association of Perioperative Registered Nurses www.aorn.orgwww.aorn.org Association for the Advancement of Medical Instrumentation www.aami.org American Institute of Architects - www.aia.orgwww.aia.org Quality Net http://www.qualitynet.orghttp://www.qualitynet.org Federal Drug Administration www.fda.gov/MedicalDeviceswww.fda.gov/MedicalDevices PubMed http://www.ncbi.nlm.nih.gov/pubmed/http://www.ncbi.nlm.nih.gov/pubmed/ Morbidity&Mortality Weekly Report http://www.cdc.gov/mmwr/http://www.cdc.gov/mmwr/ IDSA http://www.idsociety.org/IDSA_Practice_Guidelines/http://www.idsociety.org/IDSA_Practice_Guidelines/

14. Facility Unit-Based Champions (UBC)for Infection Prevention Unit Based Champion are selected to collaborate with the Infection Preventionist Nursing Units, Environmental Services, Microbiology Lab, Surgical Services, Emergency Department, etc. The IP decides the team membership based on needs of facility Distribute educational materials on a routine basis for reinforcement that is shared at staff meetings: newsletters, slides, eBug Bytes, new policies or practice change Conduct observational studies (“secret shoppers”) for compliance with hand hygiene and prevention measures (ex: environmental cleaning, assessment of HAI bundles, precaution technique) IPs assist the UBC in preparing abstracts and posters and submit to national conferences to highlight team work, projects, etc. IP analyzes data and shares results with appropriate committees

15. Unit Based Champions Infection Prevention eBug Bytes April 2013

16. Western NY Infection Rates The overall surgical-site infection rate in upstate New York declined 7.9 percent, from 2.14 per 100 procedures in 2008 to 1.97 per 100 procedures in 2011. Statewide, the infection rate decreased 3.2 percent, from 2.17 infections per 100 procedures to 2.10 infections per 100 procedures. Each year, surgical-site infection rates in upstate New York hospitals as a whole were lower, compared with statewide infection rates. The largest rate of decline - 32.9 percent - over the period examined for surgery-related infections occurred in Finger Lakes hospitals. The rate increased the most - 10.8 percent - in Central New York. Central line-associated bloodstream infections decreased in all upstate regions, and the rate was lower as a whole upstate compared with the statewide rate. In upstate New York, the central-line infection rate dropped 45.9 percent, from 2.07 infections per 1,000 days to 1.12 per 1,000 days. It declined 42.4 percent statewide, from 2.38 infections per 1,000 days to 1.37 per 1,000 days. Experts say that such simple steps as using checklists and ensuring employees, including doctors, wash their hands before touching a patient will lead to improvements..

17. Chinese told to change eating habits as H7N9 fatalities rise China asked its citizens to avoid contact with live poultry as it tries to stem a H7N9 bird flu outbreak whose death toll rose to seven today, with a further 17 people infected in three eastern provinces and Shanghai. Consumers should avoid markets where poultry are butchered as authorities increase monitoring for the new influenza strain, Feng Zijian, head of emergency response at the Chinese Center for Disease Control and Prevention, said in Beijing today. A vaccine is being prepared in case the virus starts spreading from human to human, health officials said. "Consumers should no longer pursue the kind of eating habits where they buy fresh chickens that are butchered on the spot," Feng told reporters at a briefing held jointly with the World Health Organization. "Stalls and markets in cities where live poultry is being butchered need to be closely monitored as possible venues of infection.“ Shares in Shanghai and Taiwan fell on concern that infections may become more widespread, with airlines leading the slump after trading resumed today following a two-day holiday. The H7N9 infections tally rose to 24 after Chinese authorities reported three more cases today.

19. PowerPoint Presentations for UBC  Implementing AORN Recommended Practices for Surgical Attire, 2012  Prevention of Catheter Associated Urinary Tract Infections  Prevention of Central Line Infections  Prevention of Ventilator Associated Pneumonia  Safe Needle and Medication Handling Practices  Top 10 ways to prevent infection in 2013

20. Corporate IP surveys and issues evaluated 2011-2012 MRSA Screening Immediate Use Steam Sterilization Privacy curtains changing policy and disposable curtain evaluation Procedures for handling Cidex OPA Endoscopy cleaning and reprocessing CT Scan Contrast Procedures Laryngoscope Disinfection Surgical Attire Policy VAP Prevention Bundle CLABSI Bundle: standardized central line insertion tray Alcohol cap protectors for injection port CAUTI Prevention Bundle – IC tray Biological Waste Management C.difficile and PCR, Precautions, Disinfection State reporting and new regulations Mandatory Flu Vaccinations Safe Medication and Injection Practices Employee Vaccines and Titers Reprocessing of Medical Devices Standardization of Germicidal Cloths Microfiber cloths and mops SSI Prevention Bundle Central Supply Service – biological indicator logs, flash logs, manufacturers recommendations Dialysis procedures and equipment disinfection

21. Risk Assessments Medication safety evaluation: handling of single use and multi-dose vials, USP ‘797’, contrast media preparation Reprocessing of medical equipment: operating room, CSS, endoscopy, radiology, labor and delivery, dialysis, wound care, ambulatory surgery Carbapenem-resistant Enterobacteriaceae (CRE) and infection prevention measures

22. Corporate Senior Data Analyst hired in 2012 Manages the analysis of HAIs entered into NHSN Provides consultation to facilities and IPs Conducts webinars and teleconferences for training Trains new IPs in data systems and HAI dashboard

23. Standardization of HAI Surveillance Surveillance definitions – use of algorithms Standardized methodology for corporate dashboard and entry of cases in NHSN UHS electronic medical record (Cerner) Implementation and IC module Healthcare acquired conditions (HACs) versus NHSN defined HAIs

25. Next Step: Calculate SIR by HAI by facility and compare to national data from NHSN

26. Reduction in Healthcare Acquired Infections with corporate initiatives and standardization of practices, products, procedures 2011 - 2012

27. Healthcare Acquired Infections2011- 2012 % Reduction UHS 2012 Benchmark Rate Infection Prevention Measures in Process Catheter Associated UTI (rate per Foley days) 57% 2.0Infection Control Foley Catheter Tray and Silver Foley Catheter, CHG washcloths CLABSI (rate by catheter days) 54% 0.0Central Line Insertion Kits, Alcohol Caps for Injection Hub Protection, CHG washcloths, Central Line Checklist VAP (rate by ventilator days)11% 0.0CHG rinse with oral care kits, VAP bundle checklist, CHG washcloths, nebulizer cleaning procedures, VAP rounds CABG SSI (overall rate by surgical procedures) 71% 0.0MRSA screening before surgery, CHG preop showers/cloths, Incisional sealants, CHG/alcohol skin prep Total Hip (overall rate by surgical procedures) 15% 0.0MRSA screening before surgery, CHG preop showers/cloths, Incisional sealants, CHG/alcohol skin prep Total Knee (overall rate by surgical procedures) 50% 0.0MRSA screening before surgery, CHG preop showers/cloths, Incisional sealants, CHG/alcohol skin prep C.Difficile (rate per 10,000 patient days) 12% 4.0/10,000 patient daysBleach wipes and bleach disinfectant solution, Rapid PCR Diagnostics for Early Diagnosis and Precautions, Enhanced environmental cleaning, cubicle curtain changes, room decontamination units for high rates MRSA (rate per 1,000 patient days) 62% 0.4CHG Washcloths, Pre-admission and Pre-op Screening, Rapid PCR Diagnostics for Early Diagnosis and Precautions

28. 2013 Initiative 7 “S” Bundle to Prevent SSI www.7sbundle.com S AFETY IN THE OPERATING ROOM S CREEN – FOR RISK FACTORS, PRESENCE OF MRSA & MSSA S KIN PREP WITH ALCOHOL BASED SKIN PREPS (CHLORHEXIDINE AND 70% ALCOHOL - IODOPHOR AND ALCOHOL) S HOWERS – PRE-OP WITH CHLORHEXIDINE SOLUTION OR BATH CLOTHS S OLUTION TO POLLUTION IS DILUTION CHLORHEXIDINE INCISION IRRIGATION (0.05%) S UTURES – ANTIMICROBIAL (WITH TRICLOSAN) S KIN CLOSURE – TOPICAL SKIN ADHESIVES OR ANTIMICROBIAL DRESSINGS: (PHMB), SILVER, AMD

30. IT TAKES INSPIRATIONAL LEADERSHIP

31. Principles of Social Learning Theory Albert Bandura, PhD –Role Modeling (Unit Based Champions) –Self-Efficacy (Posters, abstracts, lectures) BF Skinner, PhD –Reinforcement (Consistent education, webinars, emails) –Contracting (Risk Assessments, IP Plans) –Reciprocity (Job Descriptions, IC Summit, IC Training and CIC Prep Course )

32. Conclusion Corporate team approach in a multi-hospital system is an excellent way to standardize practices, organize team work, provide expert consultation, survey hospitals in a systematic manner and provide inspirational leadership Monthly teleconferences and webinars enhance communication and education Annual training summit creates a cohesive group, networking and commitment to the infection prevention program Onsite surveys allow the corporate office to evaluate compliance with evidence based practices and local and national standards and regulations The Corporate IP Consultant position, under the umbrella of Quality and Patient Safety, is an excellent resource for large multi-hospital systems to reduce healthcare acquired infections.

33. THANK YOU