Zero Tolerance: The ICP, TSICP, and APIC Sue Sebazco, RN, BS, CIC Infection Prevention/Employee Health Director Arlington, TX

Objectives 1.Recognize the value TSICP and APIC provide for the individual ICP. 2. Discuss the strategic role members of TSICP and APIC contribute to infection prevention and control systems that promote zero tolerance and safe patient care.

Zero Tolerance What is aiming for “zero”? Where did it come from?

Infection Control in 1972 Profession the result of Staphylococcus aureus pandemic of the 1950’s The first ICPs Early Infection Control Programs

The ICP in 1980 Knowledge and Abilities Understand nursing procedures Isolation technique Aseptic technique Use of pt care equipment Adequate decontamination, disinfection, sterilization Hospital Infection Control Principles and Practices, Mary Castle 1980

The ICP in 1980 Knowledge and Abilities Microbiology Infectious diseases Epidemiology Administration and Supervision Environmental sciences Hospital Infection Control Principles and Practices, Mary Castle 1980

APIC FUTURES SUMMIT – 2004 What Happened? More than 50 experts from across the continuum of healthcare, APIC leaders, and industry partners convened.

APIC FUTURES SUMMIT – 2004 The Future of Healthcare “Every 30 or 40 years, something comes along that completely redefines everything about healthcare.” – Jeffrey Bauer: Healthcare Futurist

APIC FUTURES SUMMIT – 2004 Top Healthcare Trends  Molecular medicine  Digital information technology  Diversity of society  Globalization of commerce  Emergence of new diseases  Rising consumer expectations

APIC FUTURES SUMMIT – 2004 Top Healthcare Trends  Proliferation of payment systems  Unfunded mandates/political gridlock  Shift from surgical to Rx interventions  Alternative medicine  Increasing violence as a public health problem  Increasing gap between haves and have nots

APIC FUTURES SUMMIT – 2004 Top Healthcare Trends Wild Cards  Economic instability  Natural disaster  Science for evil as well as good

FUTURES SUMMIT THEMES What Could Change the World as We Know It? Existing & Emerging Threats Infection Prevention in the Changing Dynamics of Healthcare The Future of Infection Prevention & Control

APIC FUTURES SUMMIT – 2004 Infection Prevention in the Changing Dynamics of Healthcare “Infection control professionals are complicit in boxing themselves in because they still spend an enormous amount of time in the records room and in retrospective data analysis. Some people are comfortable with that, but it is unconscionable.” –Ken Segel, Pittsburgh Regional Healthcare Initiative

APIC FUTURES SUMMIT – 2004 Infection Prevention in the Changing Dynamics of Healthcare “A lot of data collection and massaging, which have been a traditional role of ICPs, can be safely and better done by computers. This would allow ICPs to focus on more value-added activities, which would improve the entire healthcare process.” – Clay Dunagan, MD, VP. Quality, BJC Healthcare

APIC FUTURES SUMMIT – 2004 Infection Prevention in the Changing Dynamics of Healthcare “It is important to look at the leadership component of infection control. We must transcend the discipline of infection control to embrace the entire organization. It is the leader’s job to make sure that happens.” – Clay Dunagan, MD, VP. Quality, BJC Healthcare;

APIC FUTURES SUMMIT – 2004 The Future of Infection Prevention & Control  Technology is revolutionizing surveillance.  Increasingly care is being delivered outside of acute care and outside of ICUs, yet that is where we focus most of our surveillance and prevention activities. We must adapt. – Denise Cardo, MD, Director, DHQP, CDC; Georgian Ellis, VP. Operations, Shands Healthcare

APIC FUTURES SUMMIT – 2004 The Future of Infection Prevention & Control “We must deemphasize benchmarking. Being better than a bad benchmark is not the same as being good.” – Denise Cardo, MD, Director, DHQP, CDC

APIC FUTURES SUMMIT 2004 Key Themes  Prevention is the message  Promote zero tolerance for HAIs and other adverse events  Technology is the enabler

APIC’S PREFERRED FUTURE By 2012, APIC will be recognized as the leader in infection prevention and control by practitioners, policy makers, healthcare executives and consumers.

APIC Futures Summit Complete the business case for infection prevention ICPs as partners in profitability with hospital financial leaders

APIC Futures Summit “The fact is most hospitals don’t understand the costliness of infections The costs of these preventable infections in both human and economic terms are staggering.” Richard Shannon, MD Chair Dept of Medicine Allegheny General Hospital Pittsburgh

APIC Futures Summit “Professionals in infection prevention must learn the business of health care—and preventing infection and adverse outcomes for those who entrust us with their lives and the lives of their loved ones is our core business.” Denise Murphy, RN, BSN, MPH, CIC VP of Safety and Quality Barnes Jewish Hospital St Louis

APIC Futures Summit Participatory Management at all levels of the patient care experience Reciprocal Responsibility Incorporating infection prevention into each task

TSICP Board convened in January A new image ? A new name to better reflect the changing focus of our profession Update means of communication Revise the fundamental and intermediate courses

TSICP Education for Texas ICPs on mandatroy reporting Developing strategic goals for the next 5 years Creating our future

APIC VISION 2012 Goal #1: Zero Tolerance APIC will emphasize prevention and promote zero tolerance for healthcare-associated infections and other adverse events.

APIC Vision 2012 Goal #1 APIC activities: Protect Our Patients Visitor Education Program Monthly Heroes Press release Promotion of IHI Hand Hygiene Tool Kit Grand Rounds in Infection Prevention Free Webinars –best practice

TSICP Advisory Panel Interventionist

Putting Goal # 1 into Your Practice ICPs are Patient Safety Advocates “Prevention is Primary” (CDC) Interventionist

Putting Goal #1 into Your Practice Go and Observe Investigate in Real Time (RCA) Rick Shannon, MD

APIC VISION 2012 Goal #2: Setting the Standard APIC will ensure that appropriate standards are set by which infection prevention and control programs are evaluated by regulatory agencies, healthcare executives, payers and others.

APIC Vision 2012 Goal #2 APIC activities: Economics of Infection Prevention Futures Summit NQF development of standardized measures for reporting Tool kit Cultivate relationships

TSICP Cultivate relationships “Texas-specific” infection prevention and control needs Education on mandatory reporting

Putting Goal # 2 into Your Practice Become active in legislative issues Develop a rapport with leaders within your organizations Demonstrate cost effectiveness of the Infection Prevention and Control Program by building the business model

APIC VISION 2012 Goal #3: A Separate & Distinct Profession Infection prevention and control will be recognized as a separate and distinct profession, whose members are positioned for leadership roles in healthcare.

APIC Vision 2012 Goal #3 APIC activities: Business case for infection prevention and control Salary and reporting structure survey

TSICP Fundamental and Intermediate courses Annual conference that addresses current issues for the ICP in Texas

Putting Goal # 3 into Your Practice Develop a plan to acquire the skills to become a leader within your organization

Putting Goal #3 into Your Practice “You have to learn how to learn how to learn.” Thomas Friedman, columnist, C-Span interview 2005

APIC VISION 2012 Goal #4: A Catalyst for Leading Edge Research APIC will serve as a catalyst for leading edge research for the prevention of infection and associated adverse outcomes.

APIC Vision 2012 Goal #4 APIC activities: Comparison of data sources for reporting HAIs Prevalence Study Small grants

TSICP Approach the legislature with evidence- based practices to support our position on an issue

Putting Goal # 4 into Your Practice Establish and/or participate in an internal research committee that determines evidence-based practice

APIC VISION 2012 Goal #5: Leadership Role in Emergency Preparedness APIC will play a leadership role in emergency preparedness related to infection prevention and control including emerging and reemerging diseases, bioterrorism, natural disasters and other issues.

APIC Vision 2012 Goal #5 APIC activities: Participation in Coalition on Pandemic Preparedness Participation in Congressional Hearing on Pandemic Preparedness CDC/APIC e-learning modules

TSICP Emergency planning in Texas Drills

Putting Goal # 5 into Your Practice Participation in emergency preparedness at the local, state, federal level as well as worldwide.

APIC Futures Summit “Professionals in infection prevention must learn the business of health care—and preventing infection and adverse outcomes for those who entrust us with their lives and the lives of their loved ones is our core business.” Denise Murphy, RN, BSN, MPH, CIC VP of Safety and Quality Barnes Jewish Hospital St Louis

APIC FUTURES SUMMIT – 2004 Infection Prevention in the Changing Dynamics of Healthcare  ICPs’ core competence should be the creation and oversight of learning systems that are necessary for sustainable and constant improvement. – Clay Dunagan, MD, VP. Quality, BJC Healthcare;

Collaboration across the Continuum Model for success—Siouxland Screen for VRE Dynamic health department infrastructure Task force efforts

The Infection Prevention Professional Interventionist Collect data Analyze data Introduce intervention Measure success

Interventional Infection Prevention and Control Education and performance improvement* on CVC-BSI Before InterventionAfter Intervention * Revised hospital policy, standardized catheter insertion technique, site care & infection prevention interventions Eggiman P, et al. Lancet 2000;355:1864-8

Infection Prevention Professional Role Patient safety advocate Healthcare worker safety advocate

Zero Tolerance Relationships Collaboration Networking Compromise

Objectives 1.Recognize the value TSICP and APIC provide for the individual ICP. 2. Discuss the strategic role members of TSICP and APIC contribute to infection prevention and control systems that promote zero tolerance and safe patient care.

“Delivering safe patient care is not convenient” Sir Liam Donaldson Chief Medical Officer, UK Chair, WHO World Alliance for Patient Safety August 2005