3 9 T H A N N UA L E D U C AT I O N A L C O N F E R E N C E & I N T E R N AT I O N A L M E E T I N G

INFECTION PREVENTION:
Improving Outcomes, Saving Lives

Onsite Program
and Abstracts Book
www.apic.org/ac2012
APIC gratefully acknowledges
the following companies for their generous support of the
Annual Conference.

Platinum Sponsors

Gold Sponsors

Silver Sponsors

Bronze Sponsors

Contributors Best Practices Professionals, Inc. Oxford Immunotec Inc.

Centurion Medical Products Sanosil International
Diversey The Society for Healthcare Epidemiology
Draeger Smiths Medical
Jani-King International
 Welcome from the Chair
If you are reading this letter then you are already a member of the
choir or the cheering squad. You traveled either near or far to come
to San Antonio to join your peers in what will be an interesting,
engaging, and highly motivating three days. You figured out a way
to convince your facility that they could live without you for three
days because when you return, you will bring numerous new ideas
for improvement that will result in the prevention of infections and
many, many lives saved.
I had the honor of chairing this year’s APIC Annual Conference. I would like to salute my
co-chair, Karen Hoffmann, and the rest of the committee who have worked tirelessly and
endlessly over the past year to bring you a meaningful, practical, and memorable conference.
The theme of this year’s conference is “Infection Prevention: Improving Outcomes,
Saving Lives.” Have you ever paused to think about how many people are walking around
this earth, celebrating birthdays, attending graduations, and embracing life because of
what YOU do?
We often speak about the power of peer-to-peer learning and why it is the in-person
connection that energizes us and gives us the tools to try something new and implement
creative and innovative changes. We all know that while change does not necessarily
result in improvement, improvement can’t happen unless we change. We have science
that drives our practice but the key to success is understanding how to apply the science.
It is the “How-to’s” that we come to conference to learn. I guarantee that each of you will
leave APIC 2012 with multiple examples of how to apply the science that will impact the
patients you serve. Infection Prevention is all about Improving Outcomes and Saving
Lives. Sure feels good, doesn’t it?
Have a great conference, enjoy the beautiful city of San Antonio and all it has to offer,
and if you see me in the hallways, please stop and say hello.

Best regards,
Barb DeBaun, RN, MSN, CIC
Chair, 2012 Annual Conference Committee

2012 ANNUAL CONFERENCE COMMITTEE

Chair Kate Ellingson, PhD
Barb DeBaun, RN, MSN, CIC Michelle Farber, RN, CIC
Sally Hess, MPH, CIC
Vice-Chair Debra Johnson, BSN, RN, CIC
Karen Hoffmann, RN, MS, CIC, Lela Luper, RN, BS, CIC
Amy Richmond, RN, BSN, MHS, CIC
Members Diane Surdi, RN, BSN
Judie Bringhurst, RN, MSN, CIC Nancy Zanotti, RN, BSN, MPH, CIC
Vickie Brown, RN, MPH, CIC Mary Post, RN, MS, CNS, CIC
Titus Daniels, MD, MPH
 Table of Contents
What’s New ............................................5
Meetings-at-a-Glance ..............................7
Schedule-at-a-Glance ..............................9
2012 APIC Awards ................................13
General Conference Information..............14
Education Program Information ..............17
Exhibitor-Sponsored Symposia/Events ....53
Speaker Disclosures ..............................57
Acknowledgments..................................59
Session Tracking Form ..........................60

Continuing Education Credit

The Association for Professionals in Infection Control ACCENT® Continuing Education Credit
and Epidemiology, Inc. (APIC) is accredited as a The American Association for Clinical Chemistry, Inc.
provider of continuing nursing education by (AACC) designates this activity for ACCENT® credit
the American Nurses Credentialing Center’s hours. AACC is an approved provider of continuing
Commission on Accreditation (ANCC). education for clinical laboratory scientists licensed in,
but not limited to, the states of California, Florida,
Contact Hours Louisiana, Montana, Nevada, Noth Dakota, Rhode
One contact hour = 60 minutes. Island, and West Virginia.

APIC is approved for providing continuing nursing ACCENT® Activity No. will be provided; ACCENT®
education by the California Board of Nursing, provider Activity California No. will be provided and Florida
number CEP 7146. category ACCENT® Continuing Education Credit in
Clinical Chemistry/Toxicology; Supervisory/
Continuing Medical Laboratory Education (CMLE) QA/Administration/ QA/QC/Safety; Medical Errors;
This educational activity is recognized by the American Microbiology/Mycology/ Parasitology;
Society for Clinical Pathology as meeting the criteria for Serology/Immunology.
CMLE credit. ASCP CMLE credit hours are acceptable
to meet the continuing education requirement for the Requirements to Receive CE Contact Hours:
ASCP Board of Registry Certification Maintenance 1. Go to www.apic.org/ac2012 to log in.
Program. 2. Complete the Overall Conference Evaluation and
individual Session Evaluations for each of the
sessions that you attended.
3. Download your certificate and VOA transcript
once complete. 3
W H AT ’ S N E W
Science to Practice APIC Village
Reception and Awards An exciting area of the exhibit hall devoted
exclusively to APIC-related activities. Browse new
Ceremony APIC resources, view Film Festival entries, and
Please join us Tuesday, June 5 from 6:30-8:30 try a hands-on demo of the APIC ANYWHERE®
p.m. in Salons H-L of the Grand Ballroom at the Online Education Center. Other great
Marriott Rivercenter Hotel to celebrate our opportunities include:
research program and honor our 2012 scientific 䡲 Knowledge Bar – Have burning questions that
award winners. Space is limited so arrive early. need real answers? Use the Knowledge Bar to
meet one-on-one with clinical experts and get
those answers you’ve been waiting for.
More Science 䡲 Technology Lounge – Visit this area to find a
New this year—One full hour on Monday, June 4 willing and experience infection preventionist
dedicated to oral abstract presentations. Engage to serve as your mentor. You will also have the
in sharing the latest strategies for managing the chance to find out more about everything that
various issues faced by infection preventionists MyAPIC has to offer, as well as any new
and epidemiologists. technology-related initiatives.
䡲 Building Bridges Projects – Gain information
Education to Go about the free tools and resources launching
as part of the IP Col-lab-oration Project and
All conference attendees receive a
the Clean Spaces, Healthy Patients projects.
complimentary copy of the standard conference
proceedings which includes all applicable 䡲 Photo Booth – “Ham it up” for the camera and
educational sessions in webinar format. Share take home your conference souvenir photo.
this information with your co-workers so that they Sponsored by
too can benefit from the education at APIC
2012. This is made possible thanks to an
educational grant from Covidien. Be sure to stop
Exhibit Hall Raffle
by the Covidien booth #703 in the Exhibit Hall Stations
to pick up your copy. Sponsored by Win prizes just by scanning your badge at the
official APIC 2012 Exhibit Hall raffle stations.
Certification Matters APIC has placed two raffle stations at different
locations within the exhibit hall. Find them, scan
Every Day your badge, and you could win educational
APIC is launching its new campaign “Certification publications and fun prizes! Sponsored by
Matters Every Day” to celebrate all those who have
achieved or are seeking their CIC certification.
Look for daily events including a special CIC
Charging Station
Lounge at the Welcome Reception Sunday evening Need to charge your phone, ipad, tablet or other
featuring decadent desserts; on Wednesday mobile devices while onsite at the convention
during exhibit hall hours there will be moderated center? Don’t go back to your hotel room, just
round table discussions about certification. stop by the APIC 2012 Charging Station. You can
Sponsored by rest a few minutes while your device is charged.
Sponsored by
5
 *As of 5/5/12 subject to change

M E E T I N G S - AT- A - G L A N C E
MEETING TIME LOCATION ROOM (TENTATIVE)*
Sunday, June 3
APIC Research Council 9 a.m.-12 p.m. Marriott Rivercenter Room 2
Nominating & Awards Committee 10 a.m.-3 p.m. Marriott Rivercenter Room 6
Emergency Preparedness Committee 11 a.m.-1 p.m. Marriott Rivercenter Room 5
Section Meeting - Ambulatory Care 1-3 p.m. Marriott Rivercenter Grand Ballroom - Salon A
AJIC Editorial Meetings 1-5 p.m. Marriott Rivercenter Room 13-14
Public Policy Committee 1-5 p.m. Marriott Rivercenter Room 10
Practice Guidelines Committee 2-4 p.m. Marriott Rivercenter Room 5
Communications Committee 3-5 p.m. Marriott Rivercenter Room 4
Chapter Treasurers 3-4 p.m. Marriott Rivercenter Room 16
Professional Development Council 3-5 p.m. Marriott Rivercenter Room 8
Conference Orientation Session 3:30-4:30 p.m. Convention Center Room 214 AB
Monitor Training 4-4:30 p.m. Marriott Rivercenter Room 6
New Member Reception 4:30-5:30 p.m. Marriott Rivercenter Room 17-18
International Attendees’ Reception 4:30-5:30 p.m. Marriott Rivercenter Room 1-2
NHSN Hospital System 4:40-5:30 p.m. Convention Center Room 205
Welcome Reception 5:30-7 p.m. Marriott Rivercenter Grand Ballroom
Carole DeMille Award Winner Reception (invitation only) 8-9:30 p.m. Marriott Rivercenter Room 17-18
Monday, June 4
Partners in Leadership Reception (invitation only) 6-7 p.m. Marriott Rivercenter Room 1-2-3-4
Section Meeting - Behavioral Health 6-7:30 p.m. Marriott Rivercenter Room 13-14
Section Meeting - Pediatrics 6-7:30 p.m. Marriott Rivercenter Grand Ballroom - Salon D
Section Meeting - Long-Term Care 6-7:30 p.m. Marriott Rivercenter Salon AB
Tuesday, June 5
Exhibitor Meeting 9-10 a.m. Convention Center Room 209
Chapter Legislative Representatives 11 a.m.-1:15 p.m. Marriott Rivercenter Room 1-2-3-4
Past Presidents’ Luncheon (invitation only) 12-1:15 p.m. Marriott Rivercenter Room 13-14
Member Services Committee 1:45-3:15 p.m. Convention Center Room 209
APIC Business Meeting 4:30-6 p.m. Convention Center Room 205
Focus Group - Consultants 6-7:30 p.m. Marriott Rivercenter Room 3-4
Focus Group - Navy 6-7:30 p.m. Marriott Rivercenter Room 1
Focus Group - State Health Departments 6-7:30 p.m. Marriott Rivercenter Room 5
Focus Group - UHC Acute Care 6-7:30 p.m. Marriott Rivercenter Room 6
Capella Healthcare Group 6-7:30 p.m. Marriott Rivercenter Room 15
Section Meeting - Long-Term Acute Care 6-7:30 p.m. Marriott Rivercenter Room 16
Section Meeting - Minority Health & Safety 6-7:30 p.m. Marriott Rivercenter Room 17-18
Section Meeting - International 6-7:30 p.m. Marriott Rivercenter Room 12
Section Meeting - EMS & Public Safety 6-7:30 p.m. Marriott Rivercenter Room 9
Section Meeting - Home Care 6-7:30 p.m. Marriott Rivercenter Room 10
Section Meeting - VA 6-7:30 p.m. Marriott Rivercenter Grand Ballroom - Salon A-B
Science to Practice - Reception & Awards Ceremony 6:30-8:30 p.m. Marriott Rivercenter Grand Ballroom - Salon HIJKL
Wednesday, June 6
Heroes of Infection Prevention & VIP Breakfast (invitation only) 6:30-7:30 a.m. Marriott Rivercenter Grand Ballroom - Salon I-J
Education Committee 11:45 a.m.-1:15 p.m. Marriott Rivercenter Room 6
7
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S C H E D U L E - AT- A - G L A N C E
All events are located at the San Antonio Convention Center unless otherwise noted.
Sunday, June 3
3:30-4:30 p.m. Orientation Programs
International & New Attendees Orientation Room 214
4:30-5:30 p.m. New Member Reception Marriott Rivercenter: Room 17-18
4:30-5:30 p.m. International Attendee Reception Marriott Rivercenter: Room 1-2
5:30-7 p.m. Welcome Reception Marriott Rivercenter: Grand Ballroom
Monday, June 4
8 a.m.-5:30 p.m. Posters on Display Hall D
8-10:30 a.m. Opening Plenary Ballroom C
Opening Ceremony/President’s Address/Carole DeMille Award Presentation/Elaine Larson Lectureship
10:30 a.m.-1:30 p.m. Exhibit Hall Open (Coffee break 10:30 a.m.; Lunch served at 11:30 a.m.) Halls C-D
12:30-1:30 p.m. Poster Presentations Halls C-D
1:30-2:30 p.m. Oral Abstracts
Antimicrobial Resistance/Pathogens Room 214 CD
Blood Stream Room 217 A
Hand Hygiene Room 217 B
Infection Prevention Program Room 214 AB
Isolation & MDRO’s Room 217 C
Public Reporting/Public Policy Room 217 D
Special Populations Room 210
Surgical Site Infection Room 212
3-4 p.m. Concurrent Sessions
Brick by Brick: Building Ontario’s First Regional Hospital Infection
Surveillance System: Technology Enhances Patient Safety Room 214 CD
One Stick at a Time: A Toolkit for an Effective Healthcare Personnel
Immunization Program Room 217 A
How Do We Find Them and How Do We Keep Them: Recruitment and
Training of The New Infection Preventionist Room 217 B
CDC Outbreak Session 2012 Room 214 AB
Disinfection and Sterilization in Physician Practices and Specialty Clinics Room 217 C
Really, Are You Serious? Room 217 D
3-5:30 p.m. Workshops
Home is Where the Germs Are: Infection Prevention Surveillance in Home Care Room 008
Using the Joint Commission Infection Control Standards and NPSG 7 to Drive
Practice Change and Attain Adequate Resources: a Leadership Workshop Room 007
How to Report and Apply the NHSN SSI Definitions Ballroom C-3
Managing is More than Leading Room 006 AB
Utility Systems and Infection Prevention Implications for the Environment of Care Room 006 CD
4-4:30 p.m. COFFEE BREAK Tower View Lobby
4:30-5:30 p.m. Concurrent Sessions
Mandatory Reporting Of Healthcare Personnel (HCP) Influenza Vaccination Using
the National Healthcare Safety Network (NHSN) System Room 214 CD
The Infection Preventionist’s Role in Implementation Science: Examples From the Field Room 217 A
Elevating Your Teaching to a New Level: Becoming a Master Educator Room 217 B
Updated SHEA Guidelines for HIV or Hepatitis B Infected Workers Room 214 AB
The C-Suite Infection Preventionist Journey: Impacting Patient Safety, Community
Health, and Public Trust Room 217 C
Infection Prevention Community Response - Germs on Coats, Privacy Curtains Room 217 D
Tuesday, June 5
8-9 a.m. Concurrent Sessions
A Bundle Approach to Prevent CAUTIs Room 214 CD
It’s a Gas! Infection Prevention in Anesthesia Room 217 A
Peer Reviewed Publication: Why Not Me? Room 217 B
Talking to Patients: The Expanding Role of Infection Preventionists in Communicating 9
HAI Prevention Room 214 AB
SSI Prevention in Ambulatory Surgery Centers - A Collaborative Project AORN/APIC Room 217 C
2012AC_Onsite Pgm_BLK_PMS_PRESS_Layout 1 5/15/12 10:48 AM Page 10

S C H E D U L E - AT- A - G L A N C E
Tuesday, June 5 (continued)
8-9 a.m. Concurrent Sessions (continued)
Infection Preventionists Leading Change: Effects of Healthcare Reform on
Infection Prevention Room 217 D
8-10:30 a.m. Workshops
Infection Prevention Risk Assessment; the Starting Place for Your IP Program Room 007
NHSN - CAUTI Workshop: Preparing for CMS Reporting Ballroom C-3
Human Factors and Ergonomics in Infection Prevention Room 006 CD
How to Develop an Infection Surveillance Program in Long-Term Care Room 008
9:30-10:30 a.m. Concurrent Sessions
Immediate Use Steam Sterilization: The New Frontier Room 214 CD
A View Across The Pond: Europe’s Challenges and Successes in Addressing
Multi-Resistant Healthcare Infections Room 217 A
The Infection Prevention Liaison: Your Connection to Improve Infection
Prevention at the Bedside Room 217 B
Facility Guidelines Institute Construction Guidelines for ASHE Room 214 AB
All in the Family: Partnering With Families to Improve Outcomes Room 217 C
Preventing CAUTI: Disrupting the Life Cycle of the Urinary Catheter Room 217 D
Heroes of Infection Prevention Room 006 AB
9:30-10:30 a.m. Ask-the-Expert
T's: Talk With Titus, Tom, and Tracy Room 212 B
Occupational Health Issues That ‘Should’ Keep You Up at Night Room 212 A
Bugs Behind Bars: Infection Prevention and Control in Jails, Prisons, and
Mental Health Facilities Room 210 B
Ambulatory Care Challenges of the Now and the Future. Ask the Expert. Let’s Talk. Room 210 A
10 a.m.-5:30 p.m. Posters on Display Hall D
10:30 a.m.-1:30 p.m. Exhibit Hall Open (Coffee break 10:30 a.m.; Lunch served at 11:30 a.m.) Halls C-D
12:30-1:30 p.m. Poster Presentations Halls C-D
1:30-2:30 p.m. Concurrent Sessions
MDR Gram-Negative Infections: Across the Continuum of Care Room 214 CD
Infection Prevention Programs Measured Against Evidenced-Based Practice Room 217 A
Molecular Tools for Outbreak Investigations Room 217 B
Perspectives on Use of Standardized Infection Ratios (SIRs) for Assessing
Performance: A Surgeon and an Infection Preventionist Room 214 AB
Living Longer But are They Better? Targeted Methods to Improve Outcomes in
Nursing Home Residents: Modifiable Risk Factors for Respiratory Infections Room 217 C
Making “Contagion” Contagious: Views from the Lab and the Set Room 217 D
1:30-4 p.m. Workshops
How and Why to Write an Abstract Room 006 AB
Clean Spaces, Healthy Patients Room 007
Gaining Analytic Insights from NHSN for Prevention: Focus on CLABSI and CAUTI Ballroom C-3
Bored to Death? How to Sustain Quality and Safety Improvements in the ICU Room 006 CD
Beyond CMS: Assessing Your Ambulatory Facility Room 008
3-4 p.m. Concurrent Sessions
The Emperor’s New Clothes - CLABSI Definition and Its Impact on You, the IP Room 214 CD
Prolonged Use of Respiratory Protection: How Does it Affect the Healthcare Worker? Room 217 A
A Long and Winding Road: Meeting Current Challenges, Preparing for Future
Demands: APIC Introduces a Model of IP Competency Room 214 AB
C.diff and LTC Room 217 C
Planning and Implementation of an Infection Prevention and Control Training Program for
Healthcare Providers in Latin America Room 217 D
3-4 p.m. Ask-the-Expert
Preventing CAUTI: Disrupting the Lifecycle of the Urinary Catheter Room 212 B
Bloodstream Infections Room 210 B
The Role of the Infection Preventionist in Clostridium difficile Infection Prevention Room 210 A
4-4:30 p.m. COFFEE BREAK Tower View Lobby
10 4:30-6 p.m. APIC Annual Business Meeting (Members Only) Room 205
Wednesday, June 6
7 a.m.-1 p.m. Posters on Display Hall D
8-9 a.m. Concurrent Sessions
Hand Hygiene Update Room 214 AB
Social Networks of Infection Preventionists to Share Knowledge Room 217 A
Antimicrobial Stewardship: Optimizing Outcomes by Improving Antimicrobial
Prescribing Practices Room 217 B
Working Overseas in Military Infection Control Room 214 AB
A Collaborative Approach to Prevent CLABSI in Hemodialysis Patients Room 217 C
Innovative Devices to Reduce CLABSI: Are We Adapting Technology Fast Enough? Room 217 D
8-10:30 a.m. Workshops
To Lead or to Follow: That is the Question Room 006 AB
Using Performance Improvement Tools to Drive Infection Prevention Room 007
Gaining Analytic Insights from NHSN for Prevention: Focus on Surgical Site Infection Ballroom C-3
Innovation at the Front Line Room 006 CD
Challenges and Success in Caring For the Immunocompromised Patients in
Low Income Countries Room 008
9:30-10:30 a.m. Concurrent Sessions
Vaccine Preventable MDROs and HAIs Room 214 CD
Fecal Transplants Room 217 A
Your Infection Prevention Program: How to Size it and How to Sell it Room 217 B
Changing Approach to VAP Surveillance Room 214 AB
Update on HAIs in LTC Room 217 C
Hospital Disinfection and Disinfectant Resistance: What We Know, What We Don’t, and
What We Wish We Knew Room 217 D
9:30-10:30 a.m. Ask-the-Expert
SCIP and Beyond Room 212 B
State HAI Prevention Programs: Why LTC Should be Engaged Room 212 A
New Initiatives to Reduce Healthcare-Associated Infections Among Hemodialysis Patients Room 210 B
How to Develop an Infection Surveillance Program in Long-Term Care
Immune Compromised Patients Room 210 A
10:30 a.m.-1 p.m. Exhibit Hall Open (Coffee break 10:30 a.m.; Lunch served at 11:30 a.m.) Halls C-D
1-2 p.m. Concurrent Sessions
Innovations in HAI Data Validation Room 214 CD
30/30 Sessions: Two great topics in one hour Room 217 A
-Surviving an EF-5 Tornado-Infection Prevention (IP) Required
-So You Want to Volunteer? Preparing for a Volunteer Infection Prevention Medical Mission
The Ticket for Your Leadership Journey: APIC’s Credential of Competence Room 217 B
To End or Not to End? When Should Contact Precautions be Discontinued? National Survey
of Infection Preventionists Related to Contact Precautions for MRSA and VRE Room 214 AB
PICU Performance Improvement in Reducing Device Rates Room 217 D
1-3:30 p.m. Workshops
High-Level Disinfection, Sterilization and Antisepsis Room 007
Fearless Facilitation: How to Get Everybody Talking Room 006 AB
Is Your Dialysis Unit on Board? CDC's Dialysis Event Surveillance Workshop Room 006 CD
How to Report and Apply the NHSN SSI Definitions (Repeat) Ballroom C-3
Infection Prevention, Home Care and Health Care Reform Room 008
2:30-3:30 p.m. Concurrent Sessions
Evolution of Long-Term Care in the US: The Expanding Scope and Complexity of
Infection Prevention Room 214 CD
30/30 Sessions: Two great topics in one hour Room 217 A
-Nurses Driving IP Change in the NICU
-NICU Collaborative
State HAI Prevention Room 214 AB
Infection Prevention in Ambulatory Oncology Treatment Centers Room 217 C
Knocking at Your Door: New CMS Hospital Care Worksheet Room 217 D
3:30-4 p.m. COFFEE BREAK Tower View Lobby 11
4-5:30 p.m. Closing Plenary Ballroom C
2012AC_Onsite Pgm_CMYK_PRESS_Layout 1 5/10/12 7:12 PM Page 12
C O N G R AT U L AT I O N S T O T H E
2012 A P I C AWA R D W I N N E R S !
Chapter Leadership Awards New Investigator Abstract
Carole DeMille Achievement Nancy Barrett, RN, BES, MS, CIC Award
Award Kathryn Beier, BSN, CPHQ Kathleen Gase, MPH, CIC - New York State
Mary Jo Bellush, MSN, CIC Department of Health
Ruth Carrico, PhD, RN, FSHEA, CIC LeAnn Ellingson, BSN, CIC
An infection preventionist Diana Korpal, RN, CIC
for 20 years, Dr. Carrico’s William A. Rutala
Larry Krebsbach, CIC, REHS Research Award
prolific research has Ed Meduna, RN, CIC
influenced the practice of Gail Morchel, RN, BSN Alexis Price, RN, BSN - Lee Memorial Hospital
infection prevention and Marianne Pavia, BS, MT (ASCP), CLS, CIC
has focused on many areas Ossama Rasslan, MD, PhD Best International Abstract
of public health including infectious diseases Lee Sholtz, RN, MSN, CIC Award
transmission, emergency preparedness, and Mary Jo Stokes, RN, CIC Alejandro Macias, MD - National Institute of
immunization. Her book on the nation’s first Nancy Szilagyi, LPN, CIC Medical Sciences and Nutrition
drive thru immunization program became
a guide for others as they investigated the 2012 Heroes in Infection Blue Ribbon Abstract Awards
potential for mass immunizations in the Prevention Award
event of a bioterrorism attack or disease Audrey Adams, RN, MPH, CIC - Montefiore
outbreak within a community. Patti Bull, MS, M(ASCP), CIC - Hendrick Medical Center
Medical Center, Abilene, TX Gregory Gagliano, BSN, RN, CIC - Cleveland
Miguela Caniza, MD & Don Guimera, BSN, Clinic
RN, CIC - St. Jude Children’s Research Kathleen Gase, MPH, CIC - New York State
President’s Distinguished Hospital, Memphis, TN Department of Health
Service Award, in honor Kim Delahanty, RN, BSN, PHN, MBA/HCM, CIC Grace Lee, MD, MPH - Harvard Medical School
of Pat Lynch - University of San Diego, San Diego, CA and Harvard Pilgrim Health Care Institute
Susan Dolan, RN, MS, CIC Marlene Fishman Wolpert, MPH, CIC - St. Keith Kaye, MD, MPH - Wayne State University
Josephs Health Services of Rhode Island, School of Medicine and Detroit Medical Center
Healthcare Administrator Providence, R.I. Kathleen McMullen, MPH, CIC - Barnes-
Award Elaine Flanagan, RN, BSN, MHA, CIC - Detroit Jewish Hospital
Anthony Chavis, MD Medical Center, Detroit, MI Karen Rich, RN ,BSN, MEd, CIC - Colorado De-
Catherine Grayson, RN, MSN, CIC - Medical partment of Public Health and Environment
Chapter Excellence Awards Center of McKinney, McKinney, TX Lee Reed, RN, BA, MSPH, CIC - Novant
Member Support and Organizational Namita Jaggi, MD - Artemis Hospital, Health, Presbyterian Hospital
Excellence—APIC Chapter 111 Greater Gurgaon, India Mary Cole, BSN, CIC - Grady Health System
Buffalo Katherine Rhodes, RN, BSN, CIC, COHN-S - Marc-Oliver Wright, MT(ASCP), MS, CIC -
Member Support and Organizational Texas Health Southwest, Fort Worth, TX North Shore University Health System
Excellence—APIC Chapter 18 Minnesota Beth Ann Rhoton, RN, BSN, MS, CIC -
Education, Communication and Information Medical University of South Carolina APIC/AJIC Award for
Resources—APIC Chapter 15 Delaware Medical Center, Summerville, SC Excellence in Scientific
Valley & Philadelphia DeAnn Richards, RN, CIC - Agrace Hospice Research Publication
Strategic Alliances—APIC Chapter 89 Palmetto Care, Madison, WI “Role of hospital surfaces in the transmission of
Strategic Alliances—APIC Chapter 10 West Wynn Roberts, RN, CIC - Randall Children’s emerging health care-associated pathogens:
Virginia Hospital at Legacy Emanuel, Portland, OR Norovirus, Clostridium difficile, and
Clinical and Professional Practice—APIC Judy Warren, RN, MS, CIC, CPHQ - Tawan Acinetobacter species”
Chapter 17 Northeast Ohio Hospital, Al Ain, United Arab Emirates
David J. Weber, MD, MPH; William A. Rutala,
2012 Elaine Larson Lectureship PhD, MPH; Melissa B. Miller, PhD; Kirk
William Rutala, Ph.D, MS, MPH, CIC - UNC Huslage, RN, BSN, MSPH; Emily Sickbert-
Health Care and UNC School of Medicine Bennett, MS

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 G E N E R A L C O N F E R E N C E I N F O R M AT I O N
Annual Business Meeting APIC Conference Proceedings
The APIC Annual Business Meeting is on Tuesday, June 5, Please stop by the Covidien booth #703 in the front of the
from 4:30–6 p.m. in the Convention Center, Room 205. Exhibit Hall to pick up a complimentary copy of the APIC
This meeting is open only to APIC members. Associate 2012 Conference Proceedings. The complimentary copy of
members may attend, but may not vote. the standard conference proceedings includes all applicable
educational sessions in webinar format. Share this
All questions and items for discussion at the Business information with your coworkers so that they too can benefit
Meeting may be submitted in writing by 3 p.m., Monday, from the education at APIC 2012. This is made possible
June 4, at APIC Central. thanks to an educational grant from

APIC Member Services Note: Not all sessions will be recorded as they either do not
The APIC Member Service Desk is located in the Park View lend themselves to audiotape presentation or the speaker
Lobby of the Convention Center, as part of APIC Central. contract does not permit it.
The Member Service Desk is an area dedicated to APIC
program teams, committees, task forces, and affiliated Upgrade to the Premium Conference Proceedings to access
organizations to display information about their programs. the APIC 2012 Abstract online ePoster gallery, Conference
APP, and MP4 videos. It allows you to browse through the
APIC staff members are available to answer APIC 279 abstracts & posters from APIC 2012 with keyword
membership questions, troubleshoot problems and search, take notes or draw directly on the slides via your
concerns, print membership cards, and answer general tablet or smartphone while in a session, and transfer MP4
questions regarding APIC programs and services. versions all sessions and Film Festival Videos to your
computer or portable device like a tablet or smartphone.
The Member Services Desk is open on the following
days/times: Upgrade to Premium Option - $50
Sunday, June 3 12-5 p.m.
Upgrades can be made at the Cadmium CD Conference
Monday, June 4 7:30 a.m.-6 p.m.
Proceedings booth outside the exhibit hall in the Tower
Tuesday, June 5 7:30 a.m.-4:30 p.m.
View Lobby. For post-conference orders, please visit
Wednesday, June 6 7:30 a.m.-4 p.m.
www.apic.org/proceedings2012.
Stop by APIC Central and enjoy an afternoon snack on
Monday and Tuesday, courtesy of Stericycle. Badges
Official APIC Conference Badges must be worn to access
APIC Store the Exhibit Hall, educational sessions and social events.
The APIC Store is located in the Tower View Lobby of the
Convention Center. The APIC Store features conference Breakfast
souvenirs, APIC publications, and educational products. Inexpensive, portable breakfast items are available for
APIC staff members are available to assist attendees and purchase each morning at the Convention Center. Coffee,
answer questions regarding APIC products and services. hot tea, iced tea, lemonade, and water will be provided.

APIC Store Hours: Business Center/UPS Store

Sunday, June 3 12 -5 p.m. Open daily in the Main Lobby of the Convention Center.
Monday, June 4 7:30 a.m.-6 p.m.
Tuesday, June 5 7:30 a.m.-4:30 p.m. APIC Show Daily
Wednesday, June 6 7:30 a.m.-4 p.m. This free publication contains daily news from the
convention floor, product announcements, educational
Attendance Verification sessions, photographs, social events, and much more. The
For those attendees who do not require continuing Show Daily is available Sunday through Wednesday at
education contact hours, but wish to verify their attendance, conveniently placed news stands located near APIC Central,
a Verification of Attendance Card can be printed out online session rooms, and the Exhibit Hall. Be sure to grab your
at www.apic.org/AC2012 copy early – they go fast!
For verification of attendance for continuing education
contact hours, see Continuing Education Credits on page 3. Children
Due to the professional nature of this conference, children
Audio/Video Recording Devices under age 12 are not permitted in the educational sessions
The use of personal tape recorders, video cameras, or or the Exhibit Hall. Call your hotel operator for information
flash photography are not permitted during sessions. Most on available baby-sitters/daycare in the area.
lectures will be recorded and available on the complimentary
Conference Proceedings available to pick up at the Covidien
Booth (#703) in the exhibit hall.
14
Disability Assistance Additional Phone Numbers
If you have a disability and require assistance in order to Physician Referral Call your hotel operator
fully participate in conference activities, please see the Dental Referral 1-800-DENTIST
Conference Manager at the APIC 2012 Registration Desk to Downtown San Antonio Urgent Care (Concentra) 210-472-0211
discuss your specific needs. (1.4 miles from conv ctr)
San Antonio Convention & Visitors Bureau 1-800-447-3372
Exhibits Convention Center Security 210-207-7773
Henry B. Gonzalez Convention Center Exhibit Hall C & D
Poster Presentations
Visit the exhibits daily, talk to the representatives to become Exhibit Hall D of the convention center.
familiar with the products available, and discuss your needs.
Win prizes just by scanning your badge at the official APIC Posters will be displayed Monday, June 4 – Wednesday,
2012 Exhibit Hall raffle stations. APIC has placed two raffle June 6. Presenters will be in attendance to answer
stations at different locations within the exhibit hall. Find questions Monday, June 4 from 12:30–1:30 p.m. and
them, scan your badge, and you could win educational Tuesday, June 5 from 12:30–1:30 p.m. Refer to the
publications and fun prizes! Sponsored by abstract section of the onsite program for more detailed
information regarding each presentation.
Exhibits are open during the following hours:
Monday, June 4 10:30 a.m.-1:30 p.m. Questions for Speakers
Tuesday, June 5 10:30 a.m.-1:30 p.m. Conference participants may ask questions from
Wednesday, June 6 10:30 a.m.-1 p.m. microphones in the aisle during the question and answer
portion of the sessions. Written questions are also accepted
First Aid and should be given to the session moderator.
First Aid services are available during the meeting hours
(8 a.m.-5 p.m.) each day. The First Aid office is located Registration
inside the exhibit hall behind the APIC Village. If you require The APIC 2012 Registration Desk will be located in the
their services any APIC staff member can contact them. East Registration area of the San Antonio Convention Center.

Internet Stations Onsite Registration Hours:

Check email, browse the Internet, or complete the session Sunday, June 3 10 a.m.-7 p.m.
evaluation process online at the Internet Stations sponsored Monday, June 4 7 a.m.-4 p.m.
by , located in the Park View Lobby of the convention Tuesday, June 5 7 a.m.-4 p.m.
center. Internet Station keyboards are sponsored by , Wednesday, June 6 7 a.m.-3:30 p.m.
and keyboard cleansers are sponsored by . The Internet
Stations are open from Sunday, June 3 through Wednesday, Restaurant Reservations & Menu Information
June 6. Access is limited to 10 minute intervals per person. This desk at the convention center provides restaurant
menus, restaurant recommendations, and a reservations
Job Notices service. Located next to registration.
Job notices will be posted on notice boards in Park View Sunday, June 3 2-6 p.m.
Lobby of the Convention Center. Monday, June 4 10 a.m.-6 p.m.
Tuesday, June 5 10 a.m.-4 p.m.
Lost and Found Wednesday, June 6 10 a.m.-3 p.m.
Lost and found articles should be reported or taken to the
APIC 2012 Registration Desk located in East Registration in Ribbons
the convention center. At the end of each day, unclaimed All Badge Ribbons will be distributed on a table next to the
items will be turned over to convention center security. Conference Tote Bag pickup station in the East Registration
area of the convention center.
Phone Numbers
APIC 2012 Press Office 210-582-7009 Smoking Policy
APIC 2012 Registration/Message Desk 210-582-7010 Smoking is prohibited throughout the entire exhibit and
meeting area. This policy is strictly enforced.
APIC 2012 Hotels
Hilton Palacio del Rio 210-222-1400
Hyatt Place 210-227-6854
Hyatt Regency Riverwalk 210-222-1234
La Quinta Inn & Suites 210-222-9181
Marriott Rivercenter 210-223-1000
Marriott Riverwalk 210-224-4555
The Historic Menger Hotel 210-223-4361
15
 G E N E R A L C O N F E R E N C E I N F O R M AT I O N
Speaker Ready Room (Check in required for all presenters)
Checking in to the Speaker Ready Room, Room 207A,
is the single most important action you will take to
ensure your presentation is a success. All speakers are
required to check into the Speaker Ready Room
preferably 24 hours before their presentation, where
they will have the opportunity to review their
presentations or make any last minute changes. The
Speaker Ready Room will be open daily during the
meeting. All meeting rooms will have presentation
computers and will be networked to a central computer
located in the Speaker Ready Room. Presentations will
be downloaded from it and sent to the respective
meeting room on a secured intranet circuit approximately
45 minutes prior to the start of each session.

Hours of Operation: (Please make it a priority to visit

one day prior to your presentation.)
Sunday, June 3 12-5 p.m.
Monday, June 4 6:30 a.m.-5 p.m.
Tuesday, June 5 7 a.m.-5 p.m.
Wednesday, June 6 7 a.m.-2 p.m.

Visitor Information Office

Located inside the San Antonio convention center near
the Lila Cochrell Theater. They can provide information
including current flight schedules, shuttle requests,
restaurant and hotel information, even downtown
special events and nightlife. Office is open during
business hours M-F.

16
2012AC_Onsite Pgm_BLK_PMS_PRESS_Layout 1 5/15/12 10:48 AM Page 17

Education Program Details

Sunday, June 3 Monday, June 4

Monday, June 4
Concurrent Sessions Opening Plenary
3:30-4:30 p.m. | Session 900 Room 214 8-9:30 a.m. | Session 1000 Ballroom C
International and New Attendee Orientation Opening Ceremony with President’s Address
This session is designed to provide attendees with the Michelle R. Farber, RN, CIC
most current information in an informal setting. Review Board Certified Infection Preventionist
conference activities of interest to international and Mercy Hospital
new attendees and guide them through the program
schedule, abstracts, and exhibits directory.
9-9:30 a.m. | Session 1000 Ballroom C
OBJECTIVES:
Elaine Larson Lectureship - Disinfection and
䡲 Enable participants to choose topics that meet their educational and
Sterilization: From Benchtop to Bedside
practice requirements.
䡲 Identify where and how to meet international colleagues and illustrate This session will describe the current state of disinfection
suggestions for achieving a networking and educational balance
and sterilization and how infection preventionists expedi-
throughout the conference.
ently transfer knowledge from the benchtop to the bedside.
䡲 Describe the various educational opportunities available throughout the This will be accomplished by reviewing how new products,
conference.
practices, principles and technology in disinfection and
sterilization have been and continue to be integrated into
PRESENTER: practice to prevent patient exposure to pathogens from the
environment or medical/surgical instruments.
Gertie van Knippenberg-Gordebeke
Consultant Nurse Infection Prevention
International Consultant Nurse Infection Prevention OBJECTIVES:
䡲 Review the evolution of disinfection and sterilization products and
Mary Post, RN, MS, CNS, CIC practices over 30 years.
Infection Prevention Specialist 䡲 Review the disinfectants used and how research directed their use.
Oregon Patient Safety Commission 䡲 Review new technologies and how these technologies are improving
practice.
Nancy Zanotti RN, BSN, MPH, CIC
Director of Infection Prevention PRESENTER:
Westside Regional Medical Center William Rutala, BS, MS, PhD, MPH, CIC
Director, Hospital Epidemiology; Professor; Director,
Statewide Program for Infection Control and Epidemiology
University of North Carolina Health Care and University
of North Carolina School of Medicine

17
 Education Program Details

9:30-10:30 a.m. | Session 1000 Ballroom C Knowledge Bar (APIC Village)

Monday, June 4

From KARDEX to Bundles to....??? : In Defiance of the 11 a.m.-1 p.m. APIC Village, Exhibit Hall C
Post-Antibiotic Era Want to tap into all the expert knowledge running around
Trace the history of infection prevention in the modern era the 2012 APIC Annual Conference? Then visit the APIC
in the current context of an aging population, burgeoning Knowledge Bar inside the APIC Village for an informal
prevalence of multiple drug resistant organisms (MDRO), conversation with one or more clinical experts. Check
decline in novel antimicrobials, and the increasingly on-site for the most current schedule of experts.
aggressive healthcare technology that expands immuno-
suppressed populations in our facilities. A successful 11 a.m. EXPERTS:
vision is shared. Marita Nash, CHESP, MBA
Director of Environmental Services and Linen
Hunterdon Medical Center
OBJECTIVES:
䡲 Understand the maturation of infection prevention from a novel concept Lillian Burns, MPH, MT, CIC
into an increasingly evidence-based science. Director of Infection Control
䡲 Establish linkages with medical staff to accomplish healthcare Staten Island University Hospital
accountability in the modern healthcare facility.
䡲 Convert burgeoning MDRO into “rehabilitated antibiograms” using 12 p.m. EXPERT:
principles of warfare. Curtis Donskey, MD
Director of Infection Control
PRESENTER: Louis Stokes Veterans Affairs Medical Center (Cleveland VAMC)
Allan Morrison, FACP, FIDSA, FSHEA
Professor and Distinguished Senior Fellow
George Mason University Graduate School of Public Policy Poster Presentations with Presenters
Hospital Epidemiologist, INOVA Fairfax Hospital 12:30-1:30 p.m. Exhibit Hall D
Infectious Diseases Physicians, Inc.
Posters are arranged by topic number, listed below, and
then numerically by publication number within each
category.
Posters on Display
10:30 a.m.-5:30 p.m. Exhibit Hall D Antisepsis/Disinfection/Sterilization 2-007 to 2-022
Bioterrorism/Disaster/Emergency Preparedness 3-024 to 3-025
Device-Related Infections and/or
Exhibit Hall Open Site Specific Infections 4-026 to 4-056
10:30 a.m.-1:30 p.m. Exhibit Hall C & D Environment of Care/Construction/Remediation 6-063 to 6-072
Coffee break in the exhibit hall 10:30-11 a.m. Healthcare Worker Safety/Occupational Health 7-073 to 7-077
Product Evaluation/Cost-Effectiveness/Cost
Complimentary lunch will be served in the exhibit hall Benefit Analysis 10-140 to 10-146
from 11:30 a.m.-1 p.m. We welcome all attendees with
Special Populations (Infections in the
a wallet-style badge to join us. Immunocompromised Host, Pediatrics) 13-187 to 13-197
Specialized Settings (Ambulatory Care,
Behavioral Health, Long-Term Care, Home care) 14-198 to 14-205
Staff Training/Competency/Compliance 15-206 to 15-226

18
Oral Abstract Presentations 1:45-2 p.m.

Monday, June 4
Thirty-two abstract presentations will be presented in Publication 131. Validation of Infection
Preventionists Surveillance for Determining
four sessions. Each presentation will be 10 minutes in
Hospital-acquired Central Line-associated
length and five minutes for Q&A. Bloodstream Infection Using Centers for Disease
Control and Prevention Definitions
Session 1200 Room 214CD
Antimicrobial Resistance/Pathogens Megan J. DiGiorgio, MSN, RN, CIC
Infection Prevention
1:30-1:45 p.m. Cleveland Clinic
Publication 128. Incidence of Healthcare-
associated Infections by Pathogen at a University 2-2:15 p.m.
Hospital from 2005 to 2011
Publication 107. Efficacy of Various Antimicrobial
JaHyun Kang, BSN, MPH, CIC Central Venous Catheters in Mono- and Poly-
PhD candidate microbial Environments
School of Nursing, University of North Carolina at Chapel Hill
Shanna D. Moss, BS
Research Scientist
1:45-2 p.m.
Teleflex Medical
Publication 113. Risk Factor Score to Predict
MRSA Colonization at Hospital Admission
2:15-2:30 p.m.
Katherine Torres, D.O. Publication 124. Culture Change and CLABSI
Fellow, Infectious Diseases Reduction: Achieving Success in a Medical Center
Mayo Clinic with 10 Distinctively Different Intensive Care Units

2-2:15 p.m. Michael Anne Preas, RN, BSN, CIC

Director Infection Prevention and Hospital Epidemiology
Publication 100. Overuse of Topical Antibiotics
University Of Maryland Medical Center
Among Inmates Entering Maximum-security
Correctional Facilities in New York State
MODERATOR: Sasha Madison, MPH, CIC
Carolyn Herzig, MS
PhD Candidate Session 1202 Room 217B
Department of Epidemiology, Columbia University Hand Hygiene
2:15-2:30 p.m. 1:30-1:45 p.m.
Publication 101. Infections Due to Enterobacter Publication 126. Active Participation from the
Species: Epidemiology and Outcomes as a Hospital Executive Team Does Improve Hand
Function of Ceftazidime Resistance Hygiene Compliance
Odaliz E. Abreu Lanfranco Jan L. Wayland
ID Fellow Infection Control Manager
Wayne State University St Vincents and Mercy Private Hospital

MODERATOR: Julia Moody, MS, SM(ASCP) 1:45-2:00 p.m.

Publication 102. Efficacy of Novel Alcohol-Based
Session 1201 Room 217A Hand Rubs at Typical “In Use” Volumes
Bloodstream Infections
David R. Macinga, PhD
1:30-1:45 p.m. Principal Microbiologist
GOJO Industries, Inc.
Publication 104. Preventing Contamination of
Central Venous Catheter Valves with the Use of an
Alcohol-based Disinfecting Cap 2-2:15 p.m.
Publication 114. Understanding Hand Hygiene
Marc-Oliver Wright, MT(ASCP), MS, CIC Behavior in a Pediatric Oncology Unit in a Lower-
Corporate Director of Infection Control Middle Income Country: A Focus Group Approach
NorthShore University HealthSystem
Kyle M. Johnson, PhD, CCRP
Clinical Research Associate II 19
St. Jude Children's Research Hospital
 Education Program Details

2:15-2:30 p.m. Session 1204 Room 217C

Monday, June 4

Publication 116. Standardization of Hand Hygiene Isolation and MDROs

Observations - An Entire State Collaborates
1:30-1:45 p.m.
Barbara A. MacPike, RN, BSN, CIC Publication 130. Discontinuation of Reflex Testing
Infection Preventionist of Stool Samples for Vancomycin-Resistant
Maine Coast Memorial Hospital Enterococci Resulted in Increased Prevalence

MODERATOR: Amy Algazi, MS, MT(ASCP), CIC Kathleen McMullen, MPH, CIC
Infection Prevention Specialist
Barnes-Jewish Hospital
Session 1203 Room 214AB
Infection Prevention Programs 1:45-2 p.m.
1:30-1:45 p.m. Publication 127. Healthcare Worker Response to
Direct Monitoring of Adherence to Isolation
Publication 109. Prevention of Hospital Associated
Precautions
C. difficile Infections
Alexis Raimondi, BS, RN, BSN, MS, CIC Carolyn Herzig, MS
Infection Control Manager PhD Candidate
Beth Israel Medical Center- Kings Highway Division Department of Epidemiology, Columbia University

1:45-2 p.m. 2-2:15 p.m.

Publication 110. Preventing the FLU in You: A Publication 115. Multidrug Resistant Organisms in
Three Year Experience of Sustained Seasonal Supply Carts of Contact Isolation Patients
Influenza Vaccination Rates in Healthcare Workers
Shane Zelencik, MPH
Julia A. Moody, MS SM(ASCP) Infection Preventionist
Director, Infection Prevention NorthShore University HealthSystem
HCA Inc, Clinical Services Group
2:15-2:30 p.m.
2-2:15 p.m. Publication 117. Should Contact Precautions be
Publication 129. Comparison of Methods for Standard? A Community Hospital's Revised
Surgical Site Infection Surveillance: Traditional Criterion for Methicillin Resistant Staphylococcus
Report Review and Electronic Surveillance aureus and Vancomycin Resistant Enterococcus
Isolation
Sarah A. Jadin, MPH, CIC
Sr. Clinical Consultant-Infection Prevention Maureen J. Hodson, RN, ASN, CIC
Premier healthcare alliance Infection Preventionist
HealthAlliance Hospital
2:15-2:30 p.m.
Publication 112. Changing Bedside Care by MODERATOR: Karen Hoffmann, RN, MS, CIC
Linking Outcome and Process Data
Kathleen R. Hartless, RN, MN, CIC, CRMST Session 1205 Room 217D
Infection Prevention and Control Coordinator Public Reporting/Public Policy
Veterans Affairs North Texas Health Care System
1:30-1:45 p.m.
MODERATOR: Keith Howard, RN, BSN, CIC Publication 119. The Impact of Non-Payment for
Preventable Complications on Infection Rates in
U.S. Hospitals
Grace M. Lee, MD, MPH
Associate Professor of Population Medicine
Harvard Medical School and Harvard Pilgrim Health Care
Institute

20
 1:45-2 p.m. 2:15-2:30 p.m.

Monday, June 4
Publication 120. New York State Hospital-Acquired Publication 106. Preventing Infection in Pediatric
Infection Reporting – 2010 Audit Results: An Spinal Fusion Surgery: A Novel Perioperative and
Inter-hospital Comparison Postoperative Surgical Site Infection Prevention
Bundle
Kathleen Gase, MPH, CIC
HAI Reporting Regional Representative Patricia Hennessey, RN, BSN, MSN, CIC
New York State Department of Health Manager, Infection Prevention
St. Christopher's Hospital for Children
2-2:15 p.m.
Publication 118. Re-admissions After Diagnosis of MODERATOR: Sally Hess, MPH, CIC
Surgical Site Infection Following Knee and Hip
Arthroplasty Session 1207 Room 212
Surgical Site Infection
Keith S. Kaye, MD, MPH
Professor of Medicine and Corporate Director, Infection 1:30-1:45 p.m.
Prevention, Epidemiology and Antimicrobial Stewardship
Wayne State University School of Medicine and Detroit Publication 122. Rapid Cycle Process
Medical Center Improvements to Decrease Surgical Site
Infections in Cardiothoracic and Vascular
2:15-2:30 p.m. Surgery Patients Between 2008 and 2011
Publication 121. Assessment of the Quality and Lee Reed, RN, BA, MSPH, CIC
Accuracy of Publically Reported CLABSI Data in Infection Preventionist
Colorado Novant Health, Presbyterian Hospital
Karen Rich, RN, BSN, MEd, CIC
Patient Safety Program Nurse Consultant 1:45-2 p.m.
Colorado Department of Public Health and Environment Publication 123. Code Flash: An Interdisciplinary
Team’s Efforts to Decrease Incidents of Flash
MODERATOR: Lela Luper, RN, BS, CIC Sterilization
Diana K. Griffin, BSN, RN
Session 1206 Room 210 Infection Prevention and Control Nurse
Special Populations Central Arkansas Veterans Healthcare System

1:30-1:45 p.m. 2-2:15 p.m.

Publication 125. Using a Multi-Faceted Active Publication 111. Monitoring the Manual
Change Process and Infection Prevention to Cleaning of Flexible Endoscopes with an ATP
Reduce Post Op C-Section Infections Detection System
Jeanette J. Harris, MS, MSM, BS, MT(ASCP), CIC Grace A. Thornhill, PhD
Infection Preventionist Technical Service Specialist
MultiCare Health System 3M Infection Prevention
1:45-2 p.m.
2:15-2:30 p.m.
Publication 105. Endemic IV Fluid Contamination
Publication 103. Clean Collaboration: Toward
in Hospitalized Children in Mexico. A Problem of
Improving Arthroscopic Shaver Reprocessing
Serious Public Health Consequences.
Methods
Alejandro E. Macias, MD
Jahan Azizi , BS, CBET
Head, Infection Control
Risk Management Consultant/Biomedical Engineer
National Institute of Med Sciences and Nutrition
University of Michigan Health System
2-2:15 p.m. MODERATOR: Debra Johnson, BSN, RN, CIC
Publication 108. A Healthcare Worker with
Pertussis: High Cost and Lost Opportunity
Gregory C. Gagliano, BSN, RN, CIC
Infection Preventionist
Cleveland Clinic 21
 Education Program Details

Concurrent Sessions 3-4 p.m. | Session 1301 Room 217 A

Monday, June 4

3-4 p.m. | Session 1300 Room 214 CD One Stick at a Time: A Toolkit for an Effective
Healthcare Personnel Immunization Program
Brick by Brick: Building Ontario’s First Regional
Hospital Infection Surveillance System: Technology An effective immunization program is essential for the
Enhances Patient Safety safety of the healthcare workforce. This session will
review the results of a nationwide survey among infection
An ambitious project resulting in the implementation of
preventionists regarding their knowledge, management,
an automated surveillance system linking multiple
and implementation of an immunization program.
hospital corporations in Southeastern Ontario will be
Components of a comprehensive program will be
described. Presenters will highlight the benefits to
provided in a toolkit format.
patient safety realized by a single regional database and
common software supporting surveillance and tracking of
OBJECTIVES:
patients across the region.
䡲 Identify current immunizations recommended by the CDC ACIP for
OBJECTIVES: inclusion in a healthcare personnel immunization program applicable in
any healthcare setting.
䡲 Evaluate the benefits of a regional surveillance system in enhancing
䡲 Identify specific areas of risk for safe vaccine handling and
patient safety.
management.
䡲 Recognize the many complex processes required to implement a regional
䡲 Discuss available resources regarding safe vaccine handling,
system.
management, administration, and program evaluation.
䡲 Develop a strategy to establish a regional infection control system.
PRESENTERS:
PRESENTERS: Ruth Carrico, PhD, RN, FSHEA, CIC
Janet Allen, MLT, ART, CIC
Associate Professor
Network Coordinator
School of Public Health and Information Sciences
Public Health Ontario - Regional Infection Control Network
University of Louisville
Susan Cooper, MLT, CIC
Timothy Wiemken, PhD, MPH, CIC
Infection Control Consultant
Instructor of Medicine
Public Health Ontario- Regional Infection Control Network
University of Louisville School of Medicine, Division of Infectious
Diseases
MODERATOR: Kathleen Quan, RN, BSN, CIC, CPHQ
MODERATOR: Sue Sebazco, RN, BS, CIC

22
3-4 p.m. | Session 1302 Room 217 B 3-4 p.m. | Session 1303 Room 214 AB

Monday, June 4
How Do We Find Them and How Do We Keep Them: CDC Outbreak Session 2012
Recruitment and Training of The New Infection This session will review recent CDC outbreak
Preventionist investigations of healthcare-associated infections and
This session will present a unique approach to will highlight the process of conducting these
recruitment and training of infection preventionists (IPs), investigations. Lessons learned from the field may be
with a focus on identifying potential successful IP helpful in successfully managing future outbreak
candidates with non-traditional education or professional investigations. Attendees will be provided with useful
backgrounds. Career development strategies and and practical information on conducting outbreak
mentorship systems to retain and support the early investigations.
career IP will also be discussed.
OBJECTIVES:
OBJECTIVES: 䡲 Describe the lessons learned from recent CDC outbreak investigations.
䡲 Identify and assess potential IP candidates from non-traditional 䡲 Describe the process measures involved in outbreak investigations.
backgrounds. 䡲 Discuss emerging and re-emerging pathogens and common outbreak
䡲 Develop a training plan that is tailored to the new IPs education needs themes in the healthcare setting.
and areas of strength.
䡲 Create career development strategies to support and retain the PRESENTER:
early-career IP. Tara McCannell, MSc, PhD
Epidemiologist
PRESENTERS: Centers for Disease Control and Prevention
Virginia Kennedy, BS, MS
Principal MODERATOR: Kathy Arias, MS, CIC
Infection Prevention and Management Associates, Inc.

Kelley Boston, MPH, CIC 3-4 p.m. | Session 1304 Room 217 C
Regional Director San Antonio, Accreditation and
Regulatory Compliance Disinfection and Sterilization in Physician Practices
Infection Prevention and Management Associates, Inc. and Specialty Clinics
What's different about disinfection and sterilization in
Kelly Holmes, MS, CIC ambulatory care facilities? What's the same? This session
Director of Human Resources and Education offers guidance and explains what should be the same
Infection Prevention and Management Associates, Inc. and what should be different in these processes in
physician practices and specialty clinics that do not have
Jennifer McCarty, MPH, CIC access to a sterile processing department.
Director of Operations, Regional Director Texas Gulf Coast, Acute Care
and NHSN Lead OBJECTIVES:
Infection Prevention and Management Associates, Inc.
䡲 List differences between disinfection and sterilization in a sterile
processing department and in a physician practice or specialty clinic.
MODERATOR: Fran Feltovich, RN, MBA, CIC, CPHQ
䡲 Describe the similarities between disinfection and sterilization in a
sterile processing department and in a physician practice or specialty
clinic.
䡲 Define disinfection and sterilization in a physician's practice or
specialty clinic.

PRESENTER:
Judie Bringhurst, RN, MSN, CIC
Infection Prevention Coordinator, Ambulatory Care
UNC Healthcare System

MODERATOR: Lela Luper, RN, BS, CIC

23
 Education Program Details

3-4 p.m. | Session 1305 Room 217 D 3-5:30 p.m. | Session 1401 Room 007
Monday, June 4

Really, Are You Serious? Using the Joint Commission IC Standards and NPSG 7
This session will highlight some thought-provoking and to Drive Practice Change and Attain Adequate
often unbelievable examples of issues faced by infection Resources: a Leadership Workshop
preventionists. The presenters will provide an Joint Commission infection control (IC) standards and
entertaining and educational discussion of practices and National Patient Safety Goal (NPSG) 7 are designed to
events that made them want to cry out “Really?” allow each organization to customize an infection
prevention program that best meets its unique needs. A
OBJECTIVES: customized program is necessary in order to optimize
䡲 Discuss approaches to various infection prevention challenges limited resources, provide leadership and drive practice
encountered in a complex healthcare facility. change.
䡲 Examine unusual scenarios in infection prevention in which there is
limited evidence or guidelines regarding recommended practices. OBJECTIVES:
䡲 Express an appreciation for the ingenuity of healthcare worker behaviors 䡲 Design or improve a cost-effective, guideline-driven infection prevention
that, though well-intended, may have potential harm. program that complies with TJC requirements.
䡲 Identify evidence-based guidelines utilized by surveyors in evaluation of
PRESENTERS: compliance.
Titus Daniels, MD, MPH, MMHC 䡲 Describe methods for assessing resources and making a business case
Vice Chair for Clinical Affairs, Department of Medicine for additional funding.
Vanderbilt University School of Medicine
PRESENTER:
Thomas Talbot, MD, MPH Barbara Soule, RN, MPA, CIC, FSHEA
Associate Professor of Medicine, Chief Hospital Epidemiologist Practice Leader, Infection Prevention Services
Vanderbilt University Medical Center Joint Commission Resources

MODERATOR: Barb DeBaun, RN, MSN, CIC MODERATOR: Deanie Lancaster, RN, BSN, MHSA, CIC, CPHRM
Workshops
3-5:30 p.m. | Session 1400 Room 008 3-5:30 p.m. | Session 1402 Ballroom C-3
Home is Where the Germs Are: Infection Prevention How to Report and Apply the NHSN SSI Definitions
Surveillance in Home Care
In 2012, CMS’s Hospital Inpatient Quality Reporting
Surveillance is the backbone of an effective infection
Program expanded to include surgical site infections
prevention program in home care settings. The presenter
(SSI) for selected operative procedures using CDC’s
will discuss the use of surveillance data including review
National Healthcare Safety Network (NHSN) definitions.
of outcome and process measures with the ultimate goal
This session will review NHSN’s SSI protocol and how to
of improving the safety and quality of patient care.
meet the reporting mandate. Test your skills through
audience response to case studies.
OBJECTIVES:
䡲 Discuss methods for identifying potential infections using the Outcome OBJECTIVES:
and Assessment Information Set (OASIS) and applying the APIC-HICPAC
䡲 Define resources and methods for SSI surveillance, including
Surveillance Definitions for Home Health Care and Home Hospice
requirements for SSI reporting to CMS through NHSN.
Infections.
䡲 Review NHSN SSI protocol and key terms and definitions.
䡲 Describe the use of surveillance to improve outcome and process 䡲 Apply SSI definitions using interactive case studies.
measures.
䡲 Analyze and report findings of the surveillance data including the PRESENTERS:
development of action plans. Mary Andrus, BA, RN, CIC
President
PRESENTER: Surveillance Solutions Worldwide, Inc
Carole Yeung, RN, CIC
Clinical Practice Specialist,- Infection Prevention
Baptist Health Home Health Network

24 MODERATOR: Jennifer Geist Cox, RN, BSN, CIC

Teresa Horan, MPH PRESENTERS:

Monday, June 4
NHSN Education and Data Quality Assurance Team. Leader Tim Adams, FASHE, CHFM, CHC
Division of Healthcare Quality Promotion Director, Professional Growth
Centers for Disease Control and Prevention American Society for Healthcare Engineering

Gloria Morrell, RN, MS, MSN, CIC Linda Dickey, RN, MPH, CIC
Nurse Consultant Director, Epidemiology and Infection Prevention
Centers for Disease Control and Prevention University of California Irvine Healthcare

MODERATOR: Barbara Rusell, RN, MPH, CIC MODERATOR: Amy Nichols, RN, MBA, CIC

Concurrent Sessions
3-5:30 p.m. | Session 1403 Room 006 AB 4:30-5:30 p.m. | Session 1500 Room 214 CD
Management is More than Leading Mandatory Reporting Of Healthcare Personnel
In this session, you will explore the many elements of Influenza Vaccination Using the National Healthcare
management and leadership in todays evolving Safety Network System
workplace environment. Through reflective exercises and Beginning in January 2013, the Centers for Medicare &
engaging activities, you’ll also create your own teachable Medicaid Services will require hospitals to report
moments about managing and leading in the context of healthcare personnel influenza vaccination through
your own organizations. Just as important, you’ll have NHSN using a standardized measure. This session
fun with a purpose! includes an overview of measure definitions and
reporting protocols. Representatives from jurisdictions
OBJECTIVES: that pilot-tested the measure will share implementation
䡲 Learn what the experts say about managing and leading. recommendations.
䡲 Articulate tangible examples of management and leadership - both
what it is and what it isn't. OBJECTIVES:
䡲 Begin articulating the context for leadership and management in your 䡲 Define the three groups of healthcare personnel covered by this quality
own organizations. measure.
䡲 Classify the vaccination status of healthcare personnel according to the
PRESENTER: measure specifications.
Diana Mungai, MS, MSIR 䡲 List the most common questions related to implementation of the HCP
Vice President, Consulting Operations vaccination measure.
McManis and Monsalve Associates
PRESENTERS:
MODERATOR: Tracy M. Louis, MSN, RN, CIC Faruque Ahmed, PhD
Senior Epidemiologist
Centers for Disease Control and Prevention
3-5:30 p.m. | Session 1404 Room 006 CD
Anita Geevarughese, MD, MPH
Utility Systems and Infection Prevention Implications Adult Immunization Medical Specialist
for the Environment of Care New York City Department of Health and Mental Hygiene
The health care environment comprises complex systems
which minimize growth and transmission of airborne and Patricia McLendon, MPH
waterborne pathogens. Infection preventionists play a Epidemiologist
vital role in design and management of these systems, California Department of Public Health
Demonstrations and exercises will allow participants to
visualize and understand how these systems function Carmela Smith, MS
and support infection prevention. Healthcare Personnel Influenza Vaccination Project Manager
New Mexico Medical Review Association
OBJECTIVES:
MODERATOR: Terrie Lee, RN, MS, MPH, CIC
䡲 Describe air and water system engineering controls that limit the
growth and transmission of airborne and waterborne pathogens.
䡲 Describe the applications of each engineering control.
䡲 Identify techniques that promote collaboration with key facility design 25
partners.
 Education Program Details

4:30-5:30 p.m. | Session 1501 Room 217 A Concurrent Sessions

Monday, June 4

The Infection Preventionist’s Role in Implementation 4:30-5:30 p.m. | Session 1502 Room 217 B
Science: Examples From the Field
Elevating Your Teaching to a New Level: Becoming a
To help infection preventionists bridge the gap between Master Educator
science and practice, results from the P-NICE and
Infection preventionists (IPs) frequently conduct
CHAIPI studies will be presented. Results include:
infection prevention education and training, yet few IPs
predictors of clinician adherence to guidelines,
have formal education in adult learning principles,
importance of certification of infection preventionists and
instructional design and strategies. This session will
qualitative findings on the impact of mandatory reporting.
focus on writing educational objectives, selection of
instructional techniques and methods, crafting the
OBJECTIVES:
content to match the audience, and program evaluation.
䡲 Describe professional characteristics and skills of IPs that prepare them
for successfully implementing and disseminating evidence-based OBJECTIVES:
practice.
䡲 Compare and contrast the different types of adult learners, and identify
䡲 Identify components of practice guidelines that are appropriate for
approaches to teaching that best match primary learning styles.
implementation in their setting, using catheter-associated UTI
䡲 Identify and formulate effective learning objectives e.g. Blooms
guidelines as an example.
Taxonomy for infection prevention courses and lectures.
䡲 Upon completion, participants will be able to discuss characteristics of
䡲 Describe general teaching, learning and evaluation strategies.
key leaders associated with successful implementation and support of
infection prevention strategies.
PRESENTER:
Mary Lou Manning, PhD, CRNP, CIC
PRESENTERS: Associate Professor, Director Doctor of Nursing Practice Program.
Laurie Conway, RN, MS, CIC Thomas Jefferson University
PhD student
Columbia University School of Nursing
MODERATOR: Keith Howard, RN, BSN, CIC
Monika Pogorzelska, PhD, MPH
Associate Research Scientist
Columbia University School of Nursing 4:30-5:30 p.m. | Session 1503 Room 214 AB
Updated SHEA Guidelines for HIV or Hepatitis B
Patricia Stone, RN, PhD Infected Workers
Centennial Professor of Health Policy
This session will provide an overview of the 2010 SHEA
Columbia University School of Nursing
Guidelines for the management of healthcare workers
May Uchida, MSN, GNP-BC infected with bloodborne pathogens. If you want to be up to
Doctoral Student date and provide guidance to your employee/occupational
Columbia University health service, you won't want to miss this session.

MODERATOR: Denise Murphy, RN, MPH, CIC OBJECTIVES:

䡲 Compare and contrast the magnitude of risks for bloodborne pathogens
associated with exposures in the healthcare setting.
䡲 Describe historical perspectives about provider-to patient transmission
of the three primary bloodborne pathogens.
䡲 Discuss the tenets of the recently published, “SHEA Guideline for
Management of Healthcare Workers Who Are Infected with Hepatitis B
Virus, Hepatitis C Virus, and/or Human Immunodeficiency Virus.”

PRESENTER:
David Henderson, MD
Deputy Director for Clinical Care
Clinical Center, National Institutes of Health

MODERATOR: Lisa Outerbridge, RN

26
4:30-5:30 p.m. | Session 1504 Room 217 C 4:30-5:30 p.m. | Session 1505 Room 217 D

Monday, June 4
The C-Suite Infection Preventionist Journey: Impacting Infection Prevention Community Response - Germs on
Patient Safety, Community Health, and Public Trust Coats, Privacy Curtains
Involvement of a motivated administrator who liaisons Review the science behind environmental contamination
between your Infection Prevention Committee, physicians, of patient rooms and the role of environmental
administrators, the CEO, and infection prevention staff contamination in the spread of antibacterial-resistant
can move forward small tests of change, and essential bacteria to healthcare workers and between patients.
best practice program changes. Attend this session to
hear some simple steps you can implement for success. OBJECTIVES:
䡲 Assess the likelihood contamination of healthcare worker attire after
OBJECTIVES: entry into rooms of MDROs colonized patients.
䡲 Describe one benefit of converting an infection program goal to reduce 䡲 Determine how often the environment of MDRO+ patient rooms
surgical site infections into an organization-wide strategic intent. contaminated and which sites are most likely to be contaminated.
䡲 Describe one example when a motivated administrator can be brought in 䡲 Describe how the environment and healthcare worker interact in the
as a project champion to improve a successful outcome. spread of MDROs.
䡲 Identify one action to increase the functionality of the committee or work
group responsible for moving infection prevention changes forward. PRESENTERS:
Patti Costello
PRESENTERS: Executive Director
Anthony Chavis, MD, MMM, FCCP Association for the Healthcare Environment
Vice President, Medical Affairs and Patient Safety Officer
Community Hospital of the Monterey Peninsula Susan Huang, MD, MPH
Associate Professor of Medicine, Medical Director of Epidemiology and
Patricia Emmett, MS, RN, CIC Infection Prevention
Infection Prevention Coordinator University of California, Irvine Medical Center
Community Hospital of the Monterey Peninsula
Eli Perencevich, MD, MS
MODERATOR: Karen Hoffmann, RN, MS, CIC Professor of Internal Medicine
University of Iowa Carver College of Medicine

MODERATOR: Russell Olmsted, MPH, CIC

27
 Education Program Details

Tuesday, June 5
Posters on Display 8-9 a.m. | Session 2002 Room 217 B
Tuesday, June 5

8 a.m.-5:30 p.m. Exhibit Hall D Peer Reviewed Publication: Why Not Me?
Designed for those with publication aspirations beyond a
solid abstract. Without reviewing actual development of
Concurrent Sessions content, this course provides a “road-map” for peer-
8-9 a.m. | Session 2000 Room 214 CD reviewed publications in a one-stop-shopping approach.
A Bundle Approach to Prevent CAUTIs Attendees will leave with user-friendly advice, websites,
and helpful hints to maneuver their way to an initial
Learn how to form multidisciplinary CAUTI prevention
publication success.
teams and introduce a CAUTI prevention bundle that can
be spread to all patient care units. Reductions in CAUTI
rates and device utilization will be discussed as well as
OBJECTIVES:
cost effectiveness of CAUTI prevention efforts. 䡲 State the basic questions and premise behind the peer reviewed
publication process.
OBJECTIVES: 䡲 Describe resources available to use as a generic yet mandatory guide for
peer reviewed publications.
䡲 Describe a model for CAUTI infection reduction that can be implemented
institutionally across a health care system.
䡲 Explain the basic organizational steps to successful publication in peer
reviewed journals from idea, literature search, submission, re-submission,
䡲 Compare infection prevention practices and report infection data in a
toward final galley proof review.
timely, meaningful and understandable manner.
䡲 Demonstrate cost effectiveness of efforts.
PRESENTER:
Patti Grant, RN, BSN, MS, CIC
PRESENTER: Director Infection Prevention & Quality
Brian Koll, MD, FACP, FIDSA
Methodist Hospital for Surgery
Professor of Clinical Medicine
Albert Einstein College of Medicine
MODERATOR: Sharon Williamson, MT (ASCP), SM, CIC
MODERATOR: Sasha Madison, MPH, CIC

8-9 a.m. | Session 2003 Room 214 AB

8-9 a.m. | Session 2001 Room 217 A Talking to Patients: The Expanding Role of Infection
It's a Gas! Infection Prevention in Anesthesia Preventionists in Communicating HAI Prevention
This presentation will highlight key infection prevention Getting an infection during medical care can be
challenges in anesthesiology. Recent national anesthesia devastating for patients and families. Infection
guidelines, unique issues and application of the new preventionists can play a key role in educating patients
guidelines will be discussed. An evaluation tool of on healthcare safety. During this presentation, we will
Anesthesiology Infection Control practices for use by discuss best practices for notifying patients of infection
infection preventionists (IPs) will be shared. control breaches and provide lessons learned from
healthcare-associated infection.
OBJECTIVES:
䡲 Discuss the revised American Society of Anesthesiologists (ASA) OBJECTIVES:
Recommendations for Infection Control for the Practice of 䡲 Highlight the role of infection preventionists in educating patients about
Anesthesiology. healthcare safety.
䡲 Identify the role of the IP in working with anesthesia to address the 䡲 Discuss communication best practices for patient notification events.
prevention of HAI in patients as well as infection transmission to the 䡲 Provide lessons learned from healthcare-associated infection data
anesthesia staff. releases.
䡲 Incorporate a practical tool for IP use when evaluating compliance with
the above ASA Recommendations at your institution. PRESENTER:
Abbigail Tumpey, MPH, CHES
PRESENTER: Associate Director for Communications Science
Susan Dolan, RN, MS, CIC Division of Healthcare Quality Promotion
Hospital Epidemiologist Centers for Disease Control and Prevention
Children’s Hospital Colorado
MODERATOR: Keith Howard, RN, BSN, CIC
28
MODERATOR: Linda Green, RN, MPS, CIC
2012AC_Onsite Pgm_BLK_PMS_PRESS_Layout 1 5/15/12 10:48 AM Page 29

8-9 a.m. | Session 2004 Room 217 C

Tuesday, June 5
Workshops
SSI Prevention in Ambulatory Surgery Centers - 8-9 a.m. | Session 2100 Room 006 AB
A Collaborative Project AORN/APIC
Heroes of Infection Prevention
This session will describe a collaborative project which
This session is a gathering of past Heroes to address the
involved development of materials, tools and support
guiding question of: “How are your respective successful
relative to infection prevention, and CMS survey prep for
programs sustained and what is your drive to maintain the
ambulatory surgery centers.
program?” Come hear how their work has been developed
into best practices and the common challenges they faced
OBJECTIVES:
in finding solutions to foster a continuity in approach to
䡲 List two interventions designed to reduce the risk of surgical site improve patient outcome across the continuum of care.
infections in ambulatory surgery centers.
䡲 Describe one regulatory agency involved in surveying ASCs. PRESENTERS:
䡲 Describe two methods of support provided to ASCs by the AORN/APIC Linda Gravies
chapter collaborative project in the San Francisco Bay Area. Senior ICP
M.D. Anderson Cancer Center
PRESENTERS:
Kris Anderson, RN, BS, CNOR, CASC Brian Koll, MD, FACP, FIDSA
Independent Consultant Professor of Clinical Medicine
Albert Einstein College of Medicine
Sue Barnes, RN, BSN, CIC
Mary Ellen Scales, RN, MSN, CIC
National Program Leader Infection Prevention and Control
Director, Infection Control Program
Kaiser Permanente
Baystate Health, Inc.
MODERATOR: Frank Myers, MA, CIC Mary Walczak
Asst. Director Infection Control
Kingsbook Jewish Medical Center
8-9 a.m. | Session 2005 Room 217 D
MODERATOR: Jan Frain, RN, CIC, CPHQ, CPHRM
Infection Preventionists Leading Change: Effects of
Healthcare Reform on Infection Prevention Sponsored by
Hear the SHEA President's perspective on the effect of
healthcare reform on infection prevention, and the critical
role of the infection preventionist in leading change. 8-10:30 a.m. | Session 2101 Room 007
Infection Prevention Risk Assessment; the Starting
OBJECTIVES: Place for Your IP Program
䡲 Describe the role of infection prevention professionals in healthcare An organizational infection prevention risk assessment
reform. can assist in setting priorities and in energizing teams
䡲 Identify strategies to facilitate leadership of improvement efforts in your within an organization to implement a highly effective
institution. infection prevention plan. This workshop will take
participants through the process of conducting an
PRESENTER: infection prevention risk assessment.
Jan Patterson, MD, MS, FSHEA
Professor of Medicine/Infectious Diseases and Associate Dean, Quality OBJECTIVES:
and Lifelong Learning 䡲 Use a risk assessment tool to evaluate an organization for infection
University of Texas Health Science Center at San Antonio and South potential.
Texas Veterans Health Care System 䡲 Discuss three strategies to ensure a successful risk assessment process.
䡲 Describe a risk assessment tool to evaluate an organization for infection
MODERATOR: Barbara Soule, RN, MPA, CIC potential.

PRESENTER:
Terrie Lee, RN, MS, MPH, CIC
Director, Infection Prevention and Employee Health
Charleston Area Medical Center
29
MODERATOR: Kit Reed, RN, BSN, MPH, CIC
 Education Program Details

8-10:30 a.m. | Session 2102 Ballroom C-3 8-10:30 a.m. | Session 2104 Room 008
Tuesday, June 5

NHSN - CAUTI Workshop: Preparing for CMS Reporting How to Develop an Infection Surveillance Program in
Are you confident about your CAUTI reporting to Long-Term Care
NHSN/CMS? This interactive audience participation Infection surveillance is a critical component of any
session will provide you the information you need for Long-Term Care (LTC) infection prevention program. In
successful CAUTI case finding and reporting via NHSN. this session, participants will learn strategies for
developing an infection surveillance plan. Based on the
OBJECTIVES: needs of the resident population in their facility; discuss
䡲 Review requirements for CAUTI reporting to CMS through NHSN. ways to implement infection surveillance definitions and
䡲 Apply the Centers for Disease Control and Prevention /National preview the NHSN LTC Component.
Healthcare Safety Network definitions and criteria for catheter-
associated urinary tract infection (CAUTI) to case studies. OBJECTIVES:
䡲 Recognize the method to identify denominators for CAUTI rate 䡲 Learn strategies for developing an infection surveillance plan.
calculations. 䡲 Discuss ways to implement infection surveillance definitions.
䡲 Describe the NHSN LTC Component.
PRESENTERS:
Katherine Allen-Bridson, RN, BSN, MScPH, CIC PRESENTERS:
Nurse Consultant Lona Mody, MD, MSc
Centers for Disease Control and Prevention Associate Professor, University of Michigan
University of Michigan and VA Ann Arbor Healthcare System
Angela Bivens-Anttila, RN, MSN, NP-C, CIC
Nurse Epidemiologist Nimalie Stone, MD, MS
Centers for Disease Control and Prevention Medical Epidemiologist for Long-term Care
Division of Healthcare Quality Promotion
Connie Steed, MSN, RN, CIC Centers for Disease Control and Prevention
Director, Infection Prevention
Greenville Hospital System University Medical Center MODERATOR: Sally Hess, MPH, CIC

MODERATOR: Suzanne Cistulli, BSN, RN, CIC

8-10:30 a.m. | Session 2103 Room 006 CD

Human Factors and Ergonomics in Infection Prevention
This workshop is designed to provide an understanding
of human factors and systems engineering and how this
approach to infection prevention can improve performance,
prevent harm when error does occur, help systems
recover from error, and mitigate further harm.

OBJECTIVES:
䡲 Promote the use of human factors and systems engineering to minimize
the risk healthcare related infection.
䡲 Understand organizational issues related to infection prevention (e.g.,
organizational resilience, communication, teamwork).
䡲 Recognize the infection prevention interfaces between the job, the
person and the environment.

PRESENTER:
Carla Alvarado, PhD
Research Scientist Emerita
University of Wisconsin-Madison

30 MODERATOR: Denise Murphy, RN, MPH, CIC

 䡲 State successful strategies adopted in European countries that have

Tuesday, June 5
Concurrent Sessions
achieved a substantial trans-national reduction in MRSA prevalence
9:30-10:30 a.m. | Session 2200 Room 214 CD
over a relatively short time span.
Immediate Use Steam Sterilization: The New Frontier
Technological advancements in instrumentation and PRESENTER:
sterilizer equipment as well as updated published evidence Michael Borg, MD, PhD
based practices, standards and recommendations that Director of Infection Prevention
“flash sterilization” is an inadequate term that does not Mater Dei Hospital
fully describe the process. Accreditation, regulatory
agencies and, professional organizations recommend MODERATOR: Nancy Zanotti, RN, BSN, MPH, CIC
that the same critical reprocessing steps (e.g. cleaning,
decontaminating, documentation, and transporting the
sterilized items) are followed regardless of the specific 9:30-10:30 a.m. | Session 2202 Room 217 B
sterilization cycle used. This presentation will describe The Infection Prevention Liaison: Your Connection to
the most current multi-society positions on Immediate Improve Infection Prevention at the Bedside
Use Steam Sterilization.
This session will provide an overview of how to design
and implement an infection prevention liaison program.
OBJECTIVES:
The speaker will address the limitations and strengths of
䡲 Discuss the Multi-Society position statement on Immediate-Use Steam a liaison program and how an effective program supports
Sterilization.
the work of the infection preventionist.
䡲 Describe the most current standards and recommendations on
immediate use sterilization according to AORN, AAMI, and CDC.
OBJECTIVES:
䡲 Develop a policy and procedure on Immediate Use Steam Sterilization.
䡲 Describe the strengths and limitations of a liaison program.
䡲 Recognize the benefits of having an active liaison program to improve
PRESENTER:
communication and clinical practice of infection prevention measures.
Rose Seavey, MBA, RN, BS, CNOR, CRCST, CSPDT
President/CEO 䡲 Define the role of the Infection Prevention Liaison.
Seavey Healthcare Consulting, LLC
PRESENTER:
MODERATOR: Linda Green, RN, MS, CIC Vickie Brown, RN, MPH, CIC
Director Infection Prevention and Control
WakeMed

9:30-10:30 a.m. | Session 2201 Room 217 A MODERATOR: Amy Nichols, RN, MBA, CIC
A View Across The Pond: Europe's Challenges and
Successes in Addressing Multi-Resistant Healthcare
Infections
The session will provide an overview of the current
situation related to multi-resistant healthcare infections
in Europe, highlight possible factors behind this
epidemiological picture and identify successful
strategies that have resulted in significant improvement
in several countries. The influence of national and
organizational culture will be particularly emphasized.

OBJECTIVES:
䡲 Discuss the epidemiology of multi-resistant healthcare infections, such
as MRSA and multi-resistant Gram negative bacteria, in the different
countries of Europe.
䡲 Describe the different potential drivers behind this diversity including the
possible impact of national and organization cultural characteristics and
values on clinical practices relevant to infection prevention and control.

31
 Education Program Details

9:30-10:30 a.m. | Session 2203 Room 214 AB 9:30-10:30 a.m. | Session 2204 Room 217 C
Tuesday, June 5

Facility Guidelines Institute Construction Guidelines All in the Family: Partnering With Families to Improve
for ASHE Outcomes
The 2010 Guidelines for Design and Construction of Integrating families as essential members of the care
Health Care Facilities are currently “under construction” team. presents new infection prevention challenges and
and will be released in 2014. There are many patient requires new approaches. Partnering with families
safety and infection prevention features in the physical around strategies for facility design, transmission-based
environment being considered to enhance the current precautions, visitor screening, and communication at the
guidelines. This session will compare and contrast the bedside can moderate HAI risk, improve family experience,
infection prevention features of the 2010 guidelines and and support the best clinical outcomes.
will and describe proposed changes that will be included
in the 2014 edition. OBJECTIVES:
䡲 Describe, in terms of improved outcomes for patients, the critical
OBJECTIVES: benefits of partnering with families on infection prevention.
䡲 Identify the national direction being taken to increase the infection 䡲 Identify challenges that involving families in patient care present in terms
prevention capabilities of the physical environment. of potential for disease transmission and hospital acquired infection.
䡲 Access the FGI comment website to participate in the comment review 䡲 Identify family-centered approaches to infection prevention challenges.
process.
䡲 Define and discuss the role the physical environment has in preventing PRESENTERS:
Healthcare associated infections. Joan Heath, BSN, RN, CIC
Director, Infection Prevention Program
PRESENTERS: Seattle Children's Hospital
Linda Dickey, RN, MPH, CIC
Director of Epidemiology and Infection Prevention Lynel Westby, BA, RN
University of California Irvine Healthcare Director, Patient and Family Support Services
Seattle Children's Hospital
Douglas Erickson, BS, FASHE, CHFM, HFDP, CHC
Senior Project Manager MODERATOR: Lisa Outerbridge, RN
Northstar Management Co. LLC

MODERATOR: Barbara Soule, RN, MPA, CIC 9:30-10:30 a.m. | Session 2205 Room 217 D
Preventing CAUTI: Disrupting the Life Cycle of the
Urinary Catheter
This session will provide an overview of current and
upcoming surveillance, public reporting, and hospital
payment changes related to catheter-associated UTI
(CAUTI), and include an overview of recent progress and
challenges impacting rates of hospital-associated CAUTI.

OBJECTIVES:
䡲 Describe how challenges in data collection, interpretation, and
documentation urinary catheter use impacts public reporting and
reimbursement regarding hospital-acquired CAUTI rates.
䡲 Discuss current surveillance, public reporting, and major hospital
payment change requirements involving CAUTIs.
䡲 Describe recent trends in rates of hospital-acquired CAUTIs, according
to surveillance data and administrative data.

PRESENTER:
Jennifer Meddings, MD, MSc
Assistant Professor
University of Michigan
32
MODERATOR: Julia Moody, MS, SM (ASCP)
 9:30-10:30 a.m. | Session 2301 Room 212 A

Tuesday, June 5
Ask-the-Expert
9:30-10:30 a.m. | Session 2300 Room 212 B Occupational Health Issues That ‘Should’ Keep
You Up at Night
T's: Talk With Titus, Tom, and Tracy
This session will provide a concise review of key
Come meet a team from a large academic medical
occupational health issues relevant to infection control
center that, includes the administrative, healthcare
including an update of the recently released ACIP
epidemiology, and infection preventionist perspective.
immunization recommendations for healthcare providers
The presenters will discuss approaches and challenges
(HCP). We will discuss post-exposure prophylaxis for
related to the prevention of HAIs by fielding real-world
bloodborne pathogens, screening for TB, and work
questions and scenarios from the audience. Be prepared
restrictions.
for a dynamic and interactive discussion that will
showcase diverse approaches on how to tackle various
OBJECTIVES:
infection prevention issues.
䡲 Describe current ACIP recommendations for the immunization of
OBJECTIVES: healthcare personnel.
䡲 State the current recommendations for screening and treating HCP for
䡲 Describe the diverse approaches to IP challenges.
both latent and active TB.
䡲 Discuss IP issues relevant to participants and provide expert response.
䡲 Discuss the currently available post-exposure therapies for
䡲 Describe real world issues in Infection control and Prevention with
communicable disease exposure including HIV, HBV, and HCV.
practical and applicable solutions.

PRESENTERS:
PRESENTERS: David Henderson, MD
Titus Daniels, MD, MPH, MMHC
Deputy Director for Clinical Care
Vice Chair for Clinical Affairs, Department of Medicine
Clinical Center, National Institutes of Health
Vanderbilt University School of Medicine
David Weber, MD, MPH
Tracy Louis, MSN, RN, CIC
Professor
Infection Prevention Consultant
University of North Carolina at Chapel Hill
Vanderbilt University Medical Center

Thomas Talbot, MD, MPH

MODERATOR: Linda Gross, MSN, APRN, ANP-BC, CIC, COHN-S
Associate Professor of Medicine, Chief Hospital Epidemiologist
Vanderbilt University Medical Center

MODERATOR: Barbara Russell, RN, MPA, CIC

33
 Education Program Details

9:30-10:30 a.m. | Session 2302 Room 210 B Exhibit Hall Open

Tuesday, June 5

Bugs Behind Bars: Infection Prevention and Control in 10:30 a.m.-1:30 p.m. Exhibit Hall C & D
Jails, Prisons, and Mental Health Facilities Coffee break in the exhibit hall 10:30-11 a.m.
One percent of adults are currently incarcerated, and more
than 2 million adults are hospitalized with mental illness Complimentary lunch will be served in the back of the
annually. This session will provide useful information for exhibit hall from 11:30 a.m.–1 p.m. We welcome all
those tasked with prevention and control of MRSA, MTB, attendees with a wallet-style badge to join us.
influenza, norovirus, BBP, and other communicable
diseases in jails, prisons, and mental health facilities.
Knowledge Bar (APIC Village)
OBJECTIVES: 11 a.m.-1 p.m. APIC Village, Exhibit Hall C
䡲 Describe the basic demographics of those residing in jails, prisons, and Want to tap into all the expert knowledge running around
metal health facilities in this country. the 2012 APIC Annual Conference? Then visit the APIC
䡲 Understand the challenges and opportunities associated with prevention Knowledge Bar inside the APIC Village for an informal
and control of MRSA, gastroenteritis, tuberculosis, influenza, and other conversation with one or more clinical experts. Check
common contagious conditions within the correctional and mental on-site for the most current schedule of experts.
health setting.
䡲 Have a better appreciation of how improved infection prevention and 11 a.m. EXPERTS:
control within jails, prisons, and metal health facilities positively Ruth Carrico, PhD, CIC
impacts upon the public health of the outside community. Associate Professor
University of Louisville
PRESENTER:
Joseph Bick, MD Marita Nash, CHESP, MBA
Chief Medical Executive, Infectious Diseases Consultant Director of Environmental Services and Linen
California Medical Facility, California Correctional Health Care Services Hunterdon Medical Center

MODERATOR: Neil Pascoe, RN, BSN, CIC 12 p.m. EXPERT:

Jonathan Otter, MD
Research Fellow, CIDR & Scientific Director, Bioquell

9:30-10:30 a.m. | Session 2303 Room 210 A

Ambulatory Care Challenges of the Now and the Poster Presentations with Presenters
Future. Ask the Expert. Let's Talk.
12:30-1:30 p.m. Exhibit Hall D
The Accountable Care Act calls for more ambulatory
Posters are arranged by topic number, listed below, and
care. Federal focus on ambulatory on infection prevention
then numerically by publication number within each
programs. Federal patient safety reporting goes into
category.
effect October 2012 The ambulatory setting infection
preventionist wears more than one hat. Let's collaborate Antimicrobial Resistance 1-002 to 1-006
on dealing with these and other challenges. Emerging and Reemerging Infectious Diseases 5-057 to 5-062
Infection Prevention and Control Programs 8-078 to 8-128
OBJECTIVES: Outbreak Investigation 9-129 to 9-139
䡲 Itemize the patient safety issues reportable to CMS beginning October 2012. Public Reporting/ Regulatory Compliance 11-147 to 11-148
䡲 Discuss the challenges facing infection preventionists in the ambulatory Quality Management Systems/
settings. Process Improvement/Adverse Outcomes 12-149 to 12-186
䡲 Articulate the value of colloration with risk management to address the Surveillance 16-227 to 16-246
business/financial aspect of prevention of HAC.

PRESENTER:
Leilani Kicklighter, RN, ARM, MBA, CHSP, CPHRM, LHRM
Consultant, Risk Management, Infection Prevention and Patient Safety
The Kicklighter Group, LLC

MODERATOR: Kim Delahanty, RN, BSN, PHN, MBA/HCM, CIC

34
 Emily Rhinehart, RN, MPH, CIC, CPHQ

Tuesday, June 5
Concurrent Sessions
Vice President and Division Manager
1:30-2:30 p.m. | Session 2400 Room 214 CD Global Loss Prevention
MDR Gram-Negative Infections: Across the Continuum Chartis Insurance
of Care
Gram-negative infections are not just a hospital problem. MODERATOR: Lisa Outerbridge, RN
This session will focus on the impact that multi-drug
resistant Gram-negative bacilli have had on the
community and other healthcare settings. Methods for 1:30-2:30 p.m. | Session 2402 Room 217 B
control of spread of these pathogens will be reviewed Molecular Tools for Outbreak Investigations
and opportunities and challenges pertaining to these
This session will showcase modern technologies and
pathogens will be discussed.
tools to assist in outbreak investigations. Do you know
what Pulse Field Electrophoresis is? How do you use
OBJECTIVES:
antibiotic susceptibilities to determine the similarities of
䡲 Describe the epidemiology of MDR Gram-negative bacilli in community bacteria? Come join us for this session and hear how to
and healthcare settings. apply these technologies to improve your IP program.
䡲 Discuss different methods to control the spread of these pathogens in a
variety of settings. OBJECTIVES:
䡲 Describe challenges and opportunities for future management and
䡲 Identify and appraise the appropriate microbiological tool for
control for these pathogens.
identification and investigation of an outbreak.
䡲 Compare and contrast the advantages and disadvantages of available
PRESENTER:
techniques for identification of outbreaks.
Keith Kaye, MD, MPH
Professor of Medicine 䡲 Interpret findings and data from modern technologies used in clinical
Wayne State University microbiology that can assist outbreak investigations.

MODERATOR: Titus Daniels, MD, MPH PRESENTER:

Luke Chen, MBBS, MPH, CIC, FRACP
Co-Medical Director
Duke Program for Infection Prevention and Healthcare Epidemiology
1:30-2:30 p.m. | Session 2401 Room 217 A Duke University Medical Center
Infection Prevention Programs Measured Against
Evidenced-Based Practice MODERATOR: Neil Pascoe, RN, BSN, CIC
This session will provide the results of the assessment of
more than 20 hospital-based infection control programs.
The Best Practice Assessment for the Prevention of 1:30-2:30 p.m. | Session 2403 Room 214 AB
Healthcare-associated Infections is based upon published Perspectives on Use of Standardized Infection Ratios
guidelines and compendiums. The standardized (SIRs) for Assessing Performance: A Surgeon and an
assessment results in a score as well as the identification Infection Preventionist
of specific recommendations for improvement. Please refer to the addendum for full session details.

OBJECTIVES: PRESENTERS:
䡲 Identify sources of evidence-based practices that should be utilized to Lynn Janssen, MS, CIC
develop and implement infection prevention programs (IPP) and how to Coordinator, HAI Liaison Program
apply them in a standardized assessment. California Department of Public Health
䡲 Evaluate trends of non-compliance to best practices in a sample of
more than 20 US hospitals. MODERATOR: Debra Johnson, BSN, RN, CIC
䡲 Develop strategies to improve best practice in IPPs.

PRESENTERS:
Betsy Hugenberg, BSN, MSA, RN, CIC
Regional Consulting Manager
Healthcare Division
Global Loss Prevention
35
Chartis Insurance
 Education Program Details

1:30-2:30 p.m. | Session 2404 Room 217 C Workshops

Tuesday, June 5

Living Longer But are They Better? Targeted Methods 1:30-4 p.m. | Session 2700 Room 006 AB
to Improve Outcomes in Nursing Home Residents:
How and Why to Write an Abstract
Modifiable Risk Factors for Respiratory Infections
This workshop is designed to assist infection
The presenter will discuss key components of a structured
preventionists in developing their skills to successfully
program proven to modify risk factors for respiratory
prepare abstracts for submission to international
infections in nursing home residents. Methods of clinical
scientific conferences such as APIC. This session will
application will be described including: intensive oral
provide a hands-on, mentoring approach to guide the
hygiene, identification of dysphagia, aspiration prevention
participants in effective technical writing through
protocols, and a commitment to implement a universal
interactive discussions and feedback on drafted
vaccination program.
abstracts. You will leave this session with confidence
and the ability to submit an abstract to next year’s
OBJECTIVES:
APIC conference.
䡲 Describe the rationale and apply the key components of an effective oral
hygiene program. OBJECTIVES:
䡲 Implement three evidence- based interventions into actionable facility
䡲 Describe how to conduct an electronic literature search.
practices shown to have a significant impact on respiratory tract
䡲 Utilize real time peer review to generate submission ready abstracts.
infection outcomes in long-term care residents.
䡲 Define the essential components of an abstract.
䡲 Assess the effect of modifiable risk factors that increase the potential
for respiratory tract infections in nursing home residents.
PRESENTERS:
Kate Ellingson, PhD
PRESENTER: Epidemiologist
Sharon Bradley, RN, CIC Centers for Disease Control and Prevention
Senior Infection Prevention Analyst
ECRI Institute
Teresa Fulton, RN, MSN, CIC
Pennsylvania Patient Safety Authority
Chief Quality Officer
Whidbey General Hospital
MODERATOR: Alicia Halloran, RN, MSN
Mary Post, RN, MS, CNS, CIC
Infection Prevention Specialist
1:30-2:30 p.m. | Session 2405 Room 217 D Oregon Patient Safety Commission
Making “Contagion” Contagious: Views from the Lab
and the Set
You may have seen the hit movie, “Contagion” but did 1:30-4 p.m. | Session 2701 Room 007
you take note of what worked, what didn't and why? This Clean Spaces, Healthy Patients
session will be presented by the medical advisor who Environmental contamination plays a key role in the
guided the film makers. Practical and useful information transmission of several healthcare-associated pathogens
will be provided that will elevate your emergency including methicillin-resistant Staphylococcus aureus
preparedness to a whole new level. [MRSA], vancomycin-resistant Enterococcus [VRE],
Acinetobacter, norovirus, and Clostridium difficile. All
OBJECTIVES: these pathogens have been demonstrated to persist in
䡲 Describe the process by which the movie Contagion was made and the environment for hours to days (in some cases
promoted. months), frequently contaminate the environmental
䡲 Describe what worked and didn't work in the making of Contagion. surfaces in rooms of colonized or infected patients,
䡲 Describe why certain processes in the making of Contagion worked and transiently colonize the hands of healthcare personnel,
didn't work. be transmitted by healthcare personnel, and cause
outbreaks in which environmental transmission was
PRESENTER: deemed to play a role. Further, admission to a room in
W. Ian Lipkin, MD which the previous patient had been colonized or
Director, Center for Infection and Immunity infected with MRSA, VRE or C. difficile, has been shown
Columbia University to be a risk factor for the newly admitted patient to
develop colonization or infection.
36 MODERATOR: Lela Luper, RN, BS, CIC
OBJECTIVES: 1:30-4 p.m. | Session 2702 Ballroom C-3

Tuesday, June 5
䡲 Recognize the role of environmental contamination in the transmission Gaining Analytic Insights from NHSN for Prevention:
of HAIs. Focus on CLABSI and CAUTI
䡲 Identify four pathogens that have been demonstrated to persist in the This workshop will focus on analysis of HAI surveillance
environment and potentially cause outbreaks. data from NHSN. Presenters will demonstrate the use of
䡲 Describe best practices for environmental cleaning and assessment of the NHSN data in case-scenarios in order to apply analytic
adequacy of room disinfection practices to minimize transmission of HAIs. knowledge in assessing HAI experience, internal data
quality, and HAI prevention practices.
PRESENTERS:
William Rutala, BS, MS, PhD, MPH, CIC OBJECTIVES:
Director, Hospital Epidemiology; Professor; Director, Statewide Program
䡲 Apply statistical methods in the interpretation of rates and SIR
for Infection Control and Epidemiology
University of North Carolina Health Care and University of comparisons and understand methods behind statistical measures used
North Carolina School of Medicine in NHSN and for the CMS Hospital Inpatient Quality Reporting Program.
䡲 Correctly apply NHSN analytical functions to case-scenarios to illustrate
Philip Carling, MD, MPH analysis features and identify problems and successes within a
Clinical Professor of Medicine reporting facility.
Boston University School of Medicine 䡲 Understand how various metrics obtained from NHSN can be interpreted
and used to drive prevention of HAIs.
Curtis Donskey, MD
Chair, Infection Control Committee PRESENTERS:
Cleveland VA Medical Center Angela Bivens-Anttila, RN, MSN, NP-C, CIC
Nurse Epidemiologist
Nancy Havill, MT (ASCP) Centers for Disease Control and Prevention
Infection Prevention and Epidemiology Program
Hospital of Saint Raphael Margaret Dudeck, MPH, CPH
Epidemiologist
Jon Otter, MD Centers for Disease Control and Prevention
Research Fellow (CIDR) / Scientific Director (Bioquell)
Centre for Clinical Infection and Diagnostics Research (CIDR), Jonathan Edwards, MStat
Kings College London & Guys and St. Thomas Hospital NHS Research Mathematical Statistician
Foundation Trust / Bioquell Centers for Disease Control and Prevention

David Weber, MD, MPH Kelly Peterson, BBA

Professor NHSN Data Manager/Information Technologist Specialist
University of North Carolina at Chapel Hill Centers for Disease Control and Prevention

MODERATOR: Amy Nichols, RN, MBA, CIC MODERATOR: Shannon Oriola, RN, BSN, CIC, COHN
Sponsored by

37
 Education Program Details

Workshops Concurrent Sessions

Tuesday, June 5

1:30-4 p.m. | Session 2703 Room 006 CD 3-4 p.m. | Session 2500 Room 214 CD
Bored to Death? How to Sustain Quality and Safety The Emperor's New Clothes - CLABSI Definition and Its
Improvements in the ICU Impact on You, the IP
How many times has this happened to you? You finally Attendees will review the current NHSN definition for
managed to drop the rate of infection X/Y/Z in your ICUs. CLABSI, discuss potential concerns with the definition,
But six months later, it's creeping back up. In this session, and upcoming changes to address these concerns. Now
ICU clinicians will focus on approaches and tools to that CLABSI rates are being publically reported in many
enhance sustainability of improvements in the ICU setting. places, this issue has been elevated to new heights.

OBJECTIVES: OBJECTIVES:
䡲 Summarize key ICU-specific and human-factored barriers to sustaining 䡲 Identify potential pitfalls with the NHSN definition for CLABSI.
infection-control-related improvements from the point of view of ICU 䡲 Discuss the impact of the current NHSN definition on clinical activities
providers. and rapport between infection control and clinical teams.
䡲 Discuss key strategies for overcoming barriers to sustainability of 䡲 Discuss upcoming changes to the NHSN definition for CLABSI that
infection control-related improvements in the ICU. attempt to address current concerns.
䡲 Apply these strategies to increase sustainability of improvements in
their own ICUs. PRESENTER:
Dev Anderson, MD, MPH
Assistant Professor of Medicine
PRESENTERS: Duke University Medical Center
Jean Gillis, RN, MS
Clinical Nurse Specialist
MODERATOR: Vickie Brown, RN, MPH, CIC
Beth Israel Deaconess Medical Center

Michael Howell, MD, MPH

Director, Critical Care Quality 3-4 p.m. | Session 2501 Room 217 A
Beth Israel Deaconess Medical Center / Harvard Medical School Prolonged Use of Respiratory Protection:
How Does it Affect the Healthcare Worker?
MODERATOR: Nancy Zanotti, RN, BSN, MPA, CIC Healthcare personnel (HCP) wear respirators to protect
themselves from acquiring disease. What do we know
about the physiological and psychological effects of
1:30-4 p.m. | Session 2704 Room 008 long-term respirator usage, such as during outbreaks or
Beyond CMS: Assessing Your Ambulatory Facility pandemics? Research related to long-term respirator
Utilizing a worksheet that has guided one institution's usage, including a surgical mask overlay as
journey through four successful accreditation surveys in recommended by the Institute of Medicine, will be
five years, you will learn to assess all aspects of infection reviewed and health policy guidance will be provided.
prevention in your physician practice or specialty clinic
from safe injection practices to disinfection and
OBJECTIVES:
sterilization to refrigerated medications and beyond. 䡲 Identify obstacles to long-term respiratory protection use among HCP.
䡲 Recognize physical, psychological, and behavioral findings that may
OBJECTIVES: place HCP at risk when wearing respiratory protective equipment.
䡲 Describe interventions that may protect HCP wearing respiratory
䡲 Utilize the provided worksheet to guide an infection prevention
protective equipment for prolonged periods.
assessment of an ambulatory care facility.
䡲 Collect and analyze data as a result of implementation of the worksheet. PRESENTERS:
䡲 Conduct an effective and complete assessment of an ambulatory care Ruth Carrico, PhD, RN, FSHEA, CIC
facility. Associate Professor
School of Public Health and Information Sciences
PRESENTER: University of Louisville
Judie Bringhurst, RN, MSN, CIC
Infection Prevention Coordinator, Ambulatory Care Terri Rebmann, PhD, RN, CIC
UNC Healthcare System Associate Professor
Institute for Biosecurity
38 Saint Louis University School of Public Health
MODERATOR: Amy Richmond, RN, BSN, MHS, CIC
MODERATOR: Judith English, RN, MSN, CIC
3-4 p.m. | Session 2502 Room 214 AB 3-4 p.m. | Session 2505 Room 217 D

Tuesday, June 5
A Long and Winding Road: Meeting Current Planning and Implementation of an Infection
Challenges, Preparing for Future Demands: APIC Prevention and Control Training Program for
Introduces a Model of IP Competency Healthcare Providers in Latin America
This session will review the Infection Preventionist With healthcare institutions and educational centers
Competency Model developed by APIC leaders. The hosting this course, we collaboratively planned and
model illustrates a path for current and future practice implemented a multinational infection prevention and
along the infection preventionist's career span. The control (IPC) training course in Latin America to build
design of the model will be reviewed as well as the four their IPC program capacity. We trained over 150
competency domains and recommended areas for infection preventionists and most of them are improving
professional development. IPC in their country's hospitals.

OBJECTIVES: OBJECTIVES:
䡲 Discuss principles behind the development of the IP Competency Model 䡲 Describe the historical context of the IP career development in Latin
and elements of the model's graphic design. America.
䡲 Identify the four key competency domains and success factors 䡲 Describe the role and responsibilities of the IP.
associated with each domain. 䡲 Upon completion the participant will be able to describe educational
䡲 Discuss how the competency model can support professional resources for IPs in Latin America.
development from novice to expert practice and can be applied in
diverse settings. PRESENTER:
Miguela Caniza, MD
PRESENTERS: Associate Member, Department of Infectious Diseases
Terrie Lee, RN, MS, MPH, CIC Director of the Infectious Disease - International Outreach
Director, Infection Prevention and Employee Health St. Jude Children's Research Hospital
Charleston Area Medical Center, Charleston, WV
MODERATOR: Barbara Bor, BSN, CIC
Denise Murphy, RN, BSN, MPH, CIC
Vice President, Quality and Patient Safety Ask-the-Expert
Main Line Health System 3-4 p.m. | Session 2600 Room 212 B
Preventing CAUTI: Disrupting the Lifecycle of the
Russell Olmsted, MPH, CIC
Director, Infection Prevention and Control Services
Urinary Catheter
Saint Joseph Mercy Health System This session will describe a new conceptual model - the
lifecycle of the urinary catheter - to help frame the
MODERATOR: Marilyn Hanchett, RN, MA, CPHQ, CIC discussion and organize many potential interventions for
preventing CAUTIs into a series of actionable targets.
Pearls and pitfalls for implementation shall be showcased.
3-4 p.m. | Session 2504 Room 217 C
OBJECTIVES:
Clostridium difficile in Long-term Care Facilities
䡲 Identify actionable targets in the lifecycle of the urinary catheter to
Long-term care facilities (LTCFs) have borne a significant
design and implement interventions to prevent hospital-acquired
proportion of the increasing burden of Clostridium
CAUTIs.
difficile infection (CDI). This session will focus on the
䡲 Summarize tools and strategies available to reduce inappropriate
epidemiology of CDI in LTCFs and present scenarios
catheter placement and prolonged use.
that illustrate challenges for diagnosis, prevention,
䡲 Recognize common challenges in implementing CAUTI prevention
and NHSN reporting requirements in LTCF.
interventions, to inform and modify on-going and future interventions.

PRESENTERS: PRESENTER:
Curtis Donskey, MD
Jennifer Meddings, MD, MSc
Chair, Infection Control Committee
Assistant Professor
Cleveland VA Medical Center
University of Michigan

MODERATOR: D. Kirk Huslage, RN, BSN, MSPH MODERATOR: Beth Ann Kavanaugh, MT (ASCP), MS, MBA, CIC
39
 Education Program Details

Wednesday, June 6
3-4 p.m. | Session 2602 Room 210 B Posters on Display
Tuesday, June 5

Evidence-Based Prevention of Catheter-Related BSI 7 a.m.-1 p.m. Exhibit Hall D

Please refer to the addendum for full session details.

PRESENTER: Concurrent Sessions

Dennis Maki, MD 8-9 a.m. | Session 3000 Room 214 CD
Professor of Medicine
Department of Medicine - Infectious Disease Division Hand Hygiene Update
University of Wisconsin School of Medicine & Public Health For such a ‘simple’ and low-tech procedure, hand
hygiene (HH) has received increasing attention from both
MODERATOR: Carole Guinane, RN, MBA clinicians and administrators/regulators. In the session,
we will discuss the latest thinking and research
regarding HH efficacy and behavioral strategies.
3-4 p.m. | Session 2603 Room 210 A
OBJECTIVES:
The Role of the Infection Preventionist in Clostridium
difficile Infection Prevention 䡲 Describe and assess evidence-based and indicator-based strategies for
monitoring HH.
This review of the current topics relevant to the
䡲 Examine the role of leadership in HH behavior.
prevention of healthcare acquired Clostridium difficile
䡲 Discuss recent information about motivators and individual differences
infections will showcase the role of the infection
and perceptions regarding HH.
preventionist. A focus on the four work streams to
prevent CDI will include hand hygiene, environmental
PRESENTER:
cleaning, isolation practices, and antimicrobial
Elaine Larson, PhD, FAAN, RN, CIC
stewardship. Associate Dean
Columbia University School of Nursing
OBJECTIVES:
䡲 Describe environmental cleaning practices which can reduce HAIs and MODERATOR: Jolynn Zeller, RN, BS, CIC
list one innovative method to improve hand hygiene adherence and
isolation practices.
䡲 Describe measures of quality to determine adequate environmental 8-9 a.m. | Session 3001 Room 217 A
decontamination.
Social Networks of Infection Preventionists to Share
䡲 Describe how the IP can contribute to the development, maintenance,
Knowledge
and enhancement of a successful antimicrobial stewardship program.
Many opportunities exist for the use of social networking
PRESENTERS: in sharing knowledge and initiating and maintaining
Sue Barnes, RN, BSN, CIC collaboration with peers across all healthcare settings.
National Program Leader Infection Prevention and Control Using the social networks identified among infection
Kaiser Permanente preventionists in Kentucky and Iowa as examples, this
session will demonstrate the knowledge sharing impact
Stephen Parodi, MD and capabilities of these networks.
Chairman, The Permanente Medical Group Chiefs of Infectious Disease
Kaiser Permanente OBJECTIVES:
䡲 Define social networks and demonstrate their impact on infection
MODERATOR: Kim Delahanty, RN, BSN, PHN, MBA/HCM, CIC prevention and control in various types of healthcare facilities.
䡲 Describe the existing knowledge sharing processes using an evaluation
of the social networks identified among IPs in Kentucky and Iowa.
䡲 Identify opportunities to improve knowledge sharing, communication,
4:30-6 p.m. Room 205 and infection prevention and control practice through the use of social
APIC Business Meeting (Members Only) networks.
Meeting materials can be picked up at APIC Central
starting on Sunday, June. 3. PRESENTER:
Timothy Wiemken, PhD, MPH, CIC
Instructor of Medicine
40 University of Louisville School of Medicine, Division of Infectious Diseases

MODERATOR: Shannon Oriola, RN, BSN, CIC, COHN

 Wednesday, June 6
8-9 a.m. | Session 3002 Room 217 B 8-9 a.m. | Session 3004 Room 217 C
Antimicrobial Stewardship: Optimizing Outcomes by A Collaborative Approach to Prevent CLABSI in
Improving Antimicrobial Prescribing Practices Hemodialysis Patients
The use of antimicrobial agents has been associated with This session will review the CDC’s perspective on
adverse consequences, including the development and bloodstream infections (BSI) in hemodialysis and review
propagation of antimicrobial resistance. In this session, strategies for prevention, including data from the
we will discuss strategies that can be used to improve Dialysis BSI Prevention Collaborative. The presenters will
antibiotic prescribing practices and practical suggestions share their experiences and interventions leading to 1) a
for implementation of these strategies in hospitals and sustained reduction of CLABSIs and 2) overcoming
other healthcare settings. barriers and enacting change.

OBJECTIVES: OBJECTIVES:
䡲 Describe the association between antimicrobial use and antimicrobial 䡲 Describe a collaborative approach to preventing BSIs and advantages of
resistance. this approach.
䡲 Define antimicrobial stewardship and list three benefits that 䡲 Identify several evidence-based practices that can be implemented in
antimicrobial stewardship programs may bring to a healthcare facility. your hemodialysis facilities to reduce bloodstream BSIs.
䡲 List at least three strategies to optimize antimicrobial prescribing 䡲 Describe how one facility overcame barriers to address practical
practices within a healthcare facility. challenges and adopt new practices.

PRESENTER: PRESENTERS:
David Calfee, MD, MS Virginia (Ginnie) Bren, RN, MPH, CIC
Associate Professor of Medicine and Public Health Infection Control Coordinator
Weill Cornell Medical College Altru Health System

MODERATOR: Lela Luper, RN, BS, CIC, Gemma Downham, MPH, CIC
Infection Prevention Epidemiologist
AtlantICare Regional Medical Center
8-9 a.m. | Session 3003 Room 214 AB Priti Patel, MD, MPH
Working Overseas in Military Infection Control Medical Officer
Have you ever considered being an infection control Centers for Disease Control and Prevention
consultant in a foreign country? The presenter will
describe some of the challenges, successes, and rewards MODERATOR: Sue Barnes, RN, CIC
encountered during her tenure providing infection
control care to wounded warriors in a Level One Trauma
Military setting in Germany. 8-9 a.m. | Session 3005 Room 217 D
Prevention of Catheter Related BSI: Zero Will Not Be
OBJECTIVES: Achievable Without Technology
䡲 Discuss challenges involved in developing MDRO screening protocols for Please refer to the addendum for full session details.
injured soldiers arriving from the battlefield.
䡲 Describe the utilization of evidence- based isolation principles for PRESENTER(S):
developing on-the-spot solutions when facing emerging pathogens. Dennis Maki, MD
䡲 Utilize provided references, policies, tools, and checklists to facilitate Professor of Medicine
site assistance visits in a variety of settings. Department of Medicine - Infectious Disease Division
University of Wisconsin School of Medicine & Public Health
PRESENTER:
Jane Pool, RN, MS, CIC MODERATOR: Frank Myers, MA, CIC
Director, Infection Prevention and Control
Department of the Army

MODERATOR: Mary Post, RN, MS, CNS, CIC

41
 Education Program Details

8-10:30 a.m. | Session 3102 Ballroom C-3

Wednesday, June 6

Workshops
8-10:30 a.m. | Session 3100 Room 006 AB Gaining Analytic Insights from NHSN for Prevention:
Focus on Surgical Site Infection
To Lead or to Follow: That is the Question
This workshop will focus on analysis of surgical site
Leadership is the topic of countless books, courses, and
infection (SSI) surveillance data from NHSN. Presenters
workshops. Followership is a topic often overlooked or
will demonstrate the use of NHSN data in case-scenarios
forgotten. This workshop will explore why the distinctions
in order to apply analytic knowledge in assessing SSI
among followers are every bit as consequential as those
experience, internal data quality, and SSI prevention
among leaders, and have critical implications for how
practices.
leaders should lead, and managers should manage.
OBJECTIVES:
OBJECTIVES:
䡲 Describe the characteristics of transformational leaders and effective 䡲 Apply statistical methods in the interpretation of rates and SIR
followers. comparisons and understand methods behind statistical measures used
䡲 Analyze the leader-follower relationship. in NHSN and for the CMS Hospital Inpatient Quality Reporting Program.
䡲 Enhance personal leadership and followership skills. 䡲 Correctly apply NHSN analytical functions to case-scenarios to illustrate
analysis features and identify problems and successes within a
PRESENTER: reporting facility.
Mary Lou Manning, PhD, CRNP, CIC 䡲 Understand how various metrics obtained from NHSN can be interpreted
Associate Professor, Director Doctor of Nursing Practice Program and used to drive prevention of HAIs.
Thomas Jefferson University
PRESENTERS:
MODERATOR: Titus Daniels, MD, MPH Angela Bivens-Anttila, RN, MSN, NP-C, CIC
Nurse Epidemiologist
Centers for Disease Control and Prevention
8-10:30 a.m. | Session 3101 Room 007
Margaret Dudeck, MPH, CPH
Using Performance Improvement Tools to Drive Epidemiologist
Infection Prevention Centers for Disease Control and Prevention
Performance Improvement is a critical competency for
infection preventionists. This session will review basic Jonathan Edwards, MStat
steps in the improvement process, including Research Mathematical Statistician
implementation science, Lean and Six Sigma. Examples Centers for Disease Control and Prevention
of how meaningful change in process and/or behaviors to
reduce HAIs shall be shared. Kelley Petersen, BBA
NHSN Data Manager/Information Technologist Specialist
Centers for Disease Control and Prevention
OBJECTIVES:
䡲 Discuss steps involved in setting up a performance/process
MODERATOR: Lynn Janssen, MS, CIC
improvement project.
䡲 Identify at least two different methods that have been used for
infection prevention related PI projects: Lean and Six Sigma.
䡲 Describe gaps that may be barriers to achieving zero CLABSI and
solutions for some of these barriers.

PRESENTERS:
Mustafa Abdulali, MBA
Lead Performance Improvement Engineer
Main Line Health System

Denise Murphy, RN, BSN, MPH, CIC

Vice President, Quality and Patient Safety
Main Line Health System

MODERATOR: Debra Johnson, BSN, RN, CIC

42
 Wednesday, June 6
8-10:30 a.m. | Session 3103 Room 006 CD 8-10:30 a.m. | Session 3104 Room 008 AB
Innovation at the Front Line: A Deep Discovery of Why Challenges and Success in Caring For the
and a Firing Up the Imagination for How Immunocompromised Patients in Low Income Countries
The unlikely combination of design and healthcare Infections are major reasons for failure to cure cancer
is yielding imaginative ideas and powerful results. throughout the world, and more so in low income
This workshop will explore design thinking and offer a countries (LIC). Good understanding of the rates and
hands-on opportunity to try out a few “easy to apply” types of infections, as well as risk factors for these
techniques. infections, is a required step for targeted interventions.
In these presentations we will review the most frequent
OBJECTIVES: types of infections and their risks based on the types of
䡲 Understand the basics of design thinking. malignancies and phases of anticancer treatment.
䡲 Ability to more fully explore problems with qualitative and creative Causes of these infections are multifactorial and
techniques. focusing on targeted and cost effective interventions is
䡲 Better understand how the human complexities of medication feasible to improve outcomes.
administration and how Kaiser Permanente solved the challenge.
OBJECTIVES:
PRESENTERS: 䡲 Describe current challenges in infection prevention and control in LICs.
Chris McCarthy, MBA, MPH 䡲 List main infectious complications in cancer and their risk factors.
Innovation Specialist / Director 䡲 List interventions feasible for LICs.
Kaiser Permanente
PRESENTERS:
Stephen Szermer, MID Miguela Caniza, MD
Collaborative Lead Associate Member, Department of Infectious Diseases; Director of the
Innovation Learning Network Infectious Disease - International Outreach
St. Jude Children’s Research Hospital
MODERATOR: Amy Richmond, RN, BSN, MHS, CIC
Joanna Acebo, MD
Pediatric Infectious Diseases Physician
Hospital SOLCA-Ncleo de Quito

Sergio Gomez, MD
Hematologist/Bone Marrow Transplant
Hospital de Niños de La Plata

Alejandro Macias, MD
Head, Infection Control
National Institute of Medical Sciences and Nutrition

Elham Mandegari, MD
ID Pediatrics
Hospital Escuela, Honduras

Mario Melgar, MD
Infectious Diseases Physician
Unidad Nacional de Oncología Pediátrica

MODERATOR:
Don Guimera, BSN, RN, CIC ,CCRP

43
 Education Program Details

9:30-10:30 a.m. | Session 3202 Room 217 B

Wednesday, June 6

Concurrent Sessions
9:30-10:30 a.m. | Session 3200 Room 214 CD Your Infection Prevention Program: How to Size it and
How to Sell it
Vaccine Preventable MDROs and HAIs
Infection Prevention is in the limelight--let’s take advantage
This session will review the use of influenza vaccine,
of it! Multiple agencies are increasingly interested in the
pneumococcal vaccine, and varicella/zoster vaccines to
infection prevention arena. We’ll discuss some successful
prevent infections with multidrug-resistant pathogens. The
strategies for determining what types and number of
use of vaccines to prevent healthcare-associated infections
resources your program needs to meet those requests,
such as MRSA and C. difficile will also be discussed.
and presenting the business case to senior leaders.
OBJECTIVES:
OBJECTIVES:
䡲 Upon completion participants will understand the key role vaccines play
in public health. 䡲 Define discrete tasks necessary to respond to additional requests for IP
䡲 Upon completion participants will understand how vaccines can be used information.
to prevent infection with multidrug-resistant pathogens. 䡲 Articulate two methods for “sizing” defined tasks.
䡲 Upon completion participants will understand the current state of 䡲 Develop escalating plans for requesting appropriate resources.
research on using vaccines to prevent infections due to healthcare-
associated pathogens (e.g., MRSA, C. difficile). PRESENTER:
Amy Nichols, RN, MBA, CIC
PRESENTER: Director, Hospital Epidemiology and Infection Control
David Weber, MD, MPH University of California Medical Center and Benioff Children’s Hospital
Professor
University of North Carolina at Chapel Hill MODERATOR: Kim Delahanty, RN, BSN, PHN, MBA/HCM, CIC

MODERATOR: Vickie Brown, RN, MPH, CIC

9:30-10:30 a.m. | Session 3203 Room 214 AB
Changing the Approach to VAP Surveillance
9:30-10:30 a.m. | Session 3201 Room 217 A This session will provide an overview of the development
Fecal Transplants of a new ventilator-associated event algorithm developed
Did you ever, in your wildest dreams, imagine that stool in collaboration with several key societies and
would be a treatment therapy? This session will review organizations. Perspectives on this changing approach to
the scientific rationale for fecal bacteriotherapy for VAP surveillance will be provided by representatives from
patients with severe Clostridium difficile disease. the CDC, Critical Care and APIC.
Practical considerations such as the identification and
screening of suitable recipients and donors, and the OBJECTIVES:
details of performing the procedure will be discussed to 䡲 Discuss the process of revising the approach to VAP surveillance in the
aid in the development of a program. National Healthcare Safety Network.
䡲 Review the new approach to surveillance for ventilator-associated events.
OBJECTIVES: 䡲 Discuss the potential risks and benefits of the new approach from the
䡲 Describe the role of fecal bacteriotherapy in the treatment of refractory perspectives of infection control and prevention, critical care and public
or relapsing Clostridium difficile disease. health.
䡲 Recognize the role of the IP in the development and implementation of a
fecal transplant program. PRESENTERS:
䡲 Develop a program at your facility which will allow for the practical Linda Greene, RN, MPS, CIC
delivery of this important therapy. Director of Infection Prevention
Rochester General Health System
PRESENTER:
Stephen Parodi, MD Beth Hammer, MSN, RN, APN-BC
Chairman, The Permanente Medical Group Chiefs of Infectious Disease Nurse Practitioner
Kaiser Permanente American Association of Critical-Care Nurses

MODERATOR: Barb DeBaun, RN, MSN, CIC Shelley Magill, MD, PhD
Medical Officer
Centers for Disease Control and Prevention
44
MODERATOR: Linda Goss, MSN, APRN, ANP-BC, CIC, COHN’s
 Wednesday, June 6
9:30-10:30 a.m. | Session 3204 Room 217 C Ask-the-Expert
Update on HAIs in Long-term Care 9:30-10:30 a.m. | Session 3300 Room 212 B
If you are interested in knowing about the latest efforts SCIP and Beyond
being made by CMS, HHS and other partners to reduce
While the SCIP process initiative represents the first step
HAIs in long-term care facilities, this is the session for you.
in improving patient outcomes, additional evidence-based
practices should be embraced in our efforts to reduce risk,
OBJECTIVES:
improving surgical patient care. The present discussion
䡲 Describe the current state of the science of HAI prevention in long-term will focus on those adjunctive strategies that together
care facilities. with SCIP provide an evidence-based care bundle.
䡲 Identify research opportunities/knowledge gaps in our understanding of
HAI prevention in long-term care. OBJECTIVES:
䡲 Describe several factors that may influence rates of HAIs in long-term care.
䡲 Describe the pros and cons of the current SCIP process initiative.
䡲 Review the role of patient intrinsic and extrinsic risk factors in the
PRESENTER:
evolution of postoperative surgical site infections.
Ian Kramer, MS
Social Science Research Analyst 䡲 Discuss the evidence-based foundation for adjunctive interventional
Office of Clinical Standards and Quality, Centers for Medicare & strategies for reducing surgical patient morbidity and mortality.
Medicaid Services
PRESENTER:
MODERATOR: Karen Hoffmann, RN, MS, CIC Charles Edmiston, PhD, MS, CIC
Professor, Surgery and Hospital Epidemiologist
Medical College of Wisconsin

9:30-10:30 a.m. | Session 3205 Room 217 D MODERATOR: Sue Barnes, RN, CIC
Hospital Disinfection and Disinfectant Resistance:
What We Know, What We Don’t, and What We Wish
We Knew 9:30-10:30 a.m. | Session 3301 Room 212 A
This session will explore the use of disinfectants and
State HAI Prevention Programs: Why LTC Should Be
resistance to disinfectants in the healthcare setting, with
Engaged
a particular focus on chlorhexidine gluconate (CHG).
Please refer to the addendum for full session details.
OBJECTIVES:
OBJECTIVES:
䡲 Identify key products used in hospital disinfection.
䡲 Describe why state HAI programs are expanding their efforts to include
䡲 Distinguish between antimicrobial resistance and disinfectant
long-term care (LTC) providers.
resistance.
䡲 Provide examples of state HAI prevention activities specific to LTC
䡲 Distinguish between disinfectant resistance and disinfectant tolerance.
settings.
䡲 Discuss the benefits for LTC facilities to get involved in state HAI
PRESENTER:
James Johnson, MD, MPH prevention opportunities.
Instructor of Medicine
Vanderbilt University PRESENTER:
Nimalie Stone, MD, MS
MODERATOR: Keith Howard, RN, BSN, CIC Medical Epidemiologist for Long-term Care
Division of Healthcare Quality Promotion
Centers for Disease Control and Prevention

MODERATOR: Sharon Williamson, MT (ASCP), SM, CIC

45
 Education Program Details

9:30-10:30 a.m. | Session 3302 Room 210 B

Wednesday, June 6

Exhibit Hall Open

New Initiatives to Reduce Healthcare-Associated 10:30 a.m.-1 p.m. Exhibit Hall C & D
Infections Among Hemodialysis Patients Coffee break in the exhibit hall 10:30-11 a.m.
This session will address the role of the infection
preventionist in emerging healthcare-associated infection Complimentary lunch will be served in the back of the
prevention and surveillance efforts in outpatient exhibit hall from 11:30 a.m.–1 p.m. We welcome all
hemodialysis settings. attendees with wallet-style badges to join us.

OBJECTIVES:
䡲 Identify three actions you can take to improve prevention and Knowledge Bar (APIC Village)
surveillance of hemodialysis-related infections. 11 a.m.-1 p.m. APIC Village, Exhibit Hall C
䡲 Describe national initiatives targeting hemodialysis-related infections. Want to tap into all the expert knowledge running around
䡲 List several interventions used by the CDC Dialysis BSI Prevention the 2012 APIC Annual Conference? Then visit the APIC
collaborative to reduce hemodialysis bloodstream infections. Knowledge Bar inside the APIC Village for an informal
conversation with one or more clinical experts. Check
PRESENTER: on-site for the most current schedule of experts.
Priti Patel, MD, MPH
Medical Officer 11 a.m. EXPERT:
Centers for Disease Control and Prevention Nancy Havill, MT (ASCP)
Infection Prevention and Epidemiology Program
MODERATOR: Beth Ann Kavanaugh, MT(ASCP), MS, MBA, CIC Hospital of Saint Raphael

9:30-10:30 a.m. | Session 3303 Room 210 A Concurrent Sessions

Immune-Compromised Patients 1-2 p.m. | Session 3400 Room 214 CD
This session will provide an open forum for attendees to Innovations in HAI Data Validation
ask questions about infection prevention specific to their This session will describe the process New York State
immune compromised patients. employs to ensure accurate and valid hospital infection
rates in preparation for an annual public report. A
OBJECTIVES: demonstration of tools used to manage the validation
䡲 Identify three abnormalities in immune system function which increase process will provide the infection preventionist with
the risk of infection. techniques to self-evaluate data quality.
䡲 Identify four recommended elements of Protective Isolation.
䡲 Identify two risk factors for invasive fungal disease. OBJECTIVES:
䡲 Describe the components of a process needed to ensure accurate hospital
PRESENTERS: infection data used for creating infection rates for public reports.
Jennie Mayfield, BSN, MPH, CIC 䡲 Describe the techniques and tools New York State employs to validate
Clinical Epidemiologist hospital data prior to the public release of hospital acquired infection rates.
Barnes-Jewish Hospital/Washington University School of Medicine 䡲 Demonstrate tools developed to systematically collect and analyze
validation results and understand their impact on indicator specific
Jan Patterson, MD, MS, FSHEA (2012 SHEA President)
infection rates.
Professor of Medicine/Infectious Diseases and Associate Dean, Quality
& Lifelong Learning
University of Texas Health Science Center at San Antonio and South PRESENTER:
Texas Veterans Health Care System Carole Van Antwerpen, RN, BSN, CIC
Assistant Director Bureau Healthcare-Associated Infections
New York State Department of Health
MODERATOR: Annemarie Flood, RN, BSN, CIC
MODERATOR: Linda Goss, MSN, APRN, ANP-BC, CIC, COHN’s

46
 Wednesday, June 6
1-2 p.m. | Session 3401 Room 217 A 1-2 p.m. | Session 3402 Room 217 B
30/30 Session - Two great topics one convenient hour The Ticket for Your Leadership Journey:
So You Want to Volunteer? Preparing for a Volunteer APIC’s Credential of Competence
Infection Prevention Medical Mission Not Certified? This session is for you! Attend this panel
Medical Mission work provides challenges and rewards session to hear about the importance of certification as a
for the nurse in infection prevention. This presentation core component of the new APIC infection prevention
will showcase stories that will demonstrate what it’s like competency model. IPs across the career span (early,
to “be in the trenches” in underdeveloped countries, middle, and advanced) will share examples of how
and develop a new appreciation for the work you do. certification has made an impact in their professional
development and careers. The patient/consumer and a
OBJECTIVES: unique Canadian perspective on the significance of the
CIC® credential will also be presented. Details of both
䡲 Describe a typical medical/surgical environment in a less
APIC and CBIC strategic priorities will be detailed as
economically developed environment/country.
they pertain to the competency model and certification
䡲 Recognize and understand the impact of cultures and environments
in infection prevention and control.
that present infection risks and obstacles which must be overcome to
prevent the spread of infection.
OBJECTIVES:
䡲 Demonstrate infection control measures that adapt to the
environment with limited resources on hand. 䡲 Recognize the APIC and CBIC strategic priorities for promoting the value
of certification.
PRESENTER: 䡲 Demonstrate how the CIC® credential supports the leadership and
Mary Sibulsky, RN professional journey for the novice, intermediate and advanced Infection
Nurse Manager, AAAHC Surveyor Preventionist.
North Idaho Eye Institute, International Eye Institute, 䡲 Examine the scientific evidence for certification and the impact on
Medical Reserve Corps patient safety outcomes.

PRESENTERS:
Surviving an EF-5 Tornado-Infection Prevention Maria Bovee, MPH, CIC
Required Infection Preventionist
This might sound like a nightmare but imagine that Children’s Memorial Hospital
your hospital has taken a direct hit by an EF-5 Tornado.
Over one third of your city has been destroyed. Evacu- Michael Cloughessy, MS, BSEH, REHS, CIC
ation must be completed in 90 minutes. What would Senior Infection Control Practitioner
you do? Come and hear how this team mobilized an Cincinnati Children’s Hospital
inpatient mobile medical unit in seven days and
remained fully functional for four months. You will Michelle Farber, RN, CIC
Manager, Infection Prevention and APIC President, 2012
hear about infection prevention lessons and you will be
Mercy Community Hospital
eager to share.
Jean Rexford, CT
OBJECTIVES: Executive Director,
䡲 List three infection prevention strategies that should be incorporated Connecticut Center for Patient Safety
into an evacuation plan and recovery response.
䡲 Describe the process for recognition of infection trends in the disaster Barbara Russell, RN, MPH, CIC
aftermath. Director, Infection Prevention and Control
䡲 Describe infection prevention principles necessary to establish a fully Baptist Hospital of Miami
functioning alternate healthcare site following a disaster.
Donna Wiens, RN, BN, CIC
Director, Infection Prevention and Control,
PRESENTER:
Past President CHICA-Canada
Donna Stokes, RN
CHICA-Canada
Infection Control Coordinator
Mercy-St. John’s Joplin
MODERATOR: Katrina Crist, MBA
MODERATOR: Cheryl Sharp, LVN, CIC
47
 Education Program Details

1-2 p.m. | Session 3403 Room 214 AB 1-2 p.m. | Session 3405 Room 217 D
Wednesday, June 6

To End or Not to End? When Should Contact PICU Performance Improvement in Reducing Device
Precautions be Discontinued? National Survey Rates
of Infection Preventionists Related to Contact Children’s hospital patient safety and QI project preventing
Precautions for MRSA and VRE VAP/CLABSI using Six Sigma methods, allowed us to go
There are currently no national guidelines with respect more than 365 days without a VAP! Never heard of Six
to when Contact Precautions can be terminated. This Sigma? Come hear about how Six Sigma found the
National Survey of IP’s related to practices associated causes of our infections allowing us to taylor solutions
with Contact Precautions for MRSA and VRE will specifically preventing these HAIs!
showcase the current approaches to this dilemma.
The results of the survey will be discussed in the OBJECTIVES:
context of strategies for addressing the growing burden 䡲 Learn specific ways to engage RNs, MDs, and RTs to change the culture
of MRSA and VRE colonized patients. of a PICU to work together to prevent CLABSI and VAP.
䡲 Explain why it is important to take whatever time is necessary to define
OBJECTIVES: the problem causing HAI in PICU vs. adult units.
䡲 Describe current national policy with regards to implementation of 䡲 Obtain tools to measure Nursing Policy’s (e.g., Hand Hygiene, CVAD) and
Contact Precautions (CP) for MRSA and VRE. unit-based process measure compliance (e.g., steps to prevent VAP)
䡲 State the results of a national survey of Infection Preventionists. providing feedback to bedside staff.
䡲 Discuss how institutions are implementing CP and methods used for
documenting clearance of colonization and discontinuation of CP. PRESENTERS:
Tina Adams, RN
PRESENTER: Infection Preventionist
Paula Wright, RN, BSN, CIC University of North Carolina at Chapel Hill Health Care
Director, Infection Control Unit
Massachusetts General Hospital Cherissa Hanson, MD
Assistant Professor of Anesthesiology and Pediatrics
MODERATOR: Suzanne Cistulli, BSN, RN, CIC The University of North Carolina School of Medicine

MODERATOR: Vickie Brown, RN, MPH, CIC

48
 Wednesday, June 6
Workshops 1-3:30 p.m. | Session 3501 Room 006 AB
1-3:30 p.m. | Session 3500 Room 007 Fearless Facilitation: How to Get Everybody Talking
High-Level Disinfection, Sterilization and Antisepsis Engage your audience to make your message memorable.
You’ll learn to unify the group in the first four minutes,
Sterilization, high-level disinfection and antiseptics are
use activities that honor the experience of your audience,
used to reduce microbial contamination on instruments
and inspire creative thinking at all levels. Find the
or skin. This workshop will discuss the proper use of
fearless facilitator in you without overused techniques,
these methods to reduce microbial contamination and
expensive assessments or tools.
prevent disease based on scientific studies of efficacy
and effectiveness.
OBJECTIVES:
OBJECTIVES: 䡲 Describe a technique that unifies a group.
䡲 State key program points to facilitate and involve your audience.
䡲 Upon completion, participants will be able to describe the evolution of
䡲 Describe techniques designed to adapt to a variety of audience
disinfection and sterilization products and practices over 30 years.
members (jobs, levels, experiences and attitudes).
䡲 Upon completion, participants will be able to list the disinfectants used
in health care and how research directed their use.
PRESENTER:
䡲 Upon completion, participants will be able to discuss new technologies
Cyndi Maxey
and how these technologies improved practice. President, Maxey Creative Inc.
Speaker
PRESENTERS:
William Rutala, BS, MS, PhD, MPH, CIC MODERATOR: Keith Howard, RN, BSN, CIC
Director, Hospital Epidemiology; Professor; Director, Statewide Program
for Infection Control and Epidemiology
University of North Carolina at Chapel Hill Health Care and University
of North Carolina School of Medicine 1-3:30 p.m. | Session 3502 Ballroom C-3
Is Your Dialysis Unit on Board? CDC’s Dialysis Event
Michele Alfa, PhD Surveillance Workshop
Medical Director, Clinical Microbiology NHSN Dialysis Event surveillance is used to monitor
Diagnostic Services of Manitoba
hemodialysis outpatients for infection indicators. Part
of the CMS Quality Incentive Program rule incentivizes
Charles Edmiston, PhD, MS, CIC
Professor, Surgery and Hospital Epidemiologist NHSN reporting in 2012. This workshop will help users
Medical College of Wisconsin maximize benefits of NHSN participation by providing
instruction on creating and interpreting NHSN reports
Elaine Larson, PhD, FAAN, RN, CIC for quality improvement.
Associate Dean
Columbia University School of Nursing OBJECTIVES:
䡲 Develop NHSN Dialysis reports using the Analysis Function.
Rose Seavey, MBA, RN, BS, CNOR, CRCST, CSPDT 䡲 Interpret and use NHSN reports for quality improvement in your facility.
President/CEO 䡲 Assess performance relative to other facilities reporting to NHSN.
Seavey Healthcare Consulting, LLC
PRESENTER:
David Weber, MD, MPH Ann Goding Sauer, MSPH
Professor Public Health Analyst
University of North Carolina at Chapel Hill Health Care Centers for Disease Control and Prevention

MODERATOR: Kim Delahanty, RN, BSN, PHN, MBA/HCM, CIC Alicia Shugart, MA
Public Health Analyst
Division of Healthcare Quality Promotion
Contractor to Centers for Disease Control and Prevention

MODERATOR: Nancy Johnson, RN, MSN, CIC

49
 Education Program Details

1-3 p.m. | Session 3503 Room 006 CD 1-3:30 p.m. | Session 3504 Room 008
Wednesday, June 6

How to Report and Apply the NHSN SSI Definitions Infection Prevention, Homecare and Healthcare Reform
(Repeat) These are exciting times for health care with
In 2012, CMS’s Hospital Inpatient Quality Reporting unprecedented and transformational change happening
Program expanded to include surgical site infections all across the country. As home care providers work to
(SSI) for selected operative procedures using CDC’s navigate through opportunities and challenges, infection
National Healthcare Safety Network (NHSN) definitions. prevention will be of the utmost importance in the
This session will review NHSN’s SSI protocol and how to achievement of high quality care and significant vertical
meet the reporting mandate. Test your skills through and horizontal integration. This workshop will focus on the
audience response to case studies. development of best practices in hand hygiene, providing
care to patients with MDROs, and patient immunizations
OBJECTIVES: which is a key component of quality measures for
䡲 Define resources and methods for SSI surveillance, including accountable care organizations that include home care.
requirements for SSI reporting to CMS through NHSN.
䡲 Review NHSN SSI protocol and key terms and definitions. OBJECTIVES:
䡲 Apply SSI definitions using interactive case studies. 䡲 Develop a patient immunization program for home care.
䡲 Develop a hand hygiene program for home care.
PRESENTERS: 䡲 Develop practices for the prevention of transmission of MDROs in the
Mary Andrus, BA, RN, CIC
home care setting.
President
Surveillance Solutions Worldwide, Inc.
PRESENTERS:
Barbara Citarella, RN,MS,CHCE,CHS-V
Teresa Horan, MPH
President/CEO
NHSN Education and Data Quality Assurance Team Leader
RBC Limited
Division of Healthcare Quality Promotion
Centers for Disease Control and Prevention
Mary McGoldrick, MS, RN, CRNI
Home Care and Hospice Consultant
Gloria Morrell, Rn, MS, MSN, CIC
Home Health Systems, Inc.
Nurse Consultant
Centers for Disease Control and Prevention
Carole Yeung, RN, CIC
Clinical Practice Specialist - Infection Prevention
MODERATOR: Nancy Zanotti, RN, BSN, MPH, CIC Baptist Health Home Health Network

MODERATOR: Mary Post, RN, MS, CNS, CIC

50
 Wednesday, June 6
Concurrent Sessions Reducing Central Line Infections and
Transforming Perinatal Care Through Quality
2:30-3:30 p.m. | Session 3600 Room 214 CD
Improvement Collaboratives
Evolution of Long-term Care in the US: The Expanding
Using the experience developed in state and national
Scope and Complexity of Infection Prevention
projects to reduce catheter associated bloodstream
Nursing homes (NH’s) have become a crucial part of the infection prevention, we will define the tremendous
US healthcare system, with 1.5 million residents in opportunity that exists to radically transform health
16,100 NHs at any given time, and a burgeoning short- care delivery via the development of state and national
stay population. This session will discuss the changes in quality collaborative organizations.
the nursing home industry and its implications on scope
and practice of infection prevention. OBJECTIVES:
䡲 Upon completion participants will be able to identify elements which
OBJECTIVES:
are critical to the success of state and national neonatal quality
䡲 Illustrate the changes in long-term care including expansion of post- improvement collaborative development.
acute care and rehabilitation and their expanding role in the process of 䡲 Upon completion participants will be able to describe elements that
infection prevention. are unique to reducing catheter associated line infection rates in
䡲 Define high risk population and design an individualized infection NICU patients.
control program. 䡲 Upon completion participant will be able to define methods to
䡲 Identify practical tools, resources and collaboratives to implement partner with families and patients in order to accelerate quality
infection prevention practices. improvement as it relates to central line infection prevention.

PRESENTER: PRESENTER:
Lona Mody, MD, MSc Martin McCaffrey, MD, CAPT, USN (Ret)
Associate Professor, University of Michigan Director of the Perinatal Quality Collaborative of North Carolina,
University of Michigan and VA Ann Arbor Healthcare System Clinical Professor of Pediatrics
University of North Carolina School of Medicine
MODERATOR: D. Kirk Huslage, RN, BSN, MSPN, CIC
MODERATOR: Linda J. Barton, RN, BSN, CIC

2:30-3 p.m. | Session 3601 Room 217 A

30/30 Session - Two great topics one convenient hour 2:30-3:30 p.m. | Session 3603 Room 214 AB
Nurses Driving IP Change in the NICU State HAI Prevention
This presentation will showcase the significance of This presentation will discuss the growing role of state
nurse-driven interventions and their integral roles in public health agencies and other state-based efforts in
the success of reducing VAP and CLABSI rates within HAI prevention.
a NICU. The focus will be on development of NICU
specific bundles and the implementation process OBJECTIVES:
moving forward. 䡲 Describe how the state public health approach to HAIs is evolving.
䡲 Describe some state based resources for HAI prevention.
OBJECTIVES: 䡲 Describe potential opportunities for partnership around state-based HAI
䡲 Describe the role of a nurse-driven team approach to health-care prevention.
acquired infection reduction.
䡲 List necessary pieces to the neonatal CLABSI and VAP bundles. PRESENTER:
䡲 Describe challenges faced when addressing the neonatal population. Arjun Srinivasan, MD
Associate Director for Healthcare Associated Prevention Programs
PRESENTER: Centers for Disease Control and Prevention
Teri Hulett, RN, BSN
Infection Preventionist MODERATOR: Carole Guinane, RN, MBA
University of Colorado Hospital

51
 Education Program Details

2:30-3:30 p.m. | Session 3604 Room 217 C

Wednesday, June 6

Closing Plenary
Infection Prevention in Ambulatory Oncology 4-5:30 p.m. | Session 3700 Ballroom C
Treatment Centers
Learn It, Lead It, Live It: Strategies for Driving Change
More and more cancer care is being provided in the to Eliminate HAIs
outpatient setting. This session will review recently
This session will focus on methodologies to help achieve
released resources and guidelines, developed by the
sustained change of improvement initiatives that reduce
CDC aimed at preventing infections in cancer patients
or eliminate HAIs. Key care practices to reduce HAIs will
in the ambulatory care setting.
be used to demonstrate principles around the
consultation model and a culture of safety. The session
OBJECTIVES:
will conclude with an assessment of essential knowledge
䡲 Identify three program elements required to meet minimal expectations and skill to transition to create an environment of safety
of patient safety in an ambulatory oncology treatment setting. and sustainability of new evidence based practices
䡲 Describe two actions that can help identify potentially infectious around eliminating HAIs.
patients in the ambulatory oncology treatment setting.
䡲 List three key elements of a cleaning and disinfection program in the OBJECTIVES:
ambulatory oncology treatment setting.
䡲 Describe the forces within the current health care environment that are
driving the need resuscitate the basics with evidence to create a safer
PRESENTER:
patient environment.
Jennie Mayfield, BSN, MPH, CIC
Clinical Epidemiologist 䡲 Discuss use of an internal consultation structure to help the ICP lead
Barnes-Jewish Hospital/Washington University School of Medicine or participate in practice and culture change at the frontline.
䡲 Identify key care practices based on the evidence that can HAI’s.
MODERATOR: Ann Marie, Pettis, RN, BSN, CIC
PRESENTER:
Kathleen Vollman, MSN, RN, CCNS, FCCM, FAAN
Clinical Nurse Specialist/Educator/Consultant
2:30-3:30 p.m. | Session 3605 Room 217 D Advancing Nursing, LLC
Knocking at Your Door: New CMS Hospital Care
Worksheet
Do you wonder whether you are prepared to respond to
the new CMS Hospital Care survey? Participants will
understand how the new hospital infection control survey
tool was developed and the change in survey strategy.
There will be a review of the various sections and
structure of the tool. Finally, the pretest phase will be
explained along with the next steps to implementation.

OBJECTIVES:
䡲 Describe key components of the CMS Hospital Care Worksheet.
䡲 Define the new CMS survey strategy for infection control.
䡲 Discuss the utilization of the CMS worksheet as a self-assessment tool.

PRESENTER:
Daniel Schwartz, MD
Chief Medical Officer
Survey and Certification Group
Centers for Medicare and Medicaid Services
U.S. Department of Health and Human Services

MODERATOR: Karen Hoffmann, RN, MS, CIC

52
Exhibitor-Sponsored Symposia

Exhibit Sponsored Symposia are an excellent opportunity for APIC 2012

attendees to receive additional education during the conference. These events
are wholly sponsored by exhibitors and not endorsed by APIC.
Please review the listing to see which events you might like to attend.

Sunday, June 3, 2012 Monday, June 4, 2012

Implementing an Effective Hand Hygiene Program: What Good are Clean Hands if the Environment
Current Thought Leader Perspectives Isn’t Clean? Achieving Hospital Hygiene through
Sponsored by Collaboration
12-3 p.m. Sponsored by
Marriott Riverwalk | Alamo Ballroom 6-7:30 a.m.
San Antonio Convention Center | Room 008
SPEAKERS:
John Boyce, MD SPEAKER:
Hospital Epidemiologist Curtis J. Donskey, MD
Hospital of Saint Raphael in New Haven, CT Associate Professor of Medicine, Case Western Reserve University
Staff Physician, Infectious Disease Section,
William Jarvis, MD Louis Stokes Cleveland VA Medical Center
Consultant in Epidemiology and Infectious Diseases
How well do your infection prevention and environmental
David R Macinga, PhD
Principal Scientist, Microbiology services departments collaborate to achieve the best
GOJO Industries, Inc. possible results in reducing the risk of hospital acquired
infections? At this session, Dr. Curtis Donskey will
Didier Pittet, MD, MS, CBE introduce the concept of hospital hygiene. His presentation
Hospital Epidemiologist will then be followed by a panel discussion of infection
Director of the Infection Control Programme and WHO Collaborating prevention and environmental services leaders who have
Centre on Patient Safety collaborated in their facilities on successful hand and
University of Geneva Hospitals and Faculty of Medicine
environmental hygiene programs. Two continuing
Nimalie Stone, MD education credits are available with this session.
Medical Epidemiologist for Long-term Care
Division of Healthcare Quality Promotion of the Centers for Disease
Control and Prevention

With introduction by:

Elaine Larson, PhD, FAAN, RN, CIC
Associate Dean for Research and Professor of Pharmaceutical and
Therapeutic Research,
Columbia University School of Nursing and Professor of Epidemiology,
Columbia University Mailman School of Public Health

Thought leading experts in hand hygiene will be together

at this June 3 continuing education-accredited session to
provide their insights on the latest developments within
the hand hygiene category. Key objectives are to review
the science of alcohol-based hand rubs (ABHR) and the
critical variables which influence their antimicrobial
efficacy and clinical effectiveness; to understand the key
principles of point of care hand hygiene implementation;
to review strategies and recent advances in hand hygiene
compliance monitoring; and to understand the challenges
and opportunities of hand hygiene implementation in
long-term care settings. Attendees will also have the 53
opportunity to speak with the experts.
 Exhibitor-Sponsored Symposia

Monday, June 4, 2012

Current Trends in Environmental Decontamination: transmission and have confirmed that intraoperative
Effective Use of Guidelines, Evidence, and Newer bacterial transmission events serve as a primary cause of
Technologies – Are We There Yet? 30-day postoperative HAIs. The results of our work
Sponsored by strongly suggests that a maximal decrease in operating
6-7:30 a.m. room bacterial transmission will require a multi-modal
program targeting patients, providers, the patient
San Antonio Convention Center | Room 007
environment and improvements in the design and
handling of patient intravascular devices in parallel
SPEAKER:
Russell Olmsted, MPH, CIC during the process of intraoperative patient care.

The environment of care is an important reservoir of

pathogens that can potentially contribute to healthcare- Infection Prevention Textiles:
associated infections. Ensuring that cleaning and The New Language in Healthcare
disinfection is done safely and appropriately is an Sponsored by
ongoing challenge in busy healthcare facilities. There are 5:30-8:30 p.m.
several guidelines and practice recommendations for Marriott Rivercenter | Grand Ballroom Salon G-M
environmental decontamination, but they can be
complicated and offer outdated references. Approaches SPEAKER:
to improved disinfection of patient areas include Peggy Prinz Luebbert MS, MT(ASCP),CIC
monitoring and education of staff, patients, and families.
New technologies such as automated whole-area Studies prove that soft surfaces textiles can harbor
disinfection are available and increasingly being used. bacteria and pathogens, causing recontamination during
This symposium will identify ongoing challenges in frequent contact; however, they’re often ignored by
environmental decontamination, appraise its growing today’s infection prevention protocols. Soft surface
importance, and provide insights into new augmentation textiles cover 90 percent of a patient’s contact
strategies to for current environmental cleaning and environment in a healthcare setting and are constantly
disinfection practices with an emphasis on hydrogen exposed to bacteria between launderings. Peggy Prinz
peroxide-based automated technology. Luebbert will lead a clinical review of key findings from
current data on contamination of soft surface textiles.
She will speak about the limited regulation and lack of
Intraoperative Infection Control: A Paradigm Shift standardized protocols for laundering. An overview of
Sponsored by clinical data will show the ineffectiveness of laundering
6-7:30 a.m. alone and will underscore the need for a better and more
efficient solution.
San Antonio Convention Center | Room 006

SPEAKERS:
Randy W. Loftus, MD PDI’s 5th Annual New York Cheesecake
Assistant Professor of Anesthesiology Extravaganza!
Sponsored by
Matthew D. Koff, MD, MS
7-10 p.m.
Assistant Professor of Anesthesiology
Marriott Rivercenter | Grand Ballroom Salon I-J
The problem of healthcare-associated infections (HAIs)
is widely known by both medical and lay communities Last year over 600 people joined us for a night of fun!
because HAIs injure an alarming number of patients in Back by popular demand, illusionist Ryan Oakes will
healthcare facilities. Over the last five years, we have perform while you enjoy delicious New York style
systematically evaluated the incidence, mechanisms and cheesecake, a chocolate fountain, drinks and more!
clinical implications of intraoperative bacterial

54
 Updated as of May 1, 2012

Tuesday, June 5, 2012

Infection Control and Injectable Drug Delivery Improving Hand Hygiene Compliance Through
Sponsored by Electronic Monitoring: Technical and Behavioral
6-7:30 a.m. Considerations
San Antonio Convention Center | Room 007 Sponsored by
6-7:30 a.m.
SPEAKERS: San Antonio Convention Center | Room 006
Allen Vaida, PharmD, FASHP
Executive Vice President of the Institute for Safe Medication Practices SPEAKER:
Emily Landon Mawdsley, MD
Mark Siska
Assistant Director Informatics & Technology Pharmacy Services
Mayo Clinic Join us for breakfast and a discussion about the
challenges and opportunities when implementing
Kathy Warye electronic solutions to monitor hand hygiene. This
Vice President of Infection Prevention, BD symposium will provide an overview of the technical and
behavioral aspects of electronic monitoring, as well as
A robust discussion featuring leaders in medication real-world examples from three hospitals that have
safety practices will present new ideas for reliable, implemented systems. Hear from your peers how they
consistent solutions that reduce risks and allow for have improved hand hygiene compliance and patient
better, safer care. News at the session will reveal satisfaction through improved monitoring methods.
healthcare professionals’ perceptions of the need for new
tools to eliminate mistakes, dosage errors, and wasted
time. BD is hosting this session to identify the steps Breakthrough Research in Vascular Access Cocktail
needed to achieve greater patient safety for nurses, Reception
pharmacists, and public health professionals.
7-10 p.m.
Marriott Rivercenter Grand Ballroom | Salon C-D
Reliable Culture of Safety: Strategies to Eliminate SPEAKER:
HAI and Other Adverse Events Marcia Ryder, PhD, MS, RN
Sponsored by
6-7:30 a.m. Please join us to enjoy some hors d’oeuvres and cocktails
San Antonio Convention Center | Room 008 where Marcia Ryder, PhD, MS, RN will be informally
discussing her breakthrough research in vascular access.
SPEAKER: Dr. Ryder will informally discuss in vivo research
Denise Murphy, RN, BSN, MPH, CIC examining both the antimicrobial and antithrombogenic
properties of chlorhexidine.
This presentation will focus on the importance of a
culture of safety as it relates to the prevention and
elimination of healthcare-associated infections. The
speaker will review successful initiatives that addressed
culture and impact on reduction of HAIs, define culture
of reliability, discuss safety behaviors, error prevention
tools, and their application to infection prevention, and
examine the leader methods for reliability.

55
 Exhibitor-Sponsored Symposia

Wednesday, June 6, 2012

Chlorhexidine Across Healthcare: A Partnership to reduce these risks. A brief overview of the known data will
Protect Patients be presented followed by a group discussion of what
Sponsored by Chlorhexidine Partners Network should be done to improve documentation and appropriate
6-7:30 a.m. reporting of mucocutaneous exposure.
San Antonio Convention Center | Room 007

SPEAKER: Reducing SSI: What Can You Do Differently Tomorrow?

Keith Kaye, MD, MPH Sponsored by
Professor of Medicine 6-7:30 a.m.
Corporate Director, Infection Prevention, San Antonio Convention Center | Room 006
Epidemiology and Antimicrobial Stewardship
Detroit Medical Center and Wayne State University
SPEAKERS:
Chlorhexidine is a safe, efficacious antimicrobial, and its Peter Marcello, MD, FACS, FASCRS
use as an antimicrobial is well documented. The Vice Chairman of Colon & Rectal Surgery
Lahey Clinic
antiseptic molecule has been used for decades by the
healthcare industry as a skin prep, hand sanitizer, Dale W. Bratzler, DO, MPH
surgical prep, on vascular catheters, wound care, oral Professor and Associate Dean
care, and many other uses. Chlorhexidine has prevented Department of Health Administration and Policy
countless nosocomial infections, and it will continue to University of Oklahoma Health Sciences Center
be an important tool in protecting patients as we march
toward zero infections. Companies from across the Deborah Hobson, BSN
healthcare sector have partnered together to discuss the Patient Safety Clinical Specialist
importance of chlorhexidine in protecting patients and to Armstrong Institute for Patient Safety and Quality Surgical Intensive
drive zero infections. This educational symposium will Care Nurse
provide an overview of chlorhexidine’s efficacy against Johns Hopkins Hospital
microorganisms, its many uses in healthcare, and how
E. Patchen Dellinger, MD, FACS
best to work with industry to implement greater patient
Professor and Vice Chairman, Department of Surgery
protection solutions. University of Washington

Elizabeth C. Wick, MD
Mucocutaneous Blood Exposure and Peripheral Assistant Professor of Surgery and Oncology
Catheters - Acknowledging the Risk, Documenting Johns Hopkins University
Occurrences
A panel of leading surgeons and healthcare professionals
Sponsored by
will discuss the scope of the surgical site infection issue
6-7:30 a.m. and give attendees insight on clinically proven infection
San Antonio Convention Center | Room 008 prevention implementation methods, such as SSI bundles,
mechanical bowel preparation and antibiotics, wound
SPEAKER: protection and teamwork. A thorough review of the clinical
Lynn Hadaway, M.Ed., RN, BC, CRNI data will reveal current practices that may not be effective,
as well as evidence-based practices that can result in
Discussions among nurses and two recent published significantly improved patient outcomes and reduced
surveys reveal anecdotal reports of blood exposure to costs. The discussion will include challenges and
mucous membranes during peripheral IV catheter upcoming changes for SSI surveillance and the
insertion; however, an integrative literature review found no achievements of the Surgical Unit-based Safety Program
documented reports of these events. Reports of all (SUSP) in empowering the frontline. Attendees will also
percutaneous injuries are about four times greater than have the opportunity to participate in a question and
those from all mucocutaneous blood exposures, indicating answer session. Join us at this symposium and see what
the continued need for improvements in, and correct use you can do differently tomorrow.
of engineered safety devices. The same level of details
about mucocutaneous exposure is required to quantify and
56
Speaker Disclosures

All speakers have been requested to provide financial disclosures or indicate that there is nothing to disclose.
Michelle Alfa Keith Kaye
Healthmark, 3M Healthcare Consultant Pfizer Consultant
3M Healthcare Honoraria Merck Consultant
3M Healthcare Research Grant forrest pharmaceuticals Consultant
3M Healthcare Speaker’s Bureau Sage Products Consultant
Healthmark Royalties for license of ATS Cubist Pharmaceuticals Consultant
Cubist Pharmaceuticals Advisory Committee/Board Member
Carla Alvarado Cubist Pharmaceuticals Honoraria
Teleflex Honoraria Cubist Pharmaceuticals Research Grant
CareFusion Speaker’s Bureau Cubist Pharmaceuticals Speaker’s Bureau

Mary Andrus Virginia Kennedy

CareFusion Honoraria Infection Prevention and Consultant
Management Associates, Inc.
Michael Borg Infection Prevention and Employment (includes retainer)
CareFusion Honoraria Management Associates, Inc.
Infection Prevention and Ownership Interest
Kelley Boston Management Associates, Inc.
Infection Prevention and Employment (includes retainer)
Management Associates, Inc. Brian Koll
(IP&MA) Merck Partner Employment

Ruth Carrico Elaine Larson

Sanofi Pasteur Honoraria GOJO Industries Consultant
MedImmune Honoraria Deb Healthcare Other Research Support
CareFusion Honoraria
CareFusion Speaker’s Bureau W. Ian Lipkin
Tetragenetics Advisory Committee/Board Member
Luke Chen Prosetta Corporation Advisory Committee/Board Member
Merck Other Research Support Pathogenica Advisory Committee/Board Member
Cubist Pharmaceuticals Speaker’s Bureau Akonni Corporation Advisory Committee/Board Member
Agilent Advisory Committee/Board Member
Charles Edmiston
Sage Products Speaker’s Bureau Tracy Louis
Ethicon, Inc Speaker’s Bureau MediMedia USA Honoraria
CareFusion Speaker’s Bureau
Jennifer McCarty
Nancy Havill Infection Prevention and Employment (includes retainer)
3M Healthcare Speaker’s Bureau Management Associates, Inc.
(IP&MA)
Joan Heath
Merck Honoraria Mario Melgar
3M Healthcare Research Grant
Daverick Henderson
Merck Employment (includes retainer) Allan Morrison
Sage Products Speaker’s Bureau
Kelly Holmes Pfizer Speaker’s Bureau
Infection Prevention and Employment (includes retainer) Optimer Speaker’s Bureau
Management Associates, Inc. Cubist Pharmaceuticals Speaker’s Bureau
(IP&MA) CareFusion Speaker’s Bureau

Betsy Hugenberg Denise Murphy

Chartis Insurance, Employment (includes retainer) 3M Healthcare Speaker’s Bureau
Global Loss Prevention

57
 Speaker Disclosures

Russ Olmsted Rose Seavey

APIC Advisory Committee/Board Member Ultra Clean Systems Consultant
Arizant Healthcare, Inc Consultant Key Surgical Consultant
Arizant Healthcare, Inc Research Grant BioSeal Consultant
Mintie, Inc. Consultant Kimberly Clark Consultant
Premier Inc. Consultant 3M Healthcare Consultant
Trademark Medical, LLC Consultant 3M Healthcare Honoraria
Applied Epidemiology Solutions, Inc. Employment (includes retainer) 3M Healthcare Speaker’s Bureau
Hinshaw & Culberston LLP Employment (includes retainer) Key Surgical Ownership Interest
Ecolab Research Grant
Ecolab Honoraria Connie Steed
Carefusion Honoraria Medline Advisory Committee/Board Member
Ethicon Honoraria
Advanced Sterilization Products, Inc. Honoraria Thomas Talbot
Sage Honoraria Joint Commission Resources Consultant
Sanofi Pasteur Other Research Support
Jon Otter Sanofi Pasteur Research Grant
Bioquell Employment (includes retainer)
Pfizer Other Research Support Gertie van Knippenberg-Gordebeke
Bioquell Ownership Interest MEIKO Maschinenbau, Germany Consultant
MEIKO Maschinenbau, Germany Honoraria
Jan Patterson
Astellas Consultant Kathleen Vollman
Basilea Consultant Sage Products Inc Consultant
IHI Other Research Support Hill-Rom Inc Speaker’s Bureau
Merck Consultant
Pfizer Consultant David Weber
Toyoma Consultant Sanofi pasteur Consultant
UT System Other Research Support Pfizer Consultant
Merck Consultant
Merck Advisory Committee/Board Member
Eli Perencevich Merck Honoraria
PurThread, LLC Consultant Merck Speaker’s Bureau

Emily Rhinehart
Chartis Insurance, Employment (includes retainer)
Global Loss Prevention

William Rutala
Clorox Consultant
Clorox, Advanced Consultant
Sterilization Products
Advanced Sterilization Products Advisory Committee/Board Member
Advanced Sterilization Products Honoraria

58
 Acknowledgments

The following speakers had nothing to disclose: We wish to thank the following
Joanna Acebo Leilani Kicklighter individuals for their contributions to
Tim Adams Louise Kuhny APIC 2012!
Tina Adams Terrie Lee
Faruque Ahmed Alejandro Macias BOARD OF DIRECTORS
Janet Allen Shelley Magill President
Katherine Allen-Bridson Dennis Maki Michelle R. Farber, RN, CIC
Kris Anderson Elham Mandegari
Sue Barnes Mary Lou Manning President-Elect
Joseph Bick Cyndi Maxey Patricia S. Grant, RN, BSN, MS, CIC
Angela Bivens-Anttila Jennie Mayfield
Sharon Bradley Martin McCaffrey Secretary
Virginia (Ginnie) Bren Tara McCannell Linda R. Greene, RN, MPS, CIC
Judie Bringhurst Chris McCarthy
Vickie Brown Mary McGoldrick Treasurer
David Calfee Patricia McLendon Jennie L. Mayfield, BSN, MPH, CIC
Miguela Caniza Jennifer Meddings
Anthony Chavis Lona Mody Immediate Past President
Barbara Citarella Gloria Morrell Russell N. Olmsted, MPH, CIC
Michael Cloughessy Amy Nichols
Laurie Conway Stephen Parodi BOARD MEMBERS
Susan Cooper Priti Patel Vickie M. Brown, RN, MPH, CIC
Patti Costello Kelly Peterson Linda J. Burton, RN, BSN, CIC
Titus Daniels Monika Pogorzelska Linda K. Goss, MSN, APRN, CIC, COHN-S
Linda Dickey Jane Pool Carole S. Guinane, RN, MBA
Susan Dolan Mary Post Mary Lou Manning, PhD, CRNP, CIC
Curtis Donskey Terri Rebmann Clifton N. Orme, MBA
Gemma Downham Amy Richmond Neil P. Pascoe, RN, BSN, CIC
Margaret Dudeck Barbara Russell Marcia R. Patrick, RN, MSN, CIC
Jonathan Edwards Daniel Schwartz Connie Steed, RN, MSN, CIC
Kate Ellingson Alicia Shugart Sharon A. Williamson, BSMT(ASCP)SM,CIC
Patricia Emmett Mary Sibulsky Jolynn C. Zeller, RN, BS, CIC
Douglas Erickson Carmela Smith
Michelle Farber Barbara Soule Ex Officio Board Member
Teresa Fulton Arjun Srinivasan Katrina Crist, MBA
Anita Geevarughese Donna Stokes APIC Chief Executive Officer
Jean Gillis Nimalie Stone
Patti Grant Patricia Stone BOARD ADVISORS
Linda Greene Stephen Szermer AJIC Editor
Beth Hammer Abbigail Tumpey Elaine Larson, PhD, FAAN, RN, CIC
Marilyn Hanchett May Uchida
Cherissa Hanson Carole Van Antwerpen Auditor
Teresa Horan Lynel Westby Leonard Pepe, Grant Thornton, LLP
Michael Howell Timothy Wiemken
Susan Huang Donna Wiens Legal Counsel
Teri Hulett Paula Wright Ralph Rivkind, JD, LLM
James Johnson Carole Yeung
EDUCATION DEPARTMENT STAFF
Shawn Boynes, CAE, Senior Director, Education
The following speakers did not indicate whether or not there Sara Haywood, CMP, Associate Director, Education
were financial disclosures: Marci Thompson, Associate Director, Online Education
Marteniz Brown, Education Program Manager
Mustafa Abdulali Ian Kramer Kathryn Hitchcock, Education Project Manager
Philip Carling Diana Mungai Walter Josephs, Education Project Manager
Natalie Jenkins, Education Project Coordinator
Nicole Guy, Conference Manager
Colleen Campbell, Exhibits Manager 59
Jennifer Kerhin, Marketing and Sponsorship Manager
 2012
Online Evaluation and 1 Go to https://www.mylibralounge.com/regeng/apic2012/ and log in
using the following information, as provided with your registration:
Continuing Education • First Name
• Last Name
Instructions • Email Address

Now that you are home and rested from APIC’s 39th 2 Complete the overall conference evaluation and individual session
evaluations for each of the sessions that you attended.
Annual Educational Conference and International Meeting,
don’t forget to log in and complete your evaluations to 3 Download your certificate and VOA transcript once complete.
receive your contact hours. Simply complete the (Please note that you must self-submit your contact hours to your
following three easy steps to receive your credits: professional organization.)

The site will stay open until July 31, so be sure to log in and download your certificate of completion before that date. If
you have questions please contact [email protected].

Session Session Time Session Number Credit

Hours
Tracking Form (per session)
Monday, June 4, 2012
The Association of Professionals
in Infection Control and 8-10:30 a.m. n 1000* 2
Epidemiology, Inc. (APIC) is 1:30-2:30 p.m. n 1200 n 1201 n 1202 n 1203 n 1204 n1205 n1206 n1207 1
accredited as a provider of 3-4 p.m. n 1300 n 1301 n 1302 n 1303 n 1304 n1305 1
continuing nursing education by 3-5:30 p.m. n 1400 n 1401 n 1402 n 1403 n 1404 2.5
the American Nurses Credentialing 4:30-5:30 p.m. n 1500 n 1501 n 1502 n 1503 n 1504 n1505 1
Center’s Commission on
Accreditation (ANCC). Tuesday, June 5, 2012
8-9 a.m. n 2000 n 2001 n 2002 n 2003 n 2004 n 2005 1
The APIC 2012 educational
8-10:30 a.m. n 2100 n 2101 n 2102 n 2103 n 2104 2.5
content is also recognized by
The American Association for 9:30-10:30 a.m. n 2200 n 2201 n 2202 n 2203 n 2204 n 2205 1
Clinical Chemistry, Inc. (AACC) n 2300 n 2301 n 2302 n 2303 1
as meeting the criteria for 1:30-2:30 p.m. n 2400 n 2401 n 2402 n 2403 n 2404 n 2405 1
ACCENT® credit hours. 3-4 p.m. n 2500 n 2501 n 2502 n 2504 n 2505 1
n 2600 n 2602 n 2603 1
INSTRUCTIONS: 1:30-4 p.m. n 2700 n 2701 n 2702 n 2703 n 2704 2.5
Check each session attended.
Keep this form for your records Wednesday, June 6, 2012
and reference it when you visit 8-9 a.m. n 3000 n 3001 n 3002 n 3003 n 3004 n 3005 1
https://www.mylibralounge.com/ 8-10:30 a.m. n 3100 n 3101 n 3102 n 3103 n 3104 2.5
regeng/apic2012/ to complete
9:30-10:30 a.m. n 3200 n 3201 n 3202 n 3203 n 3204 n 3205 1
the online sessions valuations
n 3300 n 3301 n 3302 n 3303 1
and claim your contact hours.
1-2 p.m. n 3400 n 3401 n 3402 n 3403 n 3405 1
1-3:30 p.m. n 3500 n 3501 n 3502 n 3503 n 3504 2.5
2:30-3:30 p.m. n 3600 n 3601 n 3603 n 3604 n 3605 1
4-5:30 p.m. n 3700* 1
* ACCENT Credit Hours Only
Abstracts Book

2012
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APIC 2012 ABSTRACTS
APIC 39th Annual Educational Conference & International Meeting
San Antonio, TX l June 4-6, 2012

CONTENTS
Abstract Awards (denoted by *) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9–11
Poster Abstracts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Oral Abstracts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Financial Disclosures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Author Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196
Future APIC Conference Dates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200

POSTER ABSTRACTS
Antimicrobial Resistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
1-001 Risk Factors for Vancomycin-Resistant Enterococcus faecalis bacteremia: A Case-Case-Control Study
1-002 Emergence of IMP-1 Producing Escherichia coli in a Tertiary Hospital in Japan
1-003 Escalation and De-Escalation Plan for Carbapenem-Resistant Gram Negative Organisms in Critical Care*
1-004 Risk Factors for the Isolation of Vancomycin-Resistant Enterococcus faecalis from Wound Site: A Case-Case Control Analysis
1-005 The Cephalosporin Use in the Penicillin Allergic Patient
1-006 Risk Factors to Acquire Vancomycin-Resistant Enterococcus faecium (VRE) Infection in Pediatric Patients

Antisepsis/Disinfection/Sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
2-007 Disinfect to Protect- Developing a System to Enhance Disinfection of Patient Care Equipment
2-008 A Comparative In-Vivo Study on Persistent Effects of Chlorhexidine Gluconate in Alcohol Formulations and a Povidone-Iodine
Solution as Skin Preparations
2-009 Review of Proper Reprocessing of Reusable Medical Equipment in VHA Facilities
2-010 Targeted, Daily Environmental Disinfection with Clorox® Dispatch® for the Prevention of Hospital-Associated Clostridium difficile
and Acinetobacter baumannii
2-011 Comparison of the Surface Disinfection Capabilities of Two Different Methods using Automated Devices: Ultraviolet Light
Versus Hydrogen Peroxide Fogging Machine
2-012 A Comparison of the Surface Disinfection Capabilities of Two Different H2O2 Based Disinfectants used in an Automated
Fogging Machine in a 72 Cubic Meter Room
2-013 Influence of Alcohol-Based Hand Rub Format on Dry Time and Efficacy
2-014 Innovative Additions to Central Line Bundle Reduce Bloodstream Infections in Vulnerable Pediatric Patient Population
and Improve Catheter Care
2-015 A Multi-Site Study Evaluating the Effectiveness of Terminal Cleaning in Patient and Operating Rooms using an ATP
Monitoring System
2-016 Quantitative Analysis of Materials and Methods in Cleaning and Disinfection of Environmental Surfaces: Microfiber vs.
Cotton and Spray vs. Soak
2-017 Partnering With Environmental Services to Drive Infection Control Excellence
2-018 Hydrogen Peroxide Patient Privacy Cubical Curtain Cleaning Study*
2-019 Evaluation of Liquid Hydrogen Peroxide to Clean Surfaces in Patient Rooms using Aerobic Colony Counts and
Adenosine Triphosphate Bioluminescence Assay
2-020 Effect of Disinfectants on Clinically Relevant Bacteria Under Planktonic and Biofilm Conditions
2-021 Cleaning Practices for Hospital Mattresses in Top US Adult Hospitals
2-022 The Influence of ABHR Product Format on In Vivo Efficacy: A Meta-Analysis
2-023 A Multi-Disciplinary Team Tackles Standardization of Endoscope Practices in a Tertiary Care Setting: Finding Common
Ground for Patient Safety

Bioterrorism/Disaster/Emergency Preparedness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
3-024 U.S. School/Academic Institution Disaster and Pandemic Preparedness and Seasonal Influenza Vaccination Among School Nurses
3-025 Maintaining Isolation Precautions During a Hurricaine Evacuation

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 1
Contents
Device-Related Infections and/or Site Specific Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
4-026 Reduction in Catheter-Associated Urinary Tract Infections by Bundling Interventions in a Community Hospital
4-027 A Multi-Interventional, Multi-Disciplinary Effort to Reduce Hospital-Acquired Central Line-Associated Blood Stream Infections
4-028 A Multi-Disciplinary Performance Improvement Project to Reduce Craniotomy Surgical Site Infections
4-029 Sedation Reduction Leads to Reduction in Ventilator Associated Pneumonia
4-030 Reducing Ventilator Associated Pneumonia - Goal - Zero
4-031 A Multifaceted Approach Reduces Surgical Site Infection Rates, Incidents, and Associated Costs for Abdominal Hysterectomy
and Caesarean Section Patients
4-032 Reducing Peripherally Inserted Central Line Associated Blood Stream Infections (CLA-BSI): Targeting 0 in Non-Critical
Care Medical Surgical Units
4-033 Is Antimicrobial Closure Technology A Clinically Effective Strategy For Reducing the Risk of Surgical Site Infections -
A Meta-Analysis?
4-034 Pediatric Ventilator Associated Pneumonia (VAP) Prevention Bundle: 5 Years Later
4-035 When a Central Line Bundle is Not Enough: Sustaining Gains and Striving for Zero
4-036 Multifaceted Interventions to Prevent Central Line Associated Blood Stream Infections in a New York City, Neonatal
Intensive Care Unit
4-037 Ventilation Associated Pneumonia Caused by Acinetobacter baumanii at a Tertiary Hospital in Vietnam: Clinical And
Molecular Patterns
4-038 Patient Education as a Means to Reduce Methicillin-Resistant Staph Aureus Surgical Site Infections in Patients with
Known Colonization
4-039 An Interdisciplinary Approach Toward Reducing the Incidence of Catheter-Associated Urinary Tract Infections in a
Post-Acute Facility
4-040 Incidence of Hypothermia under Perioperative Standard Thermal Management in patients with abdominal surgery and Its Effect
on Surgical Site Infections
4-041 Vascular Access Associated Blood Stream Infections in Patients Undergoing Plasmapheresis Compared with those in Patients
with Hemodialysis
4-042 Total Burden Assessment Of Surgical Site Infections in Initial Admissions and Readmissions Using National Administrative
Claims Data
4-043 Challenges in Adherence with National Healthcare Safety Network Definitions: A Central Line-Associated Bloodstream
Infection Conundrum
4-044 Shared Successes for Surgical Site Infection Reduction: Utilization of CHG-impregnated Cloths as an Adjunct to the
Pre-op Shower
4-045 Micro-Patterned Surfaces for Reducing Platelet Adhesion and Bacterial Attachment Associated with Catheter-Associated Blood
Stream Infections
4-046 Our Journey to Eliminate Central Line Associated Blood Stream Infections in our NICU
4-047 Activity of Dynamic Concentrations of Silver and Chlorhexidine Against Common Bacterial Pathogens
4-048 Comparison of Antimicrobial Needleless I.V. Connectors in a Septum Contamination Assay
4-049 Micro-Patterned Surfaces for Reducing Biofilm Formation in an Endotracheal-Tube-Like Environment
4-050 A Novel Chlorhexidine Hydrogel Coating for Peripheral Venous Catheters
4-051 Our Journey to Zero: Preventing Central Line Associated Bloodstream Infections in the Pediatric Intensive Care Unit
4-052 Prevention of Central Line Associated Bloodstream Infections by Implementation of Central Line Bundle
4-053 Targeting Zero Central Line Associated Blood Stream Infection: Innovative Prevention Initiatives toward desired Outcomes
4-054 Reduction In Duration Of Post-Operative Catheter Use Following Imiplementation Of An Electronic Reminder System
4-055 Canaries in a Coal Mine: a Case Report of Increased Incidence of Clostridium difficile in a Pediatric Oncology Patient Population
4-056 Device-Related Infections and/or Site Specific Infections Differentiating Infection from Inflammation after Total Knee Arthroplasty

Emerging and Reemerging Infectious Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

5-057 The Effect of Chlorhexidine Gluconate Bathing on MRSA/VRE Acquisition Rates in Medical ICU Patients
5-058 Developing an Emergency Department Tuberculosis Triage Screening
5-059 Incidence of Klebsiella pneumoniae Carbapenemase (KPC)-producing Multidrug-Resistant Bacterial Infections in a Teaching
Hospital in SouthEast
5-060 Current Epidemiology and Clinical Impact of Extended-Spectrum β-Lactamase-Producing Escherichia coli at a Tertiary
Medical Center
5-061 Measles Outbreak Management at a Minnesota Children’s Hospital in 2011
5-062 Developing an ESBL Program

2 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Contents
Environment of Care/Construction/Remediation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
6-063 Impact of Equipment with Fans in the Operating Room
6-064 Environmental Hygiene Sustainability - Is It Possible?
6-065 Navigating through the Construction Zone
6-066 Infection Prevention and Control Planning for Development of a New Bone Marrow Transplant Unit is NOT a
Lone Star Production
6-067 Construction and Renovations using a Checklist Tool for Safety : Laborers and Patients
6-068 Preliminary Assessment: Efficacy of Room Sanitizing With Controlled Exposure to UVC Light
6-069 Microbial Load of Reusable Cleaning Towels used in Hospitals
6-070 The Safety Dance: Establishing a Comprehensive Safety Program to Ensure Contractor Compliance
6-071 Measuring the Effect of Hospital Cleaning Intervention to Prevent Health Care Assocaiated Infections
6-072 The Development of An Environmental Audit Program

HealthcareWorker Safety/Occupational Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

7-073 Healthcare Worker (HCW) Pertussis (Tdap) Vaccine Compliance Improves During a Statewide Pertussis Epidemic
7-074 Development of Point of Use Sharps Disposal Unit- A Simple Solution to a Difficult Problem
7-075 Isolation Gown Use, Performance and Potential Compliance Issues Identified by Infection Control Professionals
7-076 Implementing a Mandatory Influenza Vaccination Program in a University-Affiliated Teaching Hospital
7-077 A Comparison of Anti-Microbial Scrubs and Cotton Scrubs in a Hospital

Infection Prevention and Control Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

8-078 Success in Preventing Catheter Associated Urinary Tract Infections–What Works?
8-079 Seasonal and H1N1 Influenza Vaccine Compliance and Intent to be Vaccinated Among Emergency Medical Services Personnel
8-080 Unleashing the Positive Deviants at the Frontline: More than just Sparking Change
8-081 Expanding the Clostridium difficile Infection Prevention Bundle to Include Patient Hand Hygiene
8-082 Hand Hygiene Opportunities in Pediatric Extended Care Facilities
8-083 A CAUTI Bundle with a Twist.
8-084 Managing Clostridium difficile using a Bundled Approach
8-085 What’s for Dinner?
8-086 A Model of a Longstanding State Infection Prevention Collaborative
8-087 Annual Outcomes for Infection Prevention: Going in the Right Direction by Using Data, Knowledge and Rules to
Improve Outcomes
8-088 Can We Reduce Surgical Site Infections?
8-089 Increasing Hand Hygiene Compliance By Changing the Culture
8-090 Survey of Literature, Patient Advisory Councils, and 440 Members Leads to New Flu Campaign and Increased Flu Vaccination Rates
8-091 Control of Legionella Contamination with Monochloramine Disinfection in a Large Urban Hospital Hot Water System
8-092 First Do No Harm - Efficacy of Influenza Vaccine Mandate or Mask Mandate for the Healthcare Worker
8-093 Intervention to Reduce Central Line Associated Blood Stream Infections in Adult Critical Care Hospital
8-094 Hand Hygiene: There’s an APP for that?
8-095 Emergence of Klebsiella pneumoniae Producing KPC-Type Enzymes and Infection Control Measures for Containing
Hospital Spread
8-096 Repeated Intervention Programs to Reduce VAP Rates and Focus on Effective Components of the Prevention Bundle in
an Indian ICU
8-097 Hand Hygiene Rates for Rehabilitation and Long Term Care Facilities: One Hospital’s Journey through the National Goal
and Benchmarks
8-098 Attaining Zero Catheter Associated Bloodstream Infections in a Level III Nursery
8-099 Taxonomical Risk Assessment
8-100 Detection Capabilities of an ATP (Adenosine Triphosphate) Based Monitoring System for Clinically Relevant Sources of ATP
8-101 Monitoring the Cleaning of Surgical Instruments with an ATP Detection System
8-102 From Good to Great with Strategic Planning
8-103 A Nurse Driven Foley Catheter Removal Protocol Proves Clinically Effective to Reduce the Incidents of Catheter Related
Urinary Tract Infections
8-104 Enhancing Infection Prevention’s Role during Construction in a University Medical Center
8-105 Personal and Household Hygiene, Microbial Contamination, and Health Status in Undergraduate Residence Halls in
New York City
8-106 You are What You Eat: Engaging Long-Term Care Residents in Meal Time Hand Hygiene
8-107 The STOP (Staff Taking Ownership for Prevention) FLU Initiative: Improving Influenza Vaccination Rates among Staff in a Long-

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 3
Contents
Term Care Facility
8-108 Automatic Foley Catheter Stop Order
8-109 Clostridium difficile Infection Prevention Initiative to Reduce the Incidence and Prevalence of Clostridium difficile among
Veterans in Acute-Care Inpatient Facilities
8-110 Utilizing Electronic Surveillance to Enhance Patient Safety
8-111 Re-Ingineering Hand Hygiene Surveillance: Shifting the Focus, Sharing the Responsability.
8-112 Developing an Infection Prevention Program as a Result of a Transition From a Level II to a Level III NICU
8-113 Successful Implementation Of A Mandatory Influenza Vaccination Program Across A 12 Hospital System
8-114 Resistant Organisms: An Innovative Approach to Preventing Healthcare Transmission
8-115 The Dynamics of a Hand Hygiene Program in a Pediatric Oncology Service in El Salvador: Success Factors and Lessons Learned
8-116 A Multidisciplinary Team Approach to Reducing Ventilator Asscociated Pneumonia
8-117 Building and Maintaining Best Practices to Decrease Vascular Access-Associated Infections in the Use of Peripherally Inserted
Central Catheters
8-118 Implementing Mandatory Influenza Vaccination policy for Health Care Workers at a Long Term Acute Care Facility
8-119 Education and Communication: Improving Patient Safety and Increasing Employee Knowledge in an Acute Hospital Setting
8-120 Infection Control Liaisons: Weapons Against Hospital Acquired Infections
8-121 Hospital Hand Hygiene Compliance Improves with Increased Monitoring and Immediate Feedback
8-122 Using Infection Surveillance to Improve the Quality of Care in a Cancer Unit in a Children’s Hospital in Argentina
8-123 Impact of a Rapid Cycle Hand Hygiene Initiative in a Pediatric Emergency Department
8-124 The Quest to Reach Zero Central Line-Associated Bloodstream Infections
8-125 Embedding Hand Hygiene into a Patient Centric Communication Model: C-I-CARE
8-126 Interventions to Improve Ventilator-Associated Pneumonia in the Intensive Care Unit of a Pediatric Hospital in Nicaragua
8-127 Reporting Capabilities and Data Extrapolation Using an Electronic Hand Hygiene System Versus the Traditional Covert/Secret
Shopper Visual Observation Method
8-128 Infection Prevention and Control Program in a Public Pediatric Hospital in Argentina: Opportunities for Improvement

Outbreak Investigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
9-129 Outbreak management of Norovirus in a Pediatric Behavioral Health setting
9-130 Methicillin-resistant Staphylococcus aureus Outbreak in the Neonatal Intensive Care Unit
9-131 Why Every Hospital Should Be A “No Fly Zone”
9-132 Norovirus Outbreak in a Long Term Care Facility
9-133 A Multidisciplinary Approach toward Successful Bed Bug Elimination in a Homeless Domiciliary Setting
9-134 Outbreak of Enterococcus faecium with Low-Level Resistance to Vancomycin in Japan
9-135 Reported Endoscope Reprocessing Breaches, Minnesota, 2010-2011
9-136 Outbreak Investigation at a Dialysis Center Associated with a Multi-use Dialyzer with Removable Headers and O-rings,
Los Angeles County
9-137 Use of Molecular Biology to Confirm a Bacteremia Outbreak Caused by Burkholderia cepacia in a Pediatric Intensive Care Unit
9-138 Characterization of Two Outbreaks of Vancomycin Resistant Enterococcus faecium in a Pediatric Care Center in Mexico City
9-139 The C. diff Cycle: The Necessity of Going Beyond the Basics

Product Evaluation/Cost-Effectiveness/Cost Benefit Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99

10-140 Closing the Gap of Inconsistent Hand and Surface Sanitation
10-141 The Role Appropriate Isolation Precautions Contributes to Cost Avoidance: Conducting Active and Retrospective Isolation
Precaution Surveillance
10-142 Avoiding Unintentional Hypothermia During Prosthetic Joint Replacement Surgery
10-143 Effectiveness of an electrochemically activated saline solution for disinfection of hospital equipment
10-144 Financial implications of VRE screening intensive care units
10-145 Determining an Effective Measure of Testing for MRSA Colonization for Timely Placement in Appropriate Isolation Precautions
10-146 Cost Effectiveness of an Electronic Hand Hygiene Monitoring System (EHHMS) in the Prevention of
Healthcare-Associated Infections

Public Reporting/Regulatory Compliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103

11-147 Who Should Be in Charge of What? (Components of a State-Level Healthcare-Associated Infections Prevention Effort)
11-148 California State Mandated MRSA Screening: Healthcare Dollars Down the Drain!

4 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Contents
Quality Management Systems/Process Improvement/Adverse Outcomes . . . . . . . . . . . . . . . . . . . . . . . .105
12-149 Utilizing Lean Analysis to Conduct a Horizontal Value Stream focusing on the Reduction of Orthopedic Surgical Site Infections
12-150 Communicating Critical Surveillance Data for Improved Outcomes
12-151 Reproducibility of Results in Decreasing Healthcare-Associated Infections with the Use of Electronic Hand Hygiene
Surveillance Technology
12-152 Development of a Health Care Providers Quality Improvement Team in a Small, Rural Community
12-153 Process Improvement: Facility Wide Reduction in Hospital-Associated Infections Utilizing CHG for Oral Care and
Preoperative Preparation
12-154 Design and Implementation of a Web Application for Real-Time Display of Hand Hygiene Performance Data
12-155 Three Interventions=Zero Infections
12-156 Measurement and Analysis of Foot Traffic in a University Hospital Operating Room
12-157 Improving the Management of Orthopedic Surgical Patients with Indwelling Urinary Catheters Using a Systematic Evidence
Based Approach
12-158 The Impact of Improperly Collected Urine Cultures on Patient Treatment in the Emergency Department
12-159 Making it Personal: Utilization of an Electronic Personal Hand Hygiene System to Increase Hand Hygiene
12-161 Impact of a Hospital Wide Policy on Clostridium difficile Testing using Cepheid System®
12-162 Reducing Transmission of Multi-Drug Resistant Organisms in Procedural Areas
12-163 It’s Contagious! CLABSI Prevention is Spreading
12-164 Infection Prevention Component of Process Improvement Project to Reduce Regulated Medical Waste
12-165 A Norovirus Cluster Reveals a Big Stink: A Communication Failure Between Infection Prevention and the Laboratory
12-166 The Development of a Process Improvement Tool: The SWAT Approach to Surgical Site Infection Analysis
12-167 Decreasing Catheter Associated Urinary Tract Infections (CAUTI) using the BREAKTHROUGH (LEAN) Method
12-168 Improving Antimicrobial Stewardship in the Neonatal ICU with Computer Decision Support
12-169 Evaluating the Primary Outcomes of W.H.O Surgical Safety Checklist 2009 Application in an Obstetrics and Gynecology
Hospital of Vietnam
12-170 A Process Improvement Project Decreases Blood Culture Contamination Rates in the Emergency Room
12-171 Reaching Zero Central Line Associated Infections by Improving Compliance to Aseptic Technique
12-172 Quantitative Evaluation of Environmental Surface Cleanliness in Pediatrics Intensive Care Unit
12-173 Collaborative to Decrease Central Line Associated Blood Stream Infection (Clabsi) in a Neonatal Unit (NICU): An
Urban Teaching Hospital Experience
12-174 Attaining and Sustaining Hand Hygiene Compliance. Patient/Family, Sr. Leadership to Front-line Staff. A Winning Combination!
12-175 Standardizing Environmental Cleaning Procedures and Measurement Across a 12-Hospital System
12-176 Reducing Blood Culture Contamination in the Emergency Department
12-177 A Lean Surveillance Transformation
12-178 Clinical Attributes of Non Ventilator-Associated Hospital-Acquired Pneumonia
12-179 Successful Nurse-driven Improvement Team Raises Postpartum Tdap Rates and Surpasses Target Goal
12-180 Blood Culture Procedures and Results in a Pediatric Hospital in La Paz, Bolivia: Opportunities for Improving Efficiency
and Decreasing Cost
12-181 A Multi-faceted Approach to Increase and Sustain Hand Hygiene Compliance in a Military Treatment Facility
12-182 A Quality Assurance Project to track Compliance with Autoclave Maintenance and use of Biological Indicators in
Outpatient Physician Offices
12-183 Data, Dollars, and Determination.....
12-184 Lessons Learned from 5-yrs of Central Line-Associated Bloodstream Infection Real-Time Event Reviews
12-185 Real-Time Event Reviews: A Useful Tool for the Prompt Identification of System Failures
12-186 Colorado Clostridium difficile Infection Prevention Collaborative

Special Populations (Infections in the Immunocompromised Host, Pediatrics) . . . . . . . . . . . . . . . . . . . .127

13-187 Isolation Precaution Guidelines in NICU: Breast Milk Storage
13-188 Relationship Between Wait-Time for Antibiotic Initiation and Outcomes of Hospitalization Among Children with Cancer
Admitted to an Oncology Ward in a Hospital in the Philippines
13-189 Epidemiological Patterns and Characteristics Associated with Clostridium difficle Infection at the Largest Freestanding
Pediatric Hospital
13-190 Sustaining Zero Central Line-Associated Blood Stream Infections in Pediatric Intensive Care Unit: A Light at the End of
the Tunnel?
13-191 Outpatient Adult Hematopoietic Stem Cell Transplant Visits: Respiratory Season Interventions
13-192 Influenza Immunization of Medical/Surgical and Hematology/Oncology Pediatric Inpatients

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 5
Contents
13-193 Breaking the Bloodstream Infection Connection: Utilizing a Swab containing Chlorhexidine Gluconate (3.15%) and
Isopropyl Alcohol (70%), Chlorascrub™
13-194 Improving the Quality of Care by Reducing Contamination when Drawing Blood Cultures in the Neonatal Intensive Care Unit
13-195 Race and Ethnic Disparities in Hospitalizations with Community-Acquired Infections
13-196 Epidemiology of Nosocomial Infections in Selected Neonatal Intensive Care Units in Children Hospital No1, South Vietnam
13-197 Gender Differences in Risk of Bloodstream Infection

Specialized Settings (Ambulatory Care, Behavioral Health, Long Term Care, Home Care) . . . . . . . . . .133
14-198 Seasonal Influenza Vaccine Compliance Among Hospital and Non-Hospital-Based Healthcare Workers
14-199 Infection Prevention Communication Within a Health Sytem’s Ambulatory Surgery Centers
14-200 What Is Wrong with Using a Dishwasher to Clean My Instruments?
14-201 Effectiveness of a Comprehensive Hand Hygiene Program for Reduction of Infection Rates in a Long-Term Care Facility:
Lessons Learned
14-202 Keeping our Eyes on TASS: Our Experience in the Ambulatory Care Setting
14-203 Strengthening Healthcare-Associated Infection Prevention Efforts in Rural, Small, and Critical Access Hospitals in
California through Collaboration
14-204 Sustained Reduction in Methicillin-Resistant Staphylococcus aureus Incidence in a Geriatric Setting by Implementing Daily
Bathing with 2% Chlorhexidine Gluconate Cloths
14-205 Possible Rabies Exposure in a Community Living Center: Considerations and Decisions for Post-Exposure Prophylaxis

Staff Training/Competency/Compliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138

15-206 Increasing Nurses’ Hand Hygiene Adherence in Acute Care Settings
15-207 Bath Basins: Who Knows Where Evil Lurks
15-208 Improving Hand Hygiene Practice through Utilization of Automated Hand Hygiene Monitoring and Feedback Technology
15-209 Use of an Electronic Survey Instrument to Determine Barriers to Certification in Infection Control
15-210 Food for Thought: The Cafeteria Quiz; an Educational and Engaging Approach to Reinforce Infection Prevention Concepts
During Infection Prevention Week
15-211 Results of a Hospital-wide Initiative to Decrease CAUTIs
15-212 Competence Based Orientation Program
15-213 Engaging Staff to be Responsible for Surgical Site Infection Prevention in a Large Academic Tertiary Hospital
15-214 When You Don’t Know, What You Don’t Know (Healthcare-Associated Infection (HAI) Knowledge in Ambulatory
Surgery Centers (ASC))
15-215 Hand Hygiene Compliance and Variables of Interest at Neonate Intensive Care Unit in a Brazilian Hospital
15-216 Maintenance of Environmental Services Cleaning and Disinfection in the ICU After a Performance Improvement Project
15-217 State Public Health Department Performs External Observations of Hand Hygiene Compliance in All Maine Acute
Care Hospitals, 2011
15-218 Transforming Regulatory Guidelines to Infection Prevention Guidance
15-219 Using Electronic Counter Device to Monitor Hand Hygiene Frequency at Neonate Intensive Care Unit in a Brazilian Hospital
15-220 Infection Prevention and Pharmacy Compounding for Regulatory Compliance
15-221 The Small Group Role-Playing Educations Improved Hand Hygiene Compliance in Intensive Care Unit
15-222 Collaboration Impacting Patient Safety: Infection Control and a Unit Based Performance Improvement Team Reducing Healthcare
Associated Urinary Tract Infections
15-223 Development of Index for Compliance on Hand Hygiene Using a Nursing Need Degree and Hand Hygiene Product Usage
15-224 Development of an Introductory Disinfection/Sterilization Class in the Physician Office Setting
15-225 It’s Everybody’s Problem: A Collaborative Approach to Hand Hygiene
15-226 A Ticket To Ride: A Colloborative Approach To Infection Control Initiatives For A Hospital Relocation

Surveillance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
16-227 Streamlined Emergency Department Post-Discharge Surveillance Reduces Rehospitalizations
16-228 Healthcare Associated Legionellosis Prevention Within a Large Acute Care Center
16-229 Communication of MRSA status upon transfers of LTCF residents to an acute care hospital
16-230 In Situ Detection of Residual Protein Contamination on Surgical Instruments for On-The-Spot Monitoring of
Decontamination Procedures
16-231 Multicenter Study of Hand Carriage of Potential Pathogens by Neonatal ICU Providers
16-232 Survey to Determine Compliance with Center For Disease Control Recommendation for Vaccination of Adolescents
16-233 Nurse Jackson–A Positive Deviance Success Story

6 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Contents
16-234 Utilizing an Electronic Surveillance System to Automate Identification and Electronically Submit LabID Event Data to the National
Healthcare Safety Network
16-235 Using an Electronic Surveillance System to Generate Facility Specific Antibiogram Provides an Accurate and Time Saving Tool
for Clinical Providers
16-236 Apples to Apples: A Model for Standardizing Surveillance Throughout a Healthcare System after Implementation of an
Electronic Surveillance System
16-237 Dirty Laundry? Evaluation of Clostridium difficile Contamination in the Laundry at a Long-Term Care Facility
16-238 Use of an Electronic Surveillance System to Further Refine MDRO Isolation Categorization
16-239 Examining Processes for Identifying Central Line Associated Bloodstream Infections and Variation in a Large Acute Care Facility
16-240 The Incidence of Coccidioidomycosis in San Luis Obispo, California
16-241 Implementing an Active Surveillance Program with Multi-Site Swabbing for Methicillin-Resistant Staphylococcus aureus in a
Community Hospital
16-242 Is it necessary to determine skin closure status for all operative procedures prior to entering SSI denominator data into NHSN?
16-243 Control of MRSA Colonization in a Teritiary NICU
16-244 The Impact of Using Chlorhexadine Gluconate Products in the Adult Critical Care Setting*
16-245 Epidemiology of Infections in a Pediatric Oncology Service in Guatemala
16-246 Comparison of LAB ID and Traditional Surveillance for C difficile, are Proxy Measures Effective Tools for Identifying Performance
Improvement Opportunities?

ORAL ABSTRACTS
Antimicrobial Resistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
100 Overuse of Topical Antibiotics Among Inmates Entering Maximum-Security Correctional Facilities in New York State
101 Infections due to Enterobacter Species: Epidemiology and Outcomes as a Function of Ceftazidime Resistance

Antisepsis/Disinfection/Sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
102 Efficacy of Novel Alcohol-Based Hand Rubs at Typical “In Use” Volumes
103 Clean Collaboration: Toward Improving Arthroscopic Shaver Reprocessing Methods

Device-Related Infections and/or Site Specific Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167

104 Preventing Contamination of Central Venous Catheter Valves with the Use of an Alcohol-based Disinfecting Cap*
105 Endemic IV Fluid Contamination in Hospitalized Children in Mexico. A Problem of Serious Public Health Consequences.*
106 Preventing Infection in Pediatric Spinal Fusion Surgery: A Novel Perioperative and Postoperative Surgical Site Infection
Prevention Bundle
107 Efficacy of Various Antimicrobial Central Venous Catheters in Mono- and Poly-Microbial Environments

Healthcare Worker Safety/Occupational Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170

108 A Healthcare Worker with Pertussis: High Cost and Lost Opportunity*

Infection Prevention and Control Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170

109 Prevention of Hospital Associated C. difficile Infections
110 Preventing the FLU in You: A Three Year Experience of Sustained Seasonal Influenza Vaccination Rates in Healthcare Workers
111 Monitoring the Manual Cleaning of Flexible Endoscopes with an ATP Detection System
112 Changing Bedside Care by Linking Outcome and Process Data
113 Risk Factor Score to Predict MRSA Colonization at Hospital Admission
114 Understanding Hand Hygiene Behavior in a Pediatric Oncology Unit in a Low Middle Income Country: A Focus Group Approach
115 Multidrug Resistant Organisms in Supply Carts of Contact Isolation Patients
116 Standardization of Hand Hygiene Observations - an Entire State Collaborates
117 Should Contact Precautions be Standard? A Community Hospital’s Revised Criterion for Methicillin-Resistant Staphylococcus
aureus and Vancomycin Resistant Enterococcus Isolation

Product Evaluation/Cost-Effectiveness/Cost Benefit Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177

118 Re-Admissions After Diagnosis of Surgical Site Infection Following Knee and Hip Arthroplasty*

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 7
Contents
Public Reporting/ Regulatory Compliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
119 The Impact of Non-Payment for Preventable Complications on Infection Rates in U.S. Hospitals*
120 New York State Hospital-Acquired Infection Reporting – 2010 Audit Results: An Inter-Hospital Comparison*
121 Assessment of the Quality and Accuracy of Publically Reported CLABSI Data in Colorado*

Quality Management Systems/Process Improvement/Adverse Outcomes . . . . . . . . . . . . . . . . . . . . . . .180

122 Rapid Cycle Process Improvements to Decrease Surgical Site Infections in Cardiothoracic and Vascular Surgery Patients
between 2008 and 2011*
123 Code Flash: An Interdisciplinary Team’s Efforts to Decrease Incidents of Flash Sterilization
124 Culture Change and CLABSI Reduction: Achieving Success in a Medical Center with 10 Distinctively Different Intensive
Care Units

Special Populations (Infections in the Immunocompromised Host, Pediatrics) . . . . . . . . . . . . . . . . . . . .183

125 Using a Multi-Faceted Active Change Process and Infection Prevention to Reduce Post Op C-Section Infections

Staff Training/Competency/Compliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .183

126 Active Participation from the Hospital Executive Team Does Improve Hand Hygiene Compliance
127 Healthcare Worker Response to Direct Monitoring of Adherence to Isolation Precautions

Surveillance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
128 Relative Frequency of Healthcare-Associated Pathogens and Incidence of Healthcare-Associated Infections by Pathogen at
a University Hospital from 2006 to 2010
129 Comparison of Methods for Surgical Site Infection Surveillance: Traditional Report Review and Electronic Surveillance
130 Discontinuation of Reflex Testing of Stool Samples for Vancomycin-Resistant Enterococci Resulted in Increased Prevalence*
131 Validation of Infection Preventionists Surveillance for Determining Hospital-Acquired Central Line-Associated Bloodstream
Infection Using Centers for Disease Control and Prevention Definitions

8 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Abstract Awards

William A. Rutala Research Award

Purpose: This award is given in the name of William A. Rutala, PhD, MPH, for the best abstract on the subject of
disinfection, sterilization, or antisepsis.

Selection Criteria: To be considered for this award, applicants must: 1) submit an abstract to the APIC Annual Educational
Conference & International Meeting in the year the award is to be given; 2) have not received the award within the last 3 years;
3) submit a Format I abstract in the Antisepsis/Disinfection/Sterilization category, written in a clear, logical and concise manner
which communicates the principal objectives, methodology, results and conclusions in a straightforward fashion; 4) submit
research that is limited to the study and understanding of the principles and practices of disinfection, sterilization, and antisepsis;
5) submit an abstract that will reflect original research or (if not entirely new should supplement existing data), is conducted
with appropriate data analysis, and is of major importance to the field of disinfection, sterilization, and antisepsis; 6) abstract
is innovative, employs sound methodology, and represents a potentially significant, scientific contribution to the principles
and practices of disinfection, sterilization and antisepsis; and 7) all abstract submitters who meet the above criteria during the
abstract submission process will be considered for the “William A. Rutala Research Award.”

Award: Plaque, $1,000, and recognition in the publication of abstracts in AJIC online, the onsite Annual Conference Program,
and conference CD-ROM.

2012 Winner:
Publication Number: 2-018
sponsor: clorox
Alexis Price, RN, BSN
Hydrogen Peroxide Patient Privacy Cubical Curtain Cleaning Study

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 9
 Abstract Awards continued

Blue Ribbon Abstract Award

Purpose: Blue Ribbon Awards are given to a limited number of abstracts considered by the Abstract Selection Committee to be of
exemplary scientific and/or educational quality. Investigators are encouraged to emulate the qualities evident in these abstracts. Among
the criteria considered by the committee in awarding Blue Ribbons are the following; 1) the abstract is presented in a clear, logical and
concise format and communicates the major ideas of the work in a straightforward fashion; 2) if scientific research findings are presented,
the abstract demonstrates a high quality of research design and methodology and includes sufficient data to support the conclusions; 3) the
work is timely, novel, and represents a potentially significant, scientific or educational contribution to the field; 4) abstract submission rules
have been followed. All abstract submitters who meet the above criteria during the abstract submission process will be considered for the
Blue Ribbon Abstract Award.
Award: A plaque and recognition in the publication of abstracts in AJIC online, onsite Annual Conference Program, and conference CD-ROM.

2012 Winners:
Presentation Number: 120
Kathleen Gase, MPH, CIC
New York State Hospital-Acquired Infection Reporting – 2010 Audit Results: An Inter-Hospital Comparison

Presentation Number: 130

Kathleen McMullen, MPH, CIC
Discontinuation of Reflex Testing of Stool Samples for Vancomycin-Resistant Enterococci Resulted in Increased Prevalence

Presentation Number: 122

Lee Reed, RN, BA, MSPH, CIC
Rapid Cycle Process Improvements to Decrease Surgical Site Infections in Cardiothoracic and Vascular Surgery Patients between
2008 and 2011

Presentation Number: 108

Gregory Gagliano, BSN, RN, CIC
A Healthcare Worker with Pertussis: High Cost and Lost Opportunity

Publication Number: 1-003

Mary Cole, BSN, CIC
Escalation and De-Escalation Plan for Carbapenem-Resistant Gram Negative Organisms in Critical Care

Presentation Number: 104

Marc-Oliver Wright, MT(ASCP), MS, CIC
Preventing Contamination of Central Venous Catheter Valves with the Use of an Alcohol-based Disinfecting Cap

Presentation Number: 119

Grace Lee, MD, MPH
The Impact of Non-Payment for Preventable Complications on Infection Rates in U.S. Hospitals

Presentation Number: 118

Keith Kaye, MD, MPH
Re-Admissions After Diagnosis of Surgical Site Infection Following Knee and Hip Arthroplasty

Publication Number: 16-244

Audrey Adams, RN, MPH, CIC
The Impact of Using Chlorhexadine Gluconate Products in the Adult Critical Care Setting

Presentation Number: 121

Karen Rich, RN, BSN, MEd, CIC
Assessment of the Quality and Accuracy of Publically Reported CLABSI Data in Colorado

10 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Abstract Awards continued

New Investigator Award

Purpose: The New Investigator Award encourages research by APIC members by recognizing outstanding scientific research
by an APIC member presenting for the first time at the APIC Annual Educational Conference and International Meeting.
Selection Criteria: To be considered for the New Investigator Award, applicants must be: 1) a current APIC member; 2) the
first or presenting author on a scientific paper (Format I) selected for presentation; and 3) a first-time presenter of a scientific
paper in either an oral or poster session; 4.) Authors must indicate they are applying for the New Investigator Award during
the abstract submission process by clicking the check box labeled “New Investigator Award.” This is a one time award, and
winners may not apply for this award in the future. However, other individuals from the same institution are eligible to apply
for their scientific research.
Award: $1,500, a plaque and recognition in the publication of abstracts in AJIC online, onsite Annual Conference Program
and Abstract Publication, and conference CD-ROM.

2012 Winner:
Publication Number: 120
SPONSOR: ASP
Kathleen Gase, MPH, CIC
New York State Hospital-Acquired Infection Reporting – 2010 Audit Results: An Inter-hospital Comparison

Best International Abstract Award

Purpose: This award recognizes the best abstract from outside the United States
Selection Criteria: Abstracts will be judged on scientific merit, interest, and relevance to the infection prevention and control
community. To be considered for this award, applicants must meet the following requirements: 1) the applicant resides
outside the United States; 2) the research was conducted outside the United States; 3) the applicant is able to present the
paper at the APIC Annual Conference; 4) the applicant follows all online submission procedures. All abstract submitters
who meet the above criteria during the abstract submission process will be considered for the Best International Abstract
Award. However, abstract submitters who will not be considered for this award are those submitters who check the box
labeled “DO NOT consider for the Best International Award.”
Award: $1,000 travel stipend to APIC Annual conference, recognition in the publication of abstracts in AJIC online, onsite
Annual Conference Program and Abstract Publication, and conference CD-ROM.

2012 Winner:
Publication Number: 105
Alejandro Macias, MD
Endemic IV Fluid Contamination in Hospitalized Children in Mexico. A Problem of Serious Public Health Consequences.

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 11
Abstracts and Posters Were Submitted in Two Different Formats

FORMAT I
This format is intended for abstracts involving scientific research, such as randomized clinical
controlled trials, case-controlled studies, cohort, observational, descriptive studies, and/or
experimental design. Abstracts should disclose primary findings and should not discuss works
in progress with preliminary results.
Format I abstracts contain the following:
• Background/Objectives: Outline study objectives, hypothesis tested, or problem
addressed.
• Methods: Describe study design. NOTE: When using trade names, several companies’
trade names should be used, not just trade names from a single company.
• Indicate the setting for the study, study design, sample, sample size, study procedure,
outline, subjects, intervention, and type of statistical analysis.
• Results: Summarize essential results with appropriate statistical analysis (p-value
confidence intervals, odds ratio, relative risk, rate ratio, etc.). Present as clearly as
possible the outcome of the study and statistical significance if appropriate.
• Conclusions: Conclusions should be supported by the findings. Summarize findings
(as supported by results), implications, and conclusions. Emphasize the significance of
the results.

FORMAT II
This format is intended for abstracts describing educational programs, observations, case
studies, outbreak investigations, or other infection prevention or quality improvement
activities, including descriptions of facility- or community-based programs or interventions,
infection prevention policies, and prevention models or methods.
Format II abstracts contain the following:
• Issue: Identify specific problem or need addressed. Provide a brief introduction and
include important background information
• Project: Describe the setting, intervention, and significant detail of the program
• Results: Summarize results
• Lessons Learned: Outline lessons learned and implications.

12 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
Poster Abstracts Antimicrobial Resistance

Location: Exhibit Hall D, San Antonio Presentation Number 1-001

Convention Center Risk Factors for Vancomycin-resistant
Enterococcus faecalis bacteremia: a case-case-
Posters are arranged by topic number (see below) and then control study
numerically by Publication Number within each category. The
Kayoko Hayakawa, MD, PhD - Fellow, Wayne State University,
poster hall will be open for the duration of the conference, Friday,
June 4 – Sunday, June 6. Detroit Medical Center; Dror Marchaim, MD - Post Doctoral
Fellow Infection Control and Epidemiology, Detroit Medical
Example, Poster 1-005 is in the Antimicrobial Resistance Center/Wayne State University; Mohan B. Palla, MBBS - Research
category and precedes poster 1-006. Assistant, Wayne State University, Detroit Medical Center; Uma
Mahesh, MBBS - Research Assistant, Wayne State University,
Detroit Medical Center; Harish Pulluru, MBBS - Research
Poster Categories Assistant, Wayne State University, Detroit Medical Center; Kyeong
Pyo Lee, MD - Research Assistant, Wayne State University, Detroit
CATEGORY TOPIC Medical Center; Srinivasa Kamatam, MBBS - Research Assistant,
Wayne State University, Detroit Medical Center; Manit Singla,
1. Antimicrobial Resistance MBBS - Research Assistant, Wayne State University, Detroit
2. Antisepsis/Disinfection/ Medical Center; Mayan Ajamoughli, MD - Research Assistant,
Sterilization Wayne State University, Detroit Medical Center; Pradeep Bathina,
MBBS - Research Assistant, Wayne State University, Detroit Medical
3. Bioterrorism/Disaster/
Center; Khaled Alshabani, MD - Research Assistant, Wayne State
Emergency Preparedness
University, Detroit Medical Center; Aditya Govindavarjhulla,
4. Device-Related Infections and/ MBBS - Research Assistant, Wayne State University, Detroit Medical
or Site Specific Infections Center; Ashwini Mallad, MBBS - Research Assistant, Wayne
5. Emerging and Reemerging State University, Detroit Medical Center; Kevin Ho, BA - Medical
Infectious Diseases student, Wayne State University, Detroit Medical Center; Deepika
Reddy Abbadi, MBBS - Research Assistant, Wayne State University,
6. Environment of Care/Construction/ Detroit Medical Center; Deepti Chowdary, MBBS - Research
Remediation Assistant, Wayne State University, Detroit Medical Center; Hari
7. Healthcare Worker Safety/ Kakarlapudi, MBBS - Research Assistant, Wayne State University,
Occupational Health Detroit Medical Center; Harish Guddati, MBBS - Research
8. Infection Prevention and Assistant, Wayne State University, Detroit Medical Center; Manoj
Control Programs Das, MBBS - Research Assistant, Wayne State University, Detroit
Medical Center; Naveen Kannekanti, MBBS - Research Assistant,
9. Outbreak Investigation Wayne State University, Detroit Medical Center; Balaji Ramasamy,
10. Product Evaluation/Cost- MBBS - Research Assistant, Wayne State University, Detroit
Effectiveness/Cost Benefit Analysis Medical Center; Amber Khan, MD - Research Assistant, Division of
Infectious Diseases, Wayne State University; Praveen Vemuri, MBBS
11. Public Reporting/Regulatory
- Research Assistant, Division of Infectious Diseases, Wayne State
Compliance
University; Rajiv Doddamani, MBBS - Research Assistant, Division
12. Quality Management Systems/ of Infectious Diseases, Wayne State University; Venkat Ram Rakesh
Process Improvement/ Mundra, MBBS - Research Assistant, Division of Infectious Diseases,
Adverse Outcomes Wayne State University; Raviteja Reddy Guddeti, MBBS - Research
13. Special Populations (Infections in Assistant, Division of Infectious Diseases, Wayne State University;
the Immunocompromised Host, Rohan Policherla - Medical Student, Wayne State University, School
Pediatrics) of Medicine; Sarika Bai, MBBS, MD - Research Assistant, Division
of Infectious Diseases, Wayne State University; Sharan Lohithaswa,
14. Specialized Settings (Ambulatory MD - Research Assistant, Division of Infectious Diseases, Wayne
Care, Behavioral Health, Long Term State University; Shiva Prasad Shashidharan, MBBS - Research
Care, Home Care) Assistant, Division of Infectious Diseases, Wayne State University;
15. Staff Training/Competency/ Sowmya Chidurala, MBBS - Research Assistant, Division of
Compliance Infectious Diseases, Wayne State University; Sreelatha Diviti, MBBS
16. Surveillance - Research Assistant, Division of Infectious Diseases, Wayne State
University; Dipenkumar Patel, MBBS - Research Assistant, Detroit
Medical Center; Gayathri Vadlamudi - Research Assistant, Division

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 13
Poster Abstracts: Antimicrobial Resistance
of Infectious Diseases, Wayne State University; Tarek Obeid - with bacteremia due to VREF. In order to control the continued
Research Assistant, Division of Infectious Diseases, Wayne State spread of VREF, and possibly VRSA, a combined approach of
University; Jason Pogue, PharmD - Infectious Diseases Pharmacist, infection control focusing on care for and removal of permanent
Detroit Medical Center; Paul R. Lephart, PhD - Associate Technical devices and antimicrobial stewardship focusing on limiting
Director of Microbiology, Detroit Medical Center University vancomycin is necessary.
Laboratories; Emily Toth Martin, MPH, PhD - Assistant Professor,
Department of Pharmacy Practice, Wayne State University College
of Pharmacy and Health Sciences; Elaine Flanagan, BSN, MSA,
CIC - Director Epidemiology, Detroit Medical Center; Michael J.
Rybak, PharmD, MPH - Associate Dean for Research, Professor
of Pharmacy and Medicine Director, The Anti-Infective Research
Laboratory, Eugene Applebaum College of Pharmacy and Health
Science; Keith Kaye, MD, MPH - Corporate Director of Infection
Prevention, Hospital Epidemiology and Antimicrobial Stewardship,
Detroit Medical Center/Wayne State University

Background/Objectives: Published cohorts of patients

with bacteremia due to vancomycin-resistant Enterococcus (VRE)
have predominantly consisted of E. faecium. Little is known about
the epidemiology associated with bacteremia due to VR E. faecalis
(VREF). VREF is unusually common at DMC, and has been
growing in prevalence; in 2009, 530 of 4,377 (12.1%) isolates of E.
faecalis were VRE. In the majority of cases of vancomycin-resistant
Staphylococcus aureus (VRSA), VREF has served as the vanA donor
to S. aureus. Better understanding the epidemiology of infection
due to VREF is an essential first step in limiting the continued
proliferation and spread of these organisms, which might also
help to prevent emergence and spread of VRSA. MEthods:
A case-case-control study was conducted to identify independent Presentation Number 1-002
risk factors for bacteremia due to VREF. Unique patients with
bacteremia due to VREF from 2008 to 2009 were matched to cases Emergence of IMP-1 Producing Escherichia coli in
with bacteremia due to vancomycin-sensitive E. faecalis (VSEF) a Tertiary Hospital in Japan
and to uninfected controls in a 1:1:1 ratio. Results: Seventy-six Kei Kasahara - Associate Professor, Center for Infectious Diseases,
cases of bacteremia due to VREF were identified and were matched Nara Medical University; Yuko Komatsu - Postgraduate student,
to 76 VSEF bacteremia cases and 76 uninfected controls. The mean Center for Infectious Diseases, Nara Medical University; Akifumi
age of the study cohort was 61.9+-15.7 years, 133 (58.3%) were Nakayama - Microbiologist, Department of Clinical Microbiology,
male, 186 (81.6%) were African American. Eighty-nine subjects Nara Medical University; Koji Ui - Microbiologist, Department
(39.2%) resided in institutions (nursing homes or hospitals) prior to of Clinical Microbiology, Nara Medical University; Fumiko
admission (44 [57.9%] of VREF, 27 [36%] of VSEF, 18 [23.7%] of Mizuno - Associate Professor, Department of Microbiology,
controls; p < 0.001 for VREF compared to controls:). One hundred Nara Medical University; Keiichi Mikasa - Professor, Center for
fifty-two (66.7%) had dependent functional status on admission (60 Infectious Diseases, Nara Medical University; Reiko Sano - Director,
[78.9%] of VREF, 56 [73.7%] of VSEF, 36 [47.4%] of controls; p Department of Clinical Microbiology; Eiji Kita - Professor,
< 0.001 for VREF compared to uninfected controls, p=0.002 for Department of Microbiology, Nara Medical University
VSEF compared to controls). The Charlson’s median weighted index
comorbidity (IQR) scores were 5.4 (3.3-8.3), 4.5 (2.6-6.7), and 2.2
Background/Objectives: Cephalosporin resistance
(0.8-4.3) for VREF, VSEF and controls (p < 0.001 for VREF cases
due to extended beta lactamases have been a serious problem in
compared to controls). Thirty-one (40.8%) of the patients with
enterobacteriaceae such as E. coi. In addition to this, emergence
VREF and 35 (46.1%) of the patients VSEF had pathogens that were
of carbapenem resistant strains such as KPC or NDM producing
hospital-acquired, defined as isolated from a culture obtained after 2
ones has made the situation much more complicated. The resistance
days of hospitalization. Independent risk factors for the isolation of
pattern and recommended antibiotics may vary depending on the
VREF and VSEF were determined by multivariate analysis (Table).
resistant mechanisms and there is a need to evalulate the situation
In multivariate analysis, vancomycin was the only variable that was
in each geographic area. Methods: A total of 256 E. coli strains
associated with VREF but not with VSEF. The presence of indwelling
isolated between November 2010 and October 2011 in out hospital
permanent devices was associated with VREF to a stronger degree
(a tertiary hospital with 800 beds in Nara, Japan) were evaluated
than VSEF. Conclusions: Vancomycin exposure was a strong,
for antibiotic resistance, ESBL genes, and carbapenemase genes.
unique predictor of VREF. The presence of permanent indwelling
Results: There were 37 isolates (14.4%) that produce ESBL. All
devices, such as tracheotomies, central lines, urinary catheters, and
of the ESBL producing E. coli possessed CTX-M gene. Four isolates
hemodialysis catheters at the time of admission was also associated
produced IMP-1, a metallo beta lactamase in addition to ESBL.

14 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Antimicrobial Resistance
Isolates with only ESBL were resistant to all cephalosporins but
susceptible to cefmetazole (antibiotic that belongs to cephamycins),
whereas isolates with both ESBL and IMP-1 were resistant to all
cephalosporins and cefmetazole. Even IMP-1 producing strains were
susceptible to imipenem and meropenem according to the CLSI
2012 criteria. All of the ESBL and/or IMP-1 producing strains were
susceptible to fosfomycin. No isolates with KPC or NDM were
detected. Conclusions: The carbapenem resistance genes in
Japan (ie. IMP-1) may vary from those in the United States (NDM
or KPC). Most of the IMP-1 producins strains were shown to
be susceptible to carbapenems in vitro, but the clinical efficacy of
carbapenem on these strains is yet to be elucidated.

Presentation Number 1-003

Escalation and De-Escalation Plan for

Carbapenem-Resistant Gram Negative Organisms
in Critical Care
Mary A. Cole, BSN, CIC - Director of Infection Prevention and
Control, Grady Health System

Issue: Infections with carbapenem-resistant gram-negative

organisms are emerging as an important challenge in health-
care settings. The purpose of this initiative was to decrease the
transmission of these infections and colonization in the ICUs by
implementing consistent multi-disciplinary activities. Project: A
multidisciplinary team formed to devise an improved, more highly-
structured schematic for controlling and preventing the infections
throughout the critical care division of the hospital. Establishing an
algorithm of activities reduced confusion and guess-work, allowing
healthcare workers to respond to the outbreak based solely on
outcome results. Results: Since the implementation of this plan,
carbapenem-resistant Acinetobacter infections decreased 70.8%,
from 24 cases in July 2010 to 2 cases in December 2011. During
this time frame, intense focus has also increased hand hygiene
compliance rates by 14%. Since the height of the outbreak our central
line associated blood stream infection (CLABSI) rate has decreased
87.3% in the intensive care units. Due to the decrease in transmission,
cost savings was also incurred. Lessons Learned: This plan
is both measurable and user friendly, giving guidance and structure
as the number of new clinical cases governs the interventions rather
than subjective discretion. All stakeholders’ roles are clearly defined,
delineating responsibilities across many departments (patient care,
infection control, EVS) and levels ranging from front line staff to
senior administration. Although the initial intent was to provide
consistency to infection control activities during an outbreak, staff
reports an increased sense of empowerment and accomplishment
in controlling infection transmission, thereby, positively impacting
patient outcomes. Job satisfaction and patient satisfaction is improved
with fewer patients in contact isolation. The units are competitive
with de-escalation being a common goal. While the plan is currently
utilized for carbapenem-resistant gram negative infections, its
universality allows it to be applied to other resistant organisms as
well. This plan can easily be adapted to fit other clinical intensive care
settings and can be extended to other facilities.

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 15
Poster Abstracts: Antimicrobial Resistance

Presentation Number 1-004 Detroit Medical Center; Paul R. Lephart, PhD - Associate Technical
Director of Microbiology, Detroit Medical Center University
Risk factors for the isolation of Vancomycin- Laboratories; Emily Toth Martin, MPH, PhD - Assistant Professor,
resistant Enterococcus faecalis from wound site: A Department of Pharmacy Practice, Wayne State University College
case-case control analysis of Pharmacy and Health Sciences; Michael J. Rybak, PharmD,
MPH - Associate Dean for Research, Professor of Pharmacy and
Mohan B. Palla, MBBS - Research Assistant, Wayne State University, Medicine Director, The Anti-Infective Research Laboratory, Eugene
Detroit Medical Center; Kayoko Hayakawa, MD, PhD - Fellow, Applebaum College of Pharmacy and Health Science; Elaine
Wayne State University, Detroit Medical Center; Dror Marchaim, Flanagan, BSN, MSA, CIC - Director Epidemiology, Detroit
MD - Post Doctoral Fellow Infection Control and Epidemiology, Medical Center; Keith Kaye, MD, MPH - Corporate Director of
Detroit Medical Center/Wayne State University; Uma Mahesh, Infection Prevention, Hospital Epidemiology and Antimicrobial
MBBS - Research Assistant, Wayne State University, Detroit Stewardship, Detroit Medical Center/Wayne State University
Medical Center; Harish Pulluru, MBBS - Research Assistant,
Wayne State University, Detroit Medical Center; Kyeong Pyo Background/Objectives: VRE are most commonly
Lee, MD - Research Assistant, Wayne State University, Detroit E. faecium. However, in our health system in Southeast Michigan
Medical Center; Srinivasa Kamatam, MBBS - Research Assistant, (SEMI), VR E. faecalis (VREF) is unusually common; more than
Wayne State University, Detroit Medical Center; Manit Singla, 38% of VRE were E. faecalis in 2009. VREF is associated with
MBBS - Research Assistant, Wayne State University, Detroit development of vancomycin-resistant Staphylococcus aureus (VRSA)
Medical Center; Mayan Ajamoughli, MD - Research Assistant, via transfer of the vanA plasmid to S. aureus. Wounds have been
Wayne State University, Detroit Medical Center; Pradeep Bathina, reported as the anatomic culture source of VRSA in 10 of 12 patients
MBBS - Research Assistant, Wayne State University, Detroit Medical with VRSA, of which 8 cases were reported from SEMI. A recent
Center; Khaled Alshabani, MD - Research Assistant, Wayne State study suggested wounds were an important risk factor of MRSA and
University, Detroit Medical Center; Aditya Govindavarjhulla, VRE co-colonization. We conducted a retrospective case-case control
MBBS - Research Assistant, Wayne State University, Detroit Medical study to evaluate the independent risk factors specifically associated
Center; Ashwini Mallad, MBBS - Research Assistant, Wayne with VREF isolation from wounds, which has important implications
State University, Detroit Medical Center; Kevin Ho, BA - Medical regarding the continued emergence of VRSA in SEMI. Methods:
student, Wayne State University, Detroit Medical Center; Deepika Unique patients with VREF isolation from a wound during the study
Reddy Abbadi, MBBS - Research Assistant, Wayne State University, period (2008-2009) were matched to two groups of patients in a
Detroit Medical Center; Deepti Chowdary, MBBS - Research 1:1:1 ratio: the first, with isolation of vancomycin-sensitive E. faecalis
Assistant, Wayne State University, Detroit Medical Center; Hari (VSEF) from a wound; and the second, uninfected controls. A
Kakarlapudi, MBBS - Research Assistant, Wayne State University, case-case-control analysis was conducted. Results: One hundred-
Detroit Medical Center; Harish Guddati, MBBS - Research sixteen VREF cases were identified and matched to 116 VSEF cases
Assistant, Wayne State University, Detroit Medical Center; Manoj and to 116 uninfected controls. The mean age of the study cohort
Das, MBBS - Research Assistant, Wayne State University, Detroit was 60.7+-17.1 years, 167 (48%) were males, 266 (76.4%) were
Medical Center; Naveen Kannekanti, MBBS - Research Assistant, African American. Seventy-four (62.2%) cases with VREF and 58
Wayne State University, Detroit Medical Center; Balaji Ramasamy, (50%) VSEF patients had hospital-acquired pathogens, (isolated
MBBS - Research Assistant, Wayne State University, Detroit
Medical Center; Amber Khan, MD - Research Assistant, Division of
Infectious Diseases, Wayne State University; Praveen Vemuri, MBBS
- Research Assistant, Division of Infectious Diseases, Wayne State
University; Rajiv Doddamani, MBBS - Research Assistant, Division
of Infectious Diseases, Wayne State University; Venkat Ram Rakesh
Mundra, MBBS - Research Assistant, Division of Infectious Diseases,
Wayne State University; Raviteja Reddy Guddeti, MBBS - Research
Assistant, Division of Infectious Diseases, Wayne State University;
Rohan Policherla - Medical Student, Wayne State University, School
of Medicine; Sarika Bai, MBBS, MD - Research Assistant, Division
of Infectious Diseases, Wayne State University; Sharan Lohithaswa,
MD - Research Assistant, Division of Infectious Diseases, Wayne
State University; Shiva Prasad Shashidharan, MBBS - Research
Assistant, Division of Infectious Diseases, Wayne State University;
Sowmya Chidurala, MBBS - Research Assistant, Division of
Infectious Diseases, Wayne State University; Sreelatha Diviti, MBBS
- Research Assistant, Division of Infectious Diseases, Wayne State
University; Dipenkumar Patel, MBBS - Research Assistant, Detroit
Medical Center; Gayathri Vadlamudi - Research Assistant, Division
of Infectious Diseases, Wayne State University; Tarek Obeid -
Research Assistant, Division of Infectious Diseases, Wayne State
University; Jason Pogue, PharmD - Infectious Diseases Pharmacist,

16 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Antimicrobial Resistance
from a culture > 2 days after hospital admission). Eighty-four subjects similarity of the side chains at position 6, 7 and 3 on these antibiotics.
(24.1%) resided in institutions (nursing home or hospitals) prior to Therefore, drugs with similar chains at these positions are more likely
admission (46 [40%] of VREF, 25 [21.6%] of VSEF, 13 [11.2%] of to exhibit cross-allergenicity with each other. Cefazolin( Ancef ),
controls; p<0.001 for VREF vs uninfected controls; p=0.044 for cefonicid , cefotiam and moxalactam do not share a structural
VSEF vs controls). One hundred seventy-two (49.4%) subjects had relationship with other drugs ( including penicillin) and therefore
dependent functional status on admission (74 [64.9%] of VREF cross-reactivity would be extremely unlikely. Therefore, a history of
cases, 50 [43.1%] of VSEF cases, 48 [41.4%] of uninfected controls; penicillin should not predict an allergy to Ancef. With the approval
p=0.001 for VREF vs uninfected controls). The Charlson’s combined of the P&T, Infection Prevention Committee and Medical Executive
comorbidity score (median, [IQR]) were 6.0 (3.2-8.6), 5.5 (2.8- Committee, all standing orders were change so that only patients
7.6), and 4.8 (1.8-7.8) for VREF, VSEF, and controls respectively who noted a specific allergy to Ancef – not penicillin – were given
(p=0.03 for VREF compared to uninfected controls). Independent other antibiotics. Results: Physicians and clinical staff were
risk factors for the isolation of VREF and VSEF were determined by educated to new processes by email, personal letters and one on one
multivariate analysis (Table). Conclusions: The presence on conversations. All preoperative patients were asked if they have a
admission of permanent indwelling devices (e.g. central lines, urinary history of an Ancef allergy. If noted, vancomycin or clindamycin
catheters, hemodialysis catheters, tracheotomies, percutaneous were used. Fifty seven percent (57%) less vancomycin as well as 63%
endoscopic gastrostomy [PEG] tubes) and past exposure to Beta- less clindamycin was used todate in comparison to same period prior
lactam antibiotics were uniquely associated with isolation of VREF to this initiative implementation. Since implementation, no allergic
but not VSEF. Chronic skin ulcers were associated with the isolation reactions were reported by staff or patients. Lessons Learned:
of both VREF and VSEF. The results of this study are in accordance Nursing and pharmacy staff reported less anxiety with perceived
of reported risk factors for VRE and MRSA cocolonization in SEMI, allergic patients, calmer pre-op setting and less delayed surgeries (
and might explain in part the endemicity of VRSA in this region. due to vancomycin infusion time). Process noted a decrease in the
Surveillance, proactive infection control measures and antimicrobial amount of vancomycin and clindamycin was used leading to less risk
stewardship are key methods to control the spread of VREF and of patients developing multidrug resistant organisms.
continued emergence of VRSA.

Presentation Number 1-006

Presentation Number 1-005
The Cephalosporin Use in the Penicillin Risk factors to acquire Vancomycin-Resistant
Allergic Patient Enterococcus faecium (VRE) infection in
pediatric patients
Peggy Prinz Luebbert, MS, MT(ASCP)SC, CIC, CHSP - Owner
and Consultant, Healthcare Interventions; Infection Preventionist, Alejandra Nava Ruiz, MD - Chief of services, Hospital Infantil de
Nebraska Orthopaedic Hospital; Infection Preventionist-Consultant, Mexico Federico Gomez
Select Specialty Hospital; Chris Vollmuth - Pharmacist, Nebraska Background/Objectives: In 2009, we characterized the
Orthopaedic Hospital first strain of VRE implicated in an outbreak by using molecular
techniques. Since then, we had been isolating VRE considered those
Issue: Issue:Many patients present for orthopedic surgeries with strains endemic as infecting and colonizing agent. The aim of this
penicillin or cephalosporin allergies. These allergies are unbiquous study is to identify the risk factors for VRE infection in pediatric
and range from hives, shortness of breath to an upset stomach. The patients in order to design epidemiological control measures.
pre –operative antibiotic of choice for these procedures is Ancef. In Methods: A retrospective case-control study was performed in
the past, these “allergic” patients would be treated with vancomycin a terciary children hospital in Mexico City from January 2010 to
or clindamycin pre-operatively. This last minute antibiotic change April 2011. Demographic data, clinical characteristics and risk factors
lead to increase in pre-op nursing and pharmacy staffing time, like antibiotic exposure (cephalosporins, clindamycin, vancomycin),
delayed surgeries, operating room scheduling issues and increased surgical procedures, care in an intensive care unit (UCI), use of
risk of complications for the patient ( I.e. MDRO, renal issues or steroids, use of medical devices, and underlying conditions. We
c-diff infections etc. Project: In response to some complications compared variables in paired groups regarding age, underlying
when managing these allergic patients, our pharmacist noted in his diseases in a multivariate logistic regression model. Each case was
research that true penicillin allergies tend to be IgE mediated (type matched with 4 control patients. Antibiotic susceptibility profile
I hypersensitivity reaction) that occur within minutes to hours was performed with Kirby-Bauer method according with Clinical
after exposure and include anaphylaxis, bronchospasm, angioedema and Laboratory Standars Institute (CLSI) recommendations.
,hypotension or hives. He also discovered that early literature noted a The VRE strains genotype clonal pattern were analyzed with
cross-reactivity between penicillin and cephalosporins was originally pulsed-field electrophoresis (PFGE). For schematic representation
thought to be anywhere between 1% and 18% . However, these rates through a phylogenetic tree, the genomic profiles of isolated of
may have been overestimated due to reporting of symptoms that VRE were grouped first by visual inspections and subsequently
were not truly allergies and to the less refined manufacturing process analyzed with the program NTSYS 2.02. Results:We identify
that lead to the presence of penicillin in early cephalosporins. More 63 patients with VRE, only 12 (20%) developed infection; 5
recent research is showing that cross-reactivity is dependent on the patients (41%) had central-line associated bloodstream infection

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 17
Poster Abstracts: Antisepsis/Disinfection/Sterilization
(CLABSI) and 8 patients (58%) urinary tract infection; 5 (42%) found that equipment disinfection occurred only 47% of the time.
patients with infection had cancer and all infected or colonized. Lack of available of disinfectant to clean equipment was a factor in
(100%) patients had linezolid. Three patients (5%) died for VRE suboptimal compliance. Wall mounted brackets were installed to
septic shock. Increment of risk for VRE infections was found hold disinfectant wipes. Education on equipment disinfection was
statistically significant with vancomycin exposure Odds Ratio (OR) provided and an equipment disinfection grid listing equipment,
10 [95%Confidence Interval = 2.4-41.3 (p=0.001)]. Other risk cleaning responsibility, and method was widely distributed. A post
factors that were not statistically significant, but highly associated intervention audit was perfomed, showing increased compliance of
with VRE were ICU hospitalization and use of steroids. Hemato- 74.3% Ongoing departmental monitoring of equipment disinfection
oncology ward and ICU had highest incidence of cases. VRE strains to maintain improvement was recommended. Lessons
were identified as phenotype A: minimal inhibitory concentration Learned: What was initially expected to be a 6 month effort
(MIC) > 64mcg/ml and teicoplanin MIC > 16mgc/ml, high turned into a 2 year project. Chosing a proper and cost effective
resistance to aminoglycosides (>500mg/dl gentamicin). Those disinfectant and agreeing on a safe yet convenient location was
strains exhibited full susceptibility to linezolid, daptomycin and challenging in light of our patient population. Teamwork and
quinupristin-dalfopristin. PFGE shown similar clonal pattern of VRE involving senior administration were key to the success of our project.
strains according Tenover’ s criteria. Dendrogram analysis display Maintaining compliance by ongoing monitoring will be a long range
strains of VRE highly epidemiological related. Conclusions: challenge.
Incidence of VRE infections in our center is increasing. We found
that vancomycin exposure is frequent in those who develop VRE
infection, unclear is if use of vancomycin is a marker of overall host
susceptibility and propensity to acquire the infection and/ or favor
colonization. Because the VRE endemicity in our institution, we
are optimizing infection prevention and control practices and VRE
surveillance in high risk patients while using vancomycin when this is
indicated.

Antisepsis/Disinfection/Sterilization
Presentation Number 2-007
Disinfect To Protect- Developing a System To
Presentation Number 2-008
Enhance Disinfection of Patient Care Equipment A Comparative In-Vivo Study on Persistent
Judy Latham, RN, BSN, CRRN - Nurse Manager, Bryn Mawr Effects of Chlorhexidine Gluconate in Alcohol
Rehabilitation Hospital; Hillary B. Cooper, RN, MS, CIC - Lead Formulations and a Povidone-Iodine Solution as
Infection Preventionst, Main Line Health System Skin Preparations

Issue: Disinfection of patient care equipment is important to Yutaka Nishihara, PhD - Deputy General Manager, R&D Div,
prevent the spread of infections between patients. Our goal was to Yoshida Pharmaceutical Co., Ltd.; Takumi Kajiura, PhD - General
put in place a process to ensure that equipment disinfection routinely Manager, R&D Div, Yoshida Pharmaceutical Co., Ltd; Katsuhiro
occurs between patients. We looked at equipment disinfection Yokota - Director, R&D Div, Yoshida Pharmaceutical Co., Ltd;
to measure compliance with best practice and determine needed Hiroyoshi Kobayashi, MD, PhD - Chancellor, Tokyo Healthcare
interventions. Project: Our 148 bed acute care rehabilitation University and Postgraduate School; Takashi Okubo, MD, PhD -
hospital serves brain injury, stroke, orthopedic, and medical Professor, Tokyo Healthcare University and Postgraduate School;
rehabilitation adults. We formed a multidisciplinary performance Robert R . McCormack - Principal Study Director, BioScience
improvement team to review and evaluate the current state of Laboratories, Inc.
equipment disinfection, and make recommendations to ensure
Background/Objectives: Reducing the microbial
that a workable system for equipment disinfection is in place.
population on the skin is critical for reducing the risk of catheter-
Equipment disinfection after use on each patient was our goal to
related blood stream infections (CRBSIs). The CDC guideline
maintain best practice . The team perfomed an initial compliance
issued in 2011 recommends skin preparations containing > 0.5%
audit and based interventions on the findings. Brackets for
Chlorhexidine Gluconate (CHG) in alcohol. With a focus on
disinfectant wipes were then installed near point of use locations,
prolonged catheter care in medical practice, we conducted a study per
alcohol wipes dispensers were placed in physician charting rooms,
ASTM Standard Method E1173-09 to compare the antimicrobial
and traveling multipatient BP cuffs were replaced with permanent
efficacy among two formulations of CHG in alcohol and a Povidone-
room based BP cuffs for each patient. Housewide education on
Iodine (PVP-I) solution. OBJECTIVE: To compare the immediate
the disinfection process was provided, and a post intervention
and persistent antimicrobial effects of a 79% (v/v) ethanol containing
compliance audit was performed. Results: Initial audit results
1% (w/v) CHG (CHG-ethanol), a 70% (v/v) Isopropanol

18 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Antisepsis/Disinfection/Sterilization
containing 2% (w/v) (CHG-Isopropanol), and a marketed 10% the U.S. Congress requested VA’s Office of Inspector General
(w/v) PVP-I solution, when used for preoperative/precatheterization (OIG) to review VHA’s performance in the area of reprocessing
preparation on healthy human subjects. Methods: 55 healthy of endoscopic equipment. OIG’s Office of Healthcare Inspections
adult subjects meeting criteria for minimum baseline bacterial (OHI) undertook an inspection to determine the extent to which
counts on test sites were enrolled to evaluate the immediate and VA facilities were in compliance with directives regarding endoscope
persistent effects of the test formulations on the abdominal site at reprocessing. In a sample of VA medical centers, widespread
post-treatment time points of 30 seconds, 72 hours, and 168 hours non-compliance was identified. After extensive education and
(7 days). Testing procedures were performed according to ASTM senior VA leadership declaring proper RME reprocessing to be an
Standard Method E1173-09. RESULTS: Three blocked, two-factor organizational priority, a follow-up OHI inspection three months
ANOVAs showed that all test formulations produced significant later showed significant improvement, although issues remained.
reductions in the microbial populations on abdominal sites at all OHI then incorporated review of RME reprocessing into its routine
sample times. The persistent effects of the 1% CHG-ethanol on VA medical center inspections. This presentation discusses results
the abdominal site 72 hours and 168 hours post-treatment were generated from these inspections. Project: OHI Inspectors
significantly superior to those of the 10% PVP-I solution (p < 0.05; evaluated RME processes at 45 VA medical centers during routine
Table 1). The 1% CHG-ethanol preparation and the 2% CHG- OHI VA inspections performed from January 1 through September
Isopropanol formulation produced statistically equivalent persistence 30, 2010. In the course of these inspections, we interviewed selected
72 hours and 168 hours post-treatment. Subjects experienced no program managers and reviewed documents, including facility
adverse events over the course of the study. CONCLUSIONS: self-assessments; RME-related policies and Standard Operating
As relates to long-term catheter care in medical practice, the two Procedures (SOPs), manufacturers’ instructions; meeting minutes;
tinctures of CHG produced and maintained greater mean log10 employee training records and competency folders; and other
reductions in microbial flora at all sample times greater than did documentation related to RME reprocessing. We also observed
the PVP-I solution (p < 0.05; Table 1). Considering that Japanese employees clean or reprocess non-critical, semi-critical, and
pharmaceutical regulations limit CHG content in antiseptics to critical RME. We conducted physical inspections of reprocessing
a maximum of 1%, it is reasonable to expect that the 1% CHG- areas. We utilized relevant VHA Directives, OSHA regulations,
ethanol preparation will perform well in-use as a preoperative Joint Commission standards, and CDC recommendations as our
skin preparation and have promising potential as a catheter prep/ references. Results: Consistent with the three month follow-up
maintenance preparation to reduce the risk of CRBSIs and/or central inspection cited above, we found that VHA had made extensive
line-associated blood stream infection. efforts to improve its reprocessing of RME. Nevertheless, problems
remained. Six areas where compliance with RME requirements
still needed improvement included SOPs, employee training and
competency assessments, flash sterilization, personal protective
equipment (PPE), environmental controls, and senior management
oversight of RME activities. We made recommendations in these
areas including that VHA ensure that SOPs are current and
consistent with manufacturers’ instructions, and located within the
reprocessing areas; that VHA ensures that its employees consistently
follow SOPs, that supervisors monitor compliance, and that
annual training and competency assessments are completed and
documented; that VHA ensure that flash sterilization is used only in
emergent situations, that supervisors monitor compliance, and that
managers assess and document annual competencies for employees
who perform flash sterilization; that PPE is utilized appropriately
Presentation Number 2-009 in decontamination areas; that the heating, ventilation, and air
Review of Proper Reprocessing of Reusable conditioning systems are maintained; and that there is ongoing senior
management involvement in internal oversight of RME activities.
Medical Equipment in VHA Facilities
Lessons Learned: Proper RME reprocessing can be a
Kathleen J. Shimoda, BSN - Healthcare Inspector, VA Office continuing challenge for large healthcare organizations. The fact that
of Inspector General - Office of Healthcare Inspections; George this work reflects oversight over a three-year period is indicative of
Wesley, MD - Director, Medical Consultation and Review of the efforts and continuing vigilance required in this area.
the Department of Veterans Affairs Office of Inspector General.,
VA Office of Inspector General Office of Healthcare Inspections;
Deborah Howard, BSN, MSN - Regional Director, San Diego Presentation Number 2-010
Office of Healthcare Inspections, VA Office of Inspector General
Targeted, Daily Environmental Disinfection with
Office of Healthcare Inspections
Clorox® Dispatch® for the Prevention of Hospital-
Issue: Proper reprocessing of reusable medical equipment (RME) Associated Clostridium difficile and Acinetobacter
has been an area of major concern in Veterans Health Administration baumannii
(VHA) hospitals and clinics. In 2009, both VHA’s Secretary and
Timothy L. Wiemken, PhD, MPH, CIC - University of Louisville

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 19
Poster Abstracts: Antisepsis/Disinfection/Sterilization
Instructor of Medicine, University of Louisville Division of chemical (hydrogen peroxide fog) and non-chemical (ultraviolet
Infectious Diseases light) means of disinfection. Methods: This study compared
the efficacy of both methods of automated surface disinfection and
Background/Objectives: Environmental contamination the effect of orientation of the contaminated surface, either direct
with microorganisms is of growing concern in many healthcare line of sight or indirect facing away from the device. Stainless steel
facilities due to the risk of healthcare-associated infections. C. difficile carriers each inoculated separately with 4-log10 clinically significant
and A. baumannii are two organisms that have shown increasing microorganisms (Staphylococcus aureus, Pseudomonas aeruginosa,
incidence in healthcare facilities and have extended resistance to Aspergillus niger, and Clostridium difficile spores) were placed 3
many commonly used environmental disinfectants. Environmental meters away from the automated device with the inoculated surface
contamination with these two organisms may therefore pose an facing the source of disinfection and another set facing away from
infection risk to patients. Daily disinfection of the environment with the source of disinfection. The room was sealed and locked and
chemicals capable of killing these organisms may reduce the bioburden the automated disinfection machine was set to run a disinfection
of these organisms and decrease risk of transmission to subsequent cycle. For the automated fogging machine tests, we used a diluted
patients. The objective of this study was to determine if daily (approximately 2.6%) hydrogen peroxide (H2O2) based solution
disinfection of patient rooms is associated with decreased transmission sprayed into the air as a fine mist or fog. The total cycle time was
of C. difficile and A. baumannii. Methods: We conducted an approximately 2 hours. For the UV testing, we used a set timed
interventional study in a long-term acute care hospital in Louisville exposure to the UV lamps and we measured the UV dosage amounts
KY from September 1, 2011 through November 31, 2011. The first with a UV detector. The exposure times were 15, 30, and 60 minutes.
phase utilized a one-step hypochlorite disinfectant (Clorox Dispatch) At the completion of cycle, , either once the H2O2 level in the
for daily cleaning and disinfection of all patient rooms housing surrounding air reached 1 ppm or when the UV exposure time was
patients known to be colonized or infected with either C. difficile or reached, the stainless steel carriers were retrieved. The stainless steel
A. baumannii. The second phase (December 1, 2011 – February 28, carriers were then processed to determine the concentration of
2012) will include cleaning and disinfection of all patient rooms in surviving microorganisms by carrier elution and serial dilution/pour
the facility (data not yet collected). The Mid-P exact test was used plate methodology. Results: There was a 3 – 4 log reduction of
to evaluate the difference in infection rates for both organisms from organism with the automated fogging machine for all tests. For the
three months prior to the study and the first interventional period. No UV device, it was evident that the orientation of the carriers (direct
other infection prevention interventions were introduced during the line of sight or indirect) affected the disinfection efficacy and log
study period. Results: For the three months prior to the start of reduction ranged from 1 – 4 logs. Conclusions: Our study
the study, there were 14 cases of C. difficile infection and 8,494 patient shows that the automated fogging machine was more consistent and
days. After the first three months of the intervention, there were 4 efficacious than the UV device, where efficacy was dependant on the
cases of C. difficile and 8140 patient days (P<0.001). There were 11 orientation of the contaminated surfaces, with indirect exposure with
infections and 8,948 patient days for the second intervention period UV showing minimal efficacy.
(P=0.111). For A. baumannii infection, there were 33, 42, and 53
cases, respectively for the same numbers of patient days (P=0.224 and
P= 0.506).. Conclusions: Targeted, daily disinfection with a Presentation Number 2-012
one-step hypochlorite solution was effective at decreasing C. difficile,
but not A. baumannii in the absence of other targeted infection A Comparison of the Surface Disinfection
prevention interventions. Capabilities of Two Different H2O2 Based
Disinfectants used in an Automated Fogging
Machine in a 72 Cubic Meter Room
Presentation Number 2-011
Gladys Chang - Senior Scientist, Advanced Sterilization Products;
Comparison of the Surface Disinfection Harriet Chan-Myers, BS, RM - Manager Microbiology, Advanced
Capabilities of Two Different Methods using Sterilization Products
Automated Devices: Ultraviolet Light Versus
Hydrogen Peroxide Fogging Machine Background/Objectives: The prevalence of healthcare
associated infections has given rise to the need for additional
Harriet Chan-Myers, BS, RM - Manager Microbiology, Advanced surface disinfection of high-touch areas. Manual cleaning and
Sterilization Products; Gladys Chang - Senior Scientist, Advanced disinfection from the housekeeping staff has proved insufficient and
Sterilization Products would greatly benefit from the supplementation of an automated
disinfection machines that facilitate disinfection of hard to reach
Background/Objectives: The prevalence of healthcare surfaces and provide thorough disinfection of environmental
associated infections has given rise to the need for additional surface services. Methods: In this study, we evaluate the efficacy of an
disinfection of high-touch areas. Manual cleaning and disinfection automated fogging machine that uses a hydrogen peroxide (H2O2)
from the housekeeping staff has proved insufficient and would greatly solution which is sprayed into the air as a fine mist for the purpose of
benefit from the supplementation of an automated disinfection disinfecting surfaces. In our study, we evaluated two different types
machines that facilitate disinfection of hard to reach surfaces and of H2O2 based disinfecting solutions: one at 6.4-7.1% H2O2 by
provide thorough disinfection of environmental services. Two volume, and the other at 4.8-5.5% H2O2 by volume with 90-110
methods of automated surface disinfection evaluated here are parts per million (ppm) of silver. The automated fogging machine

20 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Antisepsis/Disinfection/Sterilization
was placed in one corner of a 72 m3 room. Stainless steel carriers volume of product determined to dry in 30 seconds. Results:
inoculated with clinically significant microorganisms (separate For all ABHR tested, the mean product volumes which dried in 30
carriers each inoculated with 4-log10 of Staphylococcus aureus, seconds ranged from 1.7-2.1 ml. The mean product volumes which
Pseudomonas aeruginosa, Aspergillus niger, Acinetobacter baumannii, dried in 30 seconds of identical 70% ethanol formulations, differing
Clostridium difficile spores or Enterobacter faecalis and dried only in product format, were 1.7ml, 1.9 ml, and 1.7 ml, for the foam,
completely) were placed 3.9 meters away from the automated fogging gel, and rinse, respectively, and were statistically equivalent. None of
machine with the inoculated surfaces facing away from the sprayer. the products met the efficacy requirements of EN 1500 when tested
The room was sealed and locked and the automated fogging machine at volumes which rub-in dry in 30 seconds. However, all products
was set to run a standard decontamination cycle. A standard cycle tested according EN 1500 were statistically equivalent to each other
for a 72 m3 room runs for a total cycle time of approximately 170 by repeated measures ANOVA (P>0.05), irrespective of alcohol
minutes. After the cycle, the stainless steel carriers were retrieved once concentration or product format. Conclusions: The results
the H2O2 level in the surrounding air reached 1 ppm. The stainless of this study demonstrate that product format does not significantly
steel carriers were then processed to determine the concentration influence ABHR dry time. The data directly refutes previous
of surviving microorganisms by carrier elution and serial dilution/ speculations, showing that ABHR foams do not take longer to dry
pour plate methodology. We then repeated this process using the and will not encourage the use of inadequate volumes. In conclusion,
second disinfectant. Results: Both H2O2 based disinfectants, product application volume was found to have a greater impact
with and without silver, were efficacious on the clinically significant on efficacy than either product format or alcohol concentration.
microorganisms used for this study. Both demonstrated a greater Further research is warranted to understand the impact of alcohol
than 4-log reduction for each microorganism. Conclusions: concentration, product formulation, and application volume on
Our study shows that we are able maintain the efficacy levels of our clinical efficacy and healthcare worker behavior and acceptance.
disinfectant even at lower concentrations of H2O2 if we add silver to
supplement a more dilute H2O2 disinfectant..
Presentation Number 2-014
Presentation Number 2-013 Innovative Additions To Central Line Bundle
Reduce Bloodstream Infections In Vulnerable
Influence of Alcohol-Based Hand Rub Format on Pediatric Patient Population & Improve Catheter
Dry Time and Efficacy Care
David J. Shumaker, BS in Microbiology - Laboratory Technician Marianne Pavia, MT(ASCP), CLS, CIC - 2011 President-Elect,
III, Microbiology, GOJO Industries, Inc.; David R. Macinga, PhD - APIC Greater New York Chapter 13; Associate Director Infection
Principal Microbiologist, GOJO Industries, Inc.; Adjunct Professor, Control, Bellevue Hospital Center
Northeast Ohio Medical University; Sarah Edmonds, MS in Biology
- Clinical Scientist, GOJO Industries, Inc.; James W. Arbogast, PhD Issue: A pediatric hospital with a vulnerable patient population
- Skin Care Science and New Technology Vice President, GOJO faced significant challenges in its efforts to minimize central-line-
Industries, Inc. associated bloodstream infections (CLABSIs). Patient conditions
include short bowel syndrome, long-term intravenous nutrition,
Background/Objectives: Alcohol-based hand rubs and the increased contaminants and line accesses entailed by those
(ABHRs) are one of the most important tools to prevent hospital conditions. CLABSI rates at the hospital were high even though
acquired infections. They are available in a variety of formats surveillance showed consistent compliance with manual disinfection
including gels, rinses, and foams. A recent publication has suggested of IV connectors. Project: During 2009-2010, the hospital made
that foam ABHRs dry more slowly than ABHR gels and rinses, additions to its central line bundle. This multi-pronged approach was
which encourages health care workers (HCWs) to use smaller, intended to improve catheter care and reduce the troublingly high
ineffective volumes. However, analysis of ABHR gels and rinses was CLABSI rate. Interventions included: 1) Addition to protocol –
not included for comparison to the foams. The objective of this study Nurses began scrubbing patients’ lines with chlorhexidine gluconate
was to determine whether there are significant dry time differences (CHG) following diaper changes to reduce exposure to fecal bacteria.
between rinse, gel, and foam ABHR formats. A secondary objective 2) Protective vest for patients– This vest, the hospital’s invention,
was to determine the antimicrobial efficacy of various formats of decreases the risk of catheter displacement caused by the inherent
ABHRs at volumes which dry in 30 seconds. Methods: Dry restlessness of young children. 3) Disinfection cap – The evidence-
times were determined for two ABHR rinses, two ABHR gels, and based device, which is designed to keep the connector hub bathed
two ABHR foams by applying specific volumes, ranging from 0.5 ml in isopropyl alcohol (IPA) between central-line accesses, improves
to 3 ml, to subjects’ hands and having them rub in the product until disinfection by prolonging the connector’s contact with IPA. It
dry. A digital timer was used to record the interval from when the also protects the hub from touch and airborne contamination by
subject began rubbing to when the subject indicated that their hands staying on the connector between accesses. This provides additional
felt dry. Linear regression analysis was performed to determine a prevention beyond what manual disinfection could provide. 4)
slope (dry time per unit volume), and to calculate the volume drying Anti-microbial patch – At the insertion site, nurses began placing
in 30 seconds for each product. A subset of products, including a an evidence-based foam patch that secretes CHG to combat
90% ethanol gel, 80% ethanol rinse, and 70% ethanol foam, were infection from skin flora. The device secretes CHG for seven days,
evaluated for antimicrobial efficacy according to EN 1500, at the inhibiting bacterial growth under the dressing between dressing and

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 21
Poster Abstracts: Antisepsis/Disinfection/Sterilization
administration set changes. Results: The disinfection cap was new insights into the levels of contamination observed in different
trialed alone in Q3 2010 and reduced CLABSIs by 54.7% (Q3 2010 locations of a hospital, as well as from hospital to hospital. It also
vs. previous six quarters). The patch, scrubbing, and vest were added demonstrates that ATP monitoring can be very useful in determining
in Q4 2010, with cap use also continuing. The four interventions quantitatively the effectiveness of terminal cleaning. The ability to
together reduced CLABSIs by 53.1% (Q4 2010 & Q1-3 2011 quantify contamination in the manner exemplified by this study may
compared to previous six quarters). Lessons Learned: The vest be foundational to a process improvement program for the hospital’s
and scrubbing protocol are applicable to pediatric patient populations environmental services.
similar to the hospital’s. The disinfection cap and foam disc can reduce
CLABSIs in both pediatric and adult patients with central lines
because they address issues common to all central line therapy.

Presentation Number 2-015

A Multi-site Study Evaluating the Effectiveness of
Terminal Cleaning in Patient and Operating Rooms
using an ATP Monitoring System
Erin A. Satterwhite, MS - Technical Supervisor - Discovery Lab, 3M
Company; Marco Bommarito, PhD - Senior Research Specialist, 3M
Infection Prevention Division; Dan J. Morse - Senior Biostatistical
Specialist, 3M Infection Prevention Division

Background/Objectives: The primary objective of

the study was to compare the level of contamination measured
using an ATP (Adenosine Tri-Phosphate) bioluminescent assay in
patient and operating rooms, before and after terminal cleaning. Presentation Number 2-016
The data was obtained from six hospitals across the US. A second
objective of the study was to assess the effectiveness of terminal Quantitative Analysis of Materials and Methods
cleaning as a function of location in a given hospital (patient versus in Cleaning and Disinfection of Environmental
operating rooms) as well as across the various sites included in the Surfaces: Microfiber vs. Cotton and Spray vs. Soak
study. Methods: Test plans for patient and operating rooms
were developed for each site and included well-known high touch Salah Qutaishat, PhD, CIC, FSHEA - Director, Infection Prevention,
surfaces and surfaces that were of particular concern to a given Columbia St. Mary’s; Sr. Clinical Advisor, Infection Prevention,
hospital site. Surfaces were tested using a swab based ATP surface Diversey Inc; Director, Epidemiology and Surveillance Systems,
test, before and after terminal cleaning, yielding a paired data set. Premier Inc; Senior Infection control Epidemiologist, Saint Joseph’s
ATP contamination levels in RLUs (Relative Light Units) were Hospital; Peter Teska, BS, MBA - Americas Portfolio Lead for
determined using a hand-held luminometer. Mean RLU values and Infection Prevention, Diversey Inc
the difference (after-before), were determined using paired t-tests
of the logarithmically transformed RLU values. The study included Background/Objectives: In the USA, healthcare-
a total of 33 patient rooms and 22 operating rooms. The total associated infections (HAIs) affect over 1.7 million patients at an
number of surfaces tested was 1322. Results: Figure 1 shows the estimated cost of 40 billion dollars annually. Studies demonstrated an
mean levels of contamination (ATP) in RLUs observed by hospital association between contaminated environmental surfaces (ES) and
site and by location before and after terminal cleaning. There are HAIs. This has lead healthcare facilities to enhance the effectiveness of
significant differences by hospital site and by location. In operating environmental cleaning and disinfection. Currently, the most common
rooms, before terminal cleaning, RLU means vary from a high of methods of ES cleaning and disinfection are spray and wipe (SPW)
1202 to a low of 262 RLUs. After terminal cleaning the observed and soak and wipe (SOW). To the best of our knowledge, no published
range decreases: the high value is 661 and low value is 113 RLUs. studies have demonstrated superiority of either method. This has led
In patient rooms, the before cleaning RLU range goes from a high us to perform a study comparing the amount of cleaner/disinfectant
value of 513 to a low value of 295. After cleaning, the range is 219 to used and associated cost. Methods: This study was performed at
52 RLUs. Importantly, we note that at given sites (see sites 1 and 2) four extended care facilities (totaling 243 beds) in the Northeast. The
contamination levels in operating rooms can be three times the levels ES in each room were cleaned according to facility cleaning policy
observed in patient rooms. Furthermore, there is a clear correlation with a quaternary disinfectant. Two groups were created, one using
in the before and after readings: a site with high RLU values before cotton cloths and the second using microfiber cloths. For SPW, the
cleaning also shows higher RLU values after cleaning. The table at disinfectant is sprayed onto high-touch surfaces and then wiped. In
the bottom of Figure 1 shows the mean difference (after-before) SOW, the cloth is immersed in a bucket of disinfectant, wrung out, and
in RLUs and the corresponding p-values. With two exceptions, then used to wipe surfaces. We measured the amount of disinfectant
the net decreases in contamination are statistically significant used calculated the cost. Results: As seen in table 1 below, the
(p<0.05).Conclusions: The results of this study provide SOW method uses approximately twice as much disinfectant as SPW.

22 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Antisepsis/Disinfection/Sterilization

For SOW applications, microfiber consumed 34% more disinfectant (both ATP and Blacklight monitoring). The 2nd Phase included
than cotton. The ratio of costs correlates directly to the amount used. training of EVS front line staff in Leadership Development principles
Conclusions: Proper cleaning and disinfection of high-touch using an on-line course available from the national organization for
ES may play a significant role in preventing HAIs. In our study, environmental services in healthcare environments. Once a core
we compared the amount of disinfectant used with two common group of staff had been trainined, individuals were selected from this
wiping cloth materials and two different methods of application. Our group of frontline staff to develop standardized written processes,
results show that the SOW consumes more disinfectant than the skills lab and competency program, based off of the traditional
SPW method. It also shows greater consumption of the disinfectant model used in nursing staff development. Lessons Learned:
by the microfiber cloth, possibly due to its increased absorptivity. Lessons learned included that more time was required to develop and
Consequently, switching to the SPW method may reduce the cost of implement the program than originally anticipated. Frequent turn
cleaning and disinfection of ES. Further studies should be performed over in the staff members of the EVS department created a need to
to evaluate the effectiveness of both methods on reduction of bio provide core classes more frequently than originally expected by the
burden and the amount of disinfectant applied by each method. IP. Also, creating an effective communication system between the
IPP and the EVS leadership took time to develop and put into place.

Presentation Number 2-017

Partnering With Environmental Services to Drive
Infection Control Excellence
Debbie Hurst, RN, BSN - Manager Infection Prevention & Control,
Rogue Valley Medical Center; Charlene Stewart, RN, MPA/HSA,
CHSP - Infection Preventionist, Rogue Valley Medical Center; Bella
Lucas, RN, BSN - Infection Preventionist, Rogue Valley Medical
Center; Carol Worden, RN, MPA - Director of Nursing Operations, Presentation Number 2-018
Rogue Valley Medical Center
Hydrogen Peroxide Patient Privacy Cubical Curtain
Issue: An effective infection prevention and control program (IPP) Cleaning Study
is critically dependent upon the duties performed by individuals
assigned to environmental cleaning in a healthcare environment. Alexis Price, RN, BSN - Infection Preventionist, Lee Memorial
Unfortunately, deparments such as Environmental Services (EVS) Hospital; Cynthia Knoke, MT, BS, CIC - Infection Preventionist,
have not traditionally received the support and resources necessary HealthPark Medical Center; B. Joann Andrews, RN, MS, CIC
to develop an evidenced based, robust staff development and - Senior Infection Preventionist, Lee Memorial Health System;
compliance monitoring program in most hospitals. Although the Stephen Streed, MS, CIC - System Director, Epidemiology and
Infection Preventionist (IP) has the background and skill sets needed Infection Prevention, Lee Memorial Health System; System Director,
to assit the EVS department in development of Infection Control Epidemiology and Infection Prevention, Lee Memorial Health
training and competencies, often they too lack the resources (i.e. System, Ft. Myers, FL
staffing) to support taking on this additional role. By utilizing a
creative “out of the box” approach, grant funds were utilized by the Background/Objectives: Collaboration between
IPP to create a “Six Step Program to Infection Control Excellence” Infection Prevention and Environmental Services (EVS) is becoming
for the EVS Department. Project: A six step program was more important on a national level and in our healthcare system.
implemented over a period of 2 years at our 378 bed facility. It With patient safety in the forefront of healthcare, it’s imperative
allowed the opportunity for our current and newly hired EVS staff to have better control over potential environmental reservoirs of
to learn the basics of infection control, cleaning and disinfection pathogenic organisms. The Infection Preventionists (IPs) and EVS
in a variety of settings including classroom, skills lab and patient performed a literature review to assess for standards regarding patient
care areas. Results: The outcome obtained included a successful privacy curtain cleaning. Little evidence was found from scientific
formal IC Environmental Training Program that was implemented investigation, regulatory agencies or in standards of practice. It was
in 2 Phases. Phase 1 included the establishment of basic training in determined that hydrogen peroxide (H2O2) has been utilized to
infection control and cleaning fundamentals for the patient care clean various hospital fabrics, however little evidence was available
areas and the launching of the environmental monitoring systems to support the efficacy of H202 curtain cleaning in a clinical setting.

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 23
Poster Abstracts: Antisepsis/Disinfection/Sterilization

This hospital system wanted to know if the 100% polyester Presentation Number 2-019
patient privacy curtains carried a bio-burden and if a spray of
3% H2O2 applied to the touch points could effectively decrease Evaluation of Liquid Hydrogen Peroxide to
the microbial counts and have an extended residual kill effect. Clean Surfaces in Patient Rooms using Aerobic
Methods: A double blind study was carried out involving Colony Counts and Adenosine Triphosphate
IPs, EVS and the microbiology department. The study consisted Bioluminescence Assay
of an experiment group (n=28) and a control group (n=11).
Rooms were excluded if previously treated with H2O2. Five “high Nancy L. Havill, MT(ASCP) - Infection Prevention and
touch” grab locations and culturing time frames were established. Epidemiology Program, Hospital of Saint Raphael; Heather L.
In the experimental group cultures were obtained pre-H202 Havill, BA - Laboratory Assistant, Hospital of Saint Raphael;
treatment, and post treatment at 5 minutes, 10 minutes, one hour Abigail Lipka - Laboratory Assistant, Hospital of Saint Raphael;
and two hour intervals. The control group did not receive any John M. Boyce, MD - Hospital Epidemiologist, Hospital of Saint
H2O2 treatment and cultures were taken at identical locations. Raphael; Clinical Professor of Medicine, Yale University School of
This process occurred in the clinical setting in between patient Medicine
room turnover. Results: In the experimental group the
mean colony forming units (CFU’s) were as follows: pre H2O2 Background/Objectives: Current guidelines recommend
= 21.679, five minutes post = 5.179, ten minutes post = 4.393, cleaning of non-critical items in patient rooms in healthcare facilities
one hour post = 0.714, and two hours post = 0.464. Paired on a regular basis. Disinfectants used in hospitals include quaternary
t-test indicated statistically significant decreases in the microbial ammonium compounds, bleach and more recently hydrogen
counts after 5 minutes of dry time (p = 0.0016) and again at 1 peroxide. We conducted a prospective study to evaluate the efficacy
hour dry time (p = 0.0027). The decreases in microbial counts of a new liquid hydrogen peroxide disinfectant using aerobic colony
were not significant from 5 to 10 minutes and from 1 to 2 hours counts and adenosine triphosphate (ATP) bioluminescence assay.
dry time. In the control group the mean CFU’s are as follows: Methods: In a convenience sample of 72 patient rooms, 10
20.727, 15.727, 15.636, 16.364, and 19.000. There was not a surfaces were sampled immediately before and 10-15 minutes after
significant change in the microbial counts at any culture site cleaning by 2 trained individuals using a liquid hydrogen peroxide
when not sprayed with H2O2. Statistical analysis was used to disinfectant (Clorox HealthcareTM , Oakland, CA). Samples were
evaluate the data and the paired t-test used to evaluate each sample taken with an ATP bioluminescence assay (3M, St. Paul, MN) and
set. See figure 1. Conclusions: This study suggests that a results were recorded as relative light units (RLUs). Aerobic colony
treatment of 3% H2O2 is an effective cleaning process in-between counts (ACCs) were determined using D/E neutralizing contact
routine laundering of 100% polyester patient privacy curtains. agar plates (BD or Remel). We defined surfaces as being clean if
The bio-burden significantly decreases after just 5 minutes of dry the relative light unit (RLU) reading was <250 for ATP. Surfaces
time and continues to decrease up to the 2 hour time period thus that yielded a RLU of <250 or no growth on the agar plate before
allowing better control of this potential environmental reservoir cleaning were omitted from further analysis. The proportion of sites
of pathogenic organisms. yielding ACC <2.5/cm2, which is a proposed definition of “clean,”
was calculated. Differences in proportion were analyzed with the Chi
Square test. Results: 99% (698/704) of cultures yielded ACCs
<2.5/cm2 after cleaning. 96% (679/704) of cultures yielded ACCs <
10 per contact plate. No growth was detected from 75% (528/704)
of the cultures with a range from 53-89% for the 10 sites. There was
a significant difference among sites with the chair arms having the
lowest proportion achieving no growth and the bedside panels having
the greatest proportion achieving no growth (P <0.001). The median
colony count per contact plate before cleaning was 63.1 with a range
of 15-119 colonies for the 10 sites. The median colony count after
cleaning was 0.0 for all 10 sites. 69.7% (388/557) of sites yielded
RLU values <250 after cleaning, with a range from 43.3-96.8% for
the 10 sites. There was a significant difference among the 10 sites with
the bedside rail having the lowest proportion achieving <250 RLUs
and the blood pressure cuff having the greatest proportion achieving
<250 RLUs after cleaning (P = <.0.001). Conclusions:
The liquid hydrogen peroxide product tested is a very effective
disinfectant against aerobic bacteria. ATP bioluminescence assays
can be used as a tool to monitor the effectiveness of cleaning practices
using liquid hydrogen peroxide. Further studies are warranted to
determine if the ATP cut-off used to classify surfaces as clean should
vary depending on the composition of the surface sampled and type
of disinfectant used.

24 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Antisepsis/Disinfection/Sterilization

Presentation Number 2-020 of Health Administration, Xavier University; Kristen Leigh. Jones,
BS - Master’s of Health Services Administration Student, Xavier
Effect of Disinfectants on Clinically Relevant University
Bacteria Under Planktonic and Biofilm Conditions
Background/Objectives: Manufacturers of hospital beds
Dean Swift, BSc, BEd, FADM, Cert. Tox. - Technical Director, and mattresses recommend cleaning the mattress first with soap and
Biolennia Laboratories water, disinfecting the surface, and then rinsing the surface. It is also
recommended to only use disinfectants with a pH of 5-9. Chemical
Background/Objectives: Microbial biofilms are now manufacturers have tested disinfectants on hard non-porous surfaces
recognized as playing a major role in the progression of infection and and not on soft surfaces. Any claim of efficacy of disinfectants
disease. Current research has shown that biofilms are more difficult to against bacterial pathogens only applies to the use of the product on
eradicate than their planktonic counterparts; however, the majority hard, non-porous surfaces. Mattresses are soft surfaces, and the use
of standardized methods used to test the efficacy of disinfectants of quaternary ammonia compounds on these soft surfaces should
rely on the use of planktonic bacterial cultures. Recently, a new be considered “off-label.” The current study is intended to define
experimental device has been developed to determine the minimum how top hospitals in the United States (U.S.) are cleaning hospital
biofilm-eliminating concentration (MBEC) of antimicrobial agents mattresses. Methods: The top 113 hospitals for 2011-2012, as
and disinfectants: the Calgary Biofilm Device (CBD). The MBEC listed in the US News & World Report, were contacted by phone and
Assay allows for rapid, high-throughput assessment of the antibiofilm asked about their cleaning procedures for hospital mattresses. Each
activity of antibiotics, disinfectants, biocides and metals at varying respondent from environmental services was asked five questions:
concentrations. The main objectives of this study are to compare the What chemical do you clean your beds and mattresses with? How do
effectiveness of various disinfectants on bacteria grown planktonically you mix or dilute the chemical? How long do you leave the chemical
and in biofilms, and to compare the minimum inhibitory concentration on the bed or do you just let it dry on the bed? Do you use anything
(MIC) and MBEC methods for testing the efficacy of disinfectants. other than that chemical first, like soap and water? Do you rinse off
Methods: Overnight cultures of Pseudomonas aeruginosa MPAO1, the cleaner after you clean the bed? Results: Of the top hospitals,
Bacillus atropheus JH642 and clinical isolates of Escherichia coli and 69 (61%; 95% CI, 52-70%) agreed to answer the survey questions.
Staphylococcus aureus were grown aerobically in brain heart infusion Six (5%; 95% CI, 3-11%) refused to participate and 38 (34%; 95%
(BHI) medium at 37C. For MIC assays, diluted overnight cultures CI, 26-43%) could not be reached after multiple attempts. Chemicals
were added to 96-well plates containing serially diluted disinfectants used to clean the beds included: quaternary ammonia compounds
including ethanol, bleach, glutaraldehyde and several commercial (58/69; 84%; 95% CI 74-91%), bleach compounds (7/69; 10%;
products. The plates were incubated for 24 hours and visually inspected 95% CI 5-19%), phenolic cleaners (3/69; 4%; 95% CI 1-12%), and
for growth, spot plated and quantitatively measured at OD590nm. hydrogen peroxide (1/69; 1%; 95%CI 0-8%). Only two hospitals
For the MBEC assay, biofilms were grown in the CBD for 48 hours. were using disinfectants with a pH between 5 and 9, as recommended
The MBEC lids were then placed in a similar serially diluted 96-well by the manufacturers. The pH of all of these compounds is not within
plate containing disinfectants and incubated for 24 hours. The biofilms the recommended range of 5-9. Only 16 (23%; 95% CI, 15-34%)
were subsequently washed twice in phosphate-buffered saline and of the hospitals reported cleaning the mattress prior to disinfection,
re-immersed in fresh BHI, sonicated, incubated for 24 hours and and only 6 (9%; 95% CI, 4-18%) reported rinsing off the disinfectant
quantitatively measured at OD590nm for regrowth. Both assays were after use. Conclusions: Most top adult hospitals in the U.S. do
performed in triplicate. MIC and MBEC values were determined as not follow manufacturer’s recommendations on appropriate cleaning
the lowest concentration of disinfectant that inhibited growth of the and disinfection of hospital mattresses. This failure may result in
bacteria. Results: Each strain exhibited different susceptibility inadequate cleaning and may damage the surface of the mattresses.
profiles to the disinfectants tested. B. atropheus was the most resistant,
while the clinical isolates were most susceptible. In addition, biofilms
were more resistant to the disinfectants compared to planktonic cultures. Presentation Number 2-022
Conclusions: Since biofilms are the primary mode of growth for
most bacteria, it is important to recognize their role in the vast majority The Influence of ABHR Product Format on In Vivo
of medically relevant infections. The results of this study support the use Efficacy: A Meta-Analysis
of the MBEC method to test the efficacy of disinfectants, as it presents
the most relevant results of antimicrobial activity. This will allow for Sarah Edmonds, MS in Biology - Clinical Scientist, GOJO
further development of standardized test methods that more accurately Industries, Inc.; David R. Macinga, PhD - Principal Microbiologist,
reflect conditions found in the field, thus leading to more effective GOJO Industries, Inc.; Adjunct Professor, Northeast Ohio Medical
strategies for controlling the spread of infection. University; Daryl Paulson - CEO, BioScience Laboratories

Background/Objectives: Alcohol-based hand rubs

(ABHR) are the primary form of hand hygiene in healthcare settings.
Presentation Number 2-021
ABHR are available in a number of different formats including
Cleaning Practices for Hospital Mattresses in Top rinse, spray, gel, and foam. In U.S. healthcare facilities the most
US Adult Hospitals common formats are gel and foam. Currently, there are conflicting
data regarding the relative efficacy of gel versus foam ABHR. The
Edmond A. Hooker, MD, DrPH - Associate Professor- Department objective of this study was to determine whether product format

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 25
Poster Abstracts: Antisepsis/Disinfection/Sterilization

influences ABHR efficacy through a meta-analysis of multiple care center has multiple specialties using a variety of scopes in many
studies comparing both gel and foam products. Methods: The patient care areas. During a review of a near miss event, we identified
test products were commercial ABHR formulations based on 70% disparate understanding of what “Is that scope clean?” means: some
ethanol and differing only by the addition of “gelling” ingredients healthcare provider (HCP) use cleaning for the point of use pre-
(Gel A) or “foaming” ingredients (Foam B). Data from a total of 18 cleaning, others equate it with manual cleaning and finally some
studies which were executed at different times of the year, by different believe it means that it is safe to use on the next patient. Project:
laboratories, where the efficacy of Gel A and Foam B were evaluated A multidisciplinary task force convened to review scope standards
were included in the analysis. Standard in vivo test methodologies and practices, assess training and competency testing, establish
were used in each study and included the U.S. Food and Drug common terminology, assure proper cleaning and disinfection /
Administration Health Care Personnel Handwash (HCPHW) sterilization, assure documentation and standard logs, develop an
method, ASTM E1174-06, ASTM E2755-10, ASTM E2784-10, inclusive scope inventory and foster collaboration. Stakeholders
and EN 1500. All methods measure test product efficacy after both included Anesthesia, Central Sterile Processing, Respiratory /
a single use and after 10 consecutive uses, except EN 1500 which Pulmonary, 4 Surgical Services suites, OR Sterile Processing, Heart
measures efficacy only after a single test product use. Two meta- Station, ICUs, Emergency Department, Supply Chain, Clinical
analyses were conducted, one based on single use data and one based Engineering, Patient Safety, Infection Prevention & Control (IP&C)
on data after 10 consecutive product uses. The Hedges’ g value was and administration. Departmental and hospital wide policies
calculated based on the log reduction from baseline for each product were reviewed using professional standards and current literature.
for each study. The model used was a complete random effects model Products were also reviewed for opportunities for standardization.
with subgroups (Gel A and Foam B) evaluated. Results:After Results: Critical elements for scope management were
a single test product use mean log reductions ranged from 2.32- identified: pre-cleaning, leak testing, manual cleaning, and high
5.25 and 2.43-5.06, for Gel A and Foam B, respectively. After 10 level disinfection /sterilization based on the Spaulding Classification
product uses, log reductions ranged from 3.11-5.24 and 2.61-5.19, system for critical, semi-critical, and non-critical devices. Policies
for Gel A and Foam B, respectively. Based on the meta-analysis were updated using common terminology and practices (flushing
both products were highly effective after a single use (Hedges’ g = scope with enzymatic cleaner, flushing with alcohol after processing,
11.746 and 12.174 for Gel A and Foam B, respectively) and after ten vertical hanging scopes during storage to promote drying , and new
product uses (Hedges’ g = 11.164 and 10.844 for Gel A and Foam standardized transport bags marked contaminated were selected).
B, respectively). Because the Hedges’ g 95% confidence intervals for Finally, a “READY TO USE” green tag adopted to indicate that a
Gel A and Foam B overlapped, there was no difference in efficacy device had been processed according to standards and was safe for
between Gel A and Foam B after a single use or after ten consecutive patient care. The new competency documents provided checklists
uses.Conclusions: This was the first example of applying meta- for critical steps plus an attestation of the individual’s training
analysis to compare the in vivo efficacy of different ABHR products and successful demonstration of competency. Each stakeholders
or product formats (gel vs. foam). The results of this meta-analysis agreed to implement the six(6)new logs to ensure compliance
indicate that ABHR format does not significantly influence efficacy. with scope processing standards and training. (These logs will be
Previously published results suggest that other attributes, including shared during presentation. Note the company or product name
product formulation and product application volume, are more is excluded. ) The logs included : Daily Scope Processor Type 1
predictive of ABHR efficacy. Log, OPA* Competencies, OPA Plus™ Solution Testing Log Sheet,
Processor 1 Biological Testing Log Sheet, Daily Processor #2 Run
Log and the Endoscope Reprocessing Competency. Manufacturer’s
Presentation Number 2-023 recommendations for care and maintenance were incorporated.
Everyone was to be re-trained within 90 days and then yearly.
A Multi-Disciplinary Team Tackles Standardization Scope practices and standards plus the new logs were placed on
of Endoscope Practices in a
Tertiary Care Setting: Finding
Common Ground for Patient
Safety
Loretta Litz. Fauerbach, MS, CIC,
FSHEA - Director, Infection Prevention
& Control, Shands at the University of
Florida; Terry K. Wilson, RN, MSN,
CNOR - Nurse Manager Operating
Room, Shands Hospital at the University
of Florida; Marie W. Ayers, RN, CIC -
infection Preventionist, Shands Hospital at
the University of Florida

Issue: Flexible endoscope management

is complex and non-standard practices
may lead to patient exposure. Our tertiary

26 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Bioterrorism/Disaster/Emergency Preparedness

the IP&C website for easy access. A comprehensive scope

inventory included manufacturer and model number, scope’s
use and the manufacturer’s recommendations for processing.
See table. Lessons Learned: Standardization of scope
practices improved communication and patient safety, facilitated
compliance monitoring, and decreases inventory by selecting
common products for all areas which also improved pricing. Use
of common terms and new labeling also improved practice and
reduced risk of error.

Bioterrorism/Disaster/Emergency
Preparedness
Presentation Number 3-024

U.S. School/Academic Institution Disaster and

Pandemic Preparedness and Seasonal Influenza
Vaccination Among School Nurses

Terri Rebmann, PhD RN CIC; Michael B. Elliott, PhD -

Assistant Professor, Saint Louis University, School of Public
Health; Dave Reddick, BS, CBCP - Executive Director,
PandemicPrep.Org; Zachary Swick, MS - PhD student, Institute
for Biosecurity, Saint Louis University

Background/Objectives: School pandemic

preparedness is essential, but has not been evaluated. The purpose
of this study was to evaluate U.S. schools’ current readiness to
respond to an infectious disease disaster, such as a pandemic.
Methods: An online survey was sent to school nurses (from
state school nurse associations and/or state departments of
education) in May – July, 2011. School pandemic preparedness
scores were calculated by assigning 1 point for each item in
school pandemic plans; maximum scores were 11. Influenza
vaccine uptake among school personnel was also assessed.
Linear regression was used to describe factors associated with
higher school pandemic preparedness scores. Fisher’s exact tests
were used to compare rates of mandating vaccine across school
employee groups (nurses, teachers, etc). Results: In all, 1,997
nurses from 26 states completed the survey. Three-quarters
(73.7%, n = 1,472) reported receiving the seasonal influenza
vaccine during the 2010/2011 season. Very few (2.2%, n = 43)
reported that their school/district had a mandatory influenza
vaccination policy. Nurses were more likely than all other school
employees (p < .001) to be mandated to receive the seasonal
influenza vaccine. Pandemic preparedness scores ranged from
0 - 10 points; the average score was 4.3. Schools designated to be
a point of dispensing (POD) had significantly higher pandemic
preparedness scores (t = 9.3, p < .001) compared with schools
that were not designated as PODs (5.1 vs. 4.1 respectively). Less
than half of participating schools have a pandemic plan (47.8%
, n = 955), only 40% (n = 814) reported that the school plan
was updated in response to the H1N1 pandemic, and almost
no schools (only 4%, n = 79) have used an infectious disease
scenario in a school disaster exercise. Most schools reported that

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 27
Poster Abstracts: Device-Related Infections and/or Site Specific Infections
they lack access to medications (98.5%, n = 1968) and personal after the hurricane, the transfer process was reversed and we became
protective equipment (71.3%, n = 1404) needed to respond to a the receiving facility. Infection Control personnel were stationed on
biological event. A little more than half of all respondent schools each unit ensuring appropriate patient placement upon their return.
(56.3%, n = 873) are participating in a community syndromic Lessons Learned: Emergency preparedness training is essential
surveillance program, such as reporting numbers of students for a full-scale evacuation. No training can cover all contingencies.
experiencing influenza-like illness, gastro-intestinal illness, or Communication, cooperation, team work and adaptability are
absenteeism rates. Determinants of school pandemic preparedness necessary intra and inter institutionally. Visual cues, such as isolation
were as follows: plan to be a point of dispensing (POD) during a signs provided all staff with immediate knowledge of the patient’s
future pandemic (p < .001), having experienced multiple student or isolation status. Although only one person can be in charge, the
employee hospitalizations and/or deaths related to H1N1 during ideas of all team members should be considered because new leaders
the pandemic (p = .01 or < .05 respectively), having a lead nurse emerged during the Hurricane Irene evacuation. A national electronic
complete the survey (p < .001), or having the school nurse study medical record would have been most helpful for both the sending
participant be a member of the school disaster planning committee and receiving hospitals.
(p < .001). Conclusions: Despite the recent H1N1 pandemic
that disproportionately affected school-aged children, schools lack
adequate pandemic plans. It is critical that schools focus on becoming
better prepared for a biological event.
Device-Related Infections and/or
Site Specific Infections
Presentation Number 3-025 Presentation Number 4-026
Maintaining Isolation Precautions During a Reduction in Catheter-Associated Urinary
Hurricaine Evacuation Tract Infections by Bundling Interventions in a
Community Hospital
Robin Haag, BC, RN, MA - Infection Control Director, Coney
Island Hospital; Joseph Marcellino, MPH - Director of Emergency Karen A. Clarke, MD, MS, MPH, FACP - Assistant Professor,
Management, Coney Island Hopsital Division of Hospital Medicine, Emory University; Bonnie Norrick,
CLS, EdM, CIC - Director, Infection Control Department, West
Issue: Issue: In late August 2011, New York City was under a Georgia Health
warning for Hurricane Irene. Two days prior to expected landfall, on
Background/Objectives: Urinary tract infections (UTIs)
Thursday, August 25th a decision to evacuate our facility was made
are the most common type of hospital-acquired infection, and 80
by the Mayor’s Office, the Office of Emergency Management, and
percent are associated with indwelling urinary catheters. In the era
New York City Health and Hospital’s Corporation because we are
of accountable care, the relative frequency of catheter-associated
located in a Zone A (Zone A faces the highest risk of flooding from a
UTIs (CAUTIs) imparts greater cost implications to hospitals and
hurricane’s storm surge). Project: The bed capacity for our acute
healthcare organizations. Strategies to actively reduce CAUTIs,
care facility is 371 and includes three intensive care units (medical,
especially those that are inexpensive and can be readily implemented,
surgical, coronary) as well as medical-surgical, obstetrical, pediatric,
could be useful in many hospital settings. We examined the
behavioral health and rehabilitation units. We were at capacity at
feasibility and cost-effectiveness of a bundled intervention to reduce
the time this unprecedented decision to evacuate was made. Eighty-
CAUTIs in a community hospital. Methods: We retrospectively
two patients were able to be discharged home prior to the hurricane.
examined the effect of a bundle of four evidence-based interventions,
Evacuation began on Friday, August 26th . A critical evacuation tracing
introduced in staggered fashion, upon the incidence rate (IR) of
form was created to provide a “snapshot” of basic patient information.
CAUTIs in a 276-bed community hospital over a 2 year period. Rates
Patients on isolation precautions were sent with the Isolation Sign that
of CAUTI per 1000 catheter-days were estimated and compared
was hung outside their room, ensuring a visual cue to the transport
using exact methods based on the Poisson distribution. The first
team and receiving facility. Fortunately our facility uses electronic
intervention was the exclusive use of silver alloy catheters in the acute
medical records and a detailed discharge summary was printed and
care areas of the hospital, the use of which had been sporadic in the
accompanied each patient. Records were maintained in the Incident
hospital over the previous 3 years. The second intervention was a
Command Center concerning isolation precautions including
new securing device to limit movement of the indwelling catheter
organism, site and the facility to which patients were transported. The
after insertion. The third intervention consisted of repositioning
Director of Infection Control was assigned to work in the Incident
the catheter tubing if it was found to be touching the floor. A two-
Command Center and accessed electronic medical records to provide
month run-in period began when the first intervention was started
receiving facilities with detailed patient information as needed to
in January 2009, and ended when the second and third interventions
ensure the safe transition of appropriate patient care. Results:
were introduced in February 2009. The fourth intervention,
242 patients were safely evacuated to13 health care facilities in 8
implemented in October 2009, was the removal of indwelling urinary
hours. Medical and Nursing staff from our facility accompanied our
catheters on postoperative day 1 or 2, for most surgical patients.
patients and worked in the receiving facilities for the duration of the
Results: During the 19-month study period, 33 of 2228 patients
evacuation. This provided continuity of care. All patient rooms were
were diagnosed with a CAUTI (10,978 catheter-days; IR = 3.0/1000
terminally cleaned as patients were evacuated. When we re-opened
catheter-days; 95% confidence interval 2.1 to 4.2). The CAUTI IRs

28 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Device-Related Infections and/or Site Specific Infections
for the 3 month baseline and subsequent 2-month run-in period were been developed based on the ICU environment, as well as focus on
5.2/1000 catheter-days and 6.5/1000 catheter-days, respectively. the patient experience throughout the hospital stay. Observation and
For the 7 months following full implementation of the first three evaluation of central line handling in the operating room, radiology
interventions, the IR was 3.1/1000 catheter-days, a non-significant and cardiac catheter lab resulted in the establishment of standard
reduction relative to the run-in period (p=0.09). However, for the infection prevention practices outside the patient units. Regular
7 months following the implementation of the fourth intervention, multi-disciplinary meetings and review of infections helped establish
the IR was 1.5/1000 catheter days, a significant reduciton relative to personal interest and responsibility for infection events. Utilizing the
the run-in period (p=0.009). Conclusions: A bundle of four industrial model of Root Cause Analysis in review of each CLABSI
evidence-based interventions, two of which were merely changes in helped obtain information from all staff involved in patient care
care processes, reduced the incidence of CAUTIs by 71 percent in and resulted in improved communication and problem-solving.
a community hospital. This relatively simple bundle appears to be Because of identification of CLABSIs occurring within five days of a
effective, feasible, and cost efficient, and it might be sustainable and procedure outside the ICU, our Anesthesia department undertook an
adaptable by other hospitals. improvement process to evaluate and standardize practice related to
central lines in the OR. CLABSI prevention efforts in the ICU have
been applied to all patients with central lines in all inpatient units of
the hospital. Administration has made CLABSI reduction a hospital
goal for several years, raising awareness and importance of these
infections to all staff. CLABSI-reduction has become an important
component of the hospital’s focus on patient safety. RESULTS:
Over time, the many actions taken to reduce infections have resulted
in a decrease in the hospital-wide yearly CLABSI rate from 6.2 to
2.2 in six years. Efforts continue to maintain and improve on these
results. LESSONS LEARNED: Seattle Children’s did not follow
strict scientific methods in analysing effects of interventions focused

Presentation Number 4-027

A Multi-interventional, Multi-disciplinary Effort to
Reduce Hospital-Acquired Central Line-Associated
Blood Stream Infections
Julie A. Smith, RN, MN, CIC - Infection Preventionist, Seattle
Children’s Hospital

Issue: Central lines are often necessary for effective care of

hospitalized patients. These lines may be needed for physiologic
monitoring, and delivery of medication and fluid in the Intensive
Care Unit, or for long term nutritional support or antibiotic
administration in less critically ill patients. These invasive devices
increase the risk of developing bacteremia. Many interventions to
reduce central line-associated blood stream infections (CLABSIs)
have been recommended based on scientific evidence. Other
interventions have been developed or trialed in an attempt to
further reduce infections. PROJECT: At our 250-bed pediatric
hospital, reduction of CLABSIs has been a focus for several years.
Participation in CLABSI-elimination collaboratives established
specific goals and increased internal communication of infection data.
Implementation of evidence-based “bundle” practices, focus on hand
hygiene compliance and other well-known interventions have been
added or elevated as standard care. Additional interventions have

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 29
Poster Abstracts: Device-Related Infections and/or Site Specific Infections
on CLABSI reduction, so there is no specific cause and effect that was 87% compliance with collecting and discarding clippered hair
can be concluded from our data. The goal was to reduce infections, and 80% compliance with physicians writing post-op incision care
specifically CLABSIs. Therefore, multiple efforts were undertaken orders. Craniotomy SSI’s decreased from 4.4% in October-December
and interventions were implemented if they made sense and could be 2009 to 1.16% in July-December 2011 (p=0.03). Lessons
achieved. The overall decrease in CLABSIs has been gratifying. The Learned: The use of a standardized pre-operative checklist
reduction of the CLABSI rate motivates staff to continue to improve and post-operative incision care instructions, together with minor
on these numbers and know their actions can result in better patient changes in OR room set-up was followed by a significant reduction in
outcome. craniotomy SSI. Interventions were most successful when they were
built into the existing workflow, such as adding bathing instructions
to preoperative patient instructions, adding incision care orders
to existing order sets, and adding a line for hair shampoo into the
Presentation Number 4-028
preoperative checklist. A team approach to change practice with close
A Multi-Disciplinary Performance Improvement collaboration between neurosurgeons, preoperative, perioperative,
Project to Reduce Craniotomy Surgical Site and postoperative unit staff was essential to success of the project.
Infections
Molly Hale, MPH, CIC - Infection Preventionist, Oregon Health Presentation Number 4-029
& Science University; Nicholas Coppa, MD - Assistant Professor,
Oregon Health & Science University; Aclan Dogan, MD - Assistant Sedation Reduction Leads to Reduction in
Professor, Oregon Health & Science University; John Townes, MD - Ventilator Associated Pneumonia
Associate Professor, Oregon Health & Science University
Janet Briggs, RN, BSN, CIC - Infection Preventionist, Hilton
Issue: Craniotomy surgical site infections (SSI) often have Head Hospital; Kelly Arashin, RN, MSN, CCNS, ACNP, CEN
devastating effects on the patient, such as cranial bone defects, - Clinical Nurse Specialist, Hilton Head Hospital; Lori Ross, RN,
brain abscess, meningitis, and may require hospital readmission, BS, MBA - Vice President of Clinical Quality Improvement, Hilton
repeat surgery and long courses of antibiotic therapy. In May 2010, Head Hospital; Robert Burnaugh, MD, FCCP - Past Chief of Staff;
the Department of Infection Prevention and Control (DIPC) Hospital Pulmonologist, Hilton Head Hospital
was notified of a perceived increase in craniotomy infections.
Retrospective surveillance revealed an infection rate of 4.4% from Issue: Hilton Head Hospital is a 93-bed community hospital that
October-December 2009, which had increased from 0.6% in the provides a broad range of services, including cardiac surgery. Historically
prior quarter. Medical record review of infection cases from July Ventilator Associated Pneumonia (VAP) has been part of the hospital
2009-May 2010 showed 88.2% occurred among non-emergent surveillance program. The rates for VAP remained constant for the years
surgeries; 22% were Coagulase Negative Staphylococci, 22% were 2007 at 5.84 and 2008 at 5.18 with a slight decline to 2.84 in 2009.
S. aureus, 26% were P. acnes, and 30% were from organisms not While standing physician orders and the IHI care bundle for VAP
commonly associated with skin flora. We conducted a case-control prevention were in place for the ventilated patient, we continued to
study and found a higher mean postoperative blood glucose among experience VAP. As a result, a project was initiated, in collaboration with
cases compared with controls (194.3mg/dL vs.155.2mg/dL;p=0.03) the pulmonologist, in an attempt to identify improvement opportunities.
and an increased risk of infection associated with a single operating
room (OR=3.34, 95%CI: 0.73-14.52). An observational study
demonstrated that neither skin preparation nor postoperative
incision care orders were standardized, clippered hair was left on the
floor during procedures, OR traffic was not minimized, and antibiotic
ointment was used on more than one patient. Project: A multi-
disciplinary task force of staff from neurosurgery, perioperative
services, neurosciences intensive care unit (NSICU), neurosciences
acute care unit and DIPC met bi-weekly from September 2010 until
January 2011 to address these issues and to standardize practice. A
“Craniotomy Checklist” was implemented February-September 2011
to assist with standardization of perioperative practice, including
skin preparation with chlorhexidine gluconate (CHG)-alcohol,
postoperative incision care orders, and preoperative bathing with
CHG and hair shampoo. Antibiotic ointment was made single-
patient use only, common equipment stored in the OR was relocated
to a central location to decrease traffic, and a new glycemic control
protocol was instituted in NSICU. Results: Within 3 months of Project: A comprehensive retrospective patient chart review was
checklist implementation, there was 100% compliance with patients completed to assess compliance with the key VAP bundle components:
receiving bathing instructions if seen in pre-op clinic, standardized head of bed (HOB) at 30 degrees, daily sedation reduction, peptic ulcer
skin prep with CHG-alcohol, and incision dressing protocol. There disease (PUD) prevention, and deep vein thrombosis (DVT) prevention.

30 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Device-Related Infections and/or Site Specific Infections
To be included in the review, patients were to have been on the ventilator the first year of trials we saw a large increase in VAP’s reported as
for greater than 72 hours. After compiling and analyzing the data, each vented patient was assessed during their ventilation and 48
sedation vacation was the one component identified as being missed most hours beyond by the Infection Control Department following the
often. Sixty-four total observations of charts yielded only 47% positive NHSN definition. We continued with modifications and education
observation for sedation vacation whereas we achieved better than instituting all six bundle elements. VAP’s decreased over the next two
90% in the other three key bundle components. This finding led to the years. In 2010 three VAP’s were identified within 5 months and the
realization there was no standardized protocol in place to assess a patient’s committee reconvened. The committee found five changes had been
response to a decrease in sedation. Therefore, a multidisciplinary team made including a bundle element no longer being done. Revisions
was convened to develop an improvement plan. Through its work, the were put into place and over the course of several months three
team determined a need to develop a formal sedation reduction protocol. new interventions were put into place. This again reduced VAP’s
The protocol was subsequently developed, implemented, and staff was to zero. Results: Assessment in January 2008 showed no VAP’s
educated on its use. The ultimate project objective was to eliminate since May 2007 with compliance of bundles at 100%. We moved to
VAP occurrences by decreasing the number of days a patient required quarterly meetings. By August 2009 we had no VAP’s for 17 months
ventilation thus reducing their exposure risk. Key project goals included: so the committee became a subcommittee of Critical Care. When
l Standardization of the ordering of sedation agents and titration we again saw VAP’s, we immediately reconvened and assessed what
parameters had changed. This again resulted in no VAP’s for another 17 months,
l Appropriate sedation utilization and initiation of daily sedation holds June 2010 through October 2011. Following the fiscal year, our rates
l Development of weaning parameters and initiation of breathing trials from for 2006-2011 ranged from 3.9 to 0. Lessons Learned:
l Daily assessment of sedation levels using the standardized Ramsay Every ventilated patient is at risk for a VAP. Be vigilant to do the
Scale. Results: Through the development of a formal protocol, bundle check list every day and assess for weaning. Always be aware
we ensured sedation reduction was incorporated into the routine care of any change in the definition of a VAP or in the use of the bundle
of the ventilated patient. Since implementation of the protocol, we elements as these may result in new cases. Engage all nurses and
have not experienced a VAP. Lessons Learned: Everyone who all the physicians including the intensivists, pulmonologists and
participated in this project learned something new and contributed hospitalists to understand and assist in the process elements. By
to the improvement effort. The following provides a summary of key reducing ventilator associated pneumonias, we saved lives, reduced
Lessons Learned: length of stay and saved thousands of dollars.
l Increased clinician awareness about the need and benefit of formal

protocols for complex and critically ill patients

l Enabled the Quality and Infection Control Departments to partner
Presentation Number 4-031
with the Medical and Clinical Staff in a successful quality improvement
effort A Multifaceted Approach Reduces Surgical Site
l Demonstrated that with interest and staff engagement, patient care
Infection Rates, Incidents, and Associated Costs
improvement is possible
l Identifying just one area for improvement can lead to important gains
for Abdominal Hysterectomy and Caesarean
Section Patients
Sonya Mauzey, RN, BS, CIC - Infection Preventionist, The Women’s
Presentation Number 4-030 Hospital

Reducing Ventilator Associated Pneumonia – Issue: Surgical site infections (SSI) are one of the leading causes
Goal – Zero of healthcare associated infections (HAI). They are associated with
increased morbidity/mortality as well as prolonged length of stay
Renee M. Savage, RN, BSN, CIC - Infection Preventionist, and costs. R. Douglas Scott, II of the CDC reported in 2009 that
Lawrence & Memorial Hospital SSI may cost anywhere from $10,443 to $25,546 per infection.
As a specialty hospital for women, our largest surgery volumes are
Issue: Ventilator Associated Pneumonias (VAP’s) are the leading hysterectomies and caesarean sections (c-sections). We estimate our
cause of death among hospital-acquired infections (HAI) and the hospital’s SSI cost for these surgeries to be approximately $10,500
second most common HAI in the United States. Literature shows per infection (please see graphs). American College of Obstetricians
the cost of a VAP ranges from $15,000 up to $50,000 per patient. and Gynecologists (ACOG) identifies abdominal hysterectomies as
The National Healthcare Safety Network (NHSN) states patients higher risk for SSI compared to vaginal approach. In spite of excellent
with mechanically assisted ventilation have a high risk of developing compliance with Surgical Care Improvement Project (SCIP)
a healthcare associated pneumonia with the incidence in 2006-2007 measures, our SSI rates remained elevated. A multidisciplinary
that ranged between 2.1 – 11.0 per 1000 ventilator days. Project: approach was utilized to search for possible causes and preventive
In July 2005 a VAP team was formed in our Medical Intensive Care measures. Project: SSI cases were reviewed for similarities,
Unit. We reviewed the Institute for Healthcare Improvement (IHI) opportunities for improvement, etc. It was recognized that most SSI
Saving 100,000 Lives Campaign and the VAP bundle of elements. were superficial incisional and occurred in women with elevated body
Reaching back I completed chart reviews for the time period of mass indexes (BMI). When looking for improvement opportunities,
9/03 – 9/05 that were coded for both a vent and pneumonia. We it was noted that during preadmission visits and phone interviews,
started education on the bundles and began trialing our forms in patients were instructed to bathe with 4% Chlorhexidine Gluconate
October, updating and revising them over several months. After

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 31
Poster Abstracts: Device-Related Infections and/or Site Specific Infections

(CHG) soap prior to admission for scheduled surgery. Laboring

patients going for unscheduled c-sections were prepped with 4%
CHG soap and water prior to being transferred to the operating
room. However, it was not able to be determined if this practice
was done in a consistent manner, e.g., whether or not the product
was used and, if so, how much was used. Another improvement
opportunity recognized was ensuring adequate dosage of preoperative
antibiotics. All patients were routinely receiving 1 gram Cefazolin,
but the dose should have been 2 grams for patients with elevated
BMI (>30). To improve practices and outcomes, we implemented
two new interventions. First, after consulting our pharmacist, we
began administering 2 grams Cefazolin to all patients preoperatively
to avoid giving an insufficient amount to those with elevated BMI’s.
Second, we implemented the use of a 2% CHG impregnated cloth
as a preoperative preparation to be utilized prior to all c-section
patients to ensure consistency with technique; we later implemented
this product for hysterectomy patients. Results: Implementing
two interventions that provided improved and consistent practices
resulted in significant reductions in SSI rate, incidence, and
associated costs. Lessons Learned: SSI prevention is a
continual and multifaceted venture that requires persistence in
looking for improvement opportunities. In our efforts to reduce SSI,
we found that implementing consistent practices such as ensuring
adequate dosing of prophylactic antibiotics and utilizing 2% CHG
cloths had the greatest sustained impact on our patients undergoing
abdominal hysterectomy or c-section surgical procedures.

Presentation Number 4-032

Reducing Peripherally Inserted Central Line
Associated Blood Stream Infections (CLA-
BSI): Targeting 0 in Non-Critical Care Medical
Surgical Units
Eileen Yaney, MT(ASCP) MS, CIC - Director, Infection Prevention
and Control, Saint Barnabas Medical Center, Livingston, NJ; Anita
Arrunategui, RN,CIC - Infection Preventionist, Saint Barnabas
Medical Center; Cindy Basile, RN, MSN, CCRN - Education
Coordinator, Saint Barnabas Medical Center

Issue: In the third quarter of 2008, a cluster of PICC line

infections were noted during routine review of laboratory blood
culture results. We understood the urgency of this dilemma; first for
patient safety and then our hospital’s financial burden. Outcomes
include a.) increased length of stay and b.) increased cost per episode
can vary from $3700 to $29,000 per episode. and c.) event not
reimbursable by Medicare. In response to this cluster, we began
hospital wide surveillance on all PICC lines. In 2010, we expanded
our surveillance hospital wide for all central lines. Project:
Saint Barnabas Medical Center participated in the Institute for
Healthcare Initiative (IHI) implementing the “Bundle Approach”

32 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Device-Related Infections and/or Site Specific Infections
for the care of central venous catheter lines in our critical care areas. Presentation Number 4-033
Central line associated blood stream infection (CLA-BSI) rates in
critical care have been reduced over the years to near zero. However, Is Antimicrobial Closure Technology A Clinically
in the fourth quarter of 2008, a cluster of PICC line infections Effective Strategy For Reducing the Risk of
in our non-ICU was observed, therefore our investigation into Surgical Site Infections – A Meta-Analysis?
CLA-BSIs in the non critical care areas began. Whole house
surveillance began with input from each unit. The collection and Charles E. Edmiston, Jr, PhD - Professor of Surgery & Hospital
inputting of central line days at the same time each evening was Epidemiologist, Medical College of Wisconsin Department of
implemented on all ten nursing units that had patients with central Surgery; David Leaper, MD - Professor, Imperial College; Frederic
lines. Separating PICC device days was a challenge as only total C. Daoud, MD, MSc - Epidemiologist, Medextens; Martin
central line device days were able to be captured. Our target was Weisberg, MD - Medical Director, Ethicon, Inc
set to 0. The investigation included: a.) accessing potential causes
for our CLA-BSI in non critical areas, b.) plan the interventions Background/Objectives: Surgical site infections
necessary to lower the rate and c.), implement the changes with the comprise 20% of all healthcare-associated infections, having a
unit managers and d.) evaluate improvement by monitoring our significant impact on patient morbidity, mortality and healthcare
rates. Results: PICC line infections decreased from an average resources. The present systematic literature review (SLR) meta-
of 27 per year from 2008-2010 to 5 in the first 6 months of 2011. analysis evaluates the current evidence-based literature in an attempt
Initiatives included: 1.) chlorhexidene/ alcohol preps were added to validate the clinical effectiveness of antimicrobial (triclosan-
to the unit stock supply; 2.) the central line checklist for insertion coated) suture technology as a complementary adjunctive strategy
of CVC was monitored hospital wide for compliance; 3.) the to reduce the risk of SSI in selected surgical patient populations.
blood culture policy was updated to limit use of the central line Methods: A systematic literature review was conducted using 4
for blood draws, 4.) all non- ICU staff were educated regarding independent, comprehensive databases; PubMed, Embase/Medline,
“Scrub the Hub” 5.) the mechanical connector was changed to a Cochrane Database Group and www.clinicaltrials.gov in an effort to
connector coated with an antimicrobial designed to help prevent identify all relevant clinical trials involving triclosan-coated braided
microbial contamination and growth of pathogens in the device; sutures that met the criteria for Evidence Level 1b. Selective eligibility
6.) rounds were conducted and staff were reminded to cap off criteria were established so as to limit the potential of either analytical
unused lumens 7.) the use of chlorhexidene protective disk was or publication bias. The relevant publications were tested against
initiated on all PICC lines at insertion. 8.) we investigated any new specific inclusion and exclusion criteria. Data extraction included
devices/procedures implemented during this time that may have study design, surgical procedure, clinical indication, outcomes,
been linked to the cluster. Lessons Learned: Targeting 0 is a suture material, and patient number. The risk ratio (RR) was chosen
monumental challenge. We are ready for the challenge but are aware as the measure of effect for the meta-analysis. A fixed-effects model
that all disciplines need to be involved in the process including was used to calculate the relative magnitude of the RR under the
celebrating the successes and correcting the failures. It involves assumption that all included RCT were drawn from the same
much time and man power and ongoing observations to keep our population with a common treatment. Homogeneity was tested
patients safe from infections during their hospital stay. We need to using the Cochran’s Q statistic and the percentage of heterogeneity
keep this project at the fore front of our daily care and continually was measure with the I2 indicator. The random-effects pooled
look for ways to improve our patient safety and our facility’s RR was also calculated to draw qualitative conclusions about the
continued operation without undue financial burdens as we strive presence or absence of a significant treatment effect in favor of one
for excellence in patient care. or the other arm under the assumption that the included RCTs were
drawn from different populations with treatment effects favoring
the same treatment but with different magnitudes. Publication bias
was assessed using the graphical funnel plot and Egger regression
intercept methods. Sensitivity analysis was conducted by rerunning
the analysis with 6 RCTs after iteratively removing each RCT and
comparing results. Results: A total of 20 relevant clinical trials
were identified from the peer-reviewed literature and following
filtering of inclusion and exclusion criteria 7 eligible RCTs were
chosen to be included in the meta-analysis. The seven RCTs were
determined to be homogeneous (Q = 6.26, NS). The random-effects
model demonstrated a RR of 0.482 (95% CI:0.31-0.75), indicating
a statistically significant reduction in the risk of SSI when triclosan-
coated sutures were compared with non-coated closure devices
(p=0.0012). No publication bias was detected (Egger Intercept test:
p = 0.974) and the results were robust to sensitivity analysis. The
results of the meta-analysis were defined as CEBM Evidence Level
1a. Conclusions: Triclosan-coated closure technology is
associated with a significant lower risk of postoperative SSI compared
to non-coated closure devices (p<0.001). In the current evidence-
base healthcare environment adoption of an antimicrobial suture

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 33
Poster Abstracts: Device-Related Infections and/or Site Specific Infections
technology is warranted as an appropriate adjunctive component of September 2008 to include neonates. Major revisions of the VPB
a thoughtful risk reduction strategy to improve clinical outcomes in are shown in Figure 1. Following implementation of the modified
surgical patient populations. VPB, NICU VAP rates decreased 62% from 3.9 to 1.5 infections
per 1000 ventilator days, and have been sustained at 0.46 per 1000
ventilator days (n=5) from 2008-2011.(Figure 2) VAP HAIs and
Bundle Compliance are targeted at zero and 100 % respectively.
Presentation Number 4-034
VAP rates have been zero (maintaining the NHSN 90th percentile
Pediatric Ventilator Associated Pneumonia (VAP) of performance) for 56 months, 48 months, 46 months in the ICU,
Prevention Bundle: 5 Years Later SCU, CCU respectively. NICU VAP rates decreased 62% from 3.9
to 1.5 infections per 1000 ventilator days in the first year post Bundle
Andrea Kiernan, MLT (ASCP) CIC - Infection Preventionist, implementation. NICU VAP rates have been sustained at 0.46 per
St. Christopher’s Hospital for Children; Patricia Hennessey, RN, 1000 ventilator days from 2008-2011 (n=5) (Figure 2). The NHSN
BSN, MSN, CIC - Manager, Infection Prevention, St. Christopher’s rate is zero for the 75th and 90th percentile of performance in Level
Hospital for Children III NICUs. Lessons Learned: • A multidisciplinary team
approach was critical to VPB development • Annual mandatory
Issue: In 2005, VAP rate in our pediatric Critical Care (CC) staff VPB education is vital to sustaining low VAP rates • NICU is
Units was below the 50th percentile of performance as compared a special needs population for VAP prevention • Zero VAP rate is
with the CDC’s NHSN Pediatric CC VAP data. Adult VAP attainable and sustainable
prevention had evolved but pediatric evidence was limited. All CC
Units are ECMO centers. Project: A multidisciplinary team
convened with the goal of developing a Pediatric VAP Prevention
Bundle (VPB). Objectives included: 1) identify opportunities for
improvement; review internal policies and practices at the bedside;
2) review evidence based literature; 3) network with other pediatric
institutions to determine best practices; 4) evaluate adult evidence to
determine applicability to pediatrics; 5) evaluate improvement on an
ongoing basis. The VPB was implemented in our ICU, SCU (Special
Care Unit/Burn Center), CCU (Cardiac Care Unit), and our Level
III NICU in May 2006. (Figure 1) Results: Using the VPB, the
ICU, CCU & SCU Units maintained zero VAPs from October 07-
October 2011 (Figure 2). Because our NICU VAP rate continued
to exceed NHSN NICU benchmarks, we modified the VPB in

Presentation Number 4-035

When a central line bundle is not enough:
Sustaining gains and striving for zero
Kathy Ware, RN, BSN, CIC - Infection Control Coordinator, Texas
Children’s Hospital; Carol Turnage. Carrier, MSN, RN, CNS,
CPHQ - Clinical Nurse Specialist, Texas Children’s Hospital; Yvette
R. Johnson, MD, MPH - Assistant Professor of Pediatrics, Baylor
College of Medicine and Texas Children’s Hospital

Background/Objectives: In 2008, it was identified that a

substantial number of central line associated blood stream infections
(CLABSI) were occurring at a higher rate in very low birthweight
infants in a 76 bed, Quanternary Care, Level 3 Neonatal Intensive
Care Unit (NICU). After implementing a central line bundle, the
CLABSI rate was lowered in 2009. Various interventions included
a bundle consisting of a neutral displacement valve, scrub the hub
technique, closed medication system, hand hygiene, maximum
barrier precautions, standardized dressing change kit, and dedicated
Vascular Access Team (VAT). In 2010, five of eleven (45 percent)
CLABSIs were attributed to umbilical line infections alone. The
Gaps in Practice (GIP) Team collaborated with various consultants
to identify problems with current umbilical line security, migration,
and dislodgement of catheters not addressed by the current central

34 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Device-Related Infections and/or Site Specific Infections
line bundle. A literature review by the team provided no evidence for
best practice in securing umbilical lines. The objective of this initiative
was to improve the security of umbilical arterial and umbilical venous
catheters using commercially available skin barrier and a clear dressing
over the coiled umbilical line to reduce migration and subsequent
neonatal umbilical line-related infections in the NICU by 40% within
6 months to 1 year. Methods: The GIP team benchmarked with
the top ten children’s hospitals to compare different methods against
their outcomes of catheter migration and infections. Four of the ten
hospitals used the skin barrier and clear dressing over the coiled catheter
and reported no associated adverse events. The GIP team collaborated
with the VAT and Infection Control Nurse to use the Plan-Do-Study-
Act (PDSA) improvement method to test the most commonly used
dressing and securement device. In January 2011, the VAT conducted
the PDSA testing of the new dressing on 4 infants in the NICU.
Specific criteria were used for eligibility to include preterm and term
neonates with 50% of the neonates being in humidified environments.
Results of the PDSA testing showed no complications of catheter
migration and no infections associated with umbilical lines in the four
patients. Nurses were educated on the procedure and the securement
device was implemented in the NICU. Weekly monitoring of infection
frequency by line type was continued. Results: Umbilical line
infections were decreased by 40 percent following full implementation
of the dressing change intervention throughout the NICU, as evidenced
by the following graphs and tables. Conclusions: Using quality
improvement tools and teamwork further reduced umbilical and central
line related infections in the NICU.

Presentation Number 4-036

Multifaceted Interventions to Prevent Central
Line Associated Blood Stream Infections in a
New York City, Neonatal Intensive Care Unit
Larry T. Colbert, MA, CIC - Associate Director of Infection
Control, Bellevue Hospital Center

Marianne Pavia, MT(ASCP), CLS, CIC - 2011 President-

Elect, APIC Greater New York Chapter 13; Associate Director
Infection Control, Bellevue Hospital Center; Susan Marchione
- Sr. Associate Director Infection Control, Bellevue Hospital
Center; Harold Horowitz - Hospital Epidemiologist, Bellevue
Hospital Center; Yang Kim - Assistant Professor Pediatrics,
Neonatologist, NYU, Bellevue Hospital Center; Roslyn
Mayers - Assistant Director Nursing, Bellevue Hospital Center

Issue: Central line associated blood stream (CLABSI)

Infections are a serious issue in a Neonatal Intensive Care Unit
(NICU). They have been associated with increased morbidity,
mortality, and length of stay in the NICU. Bellevue Hospital
RPC NICU is a 25-bed, level 3 unit where an increased
incidence of central line infections occurred from 2007 to 2009.
These rates were higher than national standards. Project:

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 35
Poster Abstracts: Device-Related Infections and/or Site Specific Infections
A multidisciplinary and multifaceted infection prevention program with the mean (SD) LOS was 24.7 (13.4) days and the mean (SD)
was developed and in place March 2009 in order to reduce the LOS in ICU was 17.2 (15.8) days. All 51 patients were infected
CLABSI rate in the NICU. Our program includes: 1. participation by multi-resistant methylase producing Acinetobacter Baumanii.
in statewide CLABSI prevention Collaborative which included 89.2% of isolates was resistant with imipenem. These Acinetobacter
use of central line check lists (insertion and maintenance) and the Baumanii are grouped as 3 clusters with the similarity 70% in each
central line bundle. 2. Implementation of “Bug Stop Here” campaign cluster. The severity of diseases is different significantly among the
which included: staff education, hand hygiene measures, aseptic cluster (p<0.01). The patients in each cluster were found to be related
technique practices, revamping of cleaning policy of all equipment/ with location, sharing the suction machine, oxygen humidifiers
NICU environment, “Leave Your White Coats at the Door” Policy, and same staff. Twenty eight (54.9%) isolates have gene 16S rRNA
Instituting “personal” plastic bags for visitors belongings. Parents were armA, and these gen were transmitted among the clusters. (Figure
also given a written NNICU infection control parent agreement. 1). Conclusions: There is an endemic of VAP due to multi-
The agreement addressed hand washing, separation of clean and dirty drug resistant Acinetobacter Baumanii in the hospital, sporadic
items on the unit, not visiting when ill. Free bottles of hand sanitizer cases as well as outbreaks of VAP due to Acinetobacter Baumanii is
were also distributed to the parents.3. Infection Control participation occurring. 16S rRNA methylase gene armA was widely distributed
in daily patient rounds to enforce central line protocol. Results: in these isolates. This suggested that the spread of clones played an
Prior to the interventions the CLABSI rates were 4.4 and 8.3 in 2007 important role in the outbreak of multi drug resistant A. baumannii
and 2008 respectively. After the interventions rates were 8.3, 1.5 and in Vietnam. Although the source of outbreak is unknown, the cases
1.6 in 2009, 2010 and 2011 respectively. Lessons Learned: showed having close contact and sharing equipments. Contaminated
A multidisciplinary intervention that included CLABSI bundle environment or instruments with inappropriate reprocessed may
components as interventions, & “Bug Stop Here” Program helped contribute an important role in transmission of this pathogen. Strict
decrease our CLABSI rate.Reduced NICU central line associated contact precaution should be enhanced in this setting. More studies
blood infection rates may lower hospital costs, length of stay, should be done to invest the source and the spread of these clones of
morbidity and mortality.Parent and staff education with continued Acinetobacter baumani in the ICU.
active surveillance can be important tools in reduction of CLABSI
rate. Collaborative groups and sharing of information can help
facilitate implementation of prevention aims.

Presentation Number 4-037

Ventilation Associated Pneumonia caused by
Acinetobacter Baumanii at a Tertiary Hospital in
Vietnam: Clinical and Molecular Patterns
Anh Thu T , LE - Chief of Infection Control department, Cho Ray
Hospital, Vietnam

Background/Objectives: The pathogen causing

ventilation associated pneumonia (VAP) in Vietnam mainly due
to multi drug resistant Acinetobacter Baumanii, which cause a high
impact for patients who required ventilators. The aim of the study Presentation Number 4-038
is to evaluate clinical and molecular epidemiological characteristics
Patient Education as a Means to Reduce
of VAP caused by Acinetobacter Baumanii and their antimicrobial
susceptibility. Methods: Study design: Cohort prospective Methicillin-Resistant Staph Aureus Surgical Site
study Setting: 30 bed medical-surgical ICU of Cho Ray Hospital, a Infections in Patients with Known Colonization
tertiary hospital of Southern Viet Nam. Subjects: Patients defined
Kathy M. Bailey, RN, CIC - Director, Infection Prevention, Centra
as Acinetobacter Baumanii VAP admitted to the ICU from 1st
Health
June to 1st September 2011. CDC definition 2003 was used to
diagnose VAP. The genotypic-resistance characteristics of all isolates Issue: Methicillin-Resistant Staph aureus (MRSA) is a frequently
of Acinetobacter Baumanii were investigated by pulsed field gel recognized pathogen causing surgical site infections (SSIs). Patients
electrophoresis (PFGE). Results: During the studied period, with MRSA colonization are known to have an increased risk of
there were 51 patients with Acinetobacter Baumanii VAP. Thirty MRSA infection. Evidence based preventive measures were in place
six (70.6%) was male with the mean (SD) age of patients was 50.8 in 2009 to include chlorhexidine cloth applications pre-operatively,
(17.7). Thirty eight (74.5%) had underline diseases, mostly diabetes appropriate antibiotic selection and timing, clipping versus shaving,
(N=12; 23.5%). Forty (78.3%) patients were coma with mean Staphylococcus aureus nasal screens for implant patients and, intranasal
(SD) Glasgow scale of 6 (3.2). Twenty-five (49.0%) patients were Mupirocin for patients with positive nasal screens. MRSA SSIs rates
undergone operation, mostly abdominal operation (N=20; 39.1%). continued to be higher than desired as evidenced by surveillance
The mortality was 52.2%. Forty seven (92.2%) patients had SIRS, of nine targeted surgical procedures. National Healthcare Safety

36 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Device-Related Infections and/or Site Specific Infections
Network (NHSN) SSI definitions were utilized to identify infections.
Project: In May 2010 a process was developed to provide face
to face patient education by an Infection Preventionist (IP) for
individuals known to be colonized with MRSA at the time of surgery.
A multidrug resistant organism (MDRO) alert in our computerized
patient medical record provided information regarding prior
colonization with MRSA. Each day patient records carrying this alert
were matched with operating room schedules to create a listing of
candidates for the education. An IP visited these patients on the first
or second post-operative day to provide education and answer any
questions of the patient or family. A one page educational tool on SSI
prevention along with a complementary alcohol based hand sanitizer
was left with the patient. Results: Our MRSA SSI rate decreased
by 75% when 2010 rates were compared to 2011 rates of infection.
The MRSA SSI rate in patients receiving the education was 0.3%
(N=331). Because we addressed our MRSA SSI rate with a sense of
urgency several preventive measures were established simultaneously. Presentation Number 4-039
As a result, we were unable to determine the specific impact of the
An Interdisciplinary Approach Toward Reducing
education towards the reduction. We did however recognize that
patients better understood their MRSA status and risk of infection.
the Incidence of Catheter-Associated Urinary Tract
Additionally, this effort was a patient satisfier as evidenced by positive Infections in a Post-Acute Facility
patient and family comments. Finally, we believe that this process will Peter Kolonoski, RN, MSN, CIC - Infection Control Coordinator,
enhance our efforts towards The Joint Commission’s national patient California Pacific Medical Center; Kim Stanley, MPH, CIC -
safety goal of patient education on surgical site infection reduction. Infection Control Coordinator, California Pacific Medical Center;
Lessons Learned: All patients meeting the criteria were not Karen Anderson - Infection Control Manager, California Pacific
educated. Outpatient surgery patients were discharged before the IP Medical Center
could see them. Some patients were medicated for pain while others
suffered from dementia with no family member available to receive the Issue: Catheter-associated urinary tract infections (CAUTI)
information. This was a labor intensive commitment for the IPs but are the most prevalent healthcare associated infection (HAI),
one that provided valuable patient education on surgical site infection accounting for more than 30% of all HAIs in the United States.
prevention, improved patient satisfaction and is one of several CAUTI has been associated with increased morbidity, mortality,
interventions that led to a significant reduction in MRSA SSIs. length of stay, cost, and antibiotic use. Indwelling urinary drainage
systems can also be a reservoir for multidrug resistant organisms.
Project: This quality-improvement project was implemented
in three post-acute units in a large tertiary teaching hospital.
Physicians and nurses were interviewed to gather opinions about
catheterization practices. A point prevalence survey of Foley catheter
use was then done, in order to determine prevalence and reason for
the use of indwelling catheters, by comparison to a list of criteria
of indications from published literature. A multidisciplinary team
consisting of physicians from urology, orthopedics, critical care and
hospitalist services, Nursing, and Infection Prevention formulated
new protocols for catheter management. Key components were
indications for catheterization and bladder training in order to
reduce long-term use. Infection Prevention would continue to
monitor device utilization and CAUTI incidence. Results: Staff
interviews demonstrated that staff felt that catheters were over-
utilized, alternatives were seldom considered, and that physicians
were often not aware that patients had an indwelling catheter. Some
physicians also felt that poor collection of urine output data led
to prolonging the use of catheters. Nurses felt that the decision to
maintain an indwelling catheter was up to the physician, and did not
consider it within their scope of practice. Prevalence studies showed
that approximately 25% of indwelling catheterizations did not meet
the selected criteria. Nurses were often unaware of why the patient
had a catheter, but did not usually advocate for its removal. These
data were used by the multidisciplinary team in formulating new
protocols. The catheter management protocol contained elements
relating to catheter insertion procedure, care, alternatives, and

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 37
Poster Abstracts: Device-Related Infections and/or Site Specific Infections
indications, with the stipulation that catheters not meeting criteria 1.99); a Body Mass Index (BMI) lower than 18.5: 1.42(1.19-1.70);
should be removed. There was general agreement among the team stoma:1.20 (1.03-1.39, P=0.01) and anemia: 1.13 (1.01-1.26,
that catheter insertion and removal should require a physician’s order. p=0.038). In multivariate analysis, thoracolaparotomy (OR 4.27,
A bladder training protocol with a baseline assessment on admission 95%CI 2.01-9.07), lithotomy position (1.97, 1.37-2.83). BMI lower
was also instituted with the goal of regaining normal bladder than 18.5 (2.52,1.67-3.84), males (1.98, 1.35-2.91) were selected
function as soon as possible. The three nursing units had a decrease as risk factors for hypothermia with a body temperature of 36.0 or
in CAUTI rate from 19.1 CAUTI/1000 catheter-days in 2008 to lower. The perioperative body temperature was not correlated with
14.29 in 2011. Device utilization declined from .142 to .099 . While the bleeding volume, duration of surgery, and transfusion volume.
patient census remained relatively constant over the study period, The incidence of SSIs was 21% (BILI-H: 16%; BILI-P: 37%; ESOP:
the number of CAUTIs decreased from 74 in 2008 to 30 in 2011. 37%; GAST: 14%: COLN: 15%; and REC: 25%). Significant risk
Lessons Learned: Quality improvement initiatives require factors for SSIs were as follows: contaminated wounds (1.60, 1.05-
multidisciplinary input and buy-in. A definitive baseline assessment is 2.43); emergency surgery (1.27, 0.98-1.64); and stoma construction
necessary to gauge progress. Having nurses aware of indications led to (1.16, 1.05-1.29). Hypothermia (36.0 or lower, 35.5 or lower) was
greater advocacy for catheter removal. not selected as a significant risk factor for SSIs [1.02 (0.94-1.12), and
0.99 (0.87-1.13), respectively]. Conclusions: The incidence of
hypothermia in abdominal surgeries was 34%, and was influenced by
combined thoracotomy, the sex, surgical position, and body weight;
Presentation Number 4-040
however, the occurrence of severe hypothermia was rare, and most of
Incidence of Hypothermia under Perioperative patients were included mild to moderate hypothermia. Hypothermia
Standard Thermal Management in Patients with in such a condition did not appear to be a risk factor for SSI.
Abdominal Surgery and Its Effect on Surgical Site
Infections
Presentation Number 4-041
Toshie Tsuchida, RN, PhD - Associate Professor, Hyogo University
of Health Sciences; Kaoru Ichiki - Infection Control Professional Vascular Access Associated Blood Stream
Head Nurse, Division of Infection Conrol and Prevention Hyogo Infections in Patients Undergoing Plasmapheresis
College of Medicine; Yoshio Takesue - Chief Professor, Hyogo Compared with those in Patients with Hemodialysis
College of Medicine; Yoko Fujimoto - Head Nurse, Hyogo college of
Medicine Hospital Kaoru Ichiki - Head Nurse, Division of Infection Conrol and
Prevention Hyogo College of Medicine; Toshie Tsuchida, RN, PhD
Background/Objectives: Perioperative thermal - Associate Professor, Hyogo University of Health Sciences; Yoshio
management has been routinely performed to prevent hypothermia Takesue - Chief Professor, Hyogo College of Medicine; Nakajima
induced adverse events including surgical site infections (SSIs). This Kazuhiko - Lecturer, Hyogo College of Medicine; Ueda Takashi
study aimed to examine the incidence of hypothermia in abdominal - Pharmacist, Division of Infection Control and Prevention Hyogo
surgeries under perioperative standard thermal management and College of Medicine
its effect on SSI. Methods: A retrospective cohort study was
conducted involving patients who underwent liver (BILI-H), Background/Objectives: Vascular access associated blood
pancreatic (BILI-P), esophageal (ESOP), gastric (GAST), colon stream infections (VABSI) underwent hemopurification have been
(COLN) and rectal (REC) surgery within the period from January to mainly studied on hemodialysis (HD). Hemopurification therapy
December 2010. Perioperative thermal management was performed is, also applied to patients with plasmapheresis (PP). This study
using a forced-air warming system in all cases. The following data were aimed to examine the incidence of VABSI on PPand investigated
collected: the lowest perioperative rectal temperature (pharyngeal risk factors affecting it. Methods: Patients who underwent PP
temperature in patients undergoing colorectal surgery); 5 patient- and HD with vascular access catheters between January 2007 and
related characteristics; 5 surgical procedure-related characteristics; September 2011 were eligible for the study. Blood stream infections
and 5 SSI-related items. Analysis was performed by calculating: 1) were diagnosed based on the criteria defined by the National
the incidence of each stratified level of hypothermia (mild; 36.0-35.6 Nosocomial Infections Surveillance (including clinical sepsis) and
degrees C; moderate; 35.5-35.1; and severe; 35.0 or lower) and odds National Healthcare Safety Network. Analysis was performed
ratios (OR) for risk factors of hypothermia. 2) risk ratios (RR) for by calculating the incidence of VABSI on HD and PP. The risk
SSI risk factors, including hypothermia (36.0 degrees C or lower, factors affecting VABSI on PP were specified using univariate and
35.5 or lower). SSI was diagnosed based on the criteria defined by multivariate analysis among 20 factors including nine host factors, six
the National Healthcare Safety Network. Results: A total of 632 catheter related factors and 5 other factors (activity on daily living,
patients (BILI-H: 81; BILI-P: 46; ESOP: 24; GAST: 133; COLN: incontinence, sanitary conditions, capacity to understand, skin lesion
134; and REC: 196) were studied. The incidence of each level of at the insertion site).Results: Two hundred seventeen patients
hypothermia was as follows: mild 151 patients (24%); moderate 54 with HD and 62 patients with PP were observed. Mean number of
patients (9%); and severe 9 patients (1%). The RR for each cause of hemopurification therapy were 5.6±4.2 on HD and 4.8±2.4 on PP.
hypothermia with a body temperature of 36.0 degrees C or lower Primary diseases underwent PP were as follows: Multiple sclerosis
was as follows: thoracolaparotomy 1.84 (95% Confidence Intervals: 32 patients, Myasthenia gravis 9 patients, Chronic inflammatory
1.22-2.76); lithotomy position: 1.28 (1.14-1.44); males: 1.55(1.20- demyelinating polyradiculoneuropathy 8 patients, Lambert-Eaton

38 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Device-Related Infections and/or Site Specific Infections
myasthenic symdrome and bullous pemphigoid 4 patients. The post-operative period. Generalized Linear Models adjusting for
incidence of VABSI was 8.8% (6.29/1,000 device-day) on HD, patient age, gender, region and diabetes were used to compute mean
14.5% (9.2/1,000 device-day) on PP (P=0.18 and P=0.10). The differences and 95% confidence intervals. A constant sample based
Odds ratio of PP for cause of VABSI was 0.82( 95%CI; 0.58-1.15, on the index procedure census was used for all three analyses to
P=0.24) PP was not an independent risk factor of VABSI in patients maintain a consistent denominator. Results: Patients developing
with hemopurification. Variables that achieved statistical significance SSI as a complication of index surgery incur an additional LOS of
in the univariate analysis for cause of VABSI in patients with PP were 6.86 days (95%CI: 6.71-7.02 days) and $20,288 (95%CI: $19,369-
follows: emergent insertion of vascular access, steroid pulse therapy $21,206) of extra payments. Patients during the 90-day post surgery
and patients with poor hygiene. In multivariate analysis, emergency period who had developed SSI in their initial admission are likely
insertion was identified as the only independent risk factor of VABSI to have 0.21 more downstream readmissions (95%CI: 0.19-0.21),
on PP. Conclusions: There was no significant difference in 1.94 days additional LOS (95%CI: 1.81-2.08) and $5,549 additional
the incidence of VABSI in patients with HD and PP. Further study payments (95%CI: $5,106-$5,993). Patients developing SSI at
is required to conclude the difference among the patients with any time during their 90-day post-operative period are at risk of
hemopurification therapy. Emergency insertion was the risk factor 1.3 additional readmissions, and incur an average additional LOS
affecting VABSI on PP. of 8.37 days (95%CI: 8.26-8.47) and $25,436 (95%CI: $25,094-
$25,779) in additional payments. Conclusions: SSI increases
current and downstream burdens by a factor of 3 to 10 times in terms
of readmission rates, and additional length of stay and payments.
Presentation Number 4-042
Appreciation of its impact emphasizes the importance of control and
Total Burden Assessment Of Surgical Site prevention of this surgical complication.
Infections In Initial Admissions And Readmissions
Using National Administrative Claims Data Presentation Number 4-043

Anuprita Patkar - Asso. Director, Health Economics & Challenges In Adherence With National Healthcare
Reimbursement, Ethicon, J&J; Somesh Nigam - VP, Healthcare, Safety Network Definitions: A Central Line-
Johnson and Johnson Corporate; Mehmet Daskiran - Statistical Associated Bloodstream Infection Conundrum
Analyst, Johnson and Johnson Corporate; Ronald Levine -
Statistician Level III, Johnson and Johnson Corporate; Scott Wolven Teresa Chou, MPH, CIC - Manager, Infection Control and
- Asso. Director Reimbursement, Ethicon, J&J; Sashi Yadalam - Epidemiology, Advocate Illinois Masonic Medical Center; James
Statistical Analyst, Johnson and Johnson Corporate Kerridge, MA, RN, CIC - Infection Preventionist, Advocate Illinois
Masonic Medical Center; Katie Wickman, MS, RN - Infection
Background/Objectives: Surgical site infections (SSIs) Preventionist, Advocate Illinois Masonic Medical Center; Mandavi
have a significant negative impact on hospital reimbursement and Kulkarni, MD - Infectious Disease Attending, Advocate Illinois
clinical outcomes. This study quantifies the incidence and economic Masonic Medical Center; James Malow, MD, FIDSA - Chairman
burden of SSIs in 6 selected surgical categories as an aggregate. Internal Medicine, Chairman Infection Prevention Committee,
Uniquely, this investigation focuses on the impact of patients having Medical Director Advocate Healthcare Infection Prevention Team,
SSI in their initial admission with downstream outcomes, including Advocate Illinois Masonic Medical Center
readmission counts, payments and total length of stay (LOS) to
assess the complete consequences of SSI, not just a single episode of Issue: The Centers for Disease Control and Prevention’s National
care. Methods: Patients were drawn from the Thomson Medstat Healthcare Safety Network (NHSN) has standardized definitions
Marketscan® Database, a national administrative database that for healthcare-associated infections including central line associated-
longitudinally tracks commercial claims data from nearly 150 million bloodstream infections (CLABSI) and pneumonia (PNU). In
patients since 1995. The economic impact of SSI was evaluated in conjunction with the Center for Medicare and Medicaid Services
selected 6 high-volume surgery specialties specified by ICD9-CM (CMS), the State of Illinois requires hospitals to report CLABSIs
procedure code (cardiac, general, orthopedic, neurological, plastic using NHSN. Last year, Illinois began conducting audits of CLABSI
and ob-gyn) during the period January 2007 to December 2009. data to validate adherence with NHSN definitions. Adherence with
Patients qualified if they had no prior surgeries in a 90-day look back these definitions may not always concur with clinical diagnoses. The
period. Subsequently, each patient was observed for readmissions in following case demonstrates the conundrum. Project: A 67
a 90-day look forward period. Patients developing infections during year old male patient with multiple co-morbidities was admitted
their index admission were defined by ICD-9-CM codes 998.5x, on October 14, 2011, with dyspnea, fever, and peritoneal dialysis
998.66 and 998.67 as their secondary diagnosis; patients developing catheter malfunction. On admission, laboratory tests showed
one or more SSI’s during their readmissions were defined by the leukocytosis and computer tomography of the lungs revealed
same codes identified as their primary readmission diagnoses. The bilateral infiltrates and multiple nodules. A bronchoalveolar lavage
total burden of SSI was assessed by evaluating differences in LOS (BAL) culture on October 19 grew few Klebsiella pneumoniae
and provider payments relative to patients with no SSI: 1) during and many yeast, not Cryptococcus. The patient did not respond
the initial admission for patients experiencing SSI; (2) during the to antibiotics or high dose steroids. Initial blood cultures were
90-day post surgery for patients who had developed SSI in their negative. Blood cultures obtained on October 28 from a peripheral
initial admission; and 3) in patients developing SSI in their 90-day site and a central line grew C. neoformans. At the time, he had
2 central lines (dialysis, peripherally inserted) and an arterial

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 39
Poster Abstracts: Device-Related Infections and/or Site Specific Infections
line. He expired on October 29; no autopsy was performed. Prevention recommended implementation of a concentrated pre-op
To determine if the patient had a CLABSI, NHSN definitions wash of the back using the CHG-impregnated cloths in pre-operative
were reviewed, pulmonologists and infectious disease physicians holding. All SCIP measures continued as previously implemented
evaluated the patient, a literature search for CLABSIs associated and no other variables were changed during the next 12 months.
with Cryptococcus was conducted, and NHSN was consulted. Given consistent success of the new process for laminectomy
Results: Although the patient exhibited signs and symptoms procedures over a one-year period, the program was expanded to
of pneumonia, it did not appear that the PNU2 definition was include orthopedic surgeries. Beginning October 2010, the use
met; Cryptococcus was isolated from blood 15 days after admission. of the CHG-impregnated cloths in the pre-op holding area was
The case met the CLABSI criteria 1 definition: the patient had implemented for knee and hip total joint replacement procedures.
central lines, no Cryptococcus was isolated from the BAL culture, Results: During FY 2007-09, the combined mean SSI rate
admission blood cultures were negative and the pathogen was for laminectomy procedures was 3.5/100 procedures. Following
isolated from blood during hospitalization. A NHSN nurse implementation of the CHG impregnated cloth pre-op wash in
consultant advised adherence with definitions but did not specify October 2009, no additional laminectomy SSI have been identified.
the infected site. Since imaging revealed infiltrates and lung The 100% reduction in SSI rate as compared to the previous three
nodules, 2 pulmonologists and 3 infectious disease physicians years is statistically significant [p value=0.017]. During FY 2007-10,
stated that the bacteremia was secondary to the pneumonia, not the combined mean SSI rate for knee and hip total joint replacement
a CLABSI. Cryptococcus is not easily isolated from a BAL, and SSI was 1.7/100 procedures. Following implementation of the CHG
the nodules were not biopsied (preferred method). Furthermore, cloth pre-op wash in this population, the decrease in SSI rate for
the BAL was obtained many days before the patient developed these procedures was noted to be statistically significant [p-value
bacteremia. Only 1 cryptococcal CLABSI case has been reported = 0.013]. Lessons Learned: Implementation of CHG-
in the literature; the patient was on chronic hemodialysis and had impregnated cloths as a pre-op wash applied directly to the operative
no other sites of infection. Lessons Learned: The CLABSI site as an adjunct to the traditional pre-op CHG shower has been
definitions leave no room for clinical interpretation. Hospitals are successful in eliminating laminectomy SSI. Expansion of this process
left in a quandary as whether to adhere to the clinical diagnosis to include orthopedic procedures resulted in a significant decrease
or NHSN definitions. If the CLABSI definition is met and not in knee and hip total joint SSIs. Our sustained success with SSI
reported, the hospital risks being cited. We support Sexton, Chen reduction supports the practice of a pre-op wash utilizing CHG-
and Anderson’s recommendation to revise the definitions and create impregnated cloths as an adjunct to the traditional pre-op surgical
an indeterminate category. shower, and demonstrates the value of sharing our learning and
success beyond the initial implementation group.

Presentation Number 4-044

Presentation Number 4-045
Shared Successes For Surgical Site Infection
Reduction: Utilization of CHG-impregnated Cloths Micro-Patterned Surfaces for Reducing Platelet
as an Adjunct to the Pre-op Shower Adhesion and Bacterial Attachment Associated
with Catheter-Associated Blood Stream Infections
Linda K. Miller, RN, CIC - Manager, Infection Prevention &
Control, Methodist Charlton Medical Center; Mary A. Fulton, Rhea M. May - Microbial Research Associate, Sharklet Technologies
RN, BSN, CIC - Infection Prevention Practitioner, Methodist Inc.; Matthew G. Hoffman - Microbial Research Associate, Sharklet
Charlton Medical Center; Zakir Hussain A. Shaikh, MD, MPH, Technologies Inc.; Shravanthi T. Reddy - Director of Research,
FIDSA, FSHEA, CPE, CMSL - Medical Director and Hospital Sharklet Technologies Inc.
Epidemiologist, Methodist Heath System of Dallas
Background/Objectives: Central venous catheters
Issue: Surgical site infections (SSI) increase hospital costs (CVCs) are responsible for approximately 90% of all catheter-related
and length of stay as well as adversely impact patient mortality. bloodstream infections (CRBSIs). The resulting 300,000 infections,
Reduction efforts have focused on implementation of a set of commonly caused by Staphylococcus aureus and Staphylococcus
measures as part of the Surgical Care Improvement Project (SCIP), epidermidis, are associated with as many as 28,000 deaths per year
evidence-based practices that are well documented as a successful in America alone. CRBSIs prolong hospital stays, induce human
reduction strategy. Our facility is a 305-bed, acute care, non-teaching suffering, and magnify healthcare costs (up to $2.68 billion).
community hospital serving an inner-city population. After intensive Infection is four times more likely to occur in patients with catheter-
implementation of the SCIP measures and compliance monitoring, related thrombosis (CRT), and up to 67% of patients with CVC
it was determined that SSI reduction efforts for laminectomy cases develop CRT. A common strategy used to prevent CRBSIs has been
could be further enhanced. Project: In early October 2009 the to impregnate CVCs with antimicrobial agents to control microbial
effectiveness of the pre-op CHG shower program was assessed. The colonization, and heparin coatings to prevent CRT. These strategies
existing process, in place for five years, included supplying patients can be limited by the short duration of efficacy and the potential for
with a CHG product and written/verbal instructions for showering contributing to antimicrobial resistance and heparin induced safety
the night before and the morning of surgery, paying special attention concerns. A novel micro-topography (Figure 1, bottom panels)
to the surgical area. As part of the SSI reduction strategy, Infection may provide an alternative strategy as it has been shown to reduce

40 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Device-Related Infections and/or Site Specific Infections
bacterial attachment and biofilm formation without the use of Presentation Number 4-046
antimicrobial agents. This biomimetic micro-pattern also inhibits
bacterial migration, offering the possibility of reducing bacterial Our Journey to Eliminate Central Line Associated
access into the bloodstream via the CVC. The objectives of this Blood Stream Infections in our NICU
study were to determine the performance of the micro-pattern in
reducing S. aureus attachment after whole blood pre-conditioning Anne Reeths, RN, MS - Infection Preventionist, Aurora BayCare
and to evaluate the innate anti-fouling properties the pattern may Medical Center
have in reducing platelet attachment and aggregation, precursors to
thrombosis that can lead to CRT related CRBSIs. Methods: Issue: Our 22 bed level III NICU opened in 2003. Our first two
Patterned and un-patterned (control) silicone samples (n=3) were years of data show an increase in central line associated blood stream
immersed statically in whole blood for either 10 minutes or 2 hours infections (CLABSI) rates in the <1000 gram infant population.
at 25°C, followed by a saline rinse, and inoculation with ~10^7 Our root cause analysis identified several challenges. First, we
CFU/mL S. aureus (ATCC6538) suspended in saline. The samples reviewed each central line and discovered the longer the central line
were incubated statically for 1 hour at 25°C before rinsing with was in place the more likely the patient would develop an infection.
saline and enumerating the attached cells after ultrasonication and This review also showed the most common organism causing the
dilution plating. Platelet adhesion was evaluated on patterned and infections were coagulase-negative Staphylococcus species. Secondly,
un-patterned silicone surfaces (n=2) through exposure to platelet we noted inconsistent central line practices that included insertion
rich plasma (150x10^4 platelets/μl) under shear laminar flow techniques and line maintenance. Finally, we wanted to determine
conditions (100 rpm) for two hours at 37°C before osmium tetroxide if our team was employing current evidenced based best practice in
fixation and imaging with scanning electron microscopy in six pre- this unique population. Our primary goal was to be current with
determined locations. Platelet area coverage was analyzed through recommended practice models and target zero CLABSIs in our unit.
ImageJ software. Results: After preconditioning surfaces with Project: In 2005, a multidisciplinary team, including Physician
blood for 10 minutes and 2 hours, the micro-pattern reduced S. Champions, Nursing, Infection Prevention, and Nursing Education
aureus attachment by 68% (p≤0.05) and 82% (p≤0.15), respectively, introduced the collaborative concepts to nursing staff and set short
when compared to preconditioned un-patterned surfaces. The and long term goals. The initial meeting focused on practice changes
patterned surfaces also reduced platelet area coverage by 90% and implementation. An education curriculum was created focusing
(p<0.00001) when compared to an un-patterned surface (Figure 1). on hand hygiene, central line access, central line maintenance and
Conclusions: The physical surface modification afforded by aseptic technique. Data, including hand hygiene compliance, line
the micro-patterned texture inhibits the adhesion of platelets, and days and infections are reviewed monthly and shared with the unit.
attachment of S. aureus after blood preconditioning. Introduction of Results: Practice changes include updating unit based policies,
this micro-pattern on a central venous catheter surface may be useful transformation of the line care, and implementation of Vancomycin
for controlling CRBSIs and CRT. locks to any patient with a central line. The NICU celebrated 613
days without a CLABSI, see figure 1. Although we acknowledge
our success, we have opportunities for improvement. Lessons
Learned: Since focusing on this initiative, we have strived to
implement evidence based practices at the neonatal bedside. With
administrative support and staff involvement, the multiple changes
that occurred with the unit have been embraced. The culture of
the unit evolved into one of accountability and safety. Milestones
are celebrated and suspected infections analyzed. The NICU team
understands the importance of making quality improvement at the
bedside a part of everyday practice.

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 41
Poster Abstracts: Device-Related Infections and/or Site Specific Infections

Presentation Number 4-047 Background/Objectives: To counteract the increase

in CABSIs that accompanied the introduction of needleless IV
Activity of Dynamic Concentrations of Silver connectors (NCs) in the 1990s, several companies have begun to
and Chlorhexidine Against Common Bacterial incorporate an antimicrobial agent into the NC. We have recently
Pathogens reported a highly relevant in vitro assay for determining the
effectiveness of antimicrobial NCs in reducing contamination on the
Ben Luchsinger - Senior Scientist, Bacterin International NC’s environmentally exposed septum. Herein we report the in vitro
Background/Objectives: Silver and chlorhexidine are activity of five antimicrobial NCs against eight relevant pathogens.
incorporated into medical devices to prevent device associated Methods: Five commercially available antimicrobial NCs were
infections. While minimum inhibitory concentrations (MICs) and examined in the present study along with their corresponding non-
standard kill curves have been measured for fixed concentrations antimicrobial twin [InVision-Plus® CS™ (RyMed Technologies Inc.,
of each antimicrobial, the effect of the concentration of the Franklin, TN), V-link® (Baxter Healthcare Corporation, Deerfield,
antimicrobial increasing over time by eluting from a medical IL) Max Guard ™ (Medegen, Ontario, CA), Antimicrobial Clave®
device is not widely understood. Performing this type of analysis (ICU Medical, San Clemente, CA) and Ultrasite® Ag (B. Braun
would not only determine the relative sensitivity and killing Medical, Bethlehem, PA)]. Contact contamination was simulated
kinetics between various bacteria but also provide insight into the by pipetting a 10 μL solution on top of the NC’s septum containing
specific pharmacokinetic of kill. Using a silver and chlorhexidine approximately 106 colony forming units (CFU) of the following
containing needleless IV connector (NC), we examine the effect of clinically relevant organisms: A. baumannii, E. coli, K. pneumoniae,
a dynamically increasing antimicrobial concentration against eight MRSA, P. aeruginosa, S. aureus, and S. epidermidis. After one hour,
common pathogens. Methods: The septum of a NC [InVision- CFU were determined by vortexing each NC in saline and plating
Plus® CS™ (RyMed Technologies Franklin, TN)] that is incorporated appropriate dilutions on permissive agar media. Log reduction was
with silver and chlorhexidine using a proprietary method [Bacterin calculated by comparing CFU counts to the NC’s respective non-
International Inc. (Belgrade, Montana)] was used to evaluate the antimicrobial twin. Results: Of the five NCs examined, only one
relative sensitivity of eight bacterial pathogens. A 10 μL solution displayed measurable antimicrobial activity under the conditions
containing approximately 10^6 colony forming units (CFU) was employed (P<0.05). It reduced contamination on the exposed surface
placed on the surface of the septum. Killing kinetics were determined by at least three logs for all bacteria tested compared to its non-
at 10, 20, and 30 minutes by vortexing the septa in saline and plating antimicrobial twin. The other four NCs provided a complete recovery
appropriate dilutions on permissive media. Log reduction was of the total surface contamination and showed no measureable
calculated for each time point. Results: S. epidermidis was the reduction in the CFU compared to their non-antimicrobial twin.
most sensitive to the silver chlorhexidine co-treatment demonstrating Conclusions: As septum contamination has been implicated
a four-log reduction in 10 minutes. K. pneumoniae and E. coli were as a source of CABSI associated with NCs, we sought to compare the
second most sensitive showing a four-log reduction in 20 minutes. A. antimicrobial NCs an in vitro assay to replicate the contamination
baumannii, S. aureus, and MRSA each showed a four-log reduction they may face in the health care environment. While the in vitro
and P. aeruginosa showed a two-log reduction in 30 minutes. The reduction in contamination of one antimicrobial NC is clearly
least sensitive was E. faecalis showing a one-log reduction in 30 demonstrated herein, the clinical efficacy of this treatment strategy
minutes. Interestingly, comparing the killing kinetics demonstrated has not been established and future work is needed to relate this, or
that some bacteria (K. pneumoniae, E. coli, A. baumannii, and S. other, in vitro assays with clinical data.
epidermidis) displayed a large kill at a discrete time point while
other bacteria (A. baumannii, S. aureus, MRSA, and E. faecalis)
displayed more smooth time-dependent killing over the course of the Presentation Number 4-049
experiment. Conclusions: This study not only determines the
relative sensitivity and killing kinetics of eight different pathogens Micro-Patterned Surfaces for Reducing Biofilm
by dynamic concentrations of silver and chlorhexidine but also gives Formation in an Endotracheal-Tube-Like
valuable insights into the pharmacokinetics of kill. This data should Environment
be considered to aid future design efforts of antimicrobial containing
medical devices and provides insights into bacterial physiology. Matthew G. Hoffman - Microbial Research Associate, Sharklet
Technologies Inc.; Rhea M. May - Microbial Research Associate,
Sharklet Technologies Inc.; Shravanthi T. Reddy - Director of
Research, Sharklet Technologies Inc.
Presentation Number 4-048
Background/Objectives: Pneumonia is the second most
Comparison of Antimicrobial Needleless I.V. common Hospital-Acquired Infection (HAI) in the U.S. and is a
Connectors in a Septum Contamination Assay leading cause of death due to HAI. Ventilator-associated pneumonia
(VAP) is one of the leading HAIs in Intensive Care Units (ICUs)
Helena M. Lovick, PhD - Research Scientist, Bacterin International,
and accounts for 86% of nosocomial pneumonia cases in hospitals.
Inc.; Mark Schallenberger - Scientist/Project Manager, Bacterin
A particularly troublesome aspect of VAP is the rise in antibiotic
International Inc.; Ben Luchsinger - Senior Scientist, Bacterin
resistant strains of bacteria causing late-onset VAP infections. There
International; Todd R. Meyer - Director of Research and
are currently no definitive methods to prevent late-onset VAP,
Development, Bacterin International, Inc.

42 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Device-Related Infections and/or Site Specific Infections
which will likely involve combining several approaches that can
work synergistically. This study presents a unique non-kill, physical
surface modification for inhibiting biofilm growth without the
use of antimicrobial agents. This biomimetic micro-pattern has
previously demonstrated reduced colonization for several species of
microorganisms in vitro. The objective of this study is to evaluate
in vitro the ability of a micro-patterned silicone surface to inhibit
Staphylococcus aureus (ATCC 29213) biofilm formation after four
days of biofilm growth. Methods: Silicone coupons with the
micro-pattern (Figure 1), with smooth silicone coupons as controls,
were sterilized and then inoculated with S. aureus (ATCC 29213)
for four days in nutrient rich growth media with and without
2g/L mucin at 37˚C to allow for biofilm formation under static
Presentation Number 4-050
conditions. Samples were then rinsed with diH2O to remove
planktonic organisms, and the remaining attached cells were fixed A Novel Chlorhexidine Hydrogel Coating for
with glutaraldehyde. Biofilm formation was assessed by confocal Peripheral Venous Catheters
microscopy (Zeiss LSM 510 microscope) using propidium iodide
stain, followed by analysis for biofilm area and volume coverage. Todd R. Meyer - Director of Research and Development, Bacterin
Results: The micro pattern demonstrated an 84% reduction International, Inc.; Mark Schallenberger - Scientist/Project
(n = 4, p = 0.06) in S. aureus biofilm formation over four days of Manager, Bacterin International Inc.
growth on 16mm silicone coupons in TSB (Figure 2), and an 89.5%
reduction (n = 3, p = 0.27) in the presence of 2g/L mucin (Figure Background/Objectives: Peripheral intravascular
3). Conclusions: The physical surface modification afforded access devices are the most commonly used medical device in
by the micro-pattern texture inhibits biofilm formation of S. aureus with 150 million used annually in North America alone. With an
(ATCC 29213) in standard microbial growth conditions and in the infection rate of 0.5% these devices contribute to approximately
presence of mucin. The results of this study suggest that the use of 750,000 infections each year creating a sizable health and economic
this micro-pattern on an endotracheal tube surface could be useful burden. To potentially mitigate this public health concern, we
for controlling ventilator-associated pneumonia. present preliminary results for a novel biocompatible, lubricious,
chlorhexidine containing hydrogel coating for peripheral venous
catheters (PVCs). Methods: The chlorhexidine hydrogel
coating is applied to PVCs using a proprietary process developed
by Bacterin International Inc. The coated PVCs were tested
for antimicrobial activity using an in vitro infection model.
Additionally, repeat zones of inhibition were monitored by
transferring the devices from plate to plate for three days. The
lubricating properties of the coating were measured using a
validated assay. Lastly, biocompatibility was evaluated through
cytotoxicity and hemolysis testing. Results: The hydrogel-
coated PVCs generated a greater than 4 log reduction of colony
forming units in the in vitro infection model against all clinically
relevant pathogens examined. The coating also continued to
produce sizable zones of inhibition (> 5 mm) for at least three
days. The coated PVCs required significantly (P > 0.05) less force
to insert though an elastomeric membrane than the non-coated
device demonstrating the lubricating properties of the coating.
Additionally, preliminary results suggest that the coating is
biocompatible by producing negative results in cytotoxicity and
hemolysis testing. Conclusions: As peripheral venous access
devices contribute to an estimated 750,000 device related infections
annually in North America, we sought to test a novel chlorhexidine
containing hydrogel coating for PVCs. Here in we report the
promising antimicrobial, lubricative, and biocompatibility results
of coated PVCs. While the in vitro antimicrobial activity is clearly
demonstrated, the clinical efficacy of this treatment strategy has not
been established and future work is needed to relate these in vitro
assays with clinical data.

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 43
Poster Abstracts: Device-Related Infections and/or Site Specific Infections

Presentation Number 4-051 Presentation Number 4-052

Our Journey to Zero: Preventing Central Line Prevention of Central Line Associated Bloodstream
Associated Bloodstream Infections in the Pediatric Infections by Implementation of Central Line Bundle
Intensive Care Unit
Muhammad Yaseen, RN, BSN, MS, CIC - Infection Control
Beth Rhoton, RN, MS, CIC - Infection Preventionist, MUSC Coordinator, King Abdulaziz Medical City Jeddah Saudi Arabia;
Medical Center; Linda Formby, RN, BSN, CIC - Manager, Abdulhakeem Al Thaqafi - Associate Executive Director Infection
Infection Prevention and Control, MUSC Medical Center Prevention and Control, National Guard Health Affairs; Fahad
Hameed - Deputy Chairman Critical Care Unit, King Abdulaziz
Issue: The mean rate of central line associated bloodstream
Medical City Jeddah; Medhat Lamfon - Infection Control
infections (CLABSI) in our PICU from November 2007 through
Coordinator, King Abdulaziz Medical City Jeddah; Areej Qudsi -
October 2009 was 6.4/1000 central line (CL) days, even after
Infection Control Practitioner, King Abdulaziz Medical City Jeddah
putting IHI’s central line placement bundle into practice. In 2009
we recognized this was a serious problem. Project: Our pediatric Issue: The prevention of central line infections is of paramount
intensive care unit (PICU) is an 11-bed medical/surgical critical care importance due to its impact on patients as well as the hospitals
unit in a university hospital setting that admits infants, children and resources. The IHI (Institute of Healthcare Improvement) bundles
adolescents who require concentrated and continuous medical care have already been proven to reduce healthcare associated infections
not available on general inpatient units. For treatment and supportive and team work to ensure its compliance helps even more to prevent
care these patients require a variety of intravascular (IV) lines, healthcare associated infections. This project was carried out in
frequently placed in femoral sites for extended periods of time. We ICU patients with one or more central lines in place. Project:
recognized the need to address more than line placement to prevent In January 2008, a multidisciplinary team was convened to work
BSI. We looked at NACHRI’s multicenter PICU project progress together and come up with prevention strategies to reduce the rate
in BSI prevention through standardizing line care and maintenance of Central Lines Associated Bloodstream Infections (CLABSI) in
(LCM). When our Medical Center’s Infection Prevention and a 22 bed Medical and Surgical ICU. The team adopted “Central
Control (IPC) Department organized a team to customize an line Bundles” by the IHI (Institute for Healthcare Improvement)
intravascular (IV) LCM bundle, key PICU nursing personnel joined to review the practices that can have an impact on the CLABSI
the effort. A customized IV LCM bundle based on CDC and INS rate. These practices included: 1. Hand hygiene prior to insertion
bloodstream infection (BSI) prevention guidellines was developed by 2.Maximal barrier precautions, 3. Chlorhexidine skin antisepsis, 4.
the hospital’s Zero BSI team. Mandating education of CL insertion Optimal catheter site selection, with subclavian vein as the preferred
and LCM bundles in the PICU was not enough. When the hospital site for insertion. 5. Daily review of line necessity with prompt
committed to participating in the national Stop BSI project, the removal of unnecessary lines. The surveillance for the rate of CLABSI
PICU volunteered and a multidisciplinary unit-based team was also continued simultaneously. The assigned Infection Control
organized to eliminate CLABSI. Patient safety became part of the Practitioner, who also acted as the coordinator for the CLABSI
unit culture. Unit champions were identified and empowered. Medical Prevention team, monitored the whole process of surveillance
and nursing staff were engaged. A daily patient goal sheet was put into activity including “Central Line Bundle”. The data was collected
practice. Line care audits were started. Days and then months since the on a daily basis by the Infection Control Practitioner with the
unit’s last CLABSI were counted. Results: This multidisciplinary help of other team members e.g. Nurses, Physicians. The data was
project resulted in nearly 97% reduction in CLABSI with a mean analyzed quarterly and presented to the concerned areas and in the
rate of 0.2/1000 CL days from November 2009 to November 2011 Infection Control Committee meetings. The CLABSI prevention
while decreasing the number of CL days. Using SHEA’s published team meetings were held regularly to discuss the overall progress.
estimates that each CLABSI has an 18% fatality rate, costs $36,000 to Results: The rate of CLABSI in the first quarter of 2008 was
treat, and increases length of stay an average of 13 days, we calculated
an expected number of CLABSI. Based on our baseline rate, the
PICU’s CLABSI prevention program has saved an estimated 3 or
4 lives, $756,000 in patient charges, and 273 days of unnecessary
hospitalization. Lessons Learned: We learned that CLABSI
prevention requires a standardized continuous multidisciplinary
effort. It involves creating a culture of safety. Frequent monitoring and
regular reports of bundle audits and infection rates to maintain staff
interest and engagement are needed. Active participation and visible
involvement of the IPC Department in the process is important.
Administrative support is essential. All of these have helped our PICU
change what is possible in CLABSI prevention.

44 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Device-Related Infections and/or Site Specific Infections
2.8/1000 central lines days. The overall rate of CLABSI in the year uncuffed catheters (especially from the femoral site) were to be either
2008 and 2009 was 2.0 and 2.8/1000 device days respectively. The discontinued or changed to long-term, cuffed catheters within one
overall rate of compliance to Central line Bundle in 2008 and 2009 week of use. We developed an algorithm to assist nurses in femoral
was 37% and 83% respectively. The real reduction in the rate of catheter removal decision making. For every identified infection, we
CLABSI was achieved in 2010 and 2011 when the CLABSI rate held ICU team debriefings to assess opportunities for improvement.
dropped to 0.7 in 2010 and 1.2/1000 device days in 2011. The Results: Incidence of cases of CLA-BSI was used as an outcome
compliance rate to Central Line Bundle increased to 98% in both measure of improvement. Since our initiatives 2006 (n=23) - 2011
2010 and 2011 which is clearly reflected in the decreased in the rate (n=8) we have sustained a continuous reduction in our CLA-BSI,
of CLABSI from 2.0/1000 device days in 2008 to 1.2/1000 device providing an average rate of one CLA-BSI/1000 central line days for
days in the year 2011. Lessons Learned: The major lesson to our combined ICU’s. The total number of CLA-BSI did not reach
be learnt was that consistency pays at the end. The team had quite a our target of zero: however lower risk catheters (PICC’s) account
few challenges in implementation and compliance to the bundles in for the majority of our CLA-BSI cases. Hands-on education did
the beginning but with the dedication of the whole team, desirable improve central line maintenance and knowledge. A collaborative,
results were achieved. Although this is a significant achievement ongoing educational process (e.g., team debriefings), however, is
but more hard work is required to bring the rate down to zero for a required to maintain this knowledge and the success of the initiatives.
prolonged period. Lessons Learned: The Infection Prevention and ICU
teams must collaborate completely to reduce risk and reach a goal
of zero infections. A multidisciplinary team approach with 100%
accountability for all participants provides an opportunity to address
Presentation Number 4-053
CLA-BSIs outside of a standardized surveillance approach.
Targeting Zero Central Line Associated Blood
Stream Infection: Innovative Prevention Initiatives
Toward Desired Outcomes Presentation Number 4-054
Debi A. Hopfner, RN, BSN, CIC - Infection Preventionist, St. Reduction In Duration Of Post-Operative Catheter
John Hospital and Medical Center; Janice Rey, MT (ASCP), CIC Use Following Imiplementation Of An Electronic
- Manager Infection Prevention, St. John Hospital and Medical Reminder System
Center; Mohamed Fakih, MD, MPH - Medical Director Infection
Control Department, St. John Hospital and Medical Center Patricia Emmett, MS, RN, CIC - Infection Prevention Coordinator,
Community Hospital of the Monterey Peninsula
Issue: The risk of developing a central line-associated bloodstream
infection (CLA-BSI) depends on a variety of factors such as insertion Issue: The risk of catheter-associated urinary tract infection
technique, length of catheterization, location of catheter, and line (CAUTI) increases each day that the indwelling urinary catheter
management. Comparing our present rate of CLA-BSI to 2004, we remains in place. Reduced duration of indwelling urinary catheter
successfully lowered our rates, but have yet to reach our goal of zero use is an important strategy to reduce CAUTI. Through process
infections. Intensive review of the infected cases revealed that the measurement, we determined that we had poor compliance with
majority developed after one week of placement—indicating a line prompt removal of indwelling urinary catheters from surgical
management issue, rather than insertion technique. Project: inpatients. Project: Our private non-profit community non-
Our infection prevention team implemented a bundle of strategies teaching 166 bed acute care California hospital serves medical-
to improve central line management in our 60-bed adult teaching surgical, oncology, family birthing, level II nursery, and critical care
intensive care units (ICU). We educated ICU staff on central line including open heart surgery patients. 799 Surgical Care Improvement
placement, management, and proper “scrub the hub” technique. We Project (SCIP) procedure cases were studied for this project and
administered identical tests both before and after the educational included total hip and knee replacements, abdominal hysterectomy,
sessions to assess immediate knowledge gain. Results were shared with vascular cases, colon cases, coronary artery bypass graft cases, and other
the staff. We conducted monthly central line maintenance audits, cardiac surgery cases, e.g. valvular surgery. Our project aim was to
and fed back results to the ICU nurses. The infection prevention measure and improve compliance with removal of indwelling urinary
team performed a critical care event analysis on each CLA-BSI, catheters from the selected population on post-operative dayone
describing all pertinent details, and forwarded a comprehensive or two. Data collection began in quarter 4, 2009 and continues to
report to ICU management, staff, and program directors. Upon date. Education was provided to physicians in an online physician
identifying a CLA-BSI, we also mailed an informational letter to newsletter, Bruits and Murmurs. Education was provided to nurses
the line-inserting physician and the corresponding medical director. in to online venues, The Nursing Newsletter and NetLearning
To optimize the educational experience, we implemented a hands- Infection Prevention, at the start of quarter 1, 2010. An electronic
on, mobile “Training on Wheels” unit. The education focused on reminder to orthopedic and general surgeons was implemented in
early assessment of central line necessity and prompt removal of the patient’s computerized medical record at the start of quarter 2,
unnecessary lines. The in-service also promoted lower- risk catheters, 2011. Compliance was determined prior to intervention (data quarter
such as peripherally-inserted central venous catheters (PICC). We 4, 2009), after education the following quarter (data quarter 1-4,
implemented the National Kidney Foundation’s guidelines for 2010; and quarter 1, 2011), and again after an electronic reminder
best practices to address femoral dialysis catheters. All short-term, system was implemented in quarter 2, 2011 (data quarter 2-3, 2011).

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 45
Poster Abstracts: Device-Related Infections and/or Site Specific Infections
Results: 1) Compliance with removal of indwelling urinary units, with no unit having more than 2 cases. No other commonly
catheters from the selected population on post-operative day one or identified sources of CDI transmission were identified. PFGE
two, without any intervention, was 47.1% (104 surgical procedures). testing of all 7 isolates revealed only two of the cases were considered
2) Compliance after education rose from 47.1% to 64.3%, and fell to related: one CO-HA and a subsequent hospital acquired, hospital
approximately 50.0% for a sustained period (486 surgical procedures). onset case on the same unit. The working hypothesis was that
3) Compliance after use of the electronic reminder reached 81.0% low-level contamination of the environment affected only the most
after two quarters (209 surgical procedures). Lessons Learned: susceptible population: the severely immunosuppressed oncology
1) An electronic reminder displayed to the orthopedic and general patients. The increased incidence was resolved by implementing
surgeons when opening the patient’s electronic chart provided the control measures commonly used during any increased incidence
greatest improvement from 47% baseline compliance to 81% post- of CDI on all GCH areas, inpatient and outpatient: scrupulous
intervention compliance. 2) Expanded use of this method beyond the attention to environmental cleaning including use of UV irradiation
SCIP cases may further reduce the risk of CAUTI. 3) Continue to of rooms, and enhanced infection prevention measures. The month
integrate education to involve nurses in best practices during catheter after the increased incidence was identified, the hospital-acquired
insertion, maintenance, and working in an advocate role for patient CDI rate fell to 0 identified cases, and the median rate for CDI
safety from infection. for the GCH from August-December 2011 was 5.7/1000 pt days.
Conclusions: Clusters of CDI in the pediatric population
have not been well described in the literature. Increased incidence of
CDI among hospitalized pediatric patients is only beginning to be
reported. This case report mirrors reported experiences with CDI in
pediatric population, and provides new information to guide further
research into the pediatric experience with CDI. Conclusions: 1.
Immunosuppressed pediatric patients are at increased risk for CDI. 2.
CDI may affect a population, not necessarily a geographic location.
Surveillance data collection should consider adding service to data
points (not currently required for NHSN surveillance). 3. Pediatric
populations are not immune to CDI, and more research is needed for
this patient population.

Presentation Number 4-056

Presentation Number 4-055 Differentiating Infection from Inflammation after
Total Knee Arthroplasty
Canaries in a Coal Mine: A Case Report of Increased Incidence of
Clostridium Difficile in a Pediatric Oncology Patient Population Crystal R. Heishman, RN - Surveillance, University of Louisville
Hospital
Melissa Z. Bronstein, RN, MPA, CIC - Infection Preventionist,
Strong Memorial Hospital, University of Rochester Medical Center Issue: Each year, approximately 15% of Healthcare Associated
Infections (HAI) are reported as Surgical Site Infections (SSI).
Background/Objectives: The Golisano Children’s SSI, according to The Center for Disease Control and Prevention
Hospital (GCH) at Strong Memorial Hospital at the University (CDC), is the third most reported HAI. SSI is reportable up to 30
of Rochester in Rochester NY provides tertiary care to over 3000 days after a non-implant procedure. This is increased to one year
patients each year, including 165 pediatric oncology patients each in surgeries such as Total Knee Arthroplasty (TKA) secondary
year. In July 2011, the incidence of C. difficile infection (CDI) in the to the implant. Criteria used in determining SSI include: pain,
GCH rose from an average 9.3/1000 pt days (n=3) to 25.7/1000 erythema, fever, tenderness, edema, purulent drainage, deliberate
pt days (n=9). Methods: Cases were reviewed for previous reopening by the surgeon, non-cultured or culture positive,
admissions, date of current admissions, onset of CDI, and category of or SSI diagnosis by the surgeon. A complication that may go
CDI using standard National Healthcare Safety Network (NHSN) unrecognized is pseudogout. Pseudogout is a condition in which
criteria. Chi square analysis was used to compare CDI rates between calcium pyrophosphate crystals that form in the cartilage migrate
oncology and non-oncology patient populations. PCR and PFGE to the synovium of a joint, thus causing inflammation. Symptoms
testing was done at New York State Dept of Health laboratories. of pseudogout include: pain, stiffness, tenderness, erythema, heat,
Results: Investigation of the cluster revealed that of the 9 cases fever, edema, and fatigue. The knee is most often affected, with a
of CDI identified during the time period, 7 were on the oncology higher incidence noted in men greater than age 50. Manipulation of
service. Attack rate for the oncology service was 4.2% versus 0.63% the cartilage during TKA allows crystals to break free and migrate
for the non-oncology pediatric population (Chi square=89.03, p< into the synovium. The inflammatory response mimics SSI, with
0.001). Of the 7 oncology CDI cases identified, 6 were community the exception of purulent drainage, and misidentification can result
onset, hospital acquired (CO-HA), as described by NHSN criteria. in non-therapeutic treatment. Project: A literature review was
Atypical of most CDI investigations, location appeared not to be a conducted utilizing multiple search methods to determine whether
factor in this outbreak, as cases were attributed to 3 of 5 pediatric TKA post surgical issues, such as infection and inflammation, could

46 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Emerging and Reemerging Infectious Diseases
be differentiated utilizing criteria in a way that eliminates unnecessary with a washout period. SETTING: Medical intensive care units at
surgical interventions, procedures, and inappropriate antibiotic a 500 bed community teaching hospital. PATIENT SELECTION:
use. Results: Extensive literature reviews revealed limited topic Phase I: Pts admitted to the medical ICUs received routine daily
information. Differentiation of infection versus pseudogout is soap and water baths. After a washout period, Phase II began: Pts
currently determined through physical assessment, medical history, were bathed using 2% CHG impregnated no-rinse cloths following
risk factors for gout and pseudogout, and the inflammatory markers a standardized protocol. Pt inclusion for analysis required a medical
C-reactive Protein (CRP) and Erythrocyte Sedimentation Rate ICU length of stay > 72 hours and obtaining admission and
(ESR). Additional diagnostics include procalcitonin levels and discharge (A/D) MRSA nasal and rectal VRE surveillance cultures
joint aspiration for gram stain and crystals. Procalcitonin usage for (SC). Pts with a previous history of either organism or positive
infection identification, while demonstrating success, is currently admission cultures were excluded. LABORATORY TECHNIQUE:
in its infancy stages. In addition, early research suggests utilizing MRSA AND VRE SURVEILLANCE CULTURES – Nasal swabs
Neutrophil CD64 to aid in earlier identification of pseudogout. for MRSA and rectal swabs for VRE were collected using culturettes
Empiric antibiotic therapy and irrigation of the wound and/or and plated on selective media. BATH BASIN CULTURES: 12 bath
joint prior to microbial confirmation are still common practices basins use for 72 hours on patients in Phase 1 were cultured using
among Orthopedists. Lesson Learned: Purulent drainage standard methods. DATABASE DEVELOPMENT and PATIENT
is a physical marker for infection. CRP and ESR are not reliable VARIABLES COLLECTED: An Access database that included pt
confirmatory markers as they tend to be elevated in both infection demographics, A/D information from the medical ICUs, MRSA and
and inflammation. Procalcitonin may have a better predictive value VRE A/D SC results with corresponding dates, number of CHG
in ruling out infection. The gold standard among orthopedists for baths completed, body mass index (BMI) and Acute Physiology and
ruling out infection after TKA is aspiration of the joint for gram Chronic Health Evaluation (APACHE) IV scores, length of stay
stain and crystals. Further research is needed in order to identify and (LOS), history of diabetes, hemodialysis, and use of a fecal collection
incorporate new and/or current differential diagnostic methods prior system was created. STATISTICAL ANALYSIS: Fisher’s exact two
to surgical intervention and empiric antibiotic therapy. tailed test was used for analysis of categorical data. Mann Whitney U
test was used for continuous data. RESULTS: 667 pts were enrolled
in Phase I, 549 were excluded with LOS < 72 hours or incomplete
A/D SC. Of the remaining 118, 76 pts were naive for MRSA and
79 were naive for VRE on admission. For Phase II, 421 pts were
enrolled, 299 were excluded with LOS < 72 hours or incomplete
Emerging And Reemerging A/D SC. Out of the remaining 122, 71 pts were naive for MRSA and
Infectious Diseases 72 were naive for VRE on admission. Only 3 pts in Phase I and 2 pts
in Phase II acquired MRSA in the ICU (p = 1.0), further analysis
Presentation Number 5-057 of MRSA was not done. VRE was isolated from 50% of bath basins
cultured. 17 pts in Phase I and 11 pts in Phase II acquired VRE in
the ICU (p = 0.4). Data for Phase II VRE cohort are described in
The Effect of Chlorhexidine Gluconate Bathing
Table I. CONCLUSIONS: Our data did not support using CHG
on MRSA/VRE Acquisition Rates in Medical ICU towellettes in our medical ICU population to reduce acquisition of
Patients MRSA or VRE.

Carla V. Hannon, RN, MS, APRN, CCRN - Clinical Nurse

Specialist, Critical Care, Hospital of Saint Raphael; Diane G.
Dumigan, RN, BSN, CIC - Infection Preventionist, Hospital
of Saint Raphael; Cynthia A. Kohan, MT, MS, CIC - Infection
Preventionist, Hospital of Saint Raphael; JoAnn Sica, BS - Six
Sigma Black Belt and Senior Decision Support Analyst, Hospital
of Saint Raphael; Jacqueline F. Nadeau, M(ASCP) - Manager
of the Microbiology, Serology and Molecular sections of the
Clinical Laboratory, Hospital of Saint Raphael; John M. Boyce,
MD - Hospital Epidemiologist, Hospital of Saint Raphael; Clinical
Professor of Medicine, Yale University School of Medicine

Background/Objectives: Chlorhexidine gluconate

(CHG) towellettes have been reported to prevent colonization
and infection when used for daily patient (pt) bathing in Medical
Intensive Care Units (ICUs). We compared soap and water bathing
to CHG towellette bathing in our medical ICU pts and measured
acquisition of methicillin-resistant Staphylococcus aureus (MRSA)
and/or vancomycin-resistant Enterococcus (VRE). Methods:
STUDY DESIGN: Prospective, multi-phase interventional study

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 47
Poster Abstracts: Emerging and Reemerging Infectious Diseases

Presentation Number 5-058 ED TB screening is now mandatory. Documentation of the TB

screening must be completed for every ED patient. Lessons
Developing an Emergency Department Learned: A team approach is very beneficial when creating and
implementing a new process.
Tuberculosis Triage Screening

Erica L. Disharoon, MS, RN, CIC - Infection Preventionist, Shore

Health System

Issue: Our acute care hospital had 199 staff exposures to a patient
that had Mycobacterium tuberculosis. This resulted in two staff PPD
conversions that required treatment. The patient presented with an
asthma exacerbation and was admitted to our hospital. He presented
with shortness of breath, fever, cough and decreased appetite. During
his admission his cough was becoming more productive, increasing
shortness of breath and he required oxygen. On the last day of the
patient’s admission, day 12, a bronchoscopy was performed. Routine
cultures were obtained which included an acid-fast bacilli culture
that grew Mycobacterium tuberculosis. Infection Prevention and
Control (IPC) had an Emergency Room TB triage screening built
into the electronic medical record/documentation system. IPC
did not understand why the patient was not suspected for TB on
admission. When reviewing this case IPC discovered that the ED Presentation Number 5-059
staff did not do the TB screening for this patient. It was discovered
that they were rarely completing the TB screening when indicated. Incidence of Klebsiella pneumoniae
At that time, IPC was requiring patients that present with a cough Carbapenemase (KPC)-Producing Multidrug-
be screened for TB. IPC discovered that the ED triage assessment Resistant Bacterial Infections in a Teaching
was very long and the TB screen was one of the last sections on the Hospital in SouthEast
assessment. It was also discovered that the screening needed to be
updated and provide more information about TB. Project: The Farah Bahrani-Mougeot, PhD - Associate Professor, Carolinas
TB exposure and findings were reported to the Infection Control Medical Center; Wendy Strader - Infection Preventionist, Carolinas
Committee (ICC). The ICC wanted a better ED TB screening tool Medical Center; Jean-Luc Mougeot - Senior Research Scientist /
created. The screening would need to accurately capture suspected Chair Institutional Biosafety Committee, Carolinas Medical Center;
TB patients without causing too many false alarms. A team was Roger Lovell - Chairman, Infection Control Committee, Clinical
formed that included the Director of Emergency Services, three Professor, Carolinas Medical Center
Emergency Department (ED) Managers, the ED Clinical Educator,
an Application System Analyst and an Infection Preventionist.
Background/Objectives: Over 1.4 million people world-
The project was to revise the TB screening in the ED triage
wide suffer from health-associated infections (HAIs) at any given
assessment that had already been created in Meditech (an electronic
time, and over 270 people die each day from these complications.
Compounding the problem is an increase in the emergence of HAIs
caused by multidrug-resistant microorganisms, most commonly by
K. pneumoniae carbapenemase (KPC)-producing K. pneumoniae.
The objective of this study was to assess and compare the rate of
infections with carbapenem-resistant K. pneumoniae at Carolinas
Medical Center (CMC) Main Hospital, an 874-bed teaching
hospital, in 3 recent years. Methods: Data were collected
for 2009 to 2011 in the following adult divisions: Critical Care,
Cardiac, Medical, Surgical, Hematology/Oncology, and Women.
documentation/medical record software). Results: The TB
Data were collected from different sources including CMC’s
screening was revised. The screening was moved to the top portion
Infection Control Surveillance database (Theradoc®), CMC’s
of the ED assessment. The risk factors (RF) were listed as primary
Medical Records (Cerner PowerChart®), and CMC’s pharmacy
and secondary. Primary RF-blood in sputum, cough, fever, night
(Trendstar® software). Data were collected in regard to demographic
sweats, unexplained weight loss were given a score of two points
characteristics, hospital units, procedure codes, and laboratory
each. Secondary RF-foreign born/foreign travel, HIV, homeless,
results. A list detailing total doses of all major classes of antibiotics
immunocompromised and incarceration were given a score of one
given over the three years time period were obtained from the CMC
each. If the patient’s TB screen total was 5 or more the nurse needs
Main Pharmacy Department using The Trendstar® software system.
to initiate airborne precautions. The type of isolation was also moved
A list of total admissions, discharges and patient-days for each year
up and added to the bottom of the TB screening. When airborne
was obtained from our billing records database to calculate total
precautions are documented IPC is alerted electronically. The new

48 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Emerging and Reemerging Infectious Diseases
patient days. The rate of KPC-producing K. pneumoniae infections University; Satya Datla, MBBS - Research assistant, Division of
were expressed as the number of positive cases per 10,000 patient Infectious Diseases, Wayne State University; Vamsi Kuchipudi,
days. For study purposes, we defined nosocomial multidrug-resistant MBBS - Research assistant, Division of Infectious Diseases, Wayne
KPC-producing K. pneumoniae infection only if these organisms State University; Swetha Reddy, MBBS - Research assistant,
were isolated at least 48 hours after admission to the hospital. The Division of Infectious Diseases, Wayne State University; Shobha
KPC-producing pathogens were identified by the Modified Hodge Shahani, MBBS - Research assistant, Division of Infectious Diseases,
Test (MHT), as recommended by Center for Disease Control and Wayne State University; Vijaya Upputuri, MBBS - Research
Prevention (CDC). CMC-IRB approval was obtained for data assistant, Division of Infectious Diseases, Wayne State University;
collection. Results: Our data show an increase in the average Judy A. Moshos, MT - Epidemiology Practitioner, Detroit Medical
rate of nosocomial KPC-producing K. pneumoniae isolates at CMC Center; Paul R. Lephart, PhD - Associate Technical Director of
in 2010 and 2011 compared to 2009 (i.e. 1.2 and 1.3, respectively, Microbiology, Detroit Medical Center University Laboratories;
vs. 0.3 per 10,000 patient days). This was also the case for the rates Emily Toth Martin, MPH, PhD - Assistant Professor, Department
for total isolates (i.e. nosocomial plus non-nosocomial isolates), of Pharmacy Practice, Wayne State University College of Pharmacy
which were 0.8, 3.4, and 5.8 per 10,000 patient days for 2009, and Health Sciences; Elaine Flanagan, BSN, MSA, CIC - Director
2010 and 2011, respectively. On average, approximately 28% of Epidemiology, Detroit Medical Center; Jason Pogue, PharmD -
the multidrug-resistant KPC-producing K. pneumoniae isolates Infectious Diseases Pharmacist, Detroit Medical Center; Keith Kaye,
for were nosocomial (i.e., 0.96 vs. 3.4). Critical Care division had MD, MPH - Corporate Director of Infection Prevention, Hospital
the highest rate of these isolates. Conclusions: The CDC Epidemiology and Antimicrobial Stewardship, Detroit Medical
requires robust efforts at detection of carbapenemase production Center/Wayne State University
and non-susceptibility in Enterobacteriaceae, especially Klebsiella
spp., in critical care units, with immediate reporting to epidemiology Background/Objectives: Extended-spectrum-β-
and infection control departments if identified. Not surprisingly, lactamase (ESBLs)-producing organisms are increasingly prevalent
we detected a higher rate in the Critical Care division, as patients in worldwide, and pose a serious public threat. Recently, increasing
this division receive multiple courses of antibiotics and often have
prolonged hospital stay. Our data show an increase in the rate of
KPC-producing K. pneumoniae isolates from 2009 to 2011.

Presentation Number 5-060

Current Epidemiology and Clinical Impact of

Extended-Spectrum β-Lactamase-Producing
Escherichia Coli At A Tertiary Medical Center

Kayoko Hayakawa, MD, PhD - Fellow, Wayne State University,

Detroit Medical Center; Dror Marchaim, MD - Post Doctoral
Fellow Infection Control and Epidemiology, Detroit Medical
Center/Wayne State University; Ashish Bhargava, MD - Fellow,
Wayne State University, Detroit Medical Center; Mohan B. Palla,
MBBS - Research Assistant, Wayne State University, Detroit
Medical Center; Khaled Alshabani, MD - Research Assistant,
Wayne State University, Detroit Medical Center; Uma Mahesh,
MBBS - Research Assistant, Wayne State University, Detroit Medical
Center; Harish Pulluru, MBBS - Research Assistant, Wayne State
University, Detroit Medical Center; Pradeep Bathina, MBBS
- Research Assistant, Wayne State University, Detroit Medical
Center; Pranathi Rao Sundaragiri, MBBS - Research assistant,
Division of Infectious Diseases, Wayne State University; Moumita
Sarkar, MD - Research assistant, Division of Infectious Diseases,
Wayne State University; Hari Kakarlapudi, MBBS - Research
Assistant, Wayne State University, Detroit Medical Center; Balaji
Ramasamy, MBBS - Research Assistant, Wayne State University,
Detroit Medical Center ; Priyanka Nanjireddy , MBBS - Research
assistant, Division of Infectious Diseases, Wayne State University;
Shah Mohin, MBBS - Research assistant, Division of Infectious
Diseases, Wayne State University; Meenakshi Dasagi, BDS -
Research assistant, Division of Infectious Diseases, Wayne State

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 49
Poster Abstracts: Emerging and Reemerging Infectious Diseases
numbers of reports have suggested a change in the epidemiological Issue: Measles cases are increasing in the United States. The
characteristics of infections due to ESBL-producing E. coli incidence of measles cases in 2011 was the highest since 1996.
(ESBLEC). ESBLEC have increased greatly in frequency and have Two measles outbreaks occurred in Minnesota in 2011, both
been reported more frequently from the community, and have been linked to index cases who acquired infection in Kenya. A spring
associated with high rates of mortality. These clinical observations outbreak included 21 cases, and an August outbreak included 3
might relate to a shift in the dominant type of ESBLs from TEM and cases. Children’s Hospitals and Clinics of Minnesota cared for
SHV types to CTX-M. Recent reports from North America focused 13 of the 24 cases. Not all cases were recognized as measles at the
on ESBLEC are still limited. We aimed to conduct a retrospective time of presentation, resulting in lack of immediate rooming into
cohort study to describe the epidemiological characters of patients Airborne Infection Isolation (AII), thus exposing patients who
with recent ESBLEC isolation at a large tertiary medical center. required follow-up. Project: Patient exposure follow-up was
Methods: All unique cases (inpatients or cases who visited conducted upon notification of confirmed measles cases. Exposed
emergency department) with ESBLEC isolation during the study Patient Identification Process: 1) Exposure definition established
period (February, 2010-July, 2010) were included. Positive ESBL based on: • Contagion period (4 days prior/4 days post rash onset)
phenotypic tests per the automated broth microdilution system • Timeframe not in AII • Department(s) exposed • Exposure
(MicroScan) were confirmed with disc diffusion tests in accordance timeframe (time of arrival to departure plus 2 hours) 2) Created
with 2009 CLSI criteria (M100-S19). Modified Hodge Test positive exposed patient list 3) Assessed measles, mumps, and rubella
isolates were excluded. Results: Three-hundred eighty-two cases (MMR) immunization status using the state immunization registry
with ESBLEC were identified during the study period. The mean Minnesota Immunization Information Connection (MIIC).
age of the study cohort was 67.6±17.5 years, 159 (42.1%) were male, 4) Prioritized exposed patient follow-up based on MMR status
249 (66%) were African American. Forty-two (11.2%) patients had (patients who received 0, 1 or 2 doses of MMR) Exposed Patient
ESBLEC isolation in the emergency department. One-hundred Follow-up Process: First Priority (Zero doses MMR): Notified
ninety-three subjects (50.5%) resided in institutions (nursing homes by phone to return within 6 days of exposure for intramuscular
or hospitals) prior to admission. Epidemiological characteristics immune globulin (IMIG). If <72 hrs or > 6 days post-exposure
of patients with ESBLEC are summarized in the Table. The most and patient was > 12 months, provided MMR. Consulted with the
common anatomic sources from which ESBLEC was isolated Minnesota Department of Health (MDH) for social distancing
were urine (n=286, 75.1%), wounds (n=37, 9.7%), blood (n=29, guidance. Second Priority (One dose MMR): Notified by phone
7.6%), and sputum 27 (7.1%). Two hundred ninety-three (77.5%) to receive 2nd MMR from primary provider if minimum interval
of the patients with ESBLEC had pathogens that were present of 4 weeks from 1st MMR was met. Third Priority (Two doses
on admission (isolated from a culture obtained within 2 days of MMR): Informed of exposure by phone or letter. All Exposed:
hospitalization). Antimicrobial exposure occurred in 170 (47.4%) Verified immune status, gave appropriate guidance for persons who
of subjects and ESBLEC isolates were resistant to multiple classes accompanied exposed patient to healthcare facility, and provided
of antibiotics in addition to beta-lactam antibiotics (Table). Twenty measles education. Results: The majority of exposed patients
patients (5.4%) died in hospital, 41 (13.3%) died within 3 months (n=788) had some level of protection to measles (32% 2 MMR,
after ESBLEC isolation. Three (10.3%) patients with bacteremia due 38% 1 MMR). IMIG was administered to 18% (n=38) of the
to ESBLEC died during hospitalization. Conclusions: These exposed patients who had zero MMR. 2 of the exposed patients
results are consistent with findings from other parts of the world, who were unvaccinated due to parental vaccine refusal and did
which suggest ESBLEC has frequently been present on admission. A not receive IMIG subsequently developed measles. Lessons
high proportion of study subjects had dependent functional status, Learned: Many pediatric viral illnesses cause symptoms similar
recent exposure to healthcare and indwelling devices. ESBLEC to measles such as fever, cough, conjunctivitis, and rash so it is not
was frequently resistant multiple classes of antimicrobials. Further necessarily obvious at initial presentation who is a suspect case.
studies focusing on the epidemiological and molecular characteristics Achieving immediate isolation in AII is difficult and exposures are
of ESBLEC in the US are needed so that appropriate infection likely to occur. It is essential for cases to be identified and confirmed
prevention and antimicrobial strategies can be optimally utilized. as quickly as possible. An established process in place allows
efficient post-exposure follow-up. The limited amount of disease

Presentation Number 5-061

Measles Outbreak Management at

a Minnesota Children’s Hospital in
2011

Julie LeBlanc, MPH, CIC - Healthcare

Epidemiologist, Children’s Hospitals and
Clinics of Minnesota; Patricia Stinchfield, MS,
RN, CPNP - Director of Infectious Disease/
Immunoloy and Infection Prevention and
Control, Children’s Hospitals and Clinics of MN

50 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Environment of Care/Construction/Remediation
transmission at our hospital can likely be attributed to existing Learned: The Ontario provincial guidelines leave significant
immune protection in the exposed, hospital air handling systems, room for interpretation within the Infection Control community
and prompt response by Infection Prevention and Control to contributing to a lack of standardization for facilities implementing
contact exposed patients. an ESBL program.

Presentation Number 5-062 Environment Of Care/Construction/

Developing An ESBL Program
Remediation

Safiyya Nazarali, BScN, RN - Infection Control Practitioner, Presentation Number 6-063

Woodstock Hospital; Natalie J. Goertz, BScN, CIC - Manager of
Infection Prevention and Control, Woodstock Hospital; Kishori Impact of Equipment with Fans in the Operating
Naik, BSc. - Infection Control Coordinator, Woodstcok Hospital Room
Rosemarie Erlichman, RN, BSN, CIC - Infection Preventionist,
Issue: Ontario guidelines recommend that patients found to be UMassMemorial Medical Center; Richard T. Ellison III. - Hospital
colonized or infected with an extended spectrum beta lactamase Epidemiologist, UMassMemorial Medical Center; James Sigler
(ESBL) organism should be placed on contact precautions, have - Vice President, Business Operations, Air Systems Technologies,
their records flagged and re-screened on re-admission. However, Inc.; Lars Erickson - Vice President, Field Operations, Air Systems
the duration of precautions depends on each facilities program, Technologies, Inc.
leaving the province varied between facility practice. In our
provincial region, ESBL programs are underdeveloped and many Issue: Proper airflow in health-care facilities can protect susceptible
facilities were resistant to implementing a program. We found patients from acquiring disease-causing organisms. In an operating
this to be especially challenging because in sharing an Electronic room (OR), it is even more imperative that airflow patterns be smooth
Patient Record (EPR) system, it becomes difficult to adjust features and non-turbulent. With increasing technology requiring more
specifically for our hospital, coupled with a lack of support for equipment in the OR, the question has arisen as to whether fan-less
developing a program outlined in our provincial best practice technology may be beneficial in this setting. To address this issue we
standards. Project: Our aim was to develop a program for undertook an investigation to determine if there were airflow issues
our hospital that would be standardized to most programs in associated with the use of OR equipment that had built-in fans when
the province. We began by polling hospitals in different regions used in the vicinity of an OR table. Project: One OR with a
compiling practice standards for patients with ESBLs. Of the 10 non-turbulent flow (perforated) supply air diffuser panel system was
hospitals polled, 8 initiated contact precautions and had patients surveyed using smoke visualization testing, utilizing theatrical smoke.
flagged. Although the polled hospitals use contact precautions A stack of blankets was used to simulate a patient on the OR table.
not all hospitals are consistent on the length of time a patient is Testing was performed with cameras capturing airflow patterns located
required to stay in precautions. Additional challenges included in thirteen predetermined locations. All smoke visualization testing
implementation of a patient flag within our regional group, was recorded using digital recording equipment. Equipment tested in
developing educational material for staff, patients and visitors this study included: Anesthesia Station, including personal computer
and attempting to standardize our hospital policy to provincial a forced air-patient warming unit (Bair Hugger™) Electrosurgical
standards. Results: The most significant implementation was a Unit Arthroscopic Machine Pyxis™ Anesthesia System High intensity
flag created in the patients electronic records. Consensus with the Light Source Two additional personal computers – One at the
regional group took a year and half, created with the provision that Picture Archiving and Communication System Station and one at the
only WGH would be using it. This initiative was significant as it charting station. Results: The baseline room airflow from a ceiling
would keep track of previously positive patients and alert staff to diffuser was fairly uniform over the simulated patient, although there
use contact precautions on re-admission to the hospital. There were was minor air turbulence in the zone between the inner and outer
a number of implementations that differed within the province sets of supply air diffusers. The operation of one piece of equipment,
making standardization difficult; these were screening and duration the high intensity light source, was found to cause turbulence in the
of isolation. Majority of hospital programs identified ESBLs airflow, but only when the back of the machine, normally positioned
through clinical isolates and did not screen based on risk, both of away from the OR table, was re-oriented to face the OR table. The
which our facility adopted. Finally the duration for precautions use of all other pieces of equipment running simultaneously had no
with most facilities was one year. Our program settled on the observable effect on the non-turbulent airflow over the OR table.
de-flagging criteria of after a year of being positive, if patients are Lessons Learned: During normal use, the fans within small
re-admitted to the hospital 3 rectal swabs will be taken one week computer stations, forced-air warming blankets, electrosurgical units,
apart. If all results are negative, patients will be discontinued from and arthroscopic equipment have no impact on non-turbulent/
contact precautions and de-flagged on the EPR. Education played unidirectional airflow. In general there does not appear to be a need
an important role in implementing the ESBL protocol. Teaching for the use of fan-less electrical equipment in a well-designed OR
occurred on the units regarding ESBLs and the new protocol. environment.
Written material was also created as a reference for staff. Lessons

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 51
Poster Abstracts: Environment of Care/Construction/Remediation

Presentation Number 6-064 Presentation Number 6-065

Environmental Hygiene Sustainability - Is It Navigating through the Construction Zone
Possible?
Michelle D. Moseley-Ladell, RN, BSN - Infection Prevention and
Sherry R. Reid, RN - Infection Prevention and Control Coordinator, Control Coordinator, Veterans Affairs North Texas Health Care System
VA North Texas Health Care System
Issue: Construction can have a profound impact on patient care and
Issue: Infection Prevention and Control (IPC) Coordinators ultimately affect everyone throughout a medical center. The role of the
understand the importance of environmental hygiene for prevention Infection Prevention Coordinator (IPC) is critical on the construction
of infections, but most will attest to the fact that it is very difficult safety teams, yet often the functions of the IPC have been limited.
to maintain and enforce environmental hygiene. Sustaining In large facilities where many new and renovation construction
environmental hygiene requires the right cleaning, consistency, projects are likely to be constantly occurring, it is necessary for IPCs
and commitment. Periodic environmental inspections have been to become more involved with construction. Project: A project
shown to have little effect on the sustainability of environmental was initiated at a large Veteran’s Affairs Medical Center to explore
hygiene, and most available checklists fall short at determining the functions for the IPC as an effective consultant on the construction
right surfaces that need cleaning and the right timing for cleaning safety team. A strategic planning approach was used to formulate
to occur. Project: At a large Veteran’s Affairs Medical Center, a the IPC’s consultant role with careful attention given to the annual
multi-disciplinary team under the direction of an IPC Coordinator construction risk assessment. Goals, outcomes, and activities were
developed a system that has proven effective for sustaining defined in a strategic planning logical framework to direct the IPC
environmental hygiene. The system included a unique checklist, an functions. Since the IPC has responsibilities other than management
education package, and a mechanism for garnering administrative of construction projects, the amount of time projected for completing
support. Items on the checklist are scored based on the frequency of each activity was also carefully considered in formulating the logical
touch (1-low, 2-medium or 3-high). The checklist also defines the framework. As a consultant the IPC worked closely with the team
frequency of cleaning expected and the types of staff responsible for and construction safety officer to initiate several improvements such
cleaning. IPC Coordinators conducted on-going training covering as weekly rounds of construction sites, checklists for data collection,
environmental hygiene clinical practice guidelines. Administrators, and a construction flow chart illustrating the project completion
managers and staff accompanied the IPC Coordinator semi-annually progress. The IPC conducted ongoing surveillance of organisms
in each clinical area to complete environmental hygiene inspections commonly transmitted due to construction. The initial IPC needs
and record observations on the checklist. The semi-annual inspections assessment as part of strategic planning indicated a general lack of
were conducted weekly for a month, and the team reviewed findings knowledge among construction workers and clinical staff regarding
to determine corrective actions for any infractions in environmental necessary infection prevention measures in construction sites. A
hygiene. Scores were computed from the checklist, and data graphs share point site was created so all members of the team could have
were shared with the clinical area staff, IPC Committee, and real-time access to project management plans, Infection Control Risk
administrators. Team inspections and educational classes continued Assessment (ICRA), and check lists. The IPC developed curriculum
beyond the scheduled inspection month when scores from any unit plans and began presenting instructional classes for clinical staff
exceeded the expected level. Administrators were held accountable for and construction workers to improve compliance with infection
providing necessary resources and encouragement for staff to properly prevention measures. Results: The visibility of the IPC as a
maintain environmental hygiene. Time-series scores analyzed using member of the construction team has caused healthcare workers
statistical process control graphs and Pareto charts were used to isolate throughout the facility to quickly share information regarding
most common areas where environmental hygiene improvements infection risks. Numerous deficiencies were identified during weekly
were needed. Comparisons were made between clinical area scores rounds, and the IPC was able to affect project improvements before
and the rate of identified infections. Results: Environmental problems occurred. No construction related healthcare associated
hygiene scores improved substantially for all clinical areas but one infections have been identified since the project began. Stakeholder
during the monthly inspection periods. Ninety percent (90%) of and credentialing surveyors have reported high satisfaction with the
the clinical areas continued to maintain scores below the cutoff level role of the IPC on the construction team. Lessons Learned:
between inspection periods. An association was found between the The IPC role as a consultant with the construction team is important,
environmental hygiene scores and the numbers of blood stream and but clear delineation must be understood between infection
urinary tract infections. The most common areas where environmental prevention and safety. When team members and healthcare workers
hygiene failed to be sustained were in non-direct patient care areas. blend safety issues with the IPC role functions, the time demands
Scores from each clinical unit were inserted into a risk assessment on the IPC can distract from other responsibilities. IPCs involved
grid for determining the amount of IPC involvement with the with construction must become knowledgeable about a vast amount
clinical area. Lessons Learned: Environmental hygiene is best of equipment, filtration, and materials specifications. Infection
sustained when administrative support is apparent. Administrative prevention is greatly enhanced when healthcare workers are better
decision making is best supported by reliable and valid data. Ongoing educated about construction projects.
education is essential to ensure commitment on the part of providers
for environmental hygiene.

52 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Environment of Care/Construction/Remediation

Presentation Number 6-066 This process allowed for better design and understanding of the care
and maintenance required after the project completion. Clearly,
Infection Prevention and Control Planning for Infection Prevention and Control planning for a bone marrow
Development of a New Bone Marrow Transplant transplant project is NOT a lone star production.
Unit is NOT a Lone Star Production
Elizabeth (Libby) Singhoffer, MPH, BSN, RN, CIC - Infection
Presentation Number 6-067
Preventionist, UCHealth University Hospital; Catherine Tierney,
RN, BSN - Transplant Coordinator, UC Health University Construction and Renovations using a Checklist
Hospital; Gregory Braswell, MBA - Division Director-Facilities Tool for Safety: Laborers and Patients
Management, UC Health University Hospital; Bradley Beckham -
Manager Plants and Operations, Electrical/Mechanical, UCHealth Ruby V. Boychuk, RN, CHN - Infection Control Specialist, Saad
University Hospital; Mark Slye - Director Plant and Operations, Specialist Hospital, Al Khobar, Kingdom of Saudi Arabia
UCHealth University Hospital
Issue: Modern technology today is pushing the construction
Issue: The decision to open a new bone marrow transplant program industry to provide better and safer facilities for the purpose of
in a large tertiary care medical center prompted an extensive risk diagnosis and treatment of patients either short term or long
assessment by the Infection Prevention and Control Professional. term. Safety is the key feature in the construction or renovation of
The risk assessment encompasses guidelines form both subject healthcare facilities. In Saudi Arabia there is a need to expand existing
matter experts and regulatory oversight agencies such as the Centers hospitals to admit and sustain long term care patients as there are
for Disease Control and Prevention (CDC), Association for no other facilities available. Project: During the last few years
Professionals in Infection Control and Epidemiology (APIC) , the were were involved in the construction of an oncology center and
Center for International Blood and Marrow Transplant Research now with extensive hospital renovations for Long term Care patients
(CIBMTR), and the American Society of Blood and Marrow in an Acute Center. Both construction and renovation have similar
Transplant (ASBMT). The purpose of these guidelines and the considerations for Interm Life Safety Meaures, and with the use of a
resultant risk assessment is to prevent infection in a high-risk patient modified OSHA checklist, were are now able to set some standards
population by decreasing environmental sources of infection through that may be considered mundane, howver, has proven necessary as
rigorous planning. Project: A multiphase renovation project in a tool for safety within our facility. The geography of Saudi Arabia
three separate areas of the hospital, one of which was built initially has been a major challenge for infection prevention and control as
in the late 1960’s. The project began with the renovation of two we encountered issues that required us to “go back to basics” and dig
rooms on an existing hematology/oncology unit. The project also into the literature of science and experience to meet the challenges
included renovation of three rooms in the medical intensive care with a positive outcome and lessons learned documented to assist in
unit, an area in the emergency department as well as the outpatient future projects. Sharing this knowledge and experience with experts
clinic. Another phase included plans for a permanent unit starting in the field has been a rewarding experience. In this presentation
with 6 beds with expansion to 14. Results: A multidisciplinary we will show how the IC Checklist became a major tool for our
team was developed, including representatives from Nursing, inspections. This included temporary construction barriers, air
Environmental Services, and Facilities Maintenance. The addition handling and dust control, removal of debris, traffic control, dress
of these members to the team helped streamline processes as the code, fire safety equipment and interm life safety- personal protective
project continued and decreased the amount of time spent rewriting equipment, hazard communication, utilities interruptions, smoking
policies and procedures. Mock up rooms were created which allowed policy, asbestos survey, work permits, security surveillance, fire walls,
for evaluation of room layout and requirements for air handling, etc. ceiling closure, and emergency communication. Results: Often
before the construction plans were finalized. The Infection Prevention we integrated our findings with Risk Management through the
and Control Professional was the key team member providing Occurence Variance System. Identifying the issues corrected many
communication between departments and monitoring all phases of processing through a root cause analysis was extremely helful in
the project for compliance. With the involvement of these department problem sloving. These issue became part of our IC Risk Assessment
representatives, we were able to instill preventive and functional plans Tool. Lessons Learned: With the use of this tool, we were able
from the beginning. Early involvement also allowed for continual to establish a safer working environment for the laborers. Recognizing
input and oversight by each department in the construction stage the gaps in the system of closure, the checklist assisted us to be more
and provided open communication between the contractors, heating, aware of wall penetrations, dust, and breaching of barriers. With new
ventilation and air-conditioning (HVAC), maintenance, and knowledge and application of safety meaures, we have added these to a
nursing representatives. Lessons Learned: Although there revised checklist.
are guidelines available, there is no published standard operating
procedure for the development of a new bone marrow transplant unit.
The Infection Prevention and Control professional was given the task
of coordinating all aspects of infection prevention for this project. The
development of a multidisciplinary team early in the project consisting
of representatives from design and construction, heating, ventilation
and air conditioning (HVAC), maintenance, environmental services,
nursing and administration contributed to the success of the project.

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 53
Poster Abstracts: Environment of Care/Construction/Remediation

Presentation Number 6-068 treatment was slightly lower (1.7/plate versus 2.8/plate for controls)
this comparison is underpowered since relatively few control samples
Preliminary Assessment: Efficacy of Room were collected. Further research and a modification of the sampling
Sanitizing with Controlled Exposure to UVC Light plan to discriminate between the germicidal effects of the liquid
cleaning compounds and UVC light exposure is needed to fully
Stephen Streed, MS, CIC - System Director, Epidemiology and demonstrate the efficacy of this re-emerging technology.
Infection Prevention, Lee Memorial Health System; System Director,
Epidemiology and Infection Prevention, Lee Memorial Health
System, Ft. Myers, FL; B. Joann Andrews, RN, MS, CIC - Senior
Infection Preventionist, Lee Memorial Health System; Alexis Price,
Presentation Number 6-069
RN, BSN - Infection Preventionist, Lee Memorial Hospital; Cynthia Microbial Load of Reusable Cleaning Towels used
Knoke, MT, BS, CIC - Infection Preventionist, HealthPark Medical
in Hospitals
Center; Elizabeth Houser - Manager, Environmental Services, Lee
Memorial Hospital Laura Y. Sifuentes, MPH - PhD Candidate, University; Peter K.
Raisanen III., Bachelor of Science - research fellow, University of
Background/Objectives: Background: The study locale
Arizona
is a 355-bed acute care hospital located in Southwest Florida. Major
service lines include medical and surgical/trauma intensive care units Issue: Hospital cleaning practices play a critical role in the
as well as extensive orthopedics, neurosurgical, oncology, general prevention of nosocomial infection transmission. To this end,
surgery and internal medicine services. Because of the seasonal nature reusable towels soaked in disinfectants are commonly used to clean
of the service demographic, demand for rapid room turnover often and disinfect hospital surfaces. There are reports linking reusable
results in compressed discharge to admission-ready intervals. Using cleaning towels to the outbreak of Bacillus cereus. Furthermore, it is
methods similar to those described below, our previous work has known that reusable towels can interfere with the action commonly
demonstrated incomplete bioburden reduction resultant from the used quaternary ammonium (QAC) disinfectants. It is therefore
standard cleaning protocols as performed by Environmental Services important to understand if reusable towels can increase the risk for
(ES). This study was designed to evaluate the affects of post-cleaning the transmission of pathogens in the hospital. The objective of this
ultraviolet light C (UVC) exposure on total bioburden reduction. study was to investigate the prevalence bacteria and fungi in reusable
Methods: Study Methods: Study rooms were selected based on cleaning towels. Project: The microbial load in reusable hospital
their availability as determined by ES, with rooms excluded only if towels was determined and the findings correlated with hospital
they had been treated with UVC at any time within the previous 7 cleaning practices. Ten hospitals were surveyed regarding their
days. Once selected, 6 standardized “touch points” were quantitatively cleaning practices after terminal discharge and the use of disinfectants.
cultured by an Infection Preventionist using standard RODAC plates Laundered reusable cleaning towels were collected in triplicate
and ES was then allowed to proceed with room cleaning. Following and evaluated for both the ability of the towel to harbor possible
cleaning, 6 more samples were collected in the same manner at sites infectious agents and the effectiveness of laundering procedures. The
immediately proximal to the original 6 sample sites. The room was buckets used to soak the towels in disinfectants were also sampled.
then treated with exposure to a UVC light source (V-360º, UVDI) The towels and buckets were evaluated, using quantitative plate count
with UVC exposure times standardized at 10 minutes in the bathroom methods, for the presence of heterotrophic bacteria, total coliforms,
and 30 minutes in the main portion of the room. For control purposes, aerobic spore formers, fungi, Staphylococcus aureus, Methicillin-
a small portion of one of the touch points was screened from the Resistant (MRSA) S. aureus, Escherichia coli, and Clostridium difficile.
UVC source in order to evaluate the time-effect of residual germicide Results: A majority of towels (93%) sampled were positive for
left on the surface. Following treatment, 6 additional samples plus bacteria. Furthermore, 37.5% of the buckets sampled were positive for
the control were collected, again in areas immediately proximal to bacteria. The mean number of heterotrophic bacteria found in towels
previous collection sites. Results: Results: Samples were was 1.7 X 104 colony forming unit (CFU) per towel, while the mean
obtained from 13 rooms as described above and quantitatively read number of total bacteria found on buckets was 67.2 CFU per bucket.
by a laboratory technologist unaware of the source or sequence of MRSA and C. difficile were not isolated from any of the sampled
the samples. Average CFU’s per plate were as follows: Pre-cleaning = towels or buckets, but interestingly total coliforms were found in both
29.4, post cleaning = 8.8, post-UVC treatment = 1.7 and controls = the towels and buckets. E. coli was found in 23.3% of clean towels.
2.8. Paired t-tests indicated significant reductions from pre-to post Lessons Learned: Reusable towels used for cleaning hospital
cleaning (p < 0.0001), post cleaning to post UVC treatment (p = rooms contain high numbers of microbial contaminants. Hospital
0.0009) and of course pre-cleaning to post-treatment (p < 0.0001). laundering practices in this study appear to be either insufficient to
There was no statistical difference between post-UVC treatment remove microbial contaminants or even add contaminants to the
counts and control counts. Conclusions: Conclusions: These towels. Furthermore, towels are known to interfere with the action of
data indicate a persistent and statistically significant downward trend common hospital grade disinfectants, such as QACs. Independently
in average CFU’s per plate as cleaning progressed from before ES and together these two factors may increase the risk for transmission
cleaning through final treatment with UVC exposure. Because of the of pathogens in the hospital. Importantly, these observations point
similarity of post-treatment versus control results, it is unclear if the to the need to critically revaluate current hospital cleaning practices
CFU reductions observed post-treatment were the result of the UVC associated use of reusable towels.
exposure, the residual effect of the germicide left on the surfaces, or a
combination of the two processes. While the average CFU’s post-

54 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Environment of Care/Construction/Remediation

Presentation Number 6-070 program was instrumental at improving communication and team
work between IP, the HSO, PD&C, and contract staff.
The Safety Dance: Establishing a Comprehensive
Safety Program to Ensure Contractor Compliance
James Kerridge, MA, RN, CIC - Infection Preventionist, Advocate
Presentation Number 6-071
Illinois Masonic Medical Center; Teresa Chou, MPH, CIC - Measuring the Effect of Hospital Cleaning
Manager - Infection Prevention & Epidemiology, Advocate Illinois
Intervention to Prevent Health Care Assocaiated
Masonic Medical Center; Katie Wickman, MS, RN - Infection
Preventionist, Advocate Illinois Masonic Medical Center; Steven Infections
Verzi, CHSP - Environment of Care Safety Officer, Advocate Illinois Yoko J. Tsukamoto, PhD, FNP, CIC - Professor, Health Sciences
Masonic Medical Center; Mandavi Kulkarni, MD - Infectious University of Hokkaido; Kaori Yamada, RN, Certified in Infection
Disease Attending, Advocate Illinois Masonic Medical Center; James Control Nurse - Graduate Student, Health Sciences University of
Malow, MD, FIDSA - Chairman Internal Medicine, Chairman Hokkaido
Infection Prevention Committee, Medical Director Advocate
Healthcare Infection Prevention Team, Advocate Illinois Masonic Background/Objectives: As evidence becomes more
Medical Center available, the importance of hospital environmental hygiene is now
emphasized to prevent health care associated infections. In this
Issue: Multiple studies have identified infections due to study, we implemented an educational intervention and measured
construction activities. In the past two years the number of an adenosin triphosphate (ATP) level of patient environmental
construction projects, ranging from small aesthetic improvements surfaces to evaluate hospital cleanliness. A relationship between
to major demolition, have increased sharply at this facility. Infection ATP level and incident rate of S.aureus, Methods: This study
Prevention (IP) noted several instances of contractors not following was a prospective study and conducted in three wards of a 553
infection control risk assessment (ICRA) guidelines. Due to these bed community hospital from July to September 2012. One of
concerns, IP sought to establish a more comprehensive construction the three wards was assigned as an interventional group and other
safety program. Previous research has examined partnerships between two were assigned as an observational group. A self-administered
IP and contractors; however, less attention has been paid to expanding questionnaire was conducted before and after the intervention to
these partnerships to other hospital safety personnel. Project: all the nursing staffs that actually cleaned the patient environmental
The facility is a 408 licensed-bed urban community-teaching hospital surfaces. The questionnaire was asking about current cleaning
with a Level 1 trauma center and a Level 3 perinatal center. IP began practice and recognition of the importance of environmental
by establishing a partnership with the hospital safety officer (HSO), hygiene to prevent infections. ATP levels at patient environmental
who conducts the interim life safety measures (ILSM) program. A surfaces were also measured before intervention. Educational
comprehensive “construction safety” education session was established program, a daily cleaning check list, and ATP levels feedback were
for contractors. The educational sessions covered regulatory provided to the interventional group. After the intervention, ATP
requirements, basic safety protocols, and infection prevention levels were measured again to compare between the interventional
guidelines. The IP and HSO began attending Planning, Design and observational group. Results: Among 96 samples, the
& Construction’s (PD&C) biweekly meetings to stay current on questionnaire was collected from 57 samples (59.0%). There was no
construction projects and to identify concerns. Weekly construction difference of years of experience between two groups, but there was
safety inspections were conducted on all projects; violations were a difference of bed occupancy rate and the interventional group’s
noted on the ICRA and ILSM checklists, and PD&C staff and rate was significantly higher than the observational group’s one
contractors were notified immediately. Minor violations consisted (p=.021). Cleaning of isolation room was significantly better after
of small breaks in barriers or documentation lapses, major violations the intervention compared to observational group (p=.05). Thirty
consisted of large breaks in barriers, absence of proper barriers, lack of four area of ATP level were measured before and after intervention
high-efficiency particulate air (HEPA) filtration and/or increases in air and total of 488 ATP levels were collected. ATP levels of door knobs
particulate measurement readings. Results: Since the beginning of at multiple bed room and bed rails, over table, TV remote controller,
the program, inspections revealed a decrease in the rate of violations and Nurse Call button at isolation rooms were significantly lower
identified. Out of 11 projects in 2010 there were 4 minor and 1 major after intervention. The reduction rate of infection rates per 1000
violations for a rate of 0.45. In 2011 there were 34 projects with 11 patient-days were compared between before and after intervention
minor and 1 major violations for a rate of 0.35. Major violations of two groups, however, there was no difference between two groups.
identified included: complete absence of proper barrier for diagnostic Conclusions: In this study, there was no significant difference
imaging department renovation and lack of HEPA filtration unit on of ATP levels between before and after intervention of interventional
inpatient nursing unit renovation project. Recurrent minor violations group. However, there was a significant reduction rate between the
included breaks in barrier seals and lack of adequate environmental interventional and the observational group, therefore, we concluded
cleaning near construction work area. Lessons Learned: there was some effectiveness of the intervention. One of the reasons
When multiple PD&C projects occur simultaneously, strict oversight is that there was a question about cleanliness of the cleaning wipes.
and guidance are needed to ensure a safe hospital environment. The The container of the cleaning wipes were ovserved dirty several
joint efforts of IP and the HSO were more effective at reducing safety times. The intervention needs to be continued longer to examine
violations and improving compliance with construction policies associated between ATP levels and infections rate.
than the individual efforts of the IP and HSO. In addition, this new

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 55
Poster Abstracts: Healthcare Worker Safety/Occupational Health

Presentation Number 6-072 Children’s Hospital, Orange, CA.

The Development of an Environmental Audit Issue: Efforts to improve levels of immunization of healthcare
Program workers have been widely published. We have offered Tdap
vaccine to staff since February 2006. The acceptance rate has been
Kishori Naik, BSc. - Infection Control Coordinator, Woodstcok poor. Tdap vaccination is recommended by CDC, the Advisory
Hospital; Safiyya Nazarali, BScN, RN - Infection Control Committee on Immunization Practices and California Department
Practitioner, Woodstock Hospital; Natalie J. Goertz, BScN, CIC - of Public Health for HCW and for contacts of children < 12
Manager of Infection Prevention and Control, Woodstock Hospital months, both relevant to HCW at childrens’ hospitals. Tdap is
strongly encouraged upon hire, at annual TB screening, and with
Issue: Health care environments significantly influence the
the annual Influenza vaccine program. All vaccines are offered free
occurrence of infection in hospitals. Frequently touched surfaces pose
to staff and physicians. Project: We include all individuals
a greater risk to patients than public areas. The role of environmental
in our program; bedside staff, indirect patient care, non-patient
services is vital in reducing the risk of transmission of hospital-
care including our offsite business office, and human resources
acquired infections. The lack of an auditing program at our facility
department. Despite efforts, compliance was poor and in 2008 we
allowed for gaps in knowledge leading to inconsistencies within the
implemented a declination form for those who refused Tdap. On
environmental services department. Project: Our aim was to
June 17, 2010 the California Department of Public Health declared
create a monthly auditing program through the use of fluorescent
a pertussis epidemic. There were 9,146 cases and 10 deaths in
dye illumination. Results: On a monthly basis IPAC performs
California. We had 133 cases and one death at our facility. Further
audits in three rooms on seven different units. Seven spots in each
revisions to the policy included mandatory Tdap for new volunteers,
room are marked with a fluorescent dye. After 24 hours IPAC returns
students, fellows, registry, travelers and for contractors with patient
to the rooms with a black light assessing whether the spots have been
care contact. We set our goal at 95% protected. Results: Prior
cleaned. Using this auditing method we were able to identify gaps
to the statewide Pertussis epidemic we had 67% of staff and 50%
in knowledge and workload issues. Various techniques were used
of attending physicians protected. We markedly improved our
to educate and train the environmental staff including on-the-spot
level of Tdap participation achieving overall 92% staff protected
feedback, which was provided once the presence/absence of the glow
and 82% attending physicians protected. Our medical residents
dots was evaluated. IPAC also provided education at environmental
and environmental services department are at 100% protected
service meetings in order to address questions in a large group setting,
followed by OICU 97.6% and PICU and emergency transport
allowing a review of high touch surface areas. Those resistant to accept
personnel both at 95.6%. Lessons Learned: We have had
change were identified and were provided with extra feedback and
vaccine available for over 5 years with small improvements in staff
support. IPAC stars were implemented for proactive staff that took
coverage from year to year. The statewide Pertussis Epidemic lead
initiative. These staff members were recognized and highlighted
to heightened awareness within our medical center due to infection
in the hospital newsletter as well as on posters throughout the
prevention update communications, patient and family education
hospital. IPAC’s consistent presence allowed for an open and positive
about the importance of Tdap vaccine and also local media coverage
relationship with the housekeeping staff. Lessons Learned:
both newsprint and television. Our staff and physicians were
Auditing environmental practice is an important part of Infection
receiving re-education on “Get your Tdap” at work and at home.
Prevention and Control. Audits helped to identify gaps in knowledge
Accountability is at all levels; staff, physicians, supervisors, managers,
and forge an open relationship where on-the-spot education and
directors, vice presidents and the CEO. It is imperative that all levels
feedback is acceptable.
of the organization are in alignment for success. In FY 2011, some
clinical managers and at least one medical director chose improving
Tdap coverage as an individual performance goal. Currently,
Healthcare Worker Safety/ infection prevention is communicating directly with department
managers who are below the 95% protected level. Although we had
Occupational Health achieved much success with a masking requirement for staff not
protected with the Influenza vaccine, this method is not feasible for
Presentation Number 7-073 Tdap. We believe that Tdap should be a condition of employment in
the childrens’ hospital setting.
Healthcare Worker (HCW) Pertussis (Tdap)
Vaccine Compliance Improves During a Statewide
Pertussis Epidemic
Presentation Number 7-074
Wendi Gornick, MS, CIC - Infection Prevention & Epidemiology
Manager, CHOC Children’s Hospital, Orange, CA; Nimfa Santos, Development of Point of use Sharps Disposal Unit-
RN, BSN, COHN - Associate Health Manager, CHOC Children’s a Simple Solution to a Difficult Problem
Hospital, Orange, CA; Bijal Patel, BS, MHA - Infection Prevention
Analyst, CHOC Children’s Hospital, Orange, CA; Jasjit Singh, Carolyn Louise Moore, Graduate Certificate in Nursing Science,
MD - Medical Director of Infection Prevention & Epidemiology, Infection Control - Infection Control Nurse, St Vincents & Mercy
Department of Pediatrics, Division of Infectious Disease, CHOC Private

56 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Healthcare Worker Safety/Occupational Health
Issue: Healthcare workers face the risk of injury from needles Linda G. Harris, BS, MT-ASCP - Senior Research Scientist,
and other sharp instruments. Injuries most often occur after use and Kimberly-Clark Corporation; F. S. Kilinc-Balci, PhD - Senior
before disposal of a sharp device. Australia is the only country with Service Fellow, National Personal Protective Technology Laboratory
well-developed systems of infection prevention and control and (NPPTL), National Institute of Occupational Safety and Health
occupational health and safety that has not yet mandated the use of (NIOSH), Centers for Disease Control and Prevention (CDC); Janet
safety devices. Such mandates currently exist in the USA, Canada A. Lewis, RN, MA, CNOR - Administrative Director Perioperative
and the United Kingdom (Australian Infection Control Guidelines, Services, Regional West Medical Center, Scottsbluff, NE
2010). The safe management of clinical and related waste is essential
for occupational, community and environmental health. Health Background/Objectives: Isolation gowns are widely used
services are legally and ethically responsible for the disposal of clinical in infection control, but little has been reported regarding their wear
and related waste. Ideally, sharps should be disposed of at point of performance and issues that may affect compliance. Infection control
use to minimise risk of injury, however, Australian Standards and professionals (ICPs) were surveyed to determine use and wear issues
the geographical layout of our patient rooms do not allow this to with these products. Methods: Members of the Association
occur. Healthcare workers are required to transport the sharp to a for Professionals in Infection Control and Epidemiology (APIC)
designated sharp disposal unit in a separate area of the clinical unit. were requested to participate in an on-line survey regarding isolation
Needle stick injury rates in clinical units (excluding perioperative gowns. Respondents provided descriptive information regarding
services) reported in 2010 via incident reports were at a rate of their use of isolation gowns and answered questions regarding risk
1.25 per month across 3 campuses (450 beds, 100,093 bed days). perceptions, protection levels, compliance issues, mobility restriction
Project: The development of an alternative means of sharps and garment failures. Descriptive statistics were used to analyze
disposal at the point of care was necessary to reduce the risk of sharps the data. Results: A total of 1498 ICPs replied to the request
injuries. A search of current products available to meet our needs with 1354 (90%) indicating that they wore isolation gowns in their
whilst ensuring Australian Standards were met identified a need for typical work activities. The following results are based on these 1354
the Infection Control team to develop a product that could fulfil our ICPs. Respondents were well distributed in years of experience in
requirements. What began as a small project that had us looking at infection prevention and control. Most (83%) indicated primary
how we could adapt plastic baskets purchased from a storage retailer, employment in a hospital. Disposable gowns (76%) were the most
saw us being introduced to a design engineer who was interested in common type used. Frequency and duration of wear by ICPs was
expanding his field of manufacturing into the area of healthcare. Over low with the majority wearing gowns once a month or less and for 10
several meetings, together we designed a product that allowed a) safe or less minutes. Perceptions of risk were low with most ICPs (82%)
transport of injectable medication, b) point of use sharps disposal believing that their isolation gowns kept them at low or very low risk.
and c) hand hygiene compliance. Cardboard mock-ups and several However, 45% indicated they had encountered punctures or tears
minor design adjustments led to the final version of the Sharps Caddy, in isolation gowns. Although 77% are involved in educating others
an ergonomically designed, infection control friendly and safe sharp about isolation gowns, less than half of the ICPs indicated they were
disposal compliant product. Results: The point of use sharps aware of the ANSI/AAMI standard PB 70:2003(R) which describes
disposal unit has been rolled out across the three campuses of our liquid barrier testing that may be done on gowns and performance
hospital over the past month. Data collection to demonstrate the levels based on the results. ICPs reported high degree of compliance
effectiveness of this product is ongoing. Lessons Learned: with isolation gowns by clinical staff, but they had less favorable
Working with external experts from a field unrelated to health care compliance perceptions for guests and visitors. The majority (74%)
enabled us to address a situation for which we had long sought a
solution. By working together, we were able to develop a product that
was practical to the wider market at a reasonable cost. We recognise
that reducing sharps injuries needs to be a multi-faceted approach, and
this is one aspect of the overall goal.

Presentation Number 7-075

Isolation Gown Use, Performance and Potential

Compliance Issues Identified by Infection Control
Professionals

Rinn M. Cloud, PhD - MGJ Endowed Chair in Textiles, Baylor

University; Uncas B. Favret, BS - President and CEO, Vestagen
Technical Textile, LLC; Terrell Cunningham, BS, RN - Senior
Reviewer/Team Leader, FDA Center for Devices and Radiological
Health, Office of Device Evaluation, Infection Control Branch;
Jacqueline Daley, HBSC, MLT, CIC, CSPDS - Director Infection
Prevention and Control, Sinai Hospital of Baltimore

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 57
Poster Abstracts: Healthcare Worker Safety/Occupational Health
Diane G. Dumigan, RN, BSN, CIC - Infection Preventionist,
Hospital of Saint Raphael; Lisa Tyler - Executive Assistant,
Department of Patient Services, Hospital of Saint Raphael;
Lizette Cortes - Executive Assistant, Human Resources, Hospital
of Saint Raphael; Elizabeth Conrad, MS - Vice President of
Human Resources, Hospital of Saint Raphael; Richard Meskill -
Information Systems Customer Service and Application Delivery
Specialist, Hospital of Saint Raphael; Andrea Santerre, RN, MS
- Manager of Critical Support, Occupational Health, Hospital of
Saint Raphael; Michelle N. Whitbread, MT, MPH - Infection
Prevention, Hospital of Saint Raphael; John M. Boyce, MD -
Hospital Epidemiologist, Hospital of Saint Raphael; Clinical
Professor of Medicine, Yale University School of Medicine

BACKGROUND/OBJECTIVES: Seasonal influenza

(flu) vaccination for health care personnel (HCP) has been
recommended by over 20 professional organizations. By 2011 flu
vaccination was mandated as a condition of employment in over
40 hospitals in the United States as reported to the Immunization
Action Coalition. During the 2010-2011 influenza season we
created a mandatory participation program that required HCP
to be vaccinated or sign a declination form and wear a mask if not
vaccinated during flu season. Objective: Convert our mandatory
influenza prevention program into a mandatory influenza
vaccination program for all our hospital-employed HCP by
Dec 1, 2011 in preparation for the 2011-2012 influenza season.
METHODS: Policy development: With the backing of senior
administration our multidisciplinary committee developed human
resource policies mandating all our HCP without a legitimate
medical exemption be vaccinated against seasonal flu by 12/1/11.
HCP with a legitimate medical contraindication to the vaccine
had between 9/1/11 and 10/15/11 to obtain a certificate of
medical exemption from their primary care provider, which
was then sent to Occupational Health for final approval. HCP
without an exemption who were not vaccinated by 12/1/11 were
reported that type of garment (disposable or reusable) had little or no
not allowed to work, using unpaid leave, until their participation
impact on their compliance, but 48% indicated that gown features
requirement was met. After 2 weeks of non-compliance HCP
could have moderate to very high impact on their compliance.
would be terminated. Vaccination documentation: We utilized
The features believed most likely to discourage compliance were:
a hand-held programmable scanner to scan HCP badges and
restricts movement, time to use/remove, ease of donning/doffing,
store employee work demographics, consent form and signature.
thermal comfort and gown fit. Although most ICPs reported no fit
Confidential vaccination information was uploaded to a secure
or mobility restriction issues with isolation gowns, 22% reported
password protected database that each manager could access
problems with tight fit in the shoulder area. Content analysis of open
to see their unit’s vaccination status. Vaccination clinics, rolling
ended questions revealed issues related to large sized clients, neck
carts and champions: Several vaccination clinics were scheduled
designs, tie closures and breathability. Conclusions: This study
in our cafeteria. Additional rolling carts were provided to large
measured usage patterns for isolation gowns among ICPs and their
departments. Nursing employees volunteered to be flu champions
perceptions of performance and compliance issues. Results indicated
and provided vaccinations to any HCP that came to their unit on
that: (1) ICPs expect and believe they achieve good protection with
any shift: day, night or weekend. RESULTS: Out of a total of 3995
isolation gowns; (2) fit, comfort and time to don/doff are important
hospital-employed HCP, 24 (0.6%) were excluded due to non-
compliance issues to be addressed; and (3) ICP education is needed
influenza seasonal work schedules; 121 (3.0%) received a certificate
regarding the current requirements for protective performance of
of medical exemption; 2 were suspended without pay but later
isolation gowns (to be included in presentation).
accepted vaccination; no HCP were terminated; 3850 (96.4%) were
vaccinated against flu. Conclusions: Mandating influenza
vaccination of all hospital-employed HCP (excluding those with
Presentation Number 7-076 a medical exemption) can go smoothly especially if it is preceded
by a year of a mandatory participation program which allows
Implementing a Mandatory Influenza Vaccination both administrators and employees to develop, and adjust to the
Program in a University-Affiliated Teaching Hospital demands of a mandatory vaccination program.

58 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Infection Prevention and Control Programs

Presentation Number 7-077 (CAUTIs) in 2008 and 2009 combined, a rate of 1.79. Following the
North Carolina Hospital Association (NCHA) NC Quality Center
A Comparison of Anti-Microbial Scrubs and Cotton Prevent CAUTI Collaborative kickoff meeting in March 2010, a
Scrubs in a Hospital multidisciplinary team was formed to reduce CAUTIs. Project:
Due to the medical unit’s high incidence of CAUTIs, efforts were
Peter K. Raisanen III., Bachelor of Science - research fellow, first focused on this patient population. This organization is a
University of Arizona; Laura Y. Sifuentes, MPH - PhD Candidate, 258-bed, not-for-profit, Magnet hospital located in the foothills
University of Arizona of NC that offers a full range of medical services and specialties
to a 5-county region. The CAUTI Prevention Team, comprised
Issue: Health care personnel come in contact with a vast array of of representatives from administration, infection prevention, risk
these infectious agents every day. It is possible that hospital personnel management, clinical resource management, medical and other
may be part of this transmission process by exposing patients and inpatient units as well as the emergency department and operating
other personnel to microorganisms in their uniforms. In this study, room, accepted a mandate to develop and implement interventions
scrubs containing an antimicrobial were compared to widely used to reduce CAUTIs. NCHA’s Prevent CAUTI Collaborative
cotton scrub uniforms in order to assess the effectiveness of silver in routine order tool was adapted and approved for implementation
preventing infectious agents from becoming impregnated on fabric. within one week. Next a daily line review process was created,
Project: Emergency personnel wore the treated scrubs for one which included a shared spreadsheet for utilization reviewers (UR),
day and the hospital provided scrubs on a separate day .The personnel who both review and advocate for removal at the earliest point
wearing the scrubs worked a 12 hour shift in a full service emergency appropriate in the patient’s catheterization. The CAUTI Prevention
room providing patient care for the entire shift. A total of 18 scrubs (9 Team determined that heightened awareness and a multifaceted
treated and 9 regular cotton) were then evaluated using quantitative approach to staff education would increase the probability of
plate count methods for the presence of heterotrophic bacteria, total success in reducing CAUTIs. We accomplished this by involving
coliforms, Staphylococcus aureus, Methicillin-Resistant (MRSA) S. direct caregivers and management throughout the organization
aureus, and Escherichia coli. Results: All scrubs sampled treated in the educational efforts. Frontline staff shift huddles, bathroom
and untreated were positive for heterotrophic bacteria. The mean blitz flyers, face-to-face physician education, a “Back to Basics”
number of total bacteria found in treated scrubs was 1.65 X 105 Foley care campaign, interdisciplinary bedside team rounding and
colony forming unit (CFU) per scrub item, while the mean number discussion of Foley necessity in bedside shift report are examples
of total bacteria for the untreated scrubs were 8.13 X 105. There was of the education provided. Results: An initial goal of reducing
a significant difference between treated and untreated scrubs (p = medical patient CAUTIs by 25% in its first year was set. In addition,
0.02) for total bacteria. MRSA was not isolated from any of the scrubs a stretch goal of achieving zero infections was established. Efforts
treated or untreated, but interestingly total coliforms were found in proved successful as the medical unit experienced only a 0.9 CAUTI
both the treated and untreated scrubs. E. coli was found in 22% of rate (N=2) in 2010. Furthermore, the stretch goal was obtained
untreated scrubs and 16% of treated scrubs. Lessons Learned: as no CAUTIs occurred in 2011 among medical inpatients. The
Scrubs containing an anti-microbial where shown to contain statically routine order for Foley insertion is now utilized in every department
significant fewer total bacteria, and less occurrence of E. coli and throughout the organization. Lessons Learned: The initial
coliform bacteria plan for implementation was too aggressive requiring postponement
and reevaluation of timeline, and we learned the importance of
establishing a realistic timeline. Early in the process, agree upon
inter-departmental expectations to eliminate confusion. The CAUTI
Prevention Team established a goal of 100% compliance with daily
Infection Prevention and Control Foley review, without a complete understanding of the UR staffing
Programs barriers. Staff buy-in is key. A physician champion can positively
influence the practice of his/her peers. Taken together these lessons
learned reinforce that it is critical to ensure all stakeholders are
Presentation Number 8-078 involved from the beginning of a project. In summary, success can be
achieved through an interdisciplinary, comprehensive approach.
Success in Preventing Catheter Associated Urinary
Tract Infections – What Works?

Michelle P. Mace, MSN, RN, CIC - Administrator, Infection

Prevention, Catawba Valley Medical Center; Starr-Nell Bowman, BS,
MBA - Risk Management Analyst, Catawba Valley Medical Center;
Joelle Calloway - Resource Coordinator, Catawba Valley Medical
Center; Carla Macijewski - Clinical Development Coordinator,
Catawba Valley Medical Center

Issue: The general medical unit at a community Magnet hospital

had a total of 10 Catheter Associated Urinary Tract Infections

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 59
Poster Abstracts: Infection Prevention and Control Programs
[OR], 10.3 [95% confidence interval {CI}, 2.4 - 44.4]), perceived
importance of vaccination [OR 8.3 (CI: 2.3 - 30.3)], perception that
influenza vaccine has few side effects [OR 6.0 (CI: 1.8 - 19.7)], and
past vaccine-seeking behavior [OR 4.1 (CI: 1.5 - 11)]. In logistic
regression controlling for demographics, determinants of intent
to be vaccinated included having the vaccine available on-site and
free [OR 21.1 (CI: 4.7 - 92.7)], and belief that EMTs should be
vaccinated every year [OR 6.8 (CI: 1.6 - 28.1)]. EMTs’ attitudes
and beliefs towards influenza vaccines differed significantly when
comparing vaccinated to non-vaccinated EMTs. Vaccinated EMTs
were significantly more likely than non-vaccinated EMTs to agree
that seasonal influenza (Χ = 7.0, p < .01) and H1N1 (Χ = 8.4, p
< .01) are serious diseases, that vaccination is important to them
(Χ = 93.2, p < .001), that non-immunized EMTs play a role in
influenza transmission (Χ = 21.8, p < .001), and that public health
officials can be trusted regarding vaccine safe (Χ = 9.2, p < .01).
Conclusions: Targeted interventions should be aimed at
EMTs to increase their vaccine compliance, including implementing
Presentation Number 8-079 a mandatory vaccination policy and addressing EMTs’ beliefs and
attitudes about vaccine in an education campaign.
Seasonal and H1N1 Influenza Vaccine Compliance
and Intent to be Vaccinated Among Emergency
Medical Services Personnel Presentation Number 8-080

Terri Rebmann, PhD RN CIC; Kate Wright, EDD - Director, Unleashing the Positive Deviants at the Frontline:
Heartland Center for Public Health Preparedness, Saint Louis More than just Sparking Change
University, School of Public Health; John Anthony - Emergency
Preparedness Manager, St Louis County Health Department; Melissa Crump - Infection Control Practitioner, Vancouver Coastal
Richard Knaup - Manager, Communicable Disease Control Services, Health: VGH; Elizabeth Bryce, MD - Regional Medical Director
St Louis County Health Department; Eleanor Peters - Epidemiology of Infection Control, Vancouver Coastal Health; Suk Ko - Patient
Specialist, St. Louis County Department of Health Services Manager, Medical and Subacute Medical Units, Vancouver
Coastal Health:VGH; Gail Busto - Infection Control Practitioner,
Background/Objectives: Influenza vaccination among Vancouver Coastal Health: Richmond
emergency medical technicians (EMT) is imperative, but only
limited data is available on factors affecting their compliance. The Background/Objectives: Hospital acquired infections
objective of this study was to examine factors influencing EMTs’ (HAI) continues to be a growing challenge and financial burden on
seasonal influenza and pandemic H1N1 vaccine compliance. Canadian hospitals. HAI accounts for 8,500 to 12,000 deaths per
Methods: A vaccine compliance questionnaire in the form of year, making it the fourth leading cause of death for Canadians. A
online and paper surveys was administered to EMTs working in patient that acquires a HAI incurs a longer hospital stay, increase risk
St Louis, MO in March - June, 2011. McNemar tests were used of morbidity and mortality, and emotional and physical isolation. The
to compare compliance rates across the three types of vaccine; financial strain cannot be ignored as the estimated cost of treating a
a non-parametric test was chosen because the outcome variable patient with C. difficile is an extra $18,000 with an average increase in
is dichotomous and it is a matched sample (same EMTs over hospital length of stay of 13.6 days. A patient infected with MRSA
different time periods). Hierarchical logistic regressions were used costs a hospital between $12,000 and $35,000 to manage their
to determine predictive models for 2010/2011 seasonal influenza care. This huge burden and growing challenge sparked a Canadian
vaccination compliance and intent to be vaccinated in the future. subacute medical unit to take a multidisciplinary team approach to
Good model fit, indicated by a nonsignificant chi square value, developing unit-based solutions in October 2009. Methods: All
was calculated with the Hosmer and Lemeshow goodness-of-fit unit staff was invited to participate in multidisciplinary bimonthly
test. Results: In all, 265 EMTs completed the survey. EMTs’ dialogues around change initiatives that they can lead and support.
attitudes and beliefs towards influenza vaccines differed significantly Positive Deviance (PD) and Liberating Structures (LS) methodology
when comparing vaccinated to non-vaccinated EMTs. EMTs whose was used to extrapolate ideas, thoughts and solutions to the identified
employer had a mandatory vaccination policy were significantly problem of eradicating HAIs. Through facilitated dialogue, the team
more likely to receive the seasonal influenza vaccine (100% versus was able to identify that the areas of hand hygiene, environmental
75.6%) or the H1N1 vaccine (100% versus 66.8%) compared to cleaning and current infection control practices needed to be
those without such a policy (Χ = 8.8, p < .001 and Χ = 6.7, p < .01 addressed. The team developed infection control unit protocols
respectively). In logistic regression controlling for demographics, and strategies to reduce the spread of HAI and to aid in their goal
the determinants of 2010/2011 seasonal influenza vaccination of reducing HAI to the point of eradication. Educational resources
included belief that EMTs should be vaccinated every year (odds ratio for patients, families, students and new hires were developed by

60 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Infection Prevention and Control Programs
staff. New signage was created, and equipment cleaning and de approved cleaning product followed by sodium hypochlorite (bleach)
cluttering protocols were developed. Emphasis on single use items to sanitize all high touch surfaces. In 2009 our hospital expanded
was encouraged on the unit and multi use items were eliminated and this bundle to include a patient HH intervention that provided
replaced with single use items when available. Removal of wash basins opportunities for handwashing prior to meals and throughout the
was also initiated and basin bathing was replaced with prepackaged day. Incidence of CD infection was followed for FY10 ( July 2009 to
cleansing bath clothes, due to questions regarding streamline June 2010) after full implementation of the patient HH intervention.
cleansing of basins. Transparency of HAI and hand hygiene rates Results: The CD infection rate during the intervention period
was promoted on the unit to increase awareness and encourage was 6.95 per 10,000 patient days (116 cases/ 166,838 patient days)
dialogue. Results: Since the beginning of this project in October in comparison to the FY09 rate of 10.45 (164 cases /156,956 patient
2009 hand hygiene compliance has increased by over 30%, MRSA days). Application of a Chi-square test was significant at p=0.0009.
rates have decreased by 64% and CDI has decreased by 41%. The expanded bundle resulted in a statistically significant decrease in
Conclusions: The utilization of PD and LS methodologies on the CD infection rate. Lessons Learned: Applying the CD
this subacute medical unit has not only resulted in a decrease of HAI, bundle and expanding the interventions to include patient HH can
but increased nurse work satisfaction and positively influenced the contribute to the reduction of CD infection in hospitalized patients.
culture. Sustainable changes have been demonstrated as the frontline Patients confined to bed do not often have the opportunity to wash
worker’s ideas and solutions were the catalyst for this change. The their hands in the hospital. Patients need assistance, education, and
creation of a medical community where infection control practices verbal reminders, along with the encouragement of the nurse to
are at the forefront of everyday care has not only enhanced quality of perform HH and help to prevent transmission of CD spores in the
care, but reduced transmission of HAI. hospital environment. It is difficult to ascribe success of a CD control
program to any one intervention; however the expanded bundle
that included patient HH significantly contributed to the decreased
incidence of CD infection in our hospital.
Presentation Number 8-081

Expanding the Clostridium difficile Infection

Prevention Bundle to Include Patient Hand
Hygiene

Jody Feigel - Infection Control Coordinator, UPMC Health

System - Shadyside Hospital; Marian Pokrywka - Infection
Preventionist, UPMC Health System Children’s Hospital; Barbara Presentation Number 8-082
Douglas - Infection Preventionist, UPMC Health System -
Shadyside Hospital; Amelia Hensler - Infection Preventionist, Hand Hygiene Opportunities in Pediatric Extended
UPMC Health System Shadyside Hospital; Susan Grossberger - Care Facilities
Infection Preventionist, UPMC Health System Mercy Hospital
Amanda E. Buet, MPH - Research Assistant, Columbia University
Issue: Clostridium difficile (CD) is one of the most prevalent, School of Nursing; Bevin Cohen, MPH - Project Coordinator,
virulent and costly pathogens of the last decade. CD infections have Columbia University School of Nursing; Melissa Marine, BS - Project
contributed to increased length of stay, adverse outcomes including Coordinator, Columbia University School of Nursing; Fiona Scully -
colectomy and ICU transfer, an attributable mortality rate of 6.9% Summer Research Assistant, Columbia University School of Nursing;
at 30 days after diagnosis (16.7% at 1 year) as well as an estimated Paul Alper, BA - Vice President, Strategy and Business Development,
healthcare cost of 3.2 billion dollars per year. Prevention strategies Deb Worldwide Healthcare Inc.; Edwin Simpser, MD - Executive
for Clostridium difficile (CD) infection prevention in hospitals Vice President, Chief Operating Officer, and Chief Medical Officer
have addressed barrier precautions, environmental disinfection, and of St. Mary’s Healthcare System for Children, St. Mary’s Healthcare
healthcare worker hand hygiene (HH). When applied as a “bundle” System for Children; Lisa Saiman, MD, MPH - Professor of Clinical
this approach is a widely utilized, evidenced-based strategy to prevent Pediatrics and Hospital Epidemiologist of Morgan Stanley Children’s
CD infection. Despite utilization of the bundle, infection rates for Hospital, Columbia University Department of Pediatrics; Elaine L.
CD remain high in many institutions. Project: The University Larson, RN, PhD, CIC - Associate Dean for Research, Columbia
of Pittsburgh Medical Center (UPMC) Shadyside Hospital is a 520 University School of Nursing
bed tertiary care and teaching facility with a specialty in oncology
and stem cell transplant and a history of proactive initiatives to Background/Objectives: Children and adolescents
prevent hospital acquired infections. Strategies to control CD began in extended care facilities (ECFs) are at high risk of healthcare-
in 2007 with interventions grouped into an “evidence-based bundle”. associated infections. Bacterial pathogens, including multidrug-
Interventions included early detection of CD cases by toxin testing resistant strains,(1) as well as viral pathogens can cause endemic and
of any patient with onset of unexplained diarrhea, electronic alerts epidemic infections in this unique population.(2-5) To date, infection
on positive toxin results to initiate barrier precautions with glove prevention and control research, particularly pertaining to hand
and gown use, staff HH with soap and water as opposed to alcohol hygiene (HH), has focused on acute care settings and adult long-term
sanitizer, extended duration of isolation for entire hospital stay, staff care facilities. Such studies are unlikely to be applicable in pediatric
and patient education and cleaning of all patient rooms with an

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 61
Poster Abstracts: Infection Prevention and Control Programs
ECFs given the different care patterns and distribution of devices in
these different healthcare settings. Pediatric ECFs provide medical
care as well as on-site social, academic, and therapeutic activities,
which require frequent and close contact between the children and
a wide variety of clinical and non-clinical care givers. The goals of
this study were to determine the frequency of various types of HH
opportunities and HH adherence in pediatric ECFs. Methods:
From June-August 2011, we conducted an observational study at
four pediatric ECFs providing subacute, long-term and residential
care, rehabilitation, chronic disease management, and/or specialty
care. Two children at each facility, aged 3 to 9 years, were each
observed by a trained observer for 16 hours. We used the World
Health Organization ‘5 Moments for HH’(6) to characterize
the types and frequency of HH opportunities and to monitor
adherence to HH by various care givers. Clinical care givers
were defined as physicians, nurses, nurse aides and respiratory,
physical or occupational therapists and non-clinical care givers
were defined as teachers, teachers’ aides, recreational support
staff, environmental service workers, social workers, volunteers
and adult visitors. Data analyses were descriptive. Comparisons of
categorical data were performed using Pearson’s χ2 test. Results:
We observed 865 HH opportunities of which a mean of 108 HH
opportunities (range, 60 - 196) occurred per child during the 16
hours of observation. ‘Prior to patient contact’ (39%) and ‘prior
to aseptic technique’ (1%) were the most and least common HH
opportunities, respectively. Nurses and nurse aides had the highest
number of HH opportunities (50%), while visitors; therapists;
school staff; other staff and physicians were associated with 22%,
9%, 9%, 8% and 1% of HH opportunities, respectively. Overall
HH adherence was 43% (27-65% per facility) and was significantly
higher among clinical care providers than among non-clinical
individuals (61% and 14%, respectively, P < 0.01). Adherence
was highest ‘after exposure to body fluids’ (66%) and lowest
‘before patient contact’ (36%). Conclusions: Overall HH
adherence was less than 50%, suggesting multiple opportunities
for transmission of infectious agents and highlighting the need
to improve HH practice in pediatric ECFs. Future studies should
investigate strategies to improve HH adherence among the wide
variety of care providers in this healthcare setting and assess their
impact on healthcare-acquired infections.

Presentation Number 8-083

A CAUTI Bundle with a Twist

Frances P. Abraham, DrPH, RN, CIC - Infection Control

Coordinator, Michael E. DeBakey VA Medical Center, Houston
Texas; Frances P. Abraham - Infection Control Coordinator,
Michael E.DeBakey VA Medical Center

Issue: For many years we struggled with high incidence rates of

Catheter-Associated Urinary Tract Infections (CAUTI) in patients
on the Long Term Care units at our facility. Project: We

62 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Infection Prevention and Control Programs
implemented a comprehensive, but modified bundle of practices to services, safety, quality improvement and nursing. The team evaluated
reduce the incidence of Catheter-Associated Urinary Tract Infections our current process of caring for C. difficile patients and developed
in patients on the Long Term care units at our facility. This bundle new initiatives to improve our current processes by implementing
consisted of increasing staff knowledge by education and competency aspects from the state Department of Public Health Collaborative
training for all staff involved with the insertion of urinary catheters, on Clostridium difficile. The initiatives included: preemptive contact
appropriate catheter insertion and maintenance techniques, and hand precautions, hand hygiene, environmental cleaning, laboratory alerts
hygiene. These conventional strategies were complemented with and education. Our hypothesis was if patients with C. difficile were
improved patient hygiene by requiring a bed bath or shower at least identified promptly then prevention measures could be instituted
three times a week for all patients. We monitored the incidence rate to prevent the acquisition and transmission of further C. difficile
of infections on a monthly basis, from August 2010 to October 2011. infection. Results: From October 2010 to November 2011, we
Results: In August 2010 the rate of CAUTI in our Long Term were able to reduce the number of healthcare facility onset infections
Care units was 10.1 per 1000 Foley catheter days. By August 2011 of C. difficile by 15% which equated to 17 fewer cases within our
the rate was reduced to 0.0 and sustained in September and October organization. The pilot unit has not had any healthcare facility onset
2011. Lessons Learned: Implementation of a modified infections of C. difficile for the last 6 months. Implementation of the
CAUTI Bundle which involved the improvement in patient personal Clostridium difficile bundle improved staff awareness of C. difficile
hygiene appeared to have a positive impact on the incidence of disease and the measures required to thwart further transmission and
catheter-associated urinary tract infections in our Long Term Care
patient population. The attempt to control CAUTI, like most other
hospital-acquired infections, must be done from different fronts.

Presentation Number 8-084

Managing Clostridium difficile using a Bundled

Approach

Karen Trimberger, RN, MPH, NE-BC, CIC - System Director

Infection Prevention & Control, Memorial Medical Center; Marcy
McGinnis, RN, BSN, CNOR - Infection Preventionist, Memorial
Medical Center

Issue: Clostridium difficile is quickly becoming a leader in the world

of healthcare associated infections. Patients with C. difficile have been
shown to have an increase length of stay by 3.6 days. As a result of
the increased length of stay, increased mortality, and treatment of C.
difficile, costs have increased by up to $18,067 per case; estimating
$3.2 Billion per year in the management of C. difficile. Our review
sought to determine whether implementation of a “Clostridium
difficile bundle” affects the incidence of healthcare facility onset
C. difficile infections on a nursing unit within our organization.
Project: The organization convened a multidisciplinary team
consisting of members from infection prevention, environmental

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 63
Poster Abstracts: Infection Prevention and Control Programs
acquisition of the disease. Lessons Learned: Environmental Presentation Number 8-085
cleaning and the use of friction are paramount. Instituting
preemptive isolation until specimen results are available is important. What’s For Dinner?
Collaboration with all members of the team is critical to ensure
compliance with all bundle components. Auditing of the process
Maria Vacca, BSN, RN, CIC - Infection Preventionist, Pennsylvania
steps is vital and sharing the results with all disciplines is necessary
Hospital
to maintain engagement. Education must be provided to all team
members including physicians, residents and medical students.
Issue: Food safety is an issue that spans the globe. Everyone needs
to eat food. According to the Centers for Disease Control (CDC),
an estimated 48 million people per year (1 in 6) in the United States
become ill due to ingestion of contaminated food. Foodborne illness
is also responsible for 125,000 hospitalizations and more that 3000
deaths. The United States Department of Agriculture (USDA)
estimates annual costs for Salmonella alone to be $2,708,292,046.
Every type of food can potentially cause foodborne illness. The price
of food contamination each year is considerable costing billions of
dollars. As staggering as these figures are, the majority of Americans
no very little regarding food safety. Massive education of healthcare
workers on ways to prevent foodborne illness is needed. Health care
workers can in turn educate patients and the community on the issue
of food safety and ways to prevent foodborne illness. Project:
An extensive search of the literature on the topic of food safety was
performed. A comprehensive educational session was developed
and implemented on food safety . The program was titled, “What’s
For Dinner? “ and was presented to various groups of health care
providers and community members from September 2011 to
December 2011. The presentation was given at several venues
including: an APIC chapter meeting , Nursing Grand Rounds,
Physician Grand Rounds, lectures to medical students, interns,
residents, and midlevel practitioners. Topics included the prevelance
and incidence of foodborne illness in the United States, recent case
presentations of foodborne illness, sources of food contamination,
Multi Drug Resistant Organism transmission from contaminated
meat, feed lots, food safety regulation, and ways consumers can
prevent foodborne illness. Results: The interest generated from
this subject/presentation was enormous. We had started out hoping
to pass on how Multi Drug Resistant Organisms are transmitted to
humans from contaminated meat. However, after researching the
literature, we realized whan an enormous problem food safety is in
our country and around the world. Every type of food can become
contaminated. We recieved requests for repeat presentations and for
follow up information. We plan to continue the education in the fall
of 2012 and to expand the topics to include other areas of food safety
including seafood and organic foods. Lessons Learned:
Lack of food safety is an enormous public health problem. It is a
multifaceted issue that affects everyone in the world. Education is
needed not only in the community but in the health care realm.

Presentation Number 8-086

A Model of a Longstanding State Infection

Prevention Collaborative

Virginia Helget, RN, MSN, CIC - Treasurer, Nebraska Infection

Control Network, Program Director, Nebraska Infection Control

64 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Infection Prevention and Control Programs
Network; Philip W. Smith, President, Nebraska Infection Control the Right Direction by Using Data, Knowledge and
Network - Professor of Infectious Diseases, University of Nebraska Rules to Improve Outcomes
Medical Center; Angela Hewlett - Assistant Professor of Infectious
Diseases, University of Nebraska Medical Center Rebecca Casaday. McKinney, RN, BSN, CIC - Infection
Prevention Manager, St. Vincent Hospital Birmingham; Christine
Issue: In an era of limited resources, it is a significant advantage to Walz, RN - Infection Prevention Coordination, St. Vincent
have collaboration among state organizations involved in healthcare Hospital Birmingham; David W. Barnes, MD, Infectious Disease -
infection prevention and control. Such collaboration may be difficult Chairman of Infection Prevention Committee, St. Vincent Hospital
due to obstacles such as organizational territoriality and lack of a Birmingham
vehicle for shared planning. Project: The Nebraska Infection
Control Network (NICN) is a nonprofit, service-oriented 501(c) Issue: Annually Infection Preventionists (IP) are responsible to
(3) organization, founded in 1980, whose objective was infection create a plan to reduce Healthcare-Associated Infections (HAI),
prevention and control in Nebraska hospitals, nursing homes, and a challenging aspect for overall patient safety issues. For many
other healthcare facilities by providing a vehicle for collaboration years the infection prevention program (IPP) used recommended
and sharing of resources. Board members include Nebraska Health evidence-based best practices (EBBP) for central venous catheters
and Human Services (NHHS), the Nebraska Hospital Association (CLABSI) and urinary catheters (CAUTI). Despite this effort, our
(NHA), the Nebraska Health Care Association (NHCA), the HAI measures were higher than expected. Our IPP uses an electronic
Greater Omaha Area Chapter of the Association for Professionals surveillance system which applies an objective HAI algorithm
in Infection Control and Epidemiology (APIC), the University of resulting in an electronic marker (EM). St. Vincent’s Birmingham
Nebraska Medical Center, several at large members and a consumer is a 409 bed acute care hospital with 52 adult ICU beds and a large
advocate. Results: The primary activity of the NICN is its footprint in cardiac, neuro and orthopedic surgery. Project: For
training program for infection preventionists (IPs) held biannually FY2011 July – June, the plan was to reduce blood and urine EMs to
since 1985. The impetus for this course was the limited ability of correlate with EBBP for CLABSI and CAUTI. EM data has been
small hospital and long term care facility (LTCF) IPs to travel to shared with each nursing unit since 2007. IPs developed a scorecard
national programs. Over 3000 trainees have attended these intensive, (SC) for each inpatient unit and the Emergency Department that
2-day, low-cost courses, held in Omaha, Nebraska. Training sessions provided unit specific rates and measures for several prevention
cover the basic programmatic aspects of infection prevention. Two efforts. These included rates for EM sources (blood, urine, respiratory,
tracks are available, one for hospital and ambulatory care IPs, and wound and stool), CLABSI and CAUTI. Additional rates provided
one for LTCF IPs. The NICN provided other periodic educational included MRSA, CDIFF, blood and urine contamination, urinary
programs throughout the state to facilitate travel for participants. catheter usage and compliance rates for isolation and hand hygiene.
These are cosponsored by various organizations with special Hand Hygiene data is collected by “secret shopper” observers. Each
interests overlapping with infection control, such as the Nebraska unit holds monthly meetings of their Bug Investigation Team (BIT)
Adult Immunization Coalition and the state Quality Improvement to review SC data and works to resolve and improve process issues
Organization. Over 2000 participants have attended these various and EM trends. The overall FY2010 EM, CLABSI and CAUTI
conferences. The NICN has also developed a newsletter and a web rates were average or trending up. Notably a second full-time IP
site (www.nicn.org). The NICN has coordinated research projects position began in October 2009. In FY2011 the IPP intensified a
in various areas including pandemic influenza preparedness, IP non-cost resource; focus and support for infection prevention from
training needs, CMV infections, prevalence of LTCF antimicrobial administration. Results: Comparing FY2010 to FY2011 the IPP
resistance, human immunodeficiency virus (HIV) policies, antibiotic established significant positive EM trends with rate improvements in
stewardship programs, urinary tract infections, and the status of LTCF double digit percents. Total or house-wide EM rates were decreased
and hospital infection prevention programs in the state. In November by 19.15%. Blood EM down by 34.19% and urine EM decreased
1988, the NICN received a National Community Health Promotion by 11.42%. CLABSI rates decreased by 2% in adult intensive care
Award from Dr. Otis Bowen, the Secretary of Health and Human units (ICU) but remarkably decreased by 70% in non-ICU units.
Services, in recognition of outstanding community health promotion
activities. Lessons Learned: The NICN serves as a model for
a streamlined organization that provides a vehicle for collaboration
among key state organizations involved in infection prevention
and control. The NICN has key stakeholders on its board, but has
remained an independent organization. The model has been effective
for over 30 years. The success of the NICN is due to the dedicated
work of state participants who have subjugated individual goals to the
public health benefits of joint infection prevention efforts.

Presentation Number 8-087

Annual Outcomes for Infection Prevention: Going in

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 65
Poster Abstracts: Infection Prevention and Control Programs
CAUTI rate decreased by 7% in adult ICUs but again significantly reduction of 24% with a drop in the overall SSIs from 0.25 in 2010 to a
decrease by 25% in non-ICU units. Lessons Learned: current rate of 0.19. Lessons Learned: MRSA surveillance and
Excellent results do not just happen by chance. The IPP patient decolonization protocol with chlorhexidine is an effective method to
safety improvements in FY2011 were realized by working the reduce surgical site infections. During the third phase of this project,
continuous improvement process with clearly defined goals. A big we will include patients who require surgical intervention during their
gain was how well patient outcome data was communicated to all hospitalization. Additionally, we will implement a process to use CHG
levels of staff (front line to administrative). The process became wipes the day of surgery for those patients who were unable to complete
effectual with the addition of IP staff and responsibility changes in the preoperative bathing protocol.
FY2011. The current state is for IPs to spend more time with unit
staff interactions, observations and assisting the BIT on scorecard
findings. The challenge now is to maintain these excellent results
and implement new projects to further reduce HAIs. Presentation Number 8-089

Increasing Hand Hygiene Compliance By Changing

the Culture
Presentation Number 8-088
Maria Vacca, BSN, RN, CIC - Infection Preventionist, Pennsylvania
Can We Reduce Surgical Site Infections? Hospital

Autumn Langford, RN, BSN - Infection Control Coordinator, Issue: Hand Hygiene rates in our facility remained low despite
Crestwood Medical Center; Ali Hassoun, MD, FACP, AAHIVS - continuous education. It occurred to us that just providing rates to
Infectious Diseases Specialist, Clinical Assistant Professor, UAB- the staff was of little value. We wanted to find a way to increase hand
Huntsville campus hygiene rates by changing the culture of the hospital. Project:
The project consisted of several parts: 1. Observations: Our Infection
Issue: Surgical site infections (SSIs) are the second most common Prevention Department obtained a grant from the Pennsylvania
healthcare associated infections. According to the CDC, SSIs affect Department of Health to purchase several iPads. We downloaded a
2-5 percent of all patients undergoing surgery. These infections are hand hygiene app onto the ipads and encouraged staff, volunteers, off
associated with significant mortality and morbidity, as well as an shift administration and students to down load the app as well to use for
increase in the length of hospital stay and the total cost for patients hand hygiene observations. All observations performed using the app
and healthcare facilities. Project: Despite historically low are downloaded into an excel spread sheet for easy, accurate tallying. 2.
overall surgical site infection rates, in 2009, our 150-bed acute care Interventions/Staff Empowering: The Infection Prevention Department
facility experienced one of our highest surgical site infection rates of took every available opportunity to educate staff on “culture change”.
0.39 per 100 surgical cases for both wound class I and II surgeries. Any health care worker who is observed not performing hand hygiene
To immediately address the issue, we introduced a Methicillin should expect to be informed of the occurrence. Any discipline should
Resistant Staphylococcus aureus (MRSA) surveillance program and feel comfortable approaching another discipline. For example, a unit
a decolonization method for patients in the preoperative period clerk should feel comfortable informing a physician that they forgot to
for elective surgeries. In the initial phase, we targeted high risk perform hand hygiene, etc. Reminder cards are given out when someone
surgeries including total hips, knee, and spine surgeries. Patients were is observed being noncompliant with the hand hygiene policy. The card
instructed during their preoperative testing appointment to shower states “You Missed a Hand Hygiene Opportunity”. Reat time education
with the provided 4% chlorhexidine gluconate solution the night occurs at the same time. The recipient of the card is encouraged to pass
before and the morning of their scheduled surgery. The patients were it on to someone they observe forgetting to perform hand hygiene.
instructed to wear clean pajamas to bed and freshly laundered clothes 3. Patient and Family Education/Empowering: Part of the money
to the hospital the day of their surgery. Patients were reminded obtained from the PA Department of Health grant was used to have
not to shave any body part. In addition, we implemented MRSA greeting cards made for every new admission and their family. The
surveillance targeting patients to have devices implanted. Our plan greeting card is educational as to the importance of hand hygiene and
included screening the patients 7 days prior to surgery with a nasal encourages the patient and their family to ask if the health care worker
swab sent for culture to check for MRSA colonization. If positive, the remembered to clean their hands. Results: Our hand hygiene rates
physician’s office would be notified and provided a decolonization increased slightly since starting the project a little over 1 year ago.
protocol. The protocol, if prescribed by the physician, instructed the We hope to see a continued increase in our hand hygiene rates as the
patient to use 1% muciprocin nasal cream in each nostril twice a day culture continues to change and staff feel more comfortable performing
for five days prior to surgery. Also, these patients were instructed to interventions. We also hope to maintain the change in culture that has
bathe with a 4% chlorhexidine gluconate solution approximatley developed since origin of this project. Lessons Learned: Hand
5-7 days prior to surgery. Results: The overall annual rate of Hygiene is an issue that requires constant education and intervention.
SSIs decreased from 0.39 per 100 surgeries in 2009 to 0.25 per 100 Education has to be done at the time of the missed opportunity to make
in 2010 with rate reduction of 35%. Our wound class I surgical site an impact. Health care workers need to know that this is not something
infection rate reduced by 61% as it dropped dramatically from 0.39 that will go away. They are expected as patient care providers to do what
per 100 in 2009 to 0.15 per 100 in 2010. After initiating the second is right for the patient and can expect to be held accountable it if they
phase of our project in May 2010, we continued to see a further rate fail to perform hand hygiene when appropriate. Also, Patients and their
families need to be included in hand hygiene education and programs.

66 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Infection Prevention and Control Programs
the flu shot isn’t effective in preventing the flu, the cost associated
with flu vaccination (our flu shots are free to our members). Flu
vaccination marketing materials were historically too wordy and
members couldn’t relate to the images used. This year’s flu campaign
was designed to educate our members using messages that are simple
and clear to dispel their current flu misinformation and to encourage
and motivate flu vaccination in themselves and their families. Our
flu vaccination rate is currently 1,135,076 members; 11.7% higher
than this same time last year. Lessons Learned: The Kaiser
Permanente flu campaign addressed misinformation and attempted
to clarify confusion on the part of our members using messages that
were simple and clear. These educational messages were also placed in
the context of a marketing campaign, selected by the primary health
care decision makers in 440 households that resonated with and
motivated them to take action (getting themselves and their families
vaccinated against the flu). The campaign visuals were created to
resonate with the intrinsic qualities and values of all of our members
regardless of age, gender, or race, specifically the importance of caring
for those we love. The campaign concepts also emphasized what was
most important to the member, time and lifestyle considerations, in
addition to protection against the flu virus.

Presentation Number 8-091

Control of Legionella Contamination with

Monochloramine Disinfection in a Large Urban
Presentation Number 8-090 Hospital Hot Water System

Survey of Literature, Patient Advisory Councils, and 440 Members Sheetal Kandiah, MD, MPH - Assistant Clinical Professor of
Leads to New Flu Campaign and Increased Flu Vaccination Rates. Medicine - Division of Infectious Diseases, Emory University;
Mohamed H. Yassin, MD, PhD - Medical Director of Infection
Gale M. Ivie, MPH - Senior Consultant, Kaiser Permanente; Enid Control, UPMC Mercy; Rahman Hariri, PhD - Head of
K. Eck, RN, MPH - Regional Director, Infection Prevention and Microbiology, UPMC Mercy; Julliet Ferrelli, MS, MT(ASCP),CIC
Control, Kaiser Permanente, Southern California - Infection Control Coordinator, UPMC Mercy; Janet Stout, PhD -
Director Special Pathogen Lab, Laboratory and consulting service
Issue: Every year Kaiser Permanente Southern California invests
a great deal of time, energy, and financial resources to insure our Issue: Legionella species, mainly L. pneumophila is the etiologic
members and employees are immunized against the flu. This year’s agent causing “Legionnaires disease” which is a systemic infection
flu campaign was created to educate our members in a simple, obtained through the aerosolization of Legionella from contaminated
motivating way to dispel current flu misinformation and encourage water sources. Multiple outbreaks of Legionnaires disease have occurred
them to get vaccinated against the flu. Project: A literature within hospitals and extended care facilities due to contaminated water
review of national research as to why individuals do not get supply with Legionella. Legionella sp is known to create biofilm in
themselves or their children vaccinated against the flu was conducted. plumbing systems making it very difficult to eradicate using current
A survey and discussion with four of our Patient Advisory Councils methods. Monochloramine has been found to be effective against
followed to determine whether or not they get the flu vaccination Legionella in vitro and against biofilm-associated Legionella in model
each year and, if not, what would motivate them to do so. These plumbing systems. Monochloramine disinfection of municipal water
councils consist of health care workers, some physicians, and supplies has been associated with decreased risk for Legionnaires’
members who are age, SES, and ethnically diverse. An online survey disease. To our knowledge, the use of monochloramine in a single
was conducted of 440 members, who identified themselves as the hospital water supply has never been evaluated in the USA. We
health care decision maker in the family, to determine which one of describe our experience with monochloramine disinfection in a
the four potential marketing concepts would motivate them to get 490 bed urban hospital in Pittsburgh, PA implemented after using
themselves and their families vaccinated against the flu. Results: a copper-silver ionization system for many years. Project: As
These efforts revealed key information about why people do not get part of a Legionella control plan, multiple sites in the hospital are
the flu vaccination. The primary reasons sited include: many think tested routinely every month. The cultures were obtained using swabs
a bad cold and the flu are the same thing; the flu shot gives you the of faucets and processed using Legionella enriched culture in our
flu; only the elderly get the flu – healthy people don’t get the flu; Microbiology laboratory. In 2011, increasing levels of Legionella

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 67
Poster Abstracts: Infection Prevention and Control Programs
were found particularly in sensor sinks (recently installed) and in increase HCW vaccination rates, this healthcare system achieved
areas with water shut down due to construction and renovation an average of 60% vaccination rate during the 2010-2011 Influenza
projects. Appropriate flushing procedures and cleaning of the faucets season. Previous strategies included free vaccine, targeted education,
with a bleach-based solution were unsuccessful in the eradication accessibility and multiple clinics “No flu” stickers were placed on
of Legionella species despite adequate copper and silver levels. In employee ID badges to encourage coworker participation and as
September of 2011 the hospital consulted and collaborated with the a visual patient safety strategy. Position statements addressing the
Special Pathogens Laboratory in Pittsburgh to implement a hospital- need for mandatory vaccination for all HCWs have been reviewed
based monochloramine delivery system manufactured in Italy by (including those from the APIC and SHEA). Project: Early
Sanipur. The monochloramine was only applied to the hot water 2011, this healthcare system of six acute care hospitals and multiple
system and the levels of the monochloramine as well as other chemical outpatient facilities began an endeavor to mandate influenza vaccine
parameters were monitored closely and remained well within the for all 10,000 HCWs. The process included obtaining support
appropriate range. Routine Legionella cultures were obtained as well as from executive and medical staff, human resource departments,
first draw water sample cultures on a monthly basis. Results: From and unions. Policies were reviewed and revised to satisfy corporate,
January 2011-September 2011, 23 faucets swabs were done monthly legal, and ethical concerns. By September, only one of the acute
with an overall average positivity rate of 33%. Sensor sinks cultures had care hospitals could support mandatory vaccine as a condition of
a higher positivity rate of 57%. After monochloramine introduction employment with the only exemptions being physician documented
into the hot water system in September 2011, faucets swabs revealed medical contraindications. The other hospitals supported mandatory
a positivity rate of 0.00 %. All sensor faucets also converted negative wearing of a surgical mask for HCWs who were unable to take
after only three weeks of monochloramine installation. Additional the vaccine due to medical contraindications or employees who
water cultures by the Special Pathogens laboratory revealed a similar refuse the influenza vaccine due to other reasons. This study will
decrease in positive cultures. Lessons Learned: This is the first demonstrate a difference in HCW vaccination rates comparing
report of evaluation of monochloramine delivery system for eradication Influenza Vaccine as a condition of employment vs. mandatory mask
of Legionella within the US health system. This new delivery system wearing or vaccine as a condition of employment. Results: As of
allows the use of monochloramine on a small scale. The eradication of Jan 1, 2012, the five hospitals with a policy of vaccination or required
Legionella was successful in a surprisingly shorter period than what masking attained an average vaccination rate of 93.2%. The hospital
was anticipated. Monochloramine was very effective in eradicating with a CEO-supported vaccine mandate for employment attained a
Legionella from sensor faucets that are particularly problematic. These vaccine rate of 99%. Lessons Learned: An important first step
results suggest that, monochloramine can penetrate biofilm more is garnering the support of system administration. Steps included:
effectively than the copper-silver ionization system. 1.Organize a planning group including key policy makers at your
institution. 2. Gather scientific evidence supporting the importance
of HCW Influenza Vaccine. 3. Create a time table with reasonable
goals for the process. 4. Communicate frequently with all levels of
Presentation Number 8-092 the organization so that you will have their input and engagement in
the process. 5. Address perceived risks of staff (accepting influenza
First Do No Harm - Efficacy of Influenza Vaccine vaccine is paramount as actual risks are often sidelined by fears and
Mandate or Mask Mandate for the Healthcare concerns perpetuated by non-evidence based sources). 6. Evaluate
Worker where your support is strong as well as where you are most likely to
meet opposition. 7. Educate, educate, educate.
Linda Faris, BSN, MSEd, CIC, CPHQ - Director of Quality
Management, Summa Western Reserve Hospital; Patricia Wells, RN,
CIC - Infection Preventionist, Summa Akron City and St. Thomas
Hospitals; Virginia Abell, RN, BA, CIC - Director, Infection
Control and Clinical Safety, Summa Akron City and St. Thomas
Hospitals; Nancy Reynolds, RN, BSN, CIC - Regional Director
Infection Prevention and Control Summa Barberton Hospital
Summa Wadsworth Rittman Hospital Nurse Manager Clinic/
Wound Care Summa Barberton Hospital, Summa Health System;
Therese Sheffer, RN, BSN, MBA, CIC - Infection Preventionist
Crystal Clinic Orthopaedic Center , Summa Health System; Joan
Seidel, MA, RN, BSN - Infection Preventionist, Summa Robinson
Memorial Hospital

Issue: The stakeholders in this healthcare system strive to

continuously improve patient safety. However healthcare worker Presentation Number 8-093
(HCW) influenza vaccination rates have historically remained
low. HCW includes anyone employed by the hospital system or Intervention to Reduce Central Line Associated
affiliates. Independent physicians and volunteers are excluded from Blood Stream Infections in Adult Critical Care
rates but not from the required vaccine or mask. Despite efforts to Hospital

68 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Infection Prevention and Control Programs
Elham R. Ghonim, MT, ASCP, CIC - Director of Infection NHSN were observed during this same period. Central line days
Prevention, University of Mississippi Medical Center, Jackson, MS; slightly decreased during 2011 CY. Please refer to table 1 and figure
Rathel Nolan, MD - Director of the Division of Infectious Diseases, 1. Lessons Learned: A multi-pronged effort focused on
University of Mississippi Medical Center, Jackson, MS; Michael H. improving technique in central line maintenance was successful in
Baumann, MD - Chief Quality Officer, University of Mississippi reducing rates of CLABSI at an 84-bed adult critical care hospital.
Medical Center, Jacskon, MS Education, accountability, communication, and ownership among
staff, administration and infection prevention were keys to success.
Issue: Central Line Associated Blood Stream Infections Publishing a routine CLABSI report increased staff awareness of the
(CLABSIs) are a major source of morbidity, mortality, and cost for problem and increased trust in the data. Efforts to decrease rates of
healthcare facilities. During 2010 calendar year (CY), we observed an infection and unnecessary use of central venous catheters are ongoing.
increase in CLABSIs rates in our 84-bed adult critical care hospital.
CLABSIs rates were higher than the National HealthCare Safety
Network (NHSN) pooled mean. Retrospective analysis of all cases
led to the development of an intervention, which led to a noticeable Presentation Number 8-094
decrease in CLABSIs. Project: Phase 1 began in September
2010 and consisted of a retrospective review of line insertion and Hand Hygiene: There’s an APP for that?
maintenance practices. Data collected included site of insertion,
type of line, time interval between insertion and infection, device Elham R. Ghonim, MT, ASCP, CIC - Director of Infection
utilization rate etc. Analysis of data revealed that most CLABSIs Prevention, University of Mississippi Medical Center, Jackson, MS;
occurred one week or greater following insertion, indicating issues Rathel Nolan, MD - Director of the Division of Infectious Diseases,
with line maintenance. Device utilization rate was higher than University of Mississippi Medical Center, Jackson, MS; Michael H.
NHSN pooled mean. Phase 2 began in January 2011 and focused on Baumann, MD - Chief Quality Officer, University of Mississippi
improving practices regarding skin care and line maintenance. Hand Medical Center, Jacskon, MS
hygiene was strictly monitored. Education regarding best practices
in line maintenance was conducted using patient mannequins. A Issue: Hand hygiene (HH) is the single most effective modality
needleless access device associated with increased rate of CLABSIs to prevent the spread of infection in healthcare. HH is also one
was replaced. Use of a disinfection cap to cover needleless connector of the most difficult quality measures to monitor. In a 722 bed
was implemented to improve aseptic technique in accessing lines. tertiary referral teaching hospital, collection of accurate and timely
Standardized kits for line insertion and maintenance were provided. HH compliance data on 25 inpatient units was problematic. We
Patient/family education was improved. Daily documentation needed a process that avoided confrontation and kept secret the
of necessity of use of all temporary central venous catheters was identity of HH surveyors to avoid compromise of professional work
required. Phase 3 is ongoing and focuses on accountability and relationships. Using easily recognized Infection Preventionists and
ownership of the process of line insertion and maintenance by collecting the data on paper records was impractical. Our solution
physicians and staff. Rates of CLABSIs by patient care unit are was to employ a unique handheld device. Project: iScrub, a
published and distributed to all units, stakeholders and pertinent hand-held application developed by The University of Iowa, is used
committees. Physicians whose patients suffer CLABSI are required to to record compliance with HH. Dates of intervention were January
complete a form in attempt to document circumstances/risk factors 1st – December 31st, 2011. HH observations were collected by
for each infection. Managers and infection prevention practitioners trained nursing volunteers and displayed on a central intranet –
reinforce use of best practices. Results: NHSN Standardized based database using SharePoint software®, then included in quality
Infection Ratio (SIR) demonstrates decrease in CLABSIs. SIR scorecard, and in the Infection Prevention (IP) monthly report.
indicated a 50% decrease in CLABSIs during 2011 compared to Data collected included: number of observations, distribution of
2010 CY. Seventeen percent fewer CLABSIs than expected by observations among different job categories, names of observed
individuals, unit, occupation, HH indication, time, date, and
method used to perform HH. Episodes of non-compliance with
HH generated e-mail notifications with escalating consequences
that might end with termination of employment. Incentives were
provided to individuals showing consistent compliance with HH.
Results: During January 2011, 1,653 observations were collected,
HH compliance was 91%, physicians’ compliance (MDs) was 74%,
and nurses’ (RNs) compliance was 98%. Gaining administrative
support, publishing HH compliance data on monthly quality
scorecard and IP report, in addition to applying strict consequences
for individuals with poor compliance with HH, led to a gradual
increase of HH observations and compliance. During December
2011, we collected 4,553 HH observations. HH compliance was
96%, MDs’ compliance was 89%, and RNs’ compliance was 99%.
During the intervention we collected 26,657 observations. Average
HH compliance was 95%, average MDs compliance was 88%, and

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 69
Poster Abstracts: Infection Prevention and Control Programs
average RNs compliance was 98% (Figure1). Non-compliance were routinely performed using the Vitek2 System (bioMérieux,
occurred at a similar frequency both before and after patient contact. Marcy l’Etoile, France). When KPC production was suspected
Alcohol hand rub was the most frequently used method to perform on the basis of increased MICs for carbapenems (ertapenem >
HH. Physicians often scored the lowest compliance rates among 0.5 mg/L, and/or imipenem > 1 mg/L, and/or meropenem > 0.5
healthcare workers. Time and date had no effect on compliance. mg/L) clinicians were promptly informed and contact isolation of
Lessons Learned: Hiding the identity of HH observers patients was applied. Carbapenemase production was then confirmed
eliminated confrontation, and probably increased the accuracy level by phenotypic and molecular methods. Treatment with colistin
of collected data. Applying strict consequences for non-compliance (eventually associated with other antibiotics based on susceptibility
with HH aided in increasing compliance among staff and physicians. results) was implemented for infected patients only. Surveillance
Publishing HH data analysis aided in increasing the compliance with rectal swabs were performed in patients with epidemiological link
HH. Data analysis identified issues related to the current application to persons from whom KPC-KP had been recovered. Results:
and led to creating a new HH application that will be implemented Over a three-year period (2009-2011), a total of 13 KPC-KP were
starting February1, 2012. detected from inpatients colonized (n=4) or infected (n=9). Most of
them were obtained from bronchoaspirate and/or urine cultures of
ICU patients (n=11), whereas the remaining were from Neurology
(n=1) and Orthopedics (n=1). In one case only, following urinary
tract infection, KPC-KP was recovered from blood despite adequate
therapy. The epidemiological analysis showed that 6/13 patients were
already colonized or infected at admission. All of them came from
ICUs of other hospitals or long-term care facilities. In the remaining
7/13 cases a presumable hospital hand transmission occurred. It
is noting that antimicrobial therapy was able to successfully treat
KPC-KP infections in 7/9 cases. Lessons Learned: So far,
infection control procedures adopted in 2009 have been effective to
contain the hospital spread of KPC-KP isolates at our institution.
Nevertheless, the high risk of transmission associated to these
worrisome strains (especially in ICUs) and the rapid increase of
carbapenem-resistant K. pneumoniae in Italy (as reported from
EARS-Net surveillance in 2010) suggest to reinforce infection
Presentation Number 8-095 control measures (e.g., by implementing active surveillance based on
rectal swab in all patients admitted to ICUs).
Emergence of Klebsiella pneumoniae Producing
KPC-Type Enzymes and Infection Control
Measures for Containing Hospital Spread Presentation Number 8-096

Patrizia Monti - Medical Director, Azienda Ospedaliera della Repeated Intervention Programmes to reduce VAP
Provincia di Lecco; Fiorenza Folsi - Medical Director, A. Manzoni rates and focus on effective components of the
Hospital (Lecco, Italy); Paolo Bonfanti - Director of Infectious Prevention Bundle in an Indian ICU
Diseases Unit, A. Manzoni Hospital (Lecco, Italy); Beatrice
Pini - Microbiologist, A. Manzoni Hospital (Lecco, Italy); Flavia Namita Jaggi - Director, Labs and Infection control, NA; Pushpa
Regazzoni - Infection Control Nurse, A. Manzoni Hospital Sissodia - Executive Microbiologist, Artemis Health Institute; Ekta
(Lecco, Italy); Cristina Tentori - Infection Control Nurse, A. Narayana - Infection control Nurrse, Artemis Health Insitute
Manzoni Hospital (Lecco, Italy); Francesco Luzzaro - Director of
Microbiology, A. Manzoni Hospital (Lecco, Italy)
Background/Objectives: Ventilator-associated
pneumonia (VAP) is the second most common hospital-acquired
Issue: Infections caused by Klebsiella pneumoniae producing infection and is associated with high morbidity and mortality rates
KPC-type enzymes (KPC-KP) are emerging worldwide as an in the intensive care unit (ICU). Prevention of VAP can be achieved
important challenge in health-care settings. Notably, these isolates by the adoption of ‘ventilator bundles’, but significant, yet labor and
are resistant to almost all antibiotics (including carbapenems) cost effective interventions are yet to be identified. The objective of
and are associated with high rates of morbidity and mortality. In the study was to examine the impact of bundled interventions in the
Italy, KPC-KP was first detected in November 2008. Beginning in ICU on VAP rates and to find out the more effective and low cost
January 2009, appropriate infection control procedures (including interventions from the bundle. Methods: The study was carried
contact precautions and guidelines for laboratory detection of out in three Phases in a 36 bedded ICU in an Indian Tertiary care
carbapenemases) were adopted at our institution, as recommended private Hospital setting over a three years period. VAP data over a
in areas where KPC-KP are not endemics. Here we describe the period of one year (2009, Phase I) was collected and retrospectively
dynamics of the emergence of KPC-KP as well as infection control analyzed for the incidence of VAP.The first supervision programme
measures implemented for containing hospital spread. Project: was introduced in December 2009 where the VAP prevention bundle
Identification and antimicrobial susceptibility of bacterial isolates

70 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Infection Prevention and Control Programs
was introduced and the staff trained. Regular surveillance audits Carol Vinci, MS, CIC, CPHQ, CPHRM, HEM, CPSO -
were carried out to evaluate the compliance to bundle components Director Risk Management, Regulatory Affairs, & Accreditation,
and the impact of each component was critically evaluated in year and Patient Safety Officer, Magee Rehabilitation Hospital; Jessica
2010 (Phase II). The second supervision program was introduced Bunson, MT(ASCP), MS, CIC - Infection Preventionist, Magee
in December 2010 in which reiteration of the bundle components Rehabilitation Hospital
was done. The impact was analysed in the subsequent year 2011
(Phase III) and the most effective components of the bundle showing John Govednik, MS - Program Manager, McGuckin Methods
statistically significant effect on VAP were determined. Results: International; Maryanne McGuckin, Dr. ScEd, MT (ASCP)
• The VAP rates over the entire study period varied between 0 and - President; Senior Fellow, McGuckin Methods International;
30.9/1000 ventilator days. • An overall reduction of 85.9% occurred Jefferson School of Population Health,Thomas Jefferson University
in the VAP rates over a three year period. The reduction in VAP rates
was observed from 9.72 (Phase I) to 3.43 (Phase II, 64.7% decrease) Background/Objectives: Hand Hygiene (HH) is the
and 1.37 (Phase III, 60.05% decrease) respectively as a result of single most important practice in the prevention of healthcare-
the interventions. • The mean VAP reduction (M=9.86, SD=8.23, associated infections (HAIs). Much research exists on the optimal
N=12) was significant, t(11)=4.14, two-tail p=0.0016, providing HH-events-per-bed-day (HH/bd) rates for ICUs and Non-
evidence that the intervention programmes are effective in reducing ICUs, based on observation of opportunities. However, there is
VAP rates. A 95% C.I. about mean VAP reduction is (4.63, 15.09). little published research which determines the optimal HH/bd
• The most effective intervention components analyzed were head rate for rehabilitation and long term care units (Rehab/LTCs).
of bed elevation, sub glottic suction, hand hygiene compliance of OBJECTIVES 1) To establish HH/bd benchmarks for Rehab/
healthcare workers and daily assessment of weaning and extubation LTCs, and 2) to discover factors that influence HH/bd rates in
for ventilated patients showing p<0.05. Conclusions: 1. a rehabilitation hospital by tracking four years of HH education,
Repeated supervision programmes are effective in reducing VAP rates monitoring, and feedback. Methods: Using a national
as evidenced by our study ( 86% reduction between the first and third measurement and benchmarking program, acute care hospitals with
phase ). Repeated programmes balance out the negative impact of rehab/LTCs and independent rehabilitation/long term care facilities
staff attrition and positively impact the staff behavioural mind sets submitted tallies of soap and sanitizer used monthly per unit, along
towards compliance to set protocols. 2. However in a high workload with the corresponding periods’ patient census. Data were used to
and stressful environment as the intensive care unit, we must move calculate the HH/bd rate. Results were analyzed to determine the
towards focusing on labour and cost effective measures and possibly mean for the aggregated data. The goal for all units in the study was
truncating the prevention bundle in order to focus on interventions 20HH/bd based on observation; this goal was used in monthly
that have maximum impact. This would free the staff to perform high reporting feedback as a goal for staff to strive to achieve. A 96 bed
yield measures as opposed to just tick the boxes in the checklist. rehabilitation hospital in Philadelphia, USA participated in the
program for over four years and provided qualitative observations to
suggest factors that influenced fluctuations in their monthly HH/
bd rates. Results: 12 months of HH tracking data were compiled
from 50 Rehab/LTCs in order to determine the benchmarks.
The mean was 14HH/bd at baseline (standard deviation (STD)
8.7); 19HH/bd at 12 months (STD 8) (Fig.1). The Philadelphia
hospital tracked three units for four years. Infection Preventionists
connected milestones in their hand hygiene education and training
interventions to fluctuations along their time-trend lines respective
of the national mean and goal. Conclusions: Our results show

Presentation Number 8-097

Hand Hygiene Rates for Rehabilitation and Long

Term Care Facilities: One Hospital’s Journey
through the National Goal and Benchmarks

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 71
Poster Abstracts: Infection Prevention and Control Programs
that there is a relatively wide STD for each monthly rate calculated equivalent to approximately 8 lives and 2 ½ million dollars saved.
for the national database (STD ranging from 8 to 9.8 depending While the collaborative initiative ended in June 2010, the SCN
on month). This suggests the difficulty in reaching a common continued the practice changes that were made and celebrated one
optimal rate, or goal, for HH/bd for Rehab/LTCs. The variation in year with zero CABSIs on November 2, 2011. We have now started
patient therapy (in room or out of room) may influence a hospital’s the second project with PQCNC, and expect continued success.
rate respective to the mean or goal. Comparing the Philadelphia Lessons Learned: While the SCN had a very low rate of
hospital’s progress along the national timeline for the first 12 months, CABSIs in previous years, it is now known that having zero CABSIs
a change in product suppliers impacted hand hygiene practice is achievable. The evidence based practices that were put into practice
and measurement for months 3 & 4, followed by increase in rates will continue and new ideas will be implemented to prevent CABSIs
possibly due to the attention of new product. However, continuing in neonates.
on for months 18-36, HH rates dipped below the national goal as
staff became complacent in practices. In the final months (42-48)
of tracking, HH became part of the nurse manager’s performance
evaluation. HH rates show dramatic increases thereafter.

Presentation Number 8-098

Attaining Zero Catheter Associated Bloodstream

Infections in a Level III Nursery

Michelle P. Mace, MSN, RN, CIC - Administrator, Infection

Prevention & Environmental Services, Catawba Valley Medical Center;
Andrea Flynn, RN-C, MS - Clinical Development Coordinator,
Presentation Number 8-099
Nurseries and Pediatrics, Catawba Valley Medical Center
Taxonomical Risk Assessment
Issue: The Special Care Nursery (SCN) at a community
Magnet hospital had a total of nine Catheter Associated Blood Jackie E. McFarlin, RN, MPH, MS, CIC - Infection Prevention and
Stream Infections (CABSIs) from January 2008 to August 2009. Control Coordinator, VA North Texas Health Care System
Project: The Special Care Nursery (SCN) is a 12-bed Level III
Nursery within a 258-bed, not-for-profit, Magnet hospital located Issue: Risk Assessments most often are developed intuitively
in North Carolina that offers a full range of medical services and or based on regulatory expectations, but we have found that a
specialties to a 5-county region. From September 2009-June 2010, taxonomical risk assessment is more useful in improving infection
the SCN participated with the Perinatal Quality Collaborative prevention outcomes and processes. Project: The project took
of North Carolina (PQCNC) in a project to decrease CABSIs in place at a Veteran’s Affairs medical center with multiple clinical
neonates. A total of 13 intensive care nurseries participated. While services. A hierarchial taxonomy with four tiers was developed
the SCN CABSI rate was considered low for a unit of its size, even representing evidence based risk characteristics related to Man (the
one CABSI was too many. The PDSA (Plan, Do, Study, Act) cycle patient), Environment, Microorganism Patterns, and Processes.
for process improvement for the SCN included implementing Intrinsic patient characteristics such as demographics, health status,
new evidence-based practices to decrease the chance of infections. lifestyle patterns, and immune compromise predispose the person
These practices included: • Discontinuing the central lines as soon to infections, and may increase exposure risks for other patients. The
as possible (to decrease the possibility of an infection occurring), • environment, a likely source for transmission of microorganisms,
Using sterile gloves during tubing changes (to maintain line sterility), includes a gradient of risks based on whether surfaces are high,
• Applying 3.15% Chlorhexidine on hubs, 2% Chlorhexidine on medium, or low touch. Clinical unit cultures based on the types
infants that qualify (a more effective skin disinfectant), • Utilizing of patients seen, the environment, or various staffing issues often
a closed system for umbilical arterial catheters (less likely to cause develop and influence the frequency of organism transmissions,
an infection), and • Obtaining a dedicated X-ray machine that stays confirmed infections, and communicable disease outbreaks. Finally,
in the SCN (to prevent contamination throughout the hospital). process behaviors for treating patients may contribute to various
During the duration of this project, nurses completed forms every infections, dialysis related adverse events, surgical site complication,
shift documenting insertion and maintenance techniques. Chart and pathogen transmission. Risk characteristics are determined
audits, observations and data entry ensured compliance from nurses, from administrative data, laboratory data, observational checklists,
mid-level practitioners and physicians. Results: The goal for process evaluations, and questionnaires. Binomial scores of zero and
this project from September 2009-June 2010 was to decrease the one are assigned to reflect the presence or absence of characteristics
CABSI infections by 50%. This goal was met, and exceeded in the in most data collection, but some scores are computed from ordinal
months to follow. In 2010, the SCN had 2 CABSIs, with a rate of scales. A cumulative score for each tier is computed by multiplying
3.19. In 2011, the SCN had zero CABSIs. Overall, the PQCNC the sum of all risk characteristic scores by a “risk constant”. The risk
experienced a 62% decrease in CABSIs across the state, which is constant for the tier representing characteristics of Man is one, and

72 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Infection Prevention and Control Programs
risk constants increase by one as the rank order of the tier increases. sample acquisition component of the system is brought into play.
The comprehensive risk assessment is the foundation for infection Conclusions: We analyzed the response of an ATP based
prevention and control (IPC) work. IPC Coordinators concentrate monitoring system to various clinically relevant sources of ATP. The
work in clinical areas with cumulative scores exceeding the median of system has a very high sensitivity to neat ATP (1 femtomole/swab)
all clinical arenas evaluated. Process improvement projects germane and to samples of diluted whole blood (detected down to a 1x10^-7
to the specific risk characteristics for the ward are implemented. dilution). For bacterial samples, the system can detect both Gram
Results: During the two years of implementing the taxonomical negative (G-) and Gram positive (G+) organisms with a different
risk assessment, we have seen a decline in the number of blood efficiency. In general, sensitivity is higher for G- organisms where for
stream infections, transmission of MRSA and other pathogens, and certain bacteria it’s possible to detect samples of 1,000-2,000 CFUs/
surgical site infections. Staff engagement in the processes of infection swab. G+ organisms can also be effectively detected, but in slightly
prevention has also increased. Lessons Learned: A method of higher concentrations. Of note is the ability to detect a resistant
automating data is essential for using a taxonomical risk assessment. strain (MRSA) with comparable sensitivity to the sensitive strain.
Continuous update of the risk assessment is less useful than semi- Finally, the system can also efficiently detect bacterial specimens
annual or annual update. Quantified results from a taxonomical collected from the surface of an inoculated coupon, albeit with a
risk assessment can be used to affect process control and ultimately lower sensitivity when compared to swabs directly inoculated with
outcomes. a similar sample. This is because the efficiency of collecting a sample
using a swab has to be taken into account.

Presentation Number 8-100

Detection Capabilities of an ATP (Adenosine

Triphosphate) Based Monitoring System for
Clinically Relevant Sources of ATP

Kathleen Baxter, SM, AAM - Director, Quality Assurance, Hill Top

Research; Marco Bommarito, PhD - Senior Research Specialist,
3M Infection Prevention Division; Julie B. Stahl - Senior Clinical
Research Specialist, 3M Infection Prevention Division; Dan J. Morse
- Senior Biostatistical Specialist, 3M Infection Prevention Division

Background/Objectives: ATP based detection systems

are becoming a more prominent tool for monitoring the patient’s
environment. Thus, it is important to understand the detection
capabilities of these ATP monitoring systems with respect to Presentation Number 8-101
clinically relevant sources of ATP. Methods: Two basic test
methods were employed in this study. In the first, the swab of
the ATP test was inoculated with a sample containing a known
Monitoring the Cleaning of Surgical Instruments
concentration of one of the following ATP sources: neat adenosine with an ATP Detection System
triphosphate, bacterial cells, blood. Several dilutions were measured
to construct a dose-response relationship. The diluents used consisted David M. Jagrosse, CRCST, CSPDT, AAMI ST79 workgroup
of either a PBS (phosphate buffer saline) buffer or an artificial - Manager CSSD, Middlesex Hospital; Marco Bommarito, PhD
test soil (ATS from Healthmark). In the second method, a 100uL - Senior Research Specialist, 3M Infection Prevention Division;
volume of PBS buffer spiked with different concentrations of Julie B. Stahl - Senior Clinical Research Specialist, 3M Infection
bacteria was applied to a 316L stainless steel coupon. A sample for Prevention Division
analysis was collected by swabbing this surface. ATP was measured
in RLUs (Relative Light Units) using a bioluminescent luminometer. Background/Objectives: The primary objective of
Results: The tables below show the range of the lowest detectable this study was to demonstrate the feasibility of using an ATP
amounts from the various ATP sources tested. These ranges were assay to monitor the cleanliness of surgical instruments during the
determined by identifying where the positive response signal in RLUs decontamination and cleaning process. The data obtained could be
from multiple runs of the sample tested, intersected the average used to define process control parameters for each step of the manual
background RLU signal from swabs not exposed to the sample. cleaning and automated wash/disinfection. These control parameters
Table I shows the results from dose-response measurements of swabs can then be applied in an auditing fashion to monitor quality control
inoculated directly with different sources of ATP. These data are an and drive process improvement. Methods: Surgical instruments
indication of the analytical performance for the assay. Table II shows from surgical procedure trays in the CSS of Middlesex Hospital
the results from dose-response measurements of swabs collected from were tested using an ATP assay. The method entailed collecting a
stainless steel coupons inoculated with different sources of ATP. sample using a 3M™ Clean-TraceTM ATP Surface Test swab and
These data give an indication of the detection capability when the determining the amount of ATP in relative light units (RLUs) with a

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 73
Poster Abstracts: Infection Prevention and Control Programs
3M™ Clean-TraceTM luminometer. Instruments were sampled after Presentation Number 8-102
manual cleaning and after automated wash/disinfection. The study
consisted of two phases. In Phase 1, data was collected from two types From Good to Great with Strategic Planning
of surgical instruments (forceps and scissors), and used to define pass,
caution, and fail values for each step of the process. In Phase 2, the
Beverly J. Gray, RN, MS, CIC - Infection Prevention and
same instruments were monitored to validate whether the cleaning
Control Program Director, VA North Texas Health Care
and disinfection process remained in control. Instruments that could
System
only be cleaned manually prior to terminal sterilization were tested
to understand how different pass, caution, and fail values may be for
this subcategory of instruments. Results: In Phase 1 two types Issue: Good Infection Prevention and Control (IPC)
of surgical instruments were benchmarked with action limits (pass, Programs strive to satisfy regulatory and stakeholder
caution and fail values) established for both the manual cleaning and expectations. A Great IPC Program is viewed as one in
automated wash/disinfection steps of the decontamination process which expectations are met in an efficient manner and
(see Table I below). In Phase 2, sampling and analysis of the data was effective actions are taken to improve and sustain practices
duplicated to generate a new set of action limits (Table II). A set of for prevention of infections. Faced with the same challenges
instruments that could only be cleaned manually was benchmarked as other programs, we turned to strategic planning as a means
with the following action limits observed (Table III). Table III – for our IPC Coordinators to work smarter and accomplish
Means and action limits for instruments that could only be cleaned greater outcomes. Project: Strategic planning begins with
manually. Conclusions: Successful quality control using this envisioning a desired future and applying a defined process
method appears highly feasible. The decontamination process was to accomplish the vision. In a large VA Health Care System,
observed at two time points. The manual cleaning step showed action we elected to use the logical framework method for strategic
limits that were similar. The automated wash/disinfection cycle planning which is a tool for outlining goals, objectives, and
action limits were different. Although the mean RLU values for each actions necessary to accomplish the vision. The vision for our
phase were very similar for this step of the process, the variability program is for all healthcare providers to comply with clinical
increased significantly, leading to higher values for the pass-caution practice guidelines for prevention of infections. Actions of
and caution-fail thresholds. Action limits for instruments that cannot the IPC Coordinators are to assess, guide, support, and direct
be processed in an automated washer/disinfector are significantly others to facilitate this vision. IPC Coordinators are assigned
higher. This may be an important consideration for reprocessing of to work with specific clinical areas identified with the greatest
these instruments. The study demonstrates: 1) use of this objective risks for patients developing infections. A logical framework
method to establish pass-caution-fail criteria to monitor cleanliness chart was developed specifically for each high risk clinical
of surgical instruments on an ongoing basis 2) use of the ATP assay as unit with objectives or outcomes based on results of a risk
a training tool, leveraging the real-time nature to provide immediate assessment. Activities were defined in terms of clinical practice
feedback to the technician on manual and automated wash behaviors needed to reduce risks and specific IPC Coordinator
techniques and processes. roles needed to assist staff. Measurable indicators and means of
verifying outcomes were specified. Careful consideration was
given to all of the extraneous events which we assumed would
be held constant for each input to be effective and possible.
Using an if-then logic we examined the logical framework
chart using the following questions: (1) If the assumptions
were satisfied and the inputs accomplished, would the outcome
then be achieved? (2) If the outcome was realized would the
purpose and goal then be accomplished? Results: The
logical framework charts served as a road map to enable the IPC
Coordinators to clearly communicate plans for improvement
with key stakeholders. Use of the logical framework increased
the amount of time IPC Coordinators were on clinical units
working with staff, decreased the number of crisis demands, and
improved staff compliance with infection prevention behaviors.
IPC program efficiency and sustainable practices for prevention
of infections were increased. Lessons Learned: Strategic
planning requires motivated leadership with evidence based
vision and IPCs who are willing to experiment with alternative
role approaches. The use of a logical framework process
forced the IPC staff to analyze roles and identify purposeful
links between activities and achievement of goals. The logical
framework also proved to be a very useful tool for increasing
collaboration between the IPC Coordinators and clinical staff.

74 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Infection Prevention and Control Programs

Presentation Number 8-103 Issue: The Centers for Disease Control (CDC), attributes
catheter associated urinary tract infections (CAUTIs) to 30% of the
A Nurse Driven Foley Catheter Removal infections in acute care hospitals. CAUTI causes major complications
Protocol Proves Clinically Effective to Reduce resulting in longer hospital stays, increased healthcare costs and
the Incidents of Catheter Related Urinary Tract mortality. This hospital implemented a nurse driven urinary catheter
Infections removal protocol the first in Kentucky to reduce urinary catheter
associated infections in the intensive care units and general floor
Lynn P. Roser, PhD Candidate, MSN, RN- Nurse units. The Infection Control Team, along with Unit Directors,
Epidemiologist, Central Baptist Hospital; Terry Altpeter, PhD, developed and implemented the protocol, empowered nurses to
JD, RN - Executive Director, Outcomes, Central Baptist Hospital initiate the protocol, and worked with physicians to remove catheters.
Project: In 2011 the hospital infection prevention team
implemented an evidence based nurse driven urinary catheter removal
protocol that identified indicators for urinary catheter insertion,
maintenance, and discontinuation. The protocol empowered nurses
to communicate with physicians to determine the medical necessity
for the catheter, and remove the urinary catheter within 24 hours
unless contraindicated. (Figure 1.) The Nurse Epidemiologist
received electronic reports of all urinary catheters in the hospital
and information related to catheter medical necessity. If the medical
necessity did not support the catheter remaining in the patient, the
nurses removed the catheter. The Nurse Epidemiologist launched
an intensive education plan to inform the nurses of the protocol.
The Infection Prevention Team conducted surveillance rounds to
evaluate medical necessity and appropriate catheter care. Education
continued with new nursing staff and reminders to existing staff of
the importance of removing catheters. The Physician Epidemiologist
responsible for the hospital’s overall infection prevention program
assured that physicians understood the hospital’s quality initiative and
reviewed data weekly in IC team meetings. The hospital’s senior team
reviewed CAUTI data by unit each month. The hospital also entered
into a collaborative program with the state Quality Improvement

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 75
Poster Abstracts: Infection Prevention and Control Programs
project, ensuring that these parties are part of the process of issuing
Infection Control Risk Assessment (ICRA), and that an Infection
Control (IC) permit was issued to each project. • Maintain
contractors in compliance with Infection Prevention and Control
(IP&C) guidelines during construction. Project: After gaining
the support and approval of the hospital administration, the IPD
identified parties involved in the ICRA to be Physical Facilities,
Environment Health and Safety (EHS), Architect, and the IPD. The
IPD rules during construction were restructured as follows: • Prior
to construction, the IPD initiates a meeting with involved parties
to ensure that the construction design is in compliance with the
guidelines of the American Institute of Architects (AIA), and The
Joint Commission (TJC) standard, and to verify the environmental
safety of employees, patients, and visitors during construction. •
During construction, Infection Preventionist Practitioner (IP)
perform routine walk through survey to ensure compliance with the
IP&C guidelines. • Upon construction completion, IP Practitioners
perform a final walkthrough survey to verify the area is free of dust,
utilities are properly working, and to ensure availability of hand
hygiene products, isolation rooms, etc. IPD was empowered by
Organization (QIO) to report CAUTI’s and the AHRQ’s 2009 Hospital Administration to stop any construction project upon
Comprehensive Unit Based Safety Program (CUSP) to end contractors’ deviation from IP&C guidelines. To ensure that the IPD
healthcare associated infections HAI’s. Results: Data collected is involved in all construction projects and satisfied with the permit
prior to the nurse driven protocol demonstrated physicians ordered process, Physical Facilities creates an infection prevention survey for
Foley catheters for inappropriate reasons (Graph 1). Physicians each construction project. Education was developed and performed
misunderstood criteria for catheter use for patients requiring comfort by the IP Practitioners and the EHS safety officer, and provided to
care at the end of life. Nurse educators and the Infection Control contractors and staff prior to each project. Results: Education to
(IC) team provided educational sessions to staff about appropriate contractors and staff increased the level of awareness of construction
urinary catheter uses. The IC team rounded reinforcing proper effect on healthcare setting and their roles during construction.
catheter use. After implementation of the protocol, the facility found Empowering the IPD to stop construction forced the contractors to
a decrease in catheter utilization in the intensive care units (ICUs) comply with the IP&C guidelines. During 2011 calendar year, the
and the medical/surgical units (Graphs 2 and 3). Catheter utilization IPD issued over 30 IC permits, provided over 60 educational sessions,
rates and number of CAUTIs show a significant decrease from and performed over 300 surveys. As a result, construction is running
2010 to 2011 (Tables 1 and 2). Lessons Learned: Medical in a smooth manner with minimum exposure to dust or construction
providers now look at catheter use seriously. Many alternatives to material. Physical Facilities’ survey plays an important role in ensuring
a catheter exist such as a bedpan, bedside commode, in and out that the IPD is involved in each construction project and that an
catheterization of the patient, and adult diapers. Nurses’ exhibit IC permit is issued for each project, prior to this survey multiple
empowerment to remove the catheter when no longer needed. non- permitted projects exist. Lessons Learned: Education,
team work, administration support, and communication between
IPD, contractors, and staff are vital tools in increasing awareness and
compliance with the IP&C guidelines
Presentation Number 8-104

Enhancing Infection Prevention’s Role during

Construction in a University Medical Center Presentation Number 8-105

Elham R. Ghonim, MT, ASCP, CIC - Director of Infection Personal and Household Hygiene, Microbial
Prevention, University of Mississippi Medical Center, Jackson, MS; Contamination, and Health Status in
Rathel Nolan, MD - Director of the Division of Infectious Diseases, Undergraduate Residence Halls in New York City
University of Mississippi Medical Center, Jackson, MS; Michael H.
Baumann, MD - Chief Quality Officer, University of Mississippi Katharine G. Haxall, RN, MPH - Research Assistant, Columbia
Medical Center, Jacskon, MS University School of Nursing

Issue: In a 722 bed tertiary teaching hospital, the Infection Bevin Cohen, MPH - Project Coordinator, Columbia University
Prevention Department (IPD) faced multiple challenges during School of Nursing; Benjamin A. Miko, MD - Fellow, Division of
construction that included: • Defining rules of the IPD during Infectious Diseases, College of Physicians and Surgeons, Columbia
construction, gaining the support from administration to implement University; Laurie Conway, RN, MS, CIC - Doctoral Student,
these rules, • Identifying parties involved in the construction Columbia University School of Nursing; Nicole Kelly - Research

76 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Infection Prevention and Control Programs
Assistant, Columbia University School of Nursing; Dianne Stare, dorms of 40 participants (18 men and 22 women). Bacterial growth
MPH - Research Assistant, Columbia University School of Nursing; ranged from 0-35 colony forming units (CFUs) with little variation
Christina Tropiano - Research Assistant, Columbia University by type of dorm, frequency of cleaning, or frequency of illnesses
School of Nursing; Allan Gilman, MS, M(ASCP), M(NCA) - (Table 2). Staphylococcus aureus was detected in three participants’
Assistant Professor, Bronx Community College; Samuel Seward Jr., rooms (on a dish, bookshelf, and remote control), and coliforms were
MD - Assistant Vice President of Health Services, Assistant Professor present in six students’ rooms (on a remote control, keyboard, desk,
of Clinical Medicine, Columbia University; Elaine L. Larson, RN, light switch, refrigerator handle, bathroom door handle, and three
PhD, CIC - Associate Dean for Research, Columbia University bookshelves). Two of these students reported cleaning daily, three
School of Nursing weekly, two monthly, and one never. Conclusions: Despite
reporting frequent cleaning, coliforms were found in some students’
Background/Objectives: Studies have described college rooms, on surfaces used for cooking and eating, and on surfaces
students’ hygienic practices but not the association between hygiene shared by multiple students, suggesting that opportunities for
and microbial contamination or frequency of illnesses. The purposes transmission may be possible, even when hygienic measures are taken.
of this study were to describe students’ knowledge, practices, and
beliefs about hygiene; examine microbial flora in dormitories;
and assess whether microbial contamination varied according to
frequency of cleaning, dormitory style, and frequency of illnesses.
Methods: Undergraduate students at Columbia University,
New York, NY were recruited at a campus dining location.
Students completed a 10-minute survey assessing demographics,
health history, and knowledge, practices, and beliefs about
hygiene. A subsample of survey respondents volunteered to have
their dormitory environments sampled. Two trained researchers
swabbed, with a sterile DACRON®-tipped applicator, a 2-cm2
area of these surfaces in each student’s dorm: computer keyboard,
bookshelf, desk, reusable cup/dish, television remote, overhead light Presentation Number 8-106
switch, refrigerator handle, toilet flush handle, and bathroom stall/
door handle. Bacterial contamination was assessed using standard
You are What You Eat: Engaging Long-Term Care
quantitative bacterial culture techniques. Results: Four hundred
and fourteen students (196 men, 217 women, 1 transgender), 17-23 Residents in Meal Time Hand Hygiene
years old, completed the survey. Less than half of students were
aware that hand washing reduces transmission of colds, flu, and Marguerite O’Donnell, RN, BSN, CIC - Infection Control
gastroenteritis, and 39.8% believed that hand washing is unimportant Nurse, Infection Control Department, Louis Stokes Cleveland VA
to prevent disease (Table 1). More women than men reported hand Medical Center; Tony Harris - Nursing Assistant, Nursing Service,
washing always or most of the time for all indications surveyed and Louis Stokes Cleveland VA Medical Center; Terancita Horn, RN
reported that hand washing can prevent colds, flu, and gastroenteritis. - Registered Nurse, Nursing Service, Louis Stokes Cleveland VA
More underclassmen than upperclassmen reported hand washing Medical Center; Blondelle Midamba, MS, RD, LD - Dietitian,
prior to preparing food and eating, but no significant differences were Medical Service, Louis Stokes Cleveland VA Medical Center; Vickie
noted between science and humanities majors. Most students (56%) Primes, DTR - Dietary Tech, Louis Stokes Cleveland VA Medical
felt that their personal hygiene was the same as others’, and only 5% Center; Rosalyn Shuler, NP - Nurse Practitioner, Nursing Service,
felt theirs was worse. Microbiologic data were collected from the Louis Stokes Cleveland VA Medical Center; Nancy Sullivan ,
RN - Registered Nurse, Nursing Service, Louis Stokes Cleveland
VA Medical Center; Trina Zabarsky, RN, MSN, CIC - Infection
Control Practitioner, Nursing Service, Louis Stokes Cleveland VA
Medical Center; Curtis J. Donskey, MD - Chair, Infection Control
Committee, Louis Stokes Cleveland VA Medical Center

Background/Objectives: Healthcare workers are the

focus of most hand hygiene improvement initiatives. Hand hygiene
by patients may also be an important means to prevent acquisition
of healthcare-associated pathogens, but few interventions have
involved patients. Our objective was to examine the frequency of
hand hygiene prior to meals in a long-term care facility (LTCF)
and implement an intervention to improve mealtime hand hygiene
practices. Methods: We conducted observations to assess the
frequency of performance of hand hygiene prior to meals on one
unit of a Department of Veterans Affairs LTCF. Residents were
surveyed regarding their opinions and knowledge of hand hygiene

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 77
Poster Abstracts: Infection Prevention and Control Programs
and of perceived barriers to hand hygiene. A team including LTCF Chasity Daugherty, RN - Registered Nurse, Nursing Service, Louis
residents, administration, nurses and nursing assistants, dieticians, Stokes Cleveland VA Medical Center; Holly Hovan, RN - Registered
and Infection Prevention performed an intervention to increase Nurse, Nursing Service, Louis Stokes Cleveland VA Medical Center;
hand hygiene performance. Results: Before the intervention, Michelle Stewart, RN - Registered Nurse, Nursing Service, Louis
hand hygiene prior to meals was performed in only 4 of 240 (2%) Stokes Cleveland VA Medical Center; Dyanne Thomas, RN -
observations. Of 21 residents surveyed, 20 (95%) knew that hand Registered Nurse, Nursing Service, Louis Stokes Cleveland VA
hygiene would protect them from infections and 20 (95%) were Medical Center; Curtis J. Donskey, MD - Chair, Infection Control
aware that contact with devices such as wheelchairs, walkers, and Committee, Louis Stokes Cleveland VA Medical Center
canes could result in hand contamination with pathogens. Although
non-antimicrobial towelettes were available on each tray, most Issue: Rates of influenza vaccination are often suboptimal
residents were either unaware that they were present or unable to in healthcare workers. Buy in from staff members and the
open them due to lack of dexterity. Based on the initial assessment, administration may be a key factor in determining the success of
an intervention was performed that included providing education initiatives to improve vaccination rates among healthcare workers.
on the importance of hand hygiene, reminders to perform hand Our objective was to test whether recruiting nurse champions on each
hygiene prior to meals, a hand hygiene stand at the entrance to the unit of a long-term care facility (LTCF) would result in improved
dining room with antimicrobial wipes and an automated dispenser of rates of staff influenza vaccination. Project: At the beginning
alcohol gel, and resident participation in education and distribution of 2011-2012 influenza season, the Infection Prevention program
of wipes. As shown in the figure, there was a significant increase and the administration recruited RN nurse champions on 5 units of
in the percentage of residents performing hand hygiene prior to the Cleveland VA Medical Center’s community-living center. The
meals on the unit by month (P<0.0001). The decrease in June was nurse champions received education on influenza and participated
attributed to lack of timely re-stocking of the stands which was in ongoing promotion of influenza vaccination of staff members on
corrected by engaging housekeepers support. Conclusions: their unit. Small incentives were provided for units that provided
LTCF residents are aware of the importance of hand hygiene before education to 100% of staff members and achieved staff vaccination
meals, but barriers such as inaccessible or difficult to use products rates of 85%. The infection Preventionist provided real-time feedback
may limit compliance. In our LTCF, a dramatic and sustained to staff and leadership. Units with a staff vaccination rate of less
improvement in mealtime hand hygiene was achieved through an than 85% were reassessed for barriers to staff acceptance of influenza
interdisciplinary team effort. vaccination. Percentages of staff members receiving vaccination
on each unit were compared with the percentages from previous
years. Results: One-hundred percent of the staff members
on the 5 units received education on the importance of influenza
vaccination. The overall percentage of nursing staff members who
received vaccination was 78% (118/152 nurses) compared with 62%
to 69% in 4 prior influenza seasons. The percentages of vaccinated
staff members varied widely on different wards, ranging from 61%
to 91%. Interviews with staff members on the unit with the lowest
level of compliance indicated that some influential nurses were vocal
in their opposition to vaccination and there had been an observed
adverse reaction to vaccination in an employee on the unit during the
previous year. Lessons Learned: Nurses can play a powerful
role in promoting or discouraging influenza vaccination among
their colleagues. Recruiting ward-level nurse champions was a useful
strategy to improve staff vaccination rates in our facility.

Presentation Number 8-107

The STOP (Staff Taking Ownership for

Prevention) FLU Initiative: Improving Influenza
Vaccination Rates among Staff in a Long-Term
Care Facility

Marguerite O’Donnell, RN, BSN, CIC - Infection Control

Nurse, Infection Control Department, Louis Stokes Cleveland
VA Medical Center; Kelli Bachman, RN - Registered Nurse,
Nursing Service, Louis Stokes Cleveland VA Medical Center;

78 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Infection Prevention and Control Programs

Presentation Number 8-108 Coordinator, National Infectious Diseases Service, VA Central

Office, Department of Veterans Affairs/VHA; Judith Whitlock,
Automatic Foley Catheter Stop Order RN, MSN, APRN, CIC - MDRO Program Education Coordinator/
Specialist, National Infectious Diseases Service, VA Central Office,
Department of Veterans Affairs/VHA; Martin Evans, MD - VHA
Romeo P. Mamon Jr., RN, BSN - Infection Prevention Practitioner,
MDRO Program Director, National Infectious Diseases Service,
Atlantic Health System
VA Central Office, Department of Veterans Affairs/VHA; Stephen
Kralovic, MD, MPH - Medical Epidemiologist, National Infectious
Background/Objectives: Use of foley catheters can Diseases Service, VA Central Office, Department of Veterans Affairs/
lead to complications, most commonly catheter-associated urinary VHA; Rajiv Jain, MD - Acting Chief Officer, Patient Care Services,
tract infections (CAUTI). Duration of foley catheter use is one VA Central Office, Department of Veterans Affairs/VHA; Gary
the major risk factor. To implement and evaluate the efficacy of an Roselle, MD - Director, National Infectious Diseases Service, VA
intervention to reduce catheter-associated urinary tract infections Central Office, Department of Veterans Affairs/VHA
in 4AB (cardiology/ medical unit) by implementing an automatic
foley catheter stop order. And further, to evaluate the impact of
Issue: Clostridium difficile infection (CDI) is the leading cause of
the protocol on foley catheter days. Methods: Indications for
healthcare-associated infectious diarrhea in United States hospitals.
continuing urinary catheterization with indwelling devices were
The severity ranges from mild colitis to toxic megacolon and death.
developed by the infection prevention department and key physicians
C. difficile contends with Methicillin-Resistant Staphylococcus
in infectious disease. For a planned 6-month intervention period
aureus (MRSA) as the most common organism to cause healthcare
(from December 2009 to May 2010), patients in 4AB who had
associated infection in the United States. Because CDI is an
foley catheters were evaluated on day 2 of having a foley catheter
important cause of morbidity and mortality among Veterans in acute-
by using a set of criteria for appropriate catheter continuance.
care inpatient facilities, a national initiative to reduce the incidence
Recommendations were made to PMD to discontinue indwelling
and prevalence of this infection was developed. Project: In order
urinary catheters in patients who did not meet the criteria. If order
to reduce the incidence of CDI in the inpatient acute care setting, a
is not written to continue foley at 72 hours, it will be discontinued
bundle- based approach of infection prevention and control strategies
in the morning at 6 am if patient does not meet identified criteria.
will be employed which includes: 1) hand hygiene, 2) contact
Medmined, a data mining tool is used to determine any positive
precautions for those symptomatic CDI patients, 3) environmental
urine culture monthly in the said unit. Those with positive urine
management, 4) cultural transformation where infection prevention
cultures are further filtered whether they have a foley catheter or not.
and control becomes everyone’s business. Care bundles are groupings
NHSN definition for catheter-associated urinary infection is used
of best practices with respect to a disease process that individually
to determine CAUTI rates monthly for those with foley catheters.
improve care, but when applied together result in substantially greater
Foley catheter days, unit census and rates of catheter-associated
improvement than when implemented individually. The CDI bundle
urinary tract infections during the intervention were compared with
follows principles similar to that of Veterans Affairs (VA) MRSA
those of the preceding 3 months. Results: During the 6-month
bundle that has proven successful in reducing MRSA infections
intervention period, the foley catheter days was reduced to an average
across VA hospitals. The CDI bundle is comparable to the MRSA
of 201 days/month compared to the baseline 3-month average rate
bundle with the exception of environmental management being
of 228 days/month (from September 2009 to November 2009).
substituted for the active surveillance strategy in the CDI bundle.
This result represented a 9% decrease in foley catheter days. It is
The CDI bundle will be implemented in all VA inpatient acute
important to note that the average baseline monthly unit census
care hospitals. A separate initiative for antimicrobial stewardship
was 1129 patients/month compared to 1183 patients/month of the
complementary to the CDI initiative has begun. Before nationwide
intervention period which represented a 9.5% increase. The rate of
distribution, the CDI bundle was beta-tested. Results: The CDI
catheter-associated urinary tract infections per 1000 days of use was
bundle was tested in 37 different VA hospitals across the United
2.9/month before the protocol was initiated and zero during the
States. All facilities were able to implement the CDI bundle elements
6-month intervention period. Conclusions: Implementation
of hand hygiene, contact precautions, environmental cleaning, and
of an intervention to automatically stop foley catheter that doesn’t fit
culture transformation. Even though the CDI bundle is directed to
in the indicated set of guidelines may result in significant reductions
a particular pathogen (vertical approach), the preventive strategies
in duration of catheterization and occurrences of catheter-associated
recommended are horizontal interventions that will be beneficial
urinary tract infections.
for the prevention of all pathogens. Based on feedback from the
beta-test sites, the bundle infection prevention strategies have been
improved for national distribution. Surveillance of CDI cases will be
Presentation Number 8-109 done nationwide to evaluate program implementation. Lessons
Learned: The successful implementation of VA’s MRSA
Prevention Initiative paved the way for further such initiatives. While
Clostridium difficile infection prevention initiative the MRSA Prevention Initiative used both vertical and horizontal
to reduce the incidence and prevalence of infection prevention approaches, the CDI prevention initiative
Clostridium difficile among Veterans in acute-care employs primarily horizontal strategies. We hope to enjoy success
inpatient facilities similar to that achieved in the MRSA Prevention Initiative using the
CDI prevention initiative.
Marla Clifton, RN, MSN, CIC - MDRO Clinical Program

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 79
Poster Abstracts: Infection Prevention and Control Programs

Presentation Number 8-110 Presentation Number 8-111

Utilizing Electronic Surveillance to Enhance Re-Ingineering Hand Hygiene Surveillance: Shifting
Patient Safety the focus, sharing the responsability.
Charlene Head, RN, CIC - Infection Preventionist, Carolinas Olga E. Guzman, RN, BSN, CIC - Infection Control Preventionist,
Healthcare System; Shelley Kester, RN, BSN, CIC - Manager, Kaiser Permanente Fontana Medical Center; Melody S. Kulsic,
Infection Prevention, Carolinas Healthcare System; Wendy MSN, PHN, RN - Project Manager III, Kaiser Permanente
Betts, RN, BSN, CIC - Manager, Infection Prevention, carolinas Fontana Medical Center; Jeanine E. Martin, RN - Infection
Healthcare System; Martha Alspaugh, RN, BA, BS, CIC - Control Preventionist, Kaiser Permanente Fontana Medical
Infection Preventionist, Carolinas Healthcare System Center; Armando De Amaya, RN, BSN, PHN - Infection Control
Preventionist, Kaiser Permanente Fontana Medical Center; Maria
Issue: Healthcare associated infections (HAIs) are common, T. Canola, RN, MSN, MPH, CIC - Director of Infection Control,
costly and deadly complications of hospital care. Over the past Kaiser Permanente Fontana Medical Center; Jea H. Lee, MD - Chair
several decades multidrug resistant organisms have become more of Infection Control and Infectious Disease, Kaiser Permanente
prevalent and utilization of invasive devices such as central lines Fontana Medical Center
and ventilators has skyrocketed. As such, the role of the Infection
Preventionist (IP) has expanded exponentially, oftentimes without Issue: Despite multiple interventions to increase Hand Hygiene
a concomitant increase in the infection prevention workforce. (HH) compliance, we were not able to sustain a housewide
The increased attention and responsiblity placed on Infection compliance rate above 90%. Project: A HH task force was
Prevention departments necessitates methods to streamline created to increase and sustain HH compliance beyond 90%. The
collection and summary of HAI data. Project: The impact of team was comprised of a Nursing, a Quality, a Patient Safety and an
computerized infection prevention software (TheraDoc) on the role Infection Prevention representative. The team met monthly until
of the IP and HAI outcomes was evaluated at 4 acute care facilities the project was completed. The WHO “5 moments” was used as the
within a large healthcare system. Rates of central line associated measurement for compliance. The observation method was switched
bloodstream infections (CLBSI), ventilator associated pneumonias from secret observers to Nursing performing the observations and
(VAP), catheter associated urinary tract infections (CAUTI), providing immediate feedback to the non-compliant employees.
surgical site infections (SSI), and hopsital acquired infections with Monthly observations were increased from 20 to 40 per Nursing
multi-drug resistant organisms (MDROs) were compared to pre- Unit a total of about 1000 observations/month. Results were shared
implementation time frames of the software at year one and year with Nursing and Hospital leadership on a weekly basis. Ancillary
two. Various activities were tracked in a log by the IP, including time department managers were recruited to perform observations of their
spent on existing and expanding surveillance activities, time saved own staff. For quality control purposes, Infection Control performed
with utilization of the “alert” features of the program, and changes a validation study after the new data collection process in order to
in IP workflow. Results: The computerized infection control identify any inconsistencies in collection methodology. Observations
software system resulted in increased productivity and effectiveness were performed in conjunction with managers of identified units.
of the IP. Rapid data extraction and analysis by the software allowed Patient’s satisfaction survey which includes a question on HH
the IP to intervene quickly at the unit level, giving real-time performance was compared to our observed results. Individual
guidance and support. A total of 0.7 full time equivelant (FTE) Physicians assigned to specialty units were observed by Nursing
employee was saved with the implementation of the software which and given direct feedback by their Chief of Service. Physician HH
allowed for expanded surveillance activities. MDROs were easily observations were repeated to measure improvement from the initial
tracked and trended, with time from identification of a MDRO to study. Promotional activities included window displays with posters
patient isolation decreasing by 24 hours. During the first year of representing different departments: Laboratory, Environmental
use, CLBSI decreased 23%, VAP decreased 85%, and Methicillin- Services, Nursing and Physicians performing HH. Elevator wrappers
Resistant Staphylococcus aureus (MRSA) infection decreased were installed in all staff elevators displaying HH messages by
60%. Lessons Learned: Implementation of computerized various health care workers. A “Hand Hygiene Excellence” trophy
infection prevention software was associated with significant was introduced to award Nursing units that achieve and sustain
improvements in HAI outcomes and increased efficiency in >90% compliance. The CDC HH video was added to the patients’
surveillance and reporting of infection issues at our institution. Real educational television channel, encouraging patients and visitors to
time feedback to stakeholders and expanded surveillance allowed remind the staff to perform HH. Nursing adopted “Scripting” to be
for identification of infection trends and can be used to mitigate incorporated into their “Patient- Nurse Knowledge Exchange” and
outbreak risks. The program allowed for ease and efficiency to track on their patient’s “care boards” regarding HH and their commitment
infections by unit, procedure and organism. Time was additionally to patient safety. The Safety Advisory Committee comprised of
saved for the IP with the ability of the program to directly export Patient Safety and designated Kaiser Permanente members were
data to the National Healthcare Safety Network (NHSN) for state consulted. They suggested the use of new educational signs that
reporting. Electronic surveillance has enhanced the ability of the were installed above all alcohol based hand rub dispensers and sinks.
IPs at our institution to prevent infections, improve patient safety Results: The following outcome was measured: House-wide
and save lives. compliance increased from 78% to 93%. Physician’s compliance
increased from72% to 90% Nursing compliance increased from

80 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Infection Prevention and Control Programs
82% to 95% Ancillary Departments increased from 64% to 87%. from home or from another facility. Finally, staff hand hygiene
Lessons Learned: A focused, and dedicated team supported compliance is audited regularly with a goal of >90% compliance.
by administration was the key for success for this project. Using a Lessons Learned: NICU’s Infection Control Committee is
team approach to elicit ideas and group consensus decision making effective because it is a small group focused on NICU and passionate
is vital. A heightened awareness of HH practices by the staff can only about providing safe patient care to premature infants. The committee
be achieved through education and accountability. Evaluation of the provides structure for ongoing program development and improved
program must be an ongoing process from beginning to end. patient safety strategies. Networking and consultation with generous
experts was invaluable. There is a need for evidence-based, infection
prevention guidelines specifically for NICUs.

Presentation Number 8-112

Developing an Infection Prevention Program as a Presentation Number 8-113

Result of a Transition From a Level II to a Level III
NICU Successful Implementation of a Mandatory
Influenza Vaccination Program across a 12
Shannon G. Hansen, MT(ASCP), CIC - Infection Control Hospital System
Coordinator, Altru Health System; Virginia Bren, RN, MPH,
CIC - Infection Control Coordinator, Altru Health System; James Donna Currie, MSN, RN - Director of Clinical Support Services,
Hargreaves, DO - Infectious Diseases, Altru Health System Advocate Health Care; James Malow, MD, FIDSA - Chairman
Internal Medicine, Chairman Infection Prevention Committee,
Issue: A successful infection prevention and control program must Medical Director Advocate Healthcare Infection Prevention Team,
identify changes in the patient population and level of services. In Advocate Illinois Masonic Medical Center
2009, Neonatal Intensive Care Unit (NICU) services were enhanced
from Level II to Level IIIB, thus adding a population of very low Issue: There is an increasing movement toward requiring Health
birth weight (VLBW) infants. The organization’s commitment to Care Worker’s (HCW’s) to receive annual influenza vaccination.
provide safe care for high risk infants created a need to perform a risk Several professional and regulatory organizations “highly
assessment and develop goals and strategies for infection prevention recommend” influenza vaccinations for HCW’s, but fall just short
relevant to an anticipated population of VLBW infants. Project: of requiring the vaccine.1,2 Most recently, the Infectious Diseases
The risk assessment included 1) a review of the literature, including Society of America (IDSA) has formally asked federal health
guidelines and resources; 2) input from stakeholders, including officials to recommend making influenza vaccination mandatory
physicians, staff, and administration; and 3) consultation with for healthcare workers (HCWs),3 For the purpose of this project,
regional and national NICU experts, including an onsite visit to a HCW’s are defined as associates, volunteers, and physicians
large, tertiary care NICU in our region. Goals included: 1) creation physically located or working in health care settings with the
of an NICU Infection Control Committee; 2) determination of the potential for exposure to infectious materials. While some HCW’s
scope of infection surveillance and operationalization of indicators; provide direct patient care, others have jobs that may put them into
3) optimization and standardization of vascular access care; 4) close contact with patients or the patient environment. Transmission
setting parameters for active surveillance testing (AST); 5) initiation of influenza to patients by HCW’s is well documented.4 HCW’s
of an effective illness screening process for visitors; 6) clarification may acquire influenza both in the health care setting and in the
of readmission/cohort policies; and 7) maintenance of high hand community, and they can easily transmit the virus to patients in
hygiene compliance. Results: The NICU Infection Prevention their care. Though there is strong evidence to support vaccination
and Control Committee meets monthly. It is chaired by infection of HCW’s with influenza vaccine, success remains low nationally.
control and includes nurse managers, staff nurses, an administrator, The Centers for Disease Control and Prevention (CDC) estimates
and neonatologists. Ad hoc members include hospital epidemiologist, that only about 40% of HCW’s in the United States are vaccinated
pharmacy, and respiratory care. Strategies were developed to meet against influenza annually.6 The organization in this abstract has
program goals. Surveillance indicators were defined to include the offered free influenza vaccines to all associates, physicians, volunteers,
following: central-line bloodstream infection (CLABSI), acute and students as required by The Joint Commission.7 The associate
respiratory illness, multi-drug resistant organisms (MDRO), and hand vaccination rate has remained consistently low over the past several
hygiene compliance. The development of a detailed table describes years between 40% to 50%. Project: A mandatory influenza
vascular access procedures and a new policy of gloving when touching vaccination program was implemented for a large healthcare system
any component of a vascular access was adopted. After a cluster of for the 2011-2012 flu season. All associates, including employed
Staphylococcus aureus skin infections and hospital onset respiratory physicians, at clinical sites (hospitals, medical groups, clinics) were
syncytial virus (RSV) in 2011, the microbiology lab optimized viral mandated to receive the vaccination. Non-employed physicians
testing, the NICU’s readmission policy was clarified, and plans are aligned with the Physician Hospital Organization (PHO) received
underway to strengthen visitor screening. To evaluate and modify credit the influenza vaccine through the clinical integration model.
the risk of transmitting Methicillin-Resistant Staphylococcus aureus The influenza vaccine was highly recommended for other non-
(MRSA) from colonized infants, the NICU Infection Control employed physicians and associates at non-clinical sites. Key elements
Committee created a policy to screen infants readmitted to NICU of the program include: • Interdisciplinary partnership • Leadership

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 81
Poster Abstracts: Infection Prevention and Control Programs
support • Communication • Exemption Review Oversight Presentation Number 8-114
Committee. Results: The program was very successful • Achieved
a compliance rate of 99.5% for mandated sites. (See table 1) • Five Resistant Organisms: An Innovative Approach to
percent of associates (1510) applied for either a medical exemption
Preventing Healthcare Transmission
or a religious exemption. Of those reviewed by the oversight
committee, 183 were denied. (See Graph 1) • 18 associates (out of
30,000) were terminated for failure to comply with the mandatory Michelle P. Mace, MSN, RN, CIC - Administrator, Infection
flu vaccine program. Lessons Learned: Implementation of Prevention, Catawba Valley Medical Center; Alisa Leonard, MHA,
a mandatory influenza vaccination requires the full support and RN, CIC - Infection Prevention Coordinator, Catawba Valley
collaboration of a large interdisciplinary team. Identified below are Medical Center; Danielle Thurman, BSN, RN, CPEN - Patient Care
several opportunities identified during the first year and will provide Coordinator, Catawba Valley Medical Center
direction as we work to improve the program for next year. 1. Sharing
information amongst data bases 2. Establish definitive criteria for Issue: Incidence and prevalence of all multidrug resistant organisms
exemptions. 3. Adherence to defined deadlines are on the rise. Highly resistant organisms such as Klebsiella pneumoniae
Carbapenemase (KPC), Acinetobacter, C. difficile, and Extended
Spectrum Beta Lactamases (ESBLs) have become a new threat to the
hospitalized patient. Infection Prevention (IP) at a community Magnet
hospital recognized a potential risk point after identifying a newly
admitted KPC positive patient during surveillance in January, 2011.
Upon investigation, it was determined that the possible incidence of
admitting patients with a highly resistant organism and not placing the
patient on isolation was a great risk. In 2010 a Multi-Drug Resistant
Organism (MDRO) Prevention Team was formed to address patient
care issues with Methicillin-Resistant Staphylococcus aureus (MRSA)
and C. difficile. In 2011, the team was asked to also address care
issues related to highly resistant organisms. Project: The MDRO
Prevention Team, comprised of interdisciplinary representatives from
administration, IP, pharmacy, lab, Environmental Services (EVS),
inpatient units, emergency department and operating room, accepted
the task of improving identification, surveillance, and care of the
patient having a highly resistant organism. To improve identification
of C. difficile, in 2011 the lab initiated Polymerase Chain Reaction
(PCR) testing. In 2010 the MDRO Prevention Team created a “C.
diff bundle”, including a small cart for soiled linen and Clorox-based
disinfectant wipes in each contact enteric isolation room. In addition,
EVS began cleaning these rooms with a Clorox-based disinfectant. The
team developed a process for identifying isolates that need further KPC
testing using a Modified Hodge Test. In 2011 this team developed a new
isolation for highly resistant organisms. Patients having a highly resistant
organism are placed on “Strict Contact Isolation”. The major difference
in Contact and Strict Contact is the cleaning requirements, keeping
patients located in one room and using dedicated equipment. Nursing
staff clean high touch surfaces once per shift. Upon discharge EVS
clean the patient room twice with different EVS staff at different times.
Infection prevention educated administration, clinical staff, medical
staff and EVS about highly resistant microorganisms and transmission
prevention. EVS staff are monitored every week randomly using a black
light process to ensure thorough cleaning. Results: The incidence
of patients with a MDRO present on admission has steadily increased
since 2009. After creating the MDRO committee and implementing
transmission risk reduction strategies the health care acquired MRSA
and C. difficile rates have steadily decreased, with an 86% reduction
of MRSA and a 25% reduction of C. difficile from 2009 to 2011. Our
other health care acquired MDROs have remained stable at a rate of .06
for 2010 and 2011, although the present on admission have increased
showing higher prevalence in the community. Lessons Learned:
Implementing Evidence Based Practices to prevent MDROs requires
an interdisciplinary approach, with stakeholder buy-in. In addition,
MDRO transmission prevention requires innovative thinking from

82 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Infection Prevention and Control Programs
front-line staff to initiate and sustain improvement. Issue: Safety and cost containment are key aspects of infection
prevention and control (IPC) efforts. Optimum hand hygiene
(HH) decreases the rates of healthcare-associated infections, and
implementing a HH program is a first step toward safe care. However,
sustaining a HH program can be challenging for a public hospital
faced with budget constraints and multiple competing needs. Our
U.S. hospital (USH) has collaborated with a public hospital in El
Salvador to improve pediatric cancer care for 10 years. Here we report
the result of a recent evaluation of the HH program and outline
success factors for sustainability, as this relates to the dynamics among
IPC team members, unit leaders, personnel, educators, a commercial
provider, and patients’ families. Project: In 2007, our USH
collaborated to implement a HH program by providing alcohol gel
to the oncology service of a 300-bed pediatric hospital in El Salvador.
Oncology services include 26 inpatient beds and an outpatient clinic.
While providing gel, we optimized HH education and promotion,
and compliance monitoring. Alcohol-gel handrubs were chosen as
an effective solution that can be placed by every bed and elsewhere
for maximum access and compliance. A local gel manufacturer has
provided service since the program’s inception, monitors usage,
and distributes the product throughout the oncology service. The
USH funded the HH program since the beginning, purchasing gel,
and supplementing the salary of a local physician who monitors
infection rates and HH practices, and periodically reports this
information. Additionally, the USH visits and monitors the site once
a year. In November 2011, a USH team assessed the HH program
and interviewed oncology service personnel regarding satisfaction
with the program, gel, supplier service, and the gel monitoring and
ordering process. Results: After 4 years, the HH program is still
Presentation Number 8-115
strong. In the inpatient area, one gel dispenser per bed was available
in 22 of the 26 beds; and 2 of the 6 sinks had soap and towels. In the
The Dynamics of a Hand Hygiene Program in a outpatient and short-term stay areas, a gel dispenser was available
Pediatric Oncology Service in El Salvador: Success in all but one of the existing 37 beds and recliners; all of the 3 sinks
Factors and Lessons Learned had soap and towels. Nurses and families are involved in monitoring
gel availability. The supplier enjoys a good relationship with hospital
Elsie L. Gerhardt, MA, MPH candidate - Administrative Specialist, staff. Visual reminders of HH are ubiquitous. Rotating personnel
St. Jude Children’s Research Hospital, University of Memphis; are trained in HH every month. Monthly use of gel has remained
Roberto Vasquez, MD - Director Oncology Service, Hospital stable, averaging 18 gallons; this suggests high compliance levels.
Nacional de Ninos Benjamin Bloom; Soad Fuentes, MD - Director Lessons Learned: Sustaining a HH program needs consistent
- Centro Medico Ayudame a Vivir - Fundacion Rafael Meza Ayau funding, education, communication, feedback, collaboration among
- outpatient clinic, Hopspital Nacional de Ninos Benjamin Bloom; stakeholders, and a good relationship with a committed vendor. Our
Gabriela Maron, MD - Staff, Hospital Nacional de Ninos Benjamin model proved to be successful in El Salvador and we believe that this
Bloom; Dinora Barrera, nurse - Head nurse of the inpatient area model is applicable to other hospitals facing similar challenges in low-
of Hospital Nacional de Ninos Benjamin Bloom - El Salvador, income countries.
Hospital Nacional de Ninos Benjamin Bloom - El Salvador; Miriam
Gonzalez, MD - Student, University of Memphis; Don Guimera,
BSN, RN, CIC, CCRP - International Epidemiology Coordinator,
St. Jude Childrens Research Hospital; Miriam De Lourdes. Duenas Presentation Number 8-116
- Pediatric Infectious Diseases Department, Infection Control,
Pediatric Infectious Diseases; Magister in Infection Control A Multidisciplinary Team Approach to Reducing
Ventilator Asscociated Pneumonia
Mario Gamero, MD - Director Infectious Diseases Hospital
Nacional de Ninos Benjamin Bloom, Hospital Nacional de Ninos Tracey Terrell, CCRN, RN CNIV - Durham Regional Hospital
Benjamin Bloom - San Salvador, El Salvador; Kyle M. Johnson, PhD,
CCRP - Clinical Research Associate II, St. Jude Children’s Research Issue: Durham Regional Hospital is a 369-bed community hospital
Hospital; Miguela Caniza, MD - Director of Infectious Diseases- located in Durham, North Carolina. The critical care staff provides
International Outreach Division, St. Jude Children’s Research care to a diverse population of patients within a 22-bed med-surg
Hospital unit. Controlling ventilator associated pneumonia is crucial to

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 83
Poster Abstracts: Infection Prevention and Control Programs
both patient care and finance. VAP occurs in up to 25% of all
patients requiring mechanical ventilation. VAP is the leading
cause of death among hospital acquired infections, prolongs
days on ventilator, increases total length of stay by 4.3 days, and
adds $40,000 to cost of hospital stay. Project: The CCU
nursing staff developed a multidisciplinary team approach to
decrease the incidence of ventilator associated pneumonia.
This team includes Physicians, Registered Nurses, Respiratory
Therapists, Certified Nursing Assistants, Infection Control, and
Pharmacists. Collaboration of this team led to the following
changes: • Incorporated VAP bundle information and sedation
vacation algorithm in bedside reference books for quick access. •
Acronym SLAP VAP created: o S - strict oral care o L - liberation
from ventilator o A - aspiration precautions o P - prophylaxis (GI
and DVT) • Reported VAP rate and compliance with bundle
to unit nurses on monthly basis. • Organized a Bundle Bash to
educate over 60 nurses and support personnel on HAI bundles. •
Celebrate success in VAP reduction. • Computerized monitoring
of VAP bundle compliance. • Peer to peer accountability for
noncompliance with bundle. • In-line suction with dedicated
suction set up. • Increased use of HiLo evac endotracheal tubes
for continuous subglottic secretion suctioning. • Charge Nurse and
Respiratory Therapist collaborate daily in planning for sedation
vacation and vent weaning. • VAP education and prevention
strategies added to orientation. • Staff education focused on: o
Pulmonary rotation 18 hours per day o Vibration or percussion
every 2 hrs o Consistent documentation of interventions performed
o Sedation vacation and daily awakening o Hand washing o
Richmond Agitation Sedation Scale assessed every 2 hours o Training
Certified Nursing Assistants to perform oral care. Results:
The work of the group was an ongoing process over two years that
included implementing strategies then following up with the critical
thinking to address the next steps to achieve the desired outcome.
This program was successful in increasing bundle compliance and
decreasing the incidence of ventilator associated pneumonia in
critically ill patients. Our VAP rate decreased by 53% for FY2010
and by 42% for FY2011. Overall decrease from FY2009 to FY2011
was 73%. Lessons Learned: •Developing a team with a staff
nurse and physician as champions is essential to facilitate successful
buy-in from all physicians, nurses, and support personnel •Ongoing
education is the foundation of successful outcomes •Peer to peer
accountability promotes ownership of patient care and outcomes,
as well as allows real-time feedback on bundle noncompliance

•Frequent audits quickly identified real-time opportunities

for reinforcement and improvement, but also celebration of
individual staff successes as it related to bundle compliance
•Ventilator associated pneumonia rates reported to staff monthly
showing the results of their efforts and celebrate successes

84 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Infection Prevention and Control Programs

Presentation Number 8-117 insertion in the operating room resulted in a decreasing trend for
infection, though not statistically significant. Possible reasons for
Building and Maintaining Best Practices to this outcome are better compliance with barrier precautions and
use of chlorhexidine. Ongoing surveillance is an integral part of
decrease Vascular Access-Associated Infections
best practices for continuous quality control in vascular access and
in the Use of Peripherally Inserted Central outcomes.
Catheters

Joanna Acebo, MD - Pediatric Infectious Diseases Physician,

Hospital SOLCA-Núcleo de Quito; Carlos Vicuna, MD - Pediatric Presentation Number 8-118
Oncology Surgeon, Hospital SOLCA-Núcleo de Quito; Jose M.
Eguiguren, MD - Chief of Pediatrics, Hospital SOLCA-Núcleo Implementing Mandatory Influenza Vaccination
de Quito; Don Guimera, BSN, RN, CIC, CCRP - International policy for Health Care Workers at a Long Term
Epidemiology Coordinator, St. Jude Childrens Research Hospital; Acute Care Facility
Kyle M. Johnson, PhD, CCRP - Clinical Research Associate II, St.
Jude Children’s Research Hospital; Miguela Caniza, MD - Director
Teena Chopra, MD, MPH - Associate Coorporate Director,
of Infectious Diseases-International Outreach Division, St. Jude
Infection Prevention, Epidemiology and Antibiotic Stewardship,
Children’s Research Hospital
Detroit Medical Center and Kindred Hospital Detroit
Background/Objectives: Central venous catheters
Background/Objectives: Although annual influenza
are indispensable devices in oncology that are used to administer
vaccination is recommended for healthcare workers (HCW) by
intravenous therapies, parenteral nutrition or blood products. The
the Center for Disease Control and Prevention (CDC), the rate
advantages of PICC include: easy insertion and removal, long term
of HCW who receive vaccination continue to be low. Whereas,
usability (up to six months), and insertion with local anesthesia.
many acute care centers have mandated influenza vaccination
In this study we ascertain infection rates of PICCs, and report
policy, scant data exits on such policy in long term acute centers
the results of introducing best practices and continuous quality
(LTACs). This study determined the effect of implementation of a
improvement in inserting and caring for this type of catheter.
mandatory influenza vaccination at a long Term Acute Care hospital
Methods: We prospectively evaluated all PICCs inserted
in Detroit, Michigan. Methods: Annual influenza vaccination
between July 2009 and December 2011 among pediatric oncology
data from 2008 to 2011 was reviewed to identify vaccination rates
patients in a 160-bed oncology hospital in Quito, Ecuador. In the 30-
among different job categories in HCWs at Kindred hospital, a
bed pediatric wards, 14 nurses and five physicians care for children.
77 bed LTAC in Detroit Michigan. In 2011, with support from
A multidisciplinary vascular care team includes nurses, physicians,
administration, mandatory influenza vaccination and educational
a surgeon, and a pediatric infectologist. Best practices in the use of
campaigns were included as part of annual mandatory competency
PICCs were: 1) develop institutional policies and procedures for
health fair. At competency fair, employees who received flu
insertion and maintenance of a PICC, such as performing hand
shot or showed proof of vaccination from somewhere else were
hygiene before handling and inserting the catheters, using appropriate
given stickers that identified them as being compliant with the
barrier methods for insertion, and doing skin antisepsis before the
mandatory flu vaccination. Employees who declined vaccination
procedure; 2) train all care providers in the policies and procedures;
were required to wear a mask within six feet of patient care during
and 3) monitor performance continuously through a surveillance
influenza season. Vaccination data from 2008 to 2011 was analyzed
system. We analyzed two periods. During the first period, July 2009
using descriptive statistics. Results: Influenza vaccination rate
to June 2010, the devices were inserted in the outpatient procedure
increased from 25% (n=272) in 2008–2009 to 65% (n=279)
room and polyvinyl pyrrolidone was used for skin antisepsis. In the
in 2010 - 2011 influenza season (n= 145) in 2010–2011 (p <
second period, July 2010 to December 2011, insertion was done
0.05). However, rate among physicians in 2008–2009 was not
in the operating room, using 2% chlorhexidine for skin antisepsis.
significantly different from rate in 2010–2011 [27% (n= 23) vs
The evaluation of infection rates in the two groups ensued. Bed rate
29% (n= 19]. The reasons for declination as given by some HCWs
occupation in the first and second period were 61.4% and 66.7%
included fear of needle (6%), fear getting influenza from vaccine
respectively. During the study, 58.4% of children with cancer had
(5.3%), non-belief in vaccination in general (12%), and no reason
central venous access and 2.5% corresponded to PICC. Care post-
(73%).Conclusions: Long-term care facilities have very high
insertion remained similar between the two periods and all other
risk elderly patient population and hence mandatory influenza
periodic education and training remained unchanged. Results:
vaccination seems to be an effective measure to improve vaccination
The total number of PICCs inserted was 58, with 442 catheter-days.
rates among health care workers in LTACs. Annual competencies
The global PICC infection rate during the observation period was
done routinely at LTACs seem to be the right time for instituting
1.8 infections per 100 catheter days. Comparing the first with the
a mandatory influenza policy to improve rates. However, lack of
second period, we observed 3 catheter infections during 120 catheter
knowledge about the safety and effectiveness of the vaccine continue
days (2.5 infections per 100 catheter days) vs. 5 infections during 322
to have effect on influenza vaccination rates.
catheter days (1.5 infections per 100 catheter days) with RR=1.6
(95% CI 0.39-6.63). Conclusions: Infection complications
rates of PICCs are similar to those published in the literature. PICC

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 85
Poster Abstracts: Infection Prevention and Control Programs

Presentation Number 8-119 Presentation Number 8-120

Education and Communication: Improving Patient Infection Control Liaisons: Weapons Against
Safety and Increasing Employee Knowledge in an Hospital Acquired Infections
Acute Hospital Setting
Saungi A. McCalla, MSN, MPH, RN, CIC - Director of Infection
Louise Hesse - Infection Prevention Specialist, Desert Springs Prevention and Control, White Plains Hospital; White Plains
Hospital Medical Center Hospital Infection Control Liaison Team - Hospital, White Plains
Hospital
Issue: The Nevada State Health Division of Healthcare Quality
and Compliance sponsored a grant based on the Centers for Issue: Hospital-acquired infections are adverse patient events
Disease Control and Prevention (CDC) guideline, “Management that affect approximately 2 million persons annually. Multi-Drug
of Multidrug-Resistant Organisms in Healthcare Settings, 2006.” Resistant Organisms (MDROs) are often hospital acquired and
The hospital performed a self assessment based on this guideline and can cause devastating effects on patients and hospitals such as
found that Education and Communication were areas in need of increase length of stay, increase costs and increase morbidity and
improvement. Project: The Infection Prevention Department mortality. According to the CDC, during the last several decades,
developed a program to increase education and communication the prevalence of MDROs in U.S. hospitals and medical centers has
among employees, patients and their families relating to the increased steadily. In 2008, the Infection Control Department at a
management of multidrug-resistant organisms in the healthcare community hospital in New York developed a multidisciplinary IC
setting. A patient education flyer was produced outlining the Liaison Committee with representation from many departments
prevention, risks and care of the patient with a multidrug-resistant across our hospital. The goal of this committee is to create awareness
infection. An Infections Present on Admission/Hospital Course and to increase staff understanding of infection prevention and
form was created and placed in the patient’s chart to communicate control at the unit/department level. The team meets monthly for
with employees the patient’s infection and isolation status and education, to discuss issues and to work on solutions. In 2009, the
document that the patient education flyer is given. The inter-facility liaisons reported that they were seeing more MDRO on their units.
transfer form was developed to alert the receiving facility of the Review of the 2009 surveillance data revealed significant hospital
type of infection, and the patient’s need for isolation. The Infection acquired MDROs (HA- MDRO) infections on the units. Overall,
Prevention Department is responsible for identifying patients with there were a total of 104 infections for a rate of 1.6 per1000 patient
infections and placing the study related forms in the patient’s chart. days. The committee’s main objective for 2010 was to reduce
A magenta sticker on the front of the chart alerts the employee that HA-MDRO infections on the units. Project: The committee
their patient is a study participant. Outcome measures for this project reviewed our current policies and compared it to all pertinent
include healthcare associated infections at or below the National evidenced-based guidelines and recommendations to identify gaps
Healthcare Safety Network (NHSN) benchmarks, documentation any in practice. The review identified that the policies were consistent
that the patient education flyer was given, and the inter-facility with the current guidelines, but that compliance was lacking in key
transfer form was initiated eighty percent of the time. Results: areas such hand hygiene and personal protective equipment (PPE).
The study began September 20, 2011 and is due to continue through The committee decided to focus their efforts on hand hygiene,
April 2013. The following results are from the time period September PPE and isolation. They re-educated staff on their respective units/
20, 2011 through December 20, 2011. The results are based on these departments on hand hygiene, PPE and isolation, and the importance
outcome measures, healthcare acquired infections, documentation of compliance. They also adopted the slogan “if you see something,
of the use of the educational flyer and implementation of the say something,” engaging all staff including environmental services
inter-facility transfer form upon patient transfer. The healthcare and unit secretaries to intervene immediately whenever they
acquired infections measured are central line blood stream infections, observed non-compliant behaviors. Through this process the staff
catheter associated urinary tract infections, ventilator associated was empowered to be true infection control champions on the units
pneumonia, surgical site infections, laminectomies, Clostridium with strong support from hospital leadership. Results: For the
difficile and Methicillin-Resistant Staphylococcus aureus infections. surveillance period of January-December 2010, the number of HA-
The measurements of these infections were within the benchmarks MDRO infections decreased on the units from 104 in 2009 to 59
of NHSN. From September 20, 2011 through December 20, 2011 in 2010 and from a rate of 1.6 per 1000 patient days to 0.9 per 1000
the Inter-facility transfer form was implemented 44%, 68% and patient days. By decreasing the number of HA-MDRO infections
47% respectively. The use of the educational flyer for the same the IC Liaison Committee were able to demonstrate a significant
time period was 62%, 69% and 69% respectively. The percentages cost avoidance of approximately $400, 000 in one year, along with a
were determined by dividing the number of patients who received substantial reduction in patient morbidity and mortality. Lessons
the paperwork by all the patients who were eligible to receive the Learned: Collaboration is key to infection prevention. The
paperwork. Lessons Learned: Providing employees the data liaisons are especially effective in the implementation of new
from outcome measures provides a sense of ownership. Continued infection control policies and initiatives because of the rapport
education and multiple daily rounds have improved communication with staff on the units, an understanding of unit specific challenges,
and compliance with isolation protocols. Perseverance with the and the ability to promote strategies that are most likely to be
Inter-facility transfer form and follow up with patients in the study is successful on their particular units. The liaison program is vital in our
crucial for success of the project. organization in promoting quality patient care and patient safety.

86 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Infection Prevention and Control Programs

Presentation Number 8-121 hand-hygiene compliance were observed in the control departments
during the study period. Conclusions: Hand hygiene remains
Hospital Hand Hygiene Compliance Improves with the most effective practice for decreasing Healthcare Associated
Infections. It is imperative for Infection Prevention departments
Increased Monitoring and Immediate Feedback
to evaluate new methods for the purpose of gaining better HCW
compliance. The implementation of the DUMC-inspired hand-
Judith ( Judy) L. Walker, RN, BSN, MHSA, CIC - Director of hygiene monitoring program increased compliance an average of
Infection Prevention, Mercy Hospital Springfield; William Sistrunk, 36% in the experimental departments. Success of this program is
MD, FACP - Medical Director Infection Prevention, Mercy Hospital attributed to increased visibility and accountability, immediate
Springfield MO; Mary Ann Higginbotham, BSN, CIC - Infection HCW feedback, and providing real-time data to hospital leadership.
Preventionist, Mercy Hospital Springfield MO; Kristi Burks, RN Mercy Hospital Springfield plans to expand the program to include
- Infection Preventionist, Mercy Hospital Springfield MO; Linda other departments with the goal of increasing hand hygiene
Halford, BSN, CIC - Infection Preventionist, Mercy Hospital compliance hospital wide.
Springfield MO; Linda Goddard, BS - Infection Preventionist,
Mercy Hospital Springfield MO; Phillip J Finley, PhD - Mercy
Medical Research Institute, Division of Trauma and Burn Research, Presentation Number 8-122
Mercy Hospital Springfield MO; Lindsay Bellm - Master of Public Using Infection Surveillance to Improve the Quality
Health Program- Student, Missouri State University, Springfield of Care in a Cancer Unit in a Children’s Hospital in
MO; Jamie Shank - Master of Public Health Program- Student,
Argentina
Missouri State University, Springfield MO; Vickie Sanchez, EdD,
MPH, CHES - Faculty , Missouri State University, Springfield MO
Sergio M. Gomez, MD - Hematology-Oncology and Bone Marrow
Transplant Physician, Hospital de Niños Sor Maria Ludovica;
Background/Objectives: Similar to most hospitals
Maria Fernanda Sosa Pueyo, RN - Infection Preventionist,
across the Nation, Mercy Hospital Springfield is concerned with
Hospital de Niños Sor Maria Ludovica: ; William Sistrunk, MD,
hand hygiene compliance. ‘Secret shoppers’ monitoring hand
FACP - Medical Director Infection Prevention, Mercy Hospital
hygiene compliance reported a rate of 95%. However, Infection
Springfield MO; Mary Ann Higginbotham, BSN, CIC - Infection
Prevention found the actual rate to be 50-55%. This discrepancy
Preventionist, Mercy Hospital Springfield MO; Kristi Burks, RN
was hypothesized to be due to reporting bias of the ‘secret shoppers.’
- Infection Preventionist, Mercy Hospital Springfield MO; Linda
In 2009, Duke University Medical Center (DUMC) initiated a
Halford, BSN, CIC - Infection Preventionist, Mercy Hospital
technology-based hand hygiene monitoring system. Independent,
Springfield MO; Linda Goddard, BS - Infection Preventionist,
visible observers monitored healthcare workers’ (HCW) hand
Mercy Hospital Springfield MO; Phillip J Finley, PhD - Mercy
hygiene (‘foam-in foam-out’) when entering and exiting patient care
Medical Research Institute, Division of Trauma and Burn Research,
areas and provided real-time data to hospital leadership. DUMC has
Mercy Hospital Springfield MO; Lindsay Bellm - Master of Public
increased compliance rates to 90% for the last 3 years (50% above
Health Program- Student, Missouri State University, Springfield
national average). Methods: Mercy Hospital Springfield, in
MO; Jamie Shank - Master of Public Health Program- Student,
collaboration with Missouri State University Master of Public Health
Missouri State University, Springfield MO; Vickie Sanchez, EdD,
Program, developed a pilot study following the DUMC model.
MPH, CHES - Faculty , Missouri State University, Springfield MO;
Four hospital departments served as pilot units for this study (2
Kyle M. Johnson, PhD, CCRP - Clinical Research Associate II, St.
experimental and 2 control). Following Institutional Review Board
Jude Children’s Research Hospital: Miguela Caniza, MD - Director
approval, baseline hand hygiene data were collected. A new education
of Infectious Diseases-International Outreach Division, St. Jude
program was provided to the experimental units, physicians, and
Children’s Research Hospital
ancillary staff. Infection Prevention performed observations of hand
hygiene compliance during a five month period. Compliance was
operationally defined as HCW foaming in and out of every patient Background/Objectives: Access to data on infections and
room. If non-compliant, the HCW was immediately approached their risk factors provide an objective guide for quality improvement
and educated. Observations continued in control units without and infection prevention. Collecting, communicating and acting
intervention. Data were recorded on electronic hand-held devices and on the results of the analysis is the cornerstone for prevention and
disseminated to hospital leadership. Results: Data were screened control of healthcare associated infections (HAI). We report the
prior to analysis for accuracy and normality. Crosstabulation and institutional response to the information obtained through use of
the chi-square test for independence were used to analyze the data. the surveillance tool and the infectious outcomes. Methods: The
An alpha criterion of p < 0.05 was used throughout the analysis. patient care unit (PCU) has 17 beds (occupancy 90%), 47 nurses and
During the study period, both experimental departments showed doctors care for the patients. The Registry of Infections and their Risk
statistically significant increases in hand-hygiene compliance p < Factors (Registry) is an infection surveillance tool used to, ultimately,
.05. Experimental Department 1 increased compliance from 49% improve care of children with cancer at the PCU. It was developed
to 86% and Experimental Department 2 increased from 60% to by a U.S. Hospital. Those using the Registry in their PCU are given
95%. In addition, by the conclusion of the study, compliance in both training on use of the form, manual of procedures and electronic
experimental departments (86% and 95%) were significantly higher database. Approval of the Registry was obtained by local ethics
(p <.05) compared to either of the control departments (Control committee. Data is collected using standard definitions in all children
1 = 52%, Control 2 = 37%). No clinically significant changes in admitted to the PCU. We calculated frequencies, percentages and

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 87
Poster Abstracts: Infection Prevention and Control Programs
relative risks of infection, and mortality due to infection during program for HH compliance o A power point presentation at
the observation period. Results: From November, 2010 to departmental meetings and dissemination of handouts about proper
November 2011, 308 children were admitted to PCU including 227 practices, current hand- washing rates, and an initiative overview o
(73%) patients with acute lymphoblastic leukemia (ALL), 16 (5.2%) Visual aids such as posters and stop signs that reminded HCW to
with acute myeloid leukemia (AML), 37 (12%) with lymphomas, engage in proper HH behavior o Reminders of what appropriate
8 (2.6%) were admitted for other malignancies and 19 (6.1%) had HH entails • Weekly reminders were sent via email • HCWs were
no malignancy. The global HAI rate was 26/1000 patient days. encouraged to identify others within the ED who were compliant or
For ALL and AML, the HAI rate was 19.0 and 68.3/1000 patient non-compliant, by giving a small paper hand cut-out o Compliant
days, respectively. The most common pathogen identified was HCWs received a white (clean) hand, with a positive statement
Staphylococcus aureus; soft tissue infections were most common. The acknowledging good behavior, ex. “You saved a life!” o Non-
most significant risk factor for HAI acquisition was neutropenia compliant providers received a green (dirty) hand print, stating “You
(RR: 4.968, 95% CI=3.977-6.205) and AML (RR: 3.566, 95% Bug Me” • “Hands” of compliant HCWs were posted on a “Good
CI=2.265, 5.616). It was found that 23% (9/39) of the bacteria Hand Hygiene Board” and were entered into a monthly drawing
isolated were multidrug resistant; therefore active surveillance was to win a monetary award • Recipients of a “dirty hand,” had their
started. Periodically, results were provided to hospital leadership, name placed in a log and participated in counseling sessions with
and other responsible individuals, to raise awareness and improve supervisors. Repeated infractions required counseling sessions with
quality of service. Under the guidance of infection preventionists, senior level administrators and ultimately the CEO of the hospital.
best practices were introduced. Patient care areas were cleaned twice a Results: The ED recognized improvements in HH rates from
day, air filters were changed more frequently, water storage tanks were 75.68% in November 2010 to 94.88% in June 2011. A total of 1861
closed and cleaned at least twice a year, bed sheets are changed once observations were completed from December 2010 to June 2011.
a day, and patients now wear pajamas. Using standard guidelines, Sub-analysis revealed that among HCWs, nurses tended to have
staff was trained in standard and transmission based precautions and better HH behaviors as compared to physicians. Two patient care
in the care of immunocompromised children. Patients and families zones (high-acuity and a low-acuity) were compared to address the
began to be educated about general and hand hygiene through potential variance of HH compliance as a function of patient acuity.
workshops. Infections among children with AML and mortality High acuity zones had lower rates of compliance than the low acuity
were further decreased since implementing antibiotic prophylaxis zone (84% vs. 91%, p=0.007). Overall, rates of compliance post-
during neutropenia. Conclusions: The Registry enabled us to intervention were higher than for the pre-intervention period (85%.
detect important gaps and formulate interventions focusing on staff vs. 92%, p=0.0001). Lessons Learned: • Generating HCW
education, improving the environment of care, while gaining support engagement in proper HH practices is essential • The presence
from hospital administration, in a systematic manner, based on the of HH champions is imperative • Multiple modalities of HH
evidence gathered during this one year time period. education reinforcement are necessary for continued improvement
• Rapid cycle, real-time feedback initiative allowed for sustained
improvement in HH compliance with low cost

Presentation Number 8-123

Impact of a Rapid Cycle Hand Hygiene Initiative in

a Pediatric Emergency Department

Andrea Kiernan, MLT (ASCP) CIC - Infection Preventionist,

St. Christopher’s Hospital for Children; Patricia Hennessey, RN,
BSN, MSN, CIC - Manager, Infection Prevention, St. Christopher’s
Hospital for Children

Issue: Despite the hospital’s ability to sustain hand hygiene (HH)

rates above 90%, the ED had rates below the hospital average. Data
indicated ED HH rates to be 76% in November 2010. Prior to
the “Clean Hands/ Dirty Hands” initiative, ED HH compliance
rates for September, October and November 2010 were 87.5%,
85.7% and 76% respectively (mean= 83.1%). Project: A rapid
cycle QI initiative was implemented in the ED to improve HH
compliance rates. The multi-modal initiative consisted of provider
education, direct HH observations, peer-accountability, provider Presentation Number 8-124
feedback, visual aids, weekly email reminders, and an incentive and
deterrent program for HH behaviors. • HH observations (further The Quest to Reach Zero Central Line-Associated
detail under “data collection”) • Healthcare worker (HCW) Bloodstream Infections
accountability for HH compliance, with no relevance of hospital
hierarchy • Implementation of a multidisciplinary education
Adriene Thornton, RN - Infection Preventionists, Children’s

88 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Infection Prevention and Control Programs
Hospitals and Clinics of Minnesota; Melanie Kuelbs, RN -
Registered Nurse, Children’s Hospitals and Clinics of Minnesota;
Erin E. Zielinski, CCRP - Clinical Research Associate, Children’s
Hospitals and Clinics of Minnesota; Meixia Liu, MS - Health
Services Research Specialist, Children’s Hospitals and Clinics
of Minnesota; Stephen Kurachek, MD - Intensivist, Children’s
Hospitals and Clinics of Minnesota

Issue: Prior to 2006, the PICU institutional practice guidelines for

central line care were based on the recommendations of the National
Nosocomial Infections Surveillance (NNIS). These guidelines were
comprehensive but not effective in decreasing central line-associated
bloodstream infection (CLABSI) incidence rates. Project: As
part of a National Association of Children’s Hospitals and Related
Institutions (NACHRI) collaborative, central-line care bundles were
implemented from September 2006-September 2010. The central
line insertion bundle included; hand hygiene prior to inserting a line,
use of full barrier precautions during the insertion of central venous Presentation Number 8-125
catheters, cleaning skin with chlorhexidine when not contraindicated,
avoiding use of the femoral site for central lines when possible, daily
Embedding Hand Hygiene into a Patient Centric
assessment of the need to maintain a central line catheter and use of
a checklist when inserting central venous catheters. The central line Communication Model: C-I-CARE
maintenance bundle included; hand hygiene prior to beginning a
dressing change, use of dressing change kit (contains a mask, sterile Alexandra S. Madison, MPH, CIC - Mngr. Infection Control &
gloves, transparent dressing and chlorhexidine for cleaning skin), Epidemiology Dept., Stanford Hospital & Clinics; Debra Johnson -
and use of a checklist when performing a dressing change. Use of Infection Control Nurse, Stanford Hospital and Clinics
chlorhexidine wipes for all central line cares was also implemented.
A retrospective study reviewed the critically ill patients in the Issue: Hand Hygiene compliance remains a challenge for healthcare
Pediatric Intensive Care Unit (PICU) and Cardiac-vascular Critical institutions. Re-invigorating existing hand hygiene programs is an
Care (CVCC) between January 1, 2005 and December 30, 2011 essential component of all hospital infection prevention programs.
to evaluate the impact of a quality improvement effort. CLABSI One such novel approach was to embed hand hygiene in a patient
rates from year 2005 and Quarter 1-2 of year 2006 were used as the centric communication model allowing the medical center to achieve
baseline to compare to the CLABSI rate of post implementation of and sustain its hand hygiene compliance goal of great than 90 percent.
central-line care bundles. Results: The average baseline CLABSI Project: In early 2011 a 452 bed academic medical center began
rate before implementation of the central-line care bundles was 3.6 a patient centric journey utilizing an innovative communication
CLABIs per 1000 central line days. At the conclusion of participation model called “C-I-CARE” (Connect, Introduce, Communicate,
in the collaborative in 2010, the average rate was significantly Ask, Respond and Exit). C-I-CARE is a framework for structuring
decreased to 0.7 CLABSIs per 1000 central line days (p<0.001). best practice communications and developing relationship based
Consistent implementation of central-line care bundles decreased the care approaches with patients. This program was a senior leadership
CLABSI rate in the PICU by 80.6% over 4 years. At the end of 2011, initiative implemented throughout the entire medical center. All
the average rate was 1.2 CLABSIs per 1000 central line days, which departments were required to create scripted templates to ensure
was significantly lower than the baseline rate (p=0.002). Lessons C-I-CARE was followed in all patient interactions. The Infection
Learned: Implementation of central line care bundles has been Prevention program saw this innovative model as an opportunity
essential in our patient care practices and supports the sustainability to re-invigorate the existing hand hygiene program by imbedding
of the lower CLABSI rates. hand hygiene in all the scripted templates and training videos. This
enabled hand hygiene to be seen as an integral part of all patient-
centric interactions, and not as a stand-alone activity. The model
requires scripting of variety of scenarios for EVERY department in the
entire medical center. The initial patient greeting template includes
“Connect “as the first step. The script states: “Gel in/perform hand
hygiene” and the video shows the patient care team entering the room
performing hand hygiene. The final step in C-I-CARE is “Exit” at
which point the script and training video again reinforce hand hygiene
concepts. Results: Hand hygiene compliance rates have been
collected on a monthly basis since third quarter, 2006. The C-I-CARE
program education was completed by the end of the second quarter
of 2011. The hand hygiene compliance rate for the third and fourth
quarters, 2011 was greater than 90 percent. Lessons Learned:

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 89
Poster Abstracts: Infection Prevention and Control Programs

Embedding hand hygiene in the C-I-CARE program not only circuits, or alcohol gel) or a shift of untrained nursing personnel. At
increased compliance rates, but made hand hygiene truly an every present, alcohol gel and trained nurses are available, and the Ministry
time, no exceptions practice. of Health is in the process of purchasing spare parts. Lessons
Learned: Improvement measures for the prevention of VAPs
are sustainable and entail a low cost of investment in relation to the
excess cost represented by the cases. Effective implementation of
Presentation Number 8-126 these measures is also feasible in the context of continuous quality
improvement in the prevention of VAPs.
Interventions to Improve Ventilator-Associated
Pneumonia in the Intensive Care Unit of a Pediatric
Hospital in Nicaragua Presentation Number 8-127
Maria Mercedes Somarriba, MD - Infectious Diseases Physician, Reporting Capabilities and Data Extrapolation
Hospital Infantil Manuel de Jesús Rivera; Maria N. Aguilar -
Using an Electronic Hand Hygiene System Versus
Nurse Infection control, Hospital Infantil Manuel de Jesus Rivera
the Traditional Covert/Secret Shopper Visual
- Nicaragua; Miriam Chamorro - Intensivist Pediatrician, Hospital
Infantil Manuel de Jesus Rivera; Grania I. Obando - Intensivist Observation Method
Pediatrician, Hospital Infantil Manuel de Jesus Rivera; Sergio Lopez
- Medical Microbiologist, USAID-HCI Jill N. Goetzinger, RN - Infection Preventionist, Miami Children’s;
Deise Granado-Villar, MD - Chief Medical Officer, Miami
Issue: A systematized process for surveillance and control Children’s Hospital
of ventilator-associated pneumonia (VAP) did not exist in the
intensive care unit (ICU) of Hospital Infantil, a pediatric hospital Issue: Covert or secret shopper visual observation had long been
in Nicaragua, before July 2008. Surveillance and interventions to the standard for collecting data on hand hygiene practices among
improve rates of VAP were organized with the assistance of the healthcare workers (HCW). This method has been found to be (i)
USAID/HCI Project, and changes geared toward VAP prevention limited in regards to subjectivity and opportunities for observation,
were implemented based on cycles of continuous improvement. (ii) time consuming, and (iii) labor intensive during aggregation
Before the intervention, the VAP rate was 40 per 1,000 ventilator of data in a standardized, readable format. Project: Miami
days. Project: We planned and implemented a quality Children’s Hospital implemented an electronic hand hygiene
improvement program for ventilator use in the ICU. The first step monitoring system (EHHS) in a 22-bed unit in August, 2010. In
was organizing a team of physicians and nurses to implement changes August/September 2011, EHHS was introduced on the medical/
in quality improvement to prevent VAP. Deficient clinical practices, surgical floors covering a further 174 beds. Information regarding
such as lack of appropriate hand hygiene, inadequate aspiration of hand hygiene for all patient interactions within the defined bed zone
respiratory secretions, patient head position at an angle lower than area were transmitted to a web based reporting system. A comparative
the recommended 30 degrees, incorrectly positioned ventilator review of the fourth quarter results for the nursing floors from
circuits, and condensation inside the circuits, were identified, and 2008-2011 (study period) was completed. Data from the EHHS was
corrections were implemented. VAP rates served as indicators of viewable by bed, unit, time, employee, department, and discipline.
the effectiveness of the changes implemented. The interventions The data was obtained objectively, i.e., the employee either did or
consisted of simple, low-cost measures, including the correct use of did not use an alcohol-containing cleansing product (soap or alcohol
antibacterials and disinfectants; appropriate hand hygiene before, based hand rub [ABHR]) before approaching the patient care area.
during, and after handling and administering mechanical ventilation; Information was drilled down to individuals or beds with an exact
aspiration of secretions; drainage of condensation in circuits; number of patient interactions (both compliant and non-compliant)
verification of a patient’s 30-degree head angle; and administration and was converted into a compliance rate. If a hospital-acquired
of H2 blockers, if applicable. We conducted research into the cost-
effectiveness of the intervention measures and the extent to which
VAPs were avoided (in press, International Journal of Pediatrics).
The organized team was responsible for monitoring the prevention
standards and VAP indicators. Monthly meetings were held with
the USAID/HCI consultant to analyze results and propose
improvements based on identified benchmarks. During the yearlong
intervention period, we shared our experiences with professionals
from other hospitals who were conducting the same interventions,
and a VAP prevention algorithm was jointly created as a result. This
algorithm was approved by the Ministry of Health and is now used
in all of the ICUs in the country. Results: The result was that
the VAP rate was reduced from 40 to 9 per 1,000 ventilator-days
with a median of 12.5 in a 30-month surveillance period. The VAPs
that were detected were associated with a lack of spare parts (filters,

90 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Infection Prevention and Control Programs

was also accessible by individual employees on the computer. Any

of the data was able to be accessed with the click of a mouse for any
defined time period. Data was able to be stratified by individual,
unit, department, and discipline. EHHS was also able to send email
reports regarding usage and rates to selective HCWs. Results:
During the study period, hand hygiene compliance was as follows:
97% in 2011 (97,442 patient interactions); 94% in 2010 (9,788
interactions); 99% in 2009 (160 interactions); 98% in 2008 (102
interactions). Lessons Learned: Traditional data collection
and extrapolation methods are time consuming and labor intensive to
use. They tend to be biased by user subjectivity and offer a finite view
of select patient interactions. EHHS reporting saves time and labor
costs, objectively measures hand hygiene compliance continuously,
presents information clearly and concisely, can be easily disseminated
for real time feedback, and is available 24/7. Non-compliance can
be addressed almost immediately. This newer technology allows for
enhanced surveillance and improvement in both clinical outcomes
and patient safety.

Presentation Number 8-128

Infection Prevention and Control Program

in a Public Pediatric Hospital in Argentina:
Opportunities for Improvement

Carlos Daniel Acevedo, RN - Nurse Preventionist, Hospital

Humberto Notti; Hector Jose Abate, MD - Chief of Infectious
Diseases, Hospital; Ana M. Rosaenz, MD - Pediatric Infectious
Diseases, Hospital Humberto Notti; Andrea Falaschi, MD -
Pediatric Infectious Diseases, Hospital Humberto Notti; Pablo
Melonari, MD - Pediatric Infectious Diseases Physician, Hospital
Humberto Notti; Liliana Rosaenz, MD - Bacteriology, Hospital
Humberto Notti; Elsie L. Gerhardt, MA, MPH candidate -
Administrative Specialist, St. Jude Children’s Research Hospital,
University of Memphis; Don Guimera, BSN, RN, CIC, CCRP
- International Epidemiology Coordinator, St. Jude Childrens
Research Hospital; Kyle M. Johnson, PhD, CCRP - Clinical
Research Associate II, St. Jude Children’s Research Hospital; Miguela
Caniza, MD - Director of Infectious Diseases-International Outreach
Division, St. Jude Children’s Research Hospital

Issue: Infection prevention and control (IPC) programs are

essential in hospitals to deliver safe care and decrease costs. In
low-income countries, most public hospital budgets cannot fully
support IPC programs, and the infection preventionists (IP) are
too overworked to perform all of their duties. In addition, although
IPC programs save lives and money in the longer term, necessary
resources inevitably compete with the immediate needs of the
hospital. Project: An IPC program was established in 1994 in a
270-bed, regional tertiary children’s hospital to decrease healthcare-
associated infections (HAIs). Program components are an IP and a
infection (HAI) was identified, the interactions leading up to the
multidisciplinary committee that meets monthly to review HAI rates
event was reviewed to ascertain whether hand hygiene adherence
and to establish strategies for decreasing HAI-associated mortality,
played a possible role in transmission. The aggregated information,
morbidity and costs. All committee decisions are binding. IPC
was posted electronically on a monitor for real-time feedback to
activities are regulated by policies and procedures (P&Ps) developed
staff and included data on current usage and compliance rates and
and approved by the program. The program conducts periodic

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 91
Poster Abstracts: Outbreak Investigation
training in IPC and enforces compliance with hospital personnel of behavioral health occupies 3 floors and includes an inpatient
hepatitis-B vaccination. The microbiology laboratory collaborates psychiatric unit, psychiatric day treatment program, neuropsychiatric
with WHONET and provides data on isolated pathogens, and the specialty care unit, eating disorders unit, medical day treatment
pharmacy advises on the availability and use of antibiotics. Hospital unit and several outpatient clinics which provide a wide range of
leaders support the program and the IP answers to the president of psychiatric care to pediatric patients and their families. At the start
the IPC program. Most of the activities charged to the IPC program of the investigation, on October 3, 2011, 32 staff and patients,
are conducted by the IP and include ongoing surveillance, patient with gastrointestinal symptoms had been identified dating back to
rounds, microbiological analyses, isolation, and data entry. The September 21, 2011. Due to the number of individuals affected and
IP trains personnel in IPC practices, products use, and behavior illness presentation, norovirus was assumed to be the causative agent.
modification, and he also manages compliance issues, reports data The inpatient psychiatric unit was immediately closed to further
to a national network, and identifies ways to decrease the risk of admits, all patients were placed on contact precautions, visitation
HAIs. Results: Since its inception, the IPC program has become was limited to 1 parent, and environmental services was contacted
a key facet of the hospital. The IP works hard in his traditional to begin terminal cleaning with Dispatch. A case definition was
role overseeing surveillance, teaching and quality control, and has identified which included any Children’s Hospital Colorado staff,
additional roles in administration and data-management. He is patient or family member whom had contact with the inpatient
supported and respected by his colleagues, and collaborates with all psychiatric unit, staff and/or patients in the previous 72 hours and
hospital departments. The catheter-related urinary tract infection was experiencing at least one symptom including vomiting, diarrhea,
and the ventilator-associated pneumonia rates have decreased steadily fever/chills, abdominal cramping or body aches. Results:
since 2005, specifically in the pediatric ICU. However, catheter- Overall, 118 individuals became ill during the course of the outbreak
related sepsis and bacteremia rates have remained high as well as (71 staff; 30pts; 17 family members). Five of these individuals
infections among neonates. In 2005, the IPC program joined the required hospitalization for dehydration. The outbreak lasted from
Programa Nacional de Vigilancia de Infecciones Hospitalarias de September 21, 2011 to October 28, 2011. Two of 8 submitted stool
Argentina (VIHdA), a national HAI system that uses the National samples were positive for norovirus by PCR. The initial cases were
Healthcare Safety Network definitions, to provide database and identified on the 6th floor of the behavioral health department and
technical support. This collaboration calculates and reports on rates then spread to the 5th and 4th floors. Spread was thought to occur
and trends and allows comparison to national trends. Lessons as a result of staff working between multiple floors. The outbreak
Learned: The IPC program has been in place for the past 17 resulted in closure of all inpatient, day treatment units and outpatient
years. Successes include organization structure, multidisciplinary IPC clinics from October 3rd through October 28th. Environmental
membership, support from hospital leaders and staff, and dedicated Services staff full-time equivalents were increased 3-fold. Lessons
IP personnel. However, to move forward and address the high rates Learned: Inpatient psychiatric units are a particularly challenging
of infection, the institution must invest in program administrative area to prevent and/or contain infectious outbreaks due to the nature
support. The IP can then devote more time to surveillance, education, of the environmental setting and patient population. Strict adherence
and other strategies for decreasing the infection rates. to isolation precautions and hospital policy and procedures for
staying home when ill are critical to the prevention of outbreaks.
During the course of an outbreak, early and open communication
lines are essential between hospital employees, epidemiology, and
executive leadership to limit confusion and misconceptions regarding
Outbreak Investigation the outbreak. Heightened awareness and early reporting of clusters of
illness in both patients and staff are essential for early recognition and
Presentation Number 9-129 containment of outbreaks.

Outbreak Management of Norovirus in a Pediatric

Behavioral Health Setting

Kelly West, MS, RN, CPON - Clinical Practice Specialist-

Infection Prevention, Children’s Hospital Colorado; Samuel R.
Dominguez, MD, PhD - Assistant Professor and Hospital Microbial
Epidemiologist, University of Colorado School of Medicine and
Children’s Hospital Colorado

Issue: In October 2011, an outbreak investigation of a cluster

of cases of patients and staff with gastroenteritis on the inpatient
psychiatric unit at Children’s Hospital Colorado began. Nearly three
fourths of cases affected hospital staff. Project: The inpatient
psychiatric unit is part of the department of behavioral health at
Children’s Hospital Colorado and is located in a separate building
but connected via hallways to the main hospital. The department

92 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Outbreak Investigation

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 93
Poster Abstracts: Outbreak Investigation

Presentation Number 9-130

Methicillin-resistant Staphylococcus aureus

Outbreak in the Neonatal Intensive Care Unit

Suzanne Rutledge, RN, BSN, CIC - Infection Preventionist,

Presbyterian Hospital - Charlotte, Novant Health

Issue: An outbreak of methicillin-resistant Staphylococcus aureus

(MRSA) infection was identified in our neonatal intensive care
unit (NICU) in the Spring of 2011. The index case was a neonate
who developed MRSA bacteremia and conjunctivitis in March,
followed by a second neonate with MRSA conjunctivitis. In
April, 2 additional neonates developed MRSA infections (1 case
of conjunctivitis, 1 cellulitis). A subsequent investigation with
changes in infection prevention practices resulted in resolution
of the outbreak. Project: Our NICU is a Level 3B unit with
an average daily census of 45. Prior to the outbreak, only neonates
transferred from outside facilities were screened upon admission
for presence of MRSA nasal colonization using rapid PCR assay. Presentation Number 9-131
When these infections were identified, all neonates sharing the same
pods as the infected neonates were screened for MRSA. All infected Why Every Hospital should be a “No Fly Zone”
and colonized neonates were cohorted and placed on contact
precautions, and healthcare workers were also cohorted whenever Ann Marie Pettis, RN, BSN, CIC - Director of Infection
possible. As additional colonized neonates were identified, MRSA Prevention, University of Rochester Medical Center; Lynn Fine,
screening was broadened to include all neonates in the NICU, with MPH, PhD, CIC - Infection Preventionist, URMC; Lynne Brown,
initiation of weekly surveillance. Colonized neonates were treated RN, BSN, MBA - Infection Preventionist, Highland Hospital;
with topical nasal and umbilical mupirocin for 5 days, and were Melissa Z. Bronstein, RN, MPA, CIC - Infection Preventionist,
rescreened 1 week later to determine if decolonization was effective. URMC; Richelle Pappalau, RN - Infection Preventionist, Rochester
If MRSA nasal colonization persisted, the neonate received 1 General Hospital ; Mark Shelly, MD - Highland Hospital; Paul
additional course of topical mupirocin therapy. Regardless of the Graman, MD - URMC
repeat screening results, all neonates remained on contact isolation
for the duration of their stay. The NICU Multidisciplinary Task Issue: Myiasis is the term for the invasion of living tissue by fly
Force (already in place) increased frequency of meetings in order to larvae. This occurs when a gravid fly lays it’s eggs in an orifice or an
address this specific issue. Infection prevention recommendations uncovered wound. Noninvasive wound myiasis is one of the more
were communicated to all departments involved in care of the common forms discussed , however reports of nosocomial wound
neonates, including respiratory therapy and physical therapy. myiasis are relatively rare. This may be explained by several facts; this
Environmental services intensified cleaning practices in the unit, is not a mandatorily reportable condition, it can be interpreted as
with special attention to high-touch surfaces. Nursing leaders a surrogate for medical negligence, and providers may not feel it is
and physician leaders were actively involved, assisting in direct worthy of reporting. As a result, the true frequency of myiasis cannot
observations of practices in the unit with frequent communication accurately be estimated A case of nosocomial wound myiasis in a 55
and feedback to staff. Results: A total of 4 neonates developed year old male with coronary artery disease (CAD) and peripheral
MRSA infections over a 1 month period. At least 2 different vascular disease (PVD) that occurred in a 750 bed university tertiary
strains of MRSA were identified based on antibiotic susceptibility hospital was investigated. Project: On August 3 Infection
profile. At one point, there were 12 neonates with MRSA. With Prevention was alerted that maggots had been found when a patient’s
the above interventions the outbreak was contained with a dressing was removed in the OR prior to performing a below the knee
continued decline in incidence of MRSA in the unit. Currently amputation. The surgery occurred in a 260 bed community teaching
there are 5 neonates with MRSA colonization in the NICU. No hospital, affiliated with the university hospital previously mentioned,
additional MRSA infections have occurred since April 2011. where the patient had been transferred from the day before, after
Lessons Learned: We had excellent adherence to infection a one month stay. The case was clearly nosocomial but two things
prevention recommendations and practices as physicians, nursing, needed to be determined; where was the patient exposed and how?
environmental services and other healthcare providers recognized Results: The gangrenous amputated limb was immediately
the critical role they play as individuals in the care and protection transferred to Pathology and continuously refrigerated at 3-5
of the neonates in their unit. All staff were empowered to enforce degrees C. On August 8 a sample of maggots was collected, placed
infection prevention practices. Hospital-acquired infections in isopropyl alcohol, and sent to the New York State Department of
decreased as a result of increased awareness and adherence to Health’s regional entomologist for identification. All were larvae of
established infection control practices, including hand hygiene and a blow fly in the genus Lucilia (order Diptera, family Calliphoridae)
strict precautions, as well as enhanced environmental cleaning.. which is the most common cause of wound myiasis in North

94 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Outbreak Investigation
America. Most case reports, including this one, occur in late Spring trays and supplies, implementing a vistor check-in process, and
or early Fall, in lower extremities of patients with PVD and/or CAD. finally closing the unit to new admissions. Initial investion led to
The age of the larvae (45 hours) proved that exposure occurred at the the hypothesis that Norovirus was the leading suspect as the cause
university hospital. It was also determined that exposure most likely of the illness. Within a week the number of new cases dropped and
occurred when the patient’s wife took him outside, 48 hours before the unit was re-opened. Lessons Learned: This was the first
maggots were discovered. Lessons Learned: Myiasis, although time than an outbreak had occurred in this facility. Use of the 13 step
not life threatening, is a condition which must be prevented since it Outbreak Investigaton process from the APIC Text and the reference
not only presents health implications, but aesthetic and cultural ones material from the EPI 201 course had a dramatic effect in sucessfully
as well . Prevention requires effort on two fronts: minimize patient controlling the outbreak. Several weeks later the State Department of
risk factors and reduce fly populations in the environment. There Health Laboratory confirmed the cause as Norovirus.
should be heightened awareness and zero tolerance for flies in the
clinical setting. In this particular case, the main lesson shared was
the importance of keeping wounds clean and covered at all times.
The importance of replacing a dressing that is leaking, soiled or Presentation Number 9-133
malodorous promptly ,and ensuring that it is secure before allowing a
patient outdoors was reinforced. A Multidisciplinary Approach toward Successful
Bed Bug Elimination in a Homeless Domiciliary
Setting
Presentation Number 9-132
Angela Christie-Smith, RN, BSN - Infection Prevention and
Control Coordinator, VA North Texas Health Care System
Norovirus Outbreak in a Long Term Care Facility
Issue: Bed bugs (Cimex lectularis) are problematic in homeless
Les Chock, MS, SM (ASCP),CIC, CHEP - Regional Manager, domiciliaries (HDOM) due to the transient population who
Infection Control, Kaiser Permanente Medical Center have been exposed to contaminated clothing , property and
environments.. Existing practice guidance for homeless domicillaries
Issue: An outbreak of gastrointestinal illness occurred in a Long is rare. Project: In response to multiple bed bug outbreaks in
Term Care Facility. Infection Control was notified and conducted a 30 bed HDOM setting, an eradication and prevention project
and outbreak investigation to successfully control the outbreak. management plan (PMP) utilizing a multidisciplinary approach was
Project: Infection Control was notified about an outbreak of developed including the HDOM staff and residents, Environmental
gastrointestinal illness in our Long Term Care Facility. Five patients Management Service (EMS), Microbiology laboratory, and the
with nausea and vomiting were initially reported. A Situation Infection Prevention and Control (IPC) Coordinator. The Chief
Management Team was formed that included Infection Control, of EMS served as the project manager and the IPC Coordinator
Administration, Nursing, Security, Risk Management, Environmental served in a consultant role. EMS, Laundry Service, Pest Management,
Services and Dietary. The 13 step Outbreak Investigation process IPC and HDOM staff developed a workable PMP for ongoing
from the APIC Text and EPI 201 was utilized to investigate and pest control while HDOM staff and EMS developed an admission
successfully control the outbreak. Results: Infection Control process algorithm. To obtain resident “buy-in” and assistance; a
immediately initiated an Oubtreak Investigation after being notified resident “press conference” was held to provide an open forum for
of the situation. Control measures were implemented that included education, questions, and discussion regarding the new process.
cohorting patients, enhanced environmental cleaning, education for HDOM staff monitored resident compliance. A “buddy system”
staff, patients and visitors and controlling access to the unit. As the among residents who work opposite shifts was created to assist each
number of cases continued to increase additional control measures other with necessary tasks. Results: Since January 2011, no
were taken. These included hand hygiene posters, disposable meal further recurrences of bed bugs have been identified. Initially, the
amount of work was overwhelming to staff and residents. Additional
equipment was needed due to the limited number of washing
machines, dryers and other options, such as clothing steamers, and
the staff time required to utilize these methods for eradication of bed
bugs. Heat packs for patient belongings were purchased to place all
resident belongings in upon admission. Because the type of mattresses
required for the furniture in the HDOM did not have impenetrable
covers, affected mattresses were destroyed and specialized mattress
covers were purchased to eliminate entry of bed bugs on remaining
mattresses. EMS obtained a contract pest control service that include
a bed bug-sniffing dog to inspect the HDOM and floors above and
below to ensure all potential areas of infestation were identified. To
ensure future bed bug infestations are identified in a timely manner,
prevention efforts now include weekly visual inspections with a unit
representative, EMS and pest control; quarterly inspection includes

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 95
Poster Abstracts: Outbreak Investigation
a bed bug sniffing dog. Lessons Learned: • Successful efforts, and Antimicrobial Resistance Unit, Minnesota Department of
require a multidisciplinary approach with a long term plan. • IPC Health
Coordinators can serve in a consultant role as liaison between
multiple services (e.g. reinforcement and promotion of service level Background/Objectives: Endoscopic diagnostics and
expertise, education, guidance, communication, etc.) • Eradication therapeutics increasingly are replacing invasive surgical procedures
and prevention measures are labor intensive, which makes staff “buy and are being performed in ambulatory and inpatient settings.
in” difficult. Staff needed to see failure to increase motivation to Cleaning and disinfection of endoscopes and their accessories is
better coordinate and follow through with tasks. • In settings such complex and must be performed according to U. S. Food and Drug
as a HDOM, the unit manager or designated staff and EMS must Administration (FDA) labeling and manufacturer instructions.
perform ongoing routine inspection and pest control measures of the Breaches in endoscope reprocessing can expose patients to viral
affected unit and surrounding units at frequent, consistent intervals. and bacterial pathogens and must be addressed on a case-by-
case basis. Infection preventionists (IPs) play a fundamental
role in identifying and investigating such breaches. State health
departments have an expanding role in healthcare-associated
Presentation Number 9-134 infection prevention and consultation separate from regulatory
functions. We discuss a state health department infectious disease
Outbreak of Enterococcus faecium with Low-Level epidemiology program’s experience of providing public health
Resistance to Vancomycin in Japan consultation to guide the investigation of endoscope reprocessing
breaches. Methods: Over the past 18 months, IPs from several
Yukihiro Yamaguchi, MD - Vice Medical Director, Kenwakai healthcare facilities requested assistance after identifying incidents of
Otemachi Hospital, KRICT; Yukiko Moronaga - Infection Control inadequate endoscope reprocessing. In each situation, IPs collected
Nurse, Kenwakai Otemachi Hospital, KRICT; Chie Nagahara - information on the nature of the breach, facility type, clinical
Chief of Microbiology, Kenwakai Otemachi Hospital, KRICT practices, endoscope/endoscopic accessories used, and cleaning/
disinfection procedures. In consultation with Centers for Disease
Issue: Vancomycin resistant Enterococcus (VRE) is rare but Control and Prevention (CDC), the risk to patients, including
emerging problem in Japan. We describe the difficulties in control of pathogen transmission, was evaluated. Interventions such as patient
a hospital-wide vancomycin low-level resistant Enterococcus faecium notification, internal facility communication, and FDA notification
outbreak in 635-bed community teaching hospital in Kitakyushu, were assessed and implemented as appropriate. Results: From
Japan. Despite of implementing standard infection control methods 5/2010-9/2011, 7 endoscope reprocessing breaches were reported
such as standard precaution, contact precaution of colonized from 5 healthcare facilities (1 clinic, 1 ambulatory surgical center,
patient and staff education, the outbreak had not controlled. The 3 hospitals) and involved various endoscope types (upper GI
endemic VRE strain in Kitakyushu area is Enterococcus faecium endoscope [3], cystoscope [1], hysteroscope [1], colonoscope
with van B gene. The strain is known to have low-level resistance [1], transesophageal echocardiography scope [1]). Breaches were
to vancomycin and standard screening method may not detect the recognized by technicians (blood in the scope after reprocessing,
strain correctly. We applied three additional methods to halt the scope occlusion due to broken accessory piece) or by IPs (cluster of
outbreak. Project: From August 2009 to October 2009, forty bacterial infections post-endoscopic procedure, observation/audit
vancomycin resistant Enterococcus and vancomycin intermediate of technician practices). These incidents resulted from incorrect
resistant Enterococcus faecium was identified. Following interventions use of endoscopic accessories, reprocessing of single use devices, or
were implemented to control the outbreak. 1) Extend incubation failure to follow FDA labeling and/or manufacturer reprocessing
period of screening culture from 48 hours to 72 hours. 2) Cohort all instructions. Four breaches were reported to FDA because the
Enterococcus faecium with MIC ≥ 4 mg/L like VRE. 3) Routine rectal manufacturer and/or vendor representative provided incorrect
swab check for every patient on antibiotics. Results: Numbers instructions. To assist future breaches, we developed an endoscope
of patient with colonized decreased gradually. In August 2011 no breach assessment tool and list of resources. Conclusions: IPs
new VRE carriage had been detected. A hospital-wide outbreak associated with healthcare facilities where endoscopic procedures are
was successfully controlled by new screening methods. Lessons performed should be familiar with national endoscope reprocessing
Learned: Enterococcus faecium with low-level resistance to guidelines. Reprocessing protocols and procedures must be assessed
vancomycin is difficult to identify correctly. The difficulty of regularly, particularly when implementing equipment or procedure
identification may prolong outbreak. Better identification and cohort changes, and all staff involved with endoscopic procedures and/
is a key to control VRE outbreak. or reprocessing must receive regular education, training, and
competency testing. State health departments should also be aware
of national endoscope reprocessing guidelines and other resources in
order to assist healthcare facilities in investigating breaches, including
Presentation Number 9-135 notifying patients, and reporting to FDA. IPs should be aware
that the investigation of endoscope reprocessing breaches can be
Reported Endoscope Reprocessing Breaches, enhanced by involving state health departments who can contribute
Minnesota, 2010-2011 epidemiologic expertise, facilitate additional laboratory testing, and
engage consultation with CDC as indicated.
Jane E . Harper, BSN, MS, CIC - Supervisor, Infection Prevention

96 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Outbreak Investigation

Presentation Number 9-136 noted to be corrected on the second visit. There was no quality
measure to verify that the o-ring is removed and properly disinfected
Outbreak Investigation at a Dialysis Center during dialyzer reprocessing. Lessons Learned: The results
of the PFGE analysis indicate that a common source likely served
Associated with a Multi-use Dialyzer with
as the mode of transmission between patients. The results of the
Removable Headers and O-rings, Los Angeles environmental samples indicate that the contaminated environment
County in the reprocessing room was a possible source of infection. Literature
reviews suggest that o-ring contamination of the reprocessed dialyzer
L’Tanya English, RN, MPH - Program Specialist, Public Health can occur when disinfection and reprocessing procedures are not
Nurse, County of Los Angeles Department of Public Health; Patricia properly followed. If multi-use dialyzers with removable headers and
Marquez, MPH - Epidemiologist, County of Los Angeles Dept. o-rings are used, processes to ensure proper disinfection must be in
of Public Health; Dawn Terashita, MD - Medical Epidemiologist, place. In this facility, which used this type of dialyzer infrequently,
County of Los Angeles Dept. of Public Health; Kelsey Oyong, we recommended discontinued use unless an automated process is
MPH - CDC/CSTE Applied Epidemiology Fellow, County of Los implemented.
Angeles Dept. of Public Health; Hector Rivas, BS - Public Health
Microbiology Supervisor, County of Los Angeles Dept. of Public
Health; Sheena Chu, MS - Public Health Microbiology Supervisor,
County of Los Angeles Dept. of Public Health; David Dassey, MD, Presentation Number 9-137
MPH - Deputy Chief, Acute Communicable Disease Control,
County of Los Angeles Dept. of Public Health; Laurene Mascola, Use of Molecular Biology to Confirm a Bacteremia Outbreak Caused
MD, MPH - Chief, Acute Communicable Disease Control, County by Burkholderia cepacia in a Pediatric Intensive Care Unit
of Los Angeles Dept. of Public Health
Hilda G Orozco. Hernandez - Infectious Comittee Doctor, Instituto
Issue: Dialyzer reuse has become the standard practice in many Nacional de Pediatria; Genny Sanchez - Infectious Disease Physician,
dialysis centers. Dialyzer reprocessing is a complex, multi-step INP; Miguela Caniza, MD - Director of Infectious Diseases-
procedure frequently provided by unlicensed healthcare workers. In International Outreach Division, St. Jude Children’s Research
August 2011, Los Angeles County (LAC) Department of Public Hospital; Don Guimera, BSN, RN, CIC, CCRP - International
Health (DPH), received notification of five patients diagnosed Epidemiology Coordinator, St. Jude Childrens Research Hospital;
with bacteremia among hemodialysis patients in Dialysis Center Kyle M. Johnson, PhD, CCRP - Cinical Research Associated
A (DCA), four of which were positive for Stenotrophomonas Departament of Infectious Disease; Gonzalez Saldaña - Instituto
maltophilia (S. maltophilia); two of these four were also positive for nacional de Pediatria; Jose Luis Castañeda Narvaez, MD -
Candida parapsilosis (C. parapsilosis). Project: An extensive Infectious Disease Physician, INP; Patricia Zarate, MD - Intensive
epidemiologic and environmental investigation was conducted Caere Unit, INP
and outbreak management and prevention recommendations are
described. DCA has 25 dialysis stations, operates three shifts daily, Background/Objectives: Since1980 Burkholderia
six days per week. The average monthly census is 110. Cases were cepacia (BC) has been identified as a pathogen that causes healthcare
defined as hemodialysis patients from May to July 2011 with a associated infections (HAI) and 80% of these infections occur
positive S. maltophilia blood culture. Microbiologic analysis was in intensive care units (ICU) Bacteremia mortality rate in BC
conducted on four case isolates and two case dialyzers. A joint site bacteremia close to 50%. Pulsed field gel electrophoresis (PFGE)
investigation with Licensing and Certification was conducted which of chromosomic DNA is the gold standard to genotype BC clones.
included a facility walk-through, observation of dialysis cleaning and Methods: We conducted an epidemiological descriptive study of
disinfection, review of reprocessing and adverse occurrence logs, and an outbreak to confirm the event by using the all patients with fever
collection of environmental specimens. A second site investigation and positive blood culture for BC from April 6 to May 12, 2010. The
was conducted to observe the reprocessing procedure. Post-treatment BC epidemiological frequency, localization, and risk factors were
flow sheets were reviewed for all cases for each dialysis session in the determined. Laboratory isolation, identification and susceptibility
two months prior to positive blood culture. Results: Four case were done by using Bact/ALERT, and commercial identification
blood cultures were positive for S. maltophilia. Three case blood and antimicrobial susceptibility kits. Through PFGE we find the
isolates and two case dialyzer isolates had indistinguishable PFGE strain genotypes with contour-clamped homogeneous electric field
pattern indicating transmission from a common source. Blood mapping system electrophoresis (CHEF) and Bio Rad. Results:
and dialyzer isolates from the index case and one environmental A probable nosocomial outbreak with an endemic channel base
isolate (reverse osmosis water faucet) in the reprocessing room of zero cases between 2005 and 2009 and an epidemiological
tested positive for C. parapsilosis and matched on molecular typing. relationship were established when three patients out of 63
Epidemiologic analysis revealed three PFGE matching cases were admissions in the ICU contracted bacteremia caused by B. cepacia.
assigned the same treatment area and on occasion shared the same The hospital length of stay was longer among these cases (median, 33
shift. These cases also used the same brand/model multi-use dialyzer. days) compared with other (median, 6 days) patients in the ICU. The
They were the only patients in the facility to use this type of dialyzer, outbreak had an attack rate of 4.76%, and was 9% in those < 2 years
which contained removable headers and o-rings. Lapses in staff of age. The mortality rate was 33%, which is greater than the global
infection control observed during the first site investigation were pediatric ICU rate of 19%. BC producing the outbreak and isolated

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 97
Poster Abstracts: Outbreak Investigation

from blood had similar biochemical profiles and antimicrobial received steroids. During hospitalization 2 patients died from septic
susceptibility pattern. Likewise, PFGE band patterns were shock. All the strains had vancomycin MIC >64mcg/mL; the isolates
compatible with the B. cepacia genotype, and they were identical were also found resistant to amikacin (>32mcg/ml), gentamicin
when restricted with the Spe I enzyme, indicating similar bacterial (>500mcg/ml) and teicoplanin (>32mcg/ml), and were susceptible
clone, confirming the outbreak. Conclusions: We suspected to streptomycin (>1000mcg/ml), linezolid (2mcg/ml) and
an outbreak because of the epidemiological, clinical, and laboratorial quinupristin (0.5mcg/ml). Multiplex PCR reported VanA genotype
characteristics and confirmed it by means of molecular biology in all the strains. PFGE showed the same banding pattern and similar
techniques. A nosocomial transmission of B. cepacia among the molecular size. Dendrogram showed strains were epidemiological
bacteremia cases in the pediatric ICU was demonstrated. Infection related. All the evidence supports the same clone of VRE was the
prevention and control measures, including optimum compliance cause of the outbreaks. Conclusions: Increase in bacterial
with hand hygiene were reinforced, and no new case of bacteremia resistance to antibiotics in the hospital setting is a serious problem
caused by B. cepacia were reported in the pediatric ICU since the nowadays. A reinforce on infection control measures and control
outbreak, until late 2010, demonstrating the role of hand hygiene to of vancomycin use is necessary to limit emerge of resistant strains.
stop an outbreak. Hand hygiene, barrier precaution, environmental cleaning and early
screening are key hospital interventions for infection control.

Presentation Number 9-138

Characterization of Two Outbreaks of Vancomycin

Resistant Enterococcus faecium in a Pediatric Care
Center in Mexico City

Martha Aviles - Infectious Diseases Attending, Hospital Infantil de

México Federico Gómez

Background/Objectives: Antimicrobial resistance is an

increasing problem and challenge worldwide. Vancomycin-Resistant
Enterococcus (VRE) has emerged as an important nosocomial
pathogen because of its increasing frequency of multidrug resistance,
rapid spread and the possibility to transfer of Vancomycin resistance
to other pathogens such as Staphylococcus aureus. In Mexico, VRE
has rarely been reported. Methods: Our hospital is a Tertiary
Care center, 244 beds facility. Two VRE outbreaks were reported
from August 2009 to October 2009. The first outbreak occurred
in the intensive care unit and the second in the oncology ward.
We performed a retrospective study to describe the isolates. The
identification of the species was based on conventional biochemical
tests. Antimicrobial drug susceptibility pattern was obtained by Presentation Number 9-139
Kirby-Bauer disk diffusion method and confirmed by minimum
inhibitory concentration (MIC). A multiplex polymerase chain The C. diff Cycle: The Necessity of Going Beyond
reaction (PCR) for detection of the genotype was used. The the Basics
molecular characterization of VRE was performed by analysis of
isolated DNA by pulse field gel electrophoresis (PFGE). The aim of Kim Stanley, MPH, CIC - Infection Control Coordinator,
this study was to determinate the strains relatedness and reinforce the California Pacific Medical Center; Peter Kolonoski, RN, MSN,
application of preventive measures by health personnel. Results: CIC - Infection Control Coordinator, California Pacific Medical
A total number of 14 strains obtained from five patients were Center; Karen Anderson - Infection Control Manager, California
identified as VRE. 5 strains were isolated from the bloodstream, 5 Pacific Medical Center
from urine, 3 from endotracheal tube aspiration secretions and 1
from soft-tissue. All the patients were female, three were oncology
Issue: When Clostridium difficile infection (CDI) rates increased
patients, one had hemophagocytic syndrome and one had medullar
in 2007, a vigorous campaign was launched at our large tertiary
section secondary to trauma. 4 patients had central line, 4 had
care teaching hospital to stop transmission of these infections.
mechanical ventilation, 4 had urinary catheter, 2 had pleural tube,
Initiatives included: 1) improving prompt communication of positive
1 had Mahurkar catheter and 1 had cistostomy. All the patients
laboratory results to the nursing units and the environmental services
received antimicrobial drugs, at least, 2 weeks before the isolation of
staff (EVS), 2) modifying room cleaning protocols by instituting
VRE. The drugs were: third- or fourth- generation cephalosporins,
bleach-cleaning, 3) working with bed control to reduce unnecessary
carbapenems, quinolones, aminoglycosides and metronidazole; of
room transfers, 4) providing education on CDI to staff via videos,
this patients, 4 received a previous course of vancomycin. 4 patients

98 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Product Evaluation/Cost-Effectiveness/Cost Benefit Analysis

in-services, focused stand-up meetings, posters, and screen saver Product Evaluation/Cost-
messages, and 5) Contact Precautions at symptom onset with strict
soap and water handwashing. Rates steadied and then began to Effectiveness/Cost Benefit Analysis
decline. Unfortunately in spite of these on-going efforts, C. diff
infection rates again significantly increased in summer of 2011. . Presentation Number 10-140
Project: For this performance improvement project our attention
was initially focused on a cluster of infections occurring in May & Closing the Gap of Inconsistent Hand and Surface
June 2011 in the post acute unit. However further investigation Sanitation
showed that majority of these cases had been transferred from
two of our acute care units: oncology and transplant services. We
Betty A. von Kohn, RN, BSN, CNOR, CIC - Infection Prevention
determined that one of these units also had a special cause variation
Manager, Baptist Memorial Hospital North Mississippi
for C. diff during the same time period. We reviewed 35 patient
charts during this two month period looking for commonalities in
these cases. Results: In spite of previous herculean educational Background/Objectives: Repetitive actions in hand
efforts about CDI, we found that staff behavior drifted away from hygiene and environmental cleaning present concerns for lapses in
adherence to contact precautions. The EVS personnel had not practice. Current healthcare guidelines require frequent sanitizing,
instituted bleach cleaning as we had assumed in post acute services. but it is not persistent or long-acting. This allows transmission
Additionally, we found antibiotic usage to be an issue, both selection of germs between normal cleaning, sanitizing and disinfecting.
and overuse. All 35 patients were on antibiotics at some point in The objective of this study is to determine if using a persistent
their hospital stay and on average more than three different types of antimicrobial hand sanitizing lotion and surface disinfectant would
antibiotics were given. In our assessment we also reviewed the use of bridge any gaps and reduce healthcare associated infection rates and
proton pump inhibitors (PPI) and H2 blockers (H2B) because of a healthcare costs. Methods: Trial was conducted at a 217 bed
previous study at our facility that showed PPI and H2B overuse. The regional hospital. Healthcare workers were instructed to apply Germ
correlation between C. diff and PPI/H2 blockers is still unclear but Pro Hand Sanitizing Lotion at start of their workday and reapply
we found that 74% of infected patients were on PPIs at some point every four hours. They were also instructed to continue hand hygiene
during their stay, many times remaining on these medications for no as per CDC recommendations. Environmental Service employees
clear reason. Lessons Learned: In order to have a sustained were instructed to apply Germ Pro Surface Disinfectant to high
decrease of C. diff, we must address all of the big picture issues that touch points after terminal discharge cleaning in patient rooms
contribute to the disease, as well as keep up the everyday precautions and monthly in other areas. Germ Pro did not replace any products
to prevent transmission. This outbreak has given us the impetus we or sanitizing practices. It was additional.This study is a before and
need to tackle antibiotic usage in the hospital through an antibiotic after comparison of nosocomial infection marker (NIMS) rates as
stewardship program. We are making physicians aware of the over reported by MedMined. Three months (April-June) NIMS rate
use of PPIs and asking them to discontinue their use when no longer before Germ Pro is compared to three months (August-October)
indicated. We also must stay vigilant and monitor actual practice to during Germ Pro use. July was not used in the comparison because
ensure staff members are following policies. Germ Pro was installed for only half the month. Results: Results
NIMS Rate reduction 43.0% MRSA reduction VRE reduction
Quantity NIMS reduced 62 Cost per NIM $4,055 3 month cost
savings $ 251,410 Projected annual savings $ 1,056,640 Estimated
annual cost $ 20,000. Conclusions: 43% reduction of NIMS
validated the theory that using a persistent antimicrobial sanitizing
lotion and surface disinfectant can fill the gaps in surface disinfection
and hand hygiene. Patient safety is greatly improved, while realizing
significant cost savings. One week’s savings pays for the persistent
products for the entire year. The staff really liked the lotion and they
are using it. The lotion was reported to heal cracked hands and be
non-sticky. Environmental Services staff took ownership of the high

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 99
Poster Abstracts: Product Evaluation/Cost-Effectiveness/Cost Benefit Analysis
touch surface adjunct more and more as project went on. The data However, overuse of isolation precautions in patients not, or
validated the importance of their role in infection prevention and no longer, at risk may incur increased costs, decreased staff and
the role high touch surfaces play in transmission. The trial has been patient satisfaction, and decreased direct caregiver time with the
a positive measure for our facility as we promote a safer environment patient. Accurate implementation of isolation precautions may
for staff, patients and visitors. result in increased cost avoidance without increased transmission.
Methods: Starting in July, 2011, an active daily review of
all inpatients was conducted to evaluate the appropriateness
of the patient’s isolation precaution status. Simultaneously, a
Presentation Number 10-141 retrospective chart review of all patients with previous positive
cultures of multidrug resistant organisms (MDRO) was
The Role Appropriate Isolation Precautions conducted. These discharged patient records were assessed for
Contributes to Cost Avoidance: Conducting continued isolation precaution appropriateness as our electronic
Active and Retrospective Isolation Precaution medical record automatically creates an isolation precaution
Surveillance order upon subsequent re-admission for all historic positive
MDRO cultures. Investigation into costs associated with gowns,
gloves, and masks was conducted as well as additional staff salary
Kerrie E. VerLee, MPH, CIC - Epidemiologist, Spectrum Health;
and time involved with adherence to isolation precautions.
Dorine Berriel-Cass, RN, BSN, MA, CIC - Manager, Infection
Results: From July 7th through December 16th, 2011, 15,287
Control and Prevention, Spectrum Health; Kristen Simpson, RN,
patients with previous positive MDRO cultures were evaluated for
BSN, CCRN-CMC - Infection Preventionist, Spectrum Health
isolation precaution clearance. Following our isolation precaution
clearance policy, 1,087 patients met criteria through retrospective
Background/Objectives: Isolation precautions are used
chart review. Daily evaluation of all 868 inpatient beds resulted
to disrupt the chain of transmission among patients with known or
in 125 patients cleared during the same time period. The daily
symptomatic infections. The use of personal protective equipment
cost avoidance for contact isolation was $35.33 per patient, which
may be effective in reducing transmission if used appropriately.
reflects 46.2 gowns and pairs of gloves used as well as 46.3 minutes
of daily excess staff time. Staff time was measured by observation
while gown numbers were collected from inventory records.
Length of stay for inpatients was measured and included both new
inpatients and those previously cleared of their MDRO history.
Cost avoidance data was collected with observations spanning
over 40 days of inpatients who were cleared from isolation
precautions. Over this observation period, 61 inpatients no longer
needed isolation precautions; 30 of these inpatients were new,
and 31 inpatients had been retrospectively cleared thus avoiding
isolation precautions with their readmission. The average number
of patients cleared from isolation precautions was 8.1 inpatients
(SD 2.5) per day, corresponding with a daily cost avoidance of
$285.29 (SD $88.4). The average daily Infection Prevention
staff time invested in this project was 3.5 hours and returned a
projected $104,130.85 (95% CI $94,131 – 114,130) in annual
cost avoidance. Additionally, no subsequent raise in MDRO
transmission has been detected and staff and patients have
expressed increased satisfaction. Conclusions: Accurate
implementation of isolation precautions may result in increased
cost avoidance and patient and staff satisfaction without increased
infection transmission. Automating isolation clearance procedures
or algorithms in electronic medical records may be beneficial for
systemizing isolation precaution appropriateness.

Presentation Number 10-142

Avoiding Unintentional Hypothermia During

Prosthetic Joint Replacement Surgery

Cynthia A. Kohan, MT, MS, CIC - Infection Preventionist,

Hospital of Saint Raphael; Michelle N. Whitbread, MT, MPH-

100 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Product Evaluation/Cost-Effectiveness/Cost Benefit Analysis
Infection Prevention, Hospital of Saint Raphael; John M. Boyce, VA Medical Center; Michelle Nerandzic - Research Assistant,
MD - Hospital Epidemiologist, Hospital of Saint Raphael; Clinical Research Service, Louis Stokes Cleveland VA Medical Center; Brett
Professor of Medicine, Yale University School of Medicine Sitzlar - Research Assistant, Geriatric Research, Education, and
Clinical Center, Louis Stokes Cleveland VA Medical Center; Curtis
Background/Objectives: Hypothermia during J. Donskey, MD - Chair, Infection Control Committee, Louis Stokes
the intraoperative period is associated with an increased risk of Cleveland VA Medical Center
developing a surgical site infection. Despite using both a forced
warm air jacket preoperatively and blanket during surgery, 36% of Background/Objectives: Hospital equipment
prosthetic joint replacement patients did not achieve normothermia that directly contacts patients may be an important source for
during the intraoperative period. Due to the surgeon’s concern that transmission of healthcare-associated pathogens such as Clostridium
the forced air motor would increase room contaminants, the forced difficile and vancomycin-resistant enterococci (VRE). There is
air blanket was not turned on until the patient’s skin preparation a need for simple, safe, and effective disinfection methods for
and draping was accomplished, often leading to unintentional equipment that include activity against C. difficile spores. The
hypothermia. Beginning in September 2011, an underbody objective is to test the hypothesis that spraying equipment with an
disposable water-based warming pad was added to the operating room electrochemically activated saline solution containing hypochlorous
(OR) table to be used in conjunction with the forced air modalities. acid (Solution C) would be an efficient and effective means to
Objectives: The objective of this study was to determine if using reduce bacterial contamination, including C. difficile spores, on
an underbody warming device, in addition to the forced warm air equipment. Methods: In the laboratory, we examined the
modalities would increase the proportion of patients achieving and efficacy of Solution C versus a 1 to 10 dilution of household bleach
maintaining normothermia during surgery. Methods: From May for killing of 3 strains of C. difficile spores and 3 clinical VRE strains
to September 2010, the baseline period, intraoperative temperatures that were inoculated onto surfaces of portable equipment. On
were obtained from anesthesia records of 50 patients who underwent hospital wards, wall-mounted and portable vital signs equipment
joint replacement surgery. The underbody disposable water-based was cultured for C. difficile, VRE, and total facultative and aerobic
warming pad was implemented for joint replacement surgeries in bacteria before and after spraying with Solution C. Results: In
September 2011. From September 2011 to January 2012, the post the laboratory, Solution C was as effective as a 1 to 10 dilution of
intervention period, anesthesia records of 56 patients were reviewed household bleach for disinfection of equipment, resulting in >5 log
to determine the first and last intraoperative temperatures, as well as and >3 log reductions in recovered counts of C. difficile spores and
the highest and lowest temperature. Temperatures were taken using VRE in the absence and presence of organic load, respectively. As
either a bladder probe or an esophageal probe. Results: During shown in the table, Solution C resulted in significant reductions
the baseline period 13/50 (26%) of patients were normothermic the in total facultative and aerobic bacterial counts and eliminated C.
entire time they were in the OR, as compared to 29/56 (52%) of difficile and VRE contamination. There was no evidence of adverse
patients during the post intervention period (p=0.0067). Thirty-six effects to surfaces after multiple applications of Solution C and no
percent (18/50) of the patients were hypothermic for the duration reported complaints from nursing staff or patients. The application of
of the surgical procedure during the baseline period, while there Solution C using a spray bottle required only a few seconds for each
were only 12% (7/56) in the post intervention period (p=0.0044). set of portable or wall-mounted equipment. Conclusions:
When comparing the last temperature taken in the operating room; Spraying equipment with electrochemically-activated saline solution
25/50 (50%) of the patients were normothermic in the baseline containing hypochlorous acid is a simple and effective means to
period, but 46/56 (82%) were normothermic in the post intervention reduce contamination with Clostridium difficile and other healthcare-
period (p=0.0004). Conclusions: Using the underbody associated pathogens.
disposable water based warming pad together with preoperative and
intraoperative forced warm air warming modalities increased and
maintained patients’ body temperature throughout the intraoperative
period. These results have supported continued utilization of the
underbody warming pad. The adoption of this new warming system
contributes to collaborative efforts to reduce postoperative infections
in prosthetic joint replacement patients.

Presentation Number 10-143

Effectiveness of an Electrochemically Activated

Saline Solution for Disinfection of Hospital
Equipment

Dennis Fertelli - Research Assistant, Infection Control Department,

Louis Stokes Cleveland VA Medical Center; Jennifer Cadnum,
BS - Research Assistant, Research Service, Louis Stokes Cleveland

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 101
Poster Abstracts: Product Evaluation/Cost-Effectiveness/Cost Benefit Analysis

Presentation Number 10-144 appropriate isolation precautions, and cultural transformation. Each
patient entering the hospital or community living center is screened
Financial Implications of VRE Screening Intensive for MRSA upon admission, transfer and discharge. If screening is
positive, is placed on appropriate isolation precautions that include
Care Units
wearing gowns and gloves with patient contact. The gap in time
from the screening to the result, presents the possibility of exposure/
Christopher S. Hollenbeak, PhD - Associate Professor, Penn transmission of MRSA to the environment, other patients and
State College of Medicine; Nathan A. Ledeboer, PhD - Assistant healthcare workers. Reducing this gap in time, would also reduce
Professor, Medical College of Wisonsin the infection risks. The decision to use polymerase chain reaction
(PCR) testing for MRSA screening would decrease that gap in
Background/Objectives: Patients are increasingly time, but greatly increase the costs of administering the program,
being admitted to hospitals colonized with vancomycin resistant the question is: Is it worth it? Project: A look at screening
Enterococcus (VRE). Many hospitals are evaluating methods to screen using ChromAGAR (AGAR) vs. Polymerase Chain Reaction
patients for VRE, particularly in intensive care units. This study (PCR) methods of testing to find the most beneficial test for MRSA
sought to evaluate the economic implications of VRE screening using colonization, as it relates to the risk of infection. Prior to May 2011,
different culture and polymerase chain reaction (PCR) methods. we used the AGAR test to determine MRSA colonization. Cost of
Methods: We used decision analysis to model VRE screening this test was about $3.00. Notification of a positive and subsequent
using two chromogenic media (CM), one PCR, and one traditional placement of patient in isolation precautions could take up to 2
culture approach. We also modeled a no screening strategy and a days, increasing the risk of MRSA transmission. We averaged 5
hypothetical perfect screen for comparison. The model estimated the transmissions per month, and 0.6 infections per month. This meant
cost and outcome implications of alternative methods of screening for that each month, 5 to 6 people acquired MRSA in our facility. We
VRE in the ICU setting and took into account spread of VRE, spread wanted to close the gap in the notification time. PCR testing could
of vancomycin resistance, and whether hospitals were prepared to report results within a couple of hours as opposed to 24+ hours. Cost
act immediately upon screening results. Outcomes included correct of this test was about $41.00. We averaged 1200 tests per month
classification, unnecessary isolation costs, unnecessary infection costs, (Table 1), to save money we changed our screening rules to: 1) all
and total costs. Sensitivity analysis tested main model parameters. persons without a history of MRSA culture or screen within the past
Results: Baseline analysis assumed: 1) a 17% colonization rate, 12 months (“history”) were screened using PCR on admission and
2) only patients with a positive screen were isolated, 3) 18 hours transfers, and AGAR on discharge, and 2) persons with a “history”
passed before action was taken on screening results, and 5) no were screened by AGAR on admission only. Still, we averaged
patients were decolonized. The CM approach was associated with the $23,000 a month in PCR testing (Table 2), so to further reduce costs,
highest combined rates of correct classification (99.7% and 99.2% we looked at changing the PCR test on transfer to AGAR. We found
for CM versus 93.4% for PCR and 77.1% for traditional culture) that an average of 3% of all transfer screens converted to positive,
and positive predictive value (PPV) (99.0% and 98.5% for CM, this translates to an average of about 3 screens in 80. (Table 3) This
72.6% for PCR, and 42.0% for traditional culture). CM was also change saved approximately $3,400 per month. Results: Average
associated with lower unnecessary isolation costs per patient than monthly transmission rate in Acute Care was 1.63 before PCR and
PCR ($16.80 and $25.20 for CM, $675 for PCR, and $1962 for 1.28 after PCR, a reduction of 20%. Average monthly infection
traditional culture) and lower unnecessary infection costs ($3.42 and rate in Acute Care was 2.12 before PCR and 0.228 after PCR, a
$11.79 for CM, $6.09 for PCR, and $30.43 for traditional culture). reduction in MRSA HAIs of 89%. Similar results occurred in the
Conclusions: For hospitals considering a screening strategy CLC. Lessons Learned: The reduction in transmissions and
for VRE in the intensive care unit, a CM approach appears to offer infections made PCR beneficial despite the cost.
the highest rates of PPV and correct classification, and lowest overall
unnecessary isolation and infection costs under baseline assumptions.
Hospitals also need to weigh other factors such as time to action and
isolation costs.

Presentation Number 10-145

Determining an Effective Measure of Testing

for MRSA Colonization for Timely Placement in
Appropriate Isolation Precautions

Cynthia Powell, BSN, RN, CCRN - MDRO Prevention

Coordinator, CTVHCS - Temple

Issue: Measures to prevent the spread of MRSA, either by active

infection or colonization, include hand hygiene, active surveillance,

102 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Public Reporting/Regulatory Compliance

Presentation Number 10-146 Public Reporting/Regulatory

Compliance
Cost Effectiveness of an Electronic Hand Hygiene
Monitoring System (EHHMS) in the Prevention of
Presentation Number 11-147
Healthcare-Associated Infections

Barbara J. Simmonds, RN, BS, CIC - Director of Infection

Who Should Be in Charge of What? (Components
Prevention, Miami Children’s Hospital; Deise Granado-Villar, MD, of a State-Level Healthcare-Associated Infections
MPH, FAAP - Chief Medical Officer/Senior Vice President For Prevention Effort)
Medical And Academic Affairs, Miami Children’s Hospital
Amber Taylor, MPH - Health Policy Analyst, US Dept. of Health
Issue: Despite the fact that the Centers for Disease Control & Human Services/Office of the Asst. Secretary for Health/Office
and Prevention (CDC) have documented downward trends in of Healthcare Quality; Ian Kramer, MS - Health Policy Analyst,
HAI rates in four major anatomic sites (bloodstream, respiratory Office of Healthcare Quality/Office of the Asssistant Secretary for
tract, urinary tract, and surgical wounds), HAIs caused by resistant Health/U.S. Department of Health & Human Services; Rani Jeeva,
pathogens at these sites continue to increase in US healthcare MPH - Team Leader, Healthcare-Associated Infections Initiative, US
facilities. The hands of HCWs invariably play a significant role Dept of Health & Human Services/Office of the Assistant Secretary
in the transmission of HAIs in healthcare facilities. Transmission for Health/Office of Healthcare Quality
of two of the principal microorganisms responsible for HAIs in
US healthcare facilities—Staphylococcus aureus and Enterococcus Issue: Public Reporting of healthcare-associated infections (HAIs)
species—is commonly facilitated by HCW hands. However, much has expanded tremendously over the last several years, from the
of the interventions, guidelines, and existing mechanisms aimed at number of states now requiring at least on type of HAI measures
improving hand hygiene adherence (e.g., behavior modification and to the number of different entities that require reporting. To date
incentive programs) have been ineffective. Project: In September there are 28 states that have state-level public reporting HAI data
2010, we instituted a novel electronic hand hygiene monitoring legislation, compared to just four states in 2004. In addition to
system (EHHMS) in an pediatric Hemonc Unit (PHOU) in our state-reporting, federal legislation has passed for reporting for certain
274-bed, stand alone, acute-care children’s hospital. Data collected HAIs as they relate to pay-for-performance (incentive measures),
prospectively have demonstrated that hand hygiene adherence rates thus creating new tasks for infection preventionsists (IPs) in addition
have improved significantly and maintained consistently above to their other daily data collections. Thus, the major issue is how to
95%, across all shifts, among both medical and nursing personnel. drive results with heterogeneous and sometimes competing entities
In previously presented data, we demonstrated an unequivocal at different maturity levels, while still protecting the public’s health
parallel fall in the occurrence of HAI in the PHOU since EHHMS
was installed. We carried out this analysis to ascertain the cost
effectiveness of implementing the EHHMS. First, we ascertained the
number of HAIs registered in the PHOU for the first two quarters of
2011 and the additional hospitalization costs attributable to HAIs.
Next, we compared these costs with parallel HAI costs for the first
two quarters of 2010 and 2009 before the official institution of the
EHHMS in our facility. Results: The total cost of installing
the EHHMS was $72,800 (i.e., $2,800 per bed). During the first
two quarters of 2011, six patients acquired HAIs. The aggregate
cost attributed to HAIs among these 6 patients was $756,207 (this
amount was ascertained by comparing the cost of care for these six
patients with six patients with similar diagnoses and duration of
hospital stay who did not acquire HAIs.) Thus, the mean cost per
patient attributable to HAI was $126,034. For parallel quarters
in 2009 and 2010, the overall HAI costs were $1,260,034 (10
infections) and $1,134,306 (9 infections), respectively. Lessons
Learned: Electronic hand hygiene monitoring and tracking has
played an important role in our facility in enhancing hand hygiene and allowing IPs to do what they do best : educating and preventing
compliance among medical and nursing personal and in reducing infections. Project: In September 2011, the Office of Healthcare
HAI occurrences. Hand hygiene adherence rates can be maintained Quality in the Office of the Assistant Secretary for Health in the
consistently above 95% across all shifts. Finally, the cost of installing U.S. Department of Health & Human Services, convened a focus
and instituting the EHHMS in our PHOU has been more than group on the “Essential Components of State Healthcare-Associated
offset by the savings engendered by the decrease in the number of Infection Efforts” and a broader meeting State-Level Partners
HAIs since institution of the EHHMS. Collaborating to Eliminate Healthcare-Associated Infections”,
Dallas/Fort Worth, TX. The meetings were held to identify

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 103
Poster Abstracts: Public Reporting/Regulatory Compliance

priorities, encourage collaboration and reduce duplication efforts.

Participants at both meetings were asked the same questions listed
below: “What are the essential thematic components required for a
state program?”; “Of these essential components, which are priority
components?”; Which stakeholder is best suited to take the lead
for each component?”; and “What resources and infrastructure
are required and how can the federal government and regional
entities best support these programs?”. At the broader meeting,
participants were asked, “What are the top four priorities of a State
HAI program?” and “Who should take the lead on those priorities?”.

Results: Based on a poll of the over 250 participants at the

broader meeting, the top four priorities, with the lead agencies in
parentheses are: 1. Coordination, collaboration and integration (State Presentation Number 11-148
and Local Health Departments), 2. Surveillance, validation, analysis
and reporting (State and Local Health Departments), 3. Culture California State Mandated MRSA Screening:
of safety, health and learning (QIO) and 4. Quality improvement/ Healthcare Dollars Down the Drain!
best practices (QIO). These results were in high agreement with the
results of the focus group. Lessons Learned: More needs Joan Finney, RN, BSN, CIC - Director of Infection Prevention and
to be done to assist the state-level HAI programs, where one of the Epidemiology, Good Samaritan Hospital, Los Angeles
biggest challenges is developing the rapidly growing HAI public
health infrastructure as public reporting and the intersection of
Issue: On January 1, 2009 our 408-bed acute hospital in Los
public health and HAI is still a burgeoning topic. Coordination and
Angeles began admission screening for MRSA in accordance with
collaboration is also a big concern as more and more requirements
California Senate Bill 1058. We were required to screen patients
are being added to state and federal legislation. As such, a detailed
within 24 hours if they were admitted from a skilled nursing facility,
environmental scan of state-HAI activities will be taking place over
were admitted to an ICU including NICU, discharged from another
the next year to identify current needs and gaps.
hospital within 30 days, on dialysis or undergoing high risk surgery.
The attending physician was required to notify the patient if MRSA
was identified. The intent of the mandated screening was to prevent
transmission of MRSA and reduce antibiotic resistance. Project:
Our infection prevention team began education for nursing staff
and physicians on the new requirements. Standard protocols were
developed to cover the swabbing of the adult patient’s nares and
NICU neonate’s groin. The nursing admission assessment in the
electronic medical record was redesigned by Information Services
to help identify patients meeting criteria. Progress Note reminder
stickers were developed to alert physicians and remind them to
discuss positive findings with the patient. Our lab prepared to handle
a heavy volume of MRSA screens using chromogenic media-based
tests. Results: Rates of our hospital-acquired MRSA infections
remained low from 2005 through 2011, indicating that the increased
screening did not lower HAI MRSA transmission. There was no

104 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Quality Management Systems/Process Improvement/Adverse Outcomes
change in our antimicrobial resistance patterns. We experienced an infection prevention was identified on July 11, 2011. Project:
847% increase in lab specimen volume beginning in January 2009. Class 1 infections are preventable infections that occur within the
Using our own hospital’s estimate of laboratory costs of $26 per ThedaCare System. From January 1, 2010 to May 31, 2011, 29 out of
specimen, we spent additional hard costs of $356,768 between 2009 1,700 Orthopedics’ Hip and Knee replacement patients experienced
and 2011 for this testing. Using costs of contact isolation based on a Class 1 infection after surgery. These infections lead to: A re-
current literature (for isolation supplies, nursing personnel time and admission rate of 83% (24 out of 29) for patients with a SSI, and a
housekeeping disinfection measures) we estimated $1734 per MRSA subsequent additional surgery procedure rate of 79% (23 out of 29).
colonization case. Our annual costs increased from $88,434 to over Additional and long term medication requirements at a rate of 83%
$749,088, for an estimated total of $2.3 million spent between 2009 (24 out of 29 ), with a average length of time of 4.2 months. Patients
and 2011 for additional isolation. Three years of testing in-born visit a Infectious Disease Provider an average of 7.6 times, and other
neonates showed that of 1554 screens done between 2009 and 2011 providers an average of 13.4 times (not including surgeries). Patients
only one positive was identified. That neonate was from a known visited the Emergency Department one or more times in 41% (12
MRSA positive mom. Lessons Learned: The volume of out of 29) of the patients with a SSI. Patients with a SSI sought
specimens this regulatory mandate required significant costs for the treatment or counsel outside of our system and partners 13.7% (4
organization. In addition to testing and isolation costs, many other out of 29) of the time. Results: Safet/Quality: Orthopedic
resources were required administratively. Our policy of initiating SSI Rate Initial 1.7% (29/1700) Target 0.85% (50% Reduction)
contact precautions for nares colonization may warrant review to Customer Satisfaction: Rate of additional surgical proceudres
weigh the cost vs. benefits of isolation for colonization of nares only. Initial 79% (23/29) Target 39.5% (50% Reduction) Number of
The data shows that screening of NICU neonates was of no value. Readmissions: Initial 83% (24/29) Target 41.5% (50% Reduction)
Feedback to our state health department regarding our data may be Financial Stewardship: Reduce cost associated with SSI’s: Initial
useful to help refine MRSA screening requirements. We did not see $928,000 Target $464,000 Completed by 07-25-11: 1. Standard
evidence that screening as mandated returned value for the dollars work in relation to bathing procedures 2. Standard Work in relation
spent or improved patient safety. Regulatory mandates need to be
carefully promulgated so healthcare dollars are well spent and not go
down the drain.

Quality Management Systems/

Process Improvement/
Adverse Outcomes

Presentation Number 12-149

Utilizing Lean Analysis to Conduct a Horizontal
Value Stream focusing on the Reduction of
Orthopedic Surgical Site Infections
Miki Gould - Infection Preventionist, ThedaCare

Issue: In a multi-complex healthcare system containing, 2 acute

care hospitals (Total beds 385), 3 critical access, 5 surgery centers,
34 clinics, 1 home health, LTC, CBRF and Hospice worked in silo’s
and not together as a team and work in individual silo’s. In February
2011, The Improvement System pulled all divisions together to
create an easy process flow for the orthopedic patient. It’s part of the
process the role of the infection prevention was identified in each
step of the patients experience, and a rapid improvement event for

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 105
Poster Abstracts: Quality Management Systems/Process Improvement/Adverse Outcomes
to bathing timing 3. Standard MRSA testing Algorithm 4. Document shows AORN compliance. Lessons Learned: Insights:
to display Infection Stats on a monthly basis 5. Checklist to ensure (aha) 1. Surgical Site Infections have not been highlighted through
AORN (Association of peri-operative Nursing) Compliance 6. the system 2. Infection Prevention touches everyone 3. The high
Posters to highlight AORN requirements Planned Work 1. Create impact on Surgical Site Infection Challenges: 1. Our culture may
Patient Education Binder for continuum of care 2. Establish standard not be ready 2. Infection Prevention has a very large scope 3. Cost of
MRSA procedures 3. Create a network of Infection Prevention Infection Prevention Actions Required to Sustain or Build Change?
Champions 4. Create digital media site for patient education 5. 1. Building a transparent feedback mechanism 2. Leadership support.
Standardize all products in OR’s 6. Create a “Infection Cross” that

Presentation Number 12-150

Communicating Critical Surveillance Data for
Improved Outcomes
Crystal R. Heishman, RN - Surveillance, University of Louisville
Hospital; Pamela Nolting , MSN, RN ,CIC - Infection Control
Practitioner, University of Louisville Hospital; Linda Goss , MSN,
APRN-BC, CIC,COHN-S - Director of Infection Prevention and
Vascular Access Specialist Team, University of Louisville Hospital

Issue: Prevention of Healthcare Acquired Infections (HAIs)

requires a multi-faceted approach. Active surveillance identifies
significant changes relative to a patient’s condition that may result
in a HAI. Ventilator Associated Pneumonia (VAP) surveillance is
one example of a HAI that requires near real-time monitoring and
timely communication of the findings in order to facilitate earlier
interventions. A lack of standardized communication techniques
of critical surveillance data was cited by the Intensive Care Unit
(ICU) managers of an urban academic medical center as a potential
reason for inadequate or delayed response to bedside practice. The
objective of this project was to identify and test a novel method of
communication that facilitated earlier identification of potential
infections. Project: In November 2010, the Infection Prevention
department implemented a communication process using a Microsoft
Excel (2007) database for use with VAP surveillance. The database
resided on the facility network drive and “read only” access granted
to the ICU Clinical Managers and physicians. The database
contained pertinent attributes necessary to assist the Infection
Preventionist in identifying potential VAP cases. The database was
updated every 24-48 hours when surveillance criteria identified a
significant change. Potential VAP cases were placed on a “watch
list” which was color coded to enable quick visual review. Managers
and physicians self reported increased awareness of surveillance
trends and earlier response times for interventions. A web based
survey was developed at www.surveymonkey.com and distributed to
the end users to assess the effectiveness and utility of the database.
Infection rates pre-database and post-database were compared.
Results: 83.3% of respondents stated they used the database to
identify potential “at risk” ventilated patients and interventions were
altered or increased based on retrieved information. 100% stated
they used the database weekly and 50% used it daily. 100% of the
respondents stated they preferred the new method of communication
over traditional methods. The overall VAP rate per 1000 ventilator
days decreased from 11.88 in 2010 to 6.71 in 2011. The number of
VAP cases decreased from 91 in 2010 to 49 in 2011. Lessons
Learned: Communication of surveillance data can be enhanced
without duplication of efforts and with minimal process alterations.
Providing a convenient method for reviewing unit specific data can
result in earlier interventions. Although this was not studied, time

106 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Quality Management Systems/Process Improvement/Adverse Outcomes
normally spent by the Infection Preventionist calling, sending email, reproducible, the team expanded deployment of the technology to
or physically locating the appropriate clinician was saved due to the the Medical Intensive Care Unit (MICU). Results of the secondary
new process. The project was deemed a success as the positive trend deployment were measured and verified, and are presented here for
in VAP reduction was identified. This process can be transferred to consideration. Methods: Researchers selected their MICU
other surveillance reviews, and it can be inferred that all HAI rates because ICUs typically have higher infection rates due to complexity
could be positively impacted. of patient mix, frequency of invasive device use, and higher severity
of illness and comorbidity within the patient population. After
recording two months of baseline dispensing activity, employees
(77) were issued Radio Frequency Identification (RFID) badges for
the pilot program. Dispensing counts from both alcohol-based hand
solution and soap dispensers were automatically tracked by hour, day,
and month with the same system. At the end of active monitoring,
hand hygiene solution dispensing data was compared to HAI trends.
Researchers compared from the monitored months with the same
months of the previous year to assess changes. Methods: During the
study period, caregivers wore RFID badges which allowed active 24/7
monitoring of hand hygiene activity. Proximity sensing of caregivers

Presentation Number 12-151

Reproducibility of Results in Decreasing
Healthcare-Associated Infections with the Use of
Electronic Hand Hygiene Surveillance Technology
Brenda D. Edwards Brazzell, RN, BS - Manager, Infection
Prevention and Employee Health, Princeton Baptist Medical Center

Background/Objectives: Healthcare associated

infections (HAIs) cause the loss of thousands of lives and millions of
dollars every year despite the widely accepted knowledge that hand
hygiene (HH) is the most effective means of reducing HAIs. Clinical
managers responsible for one Medical Center’s post-surgical unit
piloted an automated hand hygiene monitoring system and attained
a 22% reduction in HAIs. In order to verify that these results were

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 107
Poster Abstracts: Quality Management Systems/Process Improvement/Adverse Outcomes

within the patient room determined hand hygiene opportunities developed using the CDC/NHSN criteria in a checklist format
and hand cleansing activity was confirmed by the activation of a identifying the reportable information for UTI, SSI, pneumonia
sensor within the dispenser when the caregiver accessed a solution and/or Clostridium difficile. Instructions are provided for the various
for hand washing. HAI data trends were assessed using an electronic categories, allowing outside agencies to assist in reporting infections
proxy measure called a Nosocomial Infection Marker™. Results: after discharge. 4. Investigation is underway to find a standardized
Researchers noted that during the first month of the study period, method to denote Clostridium difficile infection(s) and the date of
the MICU had a total of 9,995 hand hygiene dispenses, or 30.2 the occurrence(s) in the patient’s chart so that health care providers
dispenses per patient day. For the sixth and final month, dispenses can determine the patient’s Clostridium difficile status and use this
had increased to a total of 35,713, or 99.8 dispenses per patient day. information to select the most appropriate treatment for that patient.
During the same six months the MICU infection markers per 1,000 The current hospital antibiogram will be distributed to physician’s
patient-days rate decreased by 35.1% when compared to the same offices and the health care facilities listed above to aide in choosing
months during the previous year. Based on previously published cost effective and appropriate antibiotic therapy. Lessons Learned:
data, the reduction in NIMs corresponds to a decrease of 239 patient Improvements in communication in our community have already
days and reduced net losses of $200,079. Conclusion: These had a positive impact on patient care as critical information is easier
results suggests the use of an automated hand hygiene surveillance to locate as the patient moves between hospital, nursing homes,
and communication system can achieve reproducible increases in hospice/home care agencies and assisted living facilities. There is also
hand hygiene activity and associated reductions in HAIs, patient a tremendous potential for education and sharing of ideas now that
days, and net losses. the lines of communication have been established. The true “winner”
is the patient.

Presentation Number 12-152

Presentation Number 12-153
Development of a Health Care Providers Quality
Improvement Team in a Small, Rural Community Process Improvement: Facility wide Reduction in
Hospital-Associated Infections Utilizing CHG for
Marti Heinze, RN, BS - Infection Preventionist, Gerald Champion Oral Care and Preoperative Preparation
Regional Medical Center; Erva Yarborough, RN, CHPN - Patient
Care Coordinator, Alamogordo Home Care-Hospice BJ Helton, MT (ASCP), MPH, CIC - Manager Patient Safety and
Quality, Covenant HealthCare
Issue: To improve patient care across the continuum, the health
care facilities in our community initiated monthly meetings of Issue: Like our counterparts, our hospital seeks to reduce
representatives from nursing homes, homecare/ hospice, assisted healthcare-associated infections (HAIs) through preventative
living facilities, physician’s offices and the hospital to improve efforts. To this end, we incorporated Keystone bundles into our
the availability of information as patients are transferred among preventive care measures for our critical care units many years ago.
the healthcare providers in our area. Project: We began by We experienced consistent improvement in both our central line and
improving communication on several issues: • Determined each ventilator infections. However, in second quarter 2008 we began
physicians preferred method of communication, • Developed a to see an unexpected increase in ventilator-associated pneumonia
standardized transfer form for information when patients present infections (VAPs). During this same time period we began to see
to the hospital emergency department, • Developed a form to an increase in the number of surgical site infections (SSIs) that
notify hospital infection preventionists in the event of a possible cultured positive for Methicillin-Resistant Staphylococcus aureus
infection post hospital discharge and • Started investigating a (MRSA). We focused our energies on a process improvement plan
method of notification of Clostridium difficile infection(s) and that would incorporate the use of chlorhexidine gluconate (CHG)
date(s) of episode(s) in patient’s medical record easily accessed by into our preoperative preparation protocol and facility-wide oral care
all providers. Results: Our results are as follows: 1. A physician practices. Project: Both facility-wide and targeted surveillance
communication survey form was developed and taken to the doctor’s methods were used to track and trend HAIs. VAP and SSI infections
offices so that they could indicate how they preferred to be contacted were identified using Centers for Disease Control and Prevention
for both routine items and urgent issues (telephone, fax, email, (CDC) definitions. A VAP Taskforce formed in February 2009
text, etc.). 2. After reviewing all available forms, a single transfer consisted of critical care nursing specialists, educators, managers,
form was developed by combining the most important aspects of speech and respiratory therapy. We reviewed our current practices
each so the patient’s pertinent information is readily available. The and products, realizing the need for a new comprehensive oral
form provides a single format for the local emergency department care program. The role of Oral Care Champion was developed
personnel to become familiar with, reducing the time required for with representatives from both nursing and non-nursing units.
them to locate the important information regarding a specific patient. Information gathering by the champions identified several barriers.
3. An infection reporting form was developed for long term care One barrier was consistent throughout the facility: limited
facilities, physician’s offices, rehabilitation facilities, home health care knowledge of products and their availability. We immediately began
providers and assisted living centers. The form is to be completed in-servicing staff to review products and displayed posters on each
and sent to the appropriate hospital Infection Preventionist in the unit. Articles on the oral care campaign were published both monthly
event of a suspected post-hospitalization infection. The form was and weekly in our facility newsletters. We consistently performed

108 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
Poster Abstracts: Quality Management Systems/Process Improvement/Adverse Outcomes

oral care every 4 hours and using 0.12% oral CHG every 12 hours. and reporting. We designed and implemented a web-based
A SSI Taskforce formed in February 2008 consisted of surgical computer program that allows viewers to see aggregate hand hygiene
services director, managers, coordinators, educators, operating room performance data as soon as it is entered into the program, allowing
staff and quality improvement specialist. Records reviewed were for daily tracking of performance. Project: Observers collect
selected from positive wound cultures, return to surgery reports, hand hygiene performance data on 30 to 60 patient encounters
and post-discharge letters to surgeons, information gathered from per day throughout the hospital by direct observation. Observers
staff, homecare nursing, wound care center and local hospital enter their results into the database each day, including the patient
infection prevention information sharing. We began using 2% CHG care unit where the observation was made, the role category of the
cloths for our preoperative preparation in three types of surgical person observed, and the work shift. Previously, we analyzed data and
procedures (cardiac, joint and spine). Staff education was begun and released reports at the end of each month. We designed a web-based
implementation of progressive use of the 2% CHG preoperative application that uses Crystal Reports (SAP), a business intelligence
preparation for other high risk surgeries soon followed. Results: report-writing program, to allow viewers to see hand hygiene data as
Following the implementation of these two taskforces and protocols, soon as the data are entered into the database. Data are retrievable
we saw a 76.78% decrease in MRSA-positive SSIs and 85.37% by date range, location of observation, category of staff observed,
decrease in VAPs. We have maintained a low rate to present day. weekday versus weekend, and by work shift. Each graph displays
Lessons Learned: Compliance and communication were key the percent compliance and the number of observations included.
issues for both taskforces. Communication barriers were identified Results: The web application took approximately 100 hours of
in several different stages during the implementation protocols. The information technology programmer time to design and refine. The
development of an evaluation tool to assess staff ’s understanding Infection Prevention department designed a training document to
of the process and products was pivotal for compliance. Consistent teach users how to call up their data. The application was assessed by
monitoring and concurrent feedback elevated compliance. managers as being easy to use and useful in tracking the performance
of their staff. Managers who track hand hygiene as a quality
indictor use the program several times each month. The program
eliminates many phone calls to the Infection Prevention department
requesting additional hand hygiene data. Lessons Learned:
Crystal Reports is a useful program with which to display real-time
performance data using a web-based application. A web-based hand
hygiene graphing application provides real-time display of hand
hygiene performance and gives managers immediate information on
their aggregate unit performance and on the performance of each
category of staff on their unit each day.

Presentation Number 12-155

Three Interventions=Zero Infections
Charlene Stewart, RN, MPA/HSA, CHSP - Infection
Preventionist, Rogue Valley Medical Center; Debbie Hurst, RN,
BSN - Infection Prevention & Control Program Manager, Rogue
Presentation Number 12-154 Valley Medical Center
Design and Implementation of a Web Application Issue: The SSI rate for C Sections for 2008-2009 was 1.9 and
for Real-Time Display of Hand Hygiene 2.1, respectively (infections per 100 C Sections). When the rate
Performance Data for the first half of 2009 was 2.9, which put our C Section SSI rate
almost at the 75th percentile when benchmarking with CDC, it was
April L. VanDerSlik, RN, BSN - Manager, Infection Prevention,
an indication we needed to make some changes in practice to see
Bronson Methodist Hospital; Krista Hinz - Administrative Extern,
improvement in our outcomes. Perioperative patient care was not
Bronson Methodist Hospital; John Fisher - Analyst, Information
standardized across service lines, and there were separate surgical
Technology, Bronson Methodist Hospital; Matthew Carpenter -
infection control policies in the OB Operating Room (OR), that
Programmer/analyst, Information Technology, Bronson Methodist
differed from the Main OR and Heart Cath Lab areas. Examples
Hospital; Richard A. Van Enk, PhD, CIC - Director, Infection
of differences in practice included: • OB patients did not bathe
Prevention and Epidemiology, Bronson Methodist Hospital
with CHG cloths preoperatively • OB did not do preoperative
Issue: Proper hand hygiene prevents the transmission of infection. MDRO screening • Variation in dress code requirements and patient
Hospitals measure, set goals, and employ strategies to improve surgical skin preps. Project: Infection Prevention & Control
hand hygiene as a quality monitor. Systems that rapidly assess and staff met with hospital and OB leadership to discuss the issue and to
immediately report results are more useful to improve performance develop an action plan to reduce the C Section SSI rate. Variations
than systems that have a long delay between performance assessment in practice between service lines were included in the discussion
and ways to bridge the gap that would standardize practice for

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 109
Poster Abstracts: Quality Management Systems/Process Improvement/Adverse Outcomes

perioperative patients. Three interventions were selected: • Use of rooms during open cases. Traffic is hypothesized to contribute to
CHG cloths for all patients admitted to Labor & Delivery (L&D) an increased risk of infection by increasing the microbial burden
• MDRO Screening protocol for all patients • Perioperative Policies in the air through movement and increased personnel in the room.
revised/standardized. Results: The first two interventions In addition, when a door opens it disrupts the air pressure in the
(CHG cleansing cloths and MDRO screening protocol) resulted OR compromising the effectiveness of the ventilation system.
in a C Section SSI rate decrease from 2.9 for the first half of 2009 Project: In an adult 28 suite OR and a pediatric 8 suite OR:
to 1.3 in the second half. When the third intervention was added Measure volumes and impacts of selected risk factors of infections
(standardized perioperative policies), the rate decreased further to in operation rooms through direct observation and analyses of
1.1. This rate placed us near the 50th percentile when benchmarking operating room and anesthesia databases. Measure traffic in and out
with CDC. The final rate for 2010 was 1.0; the rate for the first of selected operation rooms (ORs) and reasons for traffic. A similar
half of 2011 was Zero! While improved patient outcomes were the study was conducted in Winter 2006 and was published. That
primary goal, a positive secondary outcome also became evident. The study showed that 20% of traffic was related to supply /eqiupment
estimated cost avoidance for the 12-month period from July 2009 retrieval. Now, both ORs are going to case cart systems. The goal
through July 2010 was estimated to be $100,000. Total C-Section of Infection Control was to establish baseline numbers prior to the
infections 7/08 – 6/09 = 10 Total C-Section infections 7/09-6/10 case cart system (with recommendations for improvement). Also,
= 5 Estimated cost per SSI: $20,000 Estimated Cost Avoidance post studies will be completed after case cart implementation to see
for 12 months of CHG cloth use in L&D: $100,000. Lessons if improvements occur. Results: In Winter 2006,an Industrial
Learned: When the interventions were introduced to the OB Operations Engineering (IOE) 481 team performed study for
clinicians and staff, we were met with the challenge of convincing Infection Control on OR foot traffic – 28 cases were observed.
them that OB perioperative patients had similar risks to the general Study results showed that 20% of door openings are due to supply
surgical patient population. Key factors that gained their support and equipment retrieval. The Circulator nurse contributed to 30%
included: • Supporting evidence that standardization can lead of the overall traffic. In Winter 2011, a similar group duplicated
to improved patient outcomes • Organizational support to drive the study- 66 cases were observed. Study results showed that 25%
the sometimes unpopular changes • Organizational support to of door openings are due to supply and equipment retrieval. The
finance added expense of CHG cloths A key factor to the success of Circulator nurse contributed to 22% of the overall traffic. The
implementing these changes was engaging a physician champion to services with the highest traffic were Cardiac, Otolaryngology
assist with buy-in from other OB physicians. and Orthopedics. The circulator nurse exiting and entering the
room retrieving supplies is the main reason for excessive traffic
in the operating rooms. This was most apparent in long complex
surgeries requiring high amounts of instrumentation and supplies.
Other reasons for traffic were practice related, such as supplies,
breaks, and checking on a case. Unecessary or unknown traffic
was observed in all cases. Lessons Learned: The 2006-
2007 results were similar to our finding in the 2011 study, which
supports our decision to implement a case cart system.The
circulator nurse exiting and entering the room retrieving supplies
is the main reason for excessive traffic in the operating rooms.
This was most apparent in long complex surgeries requiring high
amounts of instrumentation and supplies. Some of these reasons
could be eliminated, thereby significantly reducing the overall
traffic volume. All of the unnecessary traffic should be eliminated.
The case cart system should decrease OR traffic, but sustained
Presentation Number 12-156 education, continued awareness, and workflow solutions are
necessary to the success of new system.
Measurement and Analysis of Foot Traffic in a
University Hospital Operating Room
Lisa K. Sturm, MPH, CIC - Supervisor, Infection Control and
Epidemiology, University of Michigan Health System; Julia A.
Jackson, CST, MEd, FAST - Infection Preventionist, Univeristy of
Michigan Health System; Shawn Murphy, RN, MSN - Director,
Surgical Services and Associate Hospital Admistrator, University
of Michigan Health System; Carol Chenoweth, MD - Hospital
Epidemiologist, Infectious Disease Physician, University of Michigan
Health System

Issue: Past observation studies and anecdotal review had revealed

that there were excessive amounts of foot traffic in the operating

110 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
Poster Abstracts: Quality Management Systems/Process Improvement/Adverse Outcomes

by post-op day one or two (depending on the type of orthopedic

procedure) was established. Using FOCUS PDCA methodology,
an inter-disciplinary team was formed. Team members included
Physicians, Nurses, Infection Prevention (IP), Quality Management
(QM), Information Technology (IT), Materials Management,
Physical Therapy, Pain Management, and Physicians Assistants (PA).
Current guidelines from the Society for Healthcare Epidemiology
(SHEA) and the Centers for Disease Control and Prevention (CDC)
were reviewed. It was determined that a systematic approach to the
problem would be undertaken to improve performance. Baseline
data and causes of process variation were reviewed including the use
of epidural analgesia, computerized prescriber order entry (CPOE)
issues, and patient satisfaction. Systematic interventions included
rebuilding CPOE order sets to include drop down selections with
specific evidence based criteria for ordering catheters. Nursing
electronic documentation was also revised to include timing of
catheter insertion and removal. Automatic expiration of catheter
orders was set at 24-48 hours dependent on the type of orthopedic
procedure. If the patient assessment indicated a continued need for
an indwelling catheter, daily reordering was required. Non invasive,
hand held devices (bladder scanners) were purchased to reduce
unnecessary invasive catheterizations and an evaluation of current
urinary care products was conducted with Materials Management.
We did not introduce any new catheters due to nursing and patient
satisfaction with current products. Patient education materials were
revised to include information about timely removal of catheters.
Results: • Timely catheter removal improved from 81% to
100%. (Fig 2) • An interdisciplinary standard for management
of patients with indwelling urinary catheters was developed with
defined accountabilities • CPOE order sets were redesigned and

Presentation Number 12-157

Improving the Management of Orthopedic Surgical
Patients with Indwelling Urinary Catheters Using a
Systematic Evidence Based Approach
Eileen A. Finerty, MS, RN, CIC - Nursing Director; Infection
Control and Occupational Health Services, Hospital for Special
Surgery; Helen Renck, MS, RN - Director of Standards and
Accreditation, Hospital for Special Surgery; Patricia Griffin, MS,
RN, CPHQ - Director of Quality Management, Hospital for Special
Surgery; Mary McDermott, MS, RN - Assistant Vice President;
Nursing, Hospital for Special Surgery

Issue: Urinary tract infections (UTI) account for more than 30%
of all hospital acquired infections (HAI) and more than 80% of UTI
infections are related to unnecessary indwelling urinary catheters.
(CDC, 2009) The risk of UTI is also influenced by the duration of
catheterization and limiting catheter use has been found to be an
important factor in reducing UTI infection rates. (Stephan, 2006).
Project: An Infection Control risk assessment was performed
at an elective orthopedic hospital which included a review of data
and current practices regarding catheter insertion, continuance and
discontinuation. (See figure 1) Opportunities for improvement were
identified and a goal of removing all indwelling urinary catheters

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 111
Poster Abstracts: Quality Management Systems/Process Improvement/Adverse Outcomes
implemented • A competency and skills validation for inserters was plan will be to improve the accuracy of diagnoses, reduce antibiotic
developed. Lessons Learned: Lessons learned/ Next Steps A exposure thereby possibly reducing unnecessary hospital admissions.
systematic, evidence based approach to the problem using established
PDCA methodology resulted in sustained performance improvement
regarding timely catheter removal. Additional improvement and
efficiency opportunities surrounding Catheter Associated Urinary
Tract Infection (CAUTI) prevention exist and are being investigated.

Presentation Number 12-158

The Impact of Improperly Collected Urine Cultures
on Patient Treatment in the Emergency Department
Kathleen Francis, RN, BSN - Infection Preventionist, Paoli
Hospital/ Main Line Health; Kathleen M. Lucente, RN, MT, CIC -
Infection Preventionist, Paoli Hospital, Main Line Health

Background/Objectives: The collection and analysis Presentation Number 12-159

of urine cultures are important for diagnosis and treatment of a
urinary tract infection (UTI). These tests are routinely performed Making it Personal: Utilization of an Electronic
but the quality of collected specimens has not been closely examined. Personal Hand Hygiene System to Increase Hand
Prior studies addressing this issue have been limited. Methods: Hygiene
Multiple system hospital computer databases were queried for clinical
data from January 2011 through May 2011. Soarian ® SmartChart Bonnie J. Schleder, APN, MS, CCRN, TNS - Advanced Practice
database was used for data on sample collection, clinical diagnosis Nurse - Critical Care, Advocate Good Shepherd Hospital; John
and treatment. The T-System, Inc®, an Emergency Department (ED) T. Brown, RN - Registered Staff Nurse, Advocate Good Shepherd
database, was used for data on hospital admission and treatment. Hospital; Patricia Moore, RN - Registered Nurse, Advocate Good
A contaminated urine culture was defined by clinical laboratory as Shepherd Hospital; John J. Vesely Jr., RN, TNCC - Patient Care
follows: multiple organisms (2 organisms or more), or mixed growth Leader, Advocate Good Shepherd Hospital; Charisma R . Trinidad,
(<100,000 colony forming units with multiple organisms). Data from RN, BSN, CCRN - Patient Care Leader, Registered Nurse, Advocate
January were reviewed to determine which patients were diagnosed Good Shepherd Hospital
with a UTI and how they were treated. The study definition of a
UTI was clinician- documented diagnosis of UTI in Smart Chart or Issue: There are 1.7 million healthcare associated infections
the T-system. Treatment was defines as antibiotics given specifically (HAI’s) annually (Klevens, Edwards, & Richards, 2007). Since hand
to treat the UTI. This information was found in the same clinical antisepsis is known to reduce the incidence of HAI’s, the World
databases. Results: Urine samples collected and contamination Health Organization (2006) introduced the “Five Moments of Hand
rates over the 5 month study period are shown in Table 1. Number of Hygiene”. The question now becomes how can this goal be met,
samples taken each month ranged from 578 to 730 with an average sustained, and easily surveyed for compliance. To achieve this depth
of 657 per month. The contamination rates per month ranged from of hand hygiene our nursing quality and safety committee partnered
32 to 40% with an average of 37%. More females were identified with industry to develop a personal hand hygiene system with an
with contaminated cultures then males. Table 2 shows patients in automatic counting system. Following a review of the literature a
the month of January who had a contaminated urine culture and stretch goal of 8 hand hygiene events per hour was established. Since
were treated for UTIs. 97 of the 215 patients, or 45% of patients, compliance and sustainability is essential to any change process,
with a contaminated urine specimen were treated for UTIs. 34 an adoption system was developed. The adoption system included
were treated as an outpatient and 63 were treated as an inpatient. education, e-mails, personal inquiries, peer coaching, communication,
Conclusions: Over the 5 month observation period 3,285 and celebrations/fun activities to achieve success. Results: Using
urine cultures were taken, 1,098 or 36.4% were contaminated. The traditional soap and water and waterless antimicrobial hand gel at
majority of those with contaminated urine cultures were women with the doorway, 71.7% of registered nurses and technicians that worked
a rate of 79%. This might be because it is more difficult, to get well- in the unit had a baseline hand hygiene practice measured at a rate
collected urine specimens from women. Of those with contaminated of 3.5 handwashes per hour. The hand hygiene rate increased to
urine cultures, 45% were treated based upon this faulty data. Prior 8.8 per hour within the first month following the introduction of
studies have been limited but have reported contamination rates of the personal hand hygiene system which the staff attached to their
10-20%. The current study found a higher rate of contamination pocket. Compliance was automatically counted electronically. Daily
than those in the published literature. Many patients were perhaps compliance reports were displayed on a TV monitor on the unit for
misdiagnosed with a UTI. A large fraction, often as inpatients, was staff, patients, and visitors to see. Staff were provided anonymous
treated based upon this data. The findings of this study identified a numbers to track their own progress; however these numbers were
need for a process improvement plan that addresses staff awareness not shared with unit management. Sustainability was present 11
of the importance of properly collected cultures. The goals of this months later at a hand hygiene rate of 8.9 episodes per clinician

112 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
Poster Abstracts: Quality Management Systems/Process Improvement/Adverse Outcomes
per hour. Lesson Learned: Traditional handwashing methods make Presentation Number 12-161
implementing and surveying the “Five Moments of Hand Hygiene”
difficult. Personal hand hygiene dispensers provided an additional Impact of a Hospital wide policy on Clostridium
alternative to traditional methods and increased frequency of hand difficile testing using Cepheid System®
washing near the patient’s environment. Automated surveillance
tools assisted in the collection of data with minimal personnel. Elise E. Kumar, PHD, MS, MPH, CIC - ICP, Barnabas Health;
When introducing a new product and process, change theory Kristin G. Fless, MD - Physician, Barnabas Health; Eileeen Yaney,
becomes important to achieve the goal. One approach to holding MS, CIC - Director of Infection Control, Barnabas Health; Mikhail
staff accountable was through peer mentoring versus traditional top Litinski, MD - Physician, Barnabas Health; Fariborz Rezai, MD -
down management. This approach was greatly appreciated by the staff Physician, Barnabas Health; Paul Yodice, MD - Director of Critical
and relieved some anxiety about the introduction of this program. Care, Barnabas Health; Ellen Cianci, MT (ASCP), MS - Director
Lessons Learned: Traditional handwashing methods make of Microbiology, Barnabas Health; Lauren Grimes, BS, CCRN -
implementing and surveying the “Five Moments of Hand Hygiene” Critical Care Nurse Manager, Barnabas Health
difficult. Personal hand hygiene dispensors provided an additional
alternative to traditional methods and increased frequency of hand ISSUE: C. difficile is an anaerobic, spore-forming Bacillus that is
washing near the patient’s environment. Automated survellance tools responsible for a spectrum of C. difficile –associated disease (CDAD),
assisted in the collection of data with minimal personnel. When including uncomplicated diarrhea, pseudomembranous colitis, and
introducing a new product and process, change theory becomes toxic megacolon, which can, in some instances, lead to sepsis and even
important to achieve the goal. One approach to holding staff death. A pilot study in our ICU found that the majority of specimens
accountable was through peer mentoring verus traditional top down sent for C. difficile testing were negative, however, repeated testing
managment. This approach was greatly appreciated by the staff and and empiric treatment led to excess lengths of stay, increased cost of
relieved some anxiety about the introduction of this program. care and over-treatment. We developed a new hospital wide policy
and procedure to ensure testing of appropriate specimens, curtail
unnecessary repeat testing and provide results in a timely manner.
PROJECT: Effective September 1, 2011, the Department of
Pathology at our hospital implemented real-time PCR (polymerase
chain reaction) methodology to determine the presence of C. difficile
toxin B gene in stool specimens. The test utilized the FDA-cleared
Cepheid® Xpert C. difficile Assay. Only patients with diarrhea or
with three (3) or more unformed stools per day were considered for
testing. Liquid or soft stool specimens taking the shape of container
were accepted for testing, otherwise specimen was rejected. One stool
specimen was considered adequate for testing because of the high
sensitivity (98.79%) and specificity (90.82%) of the assay. Repeat
testing was allowed if PCR was indeterminate, or if patient had a
relapse of diarrhea or diarrhea continued after 14 days of therapy.
If PCR assay was negative, repeat testing was allowed after 5 days.
The assay was performed by the laboratory twice a day, seven days a
week. We observed the number of specimens submitted for Cepheid®
testing, rejected specimens, and percentage of positive tests for four
months after the reduction initiative. RESULTS: Pre-Cepheid
testing was observed for four months during which 840 specimens
were submitted and 107 were rejected (12.7%). After introduction
of Cepheid® testing and hospital-wide policy implementation, 133
specimens tested positive (18.2 %) compared with 9.0% Pre-Cepheid
policy. Only 10.6% of specimens were repeatedly tested. Lessons
Learned: A change in C. difficile testing to the Cepheid ®Xpert
C. difficile assay along with a new hospital-wide policy governing
appropriate testing of specimens resulted in a higher percentage of
positive tests vs. our standard C. difficile toxin testing of three daily
consecutive specimens. A multidisciplinary team or Team Charter
drove the initiative and partnered to ensure adequate testing using the
Cepheid® PCR system as well as treatment of C. difficile. Education
must be presented multiple times in multiple ways to further limit
submission of inappropriate specimens. Our study did not look at
whether or not the 24 hour turnaround time of the Cepheid® PCR
test decreased utilization of anti-C. difficile therapy, but this would be
an exciting area for future study.

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 113
Poster Abstracts: Quality Management Systems/Process Improvement/Adverse Outcomes

Presentation Number 12-162 patients with central venous catheters (CVC) were not confined to
the PCCU. These CVC were accessed by other clinicians in many
Reducing Transmission of Multi-Drug Resistant areas of the hospital. For instance, CVC are being accessed in the
Organisms in Procedural Areas operating room, radiology, and cardiac catheter lab. In addition,
patients were transferred to acute care floors with their CVC in place.
Janet L. Curtin, MT(ASCP), BS, CIC - Infection Prevention No standardized care or protocol to care for these CVC had been
Practitioner, Quality and Patient Safety, OhioHealth, Riverside established; therefore CVC care varied from unit to unit and person
Methodist Hospital; Marcia L. Waibel, MT(ASCP), MBA, CIC - to person. A task force was formed that included nursing from all
Infection Prevention Practitioner, Riverside Methodist Hospital areas of the hospital, infection control and prevention and quality
improvement, in which to develop standard procedures for the care
Issue: Patients continue to acquire health care associated infections of CVC. Project: A multidisciplinary team was formed to look
at an alarming rate and estimated costs of approximately $8,832 per at the maintenance care of CVC throughout a children’s hospital.
infection. The Joint Commission’s 2010 National Patient Safety Several opportunities for improvement were identified; among these
Goal 07.03.01 requires the implementation of evidence-based were CVC dressing changes and accessing the CVC. The following
practices to prevent health care-associated infections due to multi- initiatives were developed: 1. Promote a new “Scrub the Hub”
drug resistant organisms (MDRO) in acute care hospitals. This campaign that included a systematic approach to scrubbing the hub.
requirement applies to, but is not limited to, epidemiologically The hospital also changed from alcohol wipes to chlorohexadine
important organisms such as MRSA, Clostridium difficile, VRE wipes. 2. Develop standardized dressing change kits. Three size kits
and multi-drug resistant gram-negative bacteria. In addition, the were developed to capture the varying sizes of pediatric patients.
Fiscal Year 2010 Riverside Methodist Hospital Risk Assessment, The kits also incorporated an appropriate sized chlorehexadine
revealed that antibiotic resistant organisms were rated the highest impregnated dressing. 3. The Vascular Access Team (VAT) expanded
risk priority of the Infection Prevention Department. Riverside’s their role to include rounding daily on all in house PICC catheters
healthcare associated infection rates for Clostridium difficile (C. diff) and troubleshooting central venous catheters in the PCCU. A future
and MRSA were above the average rates of comparative institutions initiative is to expand the troubleshooting role outside of the PCCU.
for calendar years 2008 and 2009, respectively. Project: A team 4. CLABSI event analyses (huddles) were being performed in the
was assembled with representatives from fifteen procedural areas and PCCU. These multidisciplinary huddles reviewed the CLABSIs and
charged with reducing transmission of multi-drug resistant organisms determined any commonalities. For instance, if the central venous
during patient transport. Project objectives included defining catheter had a sluggish blood return, it was noted that this increased
expectations and communication to improve the internal practice of the risk for a CLABSI. These huddles were expanded to include
contact isolation and designing metrics to measure effectiveness. The all hospital CLABSI events. 5. Bedside rounding tool templates
key deliverable of the project was a visual cue to identify patients in were developed that could be individualized to meet the needs of a
contact isolation. Process mapping of patient flow was performed to specific unit. These tools discussed catheter necessity and any issues
identify process variation and opportunities for transmission, which with that patient’s central venous catheter. Results: Following
were then addressed through standardized interventions. Results: the implementation of these initiatives, the CLABSI rates decreased
The team developed an isolation transport packet that included throughout the institution. In 2010 the numbers of CLABSIs were
the following: • An inexpensive page protector with notebook 54, for a rate of 2.4. The number of CLABSIs for 2011 totaled 17, for
ring used to affix packet to bed/gurney during transport • Contact a rate of 0.8. Lessons Learned: Collaboration from all areas
Isolation signage, to be posted in the procedural bay until the area of the institution is necessary to develop a standardization of central
has been cleaned properly • Solid color matching paper used to cover venous catheter care and foster a zero tolerance culture.
isolation sign during transport Lessons Learned: Successful
interventions to reduce MDRO transmission opportunities are best
defined by front-line workers empowered by managers providing
project sponsorship and resource allocation for project success. Presentation Number 12-164
Standardizing practices to reduce variation in the transport of
contact isolation patients is key to consistent, safe patient care for Infection Prevention Component of Process
every patient, every time. Periodic process monitoring is necessary to Improvement Project to Reduce Regulated
prevent normalized deviance from established standard practice. Medical Waste
Christy M. Wisdom, BSN, RN, CIC, LSBB - Infection
Preventionist, Arkansas Children’s Hospital; Joe Knight -
Presentation Number 12-163 Environmental Management Coordinator, Arkansas Children’s
Hospital; Jennifer Emerson, RN - RN III, Pediatric Intensive
It’s Contagious! CLABSI Prevention is Spreading Care Unit, Arkansas Children’s Hospital; Catherine Waters, BSN,
RN - Chief Quality Officer, Improvement U, Arkansas Children’s
Jackie Smith, MSN - Infection Control Consultant, Vanderbilt
Hospital; Kurtis Kuykendall, MBA - Director Process Improvement,
University Medical Center
Arkansas Children’s Hospital; Aaron Lindberg - Director of
Issue: Initiatives to reduce central line associated blood stream Environmental Services, Arkansas Children’s Hospital; Craig
infection (CLABSI) rates in the Pediatric Critical Care Unit Gilliam, BSMT, CIC - Director of Quality Development Infection
(PCCU) were reviewed in 2010. It soon became clear that the Prevention & Control, Arkansas Children’s Hospital

114 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
Poster Abstracts: Quality Management Systems/Process Improvement/Adverse Outcomes
Issue: We describe a Performance Improvement approach to To prevent further transmission, Infection Prevention (IP) measures
solving issues related to Regulated Medical Waste (RMW). The were instituted immediately: Contact Isolation for symptomatic
project identified variations in the process of RMW disposal and patients, hand-washing with soap and water only, removing waterless
clearly defined waste disposal practices. Streamlining the process hand sanitizer from symptomatic patients’ rooms, environmental
created significant disposal costs savings and standardization for cleaning with a bleach agent and discontinuing symptomatic patients’
the facility. Project: We used methodology taught through our participation in activities outside their room. The PBMTUs staff,
internal process improvement program known as Improvement U. physicians and patient’s immediate family were also surveyed for
This methodology is similar to LEAN Six Sigma but customized gastro-intestinal illness. After implementing immediate prevention
to our facility. The team utilized the DMAIC method, define, measures, there were no additional cases. While investigating, the
measure, analyze, improve and control and started in the Pediatric IPN discovered she had not received specimen results from reference
Intensive Care Unit (PICU). Baseline data was collected by sorting labs in her daily lab reviews. To better understand the process for
a minimum of 5 randomly selected containers of RMW from the reporting reference lab results within the organization, the IPN
PICU. The contents of the containers were properly categorized, performed a specimen walk-round activity, reviewing each step in
wieghed in pounds and volume was measured in gallons. Baseline the specimen send-out and reporting process. She found that tests
data showed that only 16% met criteria for RMW. Three patient sent to reference labs had results communicated directly to the
rooms in the PICU were used for the PDSA (plan, do, study, and act) ordering physician. Reference lab results were then entered into the
cycles. Each PDSA was designed to be cumulative with an additonal electronic medical record (EMR) in a lab section not accessed by IP’s
change added with each cycle. Each PDSA cycle was seven days and database, and not communicated to the IPN. A multi-disciplinary
waste was collected separately from both containers, RMW and team of physicians, IPNs and laboratory personnel met to address this
trash. RMW was collected, sorted and measured. Our contracted communication failure and identify a method to improve notification
vendor was able to track the PICU waste separately and provide a to IP regarding specimens sent to reference labs. The team discovered
waste generated per pound. Results: The best results were after a failure of lab and IP databases to interface regarding these results,
completion of the third PDSA cycle that included all three changes. indicating a need to identify an alternative method of notification.
Staff became engaged in the process and the PICU exceeded the goal The team collaboration resulted in the development of a daily
of a 25% reduction in RMW. The interventions were celebrated by automated email to IP listing the specimens sent to reference labs.
the team and the PICU staff. Control measures were in place with a Also, the lab renamed reference lab tests and results documented
tracking system for staff to monitor each department’s RMW each in the EMR, allowing for easier access of results. Now IP could be
month. Interventions were spread out department by department knowledgeable of ordered tests and could monitor for returned
throughtout the facility. We have an estimated savings of $118,000 results more efficiently. Results: While immediate interventions
annually, for the facility. This is based on a 32% reduction in the curtailed additional Norovirus cases, the inadequate communication
waste generation, reduced labor by staff and decrease use of materials process for notifying the IPN of specimen results was a significant
and supplies. Lessons Learned: Develop a team to focus defect in our IP surveillance program. A multi-disciplinary approach
on the project. Define your problem first and gather baseline data identified and solved the process failure using a relatively simple
before attempting solutions. Develop clear, concise and standardized communication system. With an improved communication process
education materials. Standardize, the size of the containers, location, and understanding of the reference lab processes, IP is informed of
education and guidelines. Assess best location of containers by tests sent to reference labs, can monitor results and can implement
analyzing work flow. Provide frequent feedback to the staff, using prevention measures sooner for epidemiologically significant
data driven charts. Celebrate victories by rewarding staff for positive pathogens. Lessons Learned: As laboratory technology
changes in behavior. advances, the use of reference labs will increase. Communication
between the lab and IP regarding epidemiologically significant testing
and results is imperative in the prevention of infection.
Presentation Number 12-165
Presentation Number 12-166
A Norovirus Cluster Reveals a Big Stink: A
The Development of a Process Improvement Tool:
Communication Failure Between Infection
The SWAT Approach to Surgical Site Infection
Prevention and the Laboratory
Analysis
Charlene Carriker, BSN, RN, CIC - Infection Prevention Nurse,
Duke University Health System; Pamela Isaacs, BSN, MHA, CIC - Amy M. Dziewior, BSN, RN - Infection Control Consultant,
Clinical Director, Duke University Health System Vanderbilt University Medical Center; Lorrie G. Ingram, BSN, RN,
CIC - Infection Control and Prevention Consultant, Vanderbilt
Issue: Laboratory tests are used by physicians to diagnose and University Medical Center
guide patient’s treatments. These results are also crucial to the
Infection Prevention Nurse (IPN) as a tool in identifying clusters and Issue: The Centers for Disease Control (CDC) estimates that
preventing infection transmission. Project: In April 2010 the in the U.S., almost 2 million HAI (Hospital Acquired Infections)
IPN was notified of 4 cases of Norovirus in our 16 bed Pediatric Bone occur annually. The cost for these infections adds between 4.5 and 11
Marrow Transplant Unit (PBMTU). The IPN’s investigation found billion dollars yearly to an overburdened healthcare system, with an
1 to be a community-acquired infection and the possible source case. average extended hospital stay of 7-10 days. Surgical Site Infections
(SSIs) comprise nearly 20% of all HAIs. More importantly, HAIs

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 115
Poster Abstracts: Quality Management Systems/Process Improvement/Adverse Outcomes

contribute to nearly 100,000 deaths annually. Of this number, an facility for a hospital-acquired CAUTI unless the condition was
estimated 8,000 deaths are secondary to SSIs. A great majority documented as present on admission. As an acute care facility in a
of these are preventable. An important aspect of SSI reduction large public hospital corporation in East Harlem, we were charged
and prevention has proven to be a “robust” surveillance program with decreasing our CAUTI rate by 20%. In 2010 we had a total
with significant and timely feedback to surgeons, perioperative/ of 27 hospital-acquired CAUTI’s for an overall hospital rate of 7.9
postoperative staff, administration, and other ancillary healthcare per 1000 catheter days. This rate triggered our Reason for Action.
providers. The Infection Preventionist’s role (along with related There were 5 non-ICU CAUTI’s for a rate of 3.6 per 1000 catheter
staff and quality interface) using objective data collection methods, days and 22 ICU CAUTI’s for a rate of 10.8 per 1000 catheter
consistently applied sound epidemiological definitions, and days. Using the Breakthrough (LEAN) method, we systematically
surveillance methods that are standardized and easily replicated, implemented strategies to decrease our CAUTI rate in 2011. The
are all very important to a facility’s overall program integrity and Breakthrough (LEAN) method improves processes and outcomes,
success. Project: Current research and studies have revealed that reduces cost, reduces cycle times and ultimately increases patient and
facility programs that perform event analysis and case breakdown, staff satisfaction. Our target state was 0 CAUTI. Project:The
with the use of objective methods and tools that can identify, collect, metrics included all symptomatic CAUTI ‘s as defined by the CDC/
track, and analyze data elements (both by general and specific NHSN 2009 definition for CAUTI’s. CAUTI’s were monitored
surgery type) are more likely to gain meaningful and significant on the non-ICU units and the ICU units. Interventions included:
insights with regards to trends and common occurrences that may revising the urinary catheter policy to reflect the best practice and
cause or predispose their patients to infection. This method/tool expectations of the nursing and physician staff, revised the CAUTI
also includes the consideration and collection of “risk adjusting” bundle, competency checked the nursing staff on insertion and
elements. Thus, two of our surgical service line teams, who have maintainance of the urinary catheter, implemented a renew/review
experienced an increase in SSI rates, developed a specific SWAT need for the urinary catheter in the Electronic Medical Record
(surgical wound analysis team) tool to assist in their analysis of cases. (EMR), standardized equipment and monitored the outcomes using
Once an infection is identified by the IP (Infection Preventionist), unit based champions and weekly prevalence data gathering. We
members of the SWAT are assigned a certain block of data elements used the A3 tool that provided a structured approach to define and
to collect/report via the tool. Elements are objectively abstracted via understand the problem. The tool contains the following seven main
the electronic medical record. Members have specific elements to elements: reason for action, initial state, target state, gap analysis,
collect and make comments on, which may be discipline specific to solution approach, rapid experiments and confirmed state. The nursing
that members interface or function on the surgical healthcare team. staff and nursing education were the champions that drove the daily
Results: The Cardiac Surgery SWAT, begun in 1995, was the practice, compliance and implementation of the “best practices”. The
original model for the current process. The successes of this group Infection Control team monitored the CAUTI’s and supported the
over this period of time include: increased participation with full nursing staff implementation of the project.Results:In 2011, the
engagement by key members of the healthcare team and development overall reduction of CAUTI’s hospital wide was 44% compared to
of a tool with specific elements for analysis related to risk factors, the CAUTI rate in 2010. The greatest improvement was seen in the
evidence based care delivery throughout the surgical episode, and ICU. A comparison of ICU CAUTI rates at baseline demonstrated
variances to any standardized processes. Lessons Learned: a decrease from 10.8 per 1000 catheter days in 2010 to 5.4 per 1000
This group has evolved over the years due to the dynamic changes catheter days post-intervention in 2011. This represents a 50%
in surveillance, care delivery, and the environment of care. Trend reduction in the ICU. Lessons Learned: Implementing “best
analysis through the years has revealed that there may not be a specific practice”, working collaboratively and actively promoting infection
cause for any one SSI (although common factors may have been prevention demonstrates a positive impact on patient care and
identified), but that etiology is most likely multifactoral. satisfaction. Using the Breakthrough (LEAN) thinking method has
provided a framework for the staff to implement the right choices
creating processess that define the primary customer, the patient.
Presentation Number 12-167
Decreasing Catheter Associated Urinary Tract
Infections (CAUTI) using the BREAKTHROUGH Presentation Number 12-168
(LEAN) Method
Improving Antimicrobial Stewardship in the
Kathi Mullaney, BSN,MPH,CIC - Associate Executive Director, Neonatal ICU with Computer Decision Support
Peri-operative Services, Metropolitan Hospital Center
Yu-hui Ferng, MPA - Project Manager, Columbia University School
Issue:Urinary tract infections (UTI’s) are the most common of Nursing; Robert S. Hum, MD, MA - Assistant Professor of
type of healthcare-associated infections (HAI’s), accounting for Clinical Pediatrics, Columbia University; Morgan Stanley Children’s
more than 30% of infections reported by acute care hospitals. Hospital of NewYork-Presbyterian; Patricia DeLaMora, MD -
Approximately 80% of all hospital-acquired Catheter Associated Assistant Attending Pediatrician; Assistant Professor of Pediatrics,
UTI’s (CAUTI’s) are caused by instrumentation of the urianary Weill Cornell Medical Center; NewYork-Presbyterian; Sameer Patel,
tract. CAUTI ‘s are one of the 10 hospital-acquired conditions “never MD, MPH - Assistant Professor in Pediatrics, Division of Pediatric
events” since they are preventable and should “never” happen. The Infectious Diseases, Columbia University; Morgan Stanley Children’s
Centers for Medicare and Medicaid Services will not reimburse a Hospital of NewYork-Presbyterian; Jennifer Duchon, MDCM,

116 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Quality Management Systems/Process Improvement/Adverse Outcomes

MPH - Assistant Professor of Clinical Pediatrics; Attending Presentation Number 12-169

Neonatologist, Columbia University; Morgan Stanley Children’s
Hospital of NewYork-Presbyterian; Kenrick Cato, RN - Programmer, Evaluating the Primary Outcomes of W.H.O
Columbia University School of Nursing; Elaine L. Larson, RN, Surgical Safety Checklist 2009 Application in an
PhD, CIC - Associate Dean for Research, Columbia University Obstetrics and Gynecology Hospital of Vietnam
School of Nursing; Lisa Saiman, MD MPH - Professor of Clinical
Pediatrics and Hospital Epidemiologist of Morgan Stanley Children’s Hang Kim. Do - Head Nurse Of Operating Room, Vietnam
Hospital, Columbia University Department of Pediatrics National OB-GYN hospital

Background/Objectives: To improve antimicrobial Background/Objectives: The number of surgical

prescribing in the Neonatal ICU, we developed a Computerized cases in National Obstetrics and Gynecology Hospital (NOGH)
Decision Support (CDS) module embedded within our commercial is quite high, estimated at 16.000 – 18.000 cases/ year. (In 2011,
electronic medical record (EMR), Eclipsys XA. The module it was 18.207 cases, in which 6.618 cases were Planned Surgeries,
(“LadyBug”) provided culture and susceptibility results obtained and 11.589 cases were Emergency Surgeries, with 29 complication
during the entire NICU hospitalization; displayed selected cases (0.16%), among which there were 9 cases of post-operative
laboratory results identified by neonatal prescribers as clinically infection. In order to enhance patient safety and minimize the
important when considering both empiric and culture-based risk of complication, NOGH started applying W.H.O Surgical
antimicrobial treatment; and provided recommendations for therapy. Safety Checklist (SSC) since Oct 2011. Objectives: Collect and
We present the preliminary results of an anonymous user survey. summarize the comments on the Surgical Safety Checklist to make
Methods: LadyBug was implemented in July 2010 in two level it applicable, appropriate with an Ob-Gyn hospital. Evaluate safe
III study NICUs. The study team taught NICU staff, identified effectiveness and reduction of risk in surgery after 2 month SSC
as antimicrobial prescribers, how to use LadyBug’s features. From application. Methods:Methods: Gather comments from 560
November 2010 to June 2011, technical challenges resulted in doctors and nurses related to the process of preparing the surgical
loss of the ability to provide culture-based antibiotic treatment patients and surgeries. Summarize all the surgical complication in
recommendations while other functionality remained intact. total 3.102 surgical cases, conducted during 2 month application
Following the completion of multiple upgrades to the hospital of the SSC. Results: All comments supported the necessity of
information technology system, full functionality was restored. An the SSC application: 95.15% comments found the SSC appropriate
18 item electronic survey was developed to identify the preferred and applicable, while the other 4.85% found it complicated and
features of LadyBug, the barriers to use, the ease of use compared to time-consuming. Suggestion to add information of neonatal doctor
other hospital electronic data sources, and the potential impact of – midwife with full neonatal intensive care equipments into “B”
the temporary loss of functionality. The first survey was administered item and checking the number of mother to match with the number
from July to September 2011 to NICU prescribers and a follow-up of newborn before bringing the newborn out of operating room
survey will be administered at the end of the study period in April into “C” item. There was only one case with severe bleeding at pre-
2012. Results: Overall, 46 (28%) of 164 eligible participants operation and during operation, leading to coagulation disorder. This
completed the survey. Participants included 12 NICU attending complication made the patient hospitalize for post-operative 20 days.
physicians, 5 fellows, 18 residents, 2 house physicians, and 9 nurse It was an emergency operation as the admission was severe bleeding
practitioners. Most respondents (63%) were aware of LadyBug. central placenta previa. No post-operative infection cases found.
The most preferred features were the summary of culture results Conclusions: The SSC was highly effective and necessary. It
(77% of respondents) and the culture-based antibiotic treatment should be applied for all surgical cases. However, there should be
recommendations for different types of infections (85%). Antibiotic some minor modifications as stated above to make it more suitable
orders (42%), antibiotic levels (38%), and complete blood counts with local culture and characteristics of an Ob- Gyn hospital.
(31%) were preferred by fewer respondents. Respondents reported
that LadyBug assisted in antibiotic decision-making (80%) and saved
time (60%) when compared to other electronic sources. However, Presentation Number 12-170
only 37% of respondents had used LadyBug during their last service
rotation. Additional features desired by respondents included A Process Improvement Project Decreases Blood
duration (80%) and dose (60%) of current antimicrobial therapy. Culture Contamination Rates in the Emergency
Conclusions: While we successfully implemented a CDS Room
module within a commercial EMR, we experienced unanticipated
technical challenges that temporarily limited functionality. While Maria C. Montero, MT(ASCP)SM, MPH, CIC - Manager,
most respondents were aware of LadyBug, fewer had used it during Infection Prevention, Rush Copley Medical Center
their latest rotation. Nonetheless, the core features, summarized
Issue:Blood cultures are routinely collected in the emergency
culture results and antibiotic treatment recommendations, were
room for infection diagnosis, source, organism identification, and
well received. The survey results suggested that these “value added
appropriate antibiotic treatment. Contaminated blood cultures
functions” potentially contributed to both improved decision-making
result in increased costs and adverse outcomes due to unnecessary
and time-savings. We speculate that loss of functionality of a core
admission to the hospital, increased length of stay, unwarranted
feature may have reduced the usage and possibly the survey response
antibiotic use, treatment side effects, and antimicrobial
rate. Anticipating technical challenges and adding desired features
resistance. Blood culture contamination rates collected in the
will be crucial in increasing usage and acceptance by prescribers.

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 117
Poster Abstracts: Quality Management Systems/Process Improvement/Adverse Outcomes

emergency room remained above the national benchmark of 3%. impregnated sponge is applied and covered with a semi-occlusive
Project:Variations in blood culture collection techniques were dressing that effectively adheres to the skin for seven days. A central
identified. The recommended procedure for application of the 2% line dressing change kit with a 3.15% chlorhexidine gluconate/70%
chlorhexidine gluconate/70% isopropyl alcohol (ChloraPrep®) skin isopropyl alcohol swabstick was established because of its seven
antiseptic was not always followed. Re-palpating the site after skin day antimicrobial persistence. A port access kit was developed with
preparation was routinely observed and tops of the bottles were necessary supplies to reduce breaks in asepsis during port access.
not disinfected before puncture. Many of the blood cultures were Results: Our goal of zero Central Line Associated Infections
collected during IV starts and 2 sets (4 bottles) were collected at the (CLABIs) in our adult intensive care unit was achieved in March,
same time. New policies were established to require two different 2009, one infection in June, 2010, and zero infections in 2011.
blood draws from two different sites. Collection of blood from the Lessons Learned: Collaboration and commitment played a
peripheral line is not recommended. A dedicated blood culture role in implementing changes. Aseptic technique must be followed at
collection team was developed and education was conducted to all times. A layered kit design with essential products in the right place
emphasize the importance of aseptic technique and the value of increases compliance. Easy to use efficacious products, such as the
proper blood collection. A 3.15% chlorhexidine gluconate/70% 3.15% Chlorhexidine gluconate/70% isopropyl alcohol solution for
isopropyl alcohol (Chlorascrub™) antiseptic swabstick for skin skin preparation and dressing changes, the 65.9% alcohol handwipe,
preparation was implemented using a 30 second scrub and a 30 the chlorhexidine gluconate sponge, and a dressing that adheres well to
second dry time before blood culture collection. Re-palpating the skin play an important role in infection prevention.
the skin after antiseptic application was prohibited and tops of
the bottles were disinfected immediately prior to use. Education
with required yearly competency for peripheral and IV line blood
Presentation Number 12-172
culture collection is required and must be repeated for any reported
contaminated blood culture. Results:Emergency room blood Quantitative Evaluation of Environmental Surface
culture contamination rates were above 7% at the beginning of Cleanliness in Pediatrics Intensive Care Unit
our project in 2002. Since implementing changes the rates remain
below 3%. Lessons Learned: Education and collaboration Yuxin Ma - Director, Infection Control Center, Fuwai Heart
in getting staff to recognize the importance of proper blood Hospital & Cardiovascular Institute
collection technique for the patient and the hospital is essential for
practice compliance. Incremental changes were necessary to obtain Background/Objectives: The objective of the
our goal. Appropriate use of an effective and easy to use product, present study was to quantitatively evaluate the environmental
such as the 3.15% chlorhexidine gluconate/70% isopropyl alcohol surface cleanliness in the pediatrics intensive care unit (PICU) of
antiseptic swabstick improved compliance and outcomes. Patient hospitals and to monitor the efficacy of the cleaning methods used.
adverse events and hospital costs are avoided when blood culture Methods: 22 different kinds of environmental surfaces in PICU,
contamination is prevented. Fuwai Heart Hospital & Cardiovascular Institute were chosen based
on the hand contact frequency and contamination risk level. Their
cleanliness was evaluated using an ATP bioluminescence method.
Results: It was shown that the average ATP values of simple
Presentation Number 12-171 respirator, physiological bedside monitor panel, infusion pump panel,
Reaching Zero Central Line Associated Infections pressurized infusion bag ball and nurse’s table were >500 relative
light units (RLU) before cleaning, indicating high contamination
by Improving Compliance to Aseptic Technique
risk, while the RLUs of all environmental surfaces reduced to
Donna Matocha, RN, MSN, CNRN - IV Therapy Coordinator <500 after cleaning. However, ATP values of physiological bedside
/Clinical Educator ONP, Rush-Copley Medical Center; Maria monitor panel, infusion pump panel, simple respirator and bedside
C. Montero, MT(ASCP)SM, MPH, CIC - Manager, Infection table showed a rapid increase after the cleaning and RLU readings
Prevention, Rush Copley Medical Center reached >500 4 h after cleaning. It is surprising to discover that the
average RLU of a blood-gas analyzer panel, screen and injection port
Issue: Central line associated bloodstream infections continued to were >15000. Conclusions: It is concluded that in a PICU
occur in our adult intensive care unit after implementing the Institute the use of an ATP method could provide quantitative information
for Healthcare Improvement’s Central Line Bundle despite our goal of cleaning efficacy and ATP trends, to allow identification of
of zero infections. Observations revealed breaks in aseptic technique environmental surfaces that require additional cleaning or cleaning
during skin preparation, line insertion, and port access. Project: schedule amendments.
Infection Prevention and IV Therapy developed an intensive staff
education program that reinforced understanding of how aseptic
technique prevents contamination. Central Line insertion kits were
Presentation Number 12-173
reconfigured to prevent breaks in asepsis. Skin antisepsis is performed
using non-sterile gloves and a ready to use swabstick containing 3.15% Collaborative To Decrease Central Line Associated
chlorhexidine gluconate/70% isopropyl alcohol placed in an outside Blood Stream Infection (Clabsi) In A Neonatal Unit
fold of the kit. A sterile field is established using sterile full body
(Nicu): An Urban Teaching Hospital Experience
drapes. Hand hygiene is performed using a 65.9% alcohol handwipe
before sterile gloves and gown are donned. A chlorhexidine gluconate

118 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Quality Management Systems/Process Improvement/Adverse Outcomes

Ona O. Fofah, MD, FAAP - Director, Division of Neonatology, Presentation Number 12-174
Department of Pediatrics, The University Hospital, Newark, NJ;
Leisha Nepomuceno, RNC - Staff Nurse, University Hospital, Attaining and Sustaining Hand Hygiene
UMDNJ Newark, NJ; Gloria Igwe, RNC, MSN, DNP - Nurse Compliance. Patient/Family, Sr. Leadership to
Manager- Neonatal Intensive Care Unit, University Hospital, Front-line Staff. A Winning Combination!
UMDNJ, Newark, NJ; Willi Cruz, RN - Infection Control
Officer, University Hospital, UMDNJ, Newark, NJ; Beverly Nancy L. Osborn, RN, CIC - Manager of Infection Prevention and
Collins, RNC, MS - Director, Hospital Infection Control Epidemiology, Medical Center of Central Georgia
Department, University Hospital- UMDNJ, Newark, NJ
Issue: Prevention of healthcare associated infections (HAI) is a
Issue: CLABSI is an important cause of increased morbidity and strategic priority at the Medical Center of Central Georgia (MCCG).
mortality in hospitalized patients. These infections are increasingly The relationship between Hand Hygiene and prevention of HAI
recognized as preventable life-threatening adverse events, even has been well documented and performance expectations clearly
among newborn infants who may be more biologically at risk defined in the CDC Guidelines for Hand Hygiene in Healthcare
than older children or adults. The avoidance of the use of central Settings, World Health Organization Guidelines on Hand Hygiene
lines (CL) as a primary prevention is often not feasible in sick in Health Care and Joint Commission National Patient Safety Goals.
neonates. Available guidelines, secondary prevention techniques In 2010 we surveyed staff and managers and discovered a surprising
and strategies are feasible in these neonates and when applied gap between Hand Hygiene practices and perception of compliance.
may help decrease CLABSI rates in NICUs. The CLABSI rate The majority of staff perceived Hand Hygiene compliance to be
in the lowest birth weight category in our NICU was high when >80%; in reality, based on 600 direct observation in 25 departments,
compared to benchmark data with an average rate of 10.8/1000 CL overall compliance was only 34%! Project: MCCG is a 637
and umbilical catheter (UC) days. We set out to decrease this rate bed, academic medical center, designated Level 1 Trauma Center
through a multidisciplinary collaborative effort, use of potentially and Magnet hospital for nursing excellence. Goals * Improve Hand
better practices and quality improvement techniques. Project: Hygiene compliance from 34% to 65% in year one, increasing to,
Our NICU is an open 24 bed level 3C perinatal center with annual and sustaining at, 85% following year. Note: data benchmarks
admission of 360 babies, 70 of whom weigh 1500gm or less. We recommended by 3M Education Division consultation. * Utilize best
developed a comprehensive unit-based safety program (CUSP) practices products, compliance monitoring, implementation and
by creating a multidisciplinary core team consisting of leaders sustainability strategies. * Assess risk factors for, and remove barriers
from the Hospital infection Control Department, Physician and to, Hand Hygiene non-compliance. * Assure Administrative and
Nursing groups. Other team members were Staff Nurses, Unit Governing Board priority of the PI project. Innovation * Utilization
Secretary, Resident physicians and Respiratory Therapists. Weekly of multiple methods of monitoring: mystery shopper observations,
presentations at Critical Care committee, Staff meetings together patient interviews, product usage. * Partners In Hand Hygiene
with monthly Resident education were initiated. Improvement in program encourages patients, families and visitors to remind all staff
hand hygiene (HH) techniques including the removal of jewelry and visitors to wash their hands. Mystery Shopper visits patients for
prior to hand washing by parents, visitors and staff were enforced perception of compliance. Patients rate staff (physicians included)
and monitored. Monthly compliance data were shared with staff. on compliance. * Weekly surveillance program is rigorous * Short
Also developed, instituted and monitored are CL insertion and turnaround time and transparent dissemination of data within 2 days
maintenance forms; Use of barrier screens with a STOP sign to departments encourage immediate “job well done” or corrective
and procedure carts during insertion of CL; Use of devices such action. * Professional marketing of “speak up” buttons, flyers,
as Swab Cap® port disinfectant; Enforcement of barriers e.g. patient brochure, staff engagement.* * Individual unit “spin” on the
hats and masks by staff within 3 feet during procedures; Use of campaign; examples: Staff say.”ladybug” if a peer or physician out of
Chlorhexidine for site preparation for CL insertion; Designated compliance. Results discussed in huddles, interdisciplinary rounds,
CL insertion and maintenance team. Results: There was linked to HAI results. Peer mystery shopper assigned for a day - give
sustained improvement in HH rates across all categories of staff. out cupons for “well done”. Meetings with key physicians to address
The monthly compliance rates are best among Nurses (above 95%), what would help improve hand hygiene compliance. Results:
attending physicians above 90%. Rates among respiratory therapists, Hand hygiene compliance improved to 65% within 5 months. Hand
consulting physicians and nursing assistants continue to improve hygiene compliance improvement continued, exceeding 90% at 6
above 90%. Rates among Resident physicians remain lowest. The months. 51% increase in product use. Sustained CLABSI, CAUTI,
PICC rate prior to intervention was 9.6/1000 CL days and UC VAP, Laminectomy SSI below benchmark. Outcomes correlated
rate was 12.0/1000 UC days among the tiniest babies in our
unit. There have been no CLABSIs in our unit for the last 215
days. Lessons Learned: We learnt that collaboration,
coordination, communication, continuity and competence are
important in Teamwork and helpful in decreasing and preventing
infection. Also, that the principles outlined using the CUSP
model are effective in our NICU.

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 119
Poster Abstracts: Quality Management Systems/Process Improvement/Adverse Outcomes

with other evidenced-based practices and hand hygiene compliance. in patient rooms can contribute to the transmission of organisms.
Lessons Learned: Challenging (see October 2011) but The Environmental Cleaning project developed a standardized
Important to keep the momentum going! Routine correlation between process for daily and discharge cleaning of patient rooms. 12
patient data and staff compliance data. When we had special cause hospitals in the health system implemented the process with the
variation in Oct. 2011, we discovered a modification in the patient intent to reduce organism bio-burden. Project: Our team
interview process by a new Mystery Shopper and a reduction in consisted of a physician and nurse champion, housekeeping
observations due to Flu Campaign focus. Multidiciplinary committee managers/directors, staff housekeepers, infection preventionists,
needs to meet regularly to re-evaluate the program. Physicians pay more and RNs. The team reviewed policies and mapped a current state.
attention to patient perception data versus staff compliance results. Sr. A standard cleaning policy was developed incorporating 14 HRO
Leadership support is critical to success. identified from the literature, a 7-step cleaning process and a
measurement method using a fluorescent marking system. Items
were considered either “clean” or “not clean” based on full or partial
removal of the marker. Housekeeping management was trained
one-on-one in the cleaning process and in the use of the marker for
monitoring 35 rooms per quarter. A spreadsheet was created, which
calculates cleaning compliance rates by room, by housekeeper and
by HRO. A toolkit was assembled to troubleshoot communication
gaps and to assist housekeeping staff in ensuring that all rooms were
cleaned daily. Results: Three hospitals piloted the project. 40
pre-and 40 post-measurements using the marker were obtained.
Post-measures were completed on the 7 HRO objects that
showed the greatest opportunity for improvement; data analysis
demonstrated improvement from 77% to 83%. The remaining
9 hospitals implemented the process during the last quarter of
2010. Pre- and post-intervention comparison revealed 17%
improvement in cleaning for all objects combined. The measures
were monitored by the project team for 2 quarters. Quarter 2 2011
“clean” percentage showed little change (81.6%) compared with the
post intervention measure (80.4%); however, Quarter 3 showed
a 10% increase in cleaning of the 14 HRO (91.8%). Lessons
Learned: A standardized cleaning policy, process and
measurement system is an effective way to improve cleaning. Use of
a fluorescent marker to assess room cleanliness resulted in improved
cleaning of objects and surfaces that may harbor organisms and
contribute to hospital-acquired infections. Exact reasons for the
increase in compliance between Quarter 2 and 3 are unknown, but
increased scrutiny and attention may have been given to the process
when initial results were below the goal of 90% clean on all 14
HROs. Monitoring and reporting results to Infection Prevention
Presentation Number 12-175
and to the housekeeping management reporting chain can be
Standardizing Environmental Cleaning Procedures effective in maintaining continued interest in such a project.
And Measurement Across A 12-Hospital System.
Ellen W. Trovillion, RN, BSN, CIC - Infection Prevention Presentation Number 12-176
Consultant, BJC HealthCare; Jill M. Skyles, RN, BSN, MBA -
Vice President and Chief Nurse Executive, Barnes-Jewish St. Peters Reducing Blood Culture Contamination in the
Hospital; Diane Hopkins-Broyles, RN, MSN - Manager, Infection Emergency Department
Prevention, BJC HealthCare; Emily L. Ostmann, MPH - Performance
Research Analyst, BJC HealthCare; Aaron D. Rogers, MA - Project Marie P. Hodgins, RN, BScN, CIC - Director, Infection Control
Manager, BJC HealthCare; Hilary Babcock, MD, MPH - Assistant and Employee Health, Harlingen Medical Center; Deborah L.
Professor of Medicine, Infectious Diseases Division, Medical Director Meeks, RN, MSN, CCRN - Director, Emergency Department,
Infection Prevention & Epidemiology Consortium, Med. Director Harlingen Medical Center
Occupational Health, Washington University in St. Louis, Barnes-
Jewish Hospital, St. Louis Childrens’ Hospital; Keith F. Woeltje, MD, Issue: Our hospital’s Emergency Department had a blood
PhD - Director, Clinical Advisory Group, BJC Center for Clinical culture contamination rate ranging from 2-4 times the national
Excellence, BJC HealthCare, Washington University in St. Louis average. Contaminated blood cultures lead to increased length
of stay, increase cost and unnecessary antibiotic use with the
Issue: Inadequate cleaning of surfaces and high risk objects (HRO) associated problems of pressure toward antimicrobial resistance

120 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Quality Management Systems/Process Improvement/Adverse Outcomes

and increased risk of C. difficile associated disease. Project: Health Network; Deborah Fry, MT(ASCP), MBA, CIC - Manager
Our emergency department does not have the volume to justify a Infection Control and Prevention, Lehigh Valley Health Network;
dedicated phlebotomist, so in the interest of optimizing turn-around Terry Lynn. Burger, MBA, BSN, RN, CIC, NE-BC - Director
time, the ED nurses and CNAs are responsible for phlebotomy. Infection Control and Prevention, Lehigh Valley Health Network
This project was a joint effort of the Infection Preventionist, the
Emergency Department Director and the Emergency Department Issue: The demands facing Infection Preventionists today have
Clinical Manager. We began by interviewing the staff and observing grown exponentially. They are challenged with increasing public
current blood culture collection practices. Wide variation and reporting requirements, more stringent regulatory requirements,
some alarmingly creative approaches were noted. Staff stated these expanding scopes of practice (inpatient and outpatient), zero
practices were intended to prevent an additional “stick” and to tolerance for healthcare associated infections and mounting pressures
save supplies and time. We created an inservice which focused on from value based pay for performance programs. Therefore it is
the adverse impact of contaminated blood cultures, the rationale important to closely examine how Infection Preventionists structure
for each recommended step in the process, and the opportunities their daily activities to assure effective surveillance is achieved and
for contamination presented by current rogue practices. We adequate time is available to invest in the multitude of other project
implemented an observation form to evaluate each individual’s responsibilities. Project: The Infection Control and Prevention
technique and provided real time feedback to individuals when a department team members gathered for several sessions to identify
sample they drew resulted with a contaminant. The rate did not opportunities to improve patient safety and enhance their value to
improve as expected. We observed again and determined that the patients. The objective of the activity was to create standard work
skin prep was rarely being performed correctly. We re-inserviced processes for surveillance and documentation and eliminate waste
with a real time demonstration of a full 30 second prep and full in their daily routine. The team utilized several lean methodology
30 second drydown. Individuals were observed in clinical practice tools to streamline work flow. They followed a 6S approach to
using the same observation checklist, but with emphasis on correct organize their work spaces, completed a process map to illustrate
duration of skin prep. This resulted in a dramatic improvement in the mechanics of their daily work load and created an A3 analysis to
our contamination rate. Results were communicated and celebrated. guide them through the activity. The format of the A3 included the
Results: Our monthly blood culture contamination rate ranged following: background, current conditions, ideal state, gap analysis,
from 6.6-8.6% in the four months prior to intervention. It actually proposed countermeasures, metrics and timelines and follow-up and
got worse immediately following the first inservice reaching 10%. feed forward. Results: The current state demonstrated a lack of
After the timing of the prep was addressed definitively, in dropped standard work, redundancy in data entry, employee dissatisfaction,
down to a sustained at a rate of 2.1-3.3% in the last 6 months. lack of time for professional development, excessive travel, numerous
Lessons Learned: Careful planning and oversight is required non-value added distracters, unused human potential and lack of
to facilitate change. Planning considerations include: -Understanding infection preventionist visibility. The goals of the ideal state was
what is motivating current behavior -Persuading individuals of the to become more efficient, more organized, more standardized, to
value of the proposed change -Reviewing the literature to determine decrease expenses, improve employee satisfaction, improve efficiency
which potential strategies are most likely to be impactful -Measuring and patient safety. A number of countermeasures were implemented.
both processes and outcomes -Revising strategies as indicated Work processes were streamlined and standardized. All data entry
-Providing individualized, timely performance feedback, not just forms were made electronic. Additional staffing resources were
aggregate results -Celebrating success obtained. Electronic devices were purchased including individual
laptops, iphones and iPads. Work assignments were redistributed.
After the countermeasures were implemented waste was reduced
and employee satisfaction and workflow efficiency were immediately
improved. Since some of the countermeasures were recently
implemented the impact on healthcare associated infections and
patient safety is currently being evaluated. Lessons Learned:
Going to the Gemba is an expression utilized in lean methodology
which means going to where the work is done. This exercise illustrates
how critical it is to success. It is imperative to involve all members of
the team when a process improvement change is needed. Energy and
enthusiam drives results. The A3 and process map information helped
to justify and support all additional resources that were requested.
Infection Preventionists are finally getting the attention and support
they have always needed. Therefore it is necessary to assure those
resources are utilized in the most efficient and effective way. In a
financial atmosphere forecasting diminishing funding and pay for
performance driving reimbursement, it is essential that infection
Presentation Number 12-177 control programs are designed to maximize efficiency to help achieve
the best outcomes for the organization and for the patient.
A Lean Surveillance Transformation
Mari Driscoll, RN, CIC - Infection Preventionist, Lehigh Valley

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 121
Poster Abstracts: Quality Management Systems/Process Improvement/Adverse Outcomes

Presentation Number 12-178 Presentation Number 12-179

Clinical Attributes of Non Ventilator-Associated Successful Nurse-driven Improvement Team
Hospital-Acquired Pneumonia Raises Postpartum Tdap Rates and Surpasses
Target Goal
Barbara Quinn, MSN, RN, ACNS-BC - Clinical Nurse Specialist,
Sutter Medical Center, Sacramento; Dian Baker, PhD, APRN-BC Tamara F. Persing, RN, BSN, MS, CIC - Director Infection
- Associate Professor, School of Nursing, California State University Prevention & Control, Geisinger Health System
Sacramento; Carol Parise, PhD - Research Scientist, Sutter Health
Sacramento-Sierra Region Issue: The death of an infant from pertussis within the state
in 2010 raised the awareness of the healthsystem to improve
Objectives: To describe the incidence and risk factors of Tdap immunization rates. Postpartum Tdap immunization is
patients with non ventilator-associated pneumonia (non-VAP recommended by the Advisory Council for Immunization Practice
HAP). Background: Numerous studies have reported the incidence (ACIP) to reduce the risk of transmitting pertussis to their infants.
and prevention of ventilator-associated pneumonia (VAP); Initial attempts to immunize unvaccinated patients in 2009 at a large
conversely, non-VAP HAP is an underreported and unstudied teaching facility resulted in a 51% average rate. Prior efforts included
area, with potential for measureable nurse-sensitive outcomes. verbal education regarding Tdap at the initial perinatal visit and
With the National Healthcare Safety Network focus on VAP, immunization ordered at time of discharge. Project: In March
hospitals are required to monitor VAP; however, there are currently 2010, the Postpartum Tdap Improvement Team was established to
no requirements to monitor non-VAP HAP. The limited studies improve immunization rates. This nurse-driven multidisciplinary
available indicate that non-VAP HAP is an emerging factor in team was composed of front-line staff, perinatal educators, infection
prolonged hospital stays, patient morbidity, and increased cost of preventionists, quality specialists, leadership sponsors and a prior
$40,000 for each case. Understanding the incidence and determining patient. Utilizing quality methodology, a team charter with a target
patients most at risk of this hospital-acquired infection is essential goal of 80% was developed that included defined process/outcome
to provide optimal patient care. Methods: Non -VAP HAP measures with target dates. A unit data wall included baseline and
data were obtained from a large, urban hospital’s electronic measurement graphs. Weekly team huddles and structured team
integrated medical management system. Inclusion criteria for this meetings were held to study the process redesign. Utilizing the
observational descriptive study were all adult discharges between Plan, Do, Study, Act (PDSA) cycle changes, the team redesigned
January 1, 2010 and December 31, 2010, coded pneumonia- not the process of educating expectant parents/significant others in
present on admission and meeting the Centers for Disease Control the perinatal period, developed a written bi-lingual pamphlet, and
and Prevention’s (CDC’s) definition for HAP. Descriptive statistics changed the timing of education from initial perinatal visit to the
including means (SD) and percents were used to determine the age, 3rd trimester by incorporating it into childbirth classes and perinatal
gender, length of stay, primary diagnosis for admission, common visits. Qualitative data collected indicated the educational timing and
risk factors, common chronic morbidities, and disposition upon pamphlets positively affected the mother’s decision to be immunized.
discharge. Results: A total of 24,482 patients comprising 94,247 Inpatient and clinic staff education regarding Tdap was held
patient days were eligible for study inclusion. 194 cases were coded regularly. Visual reminders/posters were placed in all patient care
as HAP and 115 (59%) met the CDC definition. The infection rate areas. Standardization of vaccine administration indicated a positive
per 100 patients and per 1000 patient-days was found to be 0.47 and change in vaccination rates. Standardization and automation of order
1.22, respectively. The mean age of patients was 66 +14.45 and 54% sets resulted in a decrease of missed orders, raising immunization
of the patients were male. The mean length of stay was 27 +30.48 rates to a high of 91% in June 2011. Data was monitored weekly,
days. Most HAP episodes were detected outside of the ICU (62%). then monthly, to assess for process changes and outcomes. Missed
Cardiac disease was the most frequent primary diagnosis (18%), immunization opportunities were studied by the team. Reports
followed by sepsis (14%) and cancer (10% ). The most common were sent to leadership for review and comment. Additionally, a
risk factors for HAP were >6 medications (90%), central nervous pilot program for immunizing fathers/significant others was trialed
system depressants (78%), and acid blocking medications (76%). as an offshoot of the initiative. Results: The postpartum Tdap
Notable chronic co-morbidities were cardiac disease (37%), chronic immunization rate increased from 49% (March 2009) to 91% ( June
obstructive pulmonary disorder (30%), and diabetes (27%). The 2011) with rates remaining between 77% and above. Refusal rates
most frequent disposition upon discharge was home (38%) and varied throughout the initiative from a high of 27% decreasing and
other nursing facilities (34%); 28% of the HAP patients expired. remaining below 14% with a low of 4%. Order standardization/
Conclusions: This study confirms that non-VAP HAP occurs automation decreased missed doses from 23% to <5%. The
in a large, urban hospital and should be monitored. Coded databases percentage of vaccine not ordered dropped from 19% to <6%. Of
may not be the most accurate method of surveillance for this note, an increase in outpatient immunized patients rose from <8%
hospital-acquired infection. HAP results in an extended length of to sustained >30% during the project. Lessons Learned: To
stay and occurrs most frequently in elderly, male patients with other be an effective, successful improvement team requires collaboration,
chronic conditions. Mortality among these patients is high, however, diligence and engagement by all members. The value of the PDSA
most patients are discharged directly to home or to an extended care cycle and measurement is critical to reaching target goals and
facility. More research is needed to understand and design nursing sustaining results.
interventions to prevent non-VAP HAP iatrogenic disease.

122 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Quality Management Systems/Process Improvement/Adverse Outcomes

Presentation Number 12-180 providers. Through these organizational improvements, we are

confident that BC use in our patient care will result in less waste and
Blood Culture Procedures and Results in a cost savings as well as reducing the workload for healthcare providers.
Pediatric Hospital in La Paz, Bolivia: Opportunities
for Improving Efficiency and Decreasing Cost
Juan Pablo Rodriguez Auad, MD, MSc - Pediatric Infectious Presentation Number 12-181
Disease Physician, Hospital del Niño “Dr. Ovidio Aliaga Uria”;
Loreta I. Duran Arias, MSc - Head of Microbiology Laboratory, A Multi-faceted Approach to Increase and Sustain
Hospital del Niño “Dr. Ovidio Aliaga Uria”; Kyle M. Johnson, PhD, Hand Hygiene Compliance in a Military Treatment
CCRP - Clinical Research Associate II, St. Jude Children’s Research Facility
Hospital; Miguela Caniza, MD - Director of Infectious Diseases-
International Outreach Division, St. Jude Children’s Research Michele A.T. Riboul, BSMT(ASCP), MS, CIC - Director Infection
Hospital Control, Wilford Hall Ambulatory Surgical Center; Hamidah
Franchette. El-Amin, LVN - Infection Control Surveillance Nurse,
Background/Objectives: Bacteremias are serious Wilford Hall Ambulatory Surgical Center; Hilda P. Ben, RN,
infections. Efficient use of blood cultures (BC) are quality indicators BSN, CIC - Infection Control Specialist, Wilford Hall Ambulatory
for a healthcare service. We report on 20 months of BC data Surgical Center
and outline opportunities for improvement of this procedure.
Methods: The hospital, 174-beds, is a public pediatric hospital Issue: Despite substantial evidence that hand hygiene (HH) is
in La Paz, Bolivia where 65 physicians and 165 nurses provide care. the MOST important infection control measure for preventing
As a tertiary care hospital, it has 11 units and treats children with healthcare associated infections (HAIs), adherence to HH by
acute and chronic diseases, as well as cancer. In 2011, infection healthcare workers (HCWs) remains low nationwide (between 40
was the most frequent reason for hospitalization (612/5559) and to 50 percent). In 2004, a targeted assessment of HCWs compliance
death (22/139). We reviewed institutional BC policies, and current with HH was conducted in our facility identifying a similar
practices, as well as laboratory methods for BC processing. We compliance rate to the nation. In order to improve compliance,
examined microbiology reports and calculated frequencies and the HH Program was created comprising of the Hand Hygiene
percentages from available data. We obtained permission from Compliance Team. Project: Our Program was based on the
corresponding institutional authorities to review and report our Institute of Healthcare Improvement (IHI) “How–to Guide:
findings. Results: The principal indication for BC is fever Improving Hand Hygiene”. The four IHI components to improve
and suspicion of infection. Institutional BC policy recommends compliance were implemented: 1) education of staff was conducted
collecting two samples with prior skin asepsis with 70% alcohol, through employee training and multi-component publicity
and before antimicrobial therapy. BCs are obtained by physicians campaigns, 2) improvement of HH technique using several methods,
and sometimes by laboratory personnel. The BacT/ALERT PF BC 3) increase availability of alcohol-based hand rubs(ABHRs)
system is used, according manufacturer’s instructions, to process BCs. throughout the facility, 4) HH observations performed using Center
In actual practice, one site is used for drawing the BC and there is for Disease Control and Prevention (CDC) guidelines. Results:
no technical oversight. We analyzed 1918 blood samples collected 1) Education of staff was conducted through orientation, annual
from December, 2009 to July, 2011and identified 318 (17%) positive training and section specific training. Two multi-component
BCs. The blood sample was considered contaminated in 27% campaigns were implemented-first one in 2006, and the second in
(85/318). Gram-negative Bacillus (GNB) was the most frequently 2008. Campaigns included: HH posters, life size figure of facility
isolated group (46%), followed by Gram-positive cocci (GPC) leader, HH pamphlets, quarterly HH articles, HH trophy, incentives
(33%) and fungus (10%). The most frequently isolated bacteria was for patients/staff and HH surveys for the second campaign. Survey
Staphylococcus aureus (21%, 67/318), 45% were methicillin-resistant. results (2009-2011) reveal that staff awareness of the campaign
Escherichia coli was the most common GNB (11.6%, 37/318), 43% increased with each year and was above 90% and patient awareness
of those were positive for extended spectrum beta-lactamase enzyme. was above 80%. 2) Correct techniques for using an ABHR and
The most frequent fungus was Candida albicans (5%, 16/318). The handwashing were discussed during educational sessions, 2 videotape
average turnaround of positive samples was 3.76 days (Range= 1-14 presentations, and using fluorescent dye-based training methods.
days). Conclusions: We have found that positive culture rates 3) Pocket-size ABHRs were distributed and a survey of the facility
are lower than reported from sites in similar socioeconomic situations was conducted to maximize the availability of ABHR wall units in
to ours and we have a high rate of contamination. BC contamination patient care areas. 4) HH compliance checklist was created for use
results in unnecessary admissions and antibiotic use. Better by trained observers. Targeted areas were surveyed monthly with a
understanding of the BC problem is our first step toward improving minimum of 30 opportunities for HH observed, immediate feedback
this practice in our institution. We plan to improve current practices given, and compliance rates reported to leadership. Results:
by writing and disseminating BC policies and procedures. This will 24,840 observations were performed from 2006 to 2011, with
be accomplished by: standardizing indications for ordering BCs; that the most observations done in 2006 (5369) and the least in 2011
only trained providers draw BCs and promptly transport them to the (2991). The facility goal was set at 90% compliance rate and was
laboratory; ensure that the laboratory complies with standards; create reached in the latter part of 2008. The lowest overall compliance
and use a diagnostic algorithm to determine if skin flora isolated are rate was 77% in 2006/2007, and the highest compliance rate was
true pathogens; and promptly communicate results to healthcare 94% in 2011. Physicians/Respiratory Therapy technicians improved

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 123
Poster Abstracts: Quality Management Systems/Process Improvement/Adverse Outcomes

the most. Lessons Learned: All IHI components need to quarters, submissions had improved to an average of 72%. Lessons
be implemented simultaneously in order to improve compliance. Learned: Staff needed enough time to perform the actual
Patient participation and leadership support played a significant sterilizer maintenance. (Average of 30 minutes for weekly and up to
role in achieving and sustaining our goal. HH observations were a 3 hours for monthly process). All staff that used the sterilizer needed
challenge due to the high turn-over of observers, missed assignments, to be educated on how/when to use the biological indicator, (The
and limited areas that could be observed. Another challenge was the first load of every day the unit is run) how to perform maintenance,
continuous educational need of a transient employee population. and how to log the results. This took almost a year to see significant
improvement in reporting and compliance. Supervisors were required
to review the audit and address barriers or non-compliance. The
tool actually helped some sites make changes to staffing to assure
compliance. Audits are best submitted by excel format via email.
Initially this was done via interoffice mail or FAX. This led to missing
audits and inaccurate data. Although the measure of performance
is submission of the audit, the real value is in identifying areas of
concern such as lack of staff, lack of knowledge about policies and
supervisor awareness of compliance with this important infection
prevention and patient safety component. A future Quality
Assurance project could be developed to look at actual compliance
with all requirements.

Presentation Number 12-182

A Quality Assurance Project to track Compliance
with Autoclave Maintenance and use of Biological
Indicators in Outpatient Physician Offices.
Laura L. Grant, RN - Infection Preventionist-Clinic, Aurora
Health Care

Issue: Staff turnover or unclear expectations led to a lack of

autoclave maintenance and use of biological indicators in a 125+
physician office healthcare system. After instruction in proper
autoclave maintenance and use of biological indicators, there was
no way to measure if policies were being followed. Project: A
quarterly audit tool was developed. The percentage of returned audits
by market was measured. All sites that sterilized instruments in an
autoclave were required to track these actions: • Weekly autoclave
maintenance • Monthly autoclave maintenance • Review of each
load’s printer read-out • Use of a biological indicator in the first load
of every day the unit was operated • Failed biological indicators and
actions taken for failures Each site was required to assign a trained
staff member to keep the logs and fill out the audit 30 days after
the end of the quarter. All audits must be reviewed and initialed by
the site supervisor. This was done so the supervisor could identify
lapses in completion of actions as required per policy. All audits
are submitted to the clinic Infection Preventionist who shares the
data with leadership, infection control and quality committees.
Results: From the third quarter of 2009 to the third quarter
of 2011, 97 sites were required to submit data. Initial submissions
ranged from 0% to 100% with an average of 50%. At the end of 9

124 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
Poster Abstracts: Quality Management Systems/Process Improvement/Adverse Outcomes

Community Medical Center

Issue: In times of competing healthcare dollars, how does an

Infection Control department prove the benefit of expanding an
Active Surveillance Culture (ASC) program? A Methicillin-Resistant
Staphylococcus aureus (MRSA) Active Surveillance Culture (ASC)
Program was implemented on a Surgical Intensive Care Unit (SICU)
in a 500 bed community hospital for three years. The data collected
during this time demonstrated a significant difference of Healthcare
Acquired (HA) MRSA when compared to a similar unit that does
not utilize the ASC program. Project: Three years of comparison
data were analyzed to determine the benefits associated with a
reduction in HA-MRSA for the hospital. Research was conducted
into the cost and benefit of expanding the ASC program to other
units. However, the data alone was not sufficient to have the program
prioritized for expansion to other critical care units. Support and
validation was needed for the expansion to occur. The Association
for Professionals in Infection Prevention and Control (APIC)
provided the forum needed to achieve scientific credibility and to
substantiate moving the program forward. In 2011, an abstract (and
poster) depicting the benefits of the ASC program in the SICU was
submitted and accepted to APIC. Results: The poster illustrated
the significantly lower HA-MRSA associated with the ASC unit
(SICU) than the Medical Intensive Care Unit (MICU), the unit
without the ASC program p=.001 (CI 95%). The cost difference
associated with HA-MRSA between the SICU and MICU was
$884,175. In addition, the poster was submitted and presented at the

Presentation Number 12-183

Data, Dollars, and Determination.....
Christine Filippone, DNP, ANP, CIC - Director Department
of Epidemiology/Infection Control, Community Medical
Center; Lisa M. Martinez, BSN, RN, CIC - Infection Control
Practitioner, Community Medical Center; Kelly Zabriskie, BS,
CIC - Infection Control Practitioner, Kimball Medical Center;
Mary Ann Wells, MPA, RN, CIC - Infection Control Practitioner,

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 125
Poster Abstracts: Quality Management Systems/Process Improvement/Adverse Outcomes
Hospital’s Corporate Quality Fair. This provided the opportunity reviews involving direct patient care providers are an essential element
to initiate communication with leaders on supporting the expansion for identifying individual patient risk factors for CLABSI, promoting
of the ASC program. Subsequently, the program was expanded to ongoing quality improvement processes, and ensuring sustained
the Medical Intensive Care Unit, providing those patients the same progress toward infection prevention.
benefit of early identification, isolation, and decolonization of MRSA
colonization. Lessons Learned: Valuable, sound data does not
benefit a hospital and its patients if it is not effectively communicated
Presentation Number 12-185
to the healthcare team. This communication includes validation and
at times support of a prestigious national organization to bolster the Real-Time Event Reviews: A Useful Tool for the
need for process change and improvement. Infection Preventionists Prompt Identification of System Failures
collect a large quantity of data, which alone does not benefit patient
care. Rates are reported at meetings however, when this data is peer Nancy M. Hutchinson, RN, MSN, CIC - Nurse Epidemiologist,
reviewed and supported it can help drive performance improvement Cincinnati Children’s Hospital Medical Center; Mary Lou Sorter,
for the hospital. In today’s struggling economy, every healthcare RN, CIC - Senior Infection Control Practitioner, Cincinnati
dollar is essential. It is important to demonstrate the benefit of Children’s Hospital Medical Center; Christine Voegele, RN
a program utilizing recognized forums to garner support and - Quality Outcomes Manager - Neonatal Intensive Care Unit,
validation. Cincinnati Children’s Hospital Medical Center; Beth Haberman,
MD - Assistant Professor, Division of Neonatology and Pulmonary
Biology, Cincinnati Children’s Hospital Medical Center; Beverly
Presentation Number 12-184 Connelly, MD - Director of the Infection Control Program,
Cincinnati Children’s Hospital Medical Center
Lessons Learned from 5-yrs of Central Line-
Issue:Ventilator-associated pneumonia (VAP) is one of the most
Associated Bloodstream Infection Real-Time
common infections acquired by adults and children in intensive
Event Reviews care units. Recent publications report rates of VAP that range
Nancy M. Hutchinson, RN, MSN, CIC - Nurse Epidemiologist, from 1 to 4 cases per 1,000 ventilator days, but rates may exceed
Cincinnati Children’s Hospital Medical Center; Derek Wheeler, 10 cases per 1,000 ventilator days in some neonatal and surgical
MD - Associate Professor, University of CIncinnati College of patient populations. Project: In 2005, a multidisciplinary task
Medicine; MaryJo Giaccone, RN - Cincinnati Children’s Hospital force was formed to develop a pediatric bundle designed to reduce
Medical Center; Beverly Connelly, MD - Director of the Infection these infections. The VAP bundle elements were implemented in
Control Program, Cincinnati Children’s Hospital Medical Center 2006 and included hand hygiene before and after contact with the
ventilator circuit; elevation of the head of the bed; oral care; circuit
Issue: Central line-associated bloodstream infection (CLABSI) maintenance, including every 2 hour checks to drain condensate;
prevention for all patients has been a quality improvement inititative procedures for management of oral suction devices; and daily
at this facility since 2002. Subsequently, the practice of conducting assessment of readiness to extubate. In addition, when a VAP was
real-time event reviews following recognition of a CLABSI was suspected or confirmed Infection Control e-mailed a standardized
initiated with the aim of identifying additional interventions to real-time event review form to the unit’s medical and clinical
prevent these infections. Project: At the time a CLABSI is leadership to notify them of the infection and request feedback from
suspected or confirmed, a standardized real-time event review direct care providers regarding bundle compliance and risk factors
form is e-mailed to the medical and clinical leadership of the unit. that may have contributed to the infection. From 2003 through
The form requests feedback from the direct patient care providers 2005, the CICU, NICU and PICU combined annual VAP rate was
regarding compliance with the CLABSI preventon bundle, barriers 5.1 infections per 1,000 ventilator days. Following implementation
to compliance, and risk factors that may have contributed to this of the bundle, the rate was reduced and sustained at 0.7 infections
infection. In addition, days-between-infections are posted in per 1,000 ventilator days. However, in September 2011, 2 cases of
prominent locatons on the units to communicate infection data to VAP were identified in the NICU for a unit rate of 5.5 infections per
staff, reinforce the concept that infecton preventon is everyone’s 1,000 ventilator days for the month. Results: The unexpected
responsibility, and provide tangible measures of patient care quality. increase in VAPs in the NICU prompted a thorough real-time event
The aim is to achieve zero tolerance for infectons and promote review and analysis of findings. Analysis of the first VAP identified
adherence to best practices in the delivery of patient care. Results: failure to adhere to oral care as prescribed by the bundle. Further
From January 1, 2007 through December 31, 2011 a total of 288 investigation revealed that storeroom personnel had discontinued
CLABSIs were identified. A review of returned real-time event routinely stocking mouth care kits in the nurse servers of ventilated
review forms indentified multiple risk factors that preceded an patients and therefore the visual cue of the need for oral care was no
infection. Included were lack of adherence with central line insertion longer evident. In addition, the infection occurred during a period
and maintenance bundles, mechanical problems (e.g. tear in central of high census and nursing staff had been called from other units.
line, occlusion, tip migration), misuse of medical devices, and patient A review of the just-in-time orientation provided to support staff
tampering with the central line. Observations were shared with indicated the NICU VAP bundle was not included. Analysis of the
medical and clincial leadership and utilized to identify equipment, second infection identified an unusual suction device (i.e. intended
training, and performance inadequacies to improve the central line only for use during bronchoscopy) was attached to the ventilator
management process. Lessons Learned: Real-time event circuit upon the infant’s return from this procedure. While it was not

126 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
Poster Abstracts: Special Populations (Infections in the Immunocompromised Host, Pediatrics)
clear if the device had a role in the infection, lack of staff familiarity data may be helpful. 2. Periodic recognition/awards for reporting
with medical devices is problematic. These system issues have been compliance may improve performance. 3. Data compilation by a
addressed and there have been no additional infectons. Lessons single oversight agency could expedite data analysis and reporting.
Learned: Real-time event reviews are useful tools for prompt 4. Data cleaning is necessary, requiring extensive data quality
identification of system failures and factors that may contribute to checks. 5. Data management and reporting is resource intensive,
healthcare-associated infections. This tool empowers direct patient but critical. 6. Process measurement should be standardized using a
care providers to report events that occur at the bedside that may standardized audit tool. 7. Continual reminders to submit data are
not be otherwise shared. Reliability and sustainability are dependent needed to improve compliance with process measure reporting.
on identifying opportunities for improvement and integrating these
lessons learned into practice.

Presentation Number 12-186 Special Populations (Infections

in the Immunocompromised
Colorado Clostridium difficile Infection Prevention
Collaborative Host, Pediatrics)
Tamara Hoxworth - Patient Safety Quality Improvement Specialist,
Colorado Dept. of Public Health & Environment
Presentation Number 13-187
Issue: Clostridium difficile (CDI) is a leading pathogen in
hospital-acquired infections (HAI) in the U.S., causing diarrhea, Isolation Precaution Guidelines in NICU: Breast
colitis and sepsis, often leading to prolonged hospitalization Milk Storage
and death.1 The Prevention Collaborative approach has been
successful in reducing other HAI, such as SSI 2 and CLABSI,3 Amber Wood, RN, BSN, CPN - Infection Control Practitioner, The
and has the potential to be effective in reducing hospital-associated Medical Center of Plano; Jessica Reese, RN - RN III, The Medical
CDI. Project: The Colorado Department of Public Health Center of Plano
(CDPHE) Patient Safety Program partnered with the Colorado Issue: In our Neonatal Intensive Care Unit (NICU), a neonate
Hospital Association (CHA) and Denver Health & Hospitals was found to have meningitis. The neonate’s mother was concerned
to implement a CDI prevention collaborative that began March that she had transmitted an organism to her baby through breast
2010. Twenty facilities were targeted for enrollment and originally milk. To allay the mother’s concerns, an Infectious Disease (ID)
enrolled; however, three facilities subsequently dropped out citing physician had the breast milk cultured. The breast milk cultured
workload burden. Seventeen facilities (14 hospitals, 3 Long- Term positive for multi-drug resistant Acinetobacter baumannii, which was
Acute Care Hospitals) remained throughout the collaborative’s not the same organism that caused the meningitis. The ID physician
duration (through December 2012). The collaborative enlisted classified the positive culture as colonization. Our institutions’
volunteers to work together to reduce health facility-acquired infection control policies did not address isola-tion of breast milk.
CDI through data and idea sharing and collaborative learning. What is the best practice for isolation of breast milk? Project:
Participants entered CDI event data into the National Healthcare A literature review conducted by Infection Prevention and NICU
Safety Network (NHSN) and data for three process measures nurses to determine best practice for isolation of breast milk, which
(hand hygiene, environmental cleaning, gown & gloving practices) showed that refrigeration of breast milk at 4ºC up to 96 hours did
into a secure website developed by CHA. Facilities also used the not significantly alter breast milk integrity, including bacterial colony
CHA website to blog with other members on prevention problems, counts, and thus, refrigeration would not destroy any organisms
approaches, and successes. Three face-to-face learning sessions present in the breast milk. Additionally, the literature showed that
were conducted in March and October, 2010 and June, 2011 and common exposure of both the mother and the infant were not
included presentations by experts on relevant infection prevention predictive of infection in premature infants. The Infection Prevention
topics, presentations of facility specific process and outcome Coordinator placed the neonate in con-tact isolation under the
data, and presentations by participants on their own strategies for assumption that the baby could be colonized from the mother. Since
success. Webinars or conference calls were held monthly to discuss the breast milk was confirmed to be colonized with this emerging
reporting and prevention issues and host presentations by expert multi-drug resistant organism (MDRO), Infection Prevention and
speakers on relevant topics. Results: The goal was to reduce the the NICU nurse also created a process to isolate the breast milk.
Healthcare Onset (HO) and Healthcare Acquired-Community The breast milk was placed in a storage refrigerator and freezer,
Onset (HA-CO) CDI rates by at least 15% from baseline or to which included labeling the containers of milk with the patient’s
zero. While Community Onset (CO) rates increased over the 20 identification label, placing the containers of milk in a biohazard
month duration of the collaborative, quarterly HO CDI rates (per bag, and labeling the breast milk storage bin as contact isolation.
10,000 patient days) declined by 14% from 6 to 5.2; HA-CO rates Separation of breast milk in the shared refrigerator from other breast
declined by 24% from 3.1 to 2.4; the combined rate declined by milk through distance and biohazard bags was maintained until the
17% from 9.1 from 7.6. Lessons Learned: 1. The Prevention neonate was discharged. The NICU physician allowed the neonate to
Collaborative Approach may be an effective approach to reducing con-tinue to breastfeed and receive the expressed breast milk. Since
health facility-associated CDI. 2. More frequent feedback of facility

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 127
Poster Abstracts: Special Populations (Infections in the Immunocompromised Host, Pediatrics)
breast milk culture results were not predictive of infection when reflected in a hazard ratio of 0.91, p=0.059 for number of siblings
evaluated prior to the occurrence of infection, the breast milk was not (low vs. high) We also found that the outcome measurement length
routinely cultured during the infant’s stay in the NICU. Results: of hospital stay (LOS) was on average 11.1 days for known patients
The neonate did not develop any Acinetobacter baumanni infections. versus 14.8 days for new patients, p<.1 while referred patients
No other cases of Acinetobacter baumanni were identified during averaged 14.7 days vs. 11.4 days for non-referred patients, p<.1.
the neonate’s admission or in the month follow-ing discharge. Our Outcome measurement LOS was reduced for neutropenic patients
facility has adopted this technique of isolation for breast milk as (ANC<500) who received antibiotic therapy within 12 hours post-
standard of care in NICU. Lessons Learned: Infection admission, p<.1. The survey among healthcare providers noted that
Prevention needs evidence-based guidelines for storage of breast only 59% of nurses recognized fever as an oncologic emergency and
milk for NICU patients in isolation. In the future, a research project notified the physician in <15 minutes. The perception of antibiotics
will be conducted to evaluate the risk for transmission of MRDO availability varied among nurses (49%), Physicians (40%) and
organisms in breast milk storage refrigerators and freezers. pharmacists (73%). Conclusions: Patients admitted to this
pediatric oncology unit wait much longer than the optimal 1-hour
window for antibiotic treatment. This long wait-time increases their
risk for infection progression and consequently longer hospital stay.
Presentation Number 13-188
In turn, a longer hospital stay increases the risk for hospital acquired
Relationship Between Wait-Time for Antibiotic infections to the patient itself and makes the patient a source for the
Initiation and Outcomes of Hospitalization Among continued transmission of pathogens to the other patients. It is these
considerations that underline the importance for a shorter wait-time
Children with Cancer Admitted to an Oncology
to antibiotic treatment for febrile neutropenic patients.
Ward in a Hospital in the Philippines
Jeannette Kirby, RPh - Graduate Student, School of Public
Health, University of Memphis; Miguela Caniza, MD - Director Presentation Number 13-189
of Infectious Diseases-International Outreach Division, St. Jude
Children’s Research Hospital; Don Guimera, BSN, RN, CIC, Epidemiological Patterns and Characteristics
CCRP - International Epidemiology Coordinator, St. Jude Childrens Associated with Clostridium difficle Infection at the
Research Hospital; Kyle M. Johnson, PhD, CCRP - Clinical Largest Freestanding Pediatric Hospital
Research Associate II, St. Jude Children’s Research Hospital;
Vikki Nolan, DSc, MPH - Assistant Professor of Epidemiology Tjin Koy, MT(ASCP), MPH, CIC - Infection Preventionist, Texas
and Biostatistics, University of Memphis; Fawaz Mzayek, MD, Children’s Hospital, Houston, TX; Amy Hankins, MSN, RN -
MPH, PhD - Assistant Professor of Epidemiology and Biostatistics, Infection Preventionist, Texas Children’s Hospital; Jonathan Crews,
University of Memphis; George Relyea, MS - Assistant Professor at MD - Infectious Disease Fellows, Baylor College of Medicine; Jeffrey
the School of Public Health, University of Memphis; Mae Dolendo, Starke, MD - Medical Director of Infection Control, Baylor College
MD - Pediatric-Oncology Medical Director, Davao Partner Site, St. of Medicine
Jude Children’s Research Hospital; Czarina Mae Castillo-Deluao,
RN - Registered Nurse and Infection Control Preventionist, Davao Background/Objectives: While varied literature exists
Partner Site, St. Jude Children’s Research Hospital regarding the epidemiology of Clostridium difficile infection (CDI)
in adults, data describing the occurrence of this disease in the
Background/Objectives: Timely antibiotic pediatric population is limited. Objectives: To describe the incidence
administration in children with cancer within an optimal 1- hour is and clinical characteristics of confirmed CDI cases seen at Texas
considered good clinical practice. In this study, we ascertained the Children’s Hospital (TCH). Methods: Children with confirmed
antibiotic wait-time (AWT) and identified factors associated with CDI cases at TCH between March 1, 2011 to September 30, 2011
healthcare access and delivery, and evaluated outcomes of AWT were identified through a microbiology database. Medical records
of the first dose of antibiotic given. Methods: We reviewed were reviewed to collect information regarding demographics,
retrospectively 220 medical records of patients admitted to this potential risk factors, symptoms, and co-morbidities. Rep-PCR
pediatric oncology unit between January 2011 and June 2011. method was utilized to test the specimens. Results: 124 patients
We took note of patient demographics, patient hospital course, with CDI were identified. The ages ranged from 1 month to 21 years
and antibiotic treatment and administration details. Through a old (mean = 8 years). The percentage of males was higher (60%) than
cross sectional survey questionnaire, administered to 36 healthcare females (40%). Sixty-two percent of the patients resided in Harris
providers, we assessed factors associated with the healthcare delivery County. Hispanics comprised 42% of cases, followed by Whites
systems (HDS) that included the institutional capacity (human and (36%), African-Americans (13%), and Others (9%). In addition
non-human resources) and institutional response (standard-of-care to diarrhea (87%), additional symptoms observed were abdominal
practices). Results: We found that average AWT was 2.5 days. pain (31%), fever (23%) and vomiting (20%). Ninety-five out of
Access to HDS for known and non-referred patients was shorter 124 cases (77%) had an underlying co-morbidity associated with
than for unknown and referred patients averaging 2.25 days versus CDI. Malignancy was the leading co-morbidity (37%), followed by
27 days for known patients vs. unknown patients (hazard ratio: 0.52, gastrointestinal (28%), immunodeficiency other than malignancy
p<.1), and 2.7 days versus 6.94 days for non -referred vs. referred (19%), transplantation (9%) and pulmonary (7%). Potential risk
(hazard ratio: 1.59, p<.05). Fewer siblings were also favorable as factors associated with CDI include previous hospitalization (65%)

128 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
Poster Abstracts: Special Populations (Infections in the Immunocompromised Host, Pediatrics)
and use of antibiotics in the last 30 days (65%). 1 patient died in calendar year 2011 compared to 2010. As of January 10, 2012,
during the study period. Fifteen patients (12%) were admitted to the the number of days since the last CLABSI infection was 260 days.
Pediatric Intensive Care Unit, 43 (35%) were seen as an outpatient, Lessons Learned: Education alone did not have a strong
and 66 (53%) were admitted to non-ICU units. The average length impact in sustaining zero CLABSI rates in PICU. Support from
of hospital-stay was 12 days. Ninety-four cases (76%) tested positive senior leadership and physicians contribute to the success of this
for both toxins A and B. Toxin A was exclusively identified in 19% program. Nursing staff “buys-in” and sense of ownership have been a
of cases and toxin B was identified in 5% of cases. Thirty-nine cases critical factor for the success of the program. Changes should not be
(31%) were classified as healthcare facility-associated infection feared, including changes in product or policy. Success should always
while 85 cases (69%) were classified as community-associated be recognized and celebrated with the staff.
infection. Conclusions:Clostridium difficile is an important
and frequently encountered organism in the pediatric population.
Most children with CDI at our children’s hospital have underlying
Presentation Number 13-191
co-morbidities and have been hospitalized and/or have received
antibiotics in the previous 30 days. Community-associated infection Outpatient Adult Hematopoietic Stem Cell
exceeds healthcare facility-associated infections at our hospital. Transplant Visits: Respiratory Season Interventions
Ellen C. Dougherty, RN, BSN, MA, CIC - Infection Control
Presentation Number 13-190 Practitioner, Memorial Sloan-Kettering Cancer Center; Janet
A. Eagan, RN, BSN, MPH, CIC - Infection Control Manager,
Sustaining Zero Central Line-Associated Blood Memorial Sloan-Kettering Cancer Center; Ann Jakubowski, MD,
Stream Infections in Pediatric Intensive Care Unit: PhD, Board Certified in Internal Medicine, Hematology and
A Light at the End of the Tunnel? Medical Oncology - Clinical Director of MSKCC’s Adult Bone
Marrow Transplant Outpatient Unit, Memorial Sloan-Kettering
Tjin Koy, MT(ASCP), MPH, CIC - Infection Preventionist, Texas Cancer Center; Greg Mason, BA - Supervisor, Adult Outpatient
Children’s Hospital, Houston, TX; Angela C. Morgan, MS, RN, Bone Marrow Transplant Clinic, Memorial Sloan-Kettering
CCRN - PICU Nurse Practitioner, Texas Children’s Hospital; Cancer Center; Lisa Gosman, BA - Administrator - Outpatient
Jeanine Graf, MD - Chief of Medical Staff in PICU, Baylor College Clinics, Memorial Sloan-Kettering Cancer Center; Mini Kamboj,
of Medicine MD, Board Certified in Internal Medicine and Infectious Disease
- Associate Medical Director, Infection Control, Memorial Sloan-
Issue: Eradicating Central Line-Associated Blood Stream Infection Kettering Cancer Center
(CLABSI) in the 31-bed Pediatric Intensive Care Unit (PICU) has
been the goal of our institution for many years. Despite following Issue: Respiratory virus (RV) infections among transplant
the evidence-based insertion bundles and maintenance bundles, recipients occur most commonly when patients have returned
maintaining the zero CLABSI rates seemed like an impossible target. to the community. Many are diagnosed with RV infections
Recently, the PICU team has discovered the successful approaches to during Outpatient Adult Bone Marrow Transplant (OPABMT)
sustain the zero CLABSI rates for 260 days. Project: Dispelling clinic visits. Patients evaluated in the OPABMT clinic include
the excuse that “our patient populationis sicker” was the first major potential transplant candidates, early post-transplant recipients
step in recognizing the problem. A non-punitive eporting system was and long-term survivors. The mean number of patients seen daily
used by the staff to report any breach in infection control protocol in the OPABMT clinic is 45. In the last three respiratory seasons
regarding the care of central lines. The report was reviewed by the (November-April 2008-2011) 105 patients were diagnosed with a
director/physician of the affected department and the action plan RV. The most frequent viruses were: RSV (n=45), influenza (n=26),
was documented. Based on the suggestion of the nursing staff, a Cap and parainfluenza (n=25). Previously, all patients, irrespective of
Change Kit and Dressing Change Kit were trialed and successfully respiratory symptoms, registered at a reception desk located within
implemented in the unit. The physician leadership ensured that all the waiting area of the clinic. Reporting respiratory symptoms
PICU physicians received a formal in-service regarding central line was passive; patients were instructed to report them at time of
insertion and maintenance. A four-hour mandatory interactive ( check-in. Signs were posted to reinforce this. Any patient reporting
hands-on) training session is conducted annually for all the nursing respiratory symptoms was given a mask. During the 2010-2011
staff. Our institution is very fortunate to have a deicated Vascular season, sixteen patients were diagnosed with influenza during an
Access Team who will assist in dressing change and other central OPABMT visit. 10/16 patients wore masks while in the waiting
line related issue in a timely manner. Root Cause Analysis (RCA) area. The six patients who were not wearing masks exposed staff and
“Lite” was conducted every time CLABSI was detected. Due to other patients. Oseltamivir prophylaxis was recommended to those
the non-punitive nature of this process, the staff is very vocal and exposed. Project: In the summer of 2011 a group of medical,
contributes to many new ideas during this process. The introduction nursing and administrative leaders in the adult BMT service and
of a closed medication system to reduce manipulating/accessing Infection Control agreed that masks should be worn by patients and
the central line was introduced in summer 2011. The new product visitors in the clinic. They also created a system to evaluate patients
called Site-Scrub®, which increases the compliance with “scrub the and visitors before entry to the clinic. An active screening process
hub” policy, was also trialed in summer 2011 and was well received was implemented wherein patients and visitors are now screened at
by the staff. This product was made widely available and visible in a reception desk outside the clinic. A clinic assistant confirms each
the PICU. Results: PICU CLABSI rates have decreased 35% patient’s appointment, and then asks if the patient or accompanying

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 129
Poster Abstracts: Special Populations (Infections in the Immunocompromised Host, Pediatrics)
visitor(s) has a fever, cough, or sore throat. Patients or visitors who in 2010 when mandatory masking for staff declining to receive
respond “yes” to any question are given a mask and gloves to wear vaccine was enforced. Similarly, from 2009 to 2011 physician
and are directed to a separate waiting area outside the clinic. A Influenza vaccination rates increased from 61% to 83% coverage.
nurse comes to that area and performs an assessment. The patient is The same masking requirement applied to physicians as well. During
then brought directly to an exam room for a physician evaluation. this time period there were 6 patient deaths related to community
Sick visitors remain outside the clinic. Patients who answer “no” to acquired Influenza at our facility, of which one was a Hematology/
questions about respiratory symptoms also receive a mask and gloves Oncology patient. Lessons Learned: Inpatient admissions
and are directed to wait within the actual OPABMT clinic. Staff represent an opportunity for vaccination of pediatric patients.
were educated on these practice changes at team meetings this fall. Influenza vaccination of high risk patients, including Hematology/
Results: We will evaluate all cases of RV for exposures in the Oncology patients should be a priority. Improved inpatient Influenza
coming respiratory season and also review the number of tests sent to vaccination rates at our facility seemed to be linked to improved staff
see if these increase. To date, one case of influenza A was diagnosed. and physician vaccination rates and heightened staff and patient/
The patient was appropriately triaged. No exposures occurred. family awareness, due to the introduction of the new Influenza
Lessons Learned: Patients and visitors are highly supportive (H1N1) strain, after the death of a Hematology/Oncology patient
and understanding of the program. OPABMT patients are in various and mandatory masking for those staff and physicians declining
stages of dealing with a transplant and are willing to take precautions to receive vaccine. Live attenuated Influenza vaccine seems to
to assure the best outcome for all in the clinic. be infrequently administered to pediatric inpatients due to staff
unfamiliarity with this vaccine and discomfort with using a live
product on the inpatient service. Although the number of vaccines
administered increased substantially by 2011, this was still a small
percentage of inpatients and is unadjusted for patients who had
received Influenza vaccine prior to admission. Standing protocols,
electronic medical record reminders and linkage to computerized
vaccine registries should help in this regard and may further reduce
missed opportunities.

Presentation Number 13-192

Influenza Immunization of Medical/Surgical and Presentation Number 13-193
Hematology/Oncology Pediatric Inpatients Breaking the Bloodstream Infection Connection:
Wendi Gornick, MS, CIC - Infection Prevention & Epidemiology Utilizing a Swab containing Chlorhexidine
Manager, CHOC Children’s Hospital, Orange, CA; Bijal Patel, BS, Gluconate (3.15%) and Isopropyl Alcohol (70%),
MHA - Infection Prevention Analyst, CHOC Children’s Hospital, Chlorascrub™
Orange, CA; Jasjit Singh, MD - Medical Director of Infection
Prevention & Epidemiology, Department of Pediatrics, Division of Deb Hillman, BSN, RN, OCN - BMT Clinical Educator,
Infectious Disease, CHOC Children’s Hospital, Orange, CA. Franciscan St. Francis Health

Issue: Inpatient hospitalizations represent potential opportunities Issue: The 17 bed Bone Marrow Transplant unit at our hospital
for vaccination, especially for high risk pediatric patients. Missed admits hematology patients for routine and critical care. Most
opportunities, particularly for Influenza vaccination are of great patients have central venous catheters that may increase their risk of
concern. Project: We performed a retrospective analysis of our developing bloodstream infections (BSIs). Recommended practice
inpatient Influenza vaccine administration from 2007 to 2011 for guidelines to prevent infections were implemented, but infection
Medical/Surgical patients and Hematology/Oncology patients. We rates were higher than expected. An evidence-based intervention
compared this data with our staff and physician Influenza vaccination was needed to help decrease the rate of infection. Project: The
rates over the same time period. Results: For patients greater central line insertion bundle and a transparent dressing following
than 6 months of age, inpatient Influenza vaccination administration recommended practice were already in place when our project
increased from 116 to 289 doses (149% increase) in Medical/Surgical began. We realized that many patients are admitted with previously
floors and from 1 to 73 doses (720% increase) on the Hematology/ placed and various types of central venous catheters, but we followed
Oncology floor. Medical/Surgical patient Influenza vaccination published standard definitions for documentation of a hospital-
peaked in 2010 at 475 doses and Hematology/Oncology Influenza acquired BSI. Improving bloodstream infection rates is always an
vaccination peaked in 2011 with 73 doses. Over this same time objective in the immunocompromised bone marrow transplant/
period, inpatient admissions rose by 14% on the Medical/Surgical hematology population. The first intervention began by adding
floors and 27% on the Hematology/Oncology floor. The five year a chlorhexidine-impregnated sponge to our dressing protocol.
total inpatient Influenza vaccines administered in these two patient Bloodstream infection rates improved, but our objective is to target
populations were 1,385 doses of which only 37 (2.7%) doses were zero. Observation of practice identified that central line access hub
live attenuated Influenza vaccine all of which were given to Medical/ cleaning with an alcohol swab was inconsistently performed without
Surgical patients. Staff Influenza vaccination rates increased over a standard scrub time. Literature review of current Centers for
this time period as well; from 60% to 98% coverage, most notably Disease Control guidelines suggested that using a Chlorhexidine

130 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
Poster Abstracts: Special Populations (Infections in the Immunocompromised Host, Pediatrics)
Gluconate (CHG) product to clean the hub may be beneficial. A blood cultures in the NICU. Results: During the first phase,
swab with 3.15% chlorhexidine gluconeate/70% isopropyl alcohol October 2006 through August 2007, we were unable to reduce
was selected to scrub the hub. Education was provided for use of the peripheral blood culture contamination rates. On the contrary, our
swab that directed staff to apply pressure and friction in a circular contamination rate increased from 5.19% to 6.30% of all peripheral
motion for ten seconds, then allow to dry for at least 30 seconds prior blood cultures drawn. Once the task of drawing blood cultures was
to access of the hub or lumen. Patients in the unit were encouraged assigned to nursing instead of the phlebotomists, in mid-September
to help count during the process. All alcohol swabs were taken out of 2007, the contamination rate immediately decreased. By September
the patient rooms to ensure compliance. Results: Bloodstream 2008, blood culture contamination rate in our NICU had decreased
infection rates were significantly reduced after implementation of the by 53% from the baseline first phase (5.19%) to the second phase
new practice for hub cleansing. We were able to obtain zero infections (2.46%). Lessons Learned: At our institution, designating
for several months. Lessons Learned: Following published a dedicated group of highly skilled neonatal nurses reduced the
practice guidelines plays an important role in preventing bloodstream contamination rate of peripheral blood cultures drawn on patients
infections. Implementing an effective product, such as the 3.15% in the NICU. We believe that this was the result of limiting the
Chlorhexidine Gluconate/70% alcohol swab for hub cleansing can variability in the skills of personnel drawing peripheral blood
reduce central line associated blood stream infections. cultures, as the skills of NICU nurses are more homogenous in
comparison to the phlebotomy team. Our project was successful by
having the front line staff engaged from the beginning, which enabled
us to identify specific problem areas.
Presentation Number 13-194
Improving the Quality of Care by Reducing
Contamination When Drawing Blood Cultures in
the Neonatal Intensive Care Unit
JoEllen L. Harris, RN, CIC - Infection Preventionist, All
Children’s Hospital; Stacey Stone, MD - Attending Neonatologist,
All Children’s Hospital; Carine Stromquist, MD - Attending
Neonatologist, All Childrens Hospital; David M. Berman, DO -
Pediatric Infectious Disease Consultant, All Children’s Hospital;
Rajan Wadhawan, MD - Physician, All Children’s Hospital; Tracy
L. Hullett, RN - RN- Neonatal Intensive Care Nurse, All Childrens
Hospital; Valarie J. Snyder, BSN - neonatal staff nurse in NICU, All
Childrens Hospital; Lori Sammel, RN - Neonatal Intensive Care
Nurse-Charge Nurse, All Children’s Hospital

Issue: Most coagulase-negative staphylococci positive blood

cultures are considered contaminants in adult populations. Neonates
are more susceptible to infections caused by these organisms and
most positive blood cultures are considered to be actual infections,
with the patient receiving antimicrobial treatment. In September,
2006, we identified a possible increase in false positive peripheral
blood cultures. We did not monitor blood culture contamination
rates at that time and were unable confirm our suspicion. Our
Level 3 Neonatal Intensive Care Unit (NICU) initiated a quality
assurance project in order to establish a baseline contamination rate
and reduce peripheral blood culture contamination. Project:
We established a working group consisting of Infection Prevention,
Nursing, Neonatology, Laboratory Medicine and Infectious
Diseases in September, 2006. The purpose of this group was to
address the issue of blood culture contamination and to develop
and implement measures aimed at reducing contamination of
peripheral blood cultures in the NICU. This included establishing a
Presentation Number 13-195
baseline peripheral blood culture contamination rate and a process
to monitor contamination rates on an ongoing basis. During the first Race and Ethnic Disparities in Hospitalizations with
phase (September 2006 through August 2007) the interventions Community-Acquired Infections
were primarily focused on improving blood culture technique for
the phlebotomy team. The second phase interventions (October Christie Y. Jeon, ScD - Postdoctoral Research Scientist, Columbia
2007- September 2008) were focused primarily on establishing a University School of Nursing; Matthew Neidell, PhD - Associate
small group of NICU nurses to takeover obtaining all the peripheral Professor, Health Policy and Management, Mailman School of

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 131
Poster Abstracts: Special Populations (Infections in the Immunocompromised Host, Pediatrics)

Public Health, Columbia University; Denis Nash, PhD - Associate in association resulted from adjustment for neighborhood median
Professor, CUNY School of Public Health, Hunter College; Elaine household income, independent of comorbid factors. Adjustment for
L. Larson, RN, PhD, CIC - Associate Dean for Research, Columbia emergency room referral led to further reductions in the disparity.
University School of Nursing (See Figure for results on BSI). Conclusions: Discussion:
Marked differences exist in the prevalence of community-acquired
Background/Objectives: Infections that require BSI, UTI and PNEU present on admission between non-Hispanic
hospitalization are costly and potentially life-threatening. Studies whites, non-Hispanic blacks and Hispanics. The reduction in
show that rates of infections, such as sepsis and pneumonia, differ by disparity resulting from controlling for neighborhood income level
race and ethnicity. The disparity could be attributed to differences indicates that socioeconomic and cultural context could lead to
in quality and access to care and/or pre-existing comorbidities that race/ethnic differences in infection risk independent of underlying
are influenced by the larger socioeconomic and cultural context. comorbid factors. Furthermore, the attenuation of the association
Objective: We compared the prevalence of community-acquired observed with adjustment for emergency room referral suggests that
infections (bloodstream infections (BSI), urinary tract infections blacks and Hispanics may be at greater risk of infection that require
(UTI), pneumonia (PNEU)) by race/ethnicity and determined hospitalization due to lack of primary care.
the contribution of socioeconomic and comorbid factors to the
disparity in infection. Methods: Study setting: We conducted
a retrospective study of patients who were discharged from January
2006 to December 2008 from a large tertiary hospital that serves a Presentation Number 13-196
diverse population in upper Manhattan. Analyses were conducted
Epidemiology of Nosocomial Infections in Selected
on 64,997 inpatients whose race/ethnic category was specified
and for whom data on age, sex, comorbid factors (diabetes, renal Neonatal Intensive Care Units in Children Hospital
failure, malignancy, transplant history, Charlson score), ZIP code No1, South Vietnam
of residence, insurance status and emergency room referral were
Nguyen Thi Thanh . Ha - Chief of INFECTIN CONTROL
available in the electronic health records. Methods: We used the
DEPARTMENT, Children Hospital No1
standard infection definitions as delineated by CDC’s National
Healthcare Safety Network and modified the definitions where Background/Objectives: This study aimed to determine
clinical symptoms were indicated. An infection that was confirmed the epidemiology of nosocomial infections (NIs), common
by culture within 3 days of admission was considered community- microorganisms and cost. Patients included in the study were taken
acquired. Prevalence of infections was compared between non- from a newborn intensive care unit (NICU), in Children hospital
Hispanic whites, non-Hispanic blacks and Hispanics by logistic No.1. Methods: A prospective cohort study was performed.
regression, with sequential adjustment for age, sex, comorbid The subjects were 892 neonates who were admitted to the NICU,
factors, neighborhood median household income, insurance status, survived longer than 48 hours after transferred to another unit,
and emergency room referral. Results: The crude analysis between Jan. 1. 2008 to Sep. 30, 2008. NIs were identified according
showed that non-Hispanic black and Hispanic inpatients were to the NNIS definition. Data were analyzed with descriptive statistics
more likely to be admitted with BSI (OR blacks=2.33, 95%CI by Stata 10. Results: Cumulative incidence rate for NIs was 12,4
(1.93,2.80); OR Hispanics=1.89 (1.58,2.27)), UTI (OR blacks=2.37 NIs of 100 admissions, with a total of 111 infections for 892 patients.
(2.11,2.66), OR Hispanics=2.19 (1.96,2.45)), and pneumonia The most common infections were pneumonia (50%), bloodstream
(OR blacks=1.79 (1.32,2.44), OR Hispanics=1.35 (0.99,1.83)) infection (31%), and Surgical site infection (10%). Major pathogens
compared to non-Hispanic whites. Adjusting for the covariates were Gram-negative such as Klebsiella 87 (36,5%), Acinetobacter
attenuated the associations for BSI (OR blacks=0.95 (0.76,1.19), OR spp 49 (20,5%). The factors associated with NI was also associated
Hispanics=0.84 (0.67,1.04)), UTI (OR blacks=1.01 (0.87,1.17), with a significantly increased risk of definite infection (OR > 1.19,
OR Hispanics=0.92 (0.80,1.05)), and PNEU (OR blacks=0.73 95% CI > 1 and p< 0,05): birth weight, > 7 days of hospitalized,
(0.50,1.07), OR Hispanics=0.61 (0.42,0.89)). The largest reduction CVC, mechanical ventilation, surgical. hospital stay (25 days for
Ni and 16 days for non Ni) and fiscal costs (19,9 million VN Đ for
NI and 6,5 million VND for non NI) of these infections are high.
Conclusions: Nosocomial infection is a serious problem for
neonates who are admitted for intensive care. Since it is associated
with increases in morbidity, both hospital stay and fiscal costs of
these infections are high. we need strategies for the prevention and
treatment of nosocomial infection.

132 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Specialized Settings (Ambulatory Care, Behavioral Health,
Long-Term Care, Home Care)
Presentation Number 13-197 Specialized Settings (Ambulatory
Gender Differences in Risk of Bloodstream Care, Behavioral Health, Long Term
Infection
Care, Home care)
Bevin Cohen, MPH - Project Coordinator, Columbia University
School of Nursing; Yoon Jeong Choi, RN, MSN - Doctoral Student,
Columbia University School of Nursing; Sandra R. Hyman, RN, Presentation Number 14-198
MPA, CIC - Infection Prevention Specialist, NewYork-Presbyterian
Columbia University Medical Center, Associate in Medicine, Seasonal Influenza Vaccine Compliance Among
Division of Infectious Diseases Columbia University; E. Yoko Hospital and Non-Hospital-Based Healthcare
Furuya, MD, MSc - Medical Director, Infection Prevention & Workers
Control, NewYork-Presbyterian Hospital; Matthew Neidell, PhD -
Associate Professor, Department of Health Policy and Management, Terri Rebmann, PhD, RN, CIC; Kate Wright, EDD - Director,
Mailman School of Public Health, Columbia University; Elaine L. Heartland Center for Public Health Preparedness, Saint Louis
Larson, RN, PhD, CIC - Associate Dean for Research, Columbia University, School of Public Health; John Anthony - Emergency
University School of Nursing Preparedness Manager, St Louis County Health Department;
Richard Knaup - Manager, Communicable Disease Control Services,
Background/Objectives: Previous studies suggest St Louis County Health Department; Eleanor Peters - Epidemiology
that men are at higher risk for bloodstream infections (BSIs), but Specialist, St. Louis County Department of Health
findings are inconsistent and limited by small sample sizes and
inability to control for possible confounders. High body mass index Background/Objectives: Influenza vaccination among
(BMI) increases risk of infection, so gender differences in obesity non-hospital healthcare workers (HCW) is imperative, but only
prevalence may explain differences in infection risk. The purpose limited data are available on factors affecting their compliance.
of this study was to examine the association between gender and The objective of this study was to examine factors influencing
incidence of BSI in a large cohort while controlling for a variety of hospital and non-hospital HCWs’ influenza vaccine compliance
clinical and demographic risk factors, including BMI. Methods: with the 2010/2011, 2009/2010, and H1N1 influenza vaccines.
All patients >18 years discharged from one tertiary care and one Methods: A vaccine compliance questionnaire in the form of
community hospital in New York City from 2006-2008 were online and paper surveys was administered to HCWs working in all
included in a database that captured electronically available clinical healthcare settings in St Louis, MO in March - June, 2011. McNemar
and administrative data for each patient (N=89,347). Patients tests were used to compare compliance rates across the three types
who developed BSIs were identified using a previously validated of vaccine; a non-parametric test was chosen because the outcome
computerized algorithm based on the Centers for Disease Control variable is dichotomous and it is a matched sample (same HCWs
and Prevention (CDC) National Healthcare Safety Network over different time periods). Hierarchical logistic regression, stratified
definitions. Logistic regression was used to test the association by hospital vs. non-hospital work setting, was used to determine
between gender and BSI, controlling for a wide range of clinical a predictive model for 2010/2011 seasonal influenza vaccination
and demographic characteristics. Data on height and weight were compliance. Good model fit, indicated by a nonsignificant chi square
available for all patients who underwent a surgical procedure at the value, was calculated with the Hosmer and Lemeshow goodness-
tertiary care hospital (N=20,861). BMI was calculated for these of-fit test. Results: In all, 3,188 HCWs completed the survey;
patients and categorized as underweight, normal weight, overweight, half of which (n = 1,719) reported no hospital work time. HCW
or obese, according to CDC definitions. Relative risk (RR) of BSI compliance was highest for the 2010/2011 seasonal influenza
for females vs. males was calculated within each BMI category. vaccine (78.9%, n = 2,514), followed by uptake of the 2009/2010
Results: Odds of BSI were significantly lower for women than seasonal influenza vaccine (74.9%, n = 2,383), and lowest for the
men in the crude analysis (odds ratio=0.73; p<0.01), and this H1N1 influenza vaccine (63.3%, n = 2,017); these differences in
difference remained significant after controlling for admitting compliance were highly statistically significant (p < .001) for all three
and discharge diagnoses, preexisting conditions (e.g. diabetes, comparisons (2010/2011 vs. H1N1, 2010/2011 vs. 2009/2010, and
malignancies), hospital interventions (e.g. intubation, surgery), 2009/2010 vs. H1N1). In logistic regression stratified by hospital
medications, device and catheter days, length of stay and intensive versus non-hospital setting, and controlling for demographics and
care unit stay, costs incurred, and month/year of admission (odds past behavior, the determinants of 2010/2011 seasonal influenza
ratio=0.77; p<0.01). Obesity was more prevalent in women than vaccination among non-hospital-based HCWs included having a
in men (29% vs. 25%) but overweight was more prevalent in men mandatory vaccination policy (odds ratio [OR], 21 [95% confidence
than in women (40% vs. 30%). Men had significantly greater risk interval {CI}, 6.7 - 64.4]), perceived importance (OR 7.6 [CI: 4.3 -
of BSI within each category of BMI; RRs ranged from 0.37 to 0.63 13.3]), no fear of vaccine side effects (OR 4 [CI: 2.3 - 7.1]), free and
(all p<0.01) and gender differences did not change linearly as BMI on-site access (OR 3.3 [CI: 1.9 - 5.7]), and perceived susceptibility
increased. Conclusions: The association between gender and to influenza (OR 2.4 [CI: 1.3 - 4.2]). Determinants of hospital-based
BSI is robust and unlikely to be due to confounding. HCW vaccine compliance included having a mandatory vaccination
policy (OR 32 [CI: 8.4 - 118.7]), belief that HCWs should be
vaccinated every year (OR 4.3 [CI: .11 - .50]), occupational health

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 133
Poster Abstracts: Specialized Settings (Ambulatory Care, Behavioral Health,
Long-Term Care, Home Care)
encouragement (OR 2.9 [CI: 1.3 - 6.7]), perceived importance of for proper work habits. 2. Monthly team meetings with a forum to
vaccination (OR 2.9 [CI: 1.1 - 7.6]), on-site access (OR 2.9 [CI: 1.1 address ASC management. 3. Bug Bytes news letter. 4. Daily safety
- 7.3]), and no fear of vaccine side effects (OR 2 [CI: 1.1 - 3.7]). The calls. Lessons Learned: The monthly meetings have allowed
final models correctly classified 78% of the non-hospital respondents great working relationships to develop resulting in the sharing of
and 68% of the hospital-based workers. Conclusions: information. Site visits continue quarterly and aim for continous
Non-hospital-based vs. hospital HCWs’ reasons for vaccine uptake readiness for inspections. “Bug Bytes” and the safety calls are two
differed. Targeted interventions should be aimed at workers in these more effective communication tools.
settings to increase their vaccine compliance, including implementing
a mandatory vaccination policy.
Presentation Number 14-200
Presentation Number 14-199 What Is Wrong with Using a Dishwasher to Clean
My Instruments?
Infection Prevention Communication Within a
Health Sytem’s Ambulatory Surgery Centers Linda S. Roach, BSMT, CIC - Infection Prevention, Novant
Medical Group
Barbara Doerflein, BSMT (ASCP), CIC - Infection Preventionist,
Novant Health, Charlotte, NC Issue: In 2010 a physician office group comprised of 300+ practices
added an Infection Prevention Consultant position. One of the
Issue: Ambulatory surgery became a separate department within first opportunities discussed was the need to identify the number of
our health system in the fall of 2010. The vice presidents of clinical practices that performed reprocessing and to assess their compliance
operations and business development established a team which with recognized standards. An initial survey was distributed and 111
included the nine ambulatory surgery center (ASC) administrators, offices responded that they either sterilized or high level disinfected
a business analyst, a director of operations, and representatives from instruments. On-site visits were scheduled with each practice to
anesthesia, IT, regulatory, human resources, finance and infection assess their space and processes. While it quickly became obvious that
prevention. January, 2011 was when the work began to learn the many office settings are not appropriately set-up for reprocessing, it
business of ambulatory surgery and meet the infection prevention was further evident that staff needed training as related to high level
needs of our centers. Infection prevention was seen as an important disinfection and sterilization. Employees performing this function
focus with the recent outbreaks of bloodborne pathogens in were typically given verbal instructions covering the basic process
ambulatory settings in the last few years. A critical need was effective with few written procedures. The consultant also found that in offices
communication. Project: Initially, communication involved using endocavitary probes or CPAP masks, the vendor representative
visiting all the ASCs and meeting with the adminstrators and the on was the person who provided instruction on disinfection, which
site person(s) responsible for infection prevention. This provided was not always in compliance with the manufacturer’s instructions.
an opportunity to inspect the center using the CMS survey tool, Knowledge deficits were identified in aseptic technique, instrument
review policies and procedures, and observe staff for good infection decontamination, and sterilization process monitoring. As an adjunct
prevention work habits. Monthly team meetings took place either to the observations, the consultant serves as faculty for the North
in person or by conference call and provided a forum to present new Carolina Infection Prevention Course for Outpatient Settings and
initiatives or educate administrators about subjects such as record receives many questions regarding reprocessing from attendees.
keeping, surgical site infection surveillance, or disinfection. These Project: To address identified knowledge deficits, the Infection
meetings allowed for the sharing of information and networking. Prevention Consultant developed two self learning activities (SLA)
Another communication device employed was the development for office employees. The first SLA dealt with decontamination. It
of a newsletter called “Bug Bytes” which was sent out as an email included discussion on the importance of decontamination, basic
attachment. The first edition was an update on issues that had decontamination steps and the proper use of personal protective
been identified that needed addressing such as contact precautions equipment. The second education tool focused on the sterilization
being implemented on patients that were known MRSA or VRE process. The principles of steam sterilization were covered along
colonized patients and continuing education such as the “One and with the types of process monitoring recommended. Information
Only Campaign “ from the CDC. Other editions have explored on packaging, loading the sterilizer and maintenance were provided.
sugical site infection surveillance , an anesthesia infection prevention Links to corporate policies were included. Each activity included
checklist, and sharps safety in the ASC. The administrators share a post-test and evaluation. Materials were emailed to practice
these newsletters with staff. Our health system puts great emphasis managers and clinical leads with a 30 day window to complete the
on patient safety in the hospital and has a daily safety call that activities. Results: Following the initial assessments and SLA
includes a representive, usually the department manager, from each offering, subsequent visits have revealed improved understanding
unit and service. This has also been adopted by the ASCs with each of decontamination and sterilization processes. Staff question
administrator reporting on his or her center, any safety issues or great appropriateness of processes and seek confirmation that they are in
service events of note. Infection Prevention is a part of this call and compliance. The SLAs were also favorably received by employees.
it is a quick way to find out if there are issues that need addressing. The SLA evaluation included the question “I am satisfied with this
Results: Four communication methods evolved over the course self-directed learning activity”. For the Decontamination SLA,
of the year: 1. Site visits to inspect the physical plant and observe staff 66% of respondents Strongly Agreed and 34% Agreed with the

134 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Specialized Settings (Ambulatory Care, Behavioral Health,
Long-Term Care, Home Care)
statements and for the Sterilization SLA 75% Strongly Agreed while
25% Agreed. Lessons Learned: Many physician office staff
members have significant knowledge deficits concerning reprocessing
procedures. Educational materials appropriate to the office setting
created an opportunity for improving processes and were well
received by employees. Additionally, the SLAs have been converted
to an on-line module available through a corporate intranet site to
facilitate availability and tracking completion.

Presentation Number 14-201

Effectiveness of a Comprehensive Hand Hygiene
Program for Reduction of Infection Rates in a
Long-Term Care Facility: Lessons Learned
Steven J. Schweon, RN, MPH, MSN, CIC, HEM - Infection
Preventionist, Pleasant Valley Manor Nursing Home; Sarah
Edmonds, MS in Biology - Clinical Scientist, GOJO Industries,
Inc.; Jane M. Kirk, MSN, RN, CIC - Clinical Manager, GOJO
Industries; Douglas Y. Rowland, PhD - Consultant, D Y Rowland
Associates

Background/Objectives: Hand hygiene has been

recognized as the most important intervention for preventing the
transmission of pathogens in health care settings. Alcohol-based
hand rubs (ABHRs) play a key role in reducing the transmission
of pathogens and preventing infections in acute care settings,
especially as part of a comprehensive hand hygiene program. ABHRs
are associated with reduced hospital-associated infection (HAI)
rates, including respiratory tract infections, and those caused by Methods: Infection surveillance data, including those meeting
methicillin-resistant Staphylococcus aureus (MRSA). However, McGeer et al. and the Pennsylvania Patient Safety Authority’s
their use and impact in long-term care facilities (LTCFs), where the reportable surveillance definitions, for lower respiratory tract
residents have increasingly higher acuity levels due to changing health infections (LRTIs) and skin and soft tissue infections (SSTIs), as well
care delivery systems, has been virtually unstudied. as hospitalization data were collected in a 174-bed skilled nursing
LTCF for 22 months (May 2009 and February 2011). In March
TABLES and Figures. Effectiveness of a Comprehensive HH Program 2010, a comprehensive hand hygiene program including increased
for Reduction of Infection Rates in a LTCF.docx product availability (touch-free dispensers, alcohol based sanitizing
wipes, 2 oz. personal carriage bottles), education for health care
personnel (HCP) and residents, posters promoting hand hygiene, a
resident hand hygiene program, a monthly hand hygiene champion,
and an observation tool to monitor compliance, was implemented.
Results: Pennsylvania reportable infection rates for LRTIs were
reduced from 0.97 to 0.53 infections per 1,000 resident-days (P =
0.01) following the intervention; a statistically significant decline.
McGeer LRTI (non-pneumonia) also demonstrated a statistically
significant reduction. Pennsylvania reportable infection rates for
SSTIs were reduced from 0.30 to 0.25 infections per 1,000 resident-
days (P = 0.65). There was a reduction with McGeer SSTIs that failed
to attain statistical significance. A 54% hand hygiene compliance
rate was observed among HCP. No statistically significant changes in
hospitalization rates due to LRTI and SSTI were observed during the
study period. Conclusions: This study demonstrates that the
use of ABHRs, as part of a comprehensive hand hygiene program for
HCP and residents, can decrease infection rates in LTCFs.

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 135
Poster Abstracts: Specialized Settings (Ambulatory Care, Behavioral Health,
Long-Term Care, Home Care)
Presentation Number 14-202 Presentation Number 14-203
Keeping our Eyes on TASS: Our Experience in the Strengthening Healthcare-Associated Infection
Ambulatory Care Setting Prevention Efforts in Rural, Small, and Critical
Access Hospitals in California through
Veronica Rose, RN, CNOR - Infection Prevention and Control
Collaboration
Coordinator, Saint Barnabas Ambulatory Care Center
Ian Kramer, MS - Health Policy Analyst, Office of Healthcare
Issue: Toxic Anterior Segment Syndrome (TASS) is an early post-
Quality/Office of the Asssistant Secretary for Health/U.S.
operative complication of anterior chamber cataract surgery. TASS
Department of Health & Human Services
is an inflammatory process causing decreased vision. It is reported
clusters range from a few cases to over 20 occurrences several times a Nadine Simons, MS, RN - Regional Health Administrator, US
year in the USA. Investigations have demonstrated several causes for Deptartment of Health & Human Services - Office of the Assistant
TASS which include; abnormalities in the ph. or ionic composition Secretary for Health
of irrigation solutions, ophthalmic viscoelastic devices, intraocular
medications, powdered gloves, or even the finish of an intraocular Rani Jeeva, MPH - Team Leader, Healthcare-Associated Infections
lens. TASS has also been cited by many sources as occurring from Initiative, US Dept of Health & Human Services/Office of the
toxic residues on such as on improperly rinsed instrumentation or Assistant Secretary for Health/Office of Healthcare Quality
soaked in enzymatic detergents along with improper use of ultrasonic
units. Project: 1/7/2010 to 2/4/2010. 4 cases of TASS were Lynn Janssen, MS, CIC - Coordinator, HAI Liaison Program,
reported from 2 physicians. A team was assembled to evaluate current California Department of Public Health, Center for Health Care
practices. The team included; Infection Control, Nurse Executive, Quality
Operating Room Manager, and Sterile processing Manager. Review
Issue: Healthcare-associated infections (HAIs) are a significant
of sterilizers cleaning demonstrated no servicing for one week before
cause of preventable injury and death. California recognized HAIs
trays sterilized, all loads met parameters for sterilization, no closed
as a significant public health issue and initiated assistance with HAI
container/short cycle loads were used for any instruments utilized
prevention strategies through the California Department of Public
in these cases. Our research on TASS lead to the following changes.
Health (CDPH) in the mid 1990’s. One obstacle faced is the large
1. Modification of OR post procedural cleaning/rinsing practice.
number of rural, small, and critical access (RSCA) hospitals spread
Incorporate two basins of sterile water on back table for intra-
over an extensive geographical area (>163,000 square miles). Of
procedural rinsing and a second basin for post procedural rinsing
California’s 427 hospitals, approximately one-third have less than
with copious flushing. 2. Propose purchase of a separate ultrasonic
100 beds, 72 are designated rural hospitals, and 28 are critical access
unit for only ophthalmic instruments. 3. Utilize filtered needles
hospitals (CAH). Due to many factors, including limited financial
for drawing medication. This practice decreases the possibility of
and staffing resources and limited collaboration opportunities due
microscopic shards from entering with ampule opening and changing
to geographic isolation, these hospitals may need assistance and
to preservative free medications when available, i.e. epinephrine.
training to aid in HAI prevention efforts within their facilities.
4. Evaluate all cleaning practices in sterile processing. 5/5/2010
Project: Through a project conducted by the U.S. Department
and 11/17/2010. 2 more cases reported after above changes. Team
of Health and Human Services Office of the Regional Health
reassembled: Sterile processing Manager introduced to team a rinsing
Administrator for Region IX (as part of a Regional HAI Prevention
system from a company. We contacted the company obtained a loaner
program in the Office of Healthcare Quality) in collaboration with
which flushes cannulated instruments with an enzymatic cleaning
CDPH, current HAI prevention infrastructure was expanded to
solution as well as distilled water and air. After a trial of the Quick
enable a targeted focus on assessing the needs of and providing
Rinse System, we purchased 3 units; one unit for use in the Operating
additional support to RSCA hospitals. The project, which began
Room for immediate use after manual rinsing post procedure. The
in late 2010, initiated outreach (1-on-1 consultations) to RSCA
Second and third units were placed in the sterile process department
hospitals. In March 2011, in association with the Hospital Council
one in decontamination and the other in the sterile prep area. The
of Northern and Central California, six focus groups were convened
Staff continues to follow the previous steps along with using the
via teleconference with RSCA hospitals in California to perform
Quick Rinse Unit. Results: 11/17/10 -2012 There have been
a needs assessment and determine interest in a statewide HAI
no further incidences of TASS. The Quick Rinse system has been
Prevention Collaborative(s).Results: 71 healthcare providers
successful in cleaning ophthalmic instrumentations along with all the
from 51 hospitals took part in the focus group discussions. The
lumened instruments utilized in our Operating Room. Lessons
size of participating hospitals ranged from 10 to 153 beds plus one
Learned: Review with the Operating & sterile processing staff the
600+ bed hospital from a predominantly rural county. Excluding
importance of following all steps of decontamination and sterilization.
the 600+ bed hospital, the median hospital size was 46 beds; 35
Meticulous removal of all viscoelastic, cleaning products and other
(69%) hospitals identified as rural, of which 15 (43%) identified
potential toxins is imperative for successful patient outcomes.
as CAH. 22 (43%) hospitals described past experiences with HAI
prevention interventions, with the most common infection or care
process target being central line-associated bloodstream infections.
11 (50%) of those hospitals with past experience stated they were
still “working on” one or more targets that required improvement.

136 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Specialized Settings (Ambulatory Care, Behavioral Health,
Long-Term Care, Home Care)
A majority of respondents favored participating in a RSCA-focused incidence of MRSA; although, rates of transmission increased from
HAI prevention collaborative.Lessons Learned: Less than the initial 6-month study (0.56 to 0.88, per 1000 patient days)
half of participating hospitals reported recent experience with a this still represented an 82% overall reduction in incidence over a
HAI prevention initiative and 50% of those who have experience 33-month period (p<0.001, chi-square analysis). Conclusions:
state further improvement is needed. Even without experience Many health care institutions contend with endemic rates of MRSA
many hospitals expressed interest in further participation in a rural colonization. Few studies have been conducted investigating
collaborative HAI prevention network. In 2011 CDPH began the sustainable control measures to prevent MRSA transmission among
California RSCA Hospital HAI Prevention Collaborative. Three elderly residents in chronic care facilities or nursing home settings. To
projects were launched based on the results of the focus groups: our knowledge, this is the first extended study highlighting the utility
Clostridium difficile prevention and antimicrobial stewardship, HAI of daily CHG bathing, as a standard of care in a geriatric setting, that
prevention best practices for California’s smallest hospitals, and has resulted in a sustained significant decrease in MRSA incidence.
catheter-associated urinary tract Infection prevention through the
national “On the CUSP: Stop CAUTI” initiative.
Presentation Number 14-205
Presentation Number 14-204 Possible Rabies Exposure in a Community Living
Center: Considerations and Decisions for Post-
Sustained Reduction in Methicillin-Resistant Staphylococcus aureus Exposure Prophylaxis
Incidence in a Geriatric Setting by Implementing Daily Bathing with
2% Chlorhexidine Gluconate Cloths Elicia A. Greene, RN, MSN, CIC, CPHQ - Assistant Chief,
Infection Prevention and Control, Central Texas Veterans Health
Jane E. Van Toen, BSc, MLT, CIC - Infection Prevention and Control Care System
Practitioner, Baycrest; Heather L. Candon, MSc, CIC - Infection
Prevention and Control Practitioner, Baycrest; Chingiz Amitov, Issue: Appropriate management of persons potentially exposed
MPH, CIC - Director, Infection Prevention and Control, Baycrest to rabies requires prompt evaluation with several factors for
considerations. The risk of infection (type of exposure, type of animal,
Background/Objectives: We previously described a availability and rabies vaccination status of the animal involved in the
reduction in the Methicillin-Resistant Staphylococcus aureus (MRSA) exposure, etc.) and the efficacy and risk of prophylactic treatment.
transmission rate, from 4.99 to 0.56 per 1000 patient-days, in an Bats are considered high risk. The animal was not available for
MRSA-endemic geriatric setting after the six-month implementation testing, thus post exposure prophylaxis (PEP) was recommended.
of daily baths with disposable 2% chlorhexidine gluconate (CHG) Specifically, the guidance footnoted, “In incidents involving bats,
cloths. Daily CHG bathing was then continued as a standard of care PEP may be appropriate even in the absence of demonstrable bite,
over an extended period of time and we report on the long-term scratch, or mucous membrane exposure in situations in which there
sustainability of this intervention. Methods: Previously, an is reasonable probability that such exposure may have occurred
interrupted time-series design indicated daily CHG bathing cloths (e.g., sleeping individual awakes to find a bat in the room, etc.).”
(Sage Products Inc.) reduced MRSA transmission in an Acute-Care Project: Geographically, our health care facility is located on the
and Transition (ACT) unit in a geriatric facility. The ACT unit is migration route of bats. During a Friday morning report, the nurse
an alternative to preventing an admission to an acute care hospital manager of a community living center unit on our campus reported
for elderly patients with subacute or chronic disabilities requiring that two of her night shift staff members “killed a bat in a resident’s
assessment and treatment interventions. Patients on the study unit room”. After further investigation, the bat was initially seen the day
had an average age of 87 years, with all patients being > 65 years. before in the hallway and spotted flying into the resident’s room. The
Pre-intervention there were 169 admissions and post-intervention resident was removed from the room. An exhaustive search did not
1339 admissions. We continued to monitor MRSA transmission over reveal the bat. The resident was placed back into his room. Close to
a 33-month period on the ACT unit. To assess MRSA transmission, morning, the bat was discovered on the floor of the resident’s room
swabs were collected within 48 hours of admission, and on discharge. and was subsequently captured and released by the nursing staff
MRSA-positive patients were placed on contact precautions. rather than killed as initially reported. The resident was an 89-year-
The main outcome measure was the number of ACT-acquired old, demented, total care resident, who was unable to communicate if
MRSA cases post-intervention. We considered p values <.05 to be there was contact between him and the bat. Due to the unavailability
statistically significant. MRSA acquisition rates during the two study of the bat and after further consultation with the Chief, Infectious
periods were compared using a chi-square test. The t test was used to Disease and the Zoonosis Control Specialist at Department of
compare demographic data pre- and post-intervention. Results: State Health Services (DSHS), post exposure prophylaxis was
Time periods for comparison were six months pre-intervention, recommended. Results: The resident’s provider was notified
followed by a one-month washout when staff received training, of the recommended PEP guidelines and the resident’s next of kin
and 33-months post-intervention. Patient length of stay, MRSA was contacted for disclosure and consent. Pharmacy obtained the
colonization pressure and patient demographics was comparable Human Rabies Immune Globulin (HRIG) and Rabies Vaccine. The
in both time periods. Swab-collection compliance was 95% for dosing schedule of the vaccine is day 0, 3, 7, and 14 and the HRIG is
both pre- and post-intervention. We found continuing the practice a onetime dose based on weight. The resident tolerated the vaccine
of daily CHG bathing as a standard of care sustained the reduced series well. Lessons Learned: Staff released bat, thus unable

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 137
Poster Abstracts: Staff Training/Competency/Compliance

to determine rabies status. All involved staff was educated on how perceived their adherence significantly (p = 0.013), CNAs did not
to handle encounters with bats and the importance of retention of (p = 0.408); CNAs increased adherence in post observations after
the bat for testing was emphasized. The Pest Control and Safety patient contact (p = 0.008). This suggests interventions had an affect
Specialists completed a physical assessment of the area, to include on CNAs but not RNs. One intervention, “Ask me if I’ve washed
the roof, and concluded that the bat entered the building through my hands” buttons, only two individuals wore the buttons. This
a skylight located in the dining area on the unit. Engineering staff suggests hand hygiene adherence is perceived by staff as not a priority.
concurred and caulked the skylight. Lessons Learned: 1. Interventions designed to increase
hand hygiene adherence need to be implemented over a longer
time frame. Ongoing, uninterrupted feedback may be necessary. 2.
Nursing unit culture needs to be understood and addressed prior to
Staff Training/Competency/ implementation of interventions to increase hand hygiene. 3. Prior to
increasing hand hygiene adherence, nursing staff behaviors, attitudes,
Compliance values and beliefs on hand hygiene need to be understood. These
behaviors affect the sustainability of hand hygiene adherence. 4. A
culture which encourages active verbal feedback among healthcare
Presentation Number 15-206 workers (HCWs) on hand hygiene adherence is critically needed.
Increasing Nurses’ Hand Hygiene Adherence in
Acute Care Settings
Presentation Number 15-207
Trudy Marie-Kueker. Howard, DNP, MS, RN - University of
Minnesota Bath Basins: Who Knows Where Evil Lurks
Issue: Hand hygiene is one of the most critical infection prevention Renee L. Smith, MT(ASCP) - Infection Control Coordinator,
strategies against healthcare associated infections. Hand hygiene PinnacleHealth System; Lisa Snedeker, MT(ASCP) - Infection
by healthcare workers remains dismal, ranging from 5% to 81% Control Coordinator, PinnacleHealth System; Kimberly Rivera,
with an average of 40% nationally. Mortality associated with health MT(ASCP) - Infection Control Manager, PinnacleHealth
care related infections is 90,000 annually in the United States. System; Tina Willier, MSN, RNC-NIC - NICU Nurse Manager,
Strategies to increase adherence are crucial to reduce morbidity PinnacleHealth System; Mary Lou Mortimer - Staff Development
and mortality. Hand hygiene is influenced by behaviors, attitudes, Instructor, PinnacleHealth System
beliefs, values, and pre-conceived barriers (Pittet, 2004; Whitby,
et al., 2007; O’Boyle, et al., 2001; Kretzer, et al). Worldwide 1.4 Issue: Upon discovering that there was no written process in
million people suffer complications due to infections acquired place for the storage and cleaning of bath basins, it was decided that
while hospitalized ( Jarvis, et el., 1996; Stone, et al., 2002, & Raju, this topic would become the focus for the August 2011 monthly
1999). The Joint Commissions National Patient Safety Goal 7 is Infection Control Department’s Nursing newsletter. This edition
to “Reduce the risk of health care associated infections” (The Joint included recommendations for disinfecting and storing bath basins.
Commission, 2008). Behavioral models have varying degrees of In response to the newsletter, the Nurse Manager of the Neonatal
success in increasing and sustaining adherence (Aragon, et al., 2006; Intensive Care Unit (NICU) contacted Infection Control requesting
Bischoff, et al., 2000; Creedon, Curry, et al., 2001; 2005; Erasmus, to culture bath basins. Coincidentally, Nursing was planning to
et al., 2009; Gould, et al., 2007; Larson, et al., 1997; Larson, et al., implement an Incontinence Care Process which included a procedure
2000; Lausten, et al., 2008; Mertz, et al.. 2010; O’Boyle, et al., 2001; for bath basin disinfection. The new process was introduced to
Pittet, 2004; Sax, et al., 2007; Whitby, et al., 2006). Studies that Nursing Leadership in October 2011 with a go-live date of November
apply behavioral interventions have been reviewed (Aboelela, et al., 1, 2011. This study would determine if bath basins in the NICU
2007). No significant increases in H.H. was found in the literature. were colonized with bacteria that could potentially lead to hospital
The Social Cognitive Theory and Wheatley’s Change Theory associated infections. Project: This project was conducted in a
supported behavioral change in this project. Project: This project thirty-two bed Level 3 NICU. Current practice in the NICU was
was completed in an acute care hospital. Twenty-nine nursing staff to use a single bath basin for the duration of the baby’s admission, or
participated. Five educational interventions were implemented over until the baby was big enough for a larger bath, and the basin was no
3 months. interventions included an educational video, Easter Egg longer necessary. The basins were rinsed after each use, dried with a
fortunes which included hand hygiene “tidbits” on guidelines and paper towel, and placed in a drawer by the isolette. The basins were
recommendations (and chocolate); collaboration with staff to culture then used to store various personal care items including, but not
routine objects in the environment, and viewing of results in staff limited to, body wash, tape measures, combs, sleeper outfits, wash
meeting; APIC brochures on hand hygiene; and Joint Commission cloths, etc. A total of thirty bath basins were cultured over a four-
hand hygiene buttons. Hand hygiene adherence did not increase, week period. Basins were tested if the baby had been in the NICU for
it decreased on post observations. CNA staff was enthusiastic as at least one week. The Microbiology Laboratory performed empirical
the project unfolded and actively participated in the agar culturing. identification for all organisms, and also tested for Methicillin-
Results: Hand hygiene decreased from 64.3% in pre-intervention Resistant Staphylococcus aureus (MRSA) and Vancomycin Resistant
observations to 42.6% in post observations. Behaviors associated Enterococcus (VRE). Results: Nineteen of the thirty basins (63%)
with an increase in adherence did not improve significantly. RNs that were cultured grew one or more types of bacteria. 84% (16/19)

138 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Staff Training/Competency/Compliance

of the basins grew normal skin flora including coagulase negative Presentation Number 15-208
Staphylococcus, Corynebacterium species, Bacillus species, and alpha
hemolytic Streptococcus. MRSA was isolated from one of the basins Improving Hand Hygiene Practice through
(5%) and gram negative bacteria including Pseudomonas aeruginosa Utilization of Automated Hand Hygiene Monitoring
and Escherichia coli were isolated from 11% of the basins that grew. and Feedback Technology
Lessons Learned: This study demonstrated that improperly
disinfected bath basins in the NICU are a potential reservoir to a Candie B. Northey, RN, BSN, CIC - Assistant CNO, Director
variety of pathogenic bacteria that could lead to hospital associated Infection Prevention, Critical Care & Education, Andalusia Regional
infections. Hospital - Lifepoint Hospitals

Background/Objectives: Healthcare regulatory agencies

identify effective hand hygiene as the single most important way
to reduce infection risk, yet high levels of sustained hand hygiene
compliance remain elusive in healthcare facilities. A 2010 Infection
Control and Hospital Epidemiology study systematically reviewed 96
empirical studies on hand hygiene adherence and found the median
for hand hygiene compliance was found to be only 40%, with 72%

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 139
Poster Abstracts: Staff Training/Competency/Compliance
of the studies reporting compliance rates of 50% or Presentation Number 15-209
less. This study describes the use of an automated
hand hygiene monitoring to improve hand hygiene Use of an Electronic Survey Instrument to Determine
performance and positively affect patient perception Barriers to Certification in Infection Control
of caregiver behavior. Methods: Researchers
conducted a prospective case study of the effects Anne C. Maher, MS, M(ASCP), CIC - Infection Preventionist, APIC-Northern
of electronic surveillance technology on hand New Jersey; Nancy Kerr, RN, BSN, CIC - President, APIC-NNJ; Laura Anderson
hygiene activity using soap and sanitizer dispenser RN, MSN, CIC - APIC-NNJ; Norma Atienza, RN, BSN, MPA, CIC - APIC-
counts and patient satisfaction survey results. The NNJ; Jane Badaracco, RN, BSN, CIC - APIC-NNJ; Vicki DeChirico, RN, MSN,
hand hygiene monitoring technology consisted of CIC - APIC-NNJ; Mary Ann Kellar, RN, MA, CHES, CIC - APIC-NNJ; Judith
a wireless network, active communication display Leschek, RN, BSN, CIC - APIC-NNJ; Romeo P. Mamon Jr., RN, BSN - Infection
units adjacent to dispensers, radio frequency Prevention Practitioner, Atlantic Health System
identification (RFID) tags, and existing sanitizer
and soap dispensers. Personal RFID tags worn Issue: One of our chapter goals for 2011 was to increase certification among our
by healthcare workers were used to measure the membership. To determine how to best assist members to achieve and/or maintain
number of times caregivers engaged in hand hygiene certification, the APIC-NNJ Board decided to query the membership. A survey was
activities. The system recognized the healthcare designed to identify barriers to certification for our members, their preferences for
worker in the patient room, the time spent in the overcoming these barriers, and ascertain the value of certification to our members
room, hand hygiene solution dispenses and whether and their employers. Project: The board of directors collaborated on appropriate
soap or sanitizer was used. Patient perception of questions to include in the survey. Refer to Figure 1. The survey was then formatted
hand hygiene activity associated with use of this on an electronic survey instrument (Survey Monkey) and was made available to
system was measured by the frequency of the patient chapter members for a four week period. Responses were then collected and collated.
response of “always” on the patient satisfaction
survey tool question, “How often did the patient
care staff wash their hands or use an alcohol hand
rub before providing patient care?” Results:
At the end of the six month data collection period,
researchers noted an 82.6% increase in both soap
and alcohol based hand sanitizer dispenses when
stratified by admission. Patient satisfaction survey
results where the patient responded “always”
increased by 9% overall. Conclusions: The
implementation of an electronic hand hygiene
monitoring device resulted in an increase in hand
hygiene compliance and soap and sanitizer usage.
This confirms numerous studies that indicate
that while hand hygiene education is important,
compliance improves to a greater degree when
personnel are monitored.

140 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Staff Training/Competency/Compliance
staff to experience an enjoyable
educational experience.
BACKGROUND: The
Infection Prevention (IP)
Team had an opportunity
to position a table in the
cafeteria during Infection
Prevention Week, October,
2011. We seized the valuable
occasion to reinforce infection
prevention concepts and
emphasize our culture of patient
The crosstab and filter features of the electronic survey instrument safety, while strengthening
were used to sort responses by healthcare setting, certification status communication between the IP team, hospital staff, and students.
and years of experience in infection prevention practice. A spreadsheet We were determined to connect with students and employees by
with all responses, as well as each question’s collated responses and encouraging the asking of questions related to infection prevention
graphs were downloaded. Results: Seventy of 191 members and participating in a thought-provoking raffle/quiz. For Infection
responded yielding a 37% response rate. Refer to Figure 2. The most Prevention Week in October, 2011, an ungraded, anonymous
frequent reported barriers to certification were cost of the test and raffle/quiz was developed that consisted of 8 questions related to
fear of tests (48.4% each). Although a large number of respondents infection prevention (IP). The objective was to provide education
(36.8% and 32.3% respectively) also reported lack of familiarity while reinforcing IP concepts in an enjoyable and friendly approach,
with test content and lack of experience as barriers (refer to Table 1). and questions were selected that were interesting and challenging.
Less experienced IPs (Infection Preventionists) tended to cite lack The raffle entry was at the top of the quiz and a total of six prizes
of experience more frequently. Respondents from areas other than were distributed. Hundreds of boxes of hand sanitizer wipes were
acute care expressed concern that the certification exam covers areas distributed, as well as buttons, stickers, and pamphlets. Results:
of healthcare outside their current practice setting. This survey also The Cafeteria Quiz was a huge success as each raffle/quiz entry
indicated that fewer IPs are certified in healthcare settings with no initiated dialogue between staff and the IP team. This provided an
regulatory requirements for certification. Most respondents (79.7%) important glimpse into areas where education was appropriate due
indicated that study groups and educational sessions (71.2%) would to the high level of interest the questions generated. We received
assist them in overcoming barriers to certification (refer to Table 2). numerous requests for the quiz to be e-mailed to unit managers for
Among certified IPs there was a marked preference for the SARE the purposes of future education. The IP team also wore badges
(Self-Achievement Re-Certification Exam) format for re-certification that stated “I had my Flu Shot” and we reminded staff to have
despite comments on the difficulty of the SARE. Almost 96% of
respondents indicated that they considered certification beneficial
to the profession of infection prevention. However, less than 50% of
respondents are reimbursed for the cost of the exam, and only 32%
receive an incentive for CIC certification. Lessons Learned:
Our results indicate that despite perceived barriers to CIC
certification, the overwhelming majority of IPs who responded to this
survey believe certification is beneficial to the profession. Based on this
survey the chapter has developed educational sessions to assist more
members to become CIC certified and maintain certification. It is our
hope that may serve as a model for other chapters to conduct similar
surveys that validate our findings and/ or identify other barriers to
certification and methods to overcome these barriers

Presentation Number 15-210

Food for Thought: The Cafeteria Quiz; an
Educational and Engaging Approach to Reinforce
Infection Prevention Concepts during Infection
Prevention Week
Eileen Yaney, MT(ASCP) MS, CIC - Director, Infection prevention
and Control, Saint Barnabas Medical Center; Rochel Shapiro, RN,
MSN - Nurse Intern, Saint Barnabas Medical Center

Issue: Providing education can be challenging because students

and employees have very little free time, and we wanted students and

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 141
Poster Abstracts: Staff Training/Competency/Compliance

their influenza vaccinations and provided information about flu catheterization or reinsertion of an IUC. It appears as though
vaccination. Additionally, staff truly liked the self-sticking hand the initiative is impacting CAUTI rates which have continued to
washing signs to adhere above sinks. More than 350 students and staff decrease (Figure 1) but IUC device days remain high (Figure 2).
entered the raffle contest, which required filling out the raffle quiz to
win prizes, and a total of six prizes awarded. Lessons Learned:
The cafeteria quiz was a resourceful method to initiate meaningful
communication between the IP team, students, and employees.
The opportunity to discuss infection prevention issues with IP
staff reinforced our organizational culture of safety and instilled
confidence in staff that the IP team is friendly and approachable. The
interactive cafeteria quiz encouraged critical thinking, teamwork, and
peer-learning.

Presentation Number 15-211

Results of a Hospital-wide Initiative to Decrease
CAUTIs
Diane K. Newman, DNP FAAN - Adjunct Associate Professor of
Urology in Surgery, University of Pennsylvania

Background/Objectives: Hospital-associated infections

from indwelling urinary catheters (IUC) are a major cause of patient
mortality and morbidity and are considered preventable patient
safety issues. The CDC HIPAC evidence-based (EB) guideline on
prevention of catheter-associated urinary tract infections (CAUTIs)
recommends care practices to prevent CAUTIs. Objectives of this
study were to determine if components of an EB hospital-wide
patient care initiative on prevention of CAUTIS are being practiced
on a daily basis, to determine if the CAUTIs rates and device days
had decreased, and to determine staff knowledge of prevention
of CAUTIs. The underlying hypothesis was that there would be
differences in IUC nursing care practices to prevent CAUTIs
between patient units with low CAUTI rates as compared to those
with high CAUTI rates. Methods: Prospective descriptive
study of patients with IUCs on eight units (4 high CAUTIs, 4 low
CAUTIs) as noted in Chart 1, in a large academic center located
in Eastern United States and the registered nurses (RNs) providing
direct bedside patient care on these units. Methods included
direct observations of IUC systems, an online survey of RNs and
monitoring of CAUTI rates and device days. Results: A total
of 91 IUC observations were completed, yielding 637 components
of IUC system care. The results of these observations indicate that
on all eight units, the majority of RNs practice EB patient care,
are following components of the EB initiative, and no differences
were seen between units with high and low CAUTI rates. A total
of 301 nurses (58% response rate) completed the survey noting an
experienced group of clinical RNs as seen in Chart 2. Only 7.0%
answered all EB questions correctly. Differences in knowledge
depended on the number of years the RN had practiced. More
inexperienced RNs (new to practice) would not independently
make decisions about IUC removal (p=0.000) without an attending
physician’s order. More inexperienced RNs do not feel they have
enough control over their practice to make decisions about IUC
removal even though protocols are in place and resources are
available. A higher percentage of experienced (RNs > 5 years) RN’s
(p=0.040) did not know the amount of bladder volume necessitating

142 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Staff Training/Competency/Compliance

Presentation Number 15-212 Hospital

Competence Based Orientation Program Sandra R. Hyman, RN, MPA, CIC - Infection Prevention
Specialist, NewYork-Presbyterian Columbia University Medical
Judy Prescott, RN, BSN, CIC - Director, Infection Prevention Center, Associate in Medicine, Division of Infectious Diseases
and Control, Baylor Health Care System; Margaret L. Martin, Columbia University; Louise Kertesz, ANP, MSN, CNOR
RN, MSN, BC, CIC - Infection Preventionist, Baylor Medical - Clinical Nurse Specialist, NewYork-Presbyterian Columbia
Center at Southwest Fort Worth; Stephanie Kreiling, RN, BSN, University Medical Center; Patrica Nelson, RN, MSN, CNOR
CIC - Manager, Infection Prevention and Control, Baylor All - Perioperative Clinical Nurse Educator, NewYork-Presyterian
Saints Medical Center; Brady Allen, RN, BSN, CIC - Manager, Hospital Columbia Medical Center; Audrey Compton, MD,
Infection Prevention and Control, Baylor Regional Medical Center MPH - Quality/Patient Safety Manager, NewYork-Presbyterian
at Grapevine Hospital Columbia University Medical Center; Vicki Almarez-
Fox, RN, MPA - Director, Milstein Perioperative Services,
Issue: Verifying competence of the Infection Preventionist NewYork-Presbyterian Hospital Columbia University Medical
(IP/IPs) can be challenging due to work complexity. The Joint Center; John C. Evanko, MD, MBA - Vice President, Medical
Commission (TJC) standards require verification of competence Director, Milstein Perioperative Services, Attending Dept of
of the IP through “ongoing education, training, experience and/ Gynecologic Surgery, NewYork-Presbyterian Hospital and
or certification”. A fourteen facility healthcare system wanted to Columbia University
provide consistency of orientation of the IPs. A team was selected
from varying sizes and types of facilities to develop a consistent Issue: Engaging Perioperative staff to practice and empower
competence based orientation program throughout the system. others to prevent and control infection is a struggle in large
Project: The objectives for the Competence Based Orientation tertiary teaching institutions due to rotations of residents and
Program were: • Standardization of orientation for all system IPs. • students, as well as having large numbers of employees, visitors
Individualization of orientation and competence verification based and vendors . Institutions are searching for creative ways to share
on needs of the local hospital. • Initiation of a supportive orientation policies and proper practices while using a surgical conscience
program with a preceptor that encouraged retention of qualified and empowering others to assume responsibility. Our institution
IPs. TJC Standards, APIC references, NHSN processes and current consists of a 692-bed adult academic acute care facility and a
practice was incorporated into the measurable outcomes. Modules 283-bed pediatric academic acute care facility. There are 38 adult
were developed that included complex areas of practice. Essential operating rooms (ORs) and 8 pediatric ORs. Project: Our
elements and outcome language was used for competence based Perioperative Services resources include a perioperative infection
assessment and orientation tools. Clear terms for orientation and preventionist, clinical nurse specialists , designated educators
continuing education were differentiated for the IP so that system for individual services , surgical champions and a Surgical Site
standardization was improved. A pre-assessment tool was developed Infection Prevention task force. All play a tremendous role in our
with essential competencies for a new IP. A post assessment was efforts. Education is given monthly to the adult OR nursing staff
developed to reflect the status at completion. The orientation period and every 1-2 months to the children’s OR nursing staff. Methods
timeline was defined and guidelines for the program were developed for teaching have consisted of games, fairs, teaching during routine
to standardize the essential elements. In the trial group, the new rounds, as well as posting and reporting of results of SCIP core
IP was assigned a preceptor and the tools were used. Comparison measures, observations and Standardized Infection Ratios (SIRs).
of the pre and post levels was done to measure progress of the Surgical conscience initiatives are posted. A monthly newsletter,
IPs. The pre assessment was compared with the post assessment published by staff, provides key infection prevention “hot topics”
numbers and a percent of improvement was calculated. Results: as a supplement. Instruction is given to new residents in small
All new employees showed significant improvement. The greatest group settings in the OR or classroom with return demonstration.
improvement was observed in those with less experience. This tool Educators have been trained by the Perioperative IP with ongoing
has been beneficial in the successful orientation process of new assessment to ensure consistency. Multiple attendings and residents
IPs and provides consistent evaluation of competence. Lessons have been designated infection prevention champions. Their role
Learned: Competence based statements assist the new IP to might include providing inservices, or gathering staff for programs.
achieve the outcomes expected. Minimal competencies for the IP Attending support is essential for mandating attendance. All
position establish a foundation for future growth with continuing new General Surgery medical students receive classroom training
education. Frequency of preceptor review of the competence followed by return demonstration of surgical hand preparation
tool assists in completion of the orientation. The ability to show and self and assisted gowning and gloving in the ORs. Infection
improvement from the start of orientation to the completion of prevention multidisciplinary task forces exist to develop practice
orientation is essential. guidelines and implementation that are unique to their services.
Guidelines have been developed for; Cardiac surgery, Neurosurgery,
Urology; Penile implant, and Ophthalmology. Results:
Presentation Number 15-213 Success of interventions are evaluated by the use of SIRs that are
benchmarked with other hospitals in our State. SIRs are calculated
Engaging Staff to be Responsible for Surgical Site by procedure as well as surgeon. Currently, reported SIRs fall
Infection Prevention in a Large Academic Tertiary within the expected national outcome. Program participant
evaluations are analyzed and observation of compliance results lead

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 143
Poster Abstracts: Staff Training/Competency/Compliance
to interventions and education planning. As a result of Perioperative
IP visibility, surgeons have requested observations and suggestions to
reduce their patient infections. Lessons Learned: Education
methods must vary based on available time and preferred methods
for learning. The audience must be assessed to determine their needs.
Compliance is achieved not only through traditional SCIP and SIR
surveillance but by ongoing observations of process measures for
compliance.

Presentation Number 15-214

When You Don’t Know, What You Don’t Know
(Healthcare-Associated Infection [HAI] Knowledge
in Ambulatory Surgery Centers [ASC])
Amber Taylor, MPH - Health Policy Analyst, US Dept. of Health
& Human Services/Office of the Asst. Secretary for Health/
Office of Healthcare Quality; Rani Jeeva, MPH - Team Leader,
Healthcare-Associated Infections Initiative, US Dept of Health
& Human Services/Office of the Assistant Secretary for Health/
Office of Healthcare Quality; April Velasco, PhD - Deputy Regional
Health Adminstrator/Region II, Office of the Assistant Secretary for
Health/U.S. Department of Health & Human Services; Jonathan N.
Tobin, PhD - President/CEO, Clinical Directors Network, Inc

Issue: Historically, substantial emphasis on preventing healthcare-

associated infections (HAI) has been placed on hospitals and long-
term care facilities. However, HAIs occur in Ambulatory Surgical
Centers (ASCs), and are occurring with increasing frequency,
especially as more surgical procedures are being performed outside
of the hospital setting. As such, many ASCs and their respective
clinicians need to ensure that they have adequate knowledge and
training to implement evidence-based practices to prevent HAIs
in their facilities. Project: The U.S. Department of Health
& Human Services (HHS) Office of the Assistant Secretary for
Health (OASH) Region II (New York, New Jersey, Puerto Rico
and the Virgin Islands) received funding from the OASH Office of
Healthcare Quality (OHQ) to educate healthcare professionals and
administrators working in ASCs on HAI prevention and control.
An onsite training was held in NYC for participants in the NY and
NJ metro area. Satellite locations also received the same training via

simulcast for those who were not able to travel to NY. An online
enduring CDE-accredited training webcast is available at www.
CDNetwork.org. A separate Spanish-language training was also
offered in Puerto Rico using the same curriculum design used for the
NYC training. OHQ promoted the training more widely through
listservs, twitter, blogs, and other social media. A half-day train-
the-trainer (TTT) session was held following the main training
for participants to train their ASC staff on infection control and

144 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Staff Training/Competency/Compliance
prevention. Pre- and post- tests were conducted to evaluate changes in followed by Alcohol Based Hand Rub (ABHR) product and so team
each participant’s knowledge of HAIs in ASCs. Results: A total should improve compliance to ABHR products as recommended by
of 103 ASC staff attended day 1 and 68 attended day 2 (TTT) for CDC (since 2002) and by WHO (2006 and 2009).
the unique participants. The majority of participants who completed
both pre and post questionnaires currently spend <25% of their
time doing infection control activities (37% spent only 0-5 hours on
infection prevention). Pre-test: 39% completely disagreed that they
felt confident in their ability to explain state regulations on infection
prevention to others in their ASC, as compared to 51% post-test.
Pre-test: 49% of participants completely agreed that they are aware
of how to implement an infection control program in their ASC, as
compared to 63% post-test. Though there was a lack of knowledge
about some infection control practices and guidelines, both pre and
post-test showed that 100% of respondents completely agree that it
is important to follow infection prevention guidelines. There were
significant improvements seen in the following knowledge areas:
hand hygiene, safe injection practices, sterilization and disinfection.
Lessons Learned: More educational opportunities and
training, especially TTTs, need to be carried out in ASCs to ensure
that patients are not harmed, as well as protecting the healthcare
providers from HAIs in ASCs.

Presentation Number 15-215

Hand Hygiene Compliance and Variables of
Interest at Neonate Intensive Care Unit in a
Brazilian Hospital
Luciana Rezende Barbosa, PhD - Scientist, USP - GOJO; Adelia Presentation Number 15-216
Santos - Medical Doctor, Rumel Santos Healthcare Training and
Maintenance of Environmental Services Cleaning
Consulting; Sergio Colacioppo - Pharmacist, Faculdade de Saúde
Pública USP; Maria Albertina Santiago Rego - Medical Doctor,
and Disinfection in the ICU After a Performance
Faculdade de medicina UFMG Improvement Project

Background/Objectives: Several factors influence hand Teresa A. Fitzgerald, BSN, RN, CIC - Infection Preventionist,
hygiene (HH) compliance and different variables can be evaluated The Nebraska Medical Center; Lee A. Sholtz, MSN, RN, CIC
to improve quality of care assessment, to focus on the best training, - Infection Preventionist, The Nebraska Medical Center; Nedra
to incentive for performance improvement, outbreak investigation Marion, MPA, RN, CIC - Manager, Infection Control and
and infrastructure design. Objective of this study was to describe Epidemilogy, The Nebraska Medical Center; Paul Turner, CHESP
compliance to HH associated with variables of interest in a direct - Director, Environmental Services, Sodexo and The Nebraska
observation (DO) study in a Neonate Intensive Care Unit in a Public Medical Center; Philip C.. Carling, MD - Director of Hospital
University Hospital in Brazil. Methods: Direct Observation Epidemiology, Caritas Carney Hospital; Mark E . Rupp, MD -
was performed by 10 validated observers. Variables were associated Medical Director of Infection Control and Epidemiology, The
with type of opportunity, professional category, and product used. Nebraska Medical Center
Statistical analysis used software Stata and SPSS for Windows and Issue: Performance Improvement projects (PIP) directed toward
Chi-square test. Results: 7,324 opportunities were identified improving the performance of Environmental Service (EVS) Staff
during 255 1 hour DO periods from Dec 2008 to Mar 2009. General can be successful. Sustainability of performance improvement
compliance to HH was 50,2%. 1) Compliance according to the is best ensured with permanent systematic changes and ongoing
type of opportunity and professional category - *Others mean other monitoring and feedback. If performance levels decrease, actions
Professional Category that non nurses and medical doctors, like should be taken to assess the cause of the decline and to redirect
physiotherapist, laboratory technician, speech therapist, etc. 2) Type efforts to restore performance levels. Project: In a collaborative
of product used (if alcohol based hand rub product or soap and water effort, Infection Control and Epidemiology (ICE) worked with
or both) for HH in each type of opportunity 3) Professional category EVS staff on a PIP to achieve optimal cleaning and disinfection of
x product used. Conclusions: Results evaluation helped the ICU rooms. EVS staff were provided with instruction on cleaning
infection control team to focus on training according to the needs high-touch surfaces using a training video and cleaning checklist.
related to the type of opportunity and professional category. Results ICE staff marked 15 high-touch items in approximately 45 ICU
also indicated that healthcare workers use to use soap and water rooms each month with an ultraviolet-tagged marking solution

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 145
Poster Abstracts: Staff Training/Competency/Compliance

(DAZO®, Ecolab, St. Paul, MN), and evaluated results (using ultra to reduce healthcare associated infections. The World Health
violet light) after terminal room cleaning. Results were shared with Organization established direct observation of hand hygiene practices
EVS staff in face-to-face meetings on a monthly basis for 6 months. as the “gold standard” to measure adherence rates. The goal of this
Cleaning performance increased from baseline of 52% to a sustained study was to systematically observe hand hygiene compliance in all
level of 80-85%. A maintenance program was then instituted which of Maine’s acute care hospitals to develop a baseline by which to
included surveillance of 30 ICU rooms/quarter and feedback on measure effectiveness of interventions. Project: Four external
a quarterly basis to EVS administration. Results: After three observers were trained by Maine’s state public health department
quarterly maintenance reports to EVS administration, cleaning to use standardized definitions and reporting format developed by
performance had declined to 57-66%. In an effort to restore cleaning an advisory group based on Healthcare Infection Control Practices
performance, ICE began reporting data including the room number, Advisory Committee and Joint Commission recommendations.
the date the room was marked, the date the room was read, and the Observers visited all 36 acute care hospitals in Maine between
cleaning results for the 15 marked items to EVS supervisors on a May-Nov 2011. Observations of hand hygiene compliance were
monthly basis. This allowed follow up with individual EVS staff on performed on three units for each facility (emergency department,
their cleaning performance. Also, the number of rooms marked and medical-surgical unit, and intensive care unit) for two hours per
read per quarter was increased to 45. The next two quarters showed unit. If units had low census, observations could be conducted
an increase in performance to 74% and 71% respectively. With facility-wide. Data from this initial round were immediately shared
results being less than anticipated, and below optimum, a return with the IP. Interventions were instituted dependent on the initial
to face-to-face reporting was instituted. Lessons Learned: findings. Observations were repeated on the same units at each
PIP can be effective in achieving desired results, but maintenance facility approximately 12 weeks later. Hand hygiene compliance
requires ongoing vigilance. Although quarterly feedback to EVS was calculated as the number of instances where hand hygiene was
administration was initially thought to be adequate maintenance, observed divided by the total number of hand hygiene observations.
we found this method to be inadequate in maintaining cleaning Facilities or units with at least 30 observations in each round that had
performance. With the reporting of data to staff supervisors, cleaning either 90% or higher compliance in both rounds or had improvement
performance was not restored to previously observed levels. Face- of at least 25% from the first to the second round were asked what
to-face monthly reporting with EVS front-line employees has been interventions had been done. A list of effective and ineffective
reinstituted with hopes this collaborative approach will increase interventions was compiled. Results: External observations
cleaning performance to optimum levels. showed overall hand hygiene compliance statewide was 59% the
first round and 76% the second round, compared to an internal,
self-reported rate of 89%. Statewide, compliance was lower before
contact with the patient or patient’s environment (52% first round,
62% second round) than compliance after contact with the patient or
patient’s environment (67% first round, 87% second round). Hand
hygiene compliance in physicians (43% first round, 60% second
round) was lower than for nurses (66% first round, 79% second
round). Twelve hospitals met criteria for high compliance or great
improvement, as well as seven hospitals’ emergency departments and
seven medical-surgical units. Self-reported effective interventions
included linking compliance to employee performance evaluations,
changing product used, placing reminders near alcohol dispensers,
and acknowledging both compliance and missed opportunities
Lessons Learned: There is still much variation in hand
hygiene compliance between facilities, within facilities, and by
different health disciplines. Interventions that successfully improved
or maintained high hand hygiene rates were collected from hospital
IPs and will be used to further raise hand hygiene compliance in
Maine acute care hospitals.
Presentation Number 15-217
State Public Health Department Performs External Presentation Number 15-218
Observations of Hand Hygiene Compliance in All
Maine Acute Care Hospitals, 2011 Transforming Regulatory Guidelines to Infection
Prevention Guidance
Donna Dunton, RN, BSN, CIC - Director of Infection Prevention
and Control, Eastern Maine Medical Center; Stefanie DeVita, BSN, Debra Apenhorst, MA, RN - Infection Practitioner, Mayo
RN, MPH - CDC/CSTE Applied Epidemiology Fellow, Maine Clinic; Rebecca C. Faller, MPH - Community Health Education
Center for Disease Control and Prevention Specialist, Mayo Clinic; Jean Wentink, MPH, RN - Infection
Preventionist, Mayo Clinic in Rochester; Vicky Shultz, MSN,
Issue: Hand hygiene is the most effective prevention method RN - Infection Preventionist, Mayo Clinic; Brenda Hansen, RN

146 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Staff Training/Competency/Compliance
- Infection Preventionist, Mayo Clinic; Kimberly Aronhalt, MA, care in a manner consistent with HAI prevention. Algorithms are
RN - Infection Preventionist, Mayo Clinic; Linda Diez, RN, CIC - presented to the appropriate procedural guidelines committee for
Infection Preventionist, Mayo Clinic inclusion into applicable policies. Results: Multiple algorithms
are available on the Infection Prevention and Control web site as
Issue: Healthcare is ever evolving and to remain current and a tool to assist healthcare workers in providing patient care in a
compliant requires monitoring and strict adherence to regulatory manner consistent with HAI prevention. Algorithms are presented
standards and practice guidelines. As healthcare delivery transitions to a procedural guidelines committee for inclusion into applicable
across the continuum, practice must evolve to meet the changing policies. Lessons Learned: The algorithms have been well-
needs of the patient care experience. Patients, payers and the received by healthcare workers as a tool intended to simplify, guide
public demand safer, more cost effective care, of which infection and standardize practice. Seeking feedback from healthcare workers is
prevention is an integral component. With approximately 1.7 critical to develop effective tools. There is a continued responsibility
million healthcare associated infections (HAIs) occurring in the for Infection Preventionists to interpret regulatory standards and
United States and 99,000 resulting in a patient death each year, translate them to meet the needs of healthcare workers. Future work
federal, state and institutional objectives are focusing on HAI may include the validation of tool utilization, evaluation of their
reduction. These reduction efforts may start as regulatory mandates, impact on practice, and development of tools for additional settings
but are actualized via Infection Prevention and Control (IPAC) across the healthcare continuum.
guidance and healthcare worker execution at the bedside. IPAC
staff work alongside healthcare workers with the common goal
to prevent disease transmission. Understanding the enormity of
regulatory standards expected of healthcare workers, IPAC staff Presentation Number 15-219
review guidelines and professional agency recommendations to
Using Electronic Counter Device to Monitor Hand
create policies that guide best practices. IPAC staff understand that
policies alone cannot drive practice. To promote compliance with Hygiene Frequency at Neonate Intensive Care Unit
best practices, IPAC transform select policies into simplified tools in a Brazilian Hospital
to support healthcare worker’s complex and multifaceted practice.
Luciana Rezende Barbosa, PhD - Scientist, USP - GOJO; Adelia
Project: The intent of the project is to provide healthcare
Santos - Medical Doctor, Rumel Santos Healthcare Training and
workers tools in the form of algorithms that simplify evidence-based
Consulting; Sergio Colacioppo - Pharmacist, faculdade de Saúde
regulatory guidelines relating to infection prevention across the
Pública - USP; Maria Albertina Santiago Rego - Medical Doctor,
continuum of patient care. These algorithms are incorporated into
Faculdade de Medicina UFMG
education, institutional policies and guidelines. Complex infection
prevention guidelines and regulatory requirements are more easily Background/Objectives: Monitoring hand hygiene
incorporated into practice work flow when converted into algorithms compliance by direct observation is part of several multimodal
that facilitate critical thinking. To develop the algorithms, IPAC hand hygiene promotion programs but difficult to perform during
reviews pertinent regulatory standards, frequently asked questions healthcare workers (HCW) routine. Electronic counter devices (EC)
from staff, and opportunities for improvement found during unit are being largely used to monitor hand hygiene (HH) frequency in
consultations. Feedback on algorithms is sought from Nursing and several healthcare settings. Objective of this study was to describe
other Allied Health staff. Upon recommendations the algorithms the frequency of HH at different locations in a Neonate Intensive
are revised and implemented into education and practice. Multiple Care Unit in a Public University Hospital in Brazil. Methods:
algorithms are available on the Infection Prevention and Control 28 EC were installed inside coded dispensers filled with either
web site as tools to assist healthcare workers in providing patient alcohol based hand rub product (ABHR) or soap. Number of HH
performed was checked each 24 hours. Descriptive statistics were
developed using software Stata and SPSS for Windows. Results:
The cumulative number of usages of each dispenser from December
2008 through March 2009 was plotted on the Pareto Diagram below
where dispenser #6 (soap) was used 18,902 times and dispenser #

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 147
Poster Abstracts: Staff Training/Competency/Compliance

28 (alcohol) was used nearly 100 times. Dispenser # 6 was a soap administered to staff that were in attendance. Results are currently
dispenser located on the sink at the entrance of the unit where pending; this survey is intended to identify areas of strength as well
everyone needs to perform hand hygiene and the dispenser # 28 as areas for improvement for future presentations. Observations of
was an ABHR dispenser located at a clean area where they receive staff during the aseptic compounding process were also performed,
clean materials and then soap is more used than ABHR product. and compliance was recognized. Specific behaviors that had been
Conclusions: This study helped the infection control team identified prior to the presentations were not observed upon follow-
to identify what products (if ABHR product or soap + water) were up at one year. Lessons Learned: Combined efforts between
used more often and what dispensers’ location were more likely to pharmacy leadership and infection prevention in the education
be used by the health care team. The information gathered helped of pharmacy technicians could lead to higher compliance with
the development of training sessions and re-location of dispensers to regulatory standards. Visual demonstration of potential microbial
more popular spots. transfer during the compounding process presented technicians with
the opportunity to become aware of their role in infection prevention
and patient safety.
Presentation Number 15-220
Infection Prevention and Pharmacy Compounding Presentation Number 15-221
for Regulatory Compliance
The Small Group Role-Playing Educations
Ashley M. Clark - Pharmacist, Riley Children’s Hospital Inpatient Improved Hand Hygiene Compliance in Intensive
Pharmacy at Indiana University Health; Brittany Crumpacker, RN, Care Unit
BSN - Infection Preventionist, Riley Children’s Hospital at Indiana
University Health Yukie Mishima - Subdirector of Department Of Infection Control,
Jikei University Hospital; Ayako Saito - Department Of Infection
Issue: The compounding of intravenous products by pharmacy Control, Jikei University Hospital; Taku Tamura - Department Of
personnel is guided by a strict set of guidelines called USP797. These Infection Control, Jikei University Hospital; Toshiaki Okutsu -
guidelines are rather strenuous for pharmacy technicians, and in Department Of Infection Control, Jikei University Hospital; Yasushi
some cases, were being considered as excessive and unnecessary by Nakazawa - Director Of Department Of Infection Control, Jikei
members of the pharmacy staff. In an attempt to positively influence University Hospital; Seiji Hori - Department Of Infectious Disease
both attitudes and behaviors within the department, a demonstration And Infection Control, Jikei University School Of Medicine
with Glo Germ™ was prepared to educate on the importance of these
guidelines as they relate to infection prevention and patient safety. Background/Objectives: MRSA remains a significant
Project: The compounding processes of pharmacy technicians problem for Japanese hospitals. It is well known that hand hygiene is
were observed in an IV room which complied with USP797 a key strategy to control MRSA, but the compliance of staff remains
standards. Compounding behaviors that did not comply with low. Since our hospital confronted same situation, we thought
infection prevention practices were identified and recorded. Using that our educational method was not appropriate and effective on
Glo Germ™ within the IV room, an experiment was designed in order improving compliance. Therefore our hospital innovated small
to demonstrate the possible contamination of sterile compounds group educations contained the role-playing method reflected
when non-compliant behaviors were practiced. Glo Germ™ is a daily consecutive care. Our objective was to assess the impact these
fine, white powder which is hard to identify with the human eye, educational method to control MRSA in ICU. Methods:
but is visible under blacklight. Glo Germ™ was placed on products This study is an observational study before and after intervention
around the IV room, specifically keyboards, phones, and vials based at ICU (20 beds surgical and medical ICU), Jikei University
on practices which had been observed by compounding staff. With Hospital in Tokyo. From 2009, we provided frequent small group
normal lighting and an environment meeting USP797 standards, educations to staff working at ICU. These educations contained
one dose was prepared following USP797 guidelines while another the role-playing method, based on a scenario of usual daily care.
was prepared using the identified behaviors during observation. Furthermore the optical effect using fluorescent material applied
After completion of compounding, the lights were turned off, and them to make bacterial contamination understandable. To examine
a blacklight was placed to identify the transfer of Glo Germ™ during the educational effect, we measured the product use of alcoholic
compounding. Pictures were taken, and a PowerPoint was created and hand hygiene solution and the hand hygiene compliances studied by
presented to pharmacy staff in order to demonstrate the importance direct observation method from 2008 to 2011. We also measured
of proper compounding practices. Results: USP797 requires the annual incidence rates of new patient colonized or infected
monthly and yearly media fills that reveal no microbial growth in MRSA in ICU. Results: The annual consumption index of
order to assess compliance with aseptic compounding guidelines. alcohol hand solution increased about three times during four years
While there is no historical data for comparison coupled with an (11.52/1000paitent at 2008, 20.9 at 2009, 27.3 at 2010, 33.7 at
elevated staff turnover rate within the past year, only two individual 2011). The hand hygiene compliance measured by direct observation
samples of the monthly required media fills came back positive remained 42.5% at 2008, 34.0% at 2009, but increased after 2010
for microbial growth. This is suggestive of high compliance with (54.5% at 2010, and 50.4% at 2011). Inversely annual incidence
USP797 standards and aseptic compounding practices. As a follow- rates of new MRSA patient showed decline (3.42/1000 patient days,
up to the effectiveness of the Glo Germ™ presentation, a survey was 3.76, 1.95, 0.43). Conclusions: Our educational interventions

148 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Staff Training/Competency/Compliance
using small-group and role-playing method improved hand hygiene catheters, use of bladder scanners, and accurate documentation in
compliance and MRSA transmission was suppressed in ICU. the electronic medical record. Practice team champions provided
one-to-one education to all staff members over the course of a year
to the participating units. The education initiative included; upfront
education to all staff members, data updates per infection control to
unit manager, education of new staff, and communication on progress
to staff via unit/floor-based newsletters and department specific
intranet. Each participating unit showed at least a 50% reduction
in healthcare associated UTI rates doubling the initial goal of 25%.
Nursing staff had a better overall understanding of their impact on
the reduction and prevention of healthcare associated urinary tract
infections. The back to basics approach proved to have the greatest
impact on staff education and improved patient outcomes.

Presentation Number 15-223

Development of Index for Compliance on Hand
Hygiene Using a Nursing Need Degree and Hand
Hygiene Product Usage
Presentation Number 15-222
Yoshiko Nabetani, RN, CNIC - Subdirector, Head Nurse; Hanako
Collaboration Impacting Patient Safety: Infection Misao, RN, PHN, RNM, PhD - Professor
Control and a Unit Based Performance Improvement
Background/Objectives: There is no gold-standard
Team Reducing Healthcare Associated Urinary Tract
method for evaluation of hand hygiene (HH) practice. Most
Infections existing studies of compliance on HH have used a direct observation
Lori Coddington, MSN, RN-BC - Infection preventionist, West method. However, the direct observation method requires an
Virginia University Healthcare; Dianne L. DeAngelis, RN, ICP, immense amount of time and effort for infection prevention
CIC - Infection Preventionist, West Virginia University Healthcare; practitioners. Therefore, we developed an indirect index for
Samantha Richards, MSN, RN - Director, 8th Floor & Dialysis, West compliance on HH using the Japanese version of nursing need
Virginia University Healthcare; Freda White, MSN, RN - Nurse degree and the total amount of HH product usage. All Japanese
Manager, 8NE, West Virginia University Healthcare; Kathy Nigh, hospitals evaluate the nursing need degree of all inpatients every
RN - Infection Preventionist, West Virginia University Hopitals; day for medical service fee. Using the scores of nursing need degree,
Jackie Sanner, RN - Infection Preventionist, West Virginia University each patient was classified into one of the five levels of severity.
Hospitals Methods: Data collection was conducted at a medical and a
surgical ward of the Japanese university hospital. The procedures
Issue: Each year, more than 13,000 deaths are associated with Urinary for developing the indirect index were as follows: 1) to count
tract infections (UTIs) and account for more than 30% of health care the number of HH procedures required for opportunities of
associated infections reported by acute care hospitals. Based on these treatment and care (including chest tube dressing and bed-bath);
staggering numbers presented by Infection Control, one nursing practice 2) to select 10 patients at each severity level, and count the number
team took a hard look at its own health care associated infection rates to of opportunities of medical treatment and care extracting from
determine the best strategies to combat these occurrences. Project: electronic medical records; and 3) to observe all the opportunities of
The overarching goal of the floor based practice team was to partner medical treatment and care among 10 patients at each severity level,
with the Infection Control Department and identify ways to reduce and calculate the average of the required number of HH procedures
its hospital acquired UTIs. A collaborative review of data along with of each severity level per day (the denominator). The numerator
identification of areas of improvement and action plan development; the was the values that the total amount of the HH products divided a
team set UTI reduction goal to reduce by 25%. Results: Infection single dose. We conducted the direct observation method and the
Control and the floor based practice team completed a review of the 2010 indirect method for six months, and compared the rates of HH
health care associated infection rates. The review included two acute care compliance. Results: The total numbers of the required HH of
medical-surgical units (58 beds), observation unit (10 beds) and step- each severity level for medical patients per day were as follows: level
down unit (24beds). Team findings revealed a noted increase for the year I 4, level II 11, level III 22, level IV 38, and level V 52. The total
in UTI rates indicating an immediate need to decrease this percentage numbers required for each severity level for surgical patients were
and improve patient outcomes. Lessons Learned: Ultimately as follows: level I 4, level II 14, level III 17, level IV 36, and level V
a back to basics approach was utilized to identify areas of improvement 68. The moving average rates of compliance at medical ward by the
and to develop goals. The teams approach included; education related to indirect index were 37.5%, 23.2%, 24.4%, 31.4%, 28.6%, at surgical
specimen collection/handling, review of catheter insertion/maintenance, ward 26.2%, 29.6%, 26.0%, 32.2%, 33.2%. The moving average rates
use of securement devices, prompt removal of all indwelling foley of compliance at medical ward by a direct observation method from

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 149
Poster Abstracts: Staff Training/Competency/Compliance
May to August were 12.8%, 7.9%, 8.0%, 11.3%, 20.2%, at surgical Presentation Number 15-225
ward 28.0%, 15.2%, 13.0%, 24.4%, 26.2%. Conclusions:
As compliance on HH by a direct observation method is not It’s Everybody’s Problem: A Collaborative
representative of its practice for 24 hours, the indirect index could be Approach to Hand Hygiene
used as an alternative method for evaluating HH practice.
Safiyya Nazarali, BScN, RN - Infection Control Practitioner,
Woodstock Hospital; Natalie J. Goertz, BScN, CIC -
Manager of Infection Prevention and Control, Woodstock
Presentation Number 15-224 Hospital; Kishori Naik, BSc. - Infection Control
Development of an Introductory Disinfection/ Coordinator, Woodstcok Hospital
Sterilization Class in the Physician Office Setting Issue: In Canada more than 8000 patients die from health
care associated infections a year. Hands of health care workers
Laura L. Grant, RN - Infection Preventionist-Clinic, Aurora
are the most are the most common mode of transmission.
Health Care
The number one way to prevent infection is to perform hand
Issue: Disinfection and sterilization of instruments and equipment hygiene by using alcohol based hand rub or soap and water.
is a key component of infection prevention. In the physician office In 2009/2010 our hospital hand hygiene rates were at an
setting, staff education is not always organized or consistent and overall rate of 42% compliance. In 2010/2011, hand hygiene
policies related to this area are sometimes focused on hospital was picked as a quality indicator with a goal to increase
settings or non-existent. Staff resources for infection prevention our rate to 80% compliance. Project: Our aim was to
and education are limited. Project: A large healthcare increase compliance rates but also implement a sustainable
organization in Wisconsin which includes over 125 clinics hired an hand hygiene program. In planning our initiatives we spoke
infection preventionist in 2008 to manage the infection prevention with other hospitals with successful hand hygiene programs
program for the outpatient sites. One of the first risks identified prior to developing our plan. Results: Successful hand
in a survey of supervisors was the need for policies and education hygiene programs encourage involvement and ownership
on disinfection and sterilization practices. Site tours identified from frontline staff. Unit auditors or ‘Germinators’ were
similar risk areas such as lack of Personal Protective Equipment, implemented. Staffs from inpatient units were trained to
improper cleaning/disinfection product use, unacceptable clean/ observe and collect hand hygiene data. Binders were created
dirty utility areas, improper instrument packaging/indicators and and left on each unit with reference material and this was a
autoclave use and maintenance. A curriculum was developed and place that ‘Germinators’ could drop off completed observation
in 2009, education was initiated via a region-based six hour class. sheets for IPAC to pick up. During IPAC week a matching
The initial classes included education on the above topics, staff game was put together where staff had to match a various
hands on demonstrations and competency check-offs. These initial leaders of our hospital with their hand hygiene message. Our
classes also included instruction on endoscope practices for those goal was to engage staff and show that that hand hygiene
who were responsible for cleaning and disinfection. In 2010, the impacts all departments. In addition, using case studies that
class was revised to eliminate the endoscope section to decrease the had actual outcomes of morbidity and mortality helped staff
time of the classes and offer more sessions. The typical schedule of to understand that infections do kill and that infections can
classes was to offer at least one session in each of 4 regions across the be prevented by hand hygiene. On Global Hand Hygiene day
state in the spring and fall. Each session had a four hour section in we offered staff a chance to win 6 hours of free house cleaning
the morning and afternoon. Results: From 2010 to November if they allowed IPAC to observe them for a few minutes and
2011, over 300 RN’s, LPN’s and Medical Assistants have attended provide on the spot feedback. This was well received by staff,
the introductory class on Disinfection/Sterilization. The trained creating an environment where feedback was acceptable.
caregivers are expected to be mentors at their sites until more staff can New pamphlets were implemented encouraging patients to
attend the classes. They have identified various concerns and practices ask if their health care worker had performed hand hygiene.
which affect infection prevention such as exam room cleaning, hand Finally, our program tried to use positive deviance principals.
hygiene, aseptic technique, sterilization of specialty instruments and During audits, we highlighted staff that were “caught” with
injection safety lapses. Lessons Learned: During evaluation of excellent practice and were given a coffee/muffin voucher. In
the classes, frontline caregivers have shared these observations: • All addition, IPAC recognized one staff member per quarter as an
staff should be required to take the class as it is sometimes difficult to IPAC star. An article was written for the hospital newsletter
implement best practices with other staff. • They wanted more hands recognizing their contributions to positive outcomes for our
on training on packaging of instruments. • They could state at least program. Lessons Learned: Our rates have shown that
one action they learned and could share at their sites. The instructors staff involvement and ownership of hand hygiene rates does in
have adjusted the focus to meet these needs: • The curriculum must fact impact practice. Although our work is not done and hand
remain flexible to accommodate caregiver questions/concerns. • hygiene is a continuous battle, through our various initiatives,
Offering shorter sections allows for more staff to attend the class, by being visibly present, using positive reinforcement and
leads to supervisor satisfaction and good use of resources. • Policies education we were able to see an increase in our hand hygiene
must be developed to meet the objectives of the program. • Annual compliance, from 42% to 75%.
education is offered on various topics identified by staff to support
current skills and introduce other infection prevention best practices.

150 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Surveillance

Presentation Number 15-226 Surveillance

A Ticket To Ride: A Colloborative Approach
to Infection Control Initiatives for a Hospital
Relocation
Presentation Number 16-227

Natalie J. Goertz, BScN, CIC - Manager of Infection Prevention

Streamlined Emergency Department Post-
and Control, Woodstock Hospital; Kishori Naik, BSc. - Infection Discharge Surveillance Reduces Rehospitalizations
Control Coordinator, Woodstcok Hospital; Safiyya Nazarali, BScN,
Lisa M. Pope, RN, BSN, MSN - TJC/Infection Prevention/EHS
RN - Infection Control Practitioner, Woodstock Hospital
Coordinator, Spectrum Health Reed City Hospital
Issue: Hospital relocation is a large undertaking for all involved,
Background/Objectives: This presentation looks into the
yet there are few resources available to provide guidelines for proper
daily surveillance of positive cultures in the emergency department
Infection Prevention and Control (IPAC) initiatives and patient
setting. Previous to this program the inconsistency in which positive
safety check points. Project: Numerous multidisciplinary teams
cultures was addressed and antibiotic stewardship was seen showed
were formed 18 months prior to moving to the new hospital building.
a large number of patients being placed on the incorrect antibiotic
A systematic approach was used to ensure IPAC input was included
for their positive culture result as well as the lack of follow up by
in the planning of patients and equipment being moved. A clear plan
the hospital post discharge. it also addresses re-hospitalizations
and schedule was developed with teams to address specific cleaning
related to these unaddressed issues. Methods: The setting was in
and transfer roles. Various hospitals, which previously experienced
Reed City emergency department. The use of infection preventions
relocations, were polled, and their learnings were incorporated into
electronic surveillance program by both IP and nursing staff has
the move plan for our hospital. Infection Control orientation was
increased our compliance in addressing 100% of our post-discharged
provided for all hospital staff and additional training programs were
patients positive culture results preventing a record number of re-
provided to transport, cleaning and nursing staff. Results: A
hospitalizations. it has built a new team work mentality, improved
global orientation was created to retrain staff on IPAC practice and
patient safety, improved the health and wellness of the community
provide education to new policies and procedures pertaining to their
and the relationship with our consumers, and had a significant
new environment. Case studies of hospital acquired infections were
financial impact on the hospital. Results: The outcome for this
used to futher impact staff on the importance of adhering to IPAC
project is 100% compliance with all discharged patients and the
policies and protocols. In addition, training sessions were created
addressing of their positive cultures that have resulted in a decrease
for nurses and those transporting patients to increase awareness
in infection related re-hospitalization from 19% down to 13%
of IPAC practice on move day. Results from our polls to various
since January 2011, and a annual cost savings of $438,000 for re-
hospitals found that use personal protective equipment (PPE) was
hospitalizations that could have been avoided. Conclusions:
confusing for staff on move day. Subsequently when it was indicated
Cost savings of $438,000 for avoided rehospitalizations, 100%
for isolation patients, supplies had already been depleted. To limit
compliance with antibiotic stewardship, improved teamwork
confusion a “ticket to ride” poster was created and hung on the
between nursing and physician practices, decrease in infection related
outside of isolated patient doors identifying appropriate PPE for
re-hospitalizations from 19% down to 13%.
both the transporter and the patient. On move day, after the final
roaster was made, IPAC placed the posters on the designated doors
and remained present for support on the unit the last patient had
been moved. Two separate staging areas were created for cleaning
stretchers/wheelchairs and various equipment. Clean and dirty areas
were clearly identified so equipment was not cross contaminated.
Three “Clean Teams” were created, one to clean patient transport
equipment, the second cleaning equipment prior to it entering our
new building and the third team was assigned to clean immediately
vacated spaces. Training sessions were created and implemented one
month prior to the move day. In addition, on the day of the move,
reference tools such as posters and IPAC personnel were available
for staff. Lessons Learned: Prior to relocating a hospital,
multidisciplinary teams are essential to foresee obstacles and planning
appropriate measures to mitigate potential problems. Training
sessions played a key role to prepare staff and alleviate anxiety.
Reference tools, such as the “ticket to ride” and posters for the clean
teams, were important for staff to refer too during the move. Finally,
it was essential to have multiple Infection Control Practitioners on
site to provide support.

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 151
Poster Abstracts: Surveillance

Presentation Number 16-228 Presentation Number 16-229

Healthcare Associated Legionellosis Prevention Communication of Mrsa Status upon Transfers of
Within a Large Acute Care Center Ltcf Residents to an Acute Care Hospital

Jacqueline P. Butler, CIC - 2, CIC; 3, MLT (ASCP); Director, SH Zoran Pikula - ICP, North York General Hospital; Wil Ng, MHSc
Infection Prevention & Control, Sentara Healthcare - Epidemiologist, NYGH; David Kim - IS specialist, NYGH; Diane
White - Manager of IPAC, NYGH; Kevin Katz - Medical director of
Issue: An estimated 8,000 to 18,000 cases of legionnaire’s disease IPAC; ID specialist, NYGH; University of Toronto
occur in the United States each year, 25-45% of which are health care
associated. Hospital surveys have detected Legionella contamination Issue: Acute care facilities face challenges with MRSA positive
of the water supply in 12-70% of hospitals. Transmission to patients residents transferred from Long Term Care Facilities (LTCFs),
is felt to occur by inhalation of aerosols or ingesting contaminated particularly if their MRSA status is not known on admission. In
potable water containing Legionella and has been more closely 2004 and 2005 our admission screening data showed a high rate of
correlated with the number of sites testing positive rather than MRSA colonization among residents transferred from LTCF ‘A’
the quantitative cultures; >30% of sites with positive cultures has (35%). As a result, we implemented empiric contact precautions to
been associated with hospital acquired cases. (marking of resource prevent transmission to other patients, similar to measures in place
bibliography to be added at time of presentation). Project: for high risk direct transfers from out-of-country healthcare facilities.
In November 1995, there were two cases of healthcare associated In addition, MRSA PCR testing within 24 hours of transfer was
Legionella pneumophila infections and one probable case of atypical implemented for all LTC transfers and efforts were made to improve
Legionella infection in a 525-bed tertiary care Level I Trauma Center. communication of MRSA status during the transfer process to our
The hospital complex consisted of patient care areas constructed from facility. We describe our experience over the last 5 years. Project:
1956 to 1993. In response to these cases, and in conjunction with Admission and screening data available on LTCF resident transfers
recommendations made to the facility Epidemiologist by CDC, an from January 2006 to December 2010 were reviewed. We determined
intensive preventive program was initiated in December 1995. The the incidence of unknown MRSA cases among residents transferred to
preventive program included monthly superheating (> 70 degrees C our acute care facility from any LTCF. We defined unknown MRSA
measured at the outlet with a 10 minute flush) of the entire hospital cases as those cases not identified on the transfer forms. MRSA
water system and monthly surveillance cultures. The entire hot water positive cases whose status was communicated upon transfer were
system was inspected for “dead enders”, removal of all aerators from not considered ‘at risk’, and therefore not included in the analysis.
faucets and emptying/cleaning of water tanks. In 2000, the local LTCF residents transferred to NYGH were tested by MRSA PCR
city’s actions of switching the city water system from chlorination to and confirmed by culture. MRSA admission screening data for the
chloramination led to several years of eradication of Legionella from general patient population (April-July 2008) were also analyzed
the hospital potable water system. Results: Comparison of Water for comparison reasons. Results: Over the study period, 3049
Culture Results from Different Prevention Methods: Methods/ % residents from various LTCFs in Ontario were transferred to our
of positive cultures for Legionella species: Superheating (12/1995- hospital. The number of these transfers increased steadily from 501
9/2000) 51.1% (342/669) Superheating + monochloramination residents in 2006 to 768 residents in 2010 (53% increase) indicating
(10/2000-2010) 0% (0 /560). We conclude that municipal an increased burden for our ER and inpatient units. We identified 373
chloramination is a highly effective method of eliminating Legionella unknown MRSA cases among them (12%). We found a significant
from cultures of potable water in health care facilities. Lessons decrease in the percentage of unknown resident MRSA cases
Learned: After the change from chlorination to chloramination
from 10/2000 - December 2010, there were no positive cultures for
Legionella from the hospital potable water supply (0 of 560 cultures).
After cooling tower cultures were negative in 2001 and 2003, cultures
were discontinued. On resumption of cooling tower cultures in 2010,
4 of 8 cooling towers had cultures positive for Legionella with colony
counts ranging from 5 to 1,140 cfu identified. Despite draining and
mechanically cleaning all affected cooling towers and treatment with
stabilized bromine for 24 hours with repeat flushing and institution
of a dual alternating biocide program (oxidizing and non-oxidizing),
intermittent positive cultures were found in the cooling towers. We
conclude that municipal chloramination is a highly effective method
of eliminating Legionella from cultures of potable water in health
care facilities. However, even with the increased residual activity and
efficacy in biofilms of chloramines, Legionella can persist in cooling
towers requiring continued vigilance.

152 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Surveillance
detected upon admission to our hospital from LTCF ‘A’, from 56%
in 2006 to 24% in 2010 (p<0.001). In addition, the percentage of
unknown MRSA positive cases among the residents transferred from
all LTCFs decreased significantly from 16% in 2006 to 9% in 2010
(p<0.001). This rate, however, is still higher than overall admission
MRSA prevalence in all patients without a known history of MRSA
colonization (1.4%). Lessons Learned: LTCF transfers to
acute care facilities can lead to unwanted MRSA exposures if MRSA
status is not well communicated upon transfer. Communication of the
status of known MRSA positive residents helps to avoid undesirable
MRSA exposures. Effective communication between sectors is
required and improvement is possible.

instruments. Methods: Surgical instruments used in this study

Presentation Number 16-230
In Situ Detection of Residual Protein
Contamination on Surgical Instruments for
On-The-Spot Monitoring of Decontamination
Procedures
Helen C. Baxter - Senior Research Fellow, University of
Edinburgh; Robert L. Baxter - Professor, University of Edinburgh

Background/Objectives: Current methods for

detection of residual contamination on reprocessed surgical
instruments can no longer be considered adequate for quality
control in modern hospital decontamination units. Visual
inspection by trained operatives results in rejection of instruments
with surface protein loadings of >0.1 ug/mm2. Chemical
‘swabbing’ methods are less effective. We have developed a fast
and quantitative method for analysis of surface-bound protein on
reprocessed surgical instruments. This involves derivatization of
surface-bound protein molecules with a fluorescent reagent and
epifluorescence surface scanning (EFSCAN). This technique gives
a quantitative map of sub-nanogramme/mm2 concentrations
of proteins bound to instrument surfaces in a few minutes.
Objectives of the Study a) Determining the ‘current status’ of
residual contamination on reprocessed surgical instruments
using reprocessed instruments. b) Configuring the EFSCAN
instrumentation to give a pass/fail code for reprocessed

were cleaned by conventional procedures by Hospital Sterile Service

Departments. Labelling of residual contamination was carried out
by immersing the instrument in a (0.1%) solution of fluorescein
isothiocyanate (FITC) in carbonate buffer and rinsing with water.
EFSCAN was carried out using a custom-built scanner. Excitation
of the sample was at 468 nm and the fluorescence was detected
collinearly with the excitation. FITC-Bovine serum albumin (BSA),

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 153
Poster Abstracts: Surveillance

dried onto stainless steel discs, was used for calibration. The limit Presentation Number 16-231
of detection was <10 pg/mm2.Results: A major problem in the
area of surgical instrument reprocessing is the definition of ‘clean’. Multicenter Study of Hand Carriage of Potential
Figure 1 shows a typical SEM and elemental analysis of a reprocessed Pathogens by Neonatal ICU Providers
surgical instrument, measured during a UK survey in 2004. This
Yu-hui Ferng, MPA - Project Manager, Columbia University
instrument had passed visual inspection and chemical swab tests
School of Nursing; Sarah Clock, PhD - Project Coordinator &
but SEM examination showed it to have significant surface protein
Laboratory Supervisor, Columbia University Medical Center;
contamination (ca 100 ng/mm2). This result was fairly typical
Jennifer Wong-McLoughlin, RN - Research Nurse, Columbia
(reprocessed instruments normally have 50-120 ng/mm2 protein) but
University School of Nursing; Patricia DeLaMora, MD - Assistant
this type of analysis of an instrument takes several hours. Our recently
Attending Pediatrician; Assistant Professor of Pediatrics, Weill
developed EFSCAN technique gives fast and reliable quantitation
Cornell Medical Center; NewYork-Presbyterian; Jeffrey Perlman,
of residual protein contamination on instrument surfaces. The
MB, ChB - Professor of Pediatrics; Director of the Divison of
layout of the scanner is shown in Figure 2. Using this technology we
Newborn Medicine, Weill Cornell Medical Center; Kelly Gray,
have conducted a survey of reprocessed surgical instruments taken
RN - Neonatal Clinical Research Coordinator, Christiana Care
from Scottish hospitals over the past six months. A typical scan of
Health System; David Paul, MD - Associate Professor of Pediatrics;
a reprocessed instrument is shown in Figure 3. Sample results for
Attending Neonatologist, Christiana Care Health System; Thomas
42 instruments are shown in Figure 4 and Table 1. Gratifyingly, our
Jefferson University School of Medicine; Priya Prasad, MPH
results show much lower levels of contamination than the UK survey
- Research Associate, The Children’s Hospital of Philadelphia;
of 2004 . Conclusions: We are now developing this technique
Lauren Miller, BA - Research Assistant, The Children’s Hospital of
as a method of quality control – where instruments can be validated
Philadelphia; Julie Fierro, BA - Research Technician, The Children’s
on a pass/fail (green/red) system. This is exemplified in Table 1 for a
Hospital of Philadelphia; Theoklis Zaoutis, MD, MSCE - Associate
hypothetical pass/fail threshold of 1.5 ng/mm.
Professor of Pediatrics and Epidemiology; Associate Chief, The
Children’s Hospital of Philadelphia; Setareh Tabibi, BA - Laboratory
Technician, Columbia University; Luis Alba, BS - Data Manager,
Columbia University; Susan Whittier, PhD, ABMM - Assistant
Professor of Clinical Pathology; Associate Director, Clinical
Microbiology Service, Columbia University; NewYork-Presbyterian;
Elaine L. Larson, RN, PhD, CIC - Associate Dean for Research,
Columbia University School of Nursing; Lisa Saiman, MD, MPH
- Professor of Clinical Pediatrics and Hospital Epidemiologist
of Morgan Stanley Children’s Hospital, Columbia University
Department of Pediatrics

Background/Objectives: Hand carriage of potential

bacterial pathogens by neonatal ICU (NICU) healthcare providers
is well documented and can be associated with infant colonization/
infection and outbreaks. We compared the rates and types of hand
flora among NICU providers in four level III NICUs. Methods:
We performed 4 surveillance efforts in each NICU from April 2010
to November 2011 and obtained cultures from the dominant hand
of 50 providers in each study NICU using the glove-juice method
(Larson E, et al. Arch Pediatr Adolesc Med 2005; 159:377-83).
Eligible participants included those providers with direct patient
contact whose primary clinical responsibility was in the study
NICUs (e.g., neonatology attending physicians and fellows, nurses,
nurse practitioners, respiratory therapists). Names of participants
were not collected and participants could be cultured during more
than one surveillance effort. Cultures were processed in a central
microbiology laboratory. Results: In all, 800 hand cultures
were obtained: 78% from nurses and 94% from women. Most
participants (mean 79%, range per effort: 68-90%) reported they
had performed hand hygiene within 15 minutes of obtaining hand
cultures. The proportion of cultures with normal flora and/or other
microorganisms during the four surveillance efforts is shown (Table).
The majority of cultures (99%) grew normal skin flora (defined as
coagulase negative staphylococci [CoNS] and/or diphtheroids).
The rate of recovery of normal flora was similar between sites and
surveillance efforts. Six cultures grew methicillin-resistant S. aureus

154 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Surveillance
and one culture grew vancomycin-resistant enterococci. Among the home with all seventh grade students in one of the larger school
14 gram-negative bacilli detected, none were resistant to gentamicin, districts in the county. The questionnaire was piloted with seven
ceftriaxone or meropenem. The proportion of cultures with specific sets of parents prior to mass distribution in the school district. A
microorganisms was similar among the study NICUs during each letter explaining the current recommendations was included with
individual surveillance effort and also within individual NICUs the questionnaire that was sent home to the parents. Students were
over time. However, when results from all of the surveillance efforts asked to return the questionnaire to the school by a specific date.
were aggregated, the proportion of cultures positive for S. aureus Results: 162 students were provided with questionnaires to take
or streptococcal species differed among the NICUs (both P=.001). home to parents. The questionnaire requested some demographic
Conclusions: In this multicenter study, few NICU providers information; however, names were not requested. All students who
harbored potentially pathogenic flora (with the exception of CoNS) returned questionnaires were asked to place the questionnaire in an
and none harbored resistant gram-negative bacilli. Differences enevlope so they could remain anonymous. Students who returned
in hand flora for some microorganisms, most notably S. aureus, questionnaires could place their name in a separate envelope for a
were noted among the different NICUs. We speculate that recent chance to win a $25 gift card. 86 students returned questionnaries.
performance of hand hygiene by participants removed potentially On returned questionnaires 70% of parents reported being aware of
pathogenic flora. the current recommendations for adolescent vaccines. 30% reported
not being aware prior to the information that was sent home.
Questionnaire results showed that adolescents had received some
of the recommended vaccines even if parents reported not being
aware of the recommendations. Approximately 78% of students had
received the Tdap vaccination, 46% received the MCV4 vaccination,
24% received at least one HPV vaccination, and 20% received
the 2011/2012 influenza vaccine. Lessons Learned: Most
parents are aware of the recommendations for Tdap vaccine and
their children have been immunized. Tdap vaccination became a
requirement for 7th grade entry in 2009. The primary reason parents
reported for not having children immunized with Tdap was that the
child had received Td vaccine within the past 5 years; therefore, the
vaccine wasn’t required for 7th grade entry. Parents are less aware
Presentation Number 16-232 of the MCV4 recommendation as unawareness was reported as the
primary reason children were not immunized. Many parents reported
Survey to Determine Compliance with Center for being aware of the HPV vaccine but choose not to have their child
Disease Control Recommendation for Vaccination receive the vaccine. Approximately 30% of parents cited vaccine
of Adolescents safety concerns as the primary reason for not having their child
receive HPV vaccine followed by the recommendation of their health
Christine Kettunen, PhD, MSN, RN, CIC - Director of Nursing care provider to wait until the child is older or becomes sexually
& Epidemiology, Ashtabula County Health Department; Rebecca active as the second most reported reason. The primary reason
Robinson, RN - Public Health Nurse, Ashtabula County Health reported for adolescents not receiving flu vaccine is parental belief
Department; Katie McIntrye, RN - Public Health Nurse, Ashtabula that the vaccine is unimportant followed by vaccine safety concerns
County Health Department; Cindy Anderson, BSN, RN - School as the second most reported reason. Many parents have not been
Nurse, Geneva Area City Schools educated on all of the CDC vaccine recommendations. Most parents
Issue: The Center for Disease Control & Prevention (CDC) reported they would discuss MCV4 vaccine with their provider
& the Advisory Committee on Immunization Practices (ACIP) since receiving the information included with the questionnaire.
recommend that adolescents receive vaccination for protection Follow up with providers in the community to determine reasons
against tetanus, diphtheria, pertusis (Tdap), meningococcal for not providing information to parents on all vaccines would be
meningitis (MCV4), human papillomavirus (HPV), and influenza appropriate. Additionally it is important to determine the reason
(flu). Information released from the CDC in August 2011 some providers are recommending waiting on the HPV vaccine.
demonstrated that approximately 30 - 50 percent of adolescents Initiation of a community wide campaign for educating parents
are missing at least one of the recommended critical vaccines for on the current adolescent vaccine recommendation should be
ages 11-12. Project: The county health department in a large considered. More detailed information on the importance for
rural county developed a questionnaire to determine if parents vaccinating against HPV and flu is necessary including information
of adolescents are being provided with information from their on vaccine safety. Partnering with schools to get information home to
health care providers on the CDC recommendation for adolescent parents regarding vaccines may help improve vaccination rates among
vaccines and if so are their adolescents receiving the recommended adolescents. Maximizing Office Based Immunizations (MOBI) is a
vaccines. The vaccinations on the questionnaire included Tdap, quality improvement program provided for immunization providers.
MCV4, HPV, and flu. The questionnaire also provided a section The program is an immunization education and training program
requesting parents to circle or write in the reasons for not having developed specifically for health care providers with the focus to
their child receive one or more of the vaccination if the child hadn’t increase childhool immunization rates. Expanding the program to
received all recommended vaccinations. The questionnaire was sent include more focus on adolescent vaccines may be beneficial.

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 155
Poster Abstracts: Surveillance

Presentation Number 16-233

Nurse Jackson- A Positive Deviance Success
Story
Tricia Hutton, RN - Infection Prevention and Control
Practitioner, Member of CHICA

Issue: To eliminate Healthcare Acquired Infections (HAIs) on a

LTC unit at Trillium using Positive Deviance. Project: Positive
Deviance (PD) is based on the notion that “in every community
there are certain individuals whose uncommon practices/behaviors
enable them to find better solutions than their neighbors who have
access to the same resources”. One PD technique is ‘Improvisation’.
At Trillium a group of staff, patients and families participated in
an Improvisation called “Beat It!”. This performance emphasized
poor Infection Prevention and Control (IPAC) practices of
“Nurse Jackson”. To Michael Jackson’s song “Beat It”, Nurse
Jackson enacted the spread of MRSA to another patient, staff and
surrounding environment. The exaggerated and humorous actions
of Nurse Jackson not only amused the audience but demonstrated
the seriousness of how easily the chain of transmission can be
broken. What’s most fascinating is that Nurse Jackson is neither
a male nor female; Nurse Jackson isn’t necessarily a nurse either.
The name Nurse Jackson has evolved into a ‘code word’ and/
or concept. As a result of the post-Improvisation discussion
amongst staff, patients and families, code word “Nurse Jackson”
has been established to identify gaps in IPAC standards and/or
practices. It promotes instant corrective actions by simply saying
‘Nurse Jackson’. It conveys a no-blame approach!” Results:
Nurse Jackson” has produced numerous positive outcomes. The
following are the findings of one year surveillance (May 2010-May
2011): • zero HAI rate (significant reduction in comparison to 5
HAI the year prior) • 3 months after code word “Nurse Jackson”
was initiated 31% indicated that they HAVE been called “Nurse
Jackson”, which resulted in heightening their awareness and
immediate improvement of IPAC practices. 8 months after 6%
indicated that they HAVE been called “Nurse Jackson”, signifying
a continued increase in heightened awareness and improvement
of IPAC practices. • Cultural shift from a closed culture to open
communication & collaboration. Continuous Discovery and
Action Dialogues (DADs) occur amongst staff which has resulted
in a significant improvement in creating a ‘no-blame’ culture. 8
months after introduction, 97% of staff surveyed indicated feeling
comfortable using “Nurse Jackson” to address IPAC matters.
Increase Inter-collaboration of staff “I feel I have a stronger voice
on the unit now and am a valuable contributor to the quality of
patient care delivery” –Sereena Johnson (Hospitality Associate,
Trillium) • 8 months after implementation, 100% of staff and
students surveyed agreed that the Nurse Jackson concept has/will
help to make Infection Prevention and Control a priority • PD
initiatives expanded hospital wide • Implementation of Education
Tool: Nurse Jackson Video presentation to students, new hires
and staff for educational in-services. • Senior Management
and Physician support and direct Involvement . Lessons
Learned: “Nurse Jackson” is a household name amongst staff,
some patients, families and Physicians. Involving frontline staff is
key in success and sustainablilty. Grassroots approach is key! We
love Positive Deviance!

156 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Surveillance

Presentation Number 16-234 Utilizing an ESS to identify and generate LabID events for electronic
import will reduce the burden on infection prevention staff in
Utilizing an Electronic Surveillance System to fulfilling the reporting mandate.
Automate Identification and Electronically Submit
LabID Event Data to the National Healthcare Safety
Network Presentation Number 16-235
Jennifer R. Peeples, MPH - Sr. Clinical Consultant-Infection Using an Electronic Surveillance System to
Prevention, Premier healthcare allicance; Kathy Roman - Manager, Generate Facility Specific Antibiogram Provides
Microbiology Laboratory, University Hospitals; Lisa Beno, RN, an Accurate and Time Saving Tool for Clinical
MN, Alumnus CCRN - Director System Quality Initiatives,
Providers
University Hospitals; Pamela Parker, RN, BSN, MEd, CIC -
Director, Infection Control and Prevention, University Hospitals; Rhonda Mull, RN, BSN, MHA - Clinical Consultant-Infection
Julia Wendt, RN, BSN, CIC - Infection Control Nurse, University Prevention, Premier healthcare alliance; Sarah A. Jadin, MPH, CIC
Hospitals; Sarah A. Jadin, MPH, CIC - Sr. Clinical Consultant- - Sr. Clinical Consultant-Infection Prevention, Premier healthcare
Infection Prevention, Premier healthcare alliance alliance; Jennifer R. Peeples, Mph - Sr. Clinical Consultant-
Infection Prevention, Premier healthcare alliance; Daisy Jackson,
Issue: A large academic medical facility in the Midwest
Cic - Clinical Consultant - Infection Prevention, Premier healthcare
participated in a state sponsored grant project that required
alliance; Pat Nimtz - Senior Manager Operations, Premier healthcare
utilization of clinical document architecture (CDA) to electronically
alliance
submit methicillin-resistant Staphylococcus aureus (MRSA),
methicillin susceptible Staphylococcus aureus (MSSA), and C. difficile Issue: A facility or community specific antibiogram is a tool
Laboratory-Identified (LabID) events to the National Healthcare that is utilized to provide patients with appropriate antimicrobial
Safety Network (NHSN). Project: The facility elected to employ coverage for infections. This reduces the cost of health care and
their electronic surveillance system (ESS) to meet the electronic improves patient outcomes by earlier intervention with the
submission requirement. The ESS vendor developed functionality appropriate treatment. Manually calculating the antibiogram is a
that allowed the facility to automatically identify LabID events by very time intensive process that involves many different departments
using the admission, discharge, and transfer (ADT) and laboratory and individuals within a facility. We looked at the time spent on
data sent from the facility to the ESS. The ADT and lab data was also antibiogram generation before and after the implementation of an
used to pre-populate LabID event forms within the ESS which were electronic surveillance system. Project: In 2008, a new process
made available to clinicians for review and modification. CDA files was implemented at a greater than 400 bed facility in the New
containing the LabID event form data could then be generated for England region of the US using an electronic surveillance system with
subsequent import to the NHSN reporting application. Results: the ability to generate an antibiogram with customizable options. A
The facility was able to successfully utilize the ESS to identify LabID scheduled report was set up to generate the information 6 months
events, generate the events into a CDA file, and submit the LabID after submission of data began. The parameters of the report are
events to the NHSN via electronic import. Lessons Learned: standardized to be in line with the Clinical and Laboratory Standards
The ESS contained all the data elements required to identify LabID Institute (CLSI) guidelines. Additionally, the electronic surveillance
events and populate required fields on the event form, but there were system allows for stratification by specimen sources and locations.
some challenges in implementing this functionality. Two aspects Results: The new method of generating the antibiogram takes
of the LabID definition required development of complex logic in approximately a quarter to a third of the time a manual process takes,
the ESS to ensure each specimen was appropriately classified. The going from greater than 30 hours to less than 10 hours. Automating
first was the special case that classifies a specimen as a LabID event the process provides the ability to generate an antibiogram quarterly
if it is collected in an ED or outpatient location from a patient who instead of yearly. The electronic surveillance system allowed for
is admitted to an inpatient location on the same calendar day. The stratification by specimen sources and locations, which most manual
second aspect requiring special logic is the application of the LabID processes do not allow for. Overall, using an electronic surveillance
algorithm based on whether a facility is using the “by location” or system to generate an antibiogram provides more accurate
“facility-wide” reporting method. During development of the ESS information as it relies on electronic calculations and diminishes
functionality, it was determined that values used by the NHSN for the human error factor. Lessons Learned: The benefits of
body site and specimen type do not always align well with specimen utilizing an electronic surveillance system to generate an antibiogram
sources utilized by hospital laboratories resulting in several specimens is saving time and allowing timely intervention of the best treatment
with a body site and specimen type of “unspecified”. Utilizing an ESS options for identified infections. This leads to cost savings for the
to automatically identify LabID events, pre-populate event forms, facility in addition to improved patient care. Automating the process
and generate files for subsequent upload to the NHSN results in time provides the ability to generate an antibiogram quarterly instead
savings by eliminating the need to manually identify LabID events of yearly. A timelier antibiogram is more actionable and identifies
and enter event information into the NHSN reporting application. changes, patterns or developing trends in real-time as well as current
In January 2013, the Centers for Medicare and Medicaid Services provider utilization. An important factor in correctly interpreting the
(CMS) will require all healthcare facilities participating in the antibiogram data is understanding which drugs are being suppressed.
Inpatient Prospective Payment System (IPPS) program to report Overall, using an electronic surveillance system to generate an
LabID MRSA bacteremia and C. difficile events via the NHSN.

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 157
Poster Abstracts: Surveillance

antibiogram provides more accurate information as it relies on classes improved ESS proficiency and confidence among system IPs.
electronic calculations and diminishes the human error factor. After standardization, HAI reports were abstracted directly from
the ESS by the program manager for benchmarking. Electronic
instead of manual data submission allowed for more timely and
robust HAI reports, and system stakeholders were able to view and
Presentation Number 16-236
use the reports with greater confidence. Lessons Learned:
Apples to Apples: A Model for Standardizing The effective introduction of an ESS to a hospital, and especially a
Surveillance Throughout a Healthcare System system, can be a timely and resource-intensive endeavor far beyond
its initial implementation. The creation of both a dedicated and
after Implementation of an Electronic Surveillance
resourceful leadership team and an organized, standardized process
System for surveillance and documentation are essential to mold the ESS into
Katie Wickman, MS, RN - Infection Preventionist, Advocate Illinois a useable, reliable, efficient tool for the IP and system leader alike.
Masonic Medical Center; Linda Stein, MPH, RN, CIC - Manager
of Epidemiology & Infection Control, Advocate Lutheran General
Hospital; Sinead Forkan-Kelly, BSEH, RN, CIC - Infection Presentation Number 16-237
Preventionist, Advocate Lutheran General Children’s Hospital;
Jean Watson, MT(ASCP), MPH, CIC - Infection Preventionist, Dirty laundry? Evaluation of Clostridium difficile
Advocate South Suburban Hospital; Karen Martin, MPH, RN, CIC contamination in the laundry at a long-term care
- Director of Epidemiology & Environmental Services, Advocate facility
Christ Medical Center; Katie Rivest, BS - Patient Safety Intelligence
Analyst, Advocate Health Care; Donna Currie, MSN, RN - Director Marguerite O’Donnell, RN, BSN, CIC - Infection Control Nurse,
of Clinical Support Services, Advocate Health Care Infection Control Department, Louis Stokes Cleveland VA Medical
Center; Jennifer Cadnum, BS - Research Assistant, Research Service,
Issue: The world of infection prevention is moving rapidly into Louis Stokes Cleveland VA Medical Center; Brett M. Sitzlar, BS
the electronic surveillance system (ESS) era. Benefits of ESSs have - Research Assistant, Louis Stokes Cleveland VA Medical Center;
been documented, and the Association for Professionals in Infection Curtis J. Donskey, MD - Chair, Infection Control Committee, Louis
Control and Epidemiology, Inc. advocates for their use. However, Stokes Cleveland VA Medical Center
after the implementation of an ESS, infection preventionists
(IPs) are left with questions about how best to use the system in Issue: Cultural transformation in the long-term care setting
order to improve efficiency while maximizing utility. The issue is encourages patient autonomy in activities of daily living. Because
compounded further when attempting to use the ESS to compare residents of long-term care facilities may be colonized or infected with
hospital-associated infection (HAI) rates throughout a healthcare healthcare-associated pathogens, there is a potential for transmission
system. While many articles discuss the resources needed to initially of pathogens during activities of daily living such as washing clothes.
implement an ESS, few articles discuss the process and challenges of Our objective was to assess the frequency of contamination of patient
standardizing workflows after its implementation, especially across laundry facilities with Clostridium difficile and vancomycin-resistant
a system. The IP team at a 10-hospital system created a model for Enterococcus and evaluate the effectiveness of the washer for removal
organization and standardization of the new ESS. Project: of spores from contaminated clothing. Project: We performed
Ten of 12 system hospitals simultaneously implemented an ESS in a point-prevalence culture survey of 4 patient laundry areas in a
July 2010. Experienced IPs with strong computer skills from 3 sites long-term care facility that cares for patients receiving post-acute care
were selected as ESS coordinators for the system. The coordinators for rehabilitation or chronic care. The C. difficile infection (CDI)
met regularly with a system administrator and the ESS program incidence in the facility was 4 per 10,000 bed days of care. Clothing
manager to troubleshoot issues and create system-wide standard of patients with CDI was cultured before and after washing and again
processes and documentation expectations for the ESS. Workflows after drying. Before and after washing clothes from a CDI patient, the
based on National Healthcare Safety Network (NHSN) definitions inside and outside of the washer and dryer and the countertops were
were developed for documentation of select HAIs and important cultured for C. difficile. Results: Of 19 sites cultured in the laundry
pathogens, and system-wide reports were developed based on area during the point-prevalence study, 1 (5%) was contaminated
those workflows. After workflows were created, the coordinators with C. difficile and 1 (5%) was contaminated with VRE. For 2 CDI
held classes for all system IPs that included ESS navigation, patients, 4 of 7 (57%) articles of clothing were contaminated with
documentation requirements, and case studies for each workflow. C. difficile before washing versus 0 of 7 after washing. Nine sites
The case studies tested both knowledge of the NHSN definitions inside and outside the washer and dryer were negative after washing
and documentation expectations in the ESS. Each hospital was the clothing of CDI patients. Lessons Learned: C. difficile
also assigned one coordinator through which to direct additional contamination was common on the clothing of residents with CDI.
questions, concerns, or enhancement requests related to the ESS. However, contamination of the laundry area was relatively uncommon
Results: The ESS coordinator role provided a channel for IPs to and our data suggest that routine washing of contaminated clothing
ask questions and provide feedback to a knowledgeable leader in an may be effective in reducing levels of contamination. Further studies
organized fashion, allowing for timely responses and issue trending. are needed to evaluate the potential for transmission of C. difficile by
The team approach offered a centralized setting for communication contaminated clothing.
and troubleshooting with the ESS company. The standardization

158 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Surveillance

Presentation Number 16-238 bacteremia elsewhere, when there are no confirmatory cultures. A
modified algorithm avoiding that subjectivity and at the same time
Use of an Electronic Surveillance System to Further conserving resources had been deployed in a 660 bed metropolitan
Refine MDRO Isolation Categorization acute care hospital. The resource intensive and process of intensive
chart review was initiated in 2009 in the adult and pediatric critical
Linda Nelson, RN - Infection Preventionist, Western Maryland care units and extended house-wide in 2010, when the latter rate
Health System; Brenda Gross, BSN, CIC - Infection Prevention denominator changed from patient days of experience to central line
and Control Coordinator, Western Maryland Health System; Jamie catheter (CL) days. CLABSI rates classifying only culture confirmed
Karstetter, RN - Director Clinical Services, Western Maryland infections at an alternative site as secondary BSI were compared with
Health System; Daisy Jackson, CIC - Clinical Consultant - Infection those that met additional clinical criteria of an infection and whether
Prevention, Premier healthcare alliance; Jennifer R. Peeples, MPH
- Sr. Clinical Consultant-Infection Prevention, Premier healthcare
allicance; Sarah A. Jadin, MPH, CIC - Sr. Clinical Consultant-
Infection Prevention, Premier healthcare alliance

Issue: Based on review by the Pharmacy and Therapeutics

Committee and Infectious Disease, the laboratory standards for
defining gram negative multidrug resistant organisms (MDRO)
were revised at a large regional acute care health system serving a
three state area. Hospital policy requires all patients with a history
of gram negative MDRO to be placed into isolation precautions.
Project: All patients with a gram negative MDRO lab result are
routinely flagged in the hospital’s electronic surveillance system (ESS)
using a function called “tagging”. A readmission alert for patients
with this particular tag is used to identify them on return visits in
order to assure that isolation precautions are being followed. This has
been the practice for 2 years. After the laboratory standards for gram
negative MDRO were revised, the readmission alert was used as a way
to trigger a review of the patient’s gram negative MDRO history by
the Infection Prevention Department. Patients not meeting the new
definition for gram negative MDRO had their tag removed and were
not placed in isolation. Results: As of December 31, 2011,151
patients had their tags removed from the ESS, eliminating the need
for isolation based on history. This represented a cost savings for the
hospital by preventing unnecessary isolation precautions and lead
to improved staff efficiencies. Lessons Learned: An ESS was
useful for managing patients with a history of MDRO in the face of
changing laboratory standards thereby preventing an unnecessary
isolation status. Without the ESS, it would have been difficult to
quickly identify and easily review the patients’ laboratory history.

Presentation Number 16-239

Examining Processes for Identifying Central Line
Associated Bloodstream Infections and Variation in
a Large Acute Care Facility
Michele A. Carra, BS, MT ASCP, CIC - Infection Prevention
Database Coordinator, Mercy Medical Center; Jan M. Tippett,
MSc., CIC, MT ASCP (M) - Director of Infection Prevention,
Mercy Medical Center; Daniel H. Gervich, MD, FSHEA - Medical
Director of Infection Prevention and Healthcare Epidemiology,
Mercy Medical Center

Background/Objectives: It is well established that

variation in Central Line Bloodstream Infection (CLABSI) rates
may occur when applying NHSN criteria, which include the
subjective component of attempting to assign a primary source of the

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 159
Poster Abstracts: Surveillance
the modified algorithm method was a viable surveillance option. Issue: Coccidioidomycosis (commonly known as Valley Fever or
Methods: Positive blood cultures are received via electronic Cocci) is a fungal disease that lives in the soil in endemic areas such as
surveillance and determined to be present on admission (POA), California, Arizona, New Mexico, Nevada and parts of Northwestern
contaminant or a hospital-acquired bloodstream infection (HA-BSI). Mexico. Persons become infected by inhaling the airborne spores
Patients designated as HA-BSI are then reviewed for the presence of especially when soil has been disrupted (such as during construction,
central lines and whether the infection is primary or secondary to an agriculture, archeological exploration, after earthquakes, fires or dust
infection at another site. Cases with matching positive cultures from storms). Cocci is not spread person to person, it is not contagious. It
an alternative site were eliminated and cases which were either culture can infect animals as well as humans. Each year in San Luis Obispo,
negative or not collected were reviewed for clinical indications of California many cases of Cocci are identified. The following is an
infection at another site. Results: The CLABSI sample sizes overview of the disease and the findings and data collection obtained
for this 2 year study for 2010 and 2011 were 63 and 53 infections from years of Coccidioidomycosis surveillance. Project: San Luis
respectively (Chart 1). When in-depth chart reviews were performed Obispo is a relatively small county located between Los Angeles
to determine secondary infections, these numbers were reduced to 42 and San Francisco. The population of San Luis Obispo County is
and 25 (33% and 53%) respectively for years 2010 and 2011. Rates approximately 269,637. It is divided into the south and north county,
were reduced from 1.78 to 1.18/1000 CL days in 2010 and from with the south county being more coastal in nature and north county
1.28 to 0.76/1000 CL days in 2011. There were 17 BSI during the 2 more arid. Both areas support agriculture, cattle ranching and are
year study on our Oncology floor that would have been designated most popular for their vineyards. Most Cocci cases occur in the
CLABSI using the truncated algorithm inflating the 2 year rate from north county or derive from the prison population. San Luis Obispo
1.17 to 2.70/1000 CL days (Charts 2 & 3). Conclusions: County houses the California Men’s Colony prison. The hospital that
Comparing outcome measures at these two points in the process for serves the north county is Twin Cities Community Hospital (a Tenet
CLABSI determination showed significant variation. The truncated Hospital) located in Templeton. This hospital opened a dedicated
algorithm was more objective and efficient. However, the loss in 14-bed lockdown Medical Guard Unit in 2010 which serves the
specificity greatly inflated the CLABSI rate in some service lines as prison population throughout the Central Valley endemic with
illustrated with our Oncology and Critical Care data. Completing “Valley Fever”. Results: Residents of San Luis Obispo with signs
the process through the clinical review stage limits comparisons and symptoms are frequently tested for Cocci. Inmates presenting to
because of variation in reviewer’s skills and subjectivity. With the the Medical Guard Unit at Twin Cities Hospital with pneumonia
requirement for public reporting this study further illustrates some like symptoms are worked-up for Cocci and ruled-out for tuberculosis
of the difficulties associated with inter-institution comparison, as as a differential diagnosis. The Twin Cities Infection Preventionist
outlined in the recent commentary by Weinstein et al ( J Am Med works closely with the local Public Health Department to ensure all
Inform Assoc. 2010 Jan-Feb; 17(1):42-8); Fraser et al CID 2011:52 cases are tracked and reported. Testing can be confirmed by serum
(12). et al ( J Am Med Inform Assoc. 2010 Jan-Feb; 17(1):42-8). blood testing. A Cocci titer will test for antibody (past infection) and
precipitin (acute infection). Cocci fungus can also be grown from
infected cultures. Lessons Learned: Increased awareness is
needed about the prevalence of Coccidioidomycosis among clinicians
and providers. This is especially important when patients have visited
endemic areas and contracted illness. Limited intervention and
prevention is available to decrease this disease until a a viable vaccine
can be formulated and licensed for use. Cocci is currently treated with
antifungal drugs such as fluconazole. At the San Luis Obispo Public
Health Department Laboratory new PCR testing is being researched
and validated for future use.

Presentation Number 16-241

Implementing an Active Surveillance Program
with Multi-Site Swabbing for Methicillin-Resistant
Staphylococcus aureus in a Community Hospital
Angela D. Dickson, RN, CIC - Infection Preventionist,
Presentation Number 16-240 PeaceHealth, St John Medical Center
The Incidence of Coccidioidomycosis In San Luis Issue: In many hospitals, nares only swabbing is the standard
Obispo, California for active surveillance culturing (ASC) for Methicillin-Resistant
Staphylococcus aureus (MRSA). The main goal of MRSA ASC is to
Jeannette L. Tosh, RN, CIC - Infection Preventionist, Twin Cities
identify patients who are silently colonized and place them in contact
Community Hospital / Tenet Corporation; Ann E. McDowell,
precautions thus reducing silent transmission to other patients. While
MPH - Epidemiologist, San Luis Obispo Public Health Department
nares is noted to be the most common site of colonization, multiple

160 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Surveillance
anatomic sites must be sampled to achieve sensitivity greater than (NHSN). NHSN users reporting SSI data must adhere to the
90% for MRSA detection and groin samples yield positive results NHSN definitions for reporting SSI data. In order to be considered
more consistently with community acquired MRSA (Lautenback, an NHSN operative procedure the incision must be closed. When
E., Nachamkin, I., Hu, B., Fishman, N., Tolomeo, P., Prasad, P., the skin incision edges do not meet because of wires or devices or
Bilker, W., & Zaoutis, T., 2009). Should a MRSA ASC program other objects extruding through the incision, or when “loosely closed”
include additional testing sites to identify silent colonizers thus the incision is not considered primarily closed and therefore is not
ensuring proper identification and timely implementation of contact considered an operation. For many institutions the only method
precautions? Project: In response to our annual risk assessment of accurately determining the skin closure status is to read the
and mandatory state requirements, a MRSA ASC program was operative report of every HYST and COLO case before reporting
developed and implemented within a community hospital. A denominator data into NHSN; meaning many extra hours of work
multidisciplinary team approach was used. Based on various literature for Infection Prevention (IP) staff. Project: In a large medical
sources and local data indicating endemic rates of community school associated hospital the operative reports of 1,353 inpatient
acquired MRSA, a multi-site swabbing approach was desired to HYST and COLO procedures, performed during 2010-2011, were
ensure high sensitivity of identification of patients who were silently read to determine skin closure status. Results: Of the 441 COLO
colonized with MRSA. The targeted populations were Intensive procedures 52 (12%) did not meet the definition of an NHSN
Care Unit (ICU) admissions, total joint arthroplasties (TJA), and operative procedure because the incision was not closed. Of the 912
fractured hips. The anatomic sites chosen for swabbing included HYST procedures only 1 case did not meet the definition of an
nares, throat, groin, and any wounds or percutaneous drains. Samples operative procedure (table 1.) Lessons Learned: Determining
were plated separately on CHROMagar selective plates for MRSA the skin closure status for COLO and HYST cases is labor intensive
rather than pooled together so site prevalence could be evaluated. for institutions that are performing a high number of operations. For
Turnaround time was 18-24 hours. Patients with a documented HYST cases in our institution 99.9 percent of cases had complete
history of MRSA were not swabbed but rather placed directly into skin closure over a 2 year period. Therefore it may not be necessary
contact precautions. All other patients were swabbed and contact to read all operative reports for the HYST category. Conversely 12
precautions were initiated once positive test results received unless percent of COLO operative incisions were not closed over a 2 year
evidence of infection triggered empiric isolation. Results: Data period. Therefore, for our institution, COLO operative reports must
for each population was collected on an excel spreadsheet from be reviewed to determine cases that should be excluded because the
January 1, 2010 through December 31, 2011. Compliance with skin edges do not meet. The number of denominator cases excluded
ASC was high: 98% for ICU, 98% for TJA, and 91% for fractured for the COLO category would affect the SSI rate generated by
hips. Overall MRSA prevalence for these three populations was NHSN which is reported to CMS. A computer generated report of
14% (390/2706). MRSA prevalence varied among the populations skin closure status would be the ideal solution in order to avoid the
studied likely due to the chronically ill nature of ICU and fractured labor intensive work of reading every operative report. The objective
hips versus TJA (graph 1). Overall sites positive for MRSA other for every institution should be to enter accurate denominator SSI
than nares was 31% (50/163) indicating three out of ten patients data to NHSN as efficiently as possible. Our institution is now
would be missed if nares site only was swabbed (graph 2). It was also working with the operating room staff and our medical informatics
noted that 53% of patients who tested positive were also positive at department in order to generate such a report.
one or more sites. Lessons Learned: If we did not do multi-
site swabbing for MRSA we would miss 30% of our silent colonizers.
A multidisciplinary team approach was the key to implementation
success. Multi-site swabbing should be the standard in ASC programs
to ensure identification of all patients colonized with MRSA.

Presentation Number 16-242

Is it Necessary to Determine Skin Closure Status
for all Operative Procedures Prior to Entering SSI
Denominator Data into NHSN?
Catherine Statz, RN, BSN, PHN, MPH - Nurse Manager - Surgiclal
Wound Infection Surveillance, University of Minneaota; James
Glover, BS - Administrative Specialist, University of Minnestoa

Issue: The Center for Medicare and Medicaid Services (CMS)

Presentation Number 16-243
requires reporting surgical site Infection (SSI) data for inpatient
abdominal hysterectomy (HYST) and colon (COLO) procedures Control of MRSA Colonization in a Teritiary NICU
beginning with surgical procedures performed on January 1,
2012. Hospitals are to report via the Centers for Disease Control Sarah A. Smathers, MPH, CIC - Infection Preventionist, Children’s
and Prevention’s (CDC’s) National Healthcare Safety Network Hospital of Philadelphia; Cindy L. Hoegg, RN, CIC - Infection

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 161
Poster Abstracts: Surveillance
Preventionist, Children’s Hospital of Philadelphia; Eileen Sherman, Presentation Number 16-244
MS, CIC - Manager, Infection Prevention and Control, Children’s
Hospital of Philadelphia; Lori Brittingham, RN, BSN - Registered The Impact of Using Chlorhexadine Gluconate
Nurse, Children’s Hospital of Philadelphia; Jacquelyn R. Evans, Products in the Adult Critical Care Setting
MD, FRCP, FAAP - Medical Director, Newborn/Infant Intensive
Care Unit, Children’s Hospital of Philadelphia, University of Audrey Adams, RN, MPH, CIC - Director of Infection Prevention
Pennsylvania; Susan Coffin, MD, MPH - Hospital Epidemiologist and Control, Montefiore Medical Center
and Medical Director of Infection Prevention and Control,
Children’s Hospital of Philadelphia, University of Pennsylvania Sheron Wilson, RN, MPH, CIC - Infection Prevention Nurse,
Montefiore Medical Center
Issue: Methicillin-resistant Staphylococcus aureus (MRSA)
colonization in neonates increases the risk of hospital-acquired Issue: Prevention of device-associated infections in the critical
infections. To identify transmission of MRSA in this high risk care setting has been a focus of regulatory agencies and the Centers
population routine surveillance screens are performed. Project: for Disease Control and Prevention. To address this, evidence
During routine point prevalence screen in a 76 bed tertiary newborn/ based practice in the form of “bundles” to prevent device associated
infant intensive care unit (NICU) 6 patients were identified as infections were implemented during the past six years in all critical
newly colonized with MRSA. All patients were from the same care units of our 3 division, 1,491 bed teaching hospital. These
subunit of 12 beds and were cared for by the same nursing team. bundles have contributed to lower infection rates. To further decrease
All MRSA positive patients were placed on contact isolation and infection rates in the critical care setting, a pilot study to measure
nursing assignments were cohorted. Weekly screening was initiated the impact of using Chlorhexadine Gluconate (CHG) impregnated
to identify ongoing MRSA transmission. The first weekly screen bath cloths and the use of CHG for oral care of ventilator patients
found one additional MRSA colonized baby. The NICU subunit was was implemented in one of six adult ICUs. Project: The concept
then closed to new admissions and all 7 MRSA isolates were sent for of replacing the traditional wash basins and cloths with disposable
pulse-field gel electrophoresis (PFGE). Hand hygiene observations cleaning wipes and CHG impregnated bath cloths was presented
were increased and adherence to personal protective equipment to the nursing staff. Training was given to staff on all shifts, and a
was monitored. Staff was interviewed to determine opportunities resource binder containing written guidelines and protocols was
for improvement in infection prevention protocols. Results: provided. In addition, CHG was added to the oral care regimen of
No additional episodes of MRSA transmission were found during ventilator patients, and the computerized order entry VAP bundle
weekly screens which continued until all positive patients had was updated to include CHG oral care every 12 hours. To measure
been discharged (6 weeks). None of the newly identified MRSA the impact of these interventions, the routine six month infection
colonized patients developed infections. The unit was re-opened to surveillance period, was extended by 3 months. The intervention
admissions after 2 weeks of negative screens. PFGE results suggested study period was October 2010 through March 2011. Results:
a common source of transmission as 5 of 7 strains were identical When compared to a non-intervention surveillance period in 2009
and 2 were related. Although this source was never definitively ( July – December), the overall infection rate during the intervention
identified it is thought that a baby, with a MRSA positive twin, study period decreased from 20 per 1,000 patient days to 7.5 per
went unscreened and therefore was in the NICU for several months 1,000 patient days, a statistically significant reduction of 63%
unisolated. Independent observations highlighted several breaches in (P=.0002). There was also a significant decrease in the catheter-
hospital policies, leading to inadequate cleaning of the environment associated urinary tract infection (CAUTI) rate and ventilator-
and lack of adherence to basic infection prevention principles. associated pneumonia (VAP) rate, with reductions of 70% and
Recommendations were to 1) reduce clutter of extra patient 63%, respectively. The central line-associated blood stream infection
equipment and staff personal items so that environmental services (CLABSI) rate and the “other” infection rate decreased by 67% and
could perform a deep cleaning of all common areas and patient rooms 42%, respectively. These reductions were not statistically significant.
2) reinforce appropriate cleaning of common patient equipment Due to positive patient outcomes, a decision was made to implement
after each use 3) ensure that single patient use items were not being the use of CHG impregnated bath cloths in the remaining 5 adult
cleaned and reused on different patients 4) reinforce hospital policy critical care units. CHG oral care had been previously implemented
with families to visit one another in the common areas such as the in the units. Lessons Learned: Our findings demonstrated
family lounge instead of patient bedsides 5) change the admission statistically significant overall lower infection rates when reusable
MRSA screening policy from infants 30 days or older to all infants bathing cloths and basins were replaced with disposable CHG
at admission or if in-born on day of life 7, and increase the frequency impregnated bath cloths. Statistically significant lower VAP rates
of point prevalence surveys from every 6 months to every 2 months. were identified with the addition of CHG to the oral care protocol.
Ongoing monitoring of the NICU subunit for six months has shown Intervention strategies contributed to lower infection rates in all
no additional episodes of transmission. Lessons Learned: major sites monitored. Use of a standardized process measuring tool
Unidentified MRSA colonization, along with environmental is necessary to monitor and sustain compliance with the intervention
contamination as a result of crowding and clutter were implicated in strategies. Ongoing efforts to implement new infection prevention
the spread of MRSA in a NICU. Initiating strict cohorting, isolation, strategies may improve patient outcomes in the critical care setting.
environmental cleaning and increased surveillance resulted in
immediate disruption of transmission.

162 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Poster Abstracts: Surveillance

Presentation Number 16-245 required intensive care, had clinical sepsis (57%), typhlitis (50%), and
bacteremia (33%). Conclusions: The most frequent infectious
Epidemiology of Infections in a Pediatric Oncology event in hospitalized children was phlebitis, a marker of nursing care,
Service in Guatemala and febrile neutropenia of unknown focus. Neutropenia secondary
to chemotherapy places children at high risk for infections; best
Mario Melgar, MD - Infectious Diseases Physician, Unidad Nacional practices during healthcare delivery are imperative to lower infectious
de Oncología Pediátrica, Guatemala City, Guatemala; Nancy Gatica morbi-mortality.
- Infectious Diseases Fellow, Hospital Roosevelt, Guatemala City,
Guatemala; Marylin Ramirez - Preventionist, Unidad Nacional
de Oncología Pediátrica, Guatemala City, Guatemala; Federico
Antillon-Klussmann, MD - Director of Medicine, Unidad Nacional
Presentation Number 16-246
de Oncología Pediátrica, Guatemala City, Guatemala; Don Guimera, Comparison of LAB ID and Traditional Surveillance
BSN, RN, CIC, CCRP - International Epidemiology Coordinator,
for C difficile, are Proxy Measures Effective
St. Jude Childrens Research Hospital; Kyle M. Johnson, PhD,
CCRP - Clinical Research Associate II, St. Jude Children’s Research Tools for Identifying Performance Improvement
Hospital; Miguela Caniza, MD - Director of Infectious Diseases- Opportunities?
International Outreach Division, St. Jude Children’s Research
Linda R.. Greene, RN, MPS, CIC - Director of Infection
Hospital
Prevention, Rochester General Hospital
Background/Objectives: Infection is an important
Background/Objectives: The use of proxy measures such
cause of morbidity and mortality in cancer. We aim to describe
as the c difficile Lab ID event has been used to identify c difficile
the infection epidemiology and risk factors in children with
incidence and prevalence rates, and has been proposed as an efficient
cancer in our unit. Methods: The Pediatric Oncology Service
tool to perform surveillance and to guide infection prevention
(POS), 42 beds, is a semi-autonomous unit, and cares for 300
efforts. Increased attention on HAIs as a safety and quality issue has
new patients yearly--about 50% of expected pediatric cancer in
led to public health reporting requirements and a focus on quality
Guatemala. The unit has 104 nurses and 35 physicians including
improvement activities. Traditional surveillance to detect C difficle
members of the infection prevention and control (IPC) program
disease is labor intensive. The use of proxy measures can be useful to
(an infectologist and 2 nurses). During the study period (December
identify issues and provide actionable information. Methods: We
2009 to November 2010), 1944 children were admitted to the
compared 24 months of Healthcare Facility Wide data using both
service, baseline illnesses were 1187 (61%) acute lymphoblastic
the Cdifficile surveillance defintion and the Lab ID event module as
leukemia (ALL), 113 (6%) acute myeloid leukemia (AML), 189
per National Healthcare Safety Network (NHSN) criteria. Incidence
(10%) lymphomas, and 455 (23%) other malignancies. We followed
rates were calculated and compared based upon the 2 methodologies.
standard infection definitions, entered all data in EpiInfo™ and
Results: During the 2 year period there were 364,478 patient
used frequencies and percentages to report results. This study was
days. 352 healthcare facility onset cases were identified (rate 9.6
approved by the local research ethics committee. Results: We
/10,000 patient days) and 467 combined healthcare facility onset /
recorded 540 infectious events in 263 children (global infection
community onset, healthcare facility associated cases (rate 12.8 per
rate 28%), being 265 (49%) healthcare associated infections (HAI)
10,000 patient days). 379 infections were detected by traditional c
and 275 (51%) community acquired infections (CAI). Mean age
difficile surveillance (rate 10.3 per 10,000 patient days). There was
was 8 years and 60 % were male. The underlying diseases of infected
not a statistically significant difference in incidence rates between
children were as follows: 404 leukemia (352 ALL, 45 AML, 7 other),
cases identified by traditional means and the health care facility onset
26 lymphoma, 55 solid tumors, and 55 another type of malignancy.
lab ID event . Conclusions: Although the lab ID event has
The most common infectious events in CAI were fever of unknown
limitations and underestimates the C difficile healthcare associated
origin and neutropenia (FUO-N) (133, 48%), pneumonia (41, 15%)
infection rate, our experience suggests that use of the combined
and acute diarrhea (16, 9%); and the most common HAI where
incidence rate compares favorably with traditional surveillance
phlebitis (169, 64%), pneumonia (24, 9%) and FUO-N (19, 7%).
methodologies and may be a reasonable, less labor intensive
During the study period 49 pathogens were isolated and the most
surveillance method. Combining this data with optional fields for
common one in HAI were Enterobacteriaceae (9, 34%), followed
attribution and complications in NHSN provides a reasonable means
by Staphylococcus aureus (4, 15%), and Candida (2, 8%). The most
of identifying issues and performance improvement opportunities.
common pathogens in CAI were S. aureus (5, 23%), enterobacteria
(4, 18%), Pseudomonas and Candida 1, 5% each). Five (45%) of all
S. aureus were methicillin-resistant. There were 29 deaths in patients
with infections; most of them in leukemia (26, 89.6%). These
infections were pneumonia (7), bacteremia (5), and clinical sepsis
(5), other infection (12). Seven patientsdied while in palliative care.
About half of the patients were neutropenic (52%) and in induction/
consolidation treatment phase (50%); almost half of all patients that
had pneumonia or were bacteremic had a central venous catheter
placed 7 days before the infection; 30% of all infected patients had
chemotherapy in the previous 7 days. Fifty-four children (10%)

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 163
164 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Oral Abstracts: Antimicrobial Resistance

Oral Abstracts topical antibiotic use at either facility. Among those who reported
using topical antibiotics, 59% and 40% of inmates at the men’s and
women’s prisons, respectively, used them inappropriately for dry skin,
lip balm, hair grease, and shaving. Conclusions: This is the
Antimicrobial Resistance first study to describe the widespread and inappropriate use of topical
antimicrobial agents in correctional facilities. Inmates entering both
the men’s and women’s facilities reported using topical antibiotics for
Presentation Number 100 reasons inconsistent with the recommended uses of those products.
Because the overuse of antibiotics promotes antimicrobial resistance,
Overuse of Topical Antibiotics among Inmates an intervention to reduce the inappropriate use of topical antibiotics
Entering Maximum-Security Correctional Facilities in correctional facilities would be warranted.
in New York State

Carolyn Herzig, MS - PhD Candidate, Department of Epidemiology, Presentation Number 101

Columbia University; Oliver Jovanovic, PhD - Instructor,
Department of Microbiology and Immunology; Dhritiman
Mukherjee, PhD - Project Coordinator, Department of Medicine, Infections due to Enterobacter Species:
Division of Infectious Diseases; Caroline Lee, AB - Senior Epidemiology and Outcomes as a Function of
Technician, Department of Medicine, Division of Infectious Diseases; Ceftazidime Resistance
Zoltán Apa, BS - Research Coordinator, Columbia University School
of Nursing; Dana Gage, MD - Clinical Physician II, Bedford Hills Odaliz E. Abreu Lanfranco - ID Fellow, Wayne State University;
Correctional Facility; Franklin Lowy, MD - Professor of Medicine Mohan B. Palla, MBBS - Research Assistant, Wayne State University,
and Pathology, Department of Medicine, Division of Infectious Detroit Medical Center; Satyam Patel - Research Assistant, Detroit
Diseases; Elaine L. Larson, RN, PhD, CIC - Associate Dean for Medical Center; Dipenkumar Patel, MBBS - Research Assistant,
Research, Columbia University School of Nursing Detroit Medical Center; Shahrukh Khan - Research Assistant,
Detroit Medical Center; Victoria Yee - Medical Student, Wayne State
Background/Objectives: The overuse and inappropriate University; Dror Marchaim, MD - Post Doctoral Fellow Infection
use of antimicrobial agents has been shown to promote antimicrobial Control and Epidemiology, Detroit Medical Center/Wayne State
resistance. Incarceration is a risk factor for infection with some University; Keith Kaye, MD, MPH - Corporate Director of Infection
antimicrobial pathogens, such as methicillin-resistant Staphylococcus Prevention, Hospital Epidemiology and Antimicrobial Stewardship,
aureus (MRSA). Therefore, it is of interest to determine if Detroit Medical Center/Wayne State University
inappropriate antibiotic use might contribute to this increased risk in
incarcerated populations. The objective of this study was to describe Background/Objectives: Enterobacter species is the 4th
the self-reported use of oral and topical antibiotics by inmates upon most common Gram-negative pathogen associated with bacteremia
entry to two maximum-security prisons in New York State and in hospitalized patients. Exposure to antimicrobials can select for
the association between self-reported antibiotic use and S. aureus strains that produce high levels of AmpC β-lactamase, associated
colonization. Methods: Over a period of two years, inmates were with resistance to broad-spectrum β-lactam antimicrobials, including
recruited upon entry to one male and one female maximum-security ceftazidime and greatly limits treatment options. The aim of this
prison in New York State. Three trained research assistants conducted study was to identify risk factors for ceftazidime-resistant strains
interviews via a structured questionnaire to collect demographic and of Enterobacter spp compared to ceftazidime-susceptible strains.
medical history information, including the use of antibiotics in the Methods: A retrospective chart review was conducted including
previous six months. Anterior nares and oropharyngeal samples were patients cared for at the Detroit Medical Center hospitals and
collected at the time of interview and microbiological evaluation Karmanos Cancer Institute between January, 2006 and December,
was performed at the clinical laboratory. Bivariate and multivariable 2010. Study patients were >18 years of age and had bacteremia due to
regression analyses were used to evaluate the association between an Enterobacter species. Multiple parameters, such as co-morbidities,
antibiotic usage and S. aureus colonization. Results: The final risk factors, recent health exposures, and recent antibiotic use were
sample size was 822 inmates (421 men and 401 women). Based on a extracted from patient charts. Ceftazidime resistance was defined an
positive anterior nares and/or oropharyngeal culture, the prevalence Minimal Inhibitory Concentration (MIC) ≥ 16 ug/ml. Isolates were
of S. aureus was 59% and 50% at the men’s and women’s prisons, considered to be susceptible if the MIC to ceftazidime was < 16 ug/
respectively. Among colonized inmates, the prevalence of MRSA was ml. Results: A total of 334 patients met inclusion criteria, 78.1%
10% and 21%, at the men’s and women’s prisons, respectively. Based E. cloace, 18.9% E. aerogenes, and 3% other types of Enterobacter
on self-report, 16% and 38% of inmates at the men’s and women’s spp. Average age was 56.2 ± 18.1 years, 65% were African American
prisons, respectively, reported having used oral antibiotics in the and 45.3% were female, 61.8 % of isolates were recovered after 48
previous six months. Twenty three percent and 28% of inmates at hours of hospitalization; 46.8% had hospitalization in the 90 days
the men’s and women’s prisons, respectively, reported having used prior to bacteremia, and 15.5% died during the study hospitalization.
topical antibiotics in the previous six months. Male, but not female, Seventy-one patients had ceftazidime-resistant Enterobacter and
inmates who were colonized with S. aureus were significantly less likely 263 had ceftazidime-susceptible strains. Ceftazidime-resistant
to have reported using oral antibiotics in the previous six months Enterobacter spp., compared to ceftazidime-susceptible, were more
(p-value=0.05). S. aureus colonization was not associated with likely to be exposed to antibiotics 90 days prior to culture (68.1%

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 165
Oral Abstracts: Antisepsis/Disinfection/Sterilization
and 39.3%; OR 1.73 95% CI: 1.39-2.15), needed assistance with ≥ touch free wall-mounted dispenser. A total of 10 hand contamination
3 activities of daily living (ADLs) on admission (58.3% and 32.1%; and product application cycles were executed and log10 reductions
OR 2.94 95% CI: 1.32-5.08), coming from a nursing home (27.8% from baseline were produced by each product after the first and
and 15.3%; OR 2.17 95% CI: 1.16- 4.35), had a chronic wound on tenth applications were calculated. To measure ABHR test products
admission (22.2% and 9.5%; OR 2.71 95% CI 1.35-5.26), be managed rub-in dry time, a single product actuation was dispensed onto the
in the ICU prior to bacteremia (63.9% and 34.0%; OR 3.45 95% CI hands from the automatic dispenser, and subjects were instructed
2.0-5.9), and have a low albumin on admission (55.6% and 28.6%; to rub the product onto all surfaces of the hands up to the wrists.
OR 3.13 95% CI 1.82-5.26). In multivariate analysis, independent A calibrated digital timer was used to record the time interval from
predictors for ceftazidime-resistant Enterobacter spp bacteremia when a subject began rubbing to when the subject indicated that their
included needing assistance with ≥ 3 ADLs (OR 1.90 95% CI 1.04- hands felt dry. Results: Log10 reductions for Gel A and Foam
3.47), management in the ICU prior to bacteremia (OR 2.09 95% B were 2.85 and 2.86, respectively, after a single use, and were 3.28
CI 1.09-3.98), low albumin level on admission (OR 2.58 95% CI and 3.02, respectively, after the tenth use. Both test products met
1.42-4.69), and antibiotic exposure prior to bacteremia (OR 2.73 95% U.S. FDA HCPHW requirements (i.e., ≥2 log10 reduction after a
CI 1.50-4.97). Conclusions: Bacteremia due to Ceftazidime- single use, and ≥3 log10 reduction after 10 uses). Mean product rub-
resistant Enterobacter spp was associated with increased exposure to until-dry times were 19s and 17s for the gel and foam, respectively.
healthcare, poor functional status and prior antimicrobial exposures. Conclusions: This is the first report of an ABHR meeting FDA
Ceftazidime-resistance in Enterobacter spp., often due to AmpC HCPHW requirements with a single actuation from a wall-mounted
hyperproduction is typically associated with resistance to several dispenser. The dry-times for these formulations and dispensed
other β-lactam antimicrobials, which limits treatment options. Both volumes are consistent with CDC HC hand hygiene guidelines of
infection control and antimicrobial stewardship strategies should ≥15 seconds wet-time per use. These data combined with those from
be developed to control the emergence and spread of ceftazidime- previous publications, suggest that multiple dispenser actuations per
resistant Enterobacter spp. use would be necessary to achieving FDA efficacy requirements by
many marketed ABHR. These results provide further evidence that
both product formulation and product application volume are critical
drivers of ABHR clinical in-use efficacy, which should be carefully
Antisepsis/Disinfection/ considered by infection prevention decision makers.

Sterilization
Presentation Number 103
Presentation Number 102
Clean Collaboration: Toward Improving
Efficacy of Novel Alcohol-Based Hand Rubs at Arthroscopic Shaver Reprocessing Methods
Typical “In Use” Volumes
Jahan Azizi, BS, CBET - Risk Management Consultant/Biomedical
David R. Macinga, PhD - Principal Microbiologist, GOJO Industries, Engineer, University of Michigan Health System; Shawn Murphy,
Inc.; Adjunct Professor, Northeast Ohio Medical University; Sarah RN, MSN - Director, Surgical Services and Associate Hospital
Edmonds, MS in Biology - Clinical Scientist, GOJO Industries, Admistrator, University of Michigan Health System
Inc.; Esther Campbell - Principal Study Director in the Clinical
Laboratories, BioScience Laboratories, Inc.; David J. Shumaker, BS
Issue: Reprocessing valuable reusable medical instruments is a
in Microbiology - Laboratory Technician III, Microbiology, GOJO
constant challenge, due to the numerous variations in design and
Industries, Inc.; James W. Arbogast, PhD - Skin Care Science and New
composition of the many devices that daily pass through the Central
Technology Vice President, GOJO Industries, Inc.
Sterile Supply Department (CSPD). A particularly unique problem
is found in reprocessing arthroscopic shavers, as detailed in an FDA
Background/Objectives: Alcohol-based hand rubs alert. Remnants of tissue and bone can be found within the shavers,
(ABHR) are the primary form of hand hygiene in healthcare settings. representing a potentially serious infection risk. Project: Following
Most U.S. hospitals utilize wall-mounted dispensers throughout the publication of the alert, a study was undertaken to ascertain if the
facility, and the prevalence of automated touch-free dispensers is reprocessing methods employed at a large university hospital were
increasing. However, there are few data on the efficacy of ABHRs producing adequate results. This required establishing a collaboration
when used at dispensed amounts. A recently published study showed of university personnel, representatives of the manufacturer of an
that seven ABHR commonly used in HC, as well as the 2 WHO automated reprocessing machine, and manufacturers of the chemical
recommended formulations, failed to meet HCPHW requirements tests used to track cleaning processes. Components of the study
at a volume of 2 ml. The objective of this study was to evaluate the included reprocessing instruments in the normal way, then testing
efficacy of novel ABHR foam and gel formulations when tested them after cleaning and sterilization using two different tests for
at the quantity dispensed (i.e. a typical dose). Methods: Two chemical markers of biological debris, and, most uniquely, using a tiny
commercially available ABHR, Gel A (70% v/v ethanol gel) and fiber optic camera actually to look inside the shafts and lumens of the
Foam B (70% v/v ethanol foam) were evaluated according to the shavers, to see if any visible debris remained. Data were gathered on the
U.S. FDA Healthcare Personnel Handwash (HCPHW) method presence of adenosine triphosphate (ATP), a biological marker; and
at a volume of 1.1 ml, which represents the normal output from a

166 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Oral Abstracts: Device-Related Infections and/or Site Specific Infections
on protein, hemoglobin, and carbohydrate. While the shavers became
cleaner, biological debris was detectable by the screening methods
employed. Most telling, however, were the visual checks inside the
instrument lumens, clearly showing debris inside the shavers, even after
the established cleaning process was completed. Digital photographs
were taken to document what was discovered. Results: It was
proven conclusively that instrument room personnel were following
the prescribed methods of instrument reprocessing. It was also
conclusively proven that these methods were essentially inadequate
to remove all debris from within the lumens of arthroscopic shavers.
While variations in cleaning procedures, including manual cleaning
and automated washing cycles, produced improvements, the shavers
especially were found to be most difficult to clean in a reliable and
repeatable manner. Lessons Learned: The implications for
infection control of biological debris inside arthroscopic shaver lumens
are troubling, and the need for further research is indicated. Next steps
include collaboration with designers from the shaver manufacturers to
minimize debris-trapping welds, joints, and pockets inside lumens; and
further work with automated reprocessor manufacturers to determine
the best procedures for producing the cleanest-possible instruments.
These sophisticated tools provide an invaluable healthcare service; our
physicians and patients are best served by continuous improvement in
cleaning and sterilizing, removing to the highest possible degree any
risk of infection from this route.

Device-Related Infections and/or Site

Specific Infections

Presentation Number 104

Preventing Contamination of Central Venous

Catheter Valves with the Use of an Alcohol-based
Disinfecting Cap

Marc-Oliver Wright, MT(ASCP), MS, CIC - Corporate Director

of Infection Control, NorthShore University HealthSystem; Jackie
Tropp, RN, MSN, CRNI, VA-BC - Staff Nurse, NorthShore
University HealthSystem; Mary Dillon-Grant, RN, MS - Nurse
Manager, NorthShore University HealthSystem; Kari Peterson,
BS - Researcher, NorthShore University HealthSystem; Donna
Hacek, MT(ASCP) - Administrator, Lab Epidemiology, NorthShore
University HealthSystem; Sue Boehm, RN - Research Nurse,
NorthShore University HealthSystem; Lance R. Peterson, MD
- Associate Hospital Epidemiologist, NorthShore University
HealthSystem, University of Chicago

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 167
Oral Abstracts: Device-Related Infections and/or Site Specific Infections
Background/Objectives: Catheter hub contamination Nurse, National Institute of Medical Sciences and Nutrition Salvador
is a potential cause of central line associated bloodstream infections Zubiran; Yefté Silva - Research Assistant, National Institute of
(CLABSIs). Traditional decontamination usually relies on a 15 Medical Sciences and Nutrition Salvador Zubiran; Lorena González
second or more scrub with a disinfectant. Compliance with this - Research Assistant, National Institute of Medical Sciences and
technique can vary. Methods: The study was conducted at Nutrition Salvador Zubiran; Carlos Polanco - Research Assistant,
three acute care facilities and is divided into P1 (baseline) during National Institute of Medical Sciences and Nutrition Salvador
which the standard protocol of a 30-second scrub was used to Zubiran
disinfect hubs before accessing; P2 during which an alcohol-based
disinfecting cap (DC) was used on all central venous catheters Background/Objectives: Parenteral infusions are
(CVC) including peripherally inserted central catheters (PICC); susceptible of microbial contamination during their administration
and P3 when the DC was removed from one facility and practice in the hospital setting. Previous surveys have reported that extrinsic
returned to baseline. Adult patients with PICCs inserted during their contamination is not an uncommon event in some hospitals in
index hospitalization plus five or more consecutive PICC line days Mexico. In addition, extrinsic intravenous (IV) -fluid contamination
were consented and enrolled. On days 5, 6, or 7 and twice weekly can be associated with outbreaks especially among infants with a
thereafter during hospitalization, 1.5 ml of blood was withdrawn high mortality rate. Therefore, is essential to address the prevalence
from each catheter lumen not actively in use and quantitatively of in-use IV-fluid contamination in Mexico and its possible public
cultured. Two-tailed Fisher’s exact, Wilcoxson Mann-Whitney U health repercussions. Methods: A multi-institutional cross-
tests and risk ratios with Ederer/Mantel confidence intervals were sectional study was designed, including a weighted random sample of
used for significance testing. A fourth hospital was not involved in 53 hospitals in Mexico. The study population consisted in children
the study, but implemented the DC immediately. Universal CLABSI aged less than 2 years, hospitalized for at least 48 hours. We excluded
rates are reported for all 4 hospitals using NHSN criteria. The study children receiving infusions of electrolytes, antibiotics, or cancer
was IRB approved and federally registered. Results: Overall, 799 chemotherapy at the time of the visit. The infusions were cultured
patients were sampled with 12.7% (32/252) contaminated during P1; and the microorganisms were identified by an automated method.
5.5% (20/364) in P2 (p=0.002) and 12.0% in P3 (22/183; p=1.00 vs The point prevalence was calculated as the number of contaminated
P1 and p=0.01 vs P2). The median number of colony forming units infusions against the total number of infusions cultured. The
per milliliter was 4 for P1 and 1 for P2 (p=0.009) and increased to attributable mortality and public health implications of the IV-
2 in P3 (p=0.72 vs P1 and p=0.05 vs P2). CLABSI rates decreased fluid contamination in Mexico were estimated via a Monte-Carlo
from a 1.40 (P1+P3 = 21/15,031) to 0.73 (P2=9/12,221) per simulation using 10,000 iterations, following a gamma distribution
1,000 line days for the three enrolling hospitals. The risk ratio (RR of the data to avoid issues about potential negative values. The base
(95% CI)) of 0.53 (0.25, 1.13) failed to reach statistical significance case scenario was drawn from the data of the study and the last
(p=0.10). However, when the fourth, hospital that implemented DC national mortality report in Mexico (2009), considering a mortality
immediately is included, a 51% reduction in infections is significant rate attributable to bacteremia of 30%. Results: A total 551
(P1+P3 = 23/16,508 vs 13/18,972; RR = 0.49 (0.25, 0.96), p=0.04). hospitalized children under 2 years met the inclusion criteria of the
The attack rate at all four hospitals similarly declined from 0.82% of study, from whom 101 IV-infusions were sampled. Eight of the 101
patients with CVCs in P1 and P3 to 0.45% following implementation cultures were positive, being Enerobacter spp. the most common
of DC (p=0.09). The 13 CLABSIs prevented in P2 translates to pathogen (Table 1). The iv-fluid contamination rate was 7.9% (95%
an in-house estimate of $134,893 in gross charges avoided (2008 Confidence interval 4.1 to 14.9%). An estimation of 2 (0.1-10) of
dollars), with a 64.16% cost to charge ratio, this translates to $48,346 every 100 children might die due to IV-fluid contamination in the
in cost avoidance. During the same time period, Foley catheter study population. Considering the Mexican mortality report in
associated urinary tract infection rates did not substantially change, infants less than 1 year, and assuming that 60% of the deaths occur in
increasing from 1.30 (218/168050) per 1,000 patient days in P1+P3 hospitals, the contamination of IV-fluid might cause 1,930 (220-
to 1.41 in P2 (p=0.78). Conclusions: The use of a DC cap 11,068) annual deaths in the country.
significantly reduced CVC contamination and decreased CLABSIs Table 1.- Pathogens isolated from contaminated IV-Fluid in hospitalized children in Mexico
in a multi-phased, multi-facility quasi-experimental trial of over Microorganism Sensitivity Cuantitative
35,000 line days. Culture of
the IV-fluid
CFU/ml
Amoxicillin Ceftriaxone Cefepime Imipenem Amikacin Ciprofloxacin Trimexazole
Clavulanate
E. coli S R R S S R S 60

Presentation Number 105 Klebsiella

pneumoniae
I R R S S S R >10,000

Serratia I S S S S S S 1,800
fonticola
Enterobacter R I S S R S S >10,000
Endemic IV Fluid Contamination in Hospitalized cloacae
Enterobacter R R R S S S R 5,600
Children in Mexico. A Problem of Serious Public cloacae
Enterobacter
Health Consequences cloacae complex
Enterobacter
R R R S R S S 8,200

R R R S R S S >10,000
cloacae complex
Enterobacter
R S S S S S S 3,400
cloacae complex
Alejandro E. Macias, MD - Head, Infection Control, National
Institute of Med Sciences and Nutrition; Alethse De la Torre - Conclusions: The national contamination rate of Iv-fluids
Infectious Diseases Specialist, National Institute of Medical Sciences in hospitalized children under 2 years was high (7.9%), and might
and Nutrition Salvador Zubiran; Martha A. Huertas-Jimenez - be one of the leading causes of death among this population. It is

168 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Oral Abstracts: Device-Related Infections and/or Site Specific Infections
essential to implement surveillance programs to address this problem, the number of thoracolumbar SF surgeries per year: Rate of 13.3
which might be underestimated, and to guarantee a safe intravenous (N= 30), 2.7 (N= 37), 6.7 (N=30), 0 (zero) (N=24) for 2008,
therapy in developing countries. 2009, 2010, 2011 respectively. Our PH has maintained a rate of zero
for the past 12 months post implementation of the PPPB. P value
was not statistically significant due to low sample size. Compliance
with the major elements of the PPPB has been > 97%. Lessons
Presentation Number 106
Learned: • Multidisciplinary teams provided valuable input.
• Support of hospital administration was essential for allocation
Preventing Infection in Pediatric Spinal Fusion of time, financial resources and long term support of the project. •
Surgery: A Novel Perioperative and Postoperative Recognition of the unmet needs of low socioeconomic families, the
Surgical Site Infection Prevention Bundle unavailability and non coverage of products for home care, helped to
create the “Back Home Kit.” • Traditional SSI (SCIP) Bundle did not
Patricia Hennessey, RN, BSN, MSN, CIC - Manager, Infection address post op wound care, home care and follow up. • Literature
Prevention, St. Christopher’s Hospital for Children; Andrea about post op infection prevention for pediatric and adult SF SSIs is
Kiernan, MLT (ASCP) CIC - Infection Preventionist, St. scarce. • Creation of a specialized nursing team allowed for focused
Christopher’s Hospital for Children education, optimum continuity and expertise of care. • Combining
the SSI SCIP recommendations and our interventions into one novel
Issue: Spinal fusion (SF) surgical site infections (SSIs) at our SF Prevention Bundle has led us to “zero” infections. • Our new
pediatric urban tertiary care teaching hospital (PH) were prevalent bundle can be reproduced in other pediatric and adult hospitals and
for this low volume, high risk surgery. SF SSI is common, well be extended to other surgical procedures with minor adjustments.
published & costly; often resulting in multiple hospitalizations &
surgeries, long term antibiotics, intense suffering, residual symptoms
if spinal hardware is removed, sequellae of severe secondary infection, Presentation Number 107
spinal deformity and increased mortality. Our hospital’s median
SF SSI charges and reimbursement were $467,000 & $27,775
respectively. Various risk factors & prevention recommendations have
Efficacy of Various Antimicrobial Central
been identified in the literature however; lack of evidence exists for a Venous Catheters in Mono- and Poly-microbial
combined perioperative & post operative care bundle. Project: Environments
SSI Pediatric Bundle (based on SCIP) was implemented since early
2008. Gap analysis for SF SSIs (2010) included inconsistencies Shanna D. Moss, Bachelor of Life Sciences - Research Scientist,
with bundle compliance and lack of post-operative standard of care, Teleflex Medical; Nisha Gupta, PhD - Senior Research Scientist,
written home care instructions & a specialized nursing care team. Teleflex Medical
Original SSI Bundle elements were reinforced with the surgeons
& compliance was monitored. Based on the gap analysis and Background/Objectives: One of the CDC 2011
multidisciplinary team involvement, new interventions (Table) were 1A recommendations for the prevention of Catheter-Related
added to our current bundle to develop a new SF SSI Perioperative & Bloodstream Infections (CRBSIs) is the use of antimicrobial Central
Postoperative Prevention Bundle (PPPB) (Flowchart). Results: Venous Catheters (CVCs). Mostly, CRBSIs are mono-microbial
Compliance with the original SSI Bundle was 100% within 1 month in nature and are well studied; however, poly-microbial infections,
post gap analysis. The new PPPB was implemented in January 2011. which are more difficult to treat, are less understood. Therefore, this
SF SSI rates per 100 surgeries were as follows with (N) representing study was designed to evaluate the effectiveness of Chlorhexidine-
Silver Sulfadiazine (CH-SSD), Minocycline-Rifampin (MR), and
Silver-Carbon-Platinum (SCP) impregnated CVCs in reducing
mono- and poly-microbial colonizations under in vitro conditions.
Methods: Segments from uncoated polyurethane control,
CH-SSD, MR and SCP CVCs were sealed at both ends. Then, they
were incubated for 24 hrs in either individual or mixed cultures of
Methicillin-Resistant Staphylococcus aureus (MRSA), Pseudomonas
aeruginosa (PA), and Candida albicans (CA) at a final concentration
of 5 x 105 colony forming units (cfu) per milliliter for challenge.
Subsequently, all the segments were rinsed in saline, and the
adherent organisms were recovered under neutralizing conditions
by sonication and quantitative culturing. Results: In the mono-
microbial challenges, CH-SSD CVCs were 100% effective against
each organism with at least 5.7 log10 reductions in colonization.
MR CVCs were as effective as CH-SSD against MRSA but only
led to 2.7 log10 reductions against CA colonization, and less than
1 log reduction in PA colonization. SCP catheters were ineffective
against both MRSA and PA, and led to 3.5 log10 reduction in CA

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 169
Oral Abstracts: Healthcare Worker Safety/Occupational Health
colonization. When challenged with the poly-microbial cultures, hematology-oncology patients, 31 additional infants and children,
the SCP CVCs had no effect on the initial biomass; however the and 92 co-workers. Project: Costs associated with the post-
biomass reduction achieved by the MR CVCs was 2.8 log10, almost a exposure investigation were determined by estimating the costs of
1000 fold drop. The CH-SSD CVCs performed best, achieving a 6.0 prophylaxis, occupational health screening, physician referrals and
log10 reduction in initial biomass, producing an additional 1000 fold HCW furloughs, compared to the cost of vaccination. Results:
reduction from that of the MR CVC. Additionally, the composition Prophylactic azithromycin was administered to exposed and
of the biomass recovered subsequent to polymicrobial challenge still-hospitalized patients (n=14) and to all exposed hematology-
from all three antimicrobial catheters mainly consisted of PA. MR oncology patients (n=23). Screening and/or treatment of discharged
catheters also had significant CA growth along with PA. Results are patients (n=17) was arranged through primary physicians. Exposed
summarized in the following table: HCW were provided prophylaxis (n = 79) or were referred to
their physician for prophylaxis (n = 13). Nine symptomatic HCW
were furloughed and tested for pertussis by PCR. No secondary
cases were confirmed among either exposed patients or co-workers.
Of the exposed HCW only 43% (40 of 92) had a current Tdap
immunization. All exposed and non-exposed HCW were offered a
Tdap vaccine, if not up to date. Of the under-immunized HCW, only
25% (13 of 52) agreed to receive a Tdap vaccination. Total actual
costs associated with the response were estimated to be $12,065,
based on the following data: 116 course of antibiotics ($348); 9
pertussis tests ($857); time devoted to the outbreak response and
screening ($1560); 240 hours of lost work ($7,200); and 23 physician
referrals ($2100). The hospital cost to vaccinate the index employee
would have been $30. The cost to vaccinate all 92 exposed HCW
would have been $2,760. Lessons Learned: A non-immune
HCW with pertussis exposed 54 pediatric patients and 92 HCW.
The cost of post-exposure investigation, prophylaxis, lost work, and
physician referral was estimated at $12,065. Based on a vaccine cost
of $30, the amount spent would have been sufficient to vaccinate
402 HCW. Since pertussis is highly contagious and associated with
Conclusions: The CH-SSD catheters were highly effective significant morbidity and mortality, especially in young children, it
against Gram positive and Gram negative bacteria, as well as fungi is fortunate that no secondary cases were identified. The Advisory
in both mono-microbial and poly-microbial environments. MR Committee on Immunization Practices states that HCW, regardless
catheters were equally effective against Gram positive bacteria but of age, should receive a single dose of Tdap as soon as feasible if not
had minimal or no effect against fungi and Gram negative bacteria previously vaccinated, and regardless of time since their last dose of
in both mono-microbial and poly-microbial environments. SCP tetanus and diphtheria toxoids (Td) vaccine. This exposure highlights
catheters had limited efficacy against CA, and no effect on MRSA or the low rate of Tdap vaccination among HCW and their reluctance
PA in either type of environments. to accept vaccination. Hospitals should offer Tdap vaccines to all
HCW, and a mandatory approach may be necessary to achieve a high
vaccination rate.

Healthcare Worker Safety/

Occupational Health
Infection Prevention and Control
Presentation Number 108 Programs

A Healthcare Worker with Pertussis: High Cost and Presentation Number 109
Lost Opportunity
Prevention of Hospital-Associated C. difficile
Gregory C.. Gagliano, RN, BSN, CIC - Infection Preventionist, Infections
Cleveland Clinic
Alexis Raimondi, BS, RN, BSN, MS, CIC - Infection Control
Issue: In December 2010, a pediatric hospital healthcare worker Manager, Beth Israel Medical Center- Kings Highway Division;
(HCW) with a 22-day history of cough was diagnosed with Marie Moss, RN, BSN, MPH, CIC - Infection Preventionist, Beth
pertussis based on clinical symptoms and an elevated IgM assay. Israel Medical Center- Petrie Division; David Crimmins, RN, CIC -
Based on symptoms a post-exposure investigation was performed. Infection Preventionist, Beth Israel Medical Center- Petrie Division;
The HCW worked on four pediatric units, and exposed 23 pediatric Maria Latrace, RN - Director, Patient Access Services, Beth Israel

170 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Oral Abstracts: Infection Prevention and Control Programs
Medical Center- Petrie Division; Lisa Cohen, RN - Director, Patient Presentation Number 110
Care Services, Beth Israel Medical Center - Kings Highway Division;
Margaret Amato-Hayes, BSN, RN, MSED - Director, Patient Care
Preventing the FLU in You: A Three Year
Services, Beth Israel Medical Center- Petrie Division; Ray Berrios -
Experience of Sustained Seasonal Influenza
Manager, Environmental Services, Beth Israel Medical Center- Petrie
Division; Pedro Rivera - Supervisor, Environmental Services, Beth Vaccination Rates in Healthcare Workers
Israel Medical Center - Kings Highway Division; Brian S. Koll,
Hospital Epidemiologist - Beth Israel Medical Center; Professor of Scott B. Cormier - Director, Emergency Preparedness &
Clinical Medicine - Albert Einstein College of Medicine - Medical Management, HCA Inc, Clinical Services Group; Julia Moody
Director and Chief - Infection Prevention, Beth Israel Medical Center - Director Infection Prevention and Control, HCA Inc. Clinical
Services Group; Edward Septimus - Medical Director, Infection
Issue: Clostridium difficile infection (CDI) approaches Prevention and Epidemiology, HCA Inc., Clinical Services Group;
methicillin-resistant Staphylococcus aureus as the most common Jason Hickok - AVP Patient Safety and Infection Prevention, HCA
cause of health care-associated infections. CDI has an attributable Inc., Clinical Services Group; Jonathan Perlin - CMO and President
mortality between 6.9% and 16.7%, increased length of stay Clinical Services Group, HCA Inc., Clinical Services Group
up to 4.5 days and increased costs as high as $6,326. Although
antimicrobial therapy is a major risk factor, patient-to-patient Issue: Influenza is the leading cause of vaccine-preventable death
transmission plays a major role in its epidemiology. Interventions that in the US. The national Health and Human Services action plan
interrupt transmission are a critical component of CDI prevention to prevent healthcare-associated infections includes achieving 90%
programs. Project: The primary objective was to introduce seasonal influenza vaccinations among healthcare workers (HCW)
a multidisciplinary collaborative model. The model included: 1) by 2020. Inadequate HCW vaccination is an often overlooked
support from senior leadership; 2) interdisciplinary teams composed patient safety issue. In 2009-2010, HCA Inc, implemented a patient
of clinical and non-clinical staff, of which housekeepers were a safety program consisting of 1) HCW choice of free seasonal
major component; 3) use of evidence based practices with use of influenza vaccination or wearing a mask; 2) presenteeism policy
checklists by direct monitoring to ensure compliance; 4) innovative (stay home when ill); 3) early identification and triage of patients
use of a fluorescent marking tool that simulated germs which served to droplet precautions; 4) hand hygiene; and 5) respiratory/cough
as a quality check of environmental cleanliness; 5) timely feedback etiquette. The goal of this program was to reach 100% protection
of data; and 6) use of existing technology and resources to achieve of patients through a comprehensive, multi-faceted patient safety
these goals. To prevent transmission, patients were placed on contact initiative to prevent transmission of influenza in healthcare settings
precautions at the onset of symptoms and placed in a single room and sustain ongoing performance. Project: To sustain HCA’s
or cohorted with another CDI patient. Gowns and gloves were program performance in the 2011-2012 season, new communication
made readily available, hand hygiene with soap performed and rectal activities included a video titled FLU IQ with messages from senior
thermometers eliminated. Environmental cleaning practices using a leadership and influenza FAQ’s; use of the corporate intranet site
hypochlorite- based disinfectant were standardized and included 48 to publicize the efficacy and safety of influenza vaccination; and
individual elements. Innovative use of a fluorescent marking tool that feature stories in two corporate employee news magazines. The
simulated germs was introduced to assess the quality of cleanliness, additions augmented existing communication tools of the Influenza
assure sustainability and keep the program fun. Compliance data Update newsletter and a dedicated FLU email box, where questions
and CDI rates were presented back to the teams on a monthly basis. are answered within 24 hours. Easy access to FLU vaccination
The teams used a Plan-Do-Study-Act (PDSA) methodology to was available, including novel access outside of the workplace for
identify reasons for lack of adherence to infection prevention and nonclinical business units through a voucher system redeemed at
environmental cleaning protocols and develop solutions to improve a national pharmacy chain. An influenza healthcare information
compliance in a non-punitive manner. Results: The number of hotline staffed by nurses was available to all HCW. A universal
hospital onset CDI cases decreased by 40% and the rate decreased sticker was placed on badges to make visible HCW who received
from 15.4 to 4.5 per 10,000 patient days over three years. Compliance vaccine. Vaccine tracking was entered into a centralized electronic
with CDI prevention practices increased from 60% to 98%. human resources database using a standardized consent/declination
Compliance with the environmental cleaning practices increased form. Results: The 2011-2012 season showed a reduction in
from 65% to 93%. The length of stay for patients with CDI reduced Other/No reason compared to 2009-2010. “Allergy” as a reason
by one day. Time until precautions implemented and specimen taken for declination increased despite clarification of 2011-2012 vaccine
for CDI testing from symptom onset decreased by 17 hours. All recommendations for persons reporting egg allergy. Similar increases
cause mortality for CDI patients decreased by 15%. Reductions in
CDI have saved the Medical Center between $330,000- $850,000.
Lessons Learned: An interdisciplinary collaborative effort
supported by hospital leadership successfully reduced hospital-
associated CDI. Involvement of staff to develop checklists, monitor
outcomes with timely feedback of data, allowed staff to “own” the
program. Use of fluorescent marking tool kept the program fun and
assured sustainability without the addition of extensive new resources
and separate from efforts evaluating antimicrobial practices.

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 171
Oral Abstracts: Infection Prevention and Control Programs
were seen in all other categories trending up with the exception of appears highly feasible. The higher pass-caution-fail thresholds
“pregnancy.” Lessons Learned: Keys to success in sustaining observed for duodenoscopes suggest that a different protocol or
vaccination rates greater than 90% included a focus on patient safety, more attention may need to be placed on cleaning scopes with this
visible leadership support, effective communication to leaders and type of design. Although most hospitals follow similar reprocessing
HCW, clear expectations for leaders and HCW, consistent data protocols, the difference in action limits observed between sites
collection and feedback to leaders and HCW. Tracking declination suggest that there are probably some best practices that can lead to
reasons offers opportunities to better understand HCW responses better outcomes. Identifying and sharing these best practices may be
and implement strategies to reduce declination, especially those of significant value to reprocessing facilities. The study demonstrates
classified in the category of “Other/No Reason.” The program-wide use of this objective method to establish pass-caution-fail criteria to
emphasis on education, open communication, and honest feedback monitor cleanliness of endoscopes on an ongoing basis in order to
was instrumental in overcoming misinformation about influenza and drive process quality and improvement. Furthermore, the ATP assay
resistance to the patient safety program. By focusing on education can be used as a training tool, leveraging the real-time nature of this
and making non-vaccine alternatives available, program organizers tool to provide immediate feedback to the technician on manual
were able to ease concerns and uphold employee perceptions of cleaning techniques and processes.
individual choice.

Presentation Number 111

Monitoring the Manual Cleaning of Flexible

Endoscopes with an ATP Detection System

Grace A. Thornhill, PhD - Technical Service Specialist, 3M

Infection Prevention; Marco Bommarito, PhD - Senior Research
Specialist, 3M Infection Prevention Division; Dan J. Morse - Senior
Biostatistical Specialist, 3M Infection Prevention Division

Background/Objectives: The primary objective of this

study was to demonstrate the feasibility of using ATP bioluminescent
assay to monitor the cleanliness of flexible endoscopes after the
manual cleaning step of the decontamination and disinfection process.
The data obtained from five hospital sites was used to define process
control parameters for this step of the cleaning process. These control
parameters could then be applied in an auditing fashion to monitor
quality control and drive process improvement. Methods: Three
types of flexible endoscopes were tested after manual cleaning at five
different hospital sites using an ATP Water assay. The method entailed
collecting and testing a water sample harvested from the suction/
biopsy lumen using a swab-based ATP assay. The amount of ATP,
in relative light units (RLUs), was measured with a luminometer.
The data collected was used to define pass, caution, and fail values.
Results: The figures below show the action limits (pass, caution
and fail values) established by the type of scope tested, for each
hospital site. Lower RLU values indicate lower contamination levels.
Action limits vary by the type of scope being processed. Manual
cleaning of colonoscopes resulted in significantly lower pass-caution-
fail thresholds than gastroscopes and duodenoscopes. For example,
comparing Figures 1, 2, and 3, for hospital site 1, we observe a
pass value in RLUs of 140 for colonoscopes, 692 for gastroscopes,
and 2499 for duodenoscopes. Furthermore, action limits for
duodenoscopes were significantly higher than the other two types
of scopes. We also observed differences in the outcome of manual
cleaning by hospital site. For example, referring to Figure 1, the pass
value in RLUs for hospital sites 1-5 were 140, 429, 38, 133, and 71
respectively. Comparing the size of the caution ranges in each Figure
gives an estimate of the variability for that site’s cleaning process.
Conclusions: Successful quality control using this method

172 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Oral Abstracts: Infection Prevention and Control Programs

Presentation Number 112 Presentation Number 113

Changing Bedside Care by Linking Outcome and Risk Factor Score to Predict MRSA Colonization at
Process Data Hospital Admission

Kathleen R. Hartless, RN, MN, CIC, CRMST - Infection Katherine Torres, DO - Fellow, Infectious Diseases, Mayo Clinic;
Prevention and Control Coordinator, Veterans Affairs North Texas Priya Sampathkumar, MD - Consultant, Infectious Diseases, Mayo
Health Care System Clinic; Martha Siska, RN - Infection Preventionist, Mayo Clinic

Issue: Clinical practice guidelines (CPGs) guide healthcare Background/Objectives: Methicillin-Resistant

providers (HCPs) in preventing health care-associated infections Staphylococcus aureus (MRSA) continues to be a problem in health
(HAIs). Surveillance for HAI outcomes alone fails to effect care facilities nationwide. Active surveillance cultures at admission
sustainable change in practices without direction for how CPG are recommended as an important component of a hospital’s
behaviors impact outcomes. Methods necessary for integrating infection control program, however, there is lack of consensus
outcomes and processes include efficient measurement of process on which patients to screen. In facilities with a low prevalence of
behaviors coupled with real-time reporting, synthesizing process MRSA, screening all admissions is unlikely to be cost-effective. We
and outcome data, and engaging HCPs to change practice based on conducted a retrospective analysis of nine risk factors and derived a
findings. Project: In a large Veterans Affairs Medical Center, risk factor score to identify patients with the highest likelihood of
we initiated a two- year project to develop a checklist to assess MRSA colonization. Methods: We conducted a retrospective
CPG practices, conduct assessments of CPG practices and test study of 496 adult patients admitted to an acute care hospital.
tool reliability, plan and implement strategies to involve HCPs We abstracted data on 9 variables reported in the literature as risk
in data collection, examine outcome and process findings, and factors for MRSA colonization (nursing home residence, diabetes,
evaluate changes in level of risk factors for infection. The checklist, presence of chronic skin condition or active skin infection, antibiotic
called a Clinical Practice Assessment Tool (CPAT), is based on use within the past 3 months, transfer from an outside hospital,
CPG expectations related to hand and environmental hygiene, hospitalization in the 12 months prior to admission, presence of an
isolation precautions, urinary device and central line management, indwelling medical device at admission, chronic hemodialysis, and
and specimen collection. Expanded CPATs were developed for immunocompromise). Statistical analysis was performed with Chi-
specialty areas such as dialysis and Surgical Service. The method Square tests and multivariate logistic regression to determine factors
for data collection in acute, long- term care, and mental health that were most strongly associated with MRSA colonization. These
units involves weekly observations by the Infection Prevention and were then used to generate a risk factor score to identify patients at
Control (IPC) Coordinators, though unit staff persons have also risk for MRSA colonization on admission. Results: Of the 496
been encouraged to participate. Quarterly observations are made in patients screened with nasal swabs, 34(6.9%) were colonized with
surgical and dialysis areas. Statistical process control charts are used MRSA. Multivariate analysis showed that a combination of 4 risk
to examine time-series patterns of outcome data and CPAT scores. factors (nursing home residence, diabetes, hospitalization in the 12
Both outcome and process data are entered into a grid to compare months prior to admission, and presence of a chronic skin condition
risk levels between clinical areas and between surgical procedures. A or active skin infection) was most significantly associated with MRSA
system of continuous data feedback with HCPs, attendance at nurse colonization. This model had an area under-the-curve of 0.85 on
manager meetings, communication via 2-Way Memorandums with the Receiver Operating Characteristic (ROC) curve indicating that
physicians, training of HCPs on CPGs, and strategic planning to it would be an accurate indicator of MRSA colonization. Based on
overcome barriers for effective practices has guided practice changes. the odds ratios for each risk factor, we designated a weighted score
Results: The increased interaction of IPC Coordinators as part to each variable (6 points for hospitalization within 12 months of
of the clinical unit teams was one of the strongest results from this current admission, 5 points for nursing home residence, 4 points for
project. Two- way communications between the HCPs and the chronic skin condition or active skin infection, 3 points for diabetes).
IPC Coordinators increased along with shared responsibilities for Thus a total score of 0 to 18 was possible. Using a score of 6 or
problem solving. Health care- associated transmissions of Methicillin- greater as the threshold for screening, only 52% of admissions would
Resistant Staphylococcus aureus (MRSA), gram negative-resistant be screened and almost all (94%) of the MRSA patients would be
organisms, and Clostridium difficile decreased by 50 percent (50%) identified. Using a score of 8 or greater, only 20% of patients would
to 90 percent (90%) after implementation of the project. The rates be screened, but one-third of the MRSA colonized patients would be
for central line-associated and dialysis related bloodstream infections missed. (Table 1)
also decreased by sixty-six percent (66%) and eighty percent (80%)
respectively. Minimal changes in surgical site infection (SSI) rates,
specifically for colon surgeries, were noted. Lessons Learned:
IPC Coordinator visibility and interaction with staff focused
on process improvements are critical. Process data is essential for
changing outcome results. Data must be relevant and understandable
to HCPs for change to occur. The CPAT can be adapted to a variety
of clinical areas, including ambulatory settings. Conclusions: We identified a risk factor score that can predict
MRSA colonization in adult patients. If validated prospectively, this

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 173
Oral Abstracts: Infection Prevention and Control Programs
score can increase the cost effectiveness of screening, by reducing two main motivations for HH practice: 1) protection of the patient,
the numbers of patients who need to be screened for MRSA at followed by 2) self-protection. Visual aspects of previous HH training
admission. had the greatest impact, according to focus group participants.
Participants requested HH training, visual reminders (signage), and
access to HH compliance rates. By using these themes identified by
focus groups, we have begun to implement interventions to motivate
Presentation Number 114
and reduce the barriers to practicing HH. Conclusions: Our
study confirmed that continuous education and training are needed to
Understanding Hand Hygiene Behavior in a improve and maintain reasonable HH compliance levels. However, in
Pediatric Oncology Unit in a Low Middle Income addition, we identified local factors that affect motivation and barriers
Country: A Focus Group Approach to practicing HH that are important for improving HH compliance
and reducing HAI in this setting.
Kyle M. Johnson, PhD, CCRP - Clinical Research Associate II, St.
Jude Children’s Research Hospital; Miriam Gonzalez, MD - Student,
University of Memphis; Mario Melgar, MD - Infectious Diseases
Presentation Number 115
Physician, Unidad Nacional de Oncología Pediátrica, Guatemala
City, Guatemala; Maria Mercedes Somarriba, MD - Infectious
Diseases Physician, Hospital Infantil Manuel de Jesús Rivera; Multidrug Resistant Organisms in Supply Carts of
Federico Antillon-Klussmann, MD - Director of Medicine, Unidad Contact Isolation Patients
Nacional de Oncología Pediátrica, Guatemala City, Guatemala;
Ruthbeth Finerman, PhD - Professor and Department Chair, Shane Zelencik, MPH - Infection Preventionist, NorthShore
University of Memphis, Department of Anthropology; Miguela University HealthSystem; Donna Hacek, MT(ASCP) -
Caniza, MD - Director of Infectious Diseases-International Outreach Administrator, Lab Epidemiology, NorthShore University
Division, St. Jude Children’s Research Hospital HealthSystem; Adrienne Fisher, MT(ASCP), CIC - Infection
Preventionist, NorthShore University HealthSystem; Corrinna
Background/Objectives: It is well established that Brudner, BSc, CPHI (C), CIC - Infection Preventionist,
practicing good hand hygiene (HH) is the most effective way to NorthShore University HealthSystem; Parul Patel, MT(ASCP)
prevent infections, especially in the hospital setting. For the past - Project Coordinator, Research, NorthShore University
three years HH compliance has been taught and tracked at this HealthSystem; Ari Robicsek, MD - Hospital Epidemiologist and
pediatric oncology unit and the rates have fluctuated from between Associate Chief Medical Informatics Officer, NorthShore University
29% and 65%, lower than expected. Despite improving access to HH HealthSystem and University of Chicago; Lance R. Peterson,
infrastructure and supplies and periodic educational efforts, there MD - Associate Hospital Epidemiologist, NorthShore University
has been no sustained increase in HH compliance. To understand HealthSystem, University of Chicago; Marc-Oliver Wright,
healthcare workers’ motivation and perceived barriers to practicing MT(ASCP), MS, CIC - Corporate Director of Infection Control,
HH in the unit and to customize the education provided to this local NorthShore University HealthSystem
setting, focus groups were conducted with several types of healthcare
provider. Methods: Setting – The unit is a semi-autonomous Background/Objectives: This study assesses the level
public cancer center treating 50% of the expected number of children of contamination of supply carts and their contents with multidrug
with cancer from Guatemala. Currently, this institution cares for more resistant organisms (MDROs) used in rooms of isolated patients
than 400 children in various phases of cancer treatment and it sees in the intensive care unit (ICU). Methods: The study was
about 300 new patients per year. The most common diseases seen at conducted at two medical/surgical ICUs in two acute care hospitals.
this center are hematologic malignancies and retinoblastoma. The Locked supply carts containing items used for routine patient care
center has 42 beds with 90% occupancy; 104 nurses and 35 physicians (i.e. bandages, gauze, syringes, etc) remain in patient rooms for the
care for the children. Focus Groups – We formed 5 distinctive focus entire length of stay. Supply carts of patients on contact isolation
groups of 8 – 12 participants (n=55) grouped by work categories for colonization/infection with an MDRO admitted for at least
including nursing, physicians, respiratory therapy, pharmacy, three days were selected for screening. Supply carts were sampled
volunteers, and cleaning staff. Each group was asked the same 10 with a double headed BBL TM Culture Swab, premoistened with
questions that had been developed and fine-tuned by experts in HH, Amies transport media (Beckton Dickinson & Co, Sparks, MD).
focus groups and by native Spanish speakers. Focus group recordings Two double-headed swabs were taken: one of the contents of the
and notes were transcribed and analyzed according to standard cart, and another of the external drawer pulls and internal drawer
qualitative methods. This study was approved by the appropriate surfaces. Swabs were placed in separate PRAS Anaerobic Transport
Institutional Review Boards and Research Ethics Committees. Media (Anaerobe Systems, Morgan Hill, CA) and sent to the
Results: The three most common themes identified by the focus Infectious Disease Research Lab. Each sample was plated to selective
groups that related to barriers to HH practice were: 1) perceptions media to cultivate the MDROs. BBL TM CHROMAgar MRSA II
related to patients’ family members’ hygiene; 2) social issues related to (Beckton Dickinson & Co) was used to cultivate MRSA. VACC agar
responsibility, and concerns about negative reactions to interpersonal (Remel, Lenexa, KS) was used for Vancomycin resistant enterococci
HH reminders; and 3) lack of HH training among new personnel, (VRE), extended spectrum beta lactamase (ESBL) producing
medical students, and patients’ families. The focus groups identified Enterobacteriaceae, drug resistant Acinetobacter spp and drug

174 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Oral Abstracts: Infection Prevention and Control Programs
resistant Pseudomonas spp. For Clostridium difficile, the swabs were
first plated to PRAS-CCFA HT (Anaerobe Systems) then submerged
into BBL TM Chopped Meat Glucose Broth, Pre reduced II. All
plated media was incubated per manufacturers’ recommendations.
After 48 hours, the Chopped Meat broth was subcultured to an
additional CCFA and held for five days. Organisms found on any
plate were worked up using traditional clinical microbiology methods
to identify organisms. Results: Patients whose supply carts were
sampled were on isolation for the following MDROs: MRSA (11),
VRE (4), C. difficile (4), ESBL E. coli (3), Acinetobacter spp (2),
Pseudomonas spp (1). Of the 18 cultures obtained from the carts in
ICU rooms, none were contaminated with the MDRO attributed
to the patient in the room. Conclusions: Closed supply
carts used in MDRO infected/colonized patient rooms were not
contaminated with those same MDROs in this multi-facility study.
The lack of contamination may be attributable to workflow and
health care worker hand hygiene practices, differential contamination
of ICU patients’ environment, or the closed design of supply carts
used. Without contamination there may be no need to discard
unused supplies following discharge, equating to a potential cost
savings for the organization.

Presentation Number 116

Standardization of Hand Hygiene Observations –

an Entire State Collaborates

Barbara A. MacPike, RN, BSN, CIC - Infection Preventionist,

Maine Coast Memorial Hospital

Issue: Hand hygiene data is monitored extensively in healthcare

institutions, however there is no true ‘standard’ way to collect and
share this data. Our project outlines how the Infection Preventionists
in one state worked together so all hospitals in the state would use
the same methodology for hand hygiene observations. Project: improvement. We created the document “Minimum Expectations
Within our state is a group of Infection Preventionists (IPs) from to Promote and Support Hand Hygiene Compliance” which
every hospital which meet monthly. We researched hand hygiene categorizes into groups what all hospitals need to have in place to
definitions and developed a hand hygiene observation tool. Hand reach the goal 100 % hand hygiene compliance. These areas are:
Hygiene observation data was gathered, graphed and shared. The Authority, Resources, Education & Publicity, Monitoring, Data
question that arose was: How do we know this data is valid? We Feedback and Interventions/Consequences. A letter was drafted
then set out on a journey to insure all hand hygiene observations for all hospital administrators outlining the expectations and the
were done the same way. All hospitals completed a hand hygiene 100% goal. Results: Our state now has one methodology,
variations survey. Data analysis showed, not all hospitals were one training tool and a set of expectations for every hospital to
using the observation tool in the same manner; for example what meet. Hand hygiene data is now collected and reported to our
counted as an observation in one hospital did not in another. group with the knowledge that the data was collected in the exact
We developed an observational methodology and presented it to same manner in every hospital in our state. We identify the high
every IP to implement. We determined all the observers needed to performers and they share their means of success toward the effort
receive specific training and therefore developed “Instructions for to have every hospital reach the 100% goal.
Conducting Observations & Using the Hand Hygiene Observation
Tool” so all hand hygiene observers within our state were trained
in the same manner. This document led to a discussion: Should
observers speak up when they observed hand hygiene not being done?
The answer agreed upon was YES, so how to speak up was added to
the training document. The doccuments were then fully implemented
in every hospital in the state. Once the standarization process
was completed we used what we had learned to work on process

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 175
Oral Abstracts: Infection Prevention and Control Programs
Issue: Contact Precautions has become the emphasis for most
healthcare facilities in an effort to prevent the spread of resistant
organisms. However, as community-onset colonization and
infection become more prevalent, facilities face a growing lack of
private rooms and increased cost when these patients are admitted.
Isolating only known cases presents the concern that non-tested
patients may be a factor for transmission when healthcare workers
rely on Contact Precautions as the primary means of prevention.
Due to a heavy prevalence of Methicillin-Resistant Staphylococcus
aureus (MRSA) and Vancomycin Resistant Enterococcus (VRE)
in our community, our 110 bed facility chose to adopt a policy that
emphasizes strict adherence to Standard Precautions, focusing on
hand hygiene and cleaning equipment between all patients. Contact
Precautions is reserved for MRSA and VRE patients who present
with uncontained secretions, all Extended Spectrum Beta Lactamase
and other gram-negative Multidrug Resistant Organisms and active
Clostridium difficile. Project: The Infection Prevention and
Control Committee approved Standard Precautions for MRSA and
VRE patients with contained secretions after observing that our
healthcare system’s tertiary facility adopted this approach with no
significant increase in nosocomial acquisition. A robust education
program for staff on all shifts included slide presentations, posters,
mandatory intranet training, and question and answer sessions. Strict
compliance with hand hygiene and equipment cleaning between
all patients was stressed to reduce likelihood of transmission of
organisms regardless of antibiotic resistance patterns. Nursing staff
and physicians educated patients admitted with MRSA or VRE
regarding the policy change. Increased quantities of germicidal wipes
were strategically placed throughout patient care areas. The Infection
Preventionist maintained visibility on wards and validated correct
decision–making with patient placement and compliance with policy
changes. Results: After implementing the new policy in late
August, 2011, rates of nosocomial acquisition of MRSA and VRE
showed no significant increase or declined from September through
December 2011 (Figure 1). A cost analysis of gown and glove use
comparing the 2 previous 4 month periods revealed a $20,633.00
cost reduction. Additional qualitative improvements were observed
in patient flow from the Emergency Department to admitting
wards, as well as improved nursing workflow in the absence of the
gowning process. Lessons Learned: During this 4 month
period, benefits to limiting Contact Precautions for MRSA and VRE
patients in our facility to those with uncontained secretions included
enhanced nursing encounters, improved patient flow, and significant
cost savings. Quality improvements were made without an increase
in infection. Staff was very supportive of the changes, and simplifying
Presentation Number 117

Should Contact Precautions be Standard? A

Community Hospital’s Revised Criterion for
Methicillin-Resistant Staphylococcus aureus and
Vancomycin Resistant Enterococcus Isolation

Maureen J. Hodson, RN, ASN, CIC - Infection Preventionist,

Affiliate of UMass Memorial Health Care System; Linda T. Rivard,
MT (ASCP) - Infection Control and Quality Data Coordinator,
HealthAlliance Hospital, UMASS Memorial Health Care; David
M. Bebinger, MD - Infectious Disease Specialist, HealthAlliance
Hospital, UMASS Memorial Health Care

176 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Oral Abstracts: Product Evaluation/Cost-Effectiveness/Cost Benefit Analysis
our precautions policy provided opportunities to stress the remaining subsequent SSI-related hospitalizations per person per year within
aspects of our policies. Emphasis on strict Standard Precautions and 1 year following the first SSI related hospitalization). Subsequent
cleaning protocols were essential elements in preventing increased rehospitalizations for SSI were associated with a mean hospital stay
rates of nosocomial transmission. of 8.6 days (SD = 14.3 days) and a mean cost of $26,812 (SD =
$29,155). Eight-hundred and seventy (40.8% of subjects with SSI)
subjects had at least one subsequent “all-cause” hospitalization during
the year following initial SSI hospitalization, accounting for a total of
Product Evaluation/Cost- 1,770 readmissions (mean of 2.0 subsequent all-cause hospitalizations
Effectiveness/Cost Benefit Analysis per person per year within 1 year following the first SSI related
hospitalization). Subsequent all-cause rehospitalizations following
SSI were associated with a mean hospital stay of 6.2 days (SD = 8.9
Presentation Number 118 days) and a mean cost of $31,046 (SD = $51,505). Data pertaining
to re-hospitalization rates and costs are presented in the Table.
Re-Admissions after Diagnosis of Surgical Site Conclusions: In this cohort, readmissions during the one
Infection Following Knee and Hip Arthroplasty year following SSI diagnosis accounted for a total of 2,154 hospital
admissions, and cost over $65 million. Readmissions following
Keith Kaye, MD, MPH - Professor of Medicine and Corporate diagnosis of SSI of knee or hip arthroplasty are costly and might be a
Director of Infection Prevention, Hospital Epidemiology and future target for decreased reimbursement.
Antimicrobial Stewardship, Wayne State University School of
Medicine and Detroit Medical Center; Kyle Miletic, BS - Medical
Student, Wayne State University School of Medicine; Odaliz E.
Abreu-Lanfranco, MD - Fellow, Infectious Diseases, Wayne State
University School of Medicine; Emily Toth Martin, MPH, PhD -
Assistant Professor, Department of Pharmacy Practice, Wayne State
University College of Pharmacy and Health Sciences; Tom Taylor,
PhD - Associate Professor, Department of Pharmacy Practice, Wayne
State University College of Pharmacy and Health Science

Background/Objectives: Surgical site infection (SSI)

following total hip and total knee arthroplasty is a common
postoperative complication that sometimes necessitates multiple
interventions and rehospitalizations. There have been few large-
scale studies evaluating readmission rates following SSI for these
procedures which have focused on primary readmission for initial
diagnosis and management of SSI. Because hospitals now are not
being reimbursed by Medicare for re-admissions within 30 days
of discharge following hospitalization for pneumonia, congestive
heart failure and myocardial infarction, we wanted to examine the
frequency of additional rehospitalizations after SSI following knee
or hip arthroplasty has been diagnosed. Methods: Data were
obtained from the Thomson Reuters MarketScan© database. This
database consists of health insurance claims for approximately 31 to
45 million insured individuals receiving coverage from employer-
based plans. Patients who underwent knee or hip arthroplasty
in 2007 and who experienced a hospitalization for SSI during
the subsequent year following surgery (2007-8) were identified.
Among these SSI patients, hospitalizations during the subsequent Public Reporting/ Regulatory
year following SSI diagnosis (2008-9) were identified. These Compliance
rehospitalizations were determined to be either “all-cause” versus
“SSI-related” based on diagnosis codes (Figure). Results: Of the
174,425 cases with hip or knee replacement in 2007, 2,134 (1.2%) Presentation Number 119
had a hospitalization for SSI within 1 year following surgery. The
mean time to hospitalization was 66.0 days. 59 % of these patients The Impact of Non-Payment for Preventable
had an SSI hospitalization within 30 days of surgery, 68.4% within Complications on Infection Rates in U.S. hospitals
60 days and 75.0% within 90 days. Among these 2,134 patients
with SSI, 267 (12.5%) were subsequently rehospitalized in the Grace M. Lee, MD, MPH - Associate Professor of Population
year after initial SSI hospitalization specifically due to SSI-related Medicine, Harvard Medical School and Harvard Pilgrim Health
issues, accounting for a total of 384 hospitalizations (mean of 1.4 Care Institute; Ken Kleinman - Associate Professor of Population

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 177
Oral Abstracts: Public Reporting/ Regulatory Compliance
Medicine, Harvard Pilgrim Health Care Institute & Harvard Presentation Number 120
Medical School; Stephen Soumerai - Professor of Population
Medicine, Harvard Pilgrim Health Care Institute & Harvard New York State Hospital-Acquired Infection
Medical School; Alison Tse - Epidemiologist, Harvard Medical
Reporting – 2010 Audit Results: An Inter-Hospital
School and Harvard Pilgrim Health Care Institute; David Cole -
Senior SAS Programmer/Analyst, Harvard Pilgrim Health Care Comparison
Institute & Harvard Medical School; Scott Fridkin - Deputy
Surveillance Branch Chief, Division of Healthcare Quality Kathleen Gase, MPH, CIC - HAI Reporting Regional
& Promotion, National Center for Emerging and Zoonotic Representative, New York State Department of Health; Boldtsetseg
Infections Diseases, Centers for Disease Control and Prevention; Tserenpuntsag, DrPH - Data Analyst, New York State Department
Teresa Horan - Epidemiologist, Division of Healthcare Quality of Health; Valerie Haley, MS - Data Manager, New York State
Promotion, Centers for Disease Control and Prevention; Richard Department of Health; Diana Doughty, RN, MBA, CIC,
Platt - Professor and Chair of the Department of Population CPHQ - HAI Reporting Regional Representative, New York State
Medicine, Harvard Pilgrim Health Care Institute & Harvard Department of Health; Peggy Hazamy, RN, BSN, CIC - HAI
Medical School; Charlene Gay - Project Manager, Center for Reporting Regional Representative, New York State Department
Child Health Care Studies, Department of Population Medicine, of Health; Marie Tsivitis, MPH, CIC - HAI Reporting Regional
Harvard Pilgrim Health Care Institute; William Kassler - Chief Representative, New York State Department of Health; KuangNan
Medical Officer, New England Regional Office, Center for Xiong, MS - Data Analyst, New York State Department of Health;
Medicare and Medicaid Services; Donald Goldmann - Senior Vice Carole Van Antwerpen, RN, BSN, CIC - HAI Reporting Program
President, Institute of Healthcare Improvement; John Jernigan Director, New York State Department of Health
- Director, Office of HAI Prevention Research and Evaluation,
Division of Healthcare Quality & Promotion, Centers for Disease Background/Objectives: Background: In 2007, New
Control and Prevention; Ashish Jha - C. Boyden Gray Associate York State (NYS) mandated reporting of surgical site infections
Professor of Health Policy and Management, Harvard School of (SSIs) related to coronary artery bypass graft (CABG), and colon
Public Health (COLO) surgeries; hip replacement (HPRO) surgeries were added as
a requirement in 2008. From the beginning, audit and validation of
Background/Objectives: In October 2008, the Centers this data has been an essential component of the Hospital-Acquired
for Medicare and Medicaid Services (CMS) stopped additional Infection (HAI) Reporting Program. Objectives: Evaluate the
payments for hospital-acquired conditions deemed preventable. accuracy of data submitted by NYS hospitals in 2010 and provide an
Our objective was to evaluate the impact of the CMS policy on inter-hospital comparison of audit results. Methods: Between
rates of healthcare-associated infections (HAI). Methods: We October 2010 and July 2011, HAI reporting staff conducted on-
used a quasi-experimental interrupted time series with comparison site audits at 128 out of 173 (74%) NYS hospitals reporting 2010
series design to examine changes in trends of outcomes targeted surgery data to the National Healthcare Safety Network (NHSN).
by the CMS policy (central line-associated bloodstream infections Chart selection targeted procedures with potential errors in SSI
[CLABSI] and catheter-associated urinary tract infections status. Five risk adjustment (RA) variables (procedure duration,
[CAUTI]) as compared to an outcome not targeted by the policy ASA score, wound class, trauma, emergency), and SSI status were
(ventilator-associated pneumonia [VAP]) from January 2006 to evaluated for this comparison. Each facility was assigned two letter
March 2011. Hospitals participating in National Healthcare Safety grades, one for RA and one for SSI, based on audit findings (Table
Network (NHSN) and reporting data on at least one HAI prior 1). Results: (Table 2) Overall agreement of the five RA variables
to October 2008 were eligible. We used negative binomial mixed for the three surgeries combined was 96%; range among the 128
effects regression models to measure the impact of the CMS policy facilities was 67-100%. 91% (116/128) of facilities achieved an ‘A’
on changes in HAI rates, controlling for baseline trends. Outcomes grade. RA agreement varied slightly based on procedure: CABG
of interest were changes in slopes of CLABSI, CAUTI and VAP agreement was 97% (range 85-100%); COLO agreement was
rates in the post vs. pre-October 2008 periods. Results: Three 94% (60-100%); and HPRO agreement was 96% (69-100%). 96%
hundred ninety-eight hospitals or systems contributed 14,817 to (26/27) of facilities achieved an ‘A’ grade for CABG procedures;
28,339 hospital unit-months, depending on the type of infection. 77% (97/126) for COLO procedures; and 86% (105/122) for
We observed decreasing secular trends for targeted (CLABSI, HPRO procedures. (Table 3) Errors in RA data vary based on the
CAUTI) and non-targeted (VAP) infections well before the policy type of procedure. For CABG procedures, 45% (21/47) of errors
was implemented. There were no changes in the quarterly rates of occurred in relation to emergency; for COLO, 46% (145/315) of
CLABSI (relative rate in the post vs. pre-intervention periods 1.00, errors were identified with assigning wound class; and for HPRO,
p=0.97), CAUTI (RR 1.03, p=0.08) or VAP (RR 0.99, p=0.52) 35% (95/271) of errors were related to identifying trauma. (Table
after the CMS policy was implemented. Our findings did not vary 4) Overall agreement of SSI status for the three surgeries combined
by hospitals located in states without mandatory reporting, by was 95%; range among the 128 facilities was 73-100%; 78% of the
quartile of percent Medicare admissions, or by hospital size, type disagreements were caused by under reporting. 79% of facilities
of ownership, or teaching status. Conclusions: The 2008 achieved an ‘A’ grade. SSI status agreement varied by procedure:
CMS policy to reduce payment for CLABSI and CAUTI had little CABG agreement was 94% (range 67-100%); COLO agreement
measurable effect on infection rates in U.S. hospitals. was 90% (18-100%); and HPRO agreement was 99% (67-100%).
Despite accounting for only 40% (1139/2827) of the charts audited,
COLO procedures accounted for 74% (113/152) of SSI status

178 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Oral Abstracts: Public Reporting/ Regulatory Compliance
disagreements; conversely, HPRO accounted for 47% of charts Program Coordinator, Colorado Department of Public Health and
audited and only 12% of SSI disagreement. 85% (23/27) of facilities Environment
achieved an ‘A’ grade for CABG procedures; 60% (75/126) for
COLO procedures; and 93% (114/122) for HPRO procedures. Background/Objectives: Validation of healthcare-
96% (123/128) of facilities achieved either an ‘A’ or ‘B’ grade in both associated infection (HAI) data is essential in order to verify correct
categories. Conclusions: NYS facilities are performing very understanding of definition criteria, surveillance practices, and
well collecting and entering accurate RA and SSI data. Education and reporting integrity. Additionally, comparisons between facilities
audit efforts by NYS HAI Reporting Program have been successful in may not be accurate if the infection data is incorrect, which can
ensuring accurate data is reported to the public. therefore be misleading to the public. The Patient Safety Program
at the Colorado Department of Public Health and Environment
(CDPHE) assessed the accuracy and quality of the central line-
associated bloodstream infection data reported into the National
Healthcare Safety Network (NHSN) as well as the surveillance
techniques utilized by the infection preventionists in Colorado.
Methods: Two trained auditors conducted interviews with
infection preventionists and performed onsite retrospective chart
reviews of randomly selected patients with positive blood cultures in
specific adult critical care units, neonatal critical care units level II/III
and III, and long-term acute care hospitals (LTACH) during the first
quarter of 2010. The chart reviewers were blinded to the infection
status of the patients and each chart was reviewed independently by
the auditors. Additionally, charts of patients with reported CLABSI
that were not in the initial random selection were reviewed for
potential over-reporting. Results: Thirty-five (35) acute care
hospitals and eight (8) LTACH were visited during the study. There
were a total of 648 patients with a positive blood culture while being
cared for in a critical care unit, neonatal critical care unit (Level II/
III or Level III) or LTACH during the first quarter of 2010. A total
of 527 (81%) medical records were reviewed. Prior to the study 47
CLABSI were reported. Four (0.8%) of these were over-reported.
Nineteen (33.9%) additional CLABSI were identified that had not
been reported. Furthermore, 20% of the acute care hospitals and
75% of the LTACH had an unreported CLABSI. The two primary
reasons for misclassification of CLABSI were misinterpretation of
the surveillance definition and surveillance errors. Discrepancies
were also identified in surveillance practices and denominator
data reporting. Minimal communication was occurring during the
transferring of patients between facilities, documentation of blood
culture collections needed improvement, and inconsistent collection
of line and patient days was identified. Conclusions: There
was wide variation noted in surveillance practices as well as with
application of definition criteria. Education and guidance were
provided by the auditors to achieve greater consistency across
facilities. With 34% under-reported cases, it was concluded that
ongoing validation of healthcare-acquired infection data is necessary.

Presentation Number 121

Assessment of the Quality and Accuracy of

Publically Reported CLABSI Data in Colorado

Karen Rich, RN, BSN, MEd, CIC - Patient Safety Program

Nurse Consultant, Colorado Department of Public Health and
Environment; Kirk Bol, MSPH - Statistician, Colorado Department
of Public Health and Environment: Tara Janosz, MPH - Patient
Safety Program Epidemiologist, Colorado Department of Public
Health and Environment; Sara Reese, PhD - Colorado Patient Safety

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 179
Oral Abstracts: Quality Management Systems/Process Improvement/Adverse Outcomes

Quality Management Systems/Process this team was reliant on open communication between all members,
and the willingness to be transparent with our outcomes data. The
Improvement/Adverse Outcomes physician team’s buy-in was essential, as was the recognition that
even small changes could result in large improvements in outcomes.
Presentation Number 122 Finally, the strength of objective data collection was demonstrated in
its ability to influence practice change.
Rapid Cycle Process Improvements to Decrease
Surgical Site Infections in Cardiothoracic and
Vascular Surgery Patients between 2008 and 2011

Lee Reed, RN, BA, MSPH, CIC - Infection Preventionist, Novant

Health, Presbyterian Hospital; Leslie B. Sossoman, BSN, MSN,
NP - Acute Care Nurse Practitioner, Novant Health, Cardiovascular
Institute at Presbyterian Hospital; Nancy Honeycutt, RN,
BSN - Clinical Analyst Cardiothoracic Surgery, Novant Health,
Presbyterian Hospital

Issue: The Society of Thoracic Surgeon’s (STS) benchmark

for coronary artery bypass graft (CABG) deep sternal wound
postoperative surgical site infection was 0.2% in 2008. The
rate of deep sternal wound surgical site infection in our
CABG patients was 0.5% in 2008, and rose to 0.8% in 2009.
An infection rate four times the national benchmark was
considered an unacceptable result, and addressing this was made Presentation Number 123
a priority. Project: A Multidisciplinary team was formed
that included infection prevention, quality improvement, Code Flash: An Interdisciplinary Team’s Efforts to
clinicians, anesthesiology, respiratory therapy, pharmacy, nursing Decrease Incidents of Flash Sterilization
administration, and perioperative staff. The team met weekly and
made recommendations in line with evidence-based practice.
Diana K. Griffin - Infection Prevention and Control Nurse,
These recommendations were reviewed by the full cardiovascular
Central Arkansas Veterans Healthcare System; Melissa Ball -
best practice team and implemented at point of care. Since there
Patient Safety Manager, Central Arkansas Veterans Healthcare
were no commonalities easily identified in the infected patients,
System; James Brockway - Chief SPD, Central Arkanas Veterans
the infections were considered multifactorial, and numerous areas
Healthcare System; Sandra Foster - Associate Nurse Exec Med/
were targeted for change. Literature reviews were done to provide
Surg, Central Arkansas Veterans Healthcare System; Renita Jackson
guidelines for preop identification and decolonization of patients
- Sterile Processing Department Supervisor, Central Arkansas
colonized with MRSA. In addition, antibiotic dosing regimens
Veterans Healthcare System; Timothy Mullins - Sterile Processing
were changed to reflect the recommendations in the literature, with
Department Assistant Chief, Central Arkansas Veterans Healthcare
particular attention on weight-based dosing, as well as timing of
System; Patti Thornton - OR Nurse Manager, Central Arkansas
doses and antibiotic selection. Showers with chlorhexidine (CHG)
Veterans Healthcare System: Bonnie Walker - Health Systems
the night before surgery were instituted, with a final bath using 2%
Specialist, VISN 16
impregnated CHG cloths the day of surgery. In addition, CHG was
used both for the preoperative skin prep as well as postoperative
wound care. Dressing changes were treated as sterile procedures, Issue: In an effort to decrease the flash sterilization rates and
requiring full gown, mask, and gloves. Other areas of focus meet the Healthcare Systems standard not to exceed 1% flash
improvement included rigid sternal fixation, perioperative education sterilization rates an interdisciplinary team proposed the possibility
and planning, and early followup after discharge. Results: The of developing a “fast track” method of sterilization that would
deep sternal wound infection rate for isolated CABG decreased replace the Operating Rooms (OR’s) perception of a need to
from 0.8% to zero, and has remained at zero since July 2009. The utilize the steam (flash) sterilizer. Project: This is a tertiary
Cardiovascular Institute was awarded a three star rating for isolated care facility classified as a Level 1a on the Complexity Model.
CABG surgery by the Society of Thoracic Surgeons in 2009, It is a teaching hospital, providing a full range of patient care
which is the society’s highest rating for adult cardiac surgery. The services. Comprehensive healthcare is provided through primary,
program has received this rating for all reporting periods since 2009, tertiary, and long-term care in areas of medicine, surgery, mental
including the most recent period from July 2010-June 2011. A three- health, physical medicine and rehabilitation, neurology, dentistry,
star rating from the Society of Thoracic Surgeons is only achieved ophthalmology, geriatrics and extended care, and women’s health.
by approximately 14% of adult cardiac surgery programs in the It has 280 operating hospital beds on both campuses as well as a
country. The next reporting period, for the calendar year 2011, will 152-bed Community Living Center (formally Nursing Home Care
be announced in early 2012. Lessons Learned: The success of Unit) on its North Little Rock campus. “Code Flash” is a process of
emergently transporting, reprocessing through Sterile Processing and

180 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Oral Abstracts: Quality Management Systems/Process Improvement/Adverse Outcomes
Decontamination (SPD), and returning single instruments to the
OR immediately, thereby eliminating the need for flash sterilization.
When an instrument is contaminated and there is a desire to
perform steam (flash) sterilization, a “Code Flash” is called. The OR
staff notifies SPD immediately via the “Code Flash” pager or phone.
SPD either sends a runner to the OR or awaits the arrival of the
instrument via dumbwaiter. While the contaminated instrument is
transported to SPD, the SPD staff searches the Censitrac database
(which was revamped as a part of this process) for the availability
and location of a duplicate instrument which is already sterilized.
If one is available, the “Code Flash” SPD staff member retrieves the
instrument and delivers it directly to the OR suite. If a replacement
instrument was not available sterile, SPD would continue
reprocessing the contaminated instrument. The SPD staff member
hand carries the instrument throughout reprocessing so there is no
potential for a misplaced instrument and so that the emergent need
is continually communicated. It is also important to note that both
the reprocessing of the contaminated instrument and the search
for a replacement instrument occur simultaneously. Results:
Prior to implementation of the “Code Flash” process the average
flash sterilization rate was between 4% and 6%. Following
implementation of “Code Flash” instances of flash sterilization are
less than 1% and remained at 0% for 7 consecutive months (October
2010 through April 2011). Lessons Learned: This process
has created satisfaction that the OR staff and surgeons have placed
on the process because they do not feel it is necessary to utilize flash
sterilization. This has also enhanced the relationship between OR
and SPD staff. We also have below benchmark infection rates for
surgical patients.

Presentation Number 124

Culture Change and CLABSI Reduction: Achieving

Success in a Medical Center with 10 Distinctively
Different Intensive Care Units

Michael Anne Preas, RN, BSN, CIC - Director Infection

Prevention and Hospital Epidemiology, University of Maryland
Medical Center; Michele Emerick, RN, BSN, CIC - Infection
Preventionist, University of Maryalnd Medical Center; Michelle
Harris- Williams, RN, MSN, CIC - Infection Preventionist,
University of Maryalnd Medical Center; Mala Filippell, RN,
BSN, CIC - Infection Preventionist, University of Maryalnd
Medical Center; Joan Hebden, RN, MS, CIC - Infection
Prevention Consultant, Independant; Kerri Thom, MD, MS
- Associate Hospital Epidemiologist and Assistant Professor of
Epidemiology and Preventive Medicine, University of Marland
School of Medicine; Anthony Harris, MD, MPH - Acting Hospital
Epidemiologist and Professor of Epidemiology and Public Health,
University of Marland School of Medicine; Surbhi Leekha, MPH,
MBBS - Associate Hospital Epidemiologist, Assistant Professor of
Epidemiology and Public Health, University of Maryland School of

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 181
Oral Abstracts: Quality Management Systems/Process Improvement/Adverse Outcomes

Medicine and University of Maryland Medical Center

Issue: An academic medical center with 10 ICUs and nearly 200

ICU beds had an aggregate CLABSI rate of 6.3/1000 central line
days (CL) in 2009. When public reporting of CLABSI rates was
initiated in 2010, our hospital was identified as a poor performer.
Project: In 2009 CLABSI prevention became a primary focus
in the hospital. From the bedside nurse to the Chief Medical Officer
and hospital President, healthcare workers and leaders were engaged
in CLABSI prevention efforts. While several CLABSI reduction
efforts were developed and instituted at an executive level, many
others were unit-based. For each ICU, an Infection Preventionist
(IP) and Hospital Epidemiologist partnered with a unit-based
nurse and physician champion, meeting regularly to discuss all
bloodstream infections providing real-time feedback and identifying
potential opportunities for improvement. This relationship became
a platform for development of unit-based prevention efforts and
culture change. Regular feedback and competition among ICUs
to be the unit with the longest streak of weeks without a CLABSI
increased each unit’s commitment to best practices. The IP team
conducted routine prevalence surveys and audits of all central
venous catheters, dressings and CL insertion checklists. The IP and
Hospital Epidemiologist team participated in monthly educational
sessions for new resident teams as well as informal team huddles
for bedside staff, providing education and emphasis on the issue
of CLABSIs, and elevating involvement of front line staff. Culture
change was critical for implementation of evidence based practices.
Results: Collectively, the ICUs had a 65% reduction in CLABSI
rates over two years from July 2009 to June 2011. During that time,
CLABSI rates among the Trauma ICUs decreased by 71% (from
9.3 to 2.7 CLABSIs per 1,000 CL days), in the Surgical ICUs by
64% (5.5 to 2.0), in the Medical ICUs by 55% (5.8 to 2.6), and
in the NICU by 83% (4.3 to 0.7). CLABSIs per patient months
dropped 70% while lab detected bactermias were reduced by 50%.
Lessons Learned: What began as a small group of healthcare
workers collaborating over CLABSI rates led to a hospital-wide
change in culture around patient safety and infection prevention
resulting in a 65% reduction in CLABSIs, avoidance of 132
CLABSIs, saving 26 patient lives and over 2 million US dollars over
2 years. In an academic institution with 10 distinctively different
critical care units, supporting solid organ transplants bone marrow
transplants, complex emergency surgeries and level III trauma and
level III neonatal care, the challenge to reduce CLABSI initially
seemed overwhelming. Leadership support of unit based efforts and
internal competition were powerful adjuncts to the best practices

that had been recognized by all as far back as 2009. Improvements

and reductions in CLABSI occurred due to the persistent efforts of
both leaders and front line staff.

182 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
Oral Abstracts: Special Populations (Infections in the Immunocompromised Host, Pediatrics)

Special Populations (Infections in the what can we learn from this so it doesn’t happen again.” Results:
75% infection reduction from January 2007 to December 2011. 92
Immunocompromised Host, Pediatrics) post-op C-sections have been avoided since intervention yielding
approximate cost avoidance of $4,600,000. (average of $50,000/
Presentation Number 125 readmission). Culture change: All staff using consistent practice to
avoid infections. Engagement of all staff in infection reduction with
Using a Multi-Faceted Active Change Process and these special high risk patients. Lessons Learned: Patient
Infection Prevention to Reduce Post Op C-Section involvement is crucial for success. C-section SSI IS avoidable, even in
high risk populations.
Infections

Jeanette J. Harris, MS, MSM, BS, MT(ASCP), CIC - Infection

Preventionist, MultiCare Health System; Evelyn Hickson, RN,
MSN, CNS, WCC - Clinical Nurse Specialist, MultiCare Health
System

Issue: C-section patients have a five to twenty-fold greater risk for

infection as compared to vaginal delivery. Factors associated with
an increased risk of infection; emergent C-section, socioeconomic
status, quality of prenatal care, obesity, diabetes, operative technique,
position of the incision, and early staple removal. BMI >30 is
an important added risk for development of wound infections.
National Healthcare Safety Network (NHSN) rates are estimated
to be as high as 6.6% (3.8% in elective, 7.5% following non-elective
operations). Post-op infections in low transverse incisions are
as high as 5% in the general population. Cohort studies report
that patients with BMI>30 have a 2-3 fold increase of C-section
wound infection. A single readmission due to post-op infection
can range from $5,000-$100,000. Project: The site is an inner
city women and newborn department doing 90-95 C-sections a
month with a significant number of high risk patients. The hospital Staff Training/Competency/
has a Level III NICU. Implementation methodology was utilized
for interventions and NHSN definitions and surveillance data was
Compliance
used for outcome measurement. A C-section Bundle was developed
and implemented for all C-section patients. Inclusion Criteria for Presentation Number 126
intervention: BMI>38 Diabetic with poor glucose control large
panus/evidence of skin breakdown steroids, wound complications Active Participation from the Hospital Executive
>2 previous C-sections kelloid development pregnancy induced Team does Improve Hand Hygiene Compliance
hypertension (PIH), hemolysis, elevated liver enzymes, low platelet
count (HELLP) Any other condition where the disease process/ Jan L. Wayland - Infection Control Manager, St Vincents and Mercy
medications add risk for poor wound healing. The bundle included: Private Hospital
CHG surgical scrub pre-op instructions include showering, no
shaving 2 days prior, no powder or lotion use CHG wipes for the
Issue: The purpose of this paper is to demonstrate that
night before, morning of, and right before surgery Interventions
participation by the Executive team in Hand Hygiene auditing has
to decrease skin irritation included not “ripping” the drape off
a positive impact on Hand Hygiene compliance. The national Hand
aggressively at the end of the procedure protecting skin - gently
hygiene program was launched in 2008, and we introduced it to our
peeling drapes no stretching tape across skin increasing tensile stretch
facility in 2009. Initial results showed compliance of 60%, with the
and skin abrasion with dressings dressing standardization Silver
best results being from nurses, with allied health and visiting medical
impregnated dressings for high BMI patients. Emergent patient
practitioners (VMP) having significant room for improvement. We
intervention: CHG scrub over the surgical site and blotted to dry
undertook an intensive education and promotion program for all
by a sterile towel. Post op wound interventions: Dressings changed
staff which demonstrated a gradual improvement to 66% over two
day three unless saturation required changing. Surgical dressing
audit periods. Project: In an effort to improve our compliance
site water resistant covering for showering. Staples removed on day
and raise executive awareness, we introduced a program to facilitate
7-10, not at discharge. Staples on obese patients stay in longer as
the participation of our Executive team In May 2011 six of our
needed. Negative pressure wound therapy for high risk patients. A
Executive team, including the Chief Executive Officer (CEO) and the
post-operative patient education program including proper and safe
Medical Director, undertook and successfully completed the study
wound care. Immediate team notification and root cause analysis
day to become qualified hand hygiene auditors. The participation
for every infection to answer the questions; “What happened and
and support of our senior executive is a critical factor in improving

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 183
Oral Abstracts: Staff Training/Competency/Compliance

our compliance and in particular showing leadership amongst role was not known to hospital staff, recorded comments made by
our VMPs. The Executive team audit for a minimum of 2 hours a HCWs in response to observer presence on a unit. Observations were
month each across all sites. They are very active in providing positive conducted in 5-day increments, and observers maintained a varied
feedback and education where required at the time of auditing. schedule and were unannounced. Comments were recorded and
Results: To identify the effect, if any, of having the executive assigned to one of six predetermined categories by five independent
team as active participants in our hand hygiene program, we used raters. Raters then discussed comments for which categorization was
the first and third audit period for 2011 as comparison periods (no disparate, in order to achieve consensus. Predetermined categories
data was collected for the second period). Data collection processes included: ‘Hyper-compliant/Credit seeking’ (HCW made an
remained unchanged between the two periods, with the only extra effort to demonstrate compliance with hand hygiene or
difference between the periods being the presence of the Executive responsibilities), ‘Role clarifying’ (HCW inquired about observer’s
team members. The first audit demonstrated a result of 67% role on a unit), ‘Negative’ (HCW demonstrated resentment about
compliance. The third audit period, with support and participation observer’s presence and/or monitoring), ‘Greeting/Offering help’
from the Executive team, resulted in compliance of 75%. This result (HCW welcomed observer and/or offered assistance), ‘Information
was reinforced by our exceeding the most recent private hospital seeking’ (HCW inquired about infection control policies), and
national benchmark figure of 71%. We have demonstrated that the ‘Feedback seeking’ (HCW inquired about unit compliance with
active participation of the Executive team has a positive effect on infection control policies). Results: During a three-month
hand hygiene compliance. Lessons Learned: Leadership period, 99 comments were collected and sorted into categories.
and participation by the Executive team is essential to improving Thirty-four percent of responses by HCWs to observers were ‘hyper-
compliance with hand hygiene. The promotion by our executive team compliant.’ Twenty-nine percent of comments were inquiries about
of hand hygiene, and the approach taken by them when correcting or the observer’s role on a unit. While 16% of responses were ‘negative,’
praising staff has been critical in staff seeing this as a positive program. 10% of responses were greetings and offers of help. Five percent of
The CEO and Medical Director are the most effective in changing responses were ‘information seeking’ and 5% were ‘feedback seeking.’
practice. Aditionally, there must be an ongoing commitment from Conclusions: The high frequency of ‘hyper-compliant’
the Executive team to successfully implement the program. The CEO responses in this study suggests that measures of adherence to hand
has provided positive feedback from his experiences, and uses staff hygiene and isolation protocols obtained using direct observation are
forums and relevant meetings to constantly reinforce the requirement likely to overestimate true adherence rates when HCWs are not being
for Hand Hygiene. Additionally it provides the opportunity to observed, which limits the utility of such data for the purposes of
engage VMPs and raise their awareness in a clinical setting, not just in research and mandatory reporting. However, the results also suggest
a meeting room. that overall adherence may improve if HCWs have the impression
they are being routinely monitored. Furthermore, examining
HCW responses to direct monitoring may help to identify reasons
for noncompliance with protocol: in our study, HCWs informed
Presentation Number 127
observers of issues that prevented them from following proper
procedures and asked clarifying questions about isolation precautions
Healthcare Worker Response to Direct Monitoring (e.g. which personal protective equipment were appropriate to wear).
of Adherence to Isolation Precautions

Carolyn Herzig, MS - PhD Candidate, Department of

Epidemiology, Columbia University; Bevin Cohen, MPH - Project
Coordinator, Columbia University School of Nursing; Nicole Surveillance
Geller, MPhil, MS, CNM - PhD Candidate, Columbia University
School of Nursing; Melissa Marine, BS - Project Coordinator, Presentation Number 128
Columbia University School of Nursing; Amanda Wilkman, RN,
BSN, PHN - Graduate Student, Columbia University School of
Relative Frequency of Healthcare-Associated
Nursing; Elaine L. Larson, RN, PhD, CIC- Associate Dean for
Research, Columbia University School of Nursing
Pathogens and Incidence of Healthcare-Associated
Infections by Pathogen at a University Hospital
Background/Objectives: Direct observation conducted from 2006 to 2010
by trained personnel is considered the ‘gold standard’ for assessing
healthcare worker (HCW) hand hygiene compliance and adherence JaHyun Kang, RN, BSN, BA, MPH, CIC - PhD Candidate,
to isolation precautions. However, like other methods used to audit School of Nursing, University of North Carolina at Chapel Hill;
compliance, direct observation has its shortcomings. The objective Emily E. Sickbert-Bennett, PhD - Public Health Epidemiologist,
of this study was to evaluate and discuss the challenges associated Director of Surveillance Programs, Department of Hospital
with obtaining accurate direct observations of adherence, based on Epidemiology, University of North Carolina Health Care, Chapel
HCW responses to trained observers. Methods: This project Hill, NC; Vickie M. Brown, RN, MPH, CIC - Associate Director,
was part of a larger study to assess adherence to transmission-based Hospital Epidemiology, Department of Hospital Epidemiology,
isolation precautions in four hospitals within a large, academic University of North Carolina Health Care, Chapel Hill, NC; David
healthcare network in New York City. Four trained observers, whose J. Weber, MD, MPH - Medical Director, Hospital Epidemiology

184 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Oral Abstracts: Surveillance
and Occupational Health, Department of Hospital Epidemiology,
University of North Carolina Health Care, Chapel Hill, NC;
William A. Rutala, PhD, MPH - Director, Statewide Program
for Infection Control and Epidemiology & Director, Hospital
Epidemiology,, Department of Hospital Epidemiology, University of
North Carolina Health Care, Chapel Hill, NC

Background/Objectives: The information on relative

frequencies is useful for describing the epidemiology of isolated
pathogens from healthcare-associated infections (HAI) and for
implementing infection control strategies. The relative frequency
of healthcare-associated pathogens might be impacted over time by
several factors such as increased use of broad-spectrum antimicrobials
and frequent use of invasive devices. For better interpretation of HAI. Conclusions: Significant changes in the relative
of relative frequencies of healthcare-associated pathogens, the frequency and in the incidence of HAI by healthcare-associated
review of the relative frequency with the incidence of healthcare- pathogens occurred from 2006 to 2010. The incidence rates of HAI
associated infections by pathogen is needed. Methods: All per 1,000 patient-days by 5 pathogen groups significantly decreased
data on healthcare-associated pathogens based on comprehensive although patient-days increased significantly during study period.
hospital-wide surveillance by trained infection preventionists were Only C. difficile showed significant increase in the relative frequency
extracted from our electronic hospital epidemiology database as well as in the incidence of HAI.
from 2006 to 2010. Patient-days data were extracted from hospital
census data for the study period. All pathogens were grouped into
18 categories. Interesting pathogens (e.g., methicillin-resistant Presentation Number 129
Staphylococcus aureus) were selected individually. The incidence of
HAI by healthcare-associated pathogen were calculated per 1,000 Comparison of Methods for Surgical Site Infection
patient-days. Simple regression was used to test for the changes
Surveillance: Traditional Report Review and
in patient-days during study period. To estimate trend changes in
the yearly relative frequency of pathogen and in the incidence of
Electronic Surveillance
HAI by pathogen, logistic regression analysis was conducted using
SAS version 9.2. Results: 7,407 pathogens were isolated from Sarah A. Jadin, MPH, CIC - Sr. Clinical Consultant-Infection
6,120 (86.2%) of 7,104 HAI during 5 years (Table 1). Among Prevention, Premier healthcare alliance
pathogen groups, in the relative frequency, Staphylococcus aureus,
“Clostridium difficile and other anaerobes”, Acinetobacter species, Jennifer R. Peeples, MPH - Sr. Clinical Consultant-Infection
Serratia species, and Hemophilus species increased significantly Prevention, Premier healthcare alliance; Gail M. Shenk, BS - Sr.
whereas Escherichia coli and coagulase negative staphylococci (CoNS) Manager, Premier healthcare alliance
decreased significantly. During the study period, patient-days
increased significantly (P value, <.05). However, in the incidence Background/Objectives: Surgical site infections (SSI)
of HAI by pathogen group, E.coli, Enterococcus species, CoNS, continue to be a major source of morbidity and mortality and are
“Candida and other yeasts”, and other pathogen group decreased a focus with many infection prevention programs. Additionally,
significantly whereas “C. difficile and other anaerobes” increased the scope of SSI surveillance has grown for many programs due
significantly. Although S.aureus showed significant increases in the to mandatory state and national reporting. Identification of these
relative frequency, it showed significant decrease in the incidence of infections is a time consuming process that traditionally involves
HAI. “C. difficile and other anaerobes” and C. difficile alone showed reviewing microbiology and admission complaint reports. Another
significant increase in the relative frequency as well as in the incidence identification method is utilizing an electronic surveillance system
(ESS) where patients that meet certain criteria trigger alerts for
review. These two methods were compared. Methods: The
study period was August 1st to November 30th, 2011. Procedures
generally not in infection prevention surveillance plans such as
cataract procedures, cystoscopies and bronchoscopies were excluded.
Manual surveillance was performed by generating a report of all
inpatient and outpatient wound cultures and a report of admission
complaints. The admission complaint report was filtered to include
only patients who had a complaint indicative of a sign or symptom
in the Centers for Disease Control and Prevention definition for
SSI. An ESS was utilized to flag patients that had a culture collected
from a wound source or had been readmitted to the hospital after
having a procedure with an implant in the previous 365 days or 30
days with a non-implant procedure. Descriptive statistics comparing

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 185
Oral Abstracts: Surveillance
the two surveillance methods were calculated. Results: Surgical increase in the hospital-wide, healthcare-related VRE rate after reflex
site infection surveillance was performed for 5769 procedures. Using testing was discontinued (pre rate= 0.22 versus post rate= 0.39 per
the traditional method of reviewing microbiology and admission 1000 patient-days, p<0.01) (see Table). Based on total patient days,
complaint reports, there were 932 instances, representing 705 unique this resulted in an additional 14 patients with VRE bacteremia and
patients, that would need to be investigated. The ESS triggered 564 34 patients with VRE bacteriuria in the post-discontinuation period,
alerts for 356 unique patients. There were 139 patients that were compared to the reflex testing period. During the discontinuation
identified by both methods. Conclusions: As mandatory SSI period, the institution saved $20,920 in laboratory costs ($4/ VRE
reporting expands to include additional procedures, efficient methods test x 5230 tests). Isolation bed avoidance saved approximately
for identifying potential infections are needed. The ESS method $95,788 ($77/ isolation bed per day x 1,244 less VRE isolation
yielded a much smaller number of patients that would be reviewed days). However, based on estimates in the literature, the cost of
by an infection preventionist. Patients that were identified using the treating the excess VRE bacteremia alone was approximated at $
traditional method but not by the ESS were mainly patients that had 139, 286 ($9,949/ bacteremia x 14 excess bacteremias), resulting in
wound cultures or infection admission complaints but no procedure an excess cost of approximately $22,578/year without reflex testing.
history. The ESS identified patients not found by the traditional Conclusions: Discontinuing reflex testing for VRE of stool
method when they had readmissions that were unrelated to an submitted to the laboratory for Clostridium difficile testing resulted
infection or past procedure. Ideally, the ESS could be enhanced to in an increase in the rate of healthcare-related VRE and was not
include only select readmissions instead of all readmissions. Further cost-effective. Based on these results, reflex testing was re-instituted in
studies are needed to evaluate the sensitivity and specificity of these January 2012.
methods in detecting confirmed infections.

Presentation Number 130

Discontinuation of Reflex Testing of Stool Samples

for Vancomycin-Resistant Enterococci Resulted in
Increased Prevalence

Mandy M. Bodily, RN, BSN, MPH - Infection Prevention

Specialist, Barnes-Jewish Hospital; Kathleen McMullen, MPH,
CIC - Infection Prevention Specialist, Barnes-Jewish Hospital;
Anthony Russo, MPH - Data Analyst, Barnes-Jewish Hospital;
Joan Hoppe-Bauer, BA, BS, MT(ASCP) - Clinical Microbiology
Laboratory Manager, Barnes-Jewish Hospital; David Warren, MD,
Presentation Number 131
MPH - Associate Professor of Medicine, Washington University in
Saint Louis
Validation of Infection Preventionists Surveillance
Background/Objectives: From 1999 to June 2010, for Determining Hospital-Acquired Central Line-
stool submitted to the microbiology lab for Clostridium difficile Associated Bloodstream Infection Using Centers
testing was also tested for vancomycin-resistant enterococci (VRE), for Disease Control and Prevention Definitions
which was termed “reflex testing.” Reflex testing was performed
because Clostridium difficile and VRE have several common risk Megan J. DiGiorgio, MSN, RN, CIC - Infection Prevention,
factors. Patients who were colonized with VRE were placed in Cleveland Clinic; Mary Bertin, BSN, RN, CIC - Infection
contact precautions to reduce hospital transmission. Concerns Prevention, Cleveland Clinic; Joan Vinski, MSN, RN, CIC
were raised about the cost/benefit ratio of this testing. Healthcare- - Infection Prevention, Cleveland Clinic; Zhiyuan Sun -
related VRE rates were found to remain stable in the hospital over Biostatistician, Cleveland Clinic; Nancy Albert, PhD, RN, CCNS
the last decade. Based on lack of clear evidence that reflex testing - Director of Nursing Research, Cleveland Clinic
was affecting VRE rates, reflex testing was discontinued in July
2010. The hospital infection prevention team continued to monitor Background/Objectives: Infection Preventionists
hospital-wide, healthcare-related VRE rates after the reflex testing (IP) follow Center for Disease Control (CDC) definitions for
was discontinued. Methods: A healthcare-related VRE case was surveillance of hospital-acquired infections including central-line
considered a patient with detection of VRE from blood and urine associated bloodstream infections (CLABSI), but there is no option
cultures >48 hours after admission. Healthcare-related VRE rates for an unknown or indeterminate conclusion and inter- and intra-
were expressed per 1000 patient-days. Rates during the reflex testing hospital comparison of CLABSI rates were fair (kappa coefficient
period (1/2009 to 6/2010) were compared to the post-testing period 0.31). The purposes of the study were to determine CLABSI inter-
(7/2010 to 6/2011) using chi square analysis (Epi Info 6, 1993). Cost rater reliability, to examine factors that might influence variation in
effectiveness of discontinuation of reflex testing was also evaluated. results and measure frequency of use of an indeterminate category
Results: Compared to the reflex testing period, there was a 78% when cases did not fit CDC CLABSI definitions. Methods:

186 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Oral Abstracts: Surveillance
A prospective review of 165 blood cultures was completed at a
1200+ bed tertiary-care hospital. Two randomly-assigned IPs (of
8 possible IP) reviewed each culture and patient medical records.
IP characteristics and blood culture results were collected by
survey. Inter-rater reliability was determined by kappa reliability
coefficient, and correlational and comparative statistics were used
to determine if IP characteristics were associated with inter-rater
reliability results (CLABSI and other blood culture results). Logistic
regression was used to assess IP characteristics associated with
agreement on CLABSI and other blood culture factors. Generalized
estimating equations were used to account for correlation between
samples evaluated by the same pair of IPs. Results: Mean time
to making a CLABSI determination was 11.9 (± 6.5) minutes.
CLABSI agreement (standard error) by IP pairs was moderate
(0.562 ± 0.080). When 10 blood cultures were removed due to
classification as “contaminant”, kappa remained moderate (0.599 ±
0.078); both P<0.001. When assessing agreement based on sample
source (hospital or community acquired) as primary, secondary or
intermediate, IP agreement was moderate: 0.423 ± 0.062; P<0.001.
There were no differences in agreement on CLABSI determination
by IP characteristics (years as a RN or as an IP, length of employment,
and certification status). When IPs were MSN prepared or had more
experience as a RN, there was more disagreement in determination
of infection type (P=0.002 and 0.03, respectively). There was greater
agreement in infection source determination in IPs with longer
employment and certification (both P=0.02). After controlling
for IP characteristics, agreement in secondary source was more
likely in IP pairs with larger absolute difference in years employed:
odds ratio (OR) and 95% confidence intervals (CI), 1.088 (1.018,
1.164); P=0.013. Differences in years employed between IP pairs
and certification remained associated with infection source: OR
(95% CI): 1.102 (1.004, 1.210), P=0.04 and 1.444 (1.047, 1.967),
P=0.025, respectively. Conclusions: Agreement of CLABSI
between IP pairs was moderate, which was higher than in previous
research reports. IP characteristics were not associated with IP pair
agreement of CLABSI, reflecting adequate training. Agreement
of some factors differed by some IP characteristics. Education
and/or CDC reassessment of definitions (e.g., infection source)
may promote clarity that could enhance IP pair agreement when
examining blood cultures.

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 187
188 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
Financial Disclosures The following authors provided disclosures

Key: author’s last name is followed by Donskey, Curtis J., MD Jadin, Sarah A., MPH, CIC
first initial, disclosure information and 3M (Consultant / Advisory Board); Premier healthcare alliance
EcoLab (Consultant / Advisory Board); (Employment)..............................129, 16-234
publication number(s). Pfizer (Research Grant);
Jagrosse, David M., CRCST,CSPDT,AAMI ST79
STERIS (Research Grant);
For example: Broaders, S. Clorox Services ViroPharma (Research Grant)...........10-143
workgroup
Company, Employment…. 2-016, where 3M (Other Financial or
Dumigan, Diane G., RN, BSN, CIC Material Support)....................................8-101
the last name is Broaders, the first initial Sage Products (Other Research
is S, the disclosure information is Clorox
Services Company, Employment, and then
Support, Research Grant)......................5-057 K
Katz, Kevin
publication number is 2-016. If a speaker is E Pfizer (Consultant /Advisory Board,
not listed they had nothing to disclose. Edmiston, Jr, Charles E., PhD Other Research Support,
Ethicon, Inc (Honoraria).......................4-033 Research Grant).....................................16-229
Edmonds, Sarah, MS in Biology Kirk, Jane M., MSN RN CIC
GOJO Industries, Inc GOJO Industries (Employment).......14-201
(Employment).............................................102
Kralovic, Stephen, MD, MPH
A Edmonds, Sarah, MS in Biology BARRX Medical, Inc
Alper, Paul, BA GOJO Industries, Inc. (Other Research Support).....................8-109
Deb Worldwide Healthcare, Inc. (Employment)........................................14-201
(Employment)..........................................8-082 L
Amitov, Chingiz, MPH, CIC F Larson, Elaine L., RN, PhD, CIC
Sage Products Inc (Other Financial or Fauerbach, Loretta Litz., MS, CIC, FSHEA Deb Healthcare (Research Grant).......8-082
Material Support)..................................14-204 Hospira/Theradoc (Consultant /
Leaper, David, MD
Advisory Board).......................................2-023
Anderson, Karen Ethicon, Inc (Honoraria).......................4-033
CareFusion Favret, Uncas B., BS
Ledeboer, Nathan A., PhD
(Honoraria, Speaker’s Bureau)..............4-039 Vestagen (Employment,
bioMerieux (Consultant/Advisory Board,
Ownership Interest)................................7-075
Arbogast, James W., PhD Research Grant); Cepheid (Consultant /
GOJO Industries, Inc. Advisory Board); ThermoFisher Scientific
(Employment).................................102, 2-013 G (Consultant/Advisory Board)............10-144
Graf, Jeanine, MD.......................................................13-190
Levine, Ronald
Gupta, Nisha, PhD
B Teleflex Medical (Employment)...............107
Johnson & Johnson (Employment).....4-042
Barbosa, Luciana Rezende. Lovick, Helena
GOJO AmÈrica Latina
(Employment).......................................15-215
H Bacterin International, Inc.
(Employment)..........................................4-048
Hannon, Carla V., RN, MS, APRN, CCRN
Baxter, Kathleen, SM, AAM Sage Products (Other Financial or Luchsinger, Ben
3M (Other Financial or Material Support)....................................5-057 RyMed Technologies
Material Support)....................................8-100 Harris, Linda G., BS, MT-ASCP (Consultant/Advisory Board)..............4-047
Bommarito, Marco, PhD Kimberly-Clark
3M (Employment).........................111, 8-100 Corporation (Employment)..................7-075 M
Havill, Nancy L., MT(ASCP) Macinga, David R., PhD
Boyce, John M., MD GOJO Industries, Inc
Becton-Dickinson...................................5-057 3M Corporation
(Speaker’s Bureau)...................................2-019 (Employment).................................102, 2-013

C Hesse, Louise Mascola, Laurene, MD, MPH

MedImmune (Speaker’s Bureau);
Carling, Philip C., MD Nevada State Health Division Of
Healthcare Quality and Compliance Merck (Speaker’s Bureau).......................9-136
Ecolab (Consultant/Advisory Board,
Other Financial or (Research Grant).....................................8-119 Mauzey, Sonya, RN, BS, CIC
Material Support).................................15-216 Hoffman, Matthew G. SAGE.........................................................4-031
Chan-Myers, Harriet Sharklet Technologies, Inc. May, Rhea M.
Advanced Sterilization Products (Employment)..........................................4-045 Sharklet Technologies Inc.
(Employment)..........................................2-011 Hollenbeak, Christopher S., PhD (Employment)..........................................4-045
Chang, Gladys ThermoFisher Scientific (Consultant / Melgar, Mario, MD
Advanced Sterilization Products Advisory Board)....................................10-144 Glaxo Smithkline (Speaker’s Bureau);
(Employment).........................................2-011 Hooker, Edmond A., MD, DrPH Novartis (Research Grant); Pfizer
Trinity Guardion (Speaker’s Bureau)........................114, 16-245
D (Research Grant)......................................2-021 Meyer, Todd R.
Daley, Jacqueline, HBSC, MLT, CIC, CSPDS Bacterin International, Inc.
Hurst, Debbie, RN, BSN
3M (Speaker’s Bureau); (Employment)..........................................4-048
Biopatch (Speaker’s Bureau);
Sage (Speaker’s Bureau)..........................7-075
CareFusion (Consultant/ Morse, Dan J.
Daoud, Frederic C., MD, MSc Advisory Board).......................................2-017 3M (Employment).........................111, 8-100
Ethicon, Inc
Moss, Shanna D., Bachelor of Life Sciences
(Other Research Support).....................4-033 J Teleflex Medical (Employment)...............107
Daskiran, Mehmet Jackson, Daisy, CIC
Premier healthcare alliance Mull, Rhonda
Johnson & Johnson (Employment).....4-042
(Employment).......................................16-235 Premier healthcare alliance
(Employment)........................................16-235

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 189
 Financial Disclosures

N (Speaker’s Bureau); Sanofi (Speaker’s

Bureau)......................................................9-136
Nigam, Somesh
Johnson and Johnson Teska, Peter, BS, MBA
(Employment).........................................4-042 Diversey Inc (Employment).................2-016
Thornhill, Grace A., PhD
P 3M (Employment)......................................111
Patkar, Anuprita
Tsuchida, Toshie
Johnson and Johnson
3M Health Care Ltd.
(Employment)..........................................4-042
(Research Grant).....................................4-040
Pavia, Marianne, MT(ASCP), CLS, CIC
Excelsior Medical (Other Financial
or Material Support)...............................2-014
W
Warren, David, MD, MPH ...........................................130
Peeples, Jennifer R., MPH Weisberg, Martin, MD
Premier healthcare alliance Ethicon, Inc (Employment)..................4-033
(Employment)..............................129, 16-234
Wiemken, Timothy L., PhD, MPH, CIC
Peterson, Lance R., MD Clorox (Research Grant).......................2-010
Excelsior, Inc (Research Grant)................104
Woeltje, Keith F., MD, PhD
Q Johnson and Johnson (Honoraria)....12-175
Quinn, Barbara, MSN, RN, ACNS-BC Wolven, Scott
Sage Medical (Research Grant)..........12-178 Ethicon, J&J (Employment)..................4-042
Qutaishat, Salah, PhD, CIC, FSHEA Wright, Marc-Oliver, MT(ASCP),MS,CIC
Diversey Inc (Employment)..................2-016 Excelsior, Inc (Honoraria).........................104

R Y
Reddy, Shravanthi T. Yadalam, Sashi
Sharklet Technologies Inc. Johnson and Johnson
(Employment)..........................................4-045 (Employment)..........................................4-042
Rivera, Pedro .....................................................................109
Rowland, Douglas Y., PhD
GOJO Industries, Inc. (Consultant /
Advisory Board)....................................14-201

S
Saiman, Lisa, MD, MPH
DebHealthcare (Research Grant)........8-082
Satterwhite, Erin A., MS
3M Company (Employment)...............2-015
Schallenberger, Mark
Bacterin International Inc
(Employment)..........................................4-048
Schleder, Bonnie J., APN, MS, CCRN, TNS
Sage Products (Honoraria).................12-159
Schweon, Steven J., RN, MPH, MSN, CIC, HEM
GOJO Industries (Consultant/
Advisory Board, Honoraria)...............14-201
Shenk, Gail M., BS
Premier healthcare alliance
(Employment).............................................129
Shumaker, David J.
GOJO Industries, Inc
(Employment).................................102, 2-013
Singh, Jasjit, MD
Sanofi Pasteur (Speaker’s Bureau).........7-073
Sissodia, Pushpa ............................................................8-096
Stahl, Julie B.
3M (Employment)..................................8-100

T
Terashita, Dawn, MD
Amylin (Speaker’s Bureau); Boeing
(Speaker’s Bureau); Forrest (Speaker’s
Bureau); Lily (Speaker’s Bureau); Novo
Nordisk (Speaker’s Bureau); Pfizer

190 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
The following authors have nothing to disclose

Braswell, Gregory, MBA .............................................6-066 Currie, Donna, MSN, RN .......................................16-236

Key: author’s last name is followed by Brazzell, Brenda D., RN, BS ....................................12-151 Curtin, Janet L., MT(ASCP), BS, CIC ................12-162
first initial and publication number(s). Bren, Virginia, RN, MPH, CIC ................................8-112 Das, Manoj , MBBS .....................................................1-001
Briggs, Janet, RN, BSN, CIC .....................................4-029 Dasagi, Meenakshi , BDS ...........................................5-060
For example: Bagar, K. …. 9-094, Brittingham, Lori, RN, BSN ...................................16-243 Dassey, David, MD, MPH .........................................9-136
Brockway, James ................................................................123 Datla, Satya , MBBS ....................................................5-060
where the last name is Bagar, the first
Bronstein, Melissa Z., RN, MPA, CIC ....................9-131 De Amaya, Armando, RN, BSN, PHN ...................8-111
initial is K, and the publication Brown, Vickie M., RN, MPH, CIC .............................128 De la Torre, Alethse .........................................................105
number is 9-094. Brown, John T., RN ...................................................12-159 DeAngelis, Dianne L., RN, ICP, CIC ...................15-222
Brown, Lynne, RN, BSN, MBA ................................9-131 DeLaMora, Patricia, MD .........................................16-231
Abate, Hector Jose, MD...............................................8-128 Brudner, Corrinna , BSc, CPH I (C), CIC ................115 DeVita, Stefanie, BSN, RN, MPH .........................15-217
Abbadi, Deepika Reddy, MBBS.................................1-001 Buet, Amanda E., MPH ..............................................8-082 Dhyani, Ruchi ...............................................................2-020
Abraham, Frances P., Dr.PH, RN, CIC....................8-083 Bunson, Jessica, MT(ASCP), MS, CIC ..................8-097 Dickson, Angela D., RN, CIC ................................16-241
Abreu Lanfranco, Odaliz E. ..................................101, 118 Burger, Terry Lynn., MBA, BSN, RN, Diez, Linda, RN, CIC ...............................................15-218
Acebo, Joanna, MD ......................................................8-117 CIC, NE-BC ...............................................................12-177 DiGiorgio, Megan J., MSN, RN, CIC .........................131
Acevedo, Carlos, RN ...................................................8-128 Burnaugh, Robert, MD, FCCP .................................4-029 Dillon-Grant, Mary, RN, MS ........................................104
Adams, Audrey, RN, MPH, CIC ...........................16-244 Butler, Jacqueline P., CIC .........................................16-228 Disharoon, Erica L., MS, RN, CIC ..........................5-058
Aguilar, Maria N. ..........................................................8-126 Cadnum, Jennifer, BS ................................................10-143 Diviti, Sreelatha , MBBS .............................................1-001
Ajamoughli, Mayan, MD ............................................1-001 Campbell, Esther ..............................................................102 DO, HANG KIM. ....................................................12-169
Al Thaqafi, Abdulhakeem ...........................................4-052 Candon, Heather L., M.Sc., CIC ...........................14-204 Doddamani, Rajiv , MBBS .........................................1-001
Alba, Luis, BS ..............................................................16-231 Caniza, Miguela, MD .....................................................114 Doerflein, Barbara, BSMT (ASCP) CIC .............14-199
Albert, Nancy, PhD, RN, CCNS ..................................131 Caniza, Miguela, MD ...............................................13-188 Dogan, Aclan, MD .......................................................4-028
Allen, Brady, RN, BSN, CIC ...................................15-212 Canola, Maria T., RN, MSN, MPH, CIC ..............8-111 Dolendo, Mae, MD ...................................................13-188
Almarez-Fox, Vicki, RN, MPA ...............................15-213 Carpenter, Matthew ..................................................12-154 Dominguez, Samuel R., MD, PhD ...........................9-129
Alshabani, Khaled, MD ..............................................1-001 Carra, Michele A., BS, MT ASCP, CIC ...............16-239 Dougherty, Ellen C., RN, BSN, MA, CIC ...........13-191
Alspaugh, Martha, RN, BA, BS, CIC ......................8-110 Carrier, Carol Turnage., MSN, RN, CNS, CPHQ .....4-035 Doughty, Diana, RN, MBA, CIC, CPHQ ................120
Altpeter, Terry, PhD, JD, RN .....................................8-103 Carriker, Charlene, BSN, RN, CIC .......................12-165 Douglas, Barbara ...........................................................8-081
Amato-Hayes, Margaret, BSN, RN, MSED ...............109 Castillo-Deluao, Czarina Mae, RN ........................13-188 Driscoll, Mari, RN, CIC ...........................................12-177
Anderson, Cindy, BSN, RN .....................................16-232 Cato, Kenrick, RN .....................................................12-168 Duchon, Jennifer, MDCM, MPH .........................12-168
Andrews, B. Joann, RN, MS, CIC ............................2-018 Chamorro, Miriam .......................................................8-126 Duenas, Miriam De Lourdes. .....................................8-115
Anthony, John .............................................................14-198 Chenoweth, Carol, MD ............................................12-156 Dunton, Donna, RN, BSN, CIC ............................15-217
Antillon-Klussmann, Federico, MD .............114, 16-245 Chidurala, Sowmya , MBBS .......................................1-001 Duran Arias, Loreta I., MSc .....................................12-180
Apa, Zoltán, BS ................................................................100 Chock, Les, MS, SM (ASCP),CIC, CHEP ...........9-132 Dziewior, Amy M., BSN, RN ..................................12-166
Apenhorst, Debra, MA, RN ....................................15-218 Choi, Yoon Jeong, RN, MSN ..................................13-197 Eagan, Janet A., RN, BSN, MPH, CIC ................13-191
Arashin, Kelly, RN, MSN, CCNS, ACNP, CEN....4-029 Chopra, Teena, MD .....................................................8-118 Eck, Enid K., RN, MPH .............................................8-090
Aronhalt, Kimberly, MA, RN .................................15-218 Chou, Teresa, MPH, CIC ..........................................4-043 Eguiguren, Jose M., MD .............................................8-117
Arrunategui, Anita, RN, CIC ....................................4-032 Chou, Teresa, MPH, CIC ..........................................6-070 El-Amin, Hamidah Franchette., LVN ...................12-181
Aviles, Martha ................................................................9-138 Chowdary, Deepti, MBBS ..........................................1-001 Elliott, Michael B., PhD ..............................................3-024
Ayers, Marie W., RN, CIC .........................................2-023 Christie-Smith, Angela, RN, BSN ............................9-133 Ellison, Richard T. ........................................................6-063
Azizi , Jahan .......................................................................103 Chu, Sheena, MS ..........................................................9-136 Emerick, Michele, RN, BSN, CIC ..............................124
Babcock, Hilary, MD, MPH ...................................12-175 Cianci, Ellen, MT (ASCP), MS. .............................12-161 Emerson, Jennifer, RN ..............................................12-164
Bahrani-Mougeot, Farah .............................................5-059 Clark, Ashley ...............................................................15-220 Emmett, Patricia, MS, RN, CIC ...............................4-054
Bai, Sarika , MBBS, MD .............................................1-001 Clarke, Karen A., MD, MS, MPH, FACP ..................4-026 English, L’Tanya, RN, MPH ......................................9-136
Bailey, Kathy M., RN, CIC ........................................4-038 Clifton, Marla, RN, MSN CIC .................................8-109 Erickson, Lars ................................................................6-063
Baker, Dian, PhD, APRN-BC .................................12-178 Clock, Sarah, PhD ......................................................16-231 Erlichman, Rosemarie, RN, BSN, CIC ...................6-063
Ball, Melissa .......................................................................123 Cloud, Rinn M., PhD.................................................. 7-075 Evanko, John C., MD, MBA ....................................15-213
Barnes, David W., MD, Infectious Disease .............8-087 Coddington, Lori, MSN, RN-BC ..........................15-222 Evans, Jacquelyn R., MD, FRCP, FAAP ...............16-243
Barrera, Dinora, nurse .................................................8-115 Coffin, Susan, MD, MPH ........................................16-243 Evans, Martin, MD .......................................................8-109
Basile, Cindy, RN, MSN, CCRN .............................4-032 Cohen, Bevin, MPH ........................................................127 Fakih, Mohamed, MD, MPH ....................................4-053
Bathina, Pradeep, MBBS ............................................1-001 Cohen, Lisa, RN ...............................................................109 Falaschi, Andrea, MD ..................................................8-128
Baumann, Michael H., MD ........................................8-093 Cohen, Bevin, MPH ....................................................8-082 Faller, Rebecca C., MPH ..........................................15-218
Baxter, Helen C. .........................................................16-230 Colbert, Larry T., MA, CIC ..................................... 4-036 Faris, Linda, BSN MSEd CIC CPHQ ....................8-092
Baxter, Robert L. ........................................................16-230 Cole, David .......................................................................119 Feigel, Jody .....................................................................8-081
Bebinger, David M., MD ................................................117 Cole, Mary A., BSN, CIC ......................................... 1-003 Ferng, Yu-hui, MPA ...................................................16-231
Beckham, Bradley .........................................................6-066 Collins, Beverly, RNC, MS ......................................12-173 Ferrelli, Julliet, MS, MT(ASCP),CIC .....................8-091
Ben, Hilda P., RN, BSN, CIC .................................12-181 Compton, Audrey, MD, MPH ...............................15-213 Fertelli, Dennis ...........................................................10-143
Beno, Lisa, RN, MN, Alumnus CCRN ................16-234 Connelly, Beverly, MD ..............................................12-184 Fierro, Julie, BA ..........................................................16-231
Berman, David M., D.O. ..........................................13-194 Conrad, Elizabeth , MS ...............................................7-076 Filippell, Mala, RN, BSN, CIC .....................................124
Berriel- Cass, Dorine, RN, BSN, MA, CIC .........10-141 Conway, Laurie, RN, MS, CIC .................................8-105 Filippone, Christine, DNP, ANP, CIC .................12-183
Berrios, Ray ........................................................................109 Cooper, Hillary B., RN, MS, CIC ............................2-007 Fine, Lynn, MPH, PhD, CIC ....................................9-131
Bertin, Mary, BSN, RN, CIC ........................................131 Coppa, Nicholas , MD ................................................4-028 Finerman, Ruthbeth, PhD .............................................114
Betts, Wendy , RN, BSN, CIC ..................................8-110 Cormier, Scott ...................................................................110 Finerty, Eileen A., MS, RN, CIC ...........................12-157
Bhargava, Ashish, MD .................................................5-060 Cortes, Lizette ...............................................................7-076 Finney, Joan, RN, BSN, CIC ...................................11-148
Bodily, Mandy M., RN, BSN, MPH ............................130 Crews, Jonathan, MD ................................................13-189 Fisher, Adrienne , MT(ASCP), CIC ...........................115
Boehm, Sue, RN ...............................................................104 Crimmins, David, RN, CIC ..........................................109 Fisher, John ..................................................................12-154
Bol, Kirk, MSPH ..............................................................121 Crump, Melissa .............................................................8-080 Fitzgerald, Teresa A., BSN, RN, CIC ....................15-216
Bonfanti, Paolo ..............................................................8-095 Crumpacker, Brittany, RN, BSN ............................15-220 Flanagan, Elaine , BSN, MSA, CIC .........................1-001
Bowman, Starr-Nell, BS, MBA ..................................8-078 Cruz, Willi, RN ..........................................................12-173 Fless, Kristin G., MD ................................................12-161
Boychuk, Ruby V., RN, CHN ...................................6-067 Cunningham, Terrell, BS, RN ...................................7-075 Flynn, Andrea, RN-C, MS .........................................8-098

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 191
The following authors have nothing to disclose

Fofah, Ona O., MD, FAAP .....................................12-173 Harris, JoEllen L., RN, CIC ....................................13-194 Johnson, Kyle M., PhD, CCRP......................................114
Folsi, Fiorenza ...............................................................8-095 Harris, Tony ...................................................................8-106 Johnson, Debra...............................................................8-125
Forkan-Kelly, Sinead, BSEH, RN, CIC ................16-236 Harris- Williams, Michelle, RN, MSN, CIC .............124 Johnson, Kyle M., PhD, CCRP................................13-188
Formby, Linda, RN, BSN, CIC .................................4-051 Hartless, Kathleen R., RN, MN, CIC .........................112 Johnson, Yvette R., MD, MPH .................................4-035
Foster, Sandra ....................................................................123 Hassoun, Ali, MD, FACP, AAHIVS .......................8-088 Jones, Kristen Leigh., BS .............................................2-021
Francis, Kathleen, RN, BSN ....................................12-158 Havill, Heather L., BA .................................................2-019 Jovanovic, Oliver, PhD ....................................................100
Fridkin, Scott .....................................................................119 Haxall, Katharine G., RN, MPH ..............................8-105 Kajiura, Takumi, PhD ................................................. 2-008
Fry, Deborah, MT(ASCP), MBA, CIC ...............12-177 Hayakawa, Kayoko, MD, PhD ..................................1-001 Kakarlapudi, Hari , MBBS..........................................1-001
Fuentes, Soad, MD .......................................................8-115 Hazamy, Peggy, RN, BSN, CIC ....................................120 Kamatam, Srinivasa, MBBS........................................1-001
Fujimoto, Yoko ..............................................................4-040 Hebden, Joan, RN, MS, CIC ........................................124 Kamboj, Mini, MD, Board Certified in Internal
Fulton, Mary A., RN, BSN, CIC ..............................4-044 Heinze, Marti, RN, BS ..............................................12-152 Medicine and Infectious Disease ............................13-191
Furuya, E. Yoko, MD, MSc ......................................13-197 Heishman, Crystal R., RN .......................................12-150 Kandiah, Sheetal, MD, MPH.....................................8-091
Gage, Dana, MD ..............................................................100 Helget, Virginia, RN, MSN, CIC.............................8-086 Kang, JaHyun, RN, BSN, BA, MPH, CIC.................128
Gagliano, Gregory C., RN, BSN ...................................108 Helton, BJ, MT (ASCP), MPH, CIC ...................12-153 Kannekanti, Naveen, MBBS.......................................1-001
Gamero, Mario, MD ................................................... 8-115 Hennessey, Patricia, RN, BSN, MSN, CIC ................106 Karstetter, Jamie, RN .................................................16-238
Gase, Kathleen, MPH, CIC ..........................................120 Hennessey, Patricia, RN, BSN, MSN, CIC ............4-034 Kasahara, Kei..................................................................1-002
Gatica, Nancy .............................................................16-245 Hensler, Amelia ............................................................8-081 Kassler, William.................................................................119
Gay, Charlene ....................................................................119 Hernandez, Hilda G Orozco. .....................................9-137 Kaye, Keith, MD, MPH..................................................118
Geller, Nicole, MPhil, MS, CNM.................................127 Herzig, Carolyn, MS .......................................................127 Kaye, Keith, MD, MPH...............................................1-001
Gerhardt, Elsie L., MA, MPH candidate ................8-115 Hewlett, Angela ............................................................8-086 Kazuhiko, Nakajima ....................................................4-041
Gervich, Daniel H., MD, FSHEA .........................16-239 Hickok, Jason.....................................................................110 Kelly, Nicole .................................................................. 8-105
Ghonim, Elham R., MT, ASCP, CIC ......................8-093 Hickson, Evelyn, RN, MSN, CNS, WCC...................125 Kerridge, James, MA, RN, CIC.................................4-043
Giaccone, MaryJo ......................................................12-184 Hillman, Deb, BSN, RN, OCN..............................13-193 Kertesz, Louise, ANP, MSN, CNOR....................15-213
Gilliam, Craig, BSMT, CIC ...................................12-164 Hinz, Krista..................................................................12-154 Kester, Shelley, RN, BSN, CIC..................................8-110
Gilman, Allan, MS, M(ASCP), M(NCA) ..............8-105 Ho, Kevin, BA................................................................1-001 Kettunen, Christine, PhD, MSN, RN, CIC.........16-232
Glover, James, BS .......................................................16-242 Hodgins, Marie P., RN, BScN, CIC.......................12-176 Khan, Shahrukh................................................................101
Goertz, Natalie J., BScN, CIC ................................15-225 Hodson, Maureen J., RN, ASN, CIC...........................117 Khan, Amber, MD........................................................1-001
Goetzinger, Jill N., RN ................................................8-127 Hoegg, Cindy L., RN, CIC......................................16-243 Kiernan, Andrea, MLT (ASCP) CIC..........................106
Goldmann, Donald .........................................................119 Honeycutt, Nancy, RN, BSN.........................................122 Kiernan, Andrea, MLT (ASCP) CIC.......................4-034
Gomez, Sergio M., MD ...............................................8-122 Hopfner, Debi A., RN, BSN, CIC............................4-053 Kilinc-Balci, F. S., PhD ................................................7-075
Gonzalez, Miriam, MD ......................................114, 8-115 Hopkins-Broyles, Diane, RN, MSN.......................12-175 Kim, David....................................................................16-229
González, Lorena ..............................................................105 Hoppe-Bauer, Joan, BA, BS, MT(ASCP)...................130 Kim, Yang........................................................................4-036
Gornick, Wendi, MS, CIC .........................................7-073 Horan, Teresa.....................................................................119 Kirby, Jeannette , RPh................................................13-188
Gosman, Lisa, BA .......................................................13-191 Hori, Seiji .....................................................................15-221 Kita, Eiji ......................................................................... 1-002
Goss , Linda , MSN, APRN-BC, CIC,COHN-S ...12-150 Horn, Terancita, RN.....................................................8-106 Kleinman, Ken ................................................................. 119
Gould, Miki .................................................................12-149 Horowitz, Harold..........................................................4-036 Knaup, Richard ...........................................................14-198
Govednik, John, MS....................................................8-097 Houser, Elizabeth .........................................................6-068 Knight, Joe ...................................................................12-164
Govindavarjhulla, Aditya , MBBS ............................1-001 Howard, Deborah, BSN, MSN..................................2-009 Knoke, Cynthia, MT, BS, CIC...................................2-018
Granado-Villar, Deise, MD, MPH, FAAP ...........10-146 Howard, Trudy Marie-Kueker., DNP, MS, RN......15-206 Kobayashi, Hiroyoshi , MD, PhD..............................2-008
Granado-Villar, Deise, MD ........................................8-127 Hoxworth, Tamara......................................................12-186 Kohan, Cynthia A., MT, MS, CIC............................5-057
Grant, Laura L. ...........................................................15-224 Huertas-Jimenez, Martha A............................................105 Koll, Brian S., Hospital Epidemiologist - Beth Israel
Gray, Beverly J., RN, MS, CIC ..................................8-102 Hullett, Tracy L., RN ................................................13-194 Medical Center; Professor of Clinical Medicine - Albert
Gray, Kelly, RN ...........................................................16-231 Hum, Robert S., MD, MA .......................................12-168 Einstein College of Medicine..........................................109
Greene, Elicia A., RN, MSN, CIC, CPHQ .........14-205 Hurst, Debbie, RN, BSN ..........................................12-155 Kolonoski, Peter.............................................................4-039
Greene, Linda R., RN, MPS, CIC .........................16-246 Hutchinson, Nancy M., RN, MSN, CIC .............12-184 Komatsu, Yuko...............................................................1-002
Griffin, Diana K. .............................................................. 123 Hutton, Tricia .............................................................16-233 Koy, Tjin........................................................................13-189
Griffin, Patricia, MS, RN, CPHQ ..........................12-157 Hyman, Sandra R., RN,MPA,CIC.........................15-213 Kramer, Ian, MS..........................................................11-147
Grimes, Lauren, B.S, CCRN ...................................12-161 Ichiki, Kaoru...................................................................4-040 Kreiling, Stephanie, RN, BSN, CIC.......................15-212
Gross, Brenda, BSN, CIC ........................................16-238 Igwe, Gloria, RNC, MSN, DNP.............................12-173 Kuchipudi, Vamsi , MBBS...........................................5-060
Grossberger, Susan ........................................................8-081 Infection Control Liaison Team, Kuelbs, Melanie, RN.....................................................8-124
Guddati, Harish , MBBS .............................................1-001 White Plains Hospital .................................................8-120 Kulkarni, Mandavi, MD...............................................4-043
Guimera, Don, BSN, RN, CIC, CCRP ................13-188 Ingram, Lorrie G., BSN, RN, CIC .........................12-166 Kulsic, Melody S., MSN, PHN, RN..........................8-111
Guzman, Olga E., RN, BSN, CIC.............................8-111 Isaacs, Pamela , BSN, MHA, CIC...........................12-165 Kumar, Elise E., PHD, MS, MPH, CIC................12-161
Ha , Nguyen Thi Thanh. ...........................................13-196 Ivie, Gale M., MPH ..................................................... 8-090 Kurachek, Stephen, MD..............................................8-124
Haag, Robin, BC, RN, MA ........................................3-025 Jackson, Renita...................................................................123 Kuykendall, Kurtis, MBA..........................................12-164
Haberman, Beth, MD ...............................................12-185 Jackson, Julia A., CST, MEd, FAST........................12-156 Kyle, Jhonson M............................................................9-137
Hacek, Donna, MT(ASCP) ..........................................104 Jaggi, Namita..................................................................8-096 Lamfon, Medhat ...........................................................4-052
Hale, Molly, MPH, CIC ............................................4-028 Jain, Rajiv, MD..............................................................8-109 Langford, Autumn, RN, BSN ....................................8-088
Haley, Valerie, MS ............................................................120 Jakubowski, Ann, MD, PhD, Board Certified in Larson, Elaine L., RN, PhD, CIC..................................127
Hameed, Fahad .............................................................4-052 Internal Medicine, Hematology and Latham, Judy, RN, BSN, CRRN................................2-007
Hankins, Amy, MSN, RN ........................................13-189 Medical Oncology.......................................................13-191 Latrace, Maria, RN .......................................................... 109
Hansen, Brenda, RN ..................................................15-218 Jalandoni, Josephine, BSN........................................12-167 Le , Anh Thu T. .............................................................4-037
Hansen, Shannon G., MT(ASCP), CIC .................8-112 Janosz, Tara, MPH .......................................................... 121 LeBlanc, Julie, MPH ....................................................5-061
Hargreaves, James, DO.................................................8-112 Janssen, Lynn, MS, CIC.............................................14-203 Lee, Caroline, AB .............................................................100
Hariri, Rahman, PhD ..................................................8-091 Jeeva, Rani, MPH ......................................................11-147 Lee, Grace ..........................................................................119
Harper, Jane E., BSN, MS, CIC ................................9-135 Jegede, Olufemi.............................................................8-118 Lee, Jea H., MD ............................................................8-111
Harris, Anthony, MD, MPH .........................................124 Jeon, Christie Y., ScD ................................................13-195 Lee, Kyeong Pyo, MD .................................................1-001
Harris, Jeanette J., MS, MSM, BS, Jernigan, John ................................................................... 119 Leekha, Surbhi, MPH, MBBS.......................................124
MT(ASCP), CIC ............................................................125 Jha, Ashish .........................................................................119 Leonard, Alisa, MHA, RN, CIC...............................8-114

192 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
The following authors have nothing to disclose

Lephart, Paul R., PhD...................................................1-001 Moronaga, Yukiko ........................................................9-134 Pogue, Jason , PharmD ................................................1-001
Lewis, Janet A., RN, MA, CNOR ............................7-075 Mortimer, Mary Lou .................................................15-207 Pokrywka, Marian ........................................................8-081
Lindberg, Aaron .........................................................12-164 Moseley-Ladell, Michelle D. ......................................6-065 Polanco, Carlos .................................................................105
Lipka, Abigail.................................................................2-019 Moshos, Judy A., MT ..................................................5-060 Policherla, Rohan .........................................................1-001
Litinski, Mikhail, MD ...............................................12-161 Moss, Marie, RN, BSN, MPH, CIC.............................109 Pope, Lisa M., RN, BSN, MSN ...............................16-227
Liu, Meixia, MS.............................................................8-124 Mougeot, Jean-Luc........................................................5-059 Powell, Cynthia, RN, CCRN...................................10-145
Lohithaswa, Sharan , MD............................................1-001 Mukherjee, Dhritiman, PhD...........................................100 Prasad, Priya, MPH ...................................................16-231
Lopez, Sergio..................................................................8-126 Mullaney, Kathi, BSN, MPH, CIC ........................12-167 Preas, Michael Anne, RN, BSN, CIC...........................124
Lovell, Roger...................................................................5-059 Mullins, Timothy...............................................................123 Prescott, Judy, RN, BSN, CIC ................................15-212
Lowy, Franklin, MD ........................................................100 Murphy, Shawn, RN, MSN ............................................103 Price, Alexis, RN, BSN.................................................2-018
Lucas, Bella , RN, BSN ................................................2-017 Murphy, Shawn, RN, MSN ......................................12-156 Primes, Vickie, DTR....................................................8-106
Lucente, Kathleen M., RN, MT, CIC....................12-158 Mzayek, Fawaz, MD, MPH, PhD ..........................13-188 Prinz Luebbert, Peggy, MS,MT(ASCP)SC,
Luzzaro, Francesco .......................................................8-095 Nabetani, Yoshiko, CNIC ........................................15-223 CIC,CHSP ....................................................................1-005
Ma, Yuxin .....................................................................12-172 Nadeau, Jacqueline F., M(ASCP) ..............................5-057 Pulluru, Harish , MBBS ..............................................1-001
Mace, Michelle, MSN, RN, CIC ..............................8-078 Nagahara, Chie .............................................................9-134 Qudsi, Areej ...................................................................4-052
Macias, Alejandro E. ........................................................105 Naik, Kishori, BSc. .....................................................15-225 Raimondi, Alexis, BS, RN, BSN, MS, CIC ................109
MacPike, Barbara A., RN, BSN, CIC...........................116 Nakayama, Akifumi .....................................................1-002 Raisanen, Peter K., Bachelor of Science ...................7-077
Madison, Alexandra S., MPH, CIC .........................8-125 Nakazawa, Yasushi .....................................................15-221 Ram Rakesh Mundra, Venkat, MBBS ......................1-001
Maher, Anne C., MS, M(ASCP), CIC..................15-209 Nanjireddy , Priyanka , MBBS ...................................5-060 Ramasamy, Balaji , MBBS............................................1-001
Mahesh, Uma , MBBS .................................................1-001 Napoleon, Gonzalez Saldaña. ....................................9-137 Ramirez, Marylin........................................................16-245
Mallad, Ashwini , MBBS ............................................1-001 Narayana, Ekta ..............................................................8-096 Rao Sundaragiri, Pranathi , MBBS ...........................5-060
Malow, James , MD, FIDSA........................................4-043 Nash, Denis, PhD ......................................................13-195 Rebmann, Terri , PhD RN CIC ..............................14-198
Mamon, Romeo P., RN, BSN...................................15-209 Nava Ruiz, Enid Alejandra. ........................................1-006 Reddick, Dave, BS, CBCP ........................................ 3-024
Marcellino, Joseph, MPH............................................3-025 Nazarali, Safiyya, BScN, RN ....................................15-225 Reddy, Swetha , MBBS ................................................5-060
Marchaim, Dror, MD..........................................101, 1-001 Neidell, Matthew, PhD .............................................13-195 Reddy Guddeti, Raviteja, MBBS ..............................1-001
Marchione, Susan .........................................................4-036 Neidell, Matthew, PhD..............................................13-197 Reed, Lee, RN, BA, MSPH, CIC ................................ 122
Marine, Melissa, BS ..........................................................127 Nelson, Linda, RN .....................................................16-238 Reese, Sara, PhD ...............................................................121
Marine, Melissa, BS ......................................................8-082 Nelson, Patrica, RN, MSN, CNOR .......................15-213 Reese, Jessica, RN ...................................................... 13-187
Marion, Nedra , MPA, RN, CIC ............................15-216 Nepomuceno, Leisha, RNC ....................................12-173 Reeths, Anne , RN, MS ...............................................4-046
Maron, Gabriela, MD ..................................................8-115 Nerandzic, Michelle ..................................................10-143 Regazzoni, Flavia ..........................................................8-095
Marquez, Patricia, MPH..............................................9-136 Newman, Diane K., DNP FAAN ..........................15-211 Reid, Sherry R., RN .....................................................6-064
Martin, Jeanine E., RN.................................................8-111 Ng, Wil, MHSc ..........................................................16-229 Relyea, George, MS ...................................................13-188
Martin, Karen, MPH, RN, CIC .............................16-236 Nigh, Kathy, RN .........................................................15-222 Renck, Helen, MS, RN .............................................12-157
Martin, Margaret L., RN, MSN, BC, CIC ...........15-212 Nimtz, Pat ....................................................................16-235 Rey, Janice, MT (ASCP), CIC ..................................4-053
Martinez, Lisa M., BSN,RN,CIC............................12-183 Nishihara, Yutaka, PhD ..............................................2-008 Rezai, Fariborz, MD ..................................................12-161
Mason, Greg, BA.........................................................13-191 Nolan, Rathel , MD .....................................................8-093 Rhoton, Beth, RN, MS, CIC .....................................4-051
Matocha, Donna, RN, MSN, CNRN....................12-171 Nolan, Vikki, DSc, MPH .........................................13-188 Riboul, Michele AT., BSMT(ASCP), MS, CIC ......12-181
Mayers, Roslyn...............................................................4-036 Nolting , Pamela , MSN, RN,CIC ..........................12-150 Rich, Karen, RN,BSN,MEd, CIC ................................121
McCalla, Saungi, MSN, MPH, RN, CIC ...............8-120 Norrick, Bonnie, CLS, EdM, CIC ...........................4-026 Richards, Samantha, MSN, RN ..............................15-222
McCormack, Robert R. ..............................................2-008 Northey, Candie B., RN, BSN, CIC ......................15-208 Rivard, Linda T., MT (ASCP) ......................................117
McDermott, Mary, MS, RN ....................................12-157 O’Donnell, Marguerite, BSN, CIC .......................16-237 Rivas, Hector, BS .........................................................9-136
McDowell, Ann E., MPH ........................................16-240 Obando, Grania I. ........................................................8-126 Rivera, Kimberly, MT(ASCP) ................................15-207
McFarlin, Jackie E., RN, MPH, MS, CIC ...............8-099 Obeid, Tarek ..................................................................1-001 Rivest, Katie, BS ......................................................... 16-236
McGinnis, Marcy, RN, BSN, CNOR......................8-084 Okubo, Takashi , MD, PhD .......................................2-008 Roach, Linda S., BSMT, CIC ................................. 14-200
McGuckin, Maryanne, Dr. ScEd, MT (ASCP) .......8-097 Okutsu, Toshiaki ........................................................15-221 Robicsek, Ari, MD ...........................................................115
McIntrye, Katie, RN ..................................................16-232 Osborn, Nancy L., RN CIC ....................................12-174 Robinson, Rebecca, RN ...........................................16-232
McKinney, Rebecca Casaday., RN, BSN, CIC ........8-087 Ostmann, Emily L., MPH ........................................12-175 Rodriguez Auad, Juan Pablo, MD, MSc ...............12-180
McMullen, Kathleen, MPH, CIC ................................ 130 Oyong, Kelsey, MPH ..................................................9-136 Rogers, Aaron D., MA ..............................................12-175
Meeks, Deborah L., RN, MSN, CCRN................12-176 Palla, Mohan B., MBBS ..................................................101 Roman, Kathy .............................................................16-234
Melonari, Pablo, MD .................................................. 8-128 Palla, Mohan B., MBBS ..............................................1-001 Rosaenz, Ana M., MD..................................................8-128
Meskill, Richard.............................................................7-076 Pappalau, Richelle, RN.................................................9-131 Rosaenz, Liliana, MD...................................................8-128
Meyer, Judith A., BS,MT (ASCP) CIC, Parise, Carol, PhD ......................................................12-178 Rose, Veronica, RN CNOR.....................................14-202
IP APIC ........................................................................12-160 Parker, Pamela, RN, BSN, MEd, CIC ...................16-234 Roselle, Gary, MD ........................................................8-109
Midamba, Blondelle, MS, RD, LD .......................... 8-106 Patel, Dipenkumar, MBBS .............................................101 Roser, Lynn P., MSN, RN ...........................................8-103
Mikasa, Keiichi...............................................................1-002 Patel, Parul, MT(ASCP) ................................................115 Ross, Lori, RN, BS, MBA ...........................................4-029
Miko, Benjamin A., MD .............................................8-105 Patel, Satyam .....................................................................101 Ruckriegel, Christine, RN MSN MPA CIC .......14-202
Miletic, Kyle, BS ...............................................................118 Patel, Bijal, BS, MHA .................................................7-073 Rupp, Mark E., MD ...................................................15-216
Miller, Lauren, BA ......................................................16-231 Patel, Dipenkumar, MBBS .........................................1-001 Russo, Anthony, MPH ....................................................130
Miller, Linda K., RN, CIC .........................................4-044 Patel, Sameer, MD, MPH .........................................12-168 Rutala, William A., PhD, MPH ...................................128
Misao, Hanako ............................................................15-223 Paul, David , MD ........................................................16-231 Rutledge, Suzanne, RN, CIC .....................................9-130
Mishima, Yukie ...........................................................15-221 Paulson, Daryl ...............................................................2-022 Rybak, Michael J., PharmD, MPH ...........................1-001
Mizuno, Fumiko ...........................................................1-002 Perlin, Jonathan ................................................................110 Saito, Ayako .................................................................15-221
Mohin, Shah , MBBS ...................................................5-060 Perlman, Jeffrey, MB, ChB .......................................16-231 Sammel, Lori, RN ......................................................13-194
Montero, Maria, MT(ASCP)SM, MPH, CIC......12-170 Persing, Tamara F., RN, BSN, MS, CIC ...............12-179 Sampathkumar, Priya, MD .............................................113
Monti, Patrizia ...............................................................8-095 Peters, Eleanor ............................................................14-198 Sanchez, Genny .............................................................9-137
Moody, Julia ......................................................................110 Peterson, Kari, BS ............................................................104 Sanner, Jackie, RN ......................................................15-222
Moore, Carolyn Louise., Graduate Certificate in Pettis, Ann Marie, RN, BSN, CIC ...........................9-131 Sano, Reiko ....................................................................1-002
Nursing Science, Infection Control ..........................7-074 Pikula, Zoran ..............................................................16-229 Santerre, Andrea, RN, MS ..........................................7-076
Moore, Patricia, RN ...................................................12-159 Pini, Beatrice .................................................................8-095 Santos, Adelia ..............................................................15-215
Morgan, Angela C., MS, RN, CCRN....................13-190 Platt, Richard ....................................................................119 Santos, Nimfa, RN, BSN, COHN ...........................7-073

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 193
The following authors have nothing to disclose

Sarkar, Moumita , MD ................................................5-060 Tentori, Cristina ............................................................8-095 Wilson, Sheron, RN, MPH, CIC ...........................16-244
Savage, Renee M., RN, BSN, CIC ............................4-030 Terrell, Tracey ................................................................8-116 Wilson, Terry K., RN, MSN, CNOR ......................2-023
Scully, Fiona ...................................................................8-082 Thom, Kerri, MD, MS .....................................................124 Wisdom, Christy M., BSN, RN, CIC ...................12-164
Septimus, Edward .............................................................110 Thornton, Patti .................................................................123 Wong-McLoughlin, Jennifer , RN ..........................16-231
Seward, Samuel, MD ...................................................8-105 Thornton, Adriene , RN ..............................................8-124 Wood, Amber, RN, BSN, CPN ..............................13-187
Shahani, Shobha , MBBS.............................................5-060 Tierney, Catherine, RN, BSN ....................................6-066 Worden, Carol, RN, MPA...........................................2-017
Shaikh, Zakir Hussain A., MD, MPH, FIDSA, Tippett, Jan M., MSc., CIC, MT ASCP (M) ......16-239 Wright, Kate, EDD ....................................................14-198
FSHEA, CPE, CMSL .................................................4-044 Titus-Hinson, Maureen, RN, MHA, CIC..............8-110 Xiong, KuangNan, MS ....................................................120
Shapiro, Rochel, RN, MSN .....................................15-210 Tobin, Jonathan N., PhD .........................................15-214 Yamada, Kaori, RN, Certified in
Shashidharan, Shiva Prasad, MBBS..........................1-001 Torres, Katherine, DO.....................................................113 Infection Control Nurse .............................................6-071
Sherman, Eileen, MS, CIC ......................................16-243 Tosh, Jeannette L., RN, CIC ...................................16-240 Yamaguchi, Yukihiro ....................................................9-134
Shimoda, Kathleen J., BSN ........................................2-009 Toth Martin, Emily, MPH, PhD ...................................118 Yaney, Eileeen, MS, CIC ..........................................12-161
Sholtz, Lee A., MSN, RN, CIC ..............................15-216 Toth Martin, Emily, MPH, PhD ...............................1-001 Yaney, Eileen, MT(ASCP) MS, CIC .......................4-032
Shuler, Rosalyn, NP .....................................................8-106 Townes, John, MD .......................................................4-028 Yarborough, Erva, RN, CHPN ..............................12-152
Shultz, Vicky, MSN, RN...........................................15-218 Trimberger, Karen, RN, MPH, NE-BC, CIC .......8-084 Yaseen, Muhammad .....................................................4-052
Sica, JoAnn, BS...............................................................5-057 Trinidad, Charisma R., RN, BSN, CCRN............12-159 Yassin, Mohamed H., MD, PhD ...............................8-091
Sickbert-Bennett, Emily E., PhD ..................................128 Tropiano, Christina.......................................................8-105 Yee, Victoria .......................................................................101
Sifuentes, Laura Y., M.P.H .........................................7-077 Tropp, Jackie, RN, MSN, CRNI, VA-BC...................104 Yodice, Paul, MD .......................................................12-161
Sifuentes, Laura Y., MPH ..........................................6-069 Trovillion, Ellen W., RN, BSN, CIC......................12-175 Yokota, Katsuhiro .........................................................2-008
Sigler, James ...................................................................6-063 Tse, Alison ..........................................................................119 Zabarsky, Trina, RN, MSN, CIC ..............................8-106
Silva, Yefté ..........................................................................105 Tserenpuntsag, Boldtsetseg, DrPH...............................120 Zabriskie, Kelly, BS, CIC .........................................12-183
Simmonds, Barbara J., RN, BS, CIC ......................10-146 Tsivitis, Marie, MPH, CIC.............................................120 Zaoutis, Theoklis, MD, MSCE ...............................16-231
Simons, Nadine, MS, RN..........................................14-203 Tsukamoto, Yoko J., PhD, FNP, CIC .......................6-071 Zelencik, Shane, MPH ....................................................115
Simpser, Edwin, MD ....................................................8-082 Turner, Paul, CHESP ................................................15-216 Zielinski, Erin E., CCRP ............................................8-124
Simpson, Kristen, RN, BSN, CCRN-CMC.........10-141 Tyler, Lisa .......................................................................7-076
Singhoffer, Elizabeth (Libby), MPH, Ui, Koji ...........................................................................1-002
BSN, RN, CIC ............................................................. 6-066 Upputuri, Vijaya , MBBS ............................................5-060
Singla, Manit, MBBS ...................................................1-001 Vacca, Maria, BSN, RN, CIC ....................................8-085
Siska, Martha, RN ............................................................113 Vadlamudi, Gayathri ....................................................1-001
Siska, Martha, RN ......................................................15-218 Van Antwerpen, Carole, RN, BSN, CIC.....................120
Sitzlar, Brett .................................................................10-143 Van Enk, Richard A., PhD, CIC..............................12-154
Sitzlar, Brett M., BS ...................................................16-237 Van Toen, Jane E., BSc., MLT, CIC .......................14-204
Skyles, Jill M., RN, BSN, MBA ...............................12-175 VanDerSlik, April L., RN, BSN...............................12-154
Slye, Mark .......................................................................6-066 Vasquez, Roberto , MD ...............................................8-115
Smathers, Sarah A., MPH, CIC .............................16-243 Velasco, April, PhD ....................................................15-214
Smith, Jackie, MSN ...................................................12-163 Vemuri, Praveen , MBBS .............................................1-001
Smith, Julie A., RN, MN, CIC ...................................4-027 VerLee, Kerrie E., MPH, CIC .................................10-141
Smith, Philip W., President, Nebraska Infection Verzi, Steven, CHSP ....................................................6-070
Control Network ..........................................................8-086 Vesely, John J., RN, TNCC.......................................12-159
Smith, Renee L., MT(ASCP) ..................................15-207 Vicuna, Carlos, MD .....................................................8-117
Snedeker, Lisa, MT(ASCP) .....................................15-207 Vinci, Carol, MS, CIC, CPHQ, CPHRM,
Snyder, Valarie J., BSN ..............................................13-194 HEM, CPSO .................................................................8-097
Somarriba, Maria Mercedes, MD .................................114 Vinski, Joan, MSN, RN, CIC .......................................131
Somarriba, Maria Mercedes, MD ..............................8-126 Voegele, Christine, RN .............................................12-185
Sorter, Mary Lou, RN, CIC ....................................12-185 Vollmuth, Chris ............................................................1-005
Sosa Pueyo, Maria Fernanda, RN .............................8-122 von Kohn, Betty A., RN, BSN, CNOR, CIC ..........10-140
Sossoman, Leslie B., BSN, MSN, NP ..........................122 Wadhawan, Rajan, MD .............................................13-194
Soumerai, Stephen ...........................................................119 Waibel, Marcia L., MT(ASCP), MBA, CIC .........12-162
Stanley, Kim, MPH, CIC ...........................................4-039 Walker, Bonnie...................................................................123
Stare, Dianne, MPH ....................................................8-105 Walker, Judy L., RN, BSN, MHSA, CIC ................8-121
Starke, Jeffrey, MD .....................................................13-189 Walz, Christine, RN .....................................................8-087
Statz, Catherine , RN, BSN, PHN, MPH ............16-242 Ware, Kathy, RN, BSN, CIC .....................................4-035
Stein, Linda, MPH, RN, CIC..................................16-236 Watson, Jean, MT(ASCP), MPH, CIC ...............16-236
Stewart, Charlene , RN, MPA/HSA, CHSP .......12-155 Wayland, Jan L. .................................................................126
Stinchfield, Patricia, MS, RN, CPNP........................5-061 Weber, David J., MD, MPH............................................128
Stone, Stacey, M.D. ....................................................13-194 Wells, Mary Ann, MPA, RN, CIC .........................12-183
Strader, Wendy ..............................................................5-059 Wells, Patricia, RN, CIC .............................................8-092
Streed, Stephen, MS/CIC...........................................2-018 Wendt, Julia, RN, BSN, CIC...................................16-234
Stromquist, Carine, MD .......................................... 13-194 Wentink, Jean, MPH, RN.........................................15-218
Sturm, Lisa K., MPH, CIC.......................................12-156 Wesley, George , MD ...................................................2-009
Sullivan , Nancy, RN ....................................................8-106 West, Kelly, MS, RN, CPON ....................................9-129
Sun, Zhiyuan .....................................................................131 Wheeler, Derek, MD .................................................12-184
Swick, Zachary, MS ......................................................3-024 Whitbread, Michelle N., MT, MPH .....................10-142
Swift, Dean .....................................................................2-020 White, Diane ...............................................................16-229
Tabibi, Setareh, BA ....................................................16-231 White, Freda, MSN, RN ..........................................15-222
Takashi, Ueda ................................................................4-041 Whitlock, Judith, RN, MSN, APRN, CIC ..............8-109
Takesue, Yoshio .............................................................4-040 Whittier, Susan , PhD, ABMM ..............................16-231
Tamura, Taku ..............................................................15-221 Wickman, Katie, MS, RN ........................................16-236
Taylor, Tom, PhD..............................................................118 Wilkman, Amanda, RN, BSN, PHN ...........................127
Taylor, Amber, MPH .................................................11-147 Willier, Tina, MSN, RNC-NIC .............................15-207

194 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 195
Author Index–2012 Abstracts
Key: author’s last name is followed by first initial and publication number. Duran Arias, L.........................12-180
Dziewior, A..............................12-166
Abate, HJ..................................8-128 Betts, W.......................................8-110 Coffin, S....................................16-243
Eagan, J.....................................13-191
Abbadi, DR..............................1-001 Bhargava, A................................5-060 Cohen, B............................127, 8-082
Eck, E..........................................8-090
Abraham, F...............................8-083 Bodily, M ....................................130 Cohen, L........................................109
Edmiston, Jr, C.........................4-033
Abreu Lanfranco, O..........101, 118 Boehm, S......................................104 Colbert, L...................................4-036
Edmonds, S.....................102, 14-201
Acebo,J......................................8-117 Bol, K..............................................121 Cole, D...........................................119
Eguiguren, J................................8-117
Acevedo, C...............................8-128 Bommarito, M..................111, 8-100 Cole, M.......................................1-003
El-Amin, H..............................12-181
Adams, A................................16-244 Bonfanti, P..................................8-095 Collins, B..................................12-173
Elliott, M....................................3-024
Aguilar, M................................8-126 Bowman, S-N............................8-078 Compton, A............................15-213
Ellison, R....................................6-063
Ajamoughli, M........................1-001 Boyce, J........................................5-057 Connelly, B..............................12-184
Emerick, M.....................................124
Al Thaqafi, A............................4-052 Boychuk, R................................6-067 Conrad, E...................................7-076
Emerson, J................................12-164
Alba, L....................................16-231 Braswell, G.................................6-066 Conway, L...................................8-105
Emmett, P...................................4-054
Albert, N.......................................131 Brazzell, B.................................12-151 Cooper, H...................................2-007
English, L ...................................9-136
Allen, B...................................15-212 Bren, V.........................................8-112 Coppa, N ...................................4-028
Erickson, L..................................6-063
Almarez-Fox, V......................15-213 Briggs, J........................................4-029 Cormier, S......................................110
Erlichman , R.............................6-063
Alper, P......................................8-082 Brittingham, L.........................16-243 Cortes, L.....................................7-076
Evanko, J...................................15-213
Alshabani, K.............................1-001 Brockway, J.....................................123 Crews, J.....................................13-189
Evans, J......................................16-243
Alspaugh, M.............................8-110 Bronstein, M..............................9-131 Crimmins, D..................................109
Evans, M......................................8-109
Altpeter, T................................8-103 Brown, V.........................................128 Crump, M...................................8-080
Fakih, M......................................4-053
Amato-Hayes, M........................109 Brown, J....................................12-159 Crumpacker, B........................15-220
Falaschi, A..................................8-128
Amitov, C...............................14-204 Brown, L.....................................9-131 Cruz, W....................................12-173
Faller, R.....................................15-218
Anderson, K.............................4-039 Brudner, C.....................................115 Cunningham, T.........................7-075
Faris, L.........................................8-092
Anderson, C..........................16-232 Buet, A........................................8-082 Currie, D...................................16-236
Fauerbach, L...............................2-023
Andrews, B.J.............................2-018 Bunson, J.....................................8-097 Curtin, J....................................12-162
Favret, U......................................7-075
Anthony, J..............................14-198 Burger, T...................................12-177 Daley, J.........................................7-075
Feigel, J........................................8-081
Antillon-Klussmann, F....114, 16-245 Burnaugh, R...............................4-029 Daoud, F......................................4-033
Ferng, Y.....................................16-231
Apa, Z...........................................100 Butler, J......................................16-228 Das, M.........................................1-001
Ferrelli, J......................................8-091
Apenhorst, D.........................15-218 Cadnum, J.................................10-143 Dasagi, M....................................5-060
Fertelli, D .................................10-143
Arashin, K................................4-029 Campbell, E...................................102 Daskiran, M................................4-042
Fierro, J......................................16-231
Arbogast, J.......................102, 2-013 Candon, H...............................14-204 Dassey, D.....................................9-136
Filippell, M....................................124
Aronhalt, K ...........................15-218 Caniza, M.......................114, 13-188 Datla, S........................................5-060
Filippone, C............................12-183
Arrunategui, A........................4-032 Canola, M...................................8-111 De Amaya , A..............................8-111
Fine, L..........................................9-131
Aviles, M...................................9-138 Carling, P .................................15-216 De la Torre, A................................105
Finerman, R...................................114
Ayers, M....................................2-023 Carpenter , M..........................12-154 DeAngelis, D...........................15-222
Finerty, E..................................12-157
Azizi, J...........................................103 Carra, M...................................16-239 DeLaMora, P...........................16-231
Finney, J....................................11-148
Babcock, H............................12-175 Carrier, C ...................................4-035 DeVita, S...................................15-217
Fisher, A..........................................115
Bahrani-Mougeot, F................5-059 Carriker, C...............................12-165 Dhyani, R...................................2-020
Fisher, J......................................12-154
Bai, S..........................................1-001 Castillo-Deluao, CM.............13-188 Dickson, A...............................16-241
Fitzgerald, T.............................15-216
Bailey, K....................................4-038 Cato, K......................................12-168 Diez, L.......................................15-218
Flanagan, E.................................1-001
Baker, D..................................12-178 Chamorro, M.............................8-126 DiGiorgio, M................................131
Fless, K......................................12-161
Ball, M..........................................123 Chang, G....................................2-011 Dillon-Grant, M...........................104
Flynn, A......................................8-098
Barbosa, L...............................15-215 Chan-Myers, H..........................2-011 Disharoon, E..............................5-058
Fofah, O....................................12-173
Barnes, D...................................8-087 Chenoweth, C........................12-156 Diviti, S.......................................1-001
Folsi, F..........................................8-095
Barrera, D.................................8-115 Chidurala, S...............................1-001 Do, H........................................12-169
Forkan-Kelly, S........................16-236
Basile, C....................................4-032 Chock, L.....................................9-132 Doddamani, R...........................1-001
Formby, L....................................4-051
Bathina, P..................................1-001 Choi, YJ....................................13-197 Doerflein, B..............................14-199
Foster, S...........................................123
Baumann, M............................8-093 Chopra, T...................................8-118 Dogan, A....................................4-028
Francis, K .................................12-158
Baxter, K...................................8-100 Chou, T..........................4-043, 6-070 Dolendo, M.............................13-188
Fridkin, S........................................119
Baxter, H................................16-230 Chowdary, D..............................1-001 Dominguez, S............................9-129
Fry, D.........................................12-177
Baxter, R.................................16-230 Christie-Smith, A.....................9-133 Donskey, C..............................10-143
Fuentes, S....................................8-115
Bebinger, D..................................117 Chu, S.........................................9-136 Dougherty, E...........................13-191
Fujimoto, Y.................................4-040
Beckham, B..............................6-066 Cianci, E...................................12-161 Doughty, D....................................120
Fulton, M....................................4-044
Ben, H.....................................12-181 Clark, A....................................15-220 Douglas, B..................................8-081
Furuya, E...................................13-197
Beno, L....................................16-234 Clarke, K.....................................4-026 Driscoll, M...............................12-177
Gage, D...........................................100
Berman, D..............................13-194 Clifton, M..................................8-109 Duchon, J.................................12-168
Gagliano, G...................................108
Berriel- Cass, D.....................10-141 Clock, S.....................................16-231 Duenas, M..................................8-115
Gamero, M.................................8-115
Berrios, R.....................................109 Cloud, R....................................7-075 Dumigan, D...............................5-057
Gase, K............................................120
Bertin, M ....................................131 Coddington, L........................15-222 Dunton, D................................15-217
Gatica, N..................................16-245

196 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Author Index–2012 Abstracts
Gay, C.............................................119 Hassoun, A.................................8-088 Jaggi, N.......................................8-096 Kuelbs, M....................................8-124
Geller, N.........................................127 Havill, N.....................................2-019 Jagrosse, D...................................8-101 Kulkarni, M...............................4-043
Gerhardt, E.................................8-115 Havill, H.....................................2-019 Jain, R..........................................8-109 Kulsic, M.....................................8-111
Gervich, D................................16-239 Haxall, K ...................................8-105 Jakubowski, A..........................13-191 Kumar, E...................................12-161
Ghonim, E..................................8-093 Hayakawa , K.............................1-001 Jalandoni, J...............................12-167 Kurachek, S................................8-124
Giaccone, M.............................12-184 Hazamy, P.......................................120 Janosz, T..........................................121 Kuykendall, K.........................12-164
Gilliam, C................................12-164 Hebden, J .......................................124 Janssen, L..................................14-203 Lamfon, M.................................4-052
Gilman, A ...................................8-105 Heinze, M................................12-152 Jeeva, R.....................................11-147 Langford, A................................8-088
Glover, J...................................16-242 Heishman , C...........................12-150 Jegede, O....................................8-118 Larson, E ..........................8-082, 127
Goertz, N .................................15-225 Helget, V.....................................8-086 Jeon, C......................................13-195 Latham, J ...................................2-007
Goetzinger, J...............................8-127 Helton, BJ.................................12-153 Jernigan, J.......................................119 Latrace, M.......................................109
Goldmann, D.................................119 Hennessey, P.....................106, 4-034 Jha, A...............................................119 Le, AT..........................................4-037
Gomez, S.....................................8-122 Hensler, A...................................8-081 Johnson, K..........114, 13-188, 9-137 Leaper, D ...................................4-033
Gonzalez, M......................114, 8-115 Hernandez, HG........................9-137 Johnson, D..................................8-125 LeBlanc, J ...................................5-061
González, L....................................105 Herzig, C........................................127 Johnson, Y...................................4-035 Ledeboer, N............................10-144
Gornick, W................................7-073 Hesse, L.......................................8-119 Jones, K.......................................2-021 Lee, C.............................................100
Gosman, L................................13-191 Hewlett, A..................................8-086 Jovanovic, O..................................100 Lee, G..............................................119
Goss, L......................................12-150 Hickok, J.........................................110 Kajiura, T .................................. 2-008 Lee, J.............................................8-111
Gould, M..................................12-149 Hickson, E.....................................125 Kakarlapudi, H..........................1-001 Lee, KP........................................1-001
Govednik, J................................8-097 Hillman, D...............................13-193 Kamatam, S................................1-001 Leekha, S........................................124
Govindavarjhulla, A.................1-001 Hinz, K.....................................12-154 Kamboj, M...............................13-191 Leonard, A.................................8-114
Graf, J........................................13-190 Ho, K...........................................1-001 Kandiah, S..................................8-091 Lephart, P ...................................1-001
Granado-Villar, D......10-146, 8-127 Hodgins, M.............................12-176 Kang, J.............................................128 Levine, R.....................................4-042
Grant, L....................................15-224 Hodson, M.....................................117 Kannekanti, N...........................1-001 Lewis, J........................................7-075
Gray, B.........................................8-102 Hoegg, C..................................16-243 Karstetter, J...............................16-238 Lindberg, A.............................12-164
Gray, K......................................16-231 Hoffman, M...............................4-045 Kasahara, K................................1-002 Lipka, A......................................2-019
Greene, E..................................14-205 Hollenbeak, C........................10-144 Kassler, W.......................................119 Litinski, M................................12-161
Greene, L..................................16-246 Honeycutt, N................................122 Katz, K......................................16-229 Liu, M..........................................8-124
Griffin, D........................................123 Hooker, E....................................2-021 Kaye, K...............................118, 1-001 Lohithaswa, S.............................1-001
Griffin, P...................................12-157 Hopfner, D.................................4-053 Kazuhiko, N...............................4-041 Lopez, S.......................................8-126
Grimes, L..................................12-161 Hopkins-Broyles, D................12-175 Kelly, N.......................................8-105 Lovell, R......................................5-059
Gross, B.....................................16-238 Hoppe-Bauer, J..............................130 Kerridge, J...................................4-043 Lovick, H....................................4-048
Grossberger, S............................8-081 Horan, T.........................................119 Kertesz, L.................................15-213 Lowy, F............................................100
Guddati, H.................................1-001 Hori, S.......................................15-221 Kester, S......................................8-110 Lucas, B.......................................2-017
Guimera, D..............................13-188 Horn, T.......................................8-106 Kettunen, C.............................16-232 Lucente, K................................12-158
Gupta, N.........................................107 Horowitz, H...............................4-036 Khan, S............................................101 Luchsinger, B.............................4-047
Guzman, O.................................8-111 Houser, E....................................6-068 Khan, A.......................................1-001 Luzzaro, F ..................................8-095
Ha, N........................................13-196 Howard, D.................................2-009 Kiernan, A.........................106, 4-034 Ma, Y.........................................12-172
Haag, R.......................................3-025 Howard, T................................15-206 Kilinc-Balci, F............................7-075 Mace, M......................................8-078
Haberman, B............................12-185 Hoxworth, T............................12-186 Kim, D......................................16-229 Macias, A........................................105
Hacek, D........................................104 Huertas-Jimenez, M.....................105 Kim, Y.........................................4-036 Macinga, D........................102, 2-013
Hale, M.......................................4-028 Hullett, T .................................13-194 Kirby, J......................................13-188 MacPike, B......................................116
Haley, V...........................................120 Hum, R.....................................12-168 Kirk, J........................................14-201 Madison, A.................................8-125
Hameed, F..................................4-052 Hurst, D.......................2-017, 12-155 Kita, E..........................................1-002 Maher, A...................................15-209
Hankins, A...............................13-189 Hutchinson, N........................12-184 Kleinman, K..................................119 Mahesh, U...................................1-001
Hannon, C..................................5-057 Hutton, T .................................16-233 Knaup, R .................................14-198 Mallad, A....................................1-001
Hansen, B .................................15-218 Hyman, S..................................15-213 Knight, J....................................12-164 Malow, J.......................................4-043
Hansen, S....................................8-112 Ichiki, K......................................4-040 Knoke, C.....................................2-018 Mamon, R................................15-209
Hargreaves, J...............................8-112 Igwe, G......................................12-173 Kobayashi , H.............................2-008 Marcellino, J...............................3-025
Hariri, R......................................8-091 Infection Control Liaison Team Kohan, C.....................................5-057 Marchaim, D.....................101, 1-001
Harper, J......................................9-135 White Plains Hospital..............8-120 Koll, B.............................................109 Marchione, S..............................4-036
Harris, L......................................7-075 Ingram, L..................................12-166 Kolonoski , P..............................4-039 Marine, M .........................127, 8-082
Harris, A.........................................124 Isaacs, P......................................12-165 Komatsu, Y.................................1-002 Marion, N.................................15-216
Harris, J...........................................125 Ivie, G..........................................8-090 Koy, T........................................13-189 Maron, G....................................8-115
Harris, J.....................................13-194 Jackson, D.................................16-235 Kralovic, S...................................8-109 Marquez, P..................................9-136
Harris, T......................................8-106 Jackson, R.......................................123 Kramer, I...................................11-147 Martin, J......................................8-111
Harris- Williams, M.....................124 Jackson, J..................................12-156 Kreiling, S.................................15-212 Martin, K .................................16-236
Hartless, K......................................112 Jadin, S............................ 129, 16-234 Kuchipudi, V..............................5-060 Martin, M.................................15-212

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 197
Author Index–2012 Abstracts
Martinez, L..............................12-183 Nakazawa, Y...............................15-221 Pope, L.........................................16-227 Rutala, W..........................................128
Mascola, L...................................9-136 Nanjireddy, P................................5-060 Powell, C.....................................10-145 Rutledge, S....................................9-130
Mason, G..................................13-191 Napoleon, G.................................9-137 Prasad, P......................................16-231 Rybak, M......................................1-001
Matocha, D..............................12-171 Narayana, E...................................8-096 Preas, MA.........................................124 Saiman, L......................................8-082
Mauzey, S....................................4-031 Nash, D.......................................13-195 Prescott, J....................................15-212 Saito, A........................................15-221
May, R.........................................4-045 Nava Ruiz, E.................................1-006 Price, A..........................................2-018 Sammel, L...................................13-194
Mayers, R....................................4-036 Nazarali, S...................................15-225 Primes, V........................................8-106 Sampathkumar, P.............................113
McCalla, S..................................8-120 Neidell, M....................13-195, 13-197 Prinz Luebbert, P.........................1-005 Sanchez, G....................................9-137
McCormack, R.........................2-008 Nelson, L.....................................16-238 Pulluru, H.....................................1-001 Sanner, J.......................................15-222
McDermott, M.......................12-157 Nelson, P.....................................15-213 Qudsi, A........................................4-052 Sano, R..........................................1-002
McDowell, A...........................16-240 Nepomuceno, L.........................12-173 Quinn, B.....................................12-178 Santerre, A....................................7-076
McFarlin, J..................................8-099 Nerandzic, M.............................10-143 Qutaishat, S..................................2-016 Santos, A.....................................15-215
McGinnis, M.............................8-084 Newman, D................................15-211 Raimondi, A.....................................109 Santos, N.......................................7-073
McGuckin, M............................8-097 Ng, W..........................................16-229 Raisanen, P....................................7-077 Sarkar, M......................................5-060
McIntrye, K.............................16-232 Nigam, S........................................4-042 Ram Rakesh, MV.........................1-001 Satterwhite, E...............................2-015
McKinney, R..............................8-087 Nigh, K........................................15-222 Ramasamy, B.................................1-001 Savage, R.......................................4-030
McMullen, K.................................130 Nimtz, P......................................16-235 Ramirez, M................................16-245 Schallenberger, M........................4-048
Meeks, D...................................12-176 Nishihara, Y.................................2-008 Rao Sundaragiri, P.......................5-060 Schleder, B..................................12-159
Melgar, M ........................114, 16-245 Nolan, R........................................8-093 Rebmann , T..............................14-198 Schweon, S..................................14-201
Melonari, P.................................8-128 Nolan, V......................................13-188 Reddick, D...................................3-024 Scully, F..........................................8-082
Meskill, R ...................................7-076 Nolting, P...................................12-150 Reddy, S.........................................4-045 Septimus, E.......................................110
Meyer, T......................................4-048 Norrick, B.....................................4-026 Reddy, S........................................5-060 Seward, S.......................................8-105
Meyer, J.....................................12-160 Northey, C..................................15-208 Reddy Guddeti, R.......................1-001 Shahani, S......................................5-060
Midamba, B...............................8-106 Obando, G....................................8-126 Reed, L..............................................122 Shaikh, Z.......................................4-044
Mikasa, K....................................1-002 Obeid, T........................................1-001 Reese, S..............................................121 Shapiro, R...................................15-210
Miko, B........................................8-105 O’Donnell, M............................16-237 Reese, J.........................................13-187 Shashidharan, SP.........................1-001
Miletic, K .......................................118 Okubo, T........................2-008, 15-221 Reeths, A.......................................4-046 Shenk, G............................................129
Miller, L....................................16-231 Osborn, N...................................12-174 Regazzoni , F.................................8-095 Sherman, E.................................16-243
Miller, L......................................4-044 Ostmann, E................................12-175 Reid, S............................................6-064 Shimoda, K..................................2-009
Misao, H...................................15-223 Oyong, K.......................................9-136 Relyea, G.....................................13-188 Sholtz, L......................................15-216
Mishima, Y...............................15-221 Palla, M.................................101, 1-001 Renck, H.....................................12-157 Shuler, R.......................................8-106
Mizuno, F....................................1-002 Pappalau, R...................................9-131 Rey, J...............................................4-053 Shultz, V......................................15-218
Mohin, S.....................................5-060 Parise, C......................................12-178 Rezai, F........................................12-161 Shumaker, D........................102, 2-013
Montero, M.............................12-170 Parker, P.......................................16-234 Rhoto, B........................................4-051 Sica, J..............................................5-057
Monti, P.......................................8-095 Patel, D.................................101, 1-001 Riboul, M....................................12-181 Sickbert-Bennett, E........................128
Moody, J..........................................110 Patel, P...............................................115 Rich, K...............................................121 Sifuentes, L.......................7-077, 6-069
Moore, C.....................................7-074 Patel, S...............................................101 Richards, S..................................15-222 Sigler, J...........................................6-063
Moore, P...................................12-159 Patel, B...........................................7-073 Rivard, L............................................117 Silva, Y...............................................105
Morgan, A................................13-190 Patel, S.........................................12-168 Rivas, H.........................................9-136 Simmonds, B..............................10-146
Moronaga , Y..............................9-134 Patkar, A........................................4-042 Rivera, P............................................109 Simons, N...................................14-203
Morse, D............................111, 8-100 Paul, D.........................................16-231 Rivera, K....................................15-207 Simpser, E.....................................8-082
Mortimer, M............................15-207 Paulson, D.....................................2-022 Rivest, K.....................................16-236 Simpson, K.................................10-141
Moseley-Ladell, M....................6-065 Pavia, M.........................................2-014 Roach, L......................................14-200 Singh, J...........................................7-073
Moshos, J....................................5-060 Peeples, J.............................129, 16-234 Robicsek, A......................................115 Singhoffer, E.................................6-066
Moss, S...............................................107 Perlin, J..............................................110 Robinson, R...............................16-232 Singla, M.......................................1-001
Moss, M............................................109 Perlman, J....................................16-231 Rodriguez Auad, JP..................12-180 Siska, M..............................113, 15-218
Mougeot, J-L................................5-059 Persing, T....................................12-179 Rogers, A.....................................12-175 Sissodia, P......................................8-096
Mukherjee, D...................................100 Peters, E.......................................14-198 Roman, K....................................16-234 Sitzlar, B.......................10-143, 16-237
Mull, R........................................16-235 Peterson, L........................................104 Rosaenz, A....................................8-128 Skyles, J........................................12-175
Mullaney, K................................12-167 Peterson, K.......................................104 Rosaenz, L.....................................8-128 Slye, M...........................................6-066
Mullins, T..........................................123 Pettis, A.........................................9-131 Rose, V........................................14-202 Smathers, S.................................16-243
Murphy, S ..........................103, 12-156 Pikula, Z......................................16-229 Roselle, G......................................8-109 Smith, J........................................12-163
Mzayek, F....................................13-188 Pini, B.............................................8-095 Roser, L..........................................8-103 Smith, J..........................................4-027
Nabetani, Y.................................15-223 Platt, R...............................................119 Ross, L...........................................4-029 Smith, P.........................................8-086
Nadeau, J.......................................5-057 Pogue, J..........................................1-001 Rowland, D................................14-201 Smith, R......................................15-207
Nagahara, C..................................9-134 Pokrywka, M................................8-081 Ruckriegel, C.............................14-202 Snedeker, L.................................15-207
Naik, K........................................15-225 Polanco, C.........................................105 Rupp, M......................................15-216 Snyder, V....................................13-194
Nakayama , A................................1-002 Policherla, R.................................1-001 Russo, A............................................130 Somarriba , MM..................114, 8-126

198 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
 Author Index–2012 Abstracts
Sorter, M.....................................12-185 Vadlamudi, G................................1-001 Yaney, E..........................12-161, 4-032
Sosa Pueyo, MF............................8-122 Van Antwerpen, C..........................120 Yarborough, E............................12-152
Sossoman, L......................................122 Van Enk, R.................................12-154 Yaseen. M......................................4-052
Soumerai, S.......................................119 Van Toen, J..................................14-204 Yassin, M.......................................8-091
Stahl, J............................................8-100 VanDerSlik, A............................12-154 Yee, V..................................................101
Stanley, K......................................4-039 Vasquez, R.....................................8-115 Yodice, P......................................12-161
Stare, D..........................................8-105 Velasco, A....................................15-214 Yokota, K.......................................2-008
Starke, J........................................13-189 Vemuri, P.......................................1-001 Zabarsky, T....................................8-106
Statz, C........................................16-242 VerLee, K....................................10-141 Zabriskie, K................................12-183
Stein, L........................................16-236 Verzi, S...........................................6-070 Zaoutis, T....................................16-231
Stewart, C...................................12-155 Vesely, J........................................12-159 Zelencik, S........................................115
Stinchfield, P................................5-061 Vicuna, C......................................8-117 Zielinski, E....................................8-124
Stone, S........................................13-194 Vinci, C.........................................8-097
Strader, W......................................5-059 Vinski, J.............................................131
Streed, S.........................................2-018 Voegele, C...................................12-185
Stromquist, C.............................13-194 Vollmuth, C..................................1-005
Sturm, L......................................12-156 von Kohn, B...............................10-140
Sullivan, N....................................8-106 Wadhawan, R.............................13-194
Sun, Z.................................................131 Waibel, M...................................12-162
Swick, Z.........................................3-024 Walker, B...........................................123
Swift, D..........................................2-020 Walker, J.........................................8-121
Tabibi, S.......................................16-231 Walz, C..........................................8-087
Takashi, U......................................4-041 Ware, K..........................................4-035
Takesue, Y......................................4-040 Warren, D.........................................130
Tamura, T...................................15-221 Watson, J.....................................16-236
Taylor, T............................................118 Wayland, J.........................................126
Taylor, A......................................11-147 Weber, D...........................................128
Tentori, C......................................8-095 Weisberg, M..................................4-033
Terashita, D...................................9-136 Wells. MA...................................12-183
Terrell, T........................................8-116 Wells, P...........................................8-092
Teska, P..........................................2-016 Wendt, J......................................16-234
Thom, K............................................124 Wentink, J...................................15-218
Thornhill, G.....................................111 Wesley, G.......................................2-009
Thornton, P.......................................123 West, K..........................................9-129
Thornton, A.................................8-124 Wheeler, D.................................12-184
Tierney, C.....................................6-066 Whitbread, M............................10-142
Tippett, J.....................................16-239 White, D.....................................16-229
Titus-Hinson, M.........................8-110 White, F......................................15-222
Tobin, J........................................15-214 Whitlock, J...................................8-109
Torres, K............................................113 Whittier, S..................................16-231
Tosh, J..........................................16-240 Wickman, K...............................16-236
Toth Martin, E....................118, 1-001 Wiemken, T..................................2-010
Townes, J........................................4-028 Wilkman, A......................................127
Trimberger, K...............................8-084 Willier, T....................................15-207
Trinidad, C.................................12-159 Wilson, S.....................................16-244
Tropiano, C...................................8-105 Wilson, T......................................2-023
Tropp, J.............................................104 Wisdom, C.................................12-164
Trovillion, E...............................12-175 Woeltje, K...................................12-175
Tse, A.................................................119 Wolven, S.......................................4-042
Tserenpuntsag, B.............................120 Wong-McLoughlin, J...............16-231
Tsivitis, M.........................................120 Wood, A......................................13-187
Tsuchida, T...................................4-040 Worden, C.....................................2-017
Tsukamoto, Y...............................6-071 Wright, M-O....................................104
Turner, P......................................15-216 Wright, K....................................14-198
Tyler, L..........................................7-076 Xiong, KN.......................................120
Ui, K...............................................1-002 Yadalam, S.....................................4-042
Upputuri, V...................................5-060 Yamada, K.....................................6-071
Vacca, M........................................8-085 Yamaguchi, Y................................9-134

APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012 199
 Future APIC Annual Conference Dates and Locations

Annual Conference 2013

Fort Lauderdale, FL
June 8-10, 2013

Annual Conference 2014

Anaheim, CA
June 7-9, 2014

200 APIC 39th Annual Educational Conference & International Meeting | San Antonio, TX | June 4-6, 2012
Showcase
your expertise at

Call for Presentations Call for Abstracts

APIC is seeking presentations that detail new scientific Don’t miss your opportunity to present research papers and
research in infection prevention and highlight the innovative educational presentations of scientific quality on the areas
successes and best practices of infection preventionists like of infection prevention—submit your abstract for APIC 2013!
you. Sample submission categories include:
Site open: September 24 – December 10
䡲 Surveillance and Technology
䡲 Emerging Science, Research, and Application To learn more about how to submit a proposal or an
䡲 Leadership and Professional Development abstract, visit www.apic.org/ac2013.
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Site open: June 6 – July 30 Infection Prevention and Control
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