From Linda Miller, RN, CIC
“The APIC Annual Educational Conference held in Anaheim, CA in June was an exceptional experience. There were many informative and interesting sessions. Below are take-away points from four of the sessions I attended.
Infected Healthcare Workers: Practice vs. Recommendation was a point/counterpoint session based on recent recommendation for work restriction for HBV infected coworker published in the MMWR in July of 2012. Main points focused on the obligation of Employee Health to maintain employee confidentiality and the recommendation for sending infected healthcare workers to a confidential expert review panel. This would ensure that all employees are treated fairly and equitably.
Core elements of an Antibiotic Stewardship program were defined as:
- · Leadership commitment
- · Program leadership including a physician champion and a Pharmacy leader
- · Utilization of an antibiotic use tracking system that monitors ordering practice and identifies opportunities for improvement
- · The use of facility-specific antibiotic protocols for treatment
- · Reporting and education
- · Interventions to improve antibiotic usage.
Key moments of antibiotic stewardship involves improving usage at certain specific opportunities
- C. difficile infections
- Positive blood cultures
- IV antibiotics at discharge
- Drug/organism mismatches
Measuring antibiotic usage is time consuming. An NHSN antibiotic usage module was launched in 2012. There is a hope to create benchmarks for antibiotic usage and utilization rate, both of which will be risk adjusted for facility type. Data can be submitted as unit-specific or facility-wide.
HICPAC presented the 2014 Draft Guidelines for SSI Prevention. The guidelines will be in two portions; a core section and an arthroplasty section. The draft guidelines are based on randomized controlled trials only. Since much of the recommended practices that we are used to are not necessarily supported by these types of trials, they will be classified as unresolved issues. This includes many of the measures currently required in the SCIP Core measures data set. When queried how we would be expected to continue to support the SCIP measures as evidence based practice when they were being removed from the main body of evidence that most of us rely on, the speaker indicated that the expectation is that we look to AORN for practice guidance.
A presentation on IV clean rooms outlined the expectations for UPS 797in regards to certifying rooms for IV admixture and compounding. Compounding personnel are required to wear no make, no jewelry and no artificial fingernails. Personnel are also required to submit to gloved fingertip sampling of at least 3 fingers biannually. Documentation is needed for cleaning of the room and total particle counts and surface testing is required every 6 months. Acceptable particle count levels can be on Table 2, page 15 of the USP 797 document. A contingency plan needs to be in place for when the IV cleanroom is shut down for testing failures. Hospitals are encouraged to purchase compounded medications from certified providers only.
Once again, please accept my gratitude for the APIC DFW Annual Conference Scholarship. My session was very well attended and I have been invited to present for two other APIC Chapters and to speak next year at the California APIC Consortium (CAC) at their annual conference. Thank you so much for the support and the opportunity.“