APIC Greater NY Chapter 13 Q & A Session November 18, 2015 by Natalie Fucito BSN, RN, CCRN

1. APIC Greater NY Chapter 13Q & A SessionNovember 18, 2015by Natalie Fucito BSN, RN, CCRN Infection Prevention and Control Department 212-263-5454 / 212-598-6767

2. Question #1 The IP is reviewing a research study to assess the association between needleless connector (NC) change frequency and central-line associated bloodstream infection (CLABSI) rate. In multivariate analysis, the CLABSI rate was significantly higher (p=0.001) among patients that had NC changed every 24 hours compared to patients with NC that were changed at 96-hour intervals. The IP knows that this p value indicates more evidence in support of which of the following? a. The alternative hypothesis b. The quality of the analysis c. The null hypothesis d. The statistical hypothesis

3. Answer #1 • A- The alternative hypothesis • Rational: The p value is the probability of obtaining the observed sample results (or a more extreme result) when the null hypothesis is actually true. • If the p-value is small (< the significance level), it suggests that the observed data is inconsistent with the assumption that the null hypothesis is true, and thus that hypothesis (the null one) must be rejected and the alternative hypothesis accepted as true.

4. Question #2 • The Director of Infection Prevention and Control is leading a process improvement project to decrease the rates of CLABSI in one of the hospitals ICUs. • The multidisciplinary team has discussed multiple process improvement strategies to decrease these bloodstream infections. In developing the final improvement plan, which of the choices below is most likely to help decrease the CLABSI rates? • Performing a gap analysis each month • Performing a failure mode effect analysis immediately • Incorporating the use of a CLABSI bundle and checklist to ensure all aspects of the plan are followed. • Perform a strengths, weaknesses, opportunities, and threats (SWOT) analysis.

5. Answer #2 • C- Incorporating the use of a CLABSI bundle and checklist to ensure that all aspects of the plan are followed. • Rationale: Implementing a formalized process reduces errors caused by lack of information and inconsistent procedures. Checklists and best practice bundles can promote process improvement and increase patient safety. • By applying checklists to the prevention of infection within an organization and using simple steps such as washing hands and cleaning the skin with antiseptic, organizations can eliminate hazards and problems that affect patients every day. Bundles can create standardized and simplified processes and procedures, and using checklists provides an organized way to incorporate best practices.

6. Question #2 Continued… • After implementing the CLABSI checklist over 2 quarters in the ICU, you notice that the CLABSI rates have actually increased. As the IP working on this project what intervention would you implement next? a. Contact the Senior Director of the ICU and complain that the Nurse Manager is not doing a good job. b. Re-train staff on how to use the checklist. c. Meticulously review the completed checklists over the past two quarters to identify gaps in practice. d. Round with staff and complete the checklist on a systematic basis to observe gaps in practice.

7. Answer #2 Continued… • C. • Rationale: Merely collecting data and reporting it probably doesn’t change anything. Learning from the findings needs to occur and influence ongoing clinical practice. • Additional benefit may come from the IP directly participating in the data collection to validate that staff performing the audits are doing so correctly. This active role can offer opportunity for staff education and positive feedback as well.

8. Question #3 • An employee has sustained a needlestick injury from a blood-contaminated needle. The source patient was Hepatitis B virus (HBV) positive, and the employee had completed only one of the three vaccinations in the Hepatitis B series. Which of the following is the correct post-exposure prophylaxis (PEP) for this patient? a. Complete the Hepatitis B vaccine series b. Complete the Hepatitis B vaccine series and provide Hepatitis B immunoglobulin c. Provide Hepatitis B immunoglobulin and begin interferon therapy. d. Stop the vaccine series; it is no longer needed

9. Answer #3 • B • Rationale: HBV is transmitted by percutaneous or mucosal exposure to infectious blood or body fluids. The risk of HBV seroconversion after a percutaneous injury ranges from 23 – 62 percent depending on the Hepatitis B e antigen (HBeAg) status of the source person. • For exposed persons who are in the process of being vaccinated, but have not yet completed the vaccination series, vaccination should be completed as scheduled, and Hepatitis B immune globulin (HBIG) should be added as indicated. Both HBIG and the Hepatitis B vaccine should be administered as soon as possible after the exposure (preferably within 24 hours).

10. Question #4 • You are the newly hired IP covering a rehab facility that has a hydrotherapy pool for patients to receive treatment in. Which of the following would you ensure are in place? (select all that apply). a. External laboratory testing of the pool water on a weekly basis b. An annual IPC pool party (editorial note – YEAH!) c. Policies and procedures on maintenance of the pool d. Staff competencies that use the pool on a regular basis

11. Answer #4 • A & C • Rationale: As the covering IP you would want to ensure a comprehensive policy and procedure was in place for cleaning and disinfecting the pool, including how often the water was tested and actions if water tests were to come back positive. • Note from personal experience: Also be sure the testing results are clearly and consistently communicated with the clinical leadership responsible for the pool, that the results are clearly logged, available for inspection in the event of a TJC or CMS review, and that the staff who use the pool regularly can speak to the inspection process, at least in brief.