Welcome to the GHA Infection Prevention Power Hour June 19, 2014

1. Welcome to the GHA Infection Prevention Power Hour June 19, 2014

2. GHA HEN Update • GHA/HEN Hospitals Update • Spread of C diff , Sepsis, and Worker Safety • LEAPT hospitals have implemented Rapid Cycle Change with great success • Update on SUSP Cohort 5 Recruitment • Educational Opportunities: • Enhancing Caregiver Resilience: Burnout & Quality Improvement • GHA Education Center, Marietta • July 29, 2014 • Team STEPPS Training • (Team Strategies & Tools to Enhance Performance and Patient Safety) • June 24 – 26 UGA Tifton Conference Center

3. SHEA 2014 UPDATEShttp://www.jstor.org/stable/10.10.1086/675819 • SHEA has begun to publish updates to its Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals. • The original guidance documents were published in 2008 and focused on six HAIs: • CAUTI, SSI, CDI, CLA-BSI, MRSA, VAP

4. SHEA 2014 Updates • The new compendium updates the original guidance and adds a seventh document focused entirely on hand hygiene. • Updated literature review and graded recommendation strategies broken into 2 tiers: basic practices for all hospitals and special approaches which may be used when basic strategies not effective. • Guidance documents, not guidelines

5. SHEA 2014 Updates • May issue of Infection Control and Hospital Epidemiology includes a description of the process used to develop the compendium along with the CA-UTI document • June issue includes the SSI and CDI prevention updates

6. SHEA 2014 Updates • Some recommendations have remained unchanged • Some brief observations are warranted • CA-UTI document contains a table addressing problem solving in the implementation of CA-UTI prevention strategies • CDI prevention guidance adds to the basic strategies that appropriate use of antimicrobials is an important component of CDI control. • SSI prevention expanded to include: maintenance of normothermia, optimization of tissue oxygenation, use of alcohol-containing skin preps, and use of WHO based checklists.

7. SHEA 2014 Updates • Implementation strategies around the Four E’s framework is included: • Engagement of key stakeholders • Education regarding the intervention • Intervention is Executed by Embedding it in standard processes and finally, • Evaluated to determine its impact

8. Georgia Department of Public Health Updates • Public Health HAI Update • Georgia Healthcare Advisory Committee • Policy Statement C difficile testing • GMCF/QIO Update: NHSN Updates

9. Georgia Healthcare Associated Infections Advisory CommitteePolicy Statement: Laboratory Diagnosis of Clostridium difficile for Healthcare FacilitiesIssued: April 22, 2014 Introduction: The dramatic rise in Clostridium difficile infections over the last 10 years, its spread into the community, and the clinical and economic impact this disease stimulated an intensive review of all facets of the disease including a critical analysis of laboratory testing to diagnose infection. Guidelines and position statements have been issued by:  The American Academy of Pediatrics 1  The American College of Gastroenterology 2  The American Society for Microbiology 3  The Association for Professionals in Infection Control and Epidemiology 4  The Centers for Disease Control and Prevention 5, and  The Society for Healthcare Epidemiology of America 6

10. Recommendations: Based on strength of evidence, the Georgia Healthcare Associated Infections Advisory Committee makes the following recommendations for laboratory testing when Clostridium difficile is suspected. 1. The preferred testing method is nucleic acid amplification assay (includes polymerase chain reaction [PCR]). 2. An alternative testing method is a 2-step algorithm to detect common glucose dehydrogenase antigen (GDH) and Toxin A/B, with reflex to nucleic acid amplification assay for discrepant results. 3. Diagnostic tests that ONLY detect TOXINS by EIA should NOT be performed (sensitivity 63-94%, specificity 75-100%). 4. Diagnostic tests should be performed ONLY on unformed, diarrheal stool specimens, except in the setting of ileus caused by Clostridium difficile7 5. Repeat testing during the same episode of diarrhea is discouraged, particularly when a nucleic acid amplification assay is used. 6. Test of cure should NOT be performed as the assay may be positive after clinical cure

11. Recommendations (continued) We encourage all healthcare facilities to have a written policy regarding laboratory diagnosis of Clostridium difficile. When possible, we encourage healthcare facilities to have a multidisciplinary committee to address all aspects of Clostridium difficile disease; at a minimum, this committee should include representation from infectious diseases, infection control, gastroenterology, microbiology, pharmacy, building management, and hospital administration. 1 Pediatrics (2013) 131: 196-200 2 Am J Gastroenterology (2013) 108:478-498 3 www.asm.org 4 www.apic.org/implementationguides 5 www.cdc.gov/hai/organisms/cdiff/cdiff_infect.html 6 Infection Control and Hospital Epidemiology (2013) 5: 431-455 7 Brecher S, et al. 2013. Clin Infect Dis. 8 :1175-81

12. QIO/GMCF Updates • NHSN Update • Lab ID Outliers

13. Questions / Sharing of Successful Strategies • CAUTI • American Journal of Infection Control: June 2014: Nurse-directed catheter removal protocols to prevent catheter-associated urinary tract infection: Strategies for implementation: Joan N. HebdenMS, RN, CIC • CLABSI • SSI • Success in obtaining new denominator requirements • C difficile / MRSA Blood • Physician Office Practice Infection Prevention Programs • American Journal of Infection Control: June 2014: A pragmatic approach to infection prevention and control guidelines in an ambulatory care setting

14. Thoughts / Suggestion Future Topics • Discussion by all

15. Contact Information • Jan Ratterree, RN, BSN, CIC Georgia Hospital Association 770-249-4518 | jratterree@gha.org. • Jeanne Negley, HAI Coordinator Georgia Dept. of Public Health (404) 657-2593 | jenegley@dhr.state.ga.us. • Cindy Prosnak, RN, BSN, CIC Alliant GMCF 706.836.8361 | CProsnak@gaqio.sdps.org.