Wednesday, December 29, 2010

How to be a successful IP in the 21st Century?

The article entitled “Expanding infection preventionists’ influence in the 21st Century:
Looking back to move forward”
in the December issue of American Journal of Infection
Control (AJIC) describes the three essential skills an IP should possess in order to be
effective in the 21st century.
The article highlights the challenges today’s IPs face in health care organizations as their role expands to issues beyond traditional infection control, such as in antimicrobial stewardship, facility design, patient outcome improvements, and more.

Self-knowledge, strategic relationships, and reciprocity are the three essential skills IPs need to master in order to be effective in their organizations.

Self-knowledge is the ability to understand one’s own strengths and weaknesses and knowing how and when to apply one’s capabilities.

Strategic relationships are those relationships the IPs rely on to make things happen. Few IPs have real power but they do have access to key decision makers. Successful IPs need to learn to build and leverage key relationships to get things done.

is the idea that one must give to receive and is considered by some as themost successful approach to daily decisions because it demonstrates a willingness to becooperative. It is important for an IP not to be perceived as asking for resources and support;
instead, IPs should seek common ground with others, offer assistance and compromise
where appropriate.
The last piece of advice in the article is that “IPs should take every opportunity to reach out, introduce themselves, describe their roles and responsibilities, communicate effectively, and provide information pertinent to those they seek to influence. Such people include administrators, nurses, physicians, patient safety officers, performance improvement teams, colleagues, peers, policy makers, or others.” Only after an IP has proven their value and credibility can she or he begin to fully utilize the above mentioned skills.

Monday, December 27, 2010

What's going to be on your next IP Certification exam?

The Certification Board of Infection Control and Epidemiology, Inc. (CBIC) completed a survey in September of this year to evaluate the current role of infection preventionists (IPs) and to determine which topics to cover in the IP certification examination. 

The survey asked practicing IPs to evaluate the 76 tasks that are on the current exam by first deciding whether or not a particular task is necessary for the job and second to rate the task’s significance.  A decision rule was then applied to eliminate tasks from the exam based on the survey results.  Finally the remaining tasks were grouped into themes or content domain and the number of questions for each content domain was assigned.

Here are the tasks that were removed from the exam:

#14 – Determine methods for monitoring and evaluating antimicrobial use
#25 – Use advanced statistical techniques to describe data
#58 – Prepare and manage the infection prevention and control program budget
#75 – Participate in research activities (e.g. product evaluation, prevalence surveys)
#76 – Conduct research in infection prevention and control either independently or collaboratively

Here are the content domains and the number of questions in each one:
1. Identification of infectious disease process – 18 questions
2. Surveillance and epidemiologic investigation – 38 questions
3. Preventing/controlling the transmission of infectious agents – 39 questions
4. Employee/occupational health – 10 questions
5. Management and communication (leadership) – 16 questions
6. Education and research – 14 questions

Total – 135 questions

Wednesday, December 22, 2010

HAI Case Studies

Dear IPs,

For those of you who do not receive AJIC or have been too busy to read it, I have attached some links that I think are useful. There are three case studies that NHSN and APIC developed. The case studies challenge your skills at determining if a patient has an HAI. You can answer online and then read the correct answers and explanations. You do not have to be a member of APIC to access the sites.

Here are the links to case studies that are currently available. Have fun!

Case 2

Case 3

Monday, December 20, 2010

Hemoglobin gene as a potential screening factor for Staph susceptibility?

The New York Times recently published an interesting article on the research of Dr. Eric P. Skaar at Vanderbilt University.  Dr. Skaar began researching Staphylococcus in 2002, a deadly bug that kills about 100,000 Americans each year and is the number one cause of hospital acquired infections.

Dr. Skaar's research focused on learning why some people are more susceptible to Staph than others.  Like all organisms, Staph needs iron to survive and it obtains iron by bursting open red blood cells and binding itself to hemoglobins.  Because there are genetic variations in hemoglobin, Dr. Skaar suspects that Staph prefers certain hemoglobin over others.  His research has already established that Staph prefers human hemoglobin over hemoglobin from other animals such as mice.  Dr. Skaar is now focused on identifying those genetic variations in hemoglobin that are most preferred by Staph.

If he is successful, hemoglobin screening may become a routine tool to test a patient's susceptibility to Staph.

Link to New York Times article

Monday, December 13, 2010

Poor nations have higher HAI rates

Researchers from the World Health Organization reviewed over 200 published studies on hospital acquired infections (HAIs) and found that these countries have much higher HAI rates than the U.S. and Europe.

The infection rate in developing countries was 15.5 per 100 patients, compared to 7.1 in Europe and 4.5 in U.S. The difference in intensive care units was even more pronounced - 4.7 per 1,000 patient-days in developing countries compared to 13.6 in the U.S.

According to one of the researchers, Professor Didier Pittet, "There can be a misconception that healthcare-associated infections are not often found in developing countries, simply because their healthcare systems are blitzed with other issues that high-income countries have dealt with or controlled long ago."

This study demonstrated that HAIs are highly prevalent in developing countries. It's reasonable to assume the higher infection rates are leading to longer hospital stays, extra costs, and deaths. According to the study, simple, low cost measures such as better hand hygiene, surveillance, and education could drastically reduce infection rates.

Abstract and link to full article here

Friday, December 10, 2010

“Germ Cops” or “Prophets in the Wilderness”?

Recently, there’s been a story floating around about infection prevention practices at University of Maryland Medical Center. The success that UMMC has had is remarkable, to be sure. What is even more remarkable is the variety of interesting terms journalists use to describe the job of infection prevention. If you Google articles related to the UMMC story, you get labels varying from “Germ cop” to “Germ inspector” to “eagle-eyed hospital worker” and even “prophets in the wilderness.”

In Atul Gawande’s 2007 book Better: A Surgeon’s Notes on Performance, the first chapter highlights the role of the infection preventionist, describing a day-in-the-life of Brigham and Women’s IP Deb Yokoe. Gawande quotes Yokoe as saying “I don’t want to be an infection control cop.” At the 2010 APIC keynote when Gawande repeated the same quote, an auditorium full of IPs applauded the sentiment. Perhaps the Associated Press writers should pick their headlines with more sensitivity, though I understand these labels demonstrate a flare for the sensational.

I will leave it up to individual IPs to describe how they view their job, and how they’d like to be viewed. I do know that IPs want to shed the sometimes adversarial relationship they have with other health care workers, and they want to be seen as partners in providing better quality care.

Wednesday, December 8, 2010

Resistance is useless

Not just a Vogon catchphrase anymore, a new study in Lancet Infectious Diseases has some wondering about the effect of antibiotic resistance in bacteria. I’m actually a little uncomfortable with the way that summarized the recently-published article by Lambert et al., titled “Clinical outcomes of healthcare-associated Infections.” Lambert et al. studied almost 120,000 ICU patients over a four-year time span in 10 European countries. Unsurprisingly, they found that patients who acquire a healthcare-associated infection have worse outcomes than those that don’t. However, they go on to say that if the infection acquired is resistant to narrowly-specified antibiotics, the fact of the resistance itself does not make the outcome much worse.

Specifically, the study finds that pneumonia doubles the risk of death and BSIs triple the risk of death, but when the bacteria causing those infections is antibiotic-resistant, there is only a 20% increase in the likelihood of death (results significant just for pneumonia). “Only.”

Now, I understand that 20% is not much when compared with 200%, and that that difference is what generated ICT’s summary title “Resistance Does Not Greatly Impact Mortality in ICU Patients with HAIs,” and that’s a valid viewpoint based on the study’s results. However, imagine someone coming up to you and saying “You have pneumonia; you’re now 200% more likely to die than before. By the way, given that awful news, would you rather be an additional 20% more likely to die or not?” Who would answer “Whatever, no great impact either way”? 20% doesn’t seem like much only because it’s being compared to 200%, but I’d definitely consider a 20% increase in number of deaths a significant impact.

Abstract, with link to full text for those with access:

ICT article:

Monday, December 6, 2010

Checklist at work - Rhode Island hospitals reduce BSI rates using the Checklist

Collaboration among Rhode Island hospitals' intensive care units (ICUs) to reduce infection rates led to significant reductions of central line-associated bloodstream infections (CLABSIs) and ventilator-associated pneumonia (VAP).  The state's 11 acute-care hospitals formed The Rhode Island ICU Collaborative in 2005 with the goal of reducing infection rates in the hospitals' 23 ICUs.  The effort was partially paid for by insurance companies and had strong backings of the state government.

The ICUs used the Checklist developed by Dr. Peter Pronovost's team at Johns Hopkins Hospital.  By June 2010, the effort had saved 73 lives, avoided 3,271 patient days, and saved $11.5 million.  Although the effort focused on ICUs, the same model is applicable to other units within the hospital.

Rhode Island Department of Health now publishes quality measures including infection rates on a public website.

Abstract and link to full text of the study is here.