By Gary Evans, Medical Writer
Recently recognized as having one of the best infection prevention programs in the country, IPs at Vanderbilt University Medical Center in Nashville are rapidly turning accolades into action.
“We helped APIC and CDC pilot some audit tools that will help smaller hospitals throughout the country,” says Vicki Brinsko, MSN, RN, CIC, FAPIC, director of infection prevention at Vanderbilt. “They can use these to audit processes like central-line dressing changes, urinary catheter care, high-level disinfection, and compliance in isolation rooms with PPE donning and doffing. We piloted a bunch of these tools that they can adapt and adjust to make their system better.”
The infection prevention audit tools were expected to be made publicly available in the near future — Vanderbilt’s way of saying thanks for being recently named the first recipient of an award for excellence created by the Association for Professionals in Infection Control and Epidemiology (APIC). The APIC Program of Distinction is a new comprehensive designation created by the nation’s leading association of IPs.
“Being the first recipient of this program of distinction lets us be an example and a mentor for both APIC and other institutions to strive to become excellent,” Brinsko says. “We are happy in this role and people call us on almost a daily basis. We strive to be an example for other hospitals, especially in the state of Tennessee.”
Of course, Vanderbilt has the resources of a leading teaching hospital, but even IPs in small hospitals can achieve much by networking with other members of a profession that has a history of mentoring.
“The advice I would give to other IPs is don’t hesitate to reach out to other people,” she says. “You are not in this boat alone. You may think you are if you are a new IP, but reach out to APIC and your state organizations. There are plenty of people who want to help.”
The One and the Many
“I think that one of the strengths of our program is that we don’t limit infection control to just the IPs.” Brinsko says. “We spread it out. We have partners in infection prevention who were evident and who supported us throughout this survey process for the program of distinction.”
That includes colleagues in environmental health and safety, occupational health, facilities management, and plant services, she says.
“We are working together for one goal: quality patient care and safe patient care,” she says. “We also partner with our quality consultants. Infection prevention is part of the quality umbrella, and we do safety rounds with our quality partners on a weekly basis through every single patient unit.”
In this sense, infection control at Vanderbilt has moved well beyond the historical stereotype of the IP crunching numbers in some isolated silo.
“This also goes all the way down to the staff nurse — the frontline people fighting infections every single day,” Brinsko says. “I think that is one thing the surveyors noted, that infection prevention is not limited to a single department — it goes out to the staff level.”
As an example of excellence, one of the APIC surveyors says the hospital has a state-of-the-art tracking system for instruments subject to high-level disinfection and sterilization.
“They have bar coding and computerization of the entire process,“ says Terrie Lee, RN, MS, MPH, CIC, FAPIC, strategic and clinical lead for development of the APIC Program of Distinction. “They were showing us that they can take an instrument, look in a computer, and tell where it is — whether it is in reprocessing or on a tray in an OR. It was a very clear process and we could see all of the problems that this would avoid.”
This focus and collaboration at VUMC extends to the bane of the infection preventionist: hand hygiene, or the lack thereof. Non-IP staff members are recruited as “secret shoppers,” collecting hand hygiene data on their respective units. The hand hygiene observation data can be entered via an app on a smartphone, a method particularly effective for engaging younger workers, Brinsko says.
“It’s a quick and painless phone app,” she says. “It sends it to a spreadsheet and we feed that data right back to the units on a daily basis. In fact, they can pull their own data from our dashboard, which they love because it’s electronic. Some people prefer to have a report pushed to them, so they do both.”
Hand hygiene compliance data is reported by unit level and job type, but does not identify individual healthcare workers. Data broken down to the unit level is sufficient to stir awareness and competition, but the critical step is to report what you collect.
“We don’t keep data to ourselves or collect data and not share it,” Brinsko says. “I think that is a key that some programs might miss. If you are going to collect data — share it. We feed that data back to the end users and they can see how well they are doing for compliance purposes.”
The Program of Distinction is a three-year designation of excellence based on the APIC Standards of Excellence for Infection Prevention and Control. While guidelines typically set minimal thresholds, the APIC standards establish levels of excellence in such areas as surveillance, hand hygiene, outbreak investigation, patient isolation, emergency management, employee health, and antibiotic stewardship.
In a process that is somewhat akin to the oversight of accreditation agencies, the Program of Distinction includes a rigorous application and review process, followed by a site visit by APIC IPs.
Achieving and maintaining the distinction will require administrative support, something infection control programs have historically struggled to obtain. The APIC designation includes such marketing tools as award plaques and label pins recognizing infection prevention excellence, which could be appealing to administrators wanting to underscore the message of patient safety.
“We need the involvement of the entire organization to have a successful infection prevention program,” Lee says. “That is so key. If we don’t have that, we are not going to be able to have excellent patient outcomes. That’s something that IPs across the country talk about — how discouraging it is to be held accountable when you cannot get adherence to the processes that will improve the situation. Until you have that team approach in hospitals, you are not going to reach this level of distinction.”
APIC hopes to extend the Program of Distinction to more than 1,500 facilities over the next five to seven years. That said, the distinction status will only be awarded to programs that meet the high standards set forth by the association. Those that apply and fall short will receive a gap analysis to pinpoint areas for improvement.
“We have a very comprehensive, stringent process and that’s really what will dictate the number of facilities,” says Leslie Kretzu, executive director of APIC Consulting Services, Inc. “But we certainly are getting the word out and the interest has been great.”
APIC on the Move
The Program of Distinction honor is one of several APIC efforts to revitalize and professionalize the field while reaching out to a new generation of practitioners, says Janet Haas, PhD, RN, CIC, FSHEA, FAPIC, 2018 APIC president. The profession is approaching a demographic faultline as career IPs start to leave the field. APIC is looking at a younger demographic of healthcare workers in terms of striking and maintaining an interest in the importance of infection control.
“We want to really move that to a leadership mindset,” she says. “We know that our niche has also been the surveillance and the knowledge about the processes to prevent infection, but we really have to move the needle and make things better by being ‘interventionists’ on behalf of our patients.”
As part of this effort, APIC will hold a “future” conference later in 2018, in addition to its annual educational conference, which this year is slated June 13-15 in Minneapolis. The new conference still is in the planning stages, but Haas says it will be on “the future of infection prevention within the context of the future of healthcare. How can we best serve people, patients, and families over the continuum of care in the future?”
In addition, the second iteration of the APIC MegaSurvey will be conducted next year, following up on the 2015 poll of thousands of IPs. As part of this effort, the 2012 APIC Competency Model that outlined the IP skill set is under review for possible revision.
“We are focusing on behavior change, culture change, and project management skills,” Haas says. “We are trying to get into the hearts and minds of this next generation of IPs and see what makes this work meaningful for them. Some of our original members are heading toward retirement.”
While some of the old guard may have said they did not need CIC certification, there is an expectation of earning this marker of professionalism among incoming IPs, she says. “Certification is important to really show commitment to the profession and that you are competent to do this work on behalf of patients, wherever they are in the healthcare settings,” she says.
“The younger people getting into the field expect that they are going to have to be certified. We’ve certainly seen, on the clinical side, the impact on patient outcomes. We have seen from some of the studies that if you have a certified IP you are more likely to be following evidence-based practices.”
As with these other aspects of infection prevention, the Program of Distinction requires recipients to update their improvement processes annually to prepare for recertification in three years. The idea appeals to Brinkso, who sees infection prevention as less a destination than a journey.
“You don’t say one and done,” she says. “You keep moving toward that zero mark.”
More information on the APIC Program of Distinction is available at: www.programofdistinction.org.