A reoccurring theme at APIC is the continuing evolution of new and expanding ways in which the role and footprint of the infection preventionist continues to expand. We've summarized some of the key lessons learned and most interesting panels our team attended.
Preventing Sepsis
Infection Preventionists continue to take an expanding role in sepsis prevention; one speaker called attention to the relationship between HAI pneumonias and sepsis (HAI pneumonias contribute to 35% of sepsis cases1!) Prevention of and surveillance for HAPs, particularly those not related to patients on ventilators, is a key component in preventing possible sepsis. While some states such as Pennsylvania legislatively mandate publicly reporting of all incidents of pneumonia, this is not a common practice at a national level.
The rapid pathological progression and catastrophic consequences of sepsis demand continued improvements in recognizing at risk patients and timely intervention in the earliest stages of sepsis.
We as infection preventionists can and must have a direct impact on improving patient outcomes, decreasing length of stay, and lessening the financial burdens incurred by our facilities in our efforts to prevent sepsis and HAIs.
Importance of Infection Prevention and Control Informatics
The Association for Professionals in Infection Control and Epidemiology (APIC) surveyed Infection Preventionists, interviewed expert advisors, reviewed literature, and analyzed emerging and future trends impacting Infection Prevention and Control (IPC) practice to develop a new 2019 Competency Model for application within the larger industry.
This updated and interactive model highlights various future-oriented competency domains which identify priority areas of growth and development for IPs as well as strategiesto elevate the broader IPC profession. IPC Informatics is stressed as a key future-oriented competency domain including the areas of surveillance technology, electronic medical records/data warehouse, data management, data analysis, data visualization, as well as the application of diagnostic testing data.
IPC Informatics and information technology (IT) play pivotal roles in the success of an IPC program. Additionally, the specific impact that informatics has on the IP's workflow continues to expand. IPs have daily needs to secure patient health information, ensure real-time monitoring of patients, reduce manual efforts, automate/streamline various processes, manage large datasets, analyze/interpret data, adhere to regulatory requirements, as well as disseminate findings to stakeholders.
All of these needs are critical for the larger picture and assist the facility's ability to promote patient safety by:
- Complying with evidence-based strategies
- Identifying and eliminating risks
- Advancing performance and quality improvement efforts
- Fostering multidisciplinary communication and collaboration
- Maintaining desired outcomes
Building the business case and securing appropriate resources is a constant battle. IPs have commonly expressed difficulty with receiving dedicated clinical IT support to meet their needs; however, even when dedicated support has been allocated, implementing new technology can often be painful. Some best practices to ensure the smooth transition and successful adoption of various IPC Informatics resources may include:
- Assembling a team consisting of both IT and IP stakeholders to ensure a collaborative joint approach when assessing and evaluating IP needs
- Ensuring that IT and IP are able to communicate effectively and understand terminology differences
- Ensuring that all IP needs and requests are documented in detail
- Utilizing or creating systems to efficiently track and follow-up on various types of correspondence and IP requests
A comprehensive team approach is ideal where IT stakeholders have knowledge of the IP workflow as well as where IP stakeholders also have knowledge of the IT workflow. As the healthcare and informatics industries continue to interconnect, synergy will continue to increase between the fields, and larger achievements with promoting patient safety will be observed.
How could you leverage informatics and technology to position your IPC program for further success?
The Critical Role of Nurses in Antibiotic Stewardship
Nurses are antibiotic first responders, central communicators, coordinators of care, as well as 24-hour monitors of patient status, safety, and response to antibiotic therapy.2 Nurses play a key role in antimicrobial stewardship, however, staff nurse contributions to AMS programs have not yet been well defined in the medical literature. There remains a definite need to further expand the specific education and empowerment for nurses to become more fully integrated in AMS efforts.
Linda R. Greene, RN, MPS, CIC, FAPIC and Ann Marie Pettis, RN, BSN, CIC, FAPIC presented their efforts in developing and implementing a six hour, modular approach in developing an antibiotic stewardship education course for nurses.
Two key areas in which nurses impact AMS involve culturing stewardship
- Prevention of culturing patients with asymptomatic bacteriuria, including negative leukocyte esterase and nitrite.
- Prevention of sending stools specimens for difficile that do not meet culturing criteria.
Nurses have the pivotal 24/7 role of engaging and communicating with the patient, the patient's family, as well as prescribers of cultures and antibiotics. As infection preventionists, the challenge to expand and standardize AMS education for nurse remains a vital component of our role.
We strongly encourage you to read two articles referenced in the above presentation:
- Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 62. 10.1093/cid/civ697
- Redefining the Antibiotic Stewardship Team: Recommendations from the American Nurses Association/Centers for Disease Control and Prevention Workgroup on the Role of Registered Nurses in Hospital Antibiotic Stewardship Practices, a 2017 white paper jointly released by the ANA and the CDC
The role of the infection preventionist continues to evolve, and so to does our set of responsibilities. We must be ever cognizant of emerging literature and best practices, and simultaneously balance that with a growing pool of data and tools. APIC remains one of the premier locations to help us stay apprised of this shifting landscape and to share with our peers some of the most important lessons we have learned.
References:1Sepsis: Systemic Immune Assault in the Waning Years of Antibiotic Effectiveness presented by Wava Truscott, BS, MBA, PhD, President, Truscott MedSci Associates LLC
2The Critical Role of the Staff Nurse in Antimicrobial Stewardship Unrecognized, but Already There. Olans, Richard & Olans, Rita & DeMaria, Alfred. (2015). Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 62. 10.1093/cid/civ697
3Antibiotic Stewardship for Nurses; It's Not Just Another Webinar: Linda R. Greene, RN, MPS, CIC, FAPIC and Ann Marie Pettis, RN, BSN, CIC, FAPIC
