Increasing Your Infection Prevention Capacity

Ruth Carrico PhD RN FSHEA CICAssociate Professor

Division of Infectious DiseasesUniversity of Louisville

Objectives

• Review the changing practices involved in infection prevention and control

• Explore strategies to increase your capacity and impact applicable to any healthcare setting

Increasing Capacity and Capability

Your skills

Skills you can obtain from other departments

Skills you can develop in others

Evolution of Infection Prevention: 1960s

• Era of Exploration– Advances in knowledge regarding relationships

between microbes, people and the environment– Field of public health focused on patients in

hospitals– Hospital epidemiologists– Nurses involved in case finding and surveillance– Basic CDC course

Garcia R, Bernard B, Kennedy V. The fifth evolutionary era in infection control: Interventional epidemiology. AJIC 2000;28:30-43.

Evolution of Infection Prevention: 1970s

• Era of Expansion– Medical devices– Research regarding risks of nosocomial infection– Focus on institutional capabilities for providing

and delivering quality care– Process evaluations began– Design of supplies and materials and their

relationships to infection– SENIC

Evolution of Infection Prevention: 1980s

• Era of Reaction and Response– HIV– Universal precautions– Antibiotic resistance recognized as major problem– Cost control and containment– JCAHO [TJC] Agenda for Change– Little focus on necessary resources

Evolution of Infection Prevention: 1990s

• Era of Regulation– HAI rates had been relatively “steady” from 1975 to

1990– JCAHO [TJC] introduces quality

assurance/performance improvement to Infection Control

– ABHRs hit the scene (culture change starting)– IOM To Err is Human– NNIS in 285 hospitals in 42 states– HICPAC

Evolution of Infection Prevention: 2000

• Era of Interventional Epidemiology– Patient safety movement (Root Cause Analysis, Failure

Modes and Effects Analysis, Sentinel Events)– AHRQ funds research– Advocacy– Bundles– NNIS becomes NHSN in 2005– NHSN- 3000 hospitals in all 50 states. 22 states

require use of NHSN to report HAIs (2011)– Surveillance guiding interventions

Infection Prevention in 2010 and Beyond

• Era of Transformation– Transparency and legislation– Approaches and initiatives questioned (e.g., MRSA)– CMS value based purchasing– Successes in elimination of HAI is now the expected– Getting to zero VS. Zero tolerance– Infection control continues its transformation to

Infection prevention – Links with quality and patient safety more evident

Existing Skill Set for the Function of Infection Prevention

• Clinical expertise• Knowledge of surveillance fundamentals• Identification of infectious disease processes• Preventing and controlling transmission• Employee/occupational health• Management and communication• Education

Feltovich F, Fabrey L. The current practice of infection prevention as demonstrated by the practice analysis survey of the Certification Board of Infection Control and Epidemiology, Inc. AJIC 2010;38:784-788.

New Skill Set for the Function of Infection Prevention

• Surveillance fundamentals• Epidemiology• Health behavior• Health promotion• Environmental sciences• Biostatistics• Collaborative practices• Educational techniques for instruction and design• Leadership

Increasing Capacity and Capability

• Include needs in risk assessment• Perform an inventory of your current skills and the

skills within your department• Clearly outline your weaknesses so you can

develop a plan to address them• Identify departments with similar responsibilities• Recruit unit-based champions• Develop an education plan for self and group• Develop an evaluation plan to guide your process

Increasing Capacity and Capability

• Include needs in risk assessment– Begin the process by including the need for more

capacity within the department in your risk assessment

– Be clear about your need and the impact this gap is having on systems and outcomes

– Make sure you share this information with your link to the facility executive team

Increasing Capacity and Capability

• Perform an inventory of your current skills and the skills within your department– This is difficult and humbling– Consider ‘grading’ yourself and your team in terms

of knowledge v. proficient v. expert– Take into consideration present and well as future

needs

Increasing Capacity and Capability

• Clearly outline your weaknesses so you can develop a plan to address them– Can keep this personal or ask for input from others– Outside opinion can be valuable from those you

trust. Also solicit feedback from those with whom you do not have a good working relationship

– Prioritize your weaknesses in terms of importance to you and your job roles

Increasing Capacity and Capability

• Identify departments with similar responsibilities– A first step in increasing your capacity is to identify

departments with shared interests and/or responsibilities

– Identify resources that may be able to be shared– Identify training that can be obtained from these

departments

Increasing Capacity and Capability

• Recruit unit-based champions– Liaison program– Individuals self-select based upon interest– Training provided to this group– Engagement in problem identification and

response– “Nobody knows the work better that those who

do the work” (Toyota production- Gemba: the place of the work)

Increasing Capacity and Capability

• Develop an education plan for self and group– Once you have identified strengths, weaknesses,

areas for assistance, begun the building of your liaison program, you must have a parallel education plan

– Prioritize topics according to need (look back at risk assessment)

– Develop the workers– Develop yourself

Increasing Capacity and Capability

• Develop an evaluation plan to guide your process– With your improvement plan, identify metrics for

success– Must evaluate your progress, the impact of new

resources (e.g., liaison program), and your interventions

– What is not working should be stopped or changed– Keep adequate evaluation records to justify activities

Increasing Capacity and Capability

• Include needs in risk assessment• Perform an inventory of your current skills and the

skills within your department• Clearly outline your weaknesses so you can

develop a plan to address them• Identify departments with similar responsibilities• Recruit unit-based champions• Develop an education plan for self and group• Develop an evaluation plan to guide your process

Objectives

• Review the changing practices involved in infection prevention and control

• Explore strategies to increase your capacity and impact applicable to any healthcare setting