wings and works so hard to

make us look good. TSCIP

BOD presented Doris with a

memory book of letters from

past and present TSICP mem-

bers, to affirm how deeply she

is appreciated by this organiza-

tion. A commemorative plaque

was presented to Doris as a

reminder of her faithfulness and

tireless service to TSICP. Doris

will continue to serve TSICP to

make the seamless transition for

our new Executive Director,

Jamie Kraft. Thank you, Doris

for all you have done for all of

us.

Our wonderful upcom-

ing programs are listed on the

website, for those of you who

haven’t attended Essentials; we

look forward to meeting you in

San Marcos or Amarillo or Gal-

veston. If you know new Infec-

tion Preventionists, remind

them to attend this necessary

training.

“And I think to myself, What a

Wonderful World!”

TSICP 35th Annual

Conference: Austin, Texas was a

wonderful event. The words used

to describe the conference were:

“terrific meeting, lots of usable

advice, great facility, the speak-

ers were great; I learned so

much, this was my first meeting ,

and it was wonderful. “

To all of you who attended:

What did you like best? Who

was your favorite speaker? Do

you have ideas for next year’s

conference? Have you heard a

speaker that would be a great

addition to our agenda for next

year? Would you be willing to

serve on the Board of Director’s,

help teach Essentials and serve

the infection Preventionists in

Texas and surrounding states?

Let us hear from you; we wel-

come your ideas and enthusiasm!

To our speakers: You

rock, and you made a difference

in our lives; thank you for being

part of this meeting.

To our sponsors: thank you for

sharing your time, imaginative

displays and generous support of

TSICP; we enjoyed the vendor

fair and the door prizes were

delightful.

TSICP Board of Direc-

tors: I appreciate all of your tire-

less efforts to make this confer-

ence a success. You are an ener-

getic, enthusiastic, creative, ac-

complished group of profession-

als. Thank you for caring deeply

about this organization.

Did you notice the winning

poster? Congratulations to Darcy

Minter for the winning entry.

Each year we have a Poster Con-

test; the winner is awarded a

complimentary registration fee to

the conference and the opportu-

nity to display the poster during

the meeting.

A very special thank

you to Val Sparks for leading

TSICP as President for the past 2

years. It was a delightful experi-

ence to honor Val with a token

of our appreciation for her lead-

ership. Val ,thank you for lead-

ing with integrity; you are an

authentic leader, you have made

a difference to TSICP.

Congratulations to

Charlotte Wheeler, recipient of

the Gerry Haynes award. This

award is presented to an Infec-

tion Preventionist who makes a

difference in our state. Charlotte,

a past president of TSICP is cur-

rently Director of Infection Pre-

vention Services at Scott and

White in Tyler, TX. An expert in

Infection Prevention, Charlotte

has mentored, influenced and

impacted the process of Infection

Prevention in Texas; Charlotte

has greatly influenced my prac-

tice as an Infection Preventionist

by leading with integrity and a

true servant’s heart.

We lovingly honored Doris

Kraft, our Executive Director,

who will be retiring this year.

Doris is the wind beneath our

From the President’s Desk “And I think to Myself….”

Special points of interest: • FROM THE PRESIDENT’S

DESK

• HOW DO WE GET THOSE

CNE CREDITS

• CLEANERS DISINFEC-

TANTS

• CLABSI

• WATER RECREATION

FROM THE PRESIDENT’S DESK

2222

HEPATITS DEATHS 2222

CLABSIS CALL THEM LIKE YOU SEE THEM

2222

LURKING BEHIND CLOSED DOORS

3333

THE CNE PROCESS 4444

RECREATIONAL WATER ILLNESSES

5555

READY SET SARE!! 6666

Inside this issue:

APRIL, 2012 SPRING EDITION

T E X A S S O C I E T Y O F I N F E C T I O N C O N T R O L & P R E V E N T I O N Q U A R T E R L Y N E W S L E T T E R

TSICP Times

This is a headline none of us want to see related to our facility but this has oc-

curred.

One such outbreak was listed as recently as October 2010 in the MMWR.

Infection preventionists know that one must thoroughly clean all visible soil or

organic material from glucometers prior to disinfection and disinfect the glucome-

ter after each use(between different patients) following manufacturer’s directions

using an EPA-registered disinfectant effective against HBV,HCV, and HIV. But

sometimes persons trained on using glucometers may not be aware that blood

borne pathogens such as hepatitis and HIV can be spread by something as seem-

ingly harmless as a glucometer. So, in my opinion, it is likely that lack of appro-

priate training or education may play a role in these outbreaks and can lead to

breaches in appropriate infection control.

In 2009, the CDC was asked to participate in 10 state-based investigations

of outbreaks of viral hepatitis infection. Six of the investigations were for hepatitis

B (HBV), four for hepatitis C (HCV). “The outbreaks of HBV infection occurred

in assisted-living facilities, a long-term-care facility, an outpatient oncology clinic,

a hospital, and a free dental clinic operating within a school gymnasium,” states

the report. Initially 6,748 persons were identified for potential exposure. Testing

showed 59 of these persons infected with HBV. The suspected modes of transmis-

sion for these outbreaks included: unsafe practices related to assisted blood glu-

cose monitoring and breaches in infection control. Some potential causes listed in

the 2010 report included lack of cleaning and disinfection of glucometers, lack of

hand hygiene, and /or lack of gloving.

An APIC position paper on this subject, APIC Position Paper: Safe Injec-

tion, Infusion and Medication Vial Practices in Healthcare , was published and as-

pects related to glucometers are summarized below.

Blood Glucose Monitoring Devices

Assign glucometers to individual patients. Clean and disinfect glu-

cometers if they must be reused between patients.

Restrict use of fingerstick capillary blood sampling devices to individ-

ual patients.

Maintain supplies and equipment such as fingerstick devices and glu-

cometers within individual inpatient rooms, if possible.

Use single-use lancets that permanently retract upon puncture.

Never reuse fingerstick devices and lancets. Dispose of them at the

point of use in an approved sharps container. Lancets in a pen are to

be removed by mechanical means (hemostat) to avoid finger con-

tact.

Thoroughly clean all visible soil or organic material

(e.g., blood) from glucometer prior to disinfection.

Deaths from Hepatitis B Associated with Assisted Blood

Glucose Monitoring

By: Jessica Hillburn BS, MT(ASCP), CIC

Page 2

TSICP Times

TSICP’s Board of Directors

TSICP members at the

Sponsor Reception at the

35th Annual Conference

Disinfect the exterior surfaces of the glucometer after each use fol-

lowing the manufacturer’s directions. Use an EPA-registered dis-

infectant effective against HBV, HCV and HIV, or a 1:10 bleach

solution (one part bleach to 9 parts water).

Note that different glucometers may use different methodologies for measur-

ing glucose, so it is vital to follow the manufacturer’s directions.

References and Resources: Guideline for environmental infection control in health-care facilities: rec-

ommendations of CDC and the Healthcare Infection Control Practices

Advisory Committee. MMWR, 2003;52(No. RR-10):1-44.

Centers for Disease Control and Prevention. Appendix A: Regulatory frame-

work for disinfectants and sterilants. In: Guidelines for infection control

in dental health-care settings - 2003. MMWR 2003;52(No. RR-17):62-

64.

MMWR: Notes from the Field: Deaths from Acute Hepatitis B Virus Infec-

tion Associated with Assisted Blood Glucose Monitoring in an Assisted-

Living Facility --- North Carolina, August--October 2010

MMWR: Transmission of Hepatitis B Virus Among Persons Undergoing

Blood Glucose Monitoring in Long-Term--Care Facilities --- Mississippi,

North Carolina, and Los Angeles County, California, 2003—2004

SHEA/APIC Guideline: Infection Prevention and Control in the Long-Term

Care Facility

FDA Notice: Use of Fingerstick Devices on More Than One Person Poses

Risk for Transmitting Bloodborne Pathogens: Initial Communication

FDA: Letter to Manufacturers of Blood Glucose Monitoring Systems Listed

With the FDA

Scenario to consider:

Patient Jones has been in your hospital for 4 days due to a motor vehicle accident with splenic

laceration. He has a right subclavian line and a urinary catheter in place. On day 4 he spikes a

temperature of 101.5 and blood and urine cultures are sent. The urine culture comes back with

>100K E. coli, and the UA has 21-50 WBC and is nitrite positive. The blood cultures come back

with 1 of 4 bottles growing methicillin-sensitive S. aureus (MSSA). The Infectious Disease Phy-

sician’s note states: “E. coli UTI, with likely contaminated blood culture. Will continue XXXX

antibiotic and repeat blood cultures.” The repeat blood cultures come back with no growth.

Question: What HAI(s) do you call?

Answer: CAUTI and CLABSI.

If you would not have called the CLABSI, you need to re-read the

definition:

(continued on page 4)

Deaths from Hepatitis B Associated with Assisted Blood Glucose Monitoring

CLABSIs, Call them Like you See them!! By Lynda Watkins RN, MPH, CIC

Page 3

SPRING EDITION

“TSICP’S

SUMMER

ESSENTIALS OF

INFECTION

CONTROL &

PREVENTION”

JULY 26-27, 2012

EMBASSY SUITES

HOTEL

SAN MARCOS

TEXAS

Staph aureus is a recognized pathogen, and there is no reason to think it is related to an

E. coli UTI. As you can see, the definition above doesn’t even require any signs or

symptoms.

Some of you may face pressure from various people in your hospital all the way up to

medical directors to not call these types of CLABSIs, because after all, they probably are

not real. You must work hard to educate these people on the NHSN definitions. They

are surveillance definitions, not clinical definitions. They require an IP not an MD to

make the call. If a clinical colleague wants to dispute your call, simply provide them

with the definition and ask them if the case meets the definition. Don’t engage in the

argument of whether the patient actually has a blood-stream infection. That is really not

relevant. I always tell those who question the NHSN definitions; “Don’t hate the defini-

tion; hate the application of the definition”.

If all Infection Preventionists allow those outside the IP&C world to weigh in on

whether the call makes sense to them, the integrity and reliability of NHSN is dimin-

ished. Our SIRs and comparisons that are now publically reported are based on pooled

means or the averages of CLABSI rates reported from throughout the U.S. and from

Texas. If we can’t count on our fellow IPs to make the right calls, then the comparisons

are invalid and those of us who correctly make the call, solely based on the written defi-

nition and not the opinion of medical experts, will suffer.

Maybe we can get to zero CLABSIs, but it will have to include measures like improved

blood culture collection technique to eliminate the contaminants, as well as the CVL

bundle measures to reduce the “real” CLABSIs. If we all pretend that the contaminants

don’t happen by not reporting them, then there will never be pressure to change either

the definition or the application of the definition. Or better yet; If we all reported ALL

of the CLABSIs that fit the definition, no matter how falsely positive some of them

seem, then the pooled means used to determine our SIRs would reflect the real numbers,

and we would then all be on a level playing field.

The strength of our chosen field of Infection Prevention and Epidemiology is rooted in

sound epidemiologic principles. One of our tools is the case definition. I highly encour-

age you to continually read and re-read the NHSN definitions as you are reviewing your

surveillance data and your charts in your places of work. Making infections go away on

paper does nothing to support your prevention efforts. We must stick together as a pro-

fession in order to identify and work on the real infection issues in healthcare, and they

will only be revealed if we apply our tools correctly.

Lynda Watkins MPH, BSN, RN, CIC

Infection Preventionist

TSICP Government Affairs Chair

Austin, Texas

Patient has a recognized pathogen cultured from one or more blood cultures

and

organism cultured from blood is not related to an infection at another site.

(http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf)

Page 4

TSICP Times

TSICP Board Member Jodene

Satterwhite (left) and TSICP Presi-

dent Barbara Herman (right)

proudly presented Charlotte

Wheeler (center) with this year’s

Gerry Haynes Award for excel-

lence in infection prevention.

President Barbara Herman pre-

sented Past President Val Sparks

(left) with a plaque for her excel-

lent service to TSICP.

Lurking Behind Closed Doors by Susan Jones

SPRING EDITION

Page 5

So, you think you have everything identified in your facility that individuals are doing�.guess again. Surveyors from the Joint Commission and CMS continue to focus on IC and the various chemicals and practices related to cleaning, disinfecting, and sterilizing. They are asking for a list of products that have been approved for use through the IC committee then during their tracers will ask questions related to usage of the various products and level of competency of staff using the products. The following are the respective standards: TJC IC.02.02.01 and CMS Interpretive Guidelines §482.42(a)(1). Attached is a quick reference list of approved products which can help guide you to developing a list for your respective facility.

Susan Jones MPH, M (ASCP), CIC, CHSP

Infection Preventionist

Laredo Medical Center

Summer will be coming soon, and here are some helpful hints to avoid foodborne Summer illness. Having food poisoning would not be pleasant in the Texas Summer heat.

The incidence of foodborne illness increases in the summer months because most bacteria proliferate faster in warmer temperatures. To make matters worse many of us enjoy more frequent backyard BBQ’s and other outdoor cooking events.

Foodborne illness has been in the media a lot this summer. We had a large num-ber of people infected with E. Coli form sprouts both in the U.S. and abroad. We have also heard about a salmonella outbreak related to Mexican Papaya’s. Let us not fall vic-tim to food poisoning at the family reunion from Auntie Rosie’s potato salad.

It is very important whatever the circumstances that anyone involved in food han-dling be able to wash their hands. “Unwashed hands are a prime cause of foodborne illness”. Disposable wipes can provide an alternative method for hand hygiene if water is unavailable.

Be careful during meat preparation to prevent “cross contamination” of raw meat with fruits and vegetables. Ensure when you are grilling that all meats reach a high enough temperature to kill harmful bacteria. (145 degrees Fahrenheit for beef, pork, or lamb, 160 degrees for all ground meats, & 165 degrees for poultry)

Last but not least keep your food cold. Make sure perishable foods such as lunch-eon meats, cooked or raw meat, chicken, and potato or pasta salads are kept in an insu-lated cooler. Coolers should be filled with ice and topped off each time the ice starts to melt. Consider keeping soda and bottled water in an alternate cooler as it will be opened more frequently.

If refrigeration or coolers filled with ice are not an option, consider non-perishable foods. Foods such as; pre-washed fruit, hard cheeses, canned or dried meats, trail mix, granola, and peanut butter & crackers, can all provide a satisfying substitute.

Whatever your passion just remember to wash your hands! If you are eating at any type of outdoor cooking event pay close attention to what you are about to consume. If something does not look or smell right, it may be best to pass.

Enjoy your Summer!

Shannon Young DeLaCruz BSN, RN, CIC

Page 6

TSICP Times

Safety and Summertime Eats! Shannon Young DeLaCruz BSN, RN, CIC

“TSICP’S

FALLESSENTIALS

OF INFECTION

CONTROL &

PREVENTION”

OCTOBER 18-19,

2012

AMARILLO

COLLEGE

AMARILLO,

TEXAS

It’s hard to believe it has been 5 years since I sat for my first CIC exam. Now, its time to recer-tify. After much thought, I’ve decided to take the SARE instead of the computerized exam. From what I have gleaned from conversations with other Infection Preventionists, the SARE is the more challenging of the two tests. Recertification by SARE involves a 150-question examination that is created to assess knowledge and skills in infection control. The SARE exam is more extensive and is designed to assess the knowledge and skill of a professional who has accumulated seven years of experience in infection control. The questions are more complex than those on the certification examination, which is based on the knowledge and skills of a two-year practitioner. The purpose/goal of the SARE is to demonstrate continued knowledge mastery in the field of in-fection prevention and control. This is the reason I chose to take the SARE. I want to validate that I have actually continued to master the practice of Infection Prevention in the 5 years since taking my initial certification exam. As an Infection Preventionist, I’m always up for a challenge! I like the fact that the exam can be taken at your own pace, and can be accessed until December 31st of each year. If I am unsure of something, I can look it up. This is very alluring to me. I feel that I will actually learn more while doing the SARE than I would by taking the exam. Among the 135 scored items on the SARE, approximately 25 percent require recall of information, 60 per-cent require application of knowledge, and 15 percent require analysis of a situation or critical thinking. My plan to prepare for the exam is multifaceted. I have ensured that I have the resources sug-gested in the Candidate Handbook readily available to me. I have ordered the Infection Preven-tion Competency Review Guide and I plan to take the online practice examination. It benefits me to see the questions presented in the same or very similar format as they will be on the exam. Scores and feedback are provided by major content area upon completion of the online practice exam. I have listed the suggested references from the CBIC Candidate Handbook below. I would bet that most of us use the majority of these on a daily basis. So, as I complete the required applica-tion process, I look forward to jumping right into the SARE. From this experience, I hope to get a better idea of what my strengths and weaknesses are, and ultimately, recertification. Primary References: • APIC Text of Infection Control and Epidemiology, 3rd ed.,Volume I (Essential Elements) and Vol-ume II (Scientific and Practice Elements), APIC, Washington, DC, 2009, including on-line version 2010. • Heymann, David L., ed. Control of Communicable Diseases Manual, 19th ed., Washington, DC: American Public Health Association; 2008. • Brooks, Kathy. Ready Reference to Microbes, APIC; 2007. Secondary References: • Current Recommendations of the Advisory Committee on Immunization Practices (ACIP). • Current guidelines, standards, and recommendations from CDC, APIC/CHICA-Canada, SHEA, and Public Health Agency of Canada.

• Pickering, Larry K, ed. Red Book, 28th ed., Elk Grove Village, IL: American Academy of Pedi-atrics; 2009.

Victoria L. Foxell, RN, BSN, CIC

SPRING EDITION

Page 7

Ready, Set, SARE! By Victoria L. Foxell, RN, BSN, CIC

“TSICP’S CIC

REVIEW COURSE:

OCTOBER 16-17,

2012

AMARILLO

COLLEGE

AMARILLO,

TEXAS

be asked by TSICP to be-come their Executive Director as we went out on our own as a non-profit corporation. I have never regretted my decision to take a chance on our success as an organiza-tion. It has been my privilege and pleasure to work with TSICP in the important work that this organization and its members do.

The people who work in infection prevention are warm, caring, profession-als who fully realize the im-portance of what they do.

I feel I have made life-long friends in the past fourteen years with TSICP,

Fourteen years ago, I interviewed for the position of Executive Director of four societies which were affili-ated with THA. A represen-tative of each society inter-viewed me. TSICP’s repre-sentative was Greg Bond. I think he must have felt he was being interviewed because I had never heard of the field of Infection Control—so I had a lot of questions for him.

At the time, I had no idea what a wonderful or-ganization I was being intro-duced to. Four years later, THA decided they no longer wanted to manage the socie-ties. I was very fortunate to

and I value those friendships greatly.

I can never thank each of you enough for the importance you have been to my life. I look forward to keeping in touch with many of my TSICP friends after I re-tire September 1. I know you will give the same support to your new Executive Director as you have to me.

May God continue to bless you and yours. With much thankfulness for the past fourteen years.

Doris Kraft, BA, MAG

TSICP Executive Director

FOURTEEN SPECIAL YEARS By Doris Kraft, TSICP Executive Director

P.O. Box 341357 Austin, Texas 78734 Phone: 512-263-2480 Fax: 512-402-1875

We are on the web! www.tsicp.org

MISSION STATEMENT

The mission of TSICP is to be recognized as the leading authority in pre-

vention, control, and surveillance of infection control related healthcare

issues within Texas and to provide affordable educational opportunities to

enhance individual and/or team efforts toward infection prevention.

Texas Society of Infection Control & Prevention

T S I C P

Past President Val Sparks presents

Doris Kraft with a wonderful scrap-

book of letters from members of

TSICP.