Zero Tolerance:The ICP, TSICP,

and APIC

Sue Sebazco, RN, BS, CIC

Infection Prevention/Employee Health Director

Arlington, TX

Objectives

1. Recognize the value TSICP and APIC provide for the individual ICP.

2. Discuss the strategic role members of TSICP and APIC contribute to infection prevention and control systems that promote zero tolerance and safe patient care.

Zero Tolerance

What is aiming for “zero”?

Where did it come from?

Infection Control in 1972

Profession the result of Staphylococcus aureus pandemic of the 1950’s

The first ICPs

Early Infection Control Programs

The ICP in 1980Knowledge and Abilities

Understand nursing procedures Isolation techniqueAseptic techniqueUse of pt care equipmentAdequate decontamination, disinfection,

sterilization Hospital Infection Control Principles and Practices, Mary Castle 1980

The ICP in 1980

Knowledge and AbilitiesMicrobiology Infectious diseasesEpidemiologyAdministration and SupervisionEnvironmental sciences

Hospital Infection Control Principles and Practices, Mary Castle 1980

APIC FUTURES SUMMIT – 2004APIC FUTURES SUMMIT – 2004 What Happened?What Happened?

More than 50 experts from across the continuum of healthcare,

APIC leaders, and

industry partners convened.

APIC FUTURES SUMMIT – 2004APIC FUTURES SUMMIT – 2004 The Future of HealthcareThe Future of Healthcare

“Every 30 or 40 years, something comes along that completely redefines everything about healthcare.”

– Jeffrey Bauer: Healthcare Futurist

APIC FUTURES SUMMIT – 2004APIC FUTURES SUMMIT – 2004Top Healthcare TrendsTop Healthcare Trends

Molecular medicine

Digital information technology

Diversity of society

Globalization of commerce

Emergence of new diseases

Rising consumer expectations

APIC FUTURES SUMMIT – 2004APIC FUTURES SUMMIT – 2004Top Healthcare TrendsTop Healthcare Trends

Proliferation of payment systems Unfunded mandates/political gridlock Shift from surgical to Rx interventions Alternative medicine Increasing violence as a public health problem Increasing gap between haves and have nots

APIC FUTURES SUMMIT – 2004 APIC FUTURES SUMMIT – 2004 Top Healthcare TrendsTop Healthcare Trends

Wild Cards Economic instability Natural disaster Science for evil as well as good

FUTURES SUMMIT THEMESFUTURES SUMMIT THEMES

•What Could Change the World as We Know It? Existing & Emerging Threats

• Infection Prevention in the Changing Dynamics of Healthcare

•The Future of Infection Prevention & Control

APIC FUTURES SUMMIT – 2004APIC FUTURES SUMMIT – 2004Infection Prevention in the Changing Dynamics of Healthcare

“Infection control professionals are complicit in boxing themselves in because they still spend an enormous amount of time in the records room and in retrospective data analysis. Some people are comfortable with that, but it is unconscionable.”

–Ken Segel, Pittsburgh Regional Healthcare Initiative

APIC FUTURES SUMMIT – 2004APIC FUTURES SUMMIT – 2004Infection Prevention in the Changing Dynamics of Healthcare

“A lot of data collection and massaging, which have been a traditional role of ICPs, can be safely and better done by computers. This would allow ICPs to focus on more value-added activities, which would improve the entire healthcare process.”

– Clay Dunagan, MD, VP. Quality, BJC Healthcare

APIC FUTURES SUMMIT – 2004APIC FUTURES SUMMIT – 2004Infection Prevention in the Changing Dynamics of Healthcare

“It is important to look at the leadership component of infection control. We must transcend the discipline of infection control to embrace the entire organization. It is the leader’s job to make sure that happens.”

– Clay Dunagan, MD, VP. Quality, BJC Healthcare;

APIC FUTURES SUMMIT – 2004APIC FUTURES SUMMIT – 2004The Future of Infection Prevention & Control

Technology is revolutionizing surveillance. Increasingly care is being delivered outside of

acute care and outside of ICUs, yet that is where we focus most of our surveillance and prevention activities. We must adapt.

– Denise Cardo, MD, Director, DHQP, CDC; Georgian Ellis, VP. Operations, Shands Healthcare

APIC FUTURES SUMMIT – 2004APIC FUTURES SUMMIT – 2004The Future of Infection Prevention & Control

“We must deemphasize benchmarking. Being better than a bad benchmark is not the same as being good.”

– Denise Cardo, MD, Director, DHQP, CDC

APIC FUTURES SUMMIT 2004APIC FUTURES SUMMIT 2004Key Themes Prevention is the message

Promote zero tolerance for HAIs and other adverse events

Technology is the enabler

APIC’S PREFERRED FUTUREAPIC’S PREFERRED FUTURE

By 2012, APIC will be recognized as the leader in infection prevention and control by practitioners, policy makers, healthcare executives and consumers.

APIC Futures Summit -- 2006

Complete the business case for infection prevention

ICPs as partners in profitability with hospital financial leaders

APIC Futures Summit -- 2006 “The fact is most hospitals don’t understand the costliness of infections The costs of these preventable infections in both human and economic terms are staggering.”

Richard Shannon, MDChair Dept of

Medicine Allegheny General

Hospital Pittsburgh

APIC Futures Summit--2006“Professionals in infection prevention must learn the business of health care—and preventing infection and adverse outcomes for those who entrust us with their lives and the lives of their loved ones is our core business.”

Denise Murphy, RN, BSN, MPH, CIC

VP of Safety and QualityBarnes Jewish HospitalSt Louis

APIC Futures Summit -- 2007

Participatory Management at all levels of the patient care experience

Reciprocal Responsibility

Incorporating infection prevention into each task

TSICP

Board convened in January

A new image? A new name to better reflect the

changing focus of our professionUpdate means of communicationRevise the fundamental and intermediate

courses

TSICP

Education for Texas ICPs on mandatroy reporting

Developing strategic goals for the next 5 years

Creating our future

APIC VISION 2012

Goal #1: Zero Tolerance

APIC will emphasize prevention and promote zero tolerance for healthcare-associated infections and other adverse events.

APIC Vision 2012

Goal #1APIC activities:Protect Our Patients Visitor Education

ProgramMonthly Heroes Press releasePromotion of IHI Hand Hygiene Tool KitGrand Rounds in Infection PreventionFree Webinars –best practice

TSICP

Advisory Panel

Interventionist

Putting Goal # 1 into Your Practice

ICPs are Patient Safety Advocates

“Prevention is Primary” (CDC)

Interventionist

Putting Goal #1 into Your Practice

Go and Observe

Investigate in Real Time (RCA)

Rick Shannon, MD

APIC VISION 2012

Goal #2: Setting the Standard

APIC will ensure that appropriate standards are set by which infection prevention and control programs are evaluated by regulatory agencies, healthcare executives, payers and others.

APIC Vision 2012

Goal #2

APIC activities: Economics of Infection Prevention Futures Summit NQF development of standardized measures for

reporting Tool kit Cultivate relationships

TSICP

Cultivate relationships

“Texas-specific” infection prevention and control needs

Education on mandatory reporting

Putting Goal # 2 into Your Practice

Become active in legislative issues

Develop a rapport with leaders within your organizations

Demonstrate cost effectiveness of the Infection Prevention and Control Program by building the business model

APIC VISION 2012APIC VISION 2012 Goal #3: A Separate & Distinct Profession

Infection prevention and control will be recognized as a separate and distinct profession, whose members are positioned for leadership roles in healthcare.

APIC Vision 2012

Goal #3

APIC activities:Business case for infection prevention and

controlSalary and reporting structure survey

TSICP

Fundamental and Intermediate courses

Annual conference that addresses current issues for the ICP in Texas

Putting Goal # 3 into Your Practice

Develop a plan to acquire the skills to become a leader within your organization

Putting Goal #3 into Your Practice

“You have to learn how to learn how to learn.”

Thomas Friedman, columnist, C-Span interview 2005

APIC VISION 2012APIC VISION 2012 Goal #4: A Catalyst for Leading Edge Research

APIC will serve as a catalyst for leading edge research for the prevention of infection and associated adverse outcomes.

APIC Vision 2012

Goal #4

APIC activities:Comparison of data sources for reporting

HAIsPrevalence StudySmall grants

TSICP

Approach the legislature with evidence-based practices to support our position on an issue

Putting Goal # 4 into Your Practice

Establish and/or participate in an internal research committee that determines evidence-based practice

APIC VISION 2012APIC VISION 2012 Goal #5: Leadership Role in Emergency Preparedness

APIC will play a leadership role in emergency preparedness related to infection prevention and control including emerging and reemerging diseases, bioterrorism, natural disasters and other issues.

APIC Vision 2012

Goal #5

APIC activities:Participation in Coalition on Pandemic

PreparednessParticipation in Congressional Hearing on

Pandemic PreparednessCDC/APIC e-learning modules

TSICP

Emergency planning in Texas

Drills

Putting Goal # 5 into Your Practice

Participation in emergency preparedness at the local, state, federal level as well as worldwide.

APIC Futures Summit--2006“Professionals in infection prevention must learn the business of health care—and preventing infection and adverse outcomes for those who entrust us with their lives and the lives of their loved ones is our core business.”

Denise Murphy, RN, BSN, MPH, CIC

VP of Safety and QualityBarnes Jewish HospitalSt Louis

APIC FUTURES SUMMIT – 2004APIC FUTURES SUMMIT – 2004Infection Prevention in the Changing Dynamics of Healthcare

ICPs’ core competence should be the creation and oversight of learning systems that are necessary for sustainable and constant improvement.

– Clay Dunagan, MD, VP. Quality, BJC Healthcare;

Collaboration across the Continuum

Model for success—SiouxlandScreen for VREDynamic health department infrastructureTask force efforts

The Infection Prevention Professional

InterventionistCollect data

Analyze data

Introduce intervention

Measure success

Interventional Infection Prevention and Control

Education and performance improvement* on CVC-BSI

Before Intervention After Intervention 2.4 0.8

*Revised hospital policy, standardized catheter insertion technique, site care & infection prevention interventions

Eggiman P, et al. Lancet 2000;355:1864-8

Infection Prevention Professional Role

Patient safety advocate

Healthcare worker safety advocate

Zero Tolerance

Relationships

Collaboration

Networking

Compromise

Objectives

1. Recognize the value TSICP and APIC provide for the individual ICP.

2. Discuss the strategic role members of TSICP and APIC contribute to infection prevention and control systems that promote zero tolerance and safe patient care.

“Delivering safe patient care is not convenient”

Sir Liam Donaldson

Chief Medical Officer, UK

Chair, WHO World Alliance for Patient Safety

August 2005