Linda McKinley

Vancomycin-resistant Enterococcus co-colonization rates with methicillin-resistant Staphylococcus aureus and Clostridium difficile in critically ill veterans

A prospective study was conducted to identify risk factors for vancomycin-resistant Enterococcus, including co-colonization with methicillin-resistant Staphylococcus aureus and Clostridium difficile infection in patients admitted to the intensive care unit in 2 Veterans Affairs facilities. Methicillin-resistant Staphylococcus aureus and Clostridium difficile infection co-colonization were significant risk factors for vancomycin-resistant Enterococcus colonization. Further studies are needed to identify measures for preventing co-colonization of these major organisms in veterans.

Building global partnerships in infection prevention: A report from APIC Badger and the Nairobi Infection Control Nurses Chapter

An international partnership between Wisconsin and Kenya was established after a serendipitous meeting with a newly formed infection control organization in Nairobi, Kenya, the Nairobi Infection Control Nurses Chapter (NICNC). Establishment of a sister chapter partnership between a Wisconsin Association for Professionals in Infection Control and Epidemiology chapter (APIC Badger) and the NICNC provided an opportunity to share resources. Although there are many barriers to developing infection prevention and control programs in Kenya, some needs can be met through such partnerships.

A Multidisciplinary Evaluation of Staphylococcus aureus Screening, Decolonization and Patient Adherence to Pre-Operative Decolonization Procedures

Abstract Background Colonization with Staphylococcus aureus (SA) increases the risk of surgical site infection (SSI) and de-colonization reduces this risk depending on level of patient adherence. Our VA facility’s participation in a multi-site study to identify the best strategies for implementing peri-operative SA de-colonization provided an opportunity to examine the reliability of existing internal processes. The objectives of this single-site study were to asses self-reported patient adherence, and barriers to recommended de-colonization procedures, as well as to examine if current patient educational materials were sufficient. Methods A survey measuring self-reported adherence and barriers to recommended de-colonization procedures was administered by telephone. A process map of the patient education process was employed to identify key frontline staff who were asked to review existing patient education materials and procedures. A new patient education tool was then developed with their input and input from an expert in patient education. Results 34 patients responded to the telephone interview. Self-reported de-colonization adherence was 100%. 32% of patients reported high levels of social/economic deprivation and only 32% reported using medication reminders, suggesting some risk of non-adherence. Process mapping revealed that patient education was delivered through a combination of face-to-face training and printed materials. Review of the printed materials identified a number of opportunities for improvement. The newly developed patient education tool was rewritten at a 7th grade reading level and revised to include: (1) more concrete information on the benefits of SA de-colonization; (2) visual aides to enhance performance of different de-colonization tasks; and (3) a tracking log to facilitate adherence to each of the recommended de-colonization tasks. Conclusion We identified many opportunities to improve the education of patients undergoing SA de-colonization prior to high-risk surgery at our VA. Further work will need to be done to determine whether these changes positively impacted patient adherence to recommended de-colonization procedures and whether this translates into improved patient outcomes. Disclosures M. Schweizer, B Braun: Speaker at a course, Travel reimbursement to teach course

Methodology minute: A guide for infection preventionists for sizing up systematic reviews

Systematic reviews have become a key strategy to identifying evidence-based practice guidelines in infection prevention. They are considered the highest level of evidence providing the most effective answers to practice questions. Infection preventionists need to become familiar with reading systematic reviews and learn to critically appraise the findings and implications for practice. A systematic literature review is a rigorous preplanned process established to answer a specific practice question. The preplanned methods are detailed in the final publication. There are several key components that should be outlined in systematic reviews, which are briefly reviewed here.

Regional differences in vancomycin-resistant Enterococcus colonization rates in critically ill veterans

Screening for vancomycin-resistant Enterococcus (VRE) has not been universally implemented within the Department of Veterans Affairs (VA). A prospective study was conducted to identify the admission prevalence rate of VRE in patients admitted to the intensive care unit in 2 VA facilities. Significant regional differences were found between the 2 facilities. Further studies are needed to account for regional differences in VRE admission prevalence, to optimize infection control interventions.

There and Back Again: A Tale of Institutional Review Board Considerations for Cluster Trials in Infection Control

presentation, 23%. The reduction in transfusions is not substantial from month to month, but when comparing the rate in January to the rate after the second intervention in July, it is statistically significant, p<0.0001. From July through October the average transfusion rate was 20%, with the lowest being 14% in August. CONCLUSIONS: It is possible to change the culture of staff that is responsible for deciding to transfuse a patient after surgery. A combination of education sessions, monitoring transfusion rates and the use of TXA resulted in a culture change that significantly reduced transfusion rates among joint replacement patients.

Quality Assurance Data Collection Provides Opportunity for Organizational Improvement Following a Rise in Sternal Surgical Site Infections (SSI) Post-Coronary Artery Bypass Graft (CABG) Surgery

Katherine Matteson, RN, BSN, MS, CIC, Infection Control Practitioner; Russell Hynek, PharmD, Paul Lata, PharmD, Pharmacist; Linda McKinley, RN, MPH, CIC, Infection Control Practitioner; Lynn Michel, RN, MSN, APRN, BC, VA NSQIP/CICSP Coordinator; Athanasia Schreiner, RN, MSN, APNP-BC, Nurse Practitioner; Catherine Stampfli, RN, BSN, MRSA Prevention Coordinator; Sandra Tainter, RN, BSN, Nurse Manager; Christopher Crnich, MD, MS, Staff Physician & Hospital Epidemiologist; William S. Middleton Memorial VA Hospital, Madison, WI