Changes in Chapter Officers... A message from your new Chapter President, Sonya Mauzey

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1 Spring 013 Infection Prevention Newsletter Changes in Chapter Officers... A message from your new Chapter President, Sonya Mauzey Still struggling with NHSN reporting? Inside this issue: Hopefully by now all of you have read the memo that went out to the membership last month, or perhaps heard through your regional meetings, that there were changes made in the chapter president position last month. Regretfully, Chuck Palenik had to resign as chapter president due to health and personal reasons. Moving forward with the governance of our chapter, meant that, the president elect, had to assume the role of president. Given the unusual circumstances, the chapter bylaws were reviewed carefully and consultation was done with APIC National headquarters, before these changes were implemented. Please watch for important updates regarding filling of the vacancy of president elect resulting from this situation (there will need to be a special election). In doing so, I would like to encourage all members to review the by-laws which are on the chapter website at and if eligible, consider becoming an officer. We are a strong chapter with many great members and leaders, and potential future leaders, so I am sure we will move forward in a positive direction. APIC Indiana has been long recognized as a strong voice for infection prevention and patient safety. This can be easily seen in the awards and recognitions and active involvement seen not only on the local level but, at APIC National. Our own member, Darla Carter has been appointed to the APIC National Practice Guidelines Committee Our chapter has been the recipient of the Chapter of Excellence award (011) and Susan Kraska and Diana Korpal were both previous recipients of APIC s Chapter Leadership Awards (011 & 01). This year s national conference still has a strong presence of APIC Indiana. Two of our members, Jennifer Spivey and Heather Hohenberger are scheduled as featured speakers for concurrent educational sessions at the conference and your new president, yours truly has had the privilege of being selected for one of the 013 Heroes in Infection Prevention Awards. We have also had other members in the past to present at both concurrent sessions and poster abstracts. None of this includes the many activities and partnerships we are involve in with IHA, ISDH and Bioterrorism Preparedness, Patient Safety Coalitions to name just a few, all to prevent infections and promote patient safety. Yes this is indeed a great chapter and I feel privileged to be a part of it and look forward to working with all of you! It s Time for our State Spring Program Scholarship Fund Dollars Raised in 01 by Region News from APIC National 3 Navigating NHSN Surveillance Criteria 4 More Changes. A new publisher for the newsletter By S. Mauzey With taking on the role of Chapter President, I needed to be able to delegate some of my current chapter activities to some of the other members. Michael Grow has graciously stepped up to the task and will be taking over the job of publisher for our chapter newsletter. You may remember Michael from our last newsletter, as he wrote an article sharing his experience at APIC National after receiving one of the Chapter Scholarships to attend the conference. Michael has some exciting new and fresh ideas planned including increasing the number of newsletter issues. (See what I mean about a chapter with many great leaders and future leaders?) Thank you Michael! If you have an article you would like to submit please forward to me and I will make sure he gets it. His contact information will be published in the future.

2 Page Its Time for Our State Spring Program: Infection Prevention A Kaleidoscope of Practice Friday, April 1th This year s state education program is shaping up to be another great educational and networking opportunity. Hear from the experts and the troops about the impact of the Fungal Meningitis outbreak in Indiana. Also learn about the role of the Indiana State Department of Health, preventing surgical site infections and the latest tools for meeting mandates for HAI reporting through NHSN. For the full brochure and application visit our chapter website at www. apicin.org In addition to networking with other APIC members we have a great group of vendos who will be available to talk with you and provide information on their products, so don t miss this opportunity. Don t forget to bring your checkbook and join in the fun bidding on great baskets with all proceeds going to support our scholarship fund. (See the following table demonstrating what a great job our scholarship fundraising efforts have brought. Thank you to all on the scholarship committee and all that participate in the fundraiser Scholarship Fund Dollars Raised per Region 01 9 $150 $06 7 $0 $105 6 $95 $97 5 $60 $65 Fall 4 $19 $185 Spring 3 $160 $67 $110 $634 1 $00 $10 $0 $100 $00 $300 $400 $500 $600 $700 Submitted by Gayle Walsh, APIC IN Scholarship Fundraising Chair The money we raise for the scholarship fund is incredible. This chart depicts the amounts of money raised to send members to the National Conference and to the State Spring and Fall programs.

3 Information from APIC Headquarters about the APIC 40th Anniversary Page 3 APIC is looking for contributions from members for upcoming issues of APIC Daily News the great onsite publication we know you read at Annual Conference: 40th Anniversary Issue: APIC is producing a special issue of APIC Daily News that looks at the growth of the Annual Conference and recognizes the 40th milestone. We want to feature contributions from members who have been attending conference the longer the better. We also want to include a few profiles of attendees in each onsite issue of APIC Daily News. Would you like to speak with the editors of APIC Daily News about your experiences attending APIC Annual Conferences over the years? They will supply you with the questions to answer, and you could be featured in the special anniversary of APIC Daily News, which will be distributed in Ft. Lauderdale. Contact Jenn Waters, jwaters@showdailies.com (official partner of APIC) to get started. Please include the # of years you have been attending APIC Annual Conferences. APIC Daily News wants to feature APIC members in the onsite issues. They are seeking members who are planning to attend the conference in Ft. Lauderdale to answer questions about why you are attending this year s conference. They will send you the questions contact Jenn Waters, jwaters@showdailies.com (official partner of APIC) to get started please include the # of conferences you have attended, where you are from and your specialty/area of focus: (long-term care, pediatrics, etc.). Regardless if this is your first or 0th conference, they want to hear from you. Have questions or need more information? Contact Walter Josephs at wjosephs@apic.org, or Jenn Waters at jwaters@showdailies.com. Attending APIC National? Don t miss out on the chapter dinner scheduled for Sunday evening. This is always a great opportunity to get to know fellow chapter members in a relaxed atmosphere, while enjoying some great local food fare. If you haven t sent an RSVP, please Sonya Mauzey at sonya.mauzey@deaconess.com as soon as possible so we make sure we have adequate seating reserved

4 Page 4 Navigating NHSN Surveillance Criteria By: Kari L. Kuebler RN, BSN With spring upon us, we have now had time to settle into the 013 Healthcare-Associated Infection (HAI) surveillance updates in the patient safety component of National Health and Safety Network (NHSN). We have likely all found that with new updates come questions. Website redesign NHSN has done a great job of restructuring their website in the last month. All of the links for NHSN surveillance reporting can now easily be found at The information has been divided by type of facility and then by type of HAI. Under each type of infection, you will not only find the protocol for identifying an HAI event but many additional resources. Some examples include, webinars from NHSN staff, case studies, validation toolkits, and many links to Centers for Medicare and Medicaid Services (CMS) supporting material such as the most current HAI reporting requirements to CMS. If you have not explored the new site, doing so will help ensure you are accurately identifying cases and are well prepared for external validation from CMS. Useful links Below are a few links that have proven to be excellent additional resources for HAI surveillance. In 013 NHSN added a link to an excel spreadsheet that included an exhaustive list of organisms that can be used to identify common commensals, uropathogens (used when identifying an Asymptomatic Bacteremic Urinary Tract Infection- ABUTI), and mucosal barrier injury approved pathogens (used when identifying a Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infection (MBI-LCBI)). This document, titled NHSN Organisms Lists (NHSN Complete Organisms List), Top Organisms, and NHSN Common Commensals List, can be located by going to the following web address ( and scrolling to the bottom of the page where the hyperlink is located. In 013 the new MBI-LCBI criteria was introduced. To some of our surprise, MBI-LCBIs are to be reported as Catheter Associated Bloodstream Infections (CLABSI) at this time. However, NHSN has provided a document on how to analyze these types of infections through the NHSN website. This document can be located at Q and A with NHSN Staff The new website and tools are wonderful resources, however questions have still arose with all the changes recently made. Here are helpful questions and answers, you will not find in the manual, answered by NHSN staff. Question: I understand that when ruling out a CLABSI, signs and symptoms cannot be separated by more than one calendar day. However, when ruling out a CLABSI secondary to another HAI is there a time period these two infections need to be within? Answer: To consider a secondary BSI, the primary infection must still be unresolved at the time of the blood culture. Question: I am reviewing a case in which the patient passes away from a respiratory event, likely an infection. The patient has two days of stable fi0 and PEEP. The following day the patient s Fi0 is increased by >0% and he expires. In this case the patient does not have a second day with elevated Fi0. If patient passes away before meeting the full criteria, can a VAC be called? Answer: If the patient does not fully meet criteria do not report an infection. Continued on pg 5

5 Question: When reviewing a CAUTI, the device needs to be in place > calendar days according and signs and symptoms cannot have a gap of more than one calendar day according to the 013 manual. Can signs and symptoms that take place on day one and two of the patient s admission be used to meet the criteria? Day 1 admitted at 10am with fever and Foley placed at 1pm (Day one of indwelling catheter) Day - no fever (Day of indwelling catheter) Day 3 culture done that grows >100,000. (Day 3 of indwelling catheter) Answer: You cannot use culture results or symptoms from day 1 or to meet a HAI criteria. They have to be present again on day 3 or after. See chapter, page 1 (Identifying HAI s). Page 5 Question: I have a patient that was admitted on 1/9. Patient has an indwelling catheter inserted on 1/15 and removed on 1/16. A new catheter is inserted on 1/17. In this case, the patient has 10 hours without a catheter in place from the removal on 1/16 to the placement on 1/17. Does this meet the CAUTI criteria on page 7-: an indwelling urinary catheter was in place for > calendar days when all elements of the UTI infection criterion were first present together? Answer: Each of these days the patient had a Foley in place at some point in time so they are considered a Foley day. That means the 17 th was day 3 for the Foley and you would continue to look into this as a possible CAUTI. Question: Can I call a BSI secondary to any type of VAE? Appendix 1 in chapter 4 states Secondary BSI Guide (not applicable to VAE s). Does this mean I cannot call a BSI secondary to a VAE? Answer: When assessing a positive blood culture in a mechanically ventilated patient that may be associated with one of the respiratory-related major site definitions (VAE, PNEU or LRI) please reference the guidance below: 1) Does the patient meet any of the VAE definitions? a. If possible or probable VAP, then you may attribute the blood culture to the VAE (as a secondary BSI) IF the blood culture meets the various requirements as outlined in the VAE protocol the organism isolated from blood must match an organism isolated from the respiratory tract culture used in meeting the possible or probable VAP definition AND the blood culture must be collected during the 14-day VAE event period. b. If VAC or IVAC, then a secondary BSI to VAE cannot be called. ) If VAE/possible VAP or probable VAP is met, then the positive blood culture cannot be secondary to a PNEU or an LRI. It must either be secondary to the VAE, to one of the other non-respiratory major sites, or it may be a primary BSI/CLABSI. 3) If only VAC or IVAC is met, or if no VAE definition is met, then the positive blood culture can be evaluated to see if it is secondary to any of the major sites as defined in Chapter 17 including PNEU or LRI. If the patient does not meet one of these other definitions, the BSI may need to be reported as a primary BSI/CLABSI. Special thanks to Kari L Kuebler RN BSN, Infection Control Surveillance Practitioner, Indiana University Health, for taking the time to write and share this important information. She can be reached at kkuebler@iuhealth.org