CHAIPI Understanding The Changing Role of Infection Preventionists The Columbia/APIC Study

1. CHAIPIUnderstanding The Changing Role of Infection PreventionistsThe Columbia/APIC Study May 7th, 2009 Patricia Stone, PhD, FAAN Associate Professor of Nursing, Columbia University Primary Investigator, CHAIPI Study Sarah Jordan, Study Coordinator

2. The CHAIPI Study This study is designed to inform our understanding of institutional, procedural, and technological innovations that can assist health professionals in reducing and eliminating the morbidity, mortality, and high costs associated with hospital-associated infections. The ultimate goal is to generate knowledge that will inform evidence-based decision making for health policy makers, hospital administrators, epidemiologists, and infection preventionists.

3. Problem Infection Preventionists (IPs) are key to reducing HAI The role of the Infection Preventionist is changing Monitor infection rates Monitor provider behaviors Intervene Implement Lead Increased use of technology to perform role

4. The PNICE Study The survey and research methodology used in the CHAIPI study are based on the Prevention of Nosocomial Infections & Cost Effectiveness (P-NICE) study P-NICE is a three-year, two-phase study to describe infection control department staffing and interventions implemented in ICUs across the U.S. The study is conducted by Columbia University School of Nursing and headed by Dr. Pat Stone.

5. The PNICE Study

6. Overview of the CHAIPI IP Study

7. Purpose of Research Understand the changing role of IPs Evaluate the impact of CHAIPI on IP roles Department resources Infection prevention and control processes HAI rates

8. Methods Comparison of data from two time points: Infection control department characteristics IP roles Processes HAI rates Compare CHAIPI and non-CHAIPI hospitals Web-based surveys of infection control department staff First survey took place from Oct 21, 2008 to Jan1, 2009 Second survey will take place in the Spring of 2010 Site visits at six hospitals to be conducted this summer

9. Sample: • All California acute care hospitals. Psychiatric, drug/alcohol rehab, nursing homes, and children’s hospitals were ineligible. • Participation: • 207 hospitals participated out of 350 eligible hospitals contacted; a 59% recruitment rate • 45 of 51 CHAIPI hospitals contributed to the survey; a 88% recruitment rate

10. Infection Control Department Staffing and Resources

11. Hospital Demographics • IP Study Hospitals *Teaching status provided by OSHPD; does not included military hospitals. The samples are 199 and 429. ** Actual CHAIPI and study participants. Two CHAIPI hospitals reported not participating in the program, 15% of non- CHAIPI hospitals erroneously reported participating in CHAIPI. A system of three hospitals which shares IC dept. is considered one hospital for the purpose of analysis. †Programs include hospitals ineligible for the CHAIPI study, denominator unknown. Participation in CHART or IHI was not verified.

12. Infection control departments providing services to other facilities or outpatient clinics • Hospitals with outpatient clinics average 3.65 clinics/hospital +/-1.8. • 176 (85%) of IP departments provide services to at least one outpatient clinic, rehab, or long term care unit. • * CHAIPI hospitals were significantly more likely to provide services to a outpatient GI clinics, 72 % vs. 51 %

13. Utilization of Electronic Surveillance Systems

14. Comparison of the qualifications and experience of Infection Prevention and Control Department Staff: Infection Control Department Director

15. Comparison of the qualifications and experience of Infection Prevention and Control Department Staff: Infection Preventionists

16. Comparison of the qualifications and experience of Infection Prevention and Control Department Staff: Hospital Epidemiologists

17. The difference between IP study and PNICE hospital staffing is significant at p < .05 after adjusting for hospital size.

18. Proportion of total time that Infection Preventionists spend on specific tasks

19. Proportion of total time that Infection Preventionists spend in specific locations

20. Mandatory Reporting *Scale: 1 - much less, 5 - much more

21. Hospital- wide HAI Rates and Infection Prevention and Control Policies

23. Hand hygiene practices and leadership involvement • 97% of hospitals report monitoring hand hygiene, the majority by observation. • 60% report that hand hygiene is practiced correctly more than 75% of the time

24. Policies on Infectious Agents

25. Surgical Site Infection Prevention Policies Implemented correctly is defined as 95% of the time or better. Implementation percentages are a proportion of hospital swith a written policy. Hospitals without policies did not report implementation rates.

26. ICU HAI Rates and Infection Prevention and Control Policies

28. Central Line Associated Blood Stream Infection Prevention Policies Implemented correctly is defined as 95% of the time or better. Implementation percentages are a proportion of hospital swith a written policy. Hospitals without policies did not report implementation rates.

29. Ventilator Associated Pneumonia Prevention Policies Implemented correctly is defined as 95% of the time or better. Implementation percentages are a proportion of hospital swith a written policy. Hospitals without policies did not report implementation rates.

30. Catheter Associated Urinary Tract InfectionPrevention Policies Implemented correctly is defined as 95% of the time or better. Implementation percentages are a proportion of hospital swith a written policy. Hospitals without policies did not report implementation rates.

31. Next Steps Page 31

32. Qualitative Site Visits • Visiting six CHAIPI hospitals, two from each cohort • Late June – August 2009 • Research team will conduct one hours interviews with infection control department personnel, the administrator who oversees the department, and one ICU manager • The goal of site visits is to gain a more in-depth understanding of the changes and challenges affecting infection control professionals and their daily activities • Currently recruiting hospitals

33. Timeline Papers from Survey 1 are in development Description of staffing and IP time use Use of surveillance procedures and contact precautions and their impact on MRSA rates Overview of utilization of ESS Dissemination 2010 Scientific abstracts and publications APIC 2010 session Prevention strategist article Webinar Press releases Key legislative committees Goal is to change practice based on best evidence!

34. http://cumc.columbia.edu/studies/pnice/chaipi