Special Issue for Infection Prevention Week

SHOW ME THE EVIDENCE:
Conversations with Dr. Günter Kampf and Dr. Didier Pittet on Hand Hygiene

ARE YOU READY FOR H1N1?
Planning for a Pandemic

PLUS:
FREE Hand Hygiene and CAUTI Prevention Learning Opportunities

IN THIS ISSUE
Joint Commission: Patient Safety . . . . . . . . . . . 2 H1N1: Planning for a Pandemic . . . . . . . . . . . . . 3 Show Me the Evidence: A Conversation . . . . . 9 with Two Hand Hygiene Experts Hand Hygiene: New Discoveries . . . . . . . . . . . 15 SPECIAL WEBCAST EVENT HHS: 4 Categories of Infections . . . . . . . . . . . . 16 Innovation in the Prevention of CAUTI . . . . . . 17 FREE WEBINAR CAUTI Prevention Today . . . . . . . . . . . . . . . . . . 17 ERASE CAUTI Program. . . . . . . . . . . . . . . . . . . 18

Joint Commission Center for Transforming Healthcare Takes Aim at Patient Safety Failures
Teaming up with top hospitals and health systems across the country to use new methods to find the causes of and put a stop to dangerous and potentially deadly breakdowns in patient care, The Joint Commission is launching the Center for Transforming Healthcare. The Center’s first initiative is tackling hand washing failures that contribute to healthcareassociated infections that kill nearly 100,000 Americans each year and cost U.S. hospitals $4 billion to $29 billion annually to combat. Eight leading hospitals and health systems volunteered to address hand washing failures as a critical patient safety problem–one that requires fixes far more complex than just putting up signs urging caregivers to wash their hands. The Center’s work to identify and measure poor quality and unsafe healthcare will lead to the development and testing of targeted, long-lasting patientsafety solutions. Hand washing is the Center’s first patient-safety challenge. Future projects will focus on improving other aspects of infection control, mix-ups in patient identification and medication errors.

2

Infection Prevention Now • Special Edition

H1N1
I n t e r v i e w b y H a y d n B u s h
Deborah Levy is the chief of healthcare preparedness activity for the Centers for Disease Control and Prevention.

PLANNING FOR A PANDEMIC
Better communication critical for hospitals if H1N1 returns this fall

L

ast spring's outbreak of the H1N1 flu virus flooded hospital emergency departments with potentially infected patients and their families. Hospitals scrambled to meet

increased demand for services and critical supplies. The episode overwhelmed some hospital supply chains, as materials like masks and ventilators were suddenly in short supply. Often, hospitals weren’t able to get enough supplies from manufacturers because of allocation agreements, says Deborah Levy, chief of Healthcare Preparedness Activity for the Centers for Disease Control and Prevention (CDC). “This spring, a lot of facilities seemed to struggle with getting the supplies they wanted,” Levy says. With the H1N1 virus expected to return to North America this fall—potentially in stronger form than in the spring—Levy says hospitals should be working now to improve lines of communication with their local public health departments, manufacturers and their states to adequately prepare the proper supplies and protocols. Better information, Levy says, is the key to coping with a potential pandemic.
Reprinted from Materials Management in Health Care, by permission, August 2009, Copyright 2009, by Health Forum, Inc. This article first appeared in the August 2009 issue of Materials Management in Health Care.

Infection Prevention Now • Special Edition

3

What is the most important thing hospitals can do right now to prepare for the possible return of H1N1 this fall?
They definitely need to plan for surge capacity because there is that concern it will come back in a stronger way this fall and there will be more cases. Given the demographics—and we have no way of knowing for sure how the virus will come back in the fall, which is why the CDC is watching what’s happening in the Southern Hemisphere—but if it continues to hit the same demographics, then a lot more attention to pediatrics and young adults is needed. The pediatric hospitals got pushed quite a bit during this not-ultra-severe pandemic. A lot of times, pediatricians and pediatric hospitals don’t focus on influenza as much. It’s still sometimes seen as an older person’s disease, and if this virus stays the way it is, that’s not what’s happening.

Was that something the providers weren't prepared for?
It’s not that they weren’t exactly prepared for it, but I don’t think the preparedness was specifically targeted to a surge in younger adults and children. Because children don’t just automatically go to any hospital, you try and take them to pediatric hospitals, and this fall that could put a bigger burden on those hospitals.

What are the areas where materials and supplies might be specific to a pediatric facility?
Masks and respirators aren’t made for the pediatric population. With ventilators, you have some that work for both adults and children, and others that work just for children.

4

Infection Prevention Now • Special Edition

Were there supply shortages this spring?
There were different rumors. It’s hard to say what exactly was really true and what different groups were putting out there, but we started getting a lot of messaging around “Oh well, we can’t give you more supplies because we’re holding them for the federal government,” which was incorrect. We made it clear that was not what we were doing. The rumors tended to be across the board, so it was a lot on medical supplies but we even saw some of that with diagnostic kits. Sometimes the confusion might be around the fact that a hospital might have an order, but the companies moved to allocation-only. So you might have put in an order for X amount for an entire year. And now, because of H1N1, you were asking for your full order, and the company said no, you’re going to get your monthly allocation. I think some facilities didn’t realize that manufacturers and distributors started going to allocation only. Even though they agreed to supply you with X amount, you could only get it by your monthly allotment. I think sometimes the language gets confusing. When you hear there’s a shortage, is it really a shortage, or is it just that you want more than what was planned at this particular time? There wasn't a shortage this time, and yet we continually heard there was. Most states didn’t end up having to dig into their stockpile. The CDC pushed out 25 percent of the stockpile to the states. It was sufficient, and yet you kept hearing about shortages. There was no shortage. Sometimes it’s communication, and sometimes it’s the fact that you suddenly want everything and the manufacturer or distributor is saying no, you’re going to get your monthly allotment the way you always have.

What should hospitals do to build surge capacity for next fall?
Our group at CDC focuses on the linkages between health care, public health and emergency management. You have Joint Commission requirements for exercise and planning. Some of the funding is based on your hazard vulnerability assessment. So they tend to do that and focus on what they need for their hospital. Under surge capacity conditions, especially if it were to get severe, if you’re planning by yourself in a silo, that is not the right approach. Hospitals need to work with their clinicians, other hospitals in the community and other components of the health care sector. You’re trying to use all the resources in your community so you don’t have everybody rushing to the hospital. Hospital emergency departments got overwhelmed in some cases. It was parents bringing their children in who might not have been really severely ill, but they were coming in saying, “I want you to check my child out.” As a parent, if your child starts getting sick, even if they're not severely ill, you’re going to take them to the health care system. Even though if H1N1 was not happening and your child had a sore throat, you’d tell them to stay in bed and give them two Tylenol and that would have been the end of the story. Because H1N1 was circulating around, now suddenly your child has a temperature you think, “Oh my God it’s H1N1, I need to have my child tested” and off you go and there you are in the ED.

Infection Prevention Now • Special Edition

5

Who do you need to work with outside of your facility?
You also need to get your messaging straight. Work with public health, because public health is going to do a lot of directing and messaging. In severe cases, if you haven’t done any kind of planning with emergency management, that’s a problem. Think about an ice storm or a tornado coming through. Which group within your community helps manage that incident and helps with resources? It’s emergency management. They don’t necessarily always understand the details of what goes on in a hospital and in the clinics that support the hospital. Those dialogues shouldn’t start happening in the middle of an incident.

It’s not that they weren’t exactly prepared for it, but I don’t think the preparedness was specifically targeted to a surge in younger adults and children.

you’re in the hospital how do you deal with a surge? We want 911, other urgent call centers, EMS, emergency departments and hospital administrators, your private providers, clinic officers, outpatient and other urgent care clinics, public health, emergency management, hospice, long-term care, palliative and pharmacies. If you want to do your ideal planning to respond to H1N1 or any other scenario, all of those folks should be at the table. You still need a core team within that, and that’s where we put health care, public health and emergency management as the triad to drive the planning. In case of a full-blown pandemic, will hospitals have enough beds or need to find additional space to house patients? It’s a matter of space and crowding, but it’s also a matter of doing the triage. You may end up having to think about cohorting patients. As patients come into the emergency room, it’s not like you’re just going to have H1N1. You have other illnesses. If you do end up having a lot of the mildly ill still trying to get into the hospital, you really don’t want them exposing their illnesses to your other, chronically ill patients. Thinking about how you would do that initial triage when all these people are trying to get into your facility is really important. And then it’s important to think about where you put all these patients in hospitals.

“In case of a full-blown pandemic, will hospitals have enough beds or need to find additional space to house patients?”

When we work with communities and conduct workshops, we require about 15 sectors to show up. That's how we work with them to think about the model of care delivery—everything from supplies down to managing your staff and your beds. How do you reduce demand, and once

What were some of the problems hospitals ran into in the spring?
The difficulty in the spring was somewhat artificial. It was related to communications and some

6

Infection Prevention Now • Special Edition

“Everybody thought a pandemic would begin overseas, and so you would have X amount of weeks to prepare for its arrival in the United States. Of course, that’s not at all what happened.” confusion as to what you could get when. Clearly, you need your infection control materials. There’s always the possibility if the virus changes that you would have bacterial infections over and above what you're getting with the flu. It’s also the chronic disease medications and the things that people tend to run out of. Facilities need to make sure they understand what their state and local public health department is going to do with the stockpile. When the CDC arrives and turns it over to the state, that’s it. Each state has a different strategy. The lesson is, don’t start to ping the public health department in the middle of the surge. You should have that all figured out already. Know what’s happening to the stockpile, and also know what you’re not getting. Sometimes, there’s also a false assumption that you don’t really need to get all of these materials because in a push, you think you’ll get it in from the stockpile. Everybody’s thinking the same thing, and what’s in the stockpile is not sufficient. That was never the intent of the stockpile, to support pandemics indefinitely.

How much flexibility should hospitals build into their response plans?
They should go back and see how their plans lined up with what happened with H1N1. For some of the states and some facilities, it didn’t go the way they thought it was going to go. Everybody thought a pandemic would begin overseas, and so you would have X amount of weeks to prepare for its arrival in the United States. Of course, that’s not at all what happened. Your plans need to allow flexibility. Plans need to outline everything, but they shouldn’t be rigid. You need to look at what went well and what didn’t go well, and then start making changes. Part of what allows flexibility is to build in triggers to implement certain aspects of the plan. That way, you can watch what happens and when it hits a certain trigger, then you need to implement it. I

Infection Prevention Now • Special Edition

7

Check out

www.medlineuniversity.com

Featured this Month: Nine on the Line to Improve Patient Safety & Reducing SSIs
Gain practical evidence-based solutions to improve surgical safety in the perioperative arena by learning more about surgical safety best practices. Discover the nine key areas for improving patient safety in the perioperative arena and six key activities that can help reduce surgical site infections.

Continuing education is a vital part of any nursing career—and often a requirement. That is why Medline University offers a wide range of free online, interactive and up-to-date educational courses, resources and competencies. With an all-new look and upgraded content, Medline University gives you unlimited access to nearly individual 50 online classes for continuing education credit.

Medline University course categories include: • Continence and Incontinence • Hot Topics in Healthcare • Infection Prevention • Operating Room • Pressure Ulcer Prevention • Respiratory • Wound Care

Log on to www.medlineuniverity.com today and start earning CEUs – FREE.
8 Infection Prevention Now • Special Edition

Show me the evidence:
A conversation with two hand hygiene experts
Recent news stories on global health issues such as H1N1 Influenza and MRSA, as well as the cost of
hospital-acquired infections, have brought infection control into a leading role in healthcare. As the number one defense against healthcare-acquired infections, hand hygiene has an important role to play in the prevention of infections. The CDC estimates that adherence to handwashing procedures alone could prevent the deaths of 20,000 patients each year. Studies have shown, however, that despite being a proven-effective practice, hand hygiene compliance among healthcare workers is poor, with the World Health Organization reporting an average compliance rate of 40 percent. Hospitals and healthcare facilities are adopting new tools, products and techniques that enhance infection-control efforts, such as waterless hand sanitizers that make it easier for physicians and nurses to practice optimum hand hygiene. But while most hand “…not all alcohol hand sanitizers contain isopropanol, sanitizer formulas are the ethanol, or a combination of same, and confusion remains these ingredients, not all alcohol hand sanitizer formulas are over recommendations the same, and confusion and guidelines.” remains over recommendations and guidelines. ABC News contributor and author John Nance recently sat down with two world-renowned experts – Dr. Didier Pittet, Hospital Epidemiologist and Director of the Infection Control Program at the University of Geneva Hospitals and Dr. Günter Kampf of the German Association for Infection Control and lecturer at the Ernst Moritz University in Germany – to discuss some of the current issues in hand hygiene.

The interview with Dr. Didier Pittet, Hospital Epidemiologist and Director of the Infection Control Program at the University of Geneva Hospitals. Pages 6-8.

The interview with Dr. Günter Kampf of the German Association for Infection Control and a lecturer at the Ernst Moritz University in Germany. Pages 9-11.

Infection Prevention Now • Special Edition

9

D r. P i t t e t

Dr. Pittet discusses the updated WHO Guidelines on Hand Hygiene in Healthcare and the recommendations for alcohol-based handrub formulations.

Nance: Dr. Pittet, hand washing and hand hygiene are among the simplest, most effective methods that we know of for preventing nosocomial infections, and yet, there is a struggle that has been going on for a long time to gain a level of compliance worldwide. It’s got to be frustrating for somebody who has done the kind of research that you’ve done. Pittet: Yes. It’s very frightening first to realize that the compliance is so low. On average it’s around 40%, at the best, and it’s not rare that when you come in a unit or a ward the average compliance will be around 20%. Nance: Well, what was the reason for the lack of compliance? I’m assuming that there weren’t people running around healthcare who thought that the laws of microbiology had somehow been suspended for hands?

Pittet: (chuckles) Yeah, that’s a good point. Actually, when we did our very first study – the largest epidemiological study that was ever conducted on hand hygiene practices – we realized that there were several parameters that could explain the lack of compliance. And the most important parameter, the one that stays on all the models that we have developed, is the lack of time. So time constraints for healthcare workers was really the most important issue for them. Nance: So this is not a complaint that you hear universally here in the United States; this is worldwide? Pittet: This is absolutely worldwide. You know, for example, when we monitor hand hygiene practices in the intensive care unit, we could really see that nurses had at least 20 opportunities to clean hands every hour of patient care. And if

10

Infection Prevention Now • Special Edition

you do it with soap and water, it will take you almost half an hour, each hour, to clean your hands. So it means that it is absolutely impossible for a regular nurse in the ICU to clean his or her hands on an appropriate timing. Now, with the use of the alcohol-based hand rub to clean your hands, we bypass the time constraint. Nance: But that brings me to a question—and you touched on it earlier—there certainly has been some feedback, or push back shall we say, of saying “Well, if I wash my hands X number of times per day, I’d have no oil left on my hands.” And in other words, we’ve got all the soaps and all the other emollients and then we’ve got alcohol-based. Is alcohol-based really that much better – both in effectiveness and in terms of what it does for your hands?

Nance: Let me ask you this: there is a differentiation in what the World Health Organization has as a range for alcohol content in terms of percentage. There’s an 80-90 percent that’s being recommended, I think by WHO and by others for more developing nations. Pittet: Yes. Nance: And there are some who believe that it should be lower. And over in the United States, for instance, it is usually lower. Where’s the breakpoint on all of this?

Pittet: There is an important misunderstanding. When we wrote, together with this group of international experts, the WHO guidelines, we made it universal. So the rule is the “…your product should following: There are two types contain at least 80 percent of alcohols; one is based on ethanol or ethyl alcohol, and ethanol alcohol or ethyl your product should contain at Pittet: Yes. It is more effective – alcohol. Or you can use least 80 percent ethanol alcohol really more effective. We are isopropyl alcohol, and or ethyl alcohol. Or you can use talking about log reductions, isopropyl alcohol, and there differences in the efficiency and there you need to have at you need to have at least 75 the efficacy between alcohol least 75 percent isopropyl percent isopropyl alcohol or and soaps. And of course it’s isopropanol in your product. a lot better for your hands. alcohol or isopropanol…” This is a universal rule that is Why? Because you know, in true and applicable and should your hands we have lipids. If you be applied in all countries apply soap on your hands, it actually kills the lipids around the world. Developed, under-developed, and some of the cross-links between different developing countries – they should all apply the parts of the skin. same rule. And because of the lipids, you keep actually your water in your skin. If you remove the lipids, then you let the water evaporate from you skin and from your hands. So at that point your hands become really, really damaged. Now, at the time we produced the guidelines, some people said “Well, but what about the products that are currently on the market? There are good products and there are less good products. Some of the products do not meet the norms. Some meet the norms.”

Infection Prevention Now • Special Edition

11

So we say, “Yes, if you have a good product that meets the norms, then you can continue using this product, providing that the company that is producing the product could really show you the results of the testing by the norms. The testing by the norms should be performed for every compound. So the misunderstanding is that the WHO didn’t want to say that you have to replace all the products, all over the world, but that they say if there is a product that is commercially available that meets the norms, you could use this product. Now, usually a product with 60 percent alcohol will not meet the norms – you are better to test the product, make sure it meets. There are two norms that are available internationally. There are those that are used in the North America, which is the ASTM norms, and those that are used in Europe, the European norms. The European norms are more stringent. With a 60 percent ethanol solution, you will never pass the European norms. Nance: Yet in the U.S. we have that 60 percent. Pittet: In the U.S. sometimes the product may meet the norms, but not always. So when you choose a product, you are better first of all to choose a product with a higher content

in alcohol. It will be much more efficient on some microorganisms that require a higher content in alcohol like some viruses. Nance: I would assume, not to put words in your mouth, that it would almost be a rhetorical question to say that you and WHO would probably like to see a higher level in the United States? Pittet: Of course, of course. It’s hard to believe that there have been so many products that have been used in the United States that will never pass the European norms. So some of the products that you are using in the United States have not made anything on the European market, because they just don’t pass the norms. So can you imagine that the quality of the level of care that is demanded in some European hospitals is higher than in some U.S. hospitals? It doesn’t make sense, speaking of patient safety, right? Nance: Yes, absolutely. And do you see a trend over North America, Canada, United States, Mexico in terms of understanding this, because we are still at a low compliance level in individual hospitals. Pittet: We see a trend. We see more and more compliance improvement. Also in the U.S. we see a lot of change in the products that have been used in the U.S. There are many people asking these questions. And this is more important – many of the so-called inefficient products or bad products are just going out of market because they are not appropriate for use in healthcare. Nance: Dr. Pittet, thank you so much for coming in today. Pittet: Thank you. It’s my pleasure.

“It’s hard to believe that there have been so many products that have been used in the United States that will never pass the European norms. So some of the products that you are using in the United States have not made anything on the European market, because they just don’t pass the norms.”

12

Infection Prevention Now • Special Edition

D r. K a m p f

Dr. Günter Kampf discusses the importance of technique when using alcohol-based hand sanitizers.

Nance: Dr. Kampf, there are alcohol-based foams that are popular, but the question is really are they as effective? Do they do the same thing? Do you use the same method of application as you do for a hand rub? Kampf: The foams that I have seen so far contain around 60, 62 percent ethanol. And when you look at the WHO guideline for hand hygiene, this concentration is too low for use in hospitals. At the same time we’ve just finished a study where alcohol-based foams were applied to dry skin, and we measured how long it would take for the skin to dry. We found out that if you have a 30-second time for the hands to be covered by the foam, you need a rather small amount, which is 1.6 grams. And when you apply this small amount the efficacy is even lower. So overall you have two problems to face. One is the concentration of the ethanol is too low, and the other is that

if you apply an amount in clinical practice which keeps hands moist for around 30 seconds, the total amount of foam which is applied is in addition too low. Nance: What studies have you either conducted or seen in regards to the foams? Kampf: To my knowledge, the alcohol-based foams have not really been studied in the scientific literature. That is why we have done a trial this year to find out how effective the ethanolbased foams really are. And we have used foams based on 62 percent ethanol because they are commonly used in hospitals. Nance: These results will be forthcoming soon? Kampf: Yes. They have been summarized and written up already, but have not been published yet.

Infection Prevention Now • Special Edition

13

Nance: Let me ask you this: Are all alcoholbased rubs used in a similar fashion, and if not, how do you distinguish between them and among them?

they may also reduce the efficacy of the ethanol. That is why you need to know how effective is the preparation which is actually used. Nance: The alcohol rubs that are out there now—and just the element for alcohol rubs for hands in general, is this the final answer in chasing down and getting rid of hospital-acquired infections? Kampf: It’s not the final answer, I’m afraid, but it is a very important step forward. It is believed that about one third of the hospital-acquired infections are preventable, and it is also believed that hand hygiene plays the major role, but it does not cover all the possibilities for infection prevention. But it is certainly the major part to control the spread of microorganisms in the hospital. Nance: But if we did this right, we would reduce by a tremendous degree the number of hospital-acquired infections? Kampf: Definitely, definitely. Nance: Let me ask you this: Alcohol rubs are also used in the surgical setting. And theirs is kind of a different world. There’s a concept known as persistence – could you tell me the definition of that as you see it? Kampf: This is a very interesting question. Persistence is not clearly defined to my knowledge. My perception is that persistence is seen as the level of efficacy measured over six hours. Now when the surgeon is in the operating theater, he usually wears a pair of sterile gloves. And you want to make sure that the bacterial load under the surgical glove is as low as possible during the entire operation. That is why you do surgical hand antisepsis before donning sterile gloves. You have the immediate effect, and then you can measure the bacterial count also after three hours or after six hours. To my knowledge persistence means that the number of bacteria under the surgical glove is still below baseline level after six hours.

“Now when the surgeon is in the operating theater, he usually wears a pair of sterile gloves. And you want to make sure that the bacterial load under the surgical glove is as low as possible during the entire operation. That is why you do surgical hand antisepsis before donning sterile gloves.”

Kampf: That is an excellent question. In the United States you can have rubs based on ethanol in the concentration between 60 and 95 percent ethanol. The WHO recommends 80 percent ethanol, so you see already some of the preparations may have a lower concentration in comparison to the WHO guideline. Some of them may have even a higher concentration in comparison to the WHO guideline. And then you may have liquid hand rubs. You may also have hand rubs with a higher viscosity. And then you often have gels. Nance: If you have the same level of alcohol, is it a level playing field if they are used in different ways? In other words, you adjust the utilization for one and it becomes as if you utilize another a different way? Kampf: No, unfortunately not. You have to know the efficacy of the final formulation. And when you have skin care components or other ingredients, they may enhance the efficacy of the ethanol, but

14

Infection Prevention Now • Special Edition

SPECIAL WEBCAST EVENT

HAND HYGIENE: NEW DISCOVERIES
Join us for this “must-see” webcast presentation as two world-renowned experts bring you critical information on the updated WHO Guidelines on Hand Hygiene in Health Care, the recommendations for alcohol-based handrub formulations and the importance of technique when using alcohol-based hand sanitizers.

This exclusive series is “essential viewing.” Learn from the world’s foremost experts:
Dr. Günter Kampf is a member of the German Association for Infection Control and a lecturer at the Ernst Moritz University in Germany. He is the author or co-author of 119 mainly peer-reviewed scientific papers published in international and national journals on infection control. Dr. Didier Pittet is the Hospital Epidemiologist and Director of the Infection Control Program at the University of Geneva Hospitals and Faculty of Medicine in Switzerland. He is also a member of the Advisory Board of the WHO World Alliance for Patient Safety and Lead of the First Global Patient Safety challenge “Clean Care is Safe Care.”

This webcast will be shown exclusively through Medline University’s website only during Infection Prevention Week October 18-24. One CE credit per presentation is available through Medline University.

For more information, go to www.medlineuniversity.com

Nance: Within that definition, are persistent ingredients required if we are going to get the effect in the OR for persistent activity? Kampf: From my point of view, not. There is a debate currently going on, especially in the United States, whether it is necessary or not to have chlorhexidine as an additional active ingredient. But so far the data that I have seen is not convincing in terms of an additional benefit when you have chlorhexidine in addition to ethanol in the formulation. Nance: So it might be—this is just postulating

because you are saying that it has not been proven—it might be that the same alcohol rubs that we’re talking about as a potential world standard could also be perfectly acceptable in the operating theater. Kampf: Absolutely. The efficacy requirements are also fulfilled by preparations which are only based on ethanol – the efficacy requirements which are laid down by the FDA. Nance: Dr. Kampf, thank you very much. Kampf: My pleasure. I

Infection Prevention Now • Special Edition

15

H H S

A c t i o n

P l a n

4INFECTIONS
CATEGORIES OF
ACCOUNT FOR APPROXIMATELY 3 QUARTERS OF ACUTE CARE HAIs

E

arlier this year, the Department of Health and Human Services (HHS), in conjunction with experts, developed an “Action Plan to Prevent Healthcare-Associated Infections” that identified the key actions needed to achieve and sustain progress in protecting patients from the transmission of serious, and in some cases, deadly infections.

According to the plan, four categories of infections account for approximately three quarters of HAIs in the acute care hospital setting: ® Surgical site infections; ® Central line-associated bloodstream infections; ® Ventilator-associated pneumonia, and; ® Catheter-associated urinary tract infections. In addition, infections associated with Clostridium difficile and MRSA also contribute significantly to the overall problem. The frequency of HAIs varies by location. Currently, urinary tract infections comprise the highest percentage (34%) of HAIs followed by surgical site infections (17%), bloodstream infections (14%), and pneumonia (13%).

Other
(22%)

CAUTI
(34%)

Bloodstream
(14%)

Pneumonia
(13%)

Surgical Site
(17%)

For additional details on what is in the Action Plan, visit hhs.gov/ophs/initiatives/hai/infection.html

Causes for Acute Care HAIs

16

Infection Prevention Now • Special Edition

Opportunities to learn more on CAUTI prevention.
To learn more, visit www.medline.com/ERASE.

FREE WEBINAR

INNOVATION IN THE PREVENTION OF CAUTI
With CMS’s emphasis on prevention of hospitalacquired conditions, there is no better time to examine systems to help prevent CAUTI. Join in with your colleagues from around the country to learn more about strategies to prevent catheter-acquired urinary tract infections as well as Medline’s ERASE CAUTI system. Alecia Cooper,
RN, MBA, CNOR

Lorri Downs,
RN, BSN, MS, CIC

OCTOBER
16th 19th 21st 29th 12:00 - 1:00 pm 2:00 - 3:00 pm 12:00 - 1:00 pm 3:00 - 4:00 pm

NOVEMBER
3rd 5th 9th 17th 20th 23rd 11:00 - 12:00 pm 12:00 - 1:00 pm 2:00 - 3:00 pm 9:00 - 10:00 am 12:00 - 1:00 pm 2:00 - 3:00 pm

DECEMBER
3rd 8th 11th 14th 17th 30th 11:00 - 12:00 pm 9:00 - 10:00 am 12:00 - 1:00 pm 2:00 - 3:00 pm 12:00 - 1:00 pm 11:00 - 12:00 am

COMING JANUARY 11, 2010
John Nance hosts the four-part interview series:

CAUTI PREVENTION TODAY
ABC News contributor and author John Nance will be hosting a fourpart interview series exploring prevention strategies and interventions for catheter-associated urinary tract infections. The series, CAUTI Prevention Today, features a diverse cross-section of experts who share insights into each facet of the prevention equation — from highlighting best practices to education and training. Also included are interviews with clinicians who are focusing on culture change and alternatives to catheterization as part of their prevention efforts. CAUTI Prevention Today is sponsored by Medline Industries, Inc. in conjunction with its Race to ERASE CAUTI awareness campaign to reach 100,000 nurses with CAUTI prevention education. The series is currently available on DVD and is being distributed to hospitals during infection prevention week, and will be available online January 11, 2010.

Infection Prevention Now • Special Edition

17

We didn’t just design a new tray, we designed a way to make it hard for healthcare workers to do the wrong thing.
The new ERASE CAUTI program combines design, education and awareness to tackle catheterassociated urinary tract infection – the most common hospital-acquired infection.1

Design
The innovative one-layer tray design guides the clinician through the process of placing a catheter to ensure aseptic technique.

Education
The acronym ERASE is easy to remember, reminding the clinician to:

Evaluate indications – Does the patient really
require a catheter? ead directions and tips – Follow evidence-based insertion techniques

R

Aseptic techniques – Key design solutions
support aseptic technique

Secure catheter – A properly secured catheter
will reduce movement and urethral traction ducate the patient – Printed materials tell the patient how to reduce the likelihood of infection

Design
Open up the innovative one-layer catheter tray and see the intuitive design for yourself.

E

Awareness
Join the Race to ERASE CAUTI! The current state of health care demands that nurses play a leading role in identifying and implementing CAUTI risk reduction strategies. Help us reach our goal to introduce 100,000 nurses to the ERASE CAUTI system.
Ask your Medline representative about the new ERASE CAUTI Program, call 1-800-MEDLINE (633-5463), or visit www.medline.com/erase
Reference 1. Catheter-related UTIs: a disconnect in preventive strategies. Physicians Weekly. 25(6), February 11, 2008.

18

Infection Prevention Now • Special Edition

Education
Click here for details on nursing education materials that promote evidence-based practice.

Awareness
Visit this section to join 100,000 nurses in the Race to ERASE CAUTI.

Infection Prevention Now • Special Edition

19

Sterillium® Comfort Gel™

Your hands will love you even more.
Also available: Sterillium Rub for surgical hand antisepsis

Do more with less Sterillium Comfort Gel delivers greater efficacy than other alcohol-based hand antiseptics* by virtue of its 85% ethyl alcohol concentration. Due to the high alcohol content it does more for your infection control efforts by using up to 50 percent less volume per application.* Independent in vitro testing demonstrated that Sterillium Comfort Gel achieves reductions of ≥ 5 log10 (≥ 99.999 percent) on a broad range of nosocomial pathogens.*

Comfort drives compliance Sterillium Comfort Gel’s incredible bactericidal effect doesn’t matter if the product isn’t being used! You’ll want to reach for Sterillium Comfort Gel again and again because it leverages a proprietary blend of moisturizers similar to those found in NIVEA® and Eucerin® skin care products. The result is a product proven to increase skin hydration by 14 percent in just two weeks.*

For more information on Sterillium Comfort Gel, contact your Medline sales representative, visit www.medline.com, or call 1-800-MEDLINE.
Sterillium Comfort Gel is available in three packaging styles to suit any need, including a touchless dispensing option.

*Data on file. ©2009 Medline Industries, Inc. Medline® is a registered trademark of Medline Industries, Inc. Sterillium® is a registered trademark of BODE Chemie GmbH. NIVEA and Eucerin are registered trademarks of Beiersdorf AG. Sterillium® Comfort Gel® is a registered trademark of Bode Chemie GmbH.