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Personal protective equipment (PPE) has been an invaluable yet limited resource when it comes to protecting healthcare workers against infection during the 2019 coronavirus (COVID-19) pandemic. In the US, N95 respirator supply chains are severely strained and conservation strategies are needed. A multidisciplinary team at the Washington University School of Medicine, Barnes Jewish Hospital, and BJC Healthcare was formed to implement a program to disinfect N95 respirators. The process described extends the life of N95 respirators using vaporized hydrogen peroxide (VHP) disinfection and allows healthcare workers to retain their own N95 respirator across a large metropolitan healthcare system.

Background: From August 2017 to June 2018, 11 hospitals within a large healthcare system switched from multiple different electronic medical records (EMRs) to 1 EMR. At the time of this transition, the NHSN provided guidelines to validate healthcare-associated infection (HAI) denominators when switching from manual denominator collection to electronic denominator collection, but the NHSN did not give guidelines for validation when switching from 1 EMR to another. We aimed to build a validation process to ensure the accuracy of central-line and urinary catheter days reported to the NHSN after switching EMRs. Methods: Our validation process began with a statistical phase followed by a targeted manual validation phase. The statistical phase used 3 prediction methods (linear regression, time series analysis, and statistical process control [SPC] charts) to forecast device days after the EMR switch for units within hospitals. Models were developed using baseline data from the old EMR (January 2015 through the new EMR implementation). Using prespecified criteria for each method to determine discrepancies, we built a decision tree to identify units needing manual validation. Any unit that failed the statistical phase would need to participate in the manual validation phase, using a midnight census and direct visualization of devices. The manual validation process was composed of 14-day blocks. At the end of each block, if manual device days were within ±5% of EMR device days, they were considered validated. Manual validation would be repeated in 14-day blocks until 2 consecutive blocks passed within ±5%. Results: Overall, 157 units were evaluated for urinary catheter days and central-line days. Among them, 143 units passed the statistical validation test for urinary catheter days and 151 passed for central-line days. There was no specific pattern when comparing forecasted versus actual device days. The manual validation process for the 20 failing units (14 urinary catheter and 6 central-line units) is ongoing; preliminary results identified issues with missing nursing documentation in the EMR and with inaccurate manual counting of device days. There were no systematic discrepancies associated with the new EMR. Conclusions: We developed a novel validation process using statistical prediction methods supplemented with a targeted manual process. This process saved resources by identifying the units that need manual validation. Discrepancies were largely related to nursing documentation, which the infection prevention team addressed with additional training.Funding: NoneDisclosures: None

Background The Central Sterile Processing Department (CSPD) manages the cleaning, disinfection, and sterilization of reprocessed devices and instruments. Infection Preventionists (IP) work closely with CSPD to ensure devices and instruments are reprocessed and stored according to the recommendations of manufacturer, regulatory, and expert guidelines. A large healthcare system surveyed their IP and identified opportunities related to the updated Association for Professionals in Infection Control and Epidemiology (APIC) Competency Model (2019) domains. Cleaning, Disinfection and Sterilization falls under the Operations domain and was identified as an area in which IP wanted to enhance their expertise. Methods IP partnered with CSPD experts throughout the healthcare system to provide an in-depth education workshop to grow IP competency in CSPD. IP within our system are responsible for CSPD in a range of settings, including adult and pediatric acute care, critical access hospitals, ambulatory surgery centers, and over 120 physician offices or outpatient care areas. The workshop was divided into 4 sessions that consisted of oral presentations, hands-on learning, and discussion of examples and real-life scenarios. Manufacturer instructions for use (MIFU) were addressed, and a review of standard work and best practices due to sterilization failures were discussed. Results 32 attendees from 12 settings participated in the workshop, including Infectious Diseases (ID) physicians, IP, Occupational Health (OH) practitioners, and CSPD technicians. Attendees were asked to evaluate the quality of the educational sessions. 20 attendees completed their evaluations. The 4 sessions each received either an Agree (12) or a Strongly Agree (68) approval rating. The overall quality of the program received an Excellent (16) or a Good (4). Conclusions By partnering with CSPD subject matter experts (SME) from their healthcare facilities, IP, ID Physicians and OH Specialists increased their knowledge about the cleaning, disinfection, and sterilization of reusable devices and instruments and enhanced their professional relationships with their CSPD team.

Educated anesthesia staff regarding the use of chlorhexidine gluconate (CHG) dressing after insertion and to ensure all open ports are capped before transporting; 3) Attached accessory trays to IV poles in the ICU to provide improved access of smaller supplies, i.e. caps and CHG swabs; 4) Revised nurse notes to include daily CHG bath for ICU patients increased compliance; 5) Displayed educational posters demonstrating the proper way to cleanse central line ports; and 6) Reviewed minutes with responsible staff on all open items until resolved.

ISSUE: Each year, an increasing number of healthcare procedures are performed using endoscopic equipment that is no longer confined to surgical or gastrointestinal departments in the healthcare facility. Inadequate processing of endoscopic equipment has been associated with outbreaks of infection. Infection Prevention and Control Professionals (ICPs) must assess and evaluate the cleaning, disinfection, transport, and storage processes for endoscopes used throughout their healthcare facility. The great diversity of equipment and limited hands-on knowledge require ICPs to seek guidance on best practices to prevent infections associated with endoscopes. PROJECT: A team of 4 Infection Prevention and Control Professionals (ICPs) and their Medical Director from a large, multi-hospital system developed an Endoscopy Resource Kit to meet the need for concise information. This team met several times over a 2 year period to: determine the endoscopy resource needs of the ICP; identify the types of endoscopes and current methods used for processing them; pool existing tools and resources; research best practices, manufacturer's recommendations, and professional organization guidelines; and assess the problems or barriers that ICPs face in evaluating endoscope processes. RESULTS: The team created an Endoscopy Resource Kit that includes: a step-by-step guide; descriptions of the types of endoscopes and how they are used; a sample survey to locate and identify endoscopes and the department where they are being used; a compendium of sample policies for cleaning, disinfecting, and monitoring endoscopes and their automated washers (if used); and the current guidelines and recommendations available from professional organizations and instrument manufacturers. Each hospital within the healthcare system received a copy of the Endoscopy Resource Kit and online access to it. LESSONS LEARNED: Pooling resources and expertise from various sources in the healthcare system are advantageous when creating an endoscopy resource kit. This team approach revealed the issues ICPs face in identifying and reviewing all aspects of processing endoscopes. It encouraged the sharing of information across departments and hospitals. It resulted in ICPs, physicians, and department staffs taking ownership in a concise, centralized resource kit containing best practices in the processing of endoscopes.

ISSUE: Influenza infections affect 20% of the U.S. population, with an average of 110,000 hospitalizations and 36,000 deaths annually. The shortage of influenza vaccine for the 2004–2005 season brought with it the potential for an even higher rate of morbidity and mortality due to influenza. The Infection Control and Healthcare Epidemiology Consortium of a 12-hospital healthcare system located in St. Louis, Missouri, determined that a comprehensive multi-tiered influenza management plan was needed. PROJECT: A team of four infection control practitioners (ICPs) was established from three of the system's hospitals, including a large, metropolitan teaching hospital, a comprehensive pediatric hospital, and a small community hospital, along with three system-level consultants, under the advisement of their medical directors. The team developed a resource packet containing a comprehensive multi-tiered influenza management plan. The packet included a core policy, to be customized by each entity, a checklist of recommended materials to have on hand, and algorithms for influenza testing, patient placement, and healthcare worker immunization. The packet also included an admission screening tool, examples of local health department' line list reports, and educational posters to be used throughout the healthcare facilities to heighten influenza infection prevention awareness. Many of the tools have specific recommendations for different stages of the influenza season; for example, extensive use of rapid diagnostic tests is appropriate early on, but unnecessary during peak flu season when diagnosis can reliably be made based on symptoms. The packet was developed as a guide to assist ICPs in preparing for an influenza season. RESULTS: A resource packet with a comprehensive multi-tiered influenza management plan was developed for all of the system's hospitals. The packet contains information addressing the action to be taken prior to and at the early onset of the influenza season, when there is an increased level of influenza activity, and during a pandemic event. LESSONS LEARNED: Annual influenza outbreaks are a serious threat to U.S. patients. To reduce that threat, it is necessary to carefully plan and prepare for each influenza season. A resource packet with a comprehensive multi-tiered influenza management plan is a useful tool in making the necessary plans and preparations.