June 2013

Columbia Nursing Well Represented at Leading Infection Control Conference

Elaine Larson Associate dean for research Elaine Larson, PhD, at APIC

Columbia Nursing was well represented at this year’s meeting of the Association for Professionals in Infection Control and Epidemiology (APIC) earlier this month in Ft. Lauderdale. One major theme running through the CUSON presentations was the need for surveillance and prevention of infection in long-term care facilities, an understudied area in public health. Our researchers also focused on an electronic hand-hygiene monitoring system, the emerging role of the infection preventionist, and the transmission of infection between incarceration facilities and the community.

Elaine Larson, PhD, associate dean for research, was named the recipient of APIC’s first Distinguished Scientist Award which will be given annually to an infection preventionist (IP) who has made a significant and sustained contribution to infection prevention science.

Following are capsule summaries of these presentations.

Preventing infection in pediatric long-term care facilities poses unique challenges, starting with the need for a definition of pediatric healthcare-associated infections. Surveillance Officer Meghan Murray, MPH pointed out in her poster session that the 2012 surveillance definition of HAIs in long-term care facilities for adults -- published by the Society for Healthcare Epidemiology of America and the Centers for Disease Control and Prevention -- isn’t always relevant for the pediatric population. This led the research team from the federally funded project "Keep it Clean for Kids (KICK)", to conclude that numerous comorbid conditions resulted in misclassification or too few signs and symptoms being documented. Results were also presented of a survey to identify areas of greatest concern to healthcare providers for children in pediatric long-term care facilities. The survey of 35 such facilities showed that multidrug-resistant bacterial and viral respiratory infections were the two leading concerns, followed by the need to address problems related to ill staff members and visitors.

Infection Control Practices and Concerns in Pediatric Long Term Care Facilities; Murray M, Larson E, Brozovich A, Neu N, Hutcheon G, Simpser, Saiman L.

Surveillance Definitions for Healthcare-associated Infections in Pediatric Long Term Care Facilities; Murray M, Keenan M, Mosiello L, Neu N, Larson E, Saiman L.

In addition to supporting the call for an appropriate definition of pediatric healthcare-associated infections, another member of the KICK team, Bevin Cohen, MPH, Project Director, Center for Interdisciplinary Research to Prevent Infections (CIRI) presented a review of the challenges facing infection surveillance and prevention for the long-term care pediatric population. This work points to the often unique social interactions among staff, family, and other children that make infection-control for this population more difficult and suggests that integrating better hand-hygiene adherence with traditional nursing tasks in this setting could improve the control of infection.

Unique Challenges of Infection Prevention and Surveillance in Pediatric Long-Term Care; Cohn, B.

The quality of infection-prevention research in adult long-term care facilities was the subject of a presentation by doctoral student May Uchida, MSN, Center for Health Policy. As many as 3.8 million infections occur in such facilities each year, and cost estimates for addressing them are as high as $2 billion annually. Yet research has not fully examined the utilization of many planned interventions, while previous reviews have often focused on limited types of infection. Uchida’s systematic review of the literature found no consensus on the type of interventions and outcome-measures reported, with variations in content, intensity, and duration making comparisons among interventions difficult.

Infection Prevention in Long-Term Care for Older Adults: A Systematic Review of Randomized and Non-Randomized Trials; Uchida, M.

The need for greater methodological rigor for future studies was also the conclusion made by Monika Pogozelska-Maziarz, MPH, PhD in her literature review of antibiotic-resistance in nursing homes. She presented on the topic with Cohen, Uchida, and Patricia W. Stone, PhD, RN, director of the Center for Health Policy. Their review of MRSA studies in the US and Europe found that the prevalence of colonization varied greatly, but that comparisons between different studies are hampered by the lack of standardization of surveillance methods and outcomes. As part of her review of the infection-related challenges facing nursing homes, Stone reviewed Category-1 recommendations for infection control in nursing homes, outlining activities in four major areas: structure of the program, functional processes of the program, employee processes, and resident care processes.

Estimates of Antibiotic Resistance in Nursing Homes: A Systematic Review of the Literature; Pogorzelska-Maziarz, M.

Current Challenges and Emerging Evidence in Infection Prevention in Adult and Pediatric Long-term Care Facilities; Stone P, Uchida M, Pogorzelska-Maziarz M, Cohen B.

Hand hygiene is one of the most effective methods to control infection in health-care settings, yet compliance continues to be a hurdle. The World Health Organization’s “5 Moments of Hand Hygiene” defines the key moments when health-care workers should perform hand hygiene. To evaluate and ensure compliance, direct observation of healthcare workers is often required, which can be labor-intensive and often impractical. In her poster presentation, doctoral student Laurie J. Conway, RN, Center for Health Policy, reviewed an emerging technology that electronically monitors hand-hygiene and generates reports used by the healthcare team to improve compliance.

Implementing an Electronic Hand Hygiene Monitoring System: Meeting the Challenges; Conway L, Riley L, Cohen B, Saiman L, Alper P, Larson E.

Infection preventionists are a key component of patient safety programs. These professionals serve as expert resources across the continuum of care for infection-control research and evidence-based interventions. One finding from Laurie Conway’s research was that as the infection-preventionist role has expanded, so has tension and uncertainty associated with the position. She points to four themes contributing to this trend: 1) expanding responsibilities outstrip resources, 2) shifting role boundaries create uncertainty, 3) evolving mechanisms of influence involve tradeoffs, and 4) the stress of constant change is compounded by chronic recurring challenges.

Tensions Inherent in the Evolving Role of the Infection Preventionist: A Qualitative Descriptive Study; Conway L, Raveis V, Pogorzelska M, Uchida M, Stone P, Larson E.

Emergency Departments face a number of factors that affect infection-prevention practices, including crowding, high patient turnover, and frequent provider interruptions. Doctoral student Eileen J. Carter, RN participated in a workshop panel that described emergency departments nationwide that have successfully implemented and sustained best practices to reduce infection.

Infection Prevention in Emergency Departments: A Workshop to Identify Barriers and Successful Strategies; Carter EJ, Savor Price C, Schuur J.

Incarcerated individuals are at high risk for community-associated MRSA outbreaks. However, little is known about how MRSA is introduced into correctional facilities as well as the transmission dynamics of the infection among prisoners. Based on an ongoing, five-year study evaluating MRSA colonization, infection, and transmission within New York State correctional facilities, Columbia Nursing researchers reviewed current issues related to MRSA, described the prevalence and risk factors for MRSA at admission to and release from prison, and used social-network analysis to describe the effect of inmate-transfer between prison facilities on transmission of infections. One finding was that the prevalence of S. aureus and MRSA colonization among inmates being released is lower than colonization among inmates entering prison, but remains much higher than that found in the general population.

A Revolving Door? Transmission of Staphylococcus aureus Between Correctional Facilities and the Community; Befus M, Herzig C, Larson E, Mukherjee D.