ICPs Will Play More Influential Role
in Emergency Preparedness

By Kathy Warye
Executive Director, APIC

In this second part of the final issue of APIC News for 2005, we continue to examine the issue of emergency preparedness. At all levels of APIC, this issue is gaining greater attention.

On November 11 and 12, the APIC Board, experts from across the continuum of healthcare, key corporate partners, and senior staff participated in an event that will have lasting repercussions for the Association. The Futures Summit was the first step in the development of a preferred future for the profession and the Association. Unlike previous strategic planning initiatives, the Summit enabled APIC leaders to examine a range of challenges, opportunities, and approaches to the future from the perspective of those who will influence the direction of healthcare delivery, and the position of infection prevention and control within this larger environment.

A recurring theme during the event was the need for infection control professionals to play a more comprehensive and influential role in our nation's preparedness for health emergencies - from bioterrorism to the next pandemic to natural disasters. Mike Osterholm, Director of the Center for Infectious Disease Research and Policy at the University of Minnesota and advisor to HHS Secretary Tommy Thompson, posed the questions "Who is the ICP of tomorrow with regard to public health? How can APIC, as an organization, influence the development of federal policy to advance the development of new antibiotics? And finally, how can ICPs influence the development of preparedness measures that would be effective in the event of pandemic influenza?"

Ed Hedblom, Global Manager of Health Economics discussed the economic consequences of a pandemic influenza in the US, reporting that research conducted in 1995 indicates the cost to the healthcare system alone would be in the range of $169 billion, closer to $200 billion in today's dollars. This research assumed the presence of an effective vaccine, a condition which does not exist today, and did not take into account the impact on the general economy. As a case in point, Dr. Hedblom indicated that SARS did more economic damage to the airline industry than the events of September 11th. Yet a pandemic influenza is not on the radar screen of the nation, including insurers, business leaders and the general public.

There was general consensus among the participants that APIC should play a more influential role in building awareness and driving initiatives to increase investment in emergency preparedness. This will require taking action at both the national and local levels as well as effective collaboration with colleagues from around the world. Over the coming months, APIC's leaders, together with the Summit participants, will explore what specifically the Association can and should do to increase overall preparedness and empower the infection control community toward this goal.

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Reflecting on the Past Year, Welcoming New Leadership

By Jeanne Pfeiffer, RN, MPH, CIC
2004 APIC President

This has been an amazing year of change and growth for APIC, and I have been honored to serve as your President during this period of evolution for both the organization and the infection control profession. All of APIC’s leadership, many members, and the National Office staff have been supportive and provided inspiration and guidance during these past 12 months, which have been productive and exciting.

In March, Kathy Warye joined APIC as Executive Director. She enthusiastically embraced her role and studied the issues before our profession and realigned the National Office’s resources to support the work of the programs. She, along with staff and leadership, began to develop a strategy where the Association and profession could keep pace with our ever-changing world.

Part of that strategy included gathering together thought leaders from across the continuum of healthcare, academia, government, and the nonprofit world at a Futures Summit this past November in California. Participants explored the challenges and opportunities present in the ever-evolving field of infection prevention and helped shape the future direction of the profession, the practice, and the Association. More will be written on the Summit in future editions of APIC News and the highlights of these discussions will result in a published report intended to create the foundation for APIC’s strategic approach for the next three to five years.

A major topic of discussion which began after 9/11 and was explored in earnest during this past year and at the Summit was the future practice of infection control relating to disaster preparedness, both for natural occurrences such as the devastating hurricanes of this past season, and manmade attacks that are involved with bioterrorism. It is clear that planning for these events cannot begin and end at the door of the individual healthcare system, but must involve community public health and the other healthcare systems in our local communities and state.

Infection control professionals (ICPs) often are already responsible for ambulatory care sites within their own facilities (e.g., clinics, urgent care, and emergency rooms), and are expected to develop relationships with all departments. All ICPs should have an established relationship with their public health department since communicable diseases must be reported to local and state public health agencies. Involvement with public health may create the opportunity for ICPs to connect with some ambulatory care sites that are not connected officially to an acute care facility. This is occurring in my home state of Minnesota, as all emergency preparedness planning is extending into ambulatory care sites. Community Public Health Departments that have worked with my infection control department for years are now asking us to assist them with helping ambulatory care sites address infection control issues such as reprocessing of equipment and choosing the correct personal protective equipment to examine patients who have not yet received a diagnosis.

Hospital emergency incident command systems (HEICS) have been set up to mirror the community incident command systems, but this is only the beginning of the work facing infection control. We need to consider how we operate and mobilize our resources each day along with all other departments in relation to the infrastructure of HEICS. Should a situation escalate and overwhelm our usual infection control resources or span of control, we should naturally move to calling in more resources. We need to address prevention in a more proactive way in ambulatory care and public health to protect healthcare workers and the public.

APIC is supporting these collaborations by focusing on developing products and services that will provide infection control professionals, public health officials, and first responders, among others, with the tools necessary to build local communication networks; to develop true working partnerships focused both around effective prevention and swift and effective response where prevention fails.

Another infection control issue that has reemerged this past year and that will affect all ICPs is mandatory reporting of healthcare-associated infections. More and more, government and quality improvement/patient safety organizations are recognizing that healthcare-associated infections cost billions of dollars; an expense that could be significantly reduced if best practices were in place in every hospital in this country. These external drivers are bringing infections to the attention of our hospital administrators.

Establishing APIC as a leader in this issue, the National Office has organized a Consensus Conference entitled, "Healthcare-Associated Infections: Realizing the Benefits of Mandatory Public Reporting," to be held February 7-8, 2005, in Atlanta, GA. This Conference, cosponsored by SHEA, AHA, CDC, Consumers Union, and the National Quality Forum, will bring together all stakeholders including legislators and third party payers to address this issue. The goal is to standardize methodologies, language and definitions so that meaningful data can be produced and trends can be compared nationwide.

With so many roles to play on an average day, the job of an infection control professional can be overwhelming. To help, APIC continues to mobilize teams to define our gaps and institute best practices. During the past few months, we have restructured the Practice Guidance Program Team to increase capacity by delegating specialized aspects of practice guidance to at least a dozen Co-Chairs. This will help us be more responsive to the increasing demands for infection control expertise in the various healthcare sectors and be an effective leader in the development of a national infection control guideline.

On the international level, APIC supports the work of the International Federation of Infection Control (IFIC), led by Patricia Lynch. I had the honor of attending this Conference with 600 attendees in Croatia in October. I was impressed with the papers that were accepted for posters and oral presentation, topics of which were aligned with work APIC is undertaking. The conference included workshops that involved addressing a given problem by breaking into sections of the world to describe practice solutions. APIC, several Chapters, and individuals gave money to use for scholarships for IFIC attendees who had prepared a poster about their work, but would not have been able to attend without financial assistance.

I’ve only touched upon a few of the many exciting initiatives and developments that have occurred over this past year. I want to thank you all for supporting me this year as your President; especially the Board of Directors, Program Chairs, and Task Force Leaders who have guided me along the way. I also want to welcome Sue Sebazco as she assumes her Presidency in 2005. Sue has been very involved in planning with us and I am confident that the transition will be seamless. She is prepared to face expanding infection control demands in the healthcare challenges of our nation and will lead APIC with a strategic vision and her own clinical and programmatic expertise.

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President Signs Omnibus Appropriations Bill with
Fit-Testing Prohibition

By Jennifer Thomas Barrows
Director of Public Relations & Governmental Affairs, APIC

On Wednesday, December 8, 2004, President Bush signed into law the Fiscal Year 2005 omnibus spending bill, including the APIC-supported Wicker provision prohibiting OSHA from enforcing the annual fit-testing mandate for occupational exposure to tuberculosis (TB) in healthcare facilities for FY 2005 (through September 30, 2005).

The bill also included Wicker-sponsored report language (non-binding, but expressing the "Sense of the Congress") advising OSHA to take no further action with regard to respiratory protection for occupational exposure to TB until such time as the CDC has completed the ongoing revisions of its TB guidelines.

Again, this provision will apply only to fiscal year 2005, but will hopefully provide an important window of time during which we can continue to work with our public health and healthcare partners to ensure effective strategies for addressing healthcare worker protection. Toward this end, CDC hosted a meeting November 30-December 1, 2004, to address respiratory protection for preventing transmission of airborne infectious agents, where many participants concurred that there are not enough data to support annual fit-testing. We hope to convince OSHA that it should reconsider the annual fit-testing requirement.

According to Congressman Wicker, the sponsor of this legislation, any action OSHA may take during fiscal year 2005 (until Sept 30, 2005) to enforce the annual fit-testing mandate as it applies to occupational exposure to TB in healthcare facilities would be against the law and, therefore, it is not necessary for you to continue with annual fit-testing for TB through the remainder of this fiscal year.

APIC has been working closely with Congressman Wicker since 1997 on the OSHA/TB issue. With his help, we were able to secure funding for an Institute of Medicine (IOM) study of the proposed TB rule back in 1999, and his work has continued with these most recent actions to urge OSHA to reconsider applying the General Industry Respiratory Protection Standard (GIRPS) to TB in healthcare facilities. We thank Congressman Wicker for his steadfast support in ensuring that regulations are science-based. We also thank Julie Rish McCord, APIC Public Policy Team member, who is Congressman Wicker&srquo;s constituent and has been instrumental in helping us to gain his support over many years.

APIC also has collaborated with many other healthcare organizations that share our concern about the requirement for annual fit-testing, including the American Health Care Association, American Thoracic Society, National Association for Home Care and Hospice, American College of Chest Physicians, College of American Pathologists, American Society of Clinical Pathology, National Rural Health Association, SHEA, Infectious Disease Society of America, and the American Hospital Association (AHA). In particular we note that AHA has played a key role in the overall efforts to urge OSHA to reconsider the GIRPS and we appreciate partnering with them in numerous activities.. Collaboration is key to success and without the efforts of these groups, our message would not have been as strong.

Last, but by no means least, we thank those APIC members who rallied to help us in these efforts. Without your letters and phone calls to Members of Congress, we would not have secured the necessary support to carry this bill through to passage. We cannot thank you enough and we hope that you understand that your involvement was critical to this outcome.

Our work is not over, however. During the remainder of this fiscal year (through September 30, 2005), we will be making every effort to urge OSHA to reconsider this mandate. We will likely be calling upon our members to assist us again in future grassroots efforts and we thank you in advance for your ongoing support.

APIC wholeheartedly supports scientifically-proven methods for protecting workers and will continue to advocate for measures that are both necessary and effective. Please contact Jennifer Thomas Barrows, jthomas@apic.org Director of Government and Public Affairs, APIC, if you have any questions.

CMS to Allow Handrub Dispensers in Hospital Corridors

Hospitals striving to increase handwashing compliance among their healthcare workers will soon receive good news from the Centers for Medicare and Medicaid Services (CMS). A CMS regulation prohibiting the placement of alcohol-based hand sanitizers in exit corridors is due to be lifted, according to a letter to APIC from CMS.

"You have requested that CMS take action to ensure that alcohol-based hand rubs can be conveniently accessed in healthcare facilities," the CMS letter stated. "We agree that alcohol-based hand rubs are a useful and effective infection control tool, and that convenient access to alcohol-based hand rubs is an important factor in encouraging their use."

The letter further explained that CMS officials have prepared an interim final rule with comment period to address this issue. The rule is now under review during the next 90 days by the Office of Management and Budget (OMB), and according to CMS, should be published sometime in March in the Federal Register, likely with an official effective date 60 days thereafter. The letter goes on to mention, however, that until the revised regulation is published, the current regulation does remain in effect.

In a September 22, 2004, letter to CMS, APIC had urged the agency to revoke its policy, in light of recent studies proving that alcohol-based hand products (formerly considered to be a fire hazard) could indeed safely be installed in exit corridors.

"As an organization of professionals dedicated to preventing and controlling healthcare-associated infections, we consider these wall-mounted dispensers absolutely critical for assuring improved access and compliance with recommended hand hygiene practices," the APIC letter stated.

In October 2002, the Centers for Disease Control and Prevention (CDC) issued recommendations stating that alcohol-based hand rubs may be a better option than traditional handwashing with plain soap and water. However, the outdated CMS policy made ensuring optimal access to these products a particular challenge.

"We are hopeful that CMS will choose to play an active and collaborative role in markedly improving healthcare by updating this policy to assure consistency with recommendations from CDC. Failure to take immediate action may significantly jeopardize patient safety in hospitals nationwide," the APIC letter continued.

The news from CMS comes at a pivotal time - when facilities are gearing up their efforts toward flu prevention. "This is an important step in the right direction and at the right time when every opportunity to make hand hygiene easier matters," said APIC member Judene Bartley, MS, MPH, CIC, who played a key role in the overall effort to demonstrate the safety of these products and to change federal policy to ensure their ready access.

Bartley also serves as liaison to the American Society for Healthcare Engineering, which commissioned the study that provided the necessary data to support the Life Safety Code changes, and subsequently worked to modify the code. "We are thrilled that CMS understands the critical nature of this issue and that the agency is moving forward to change this policy based on solid data," said Bartley. She noted that the efforts of many brought this about, beginning with the AHA- and CDC-sponsored stakeholders meeting in July of 2003 that brought clinicians and fire safety professionals together to determine how they could effect this important change.

In the meantime, infection control professionals should continue to contact their local jurisdiction if their facility is cited for having dispensers in corridors. States vary in their approach, but CMS has been recommending that if facilities are cited for this deficiency, they should request a "temporary waiver" from enforcement action in their plan of correction.

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Research Foundation President's Report

By Criag Gilliam, BSMT, MT (ASCP), CIC

We must become the change we want to see.
--Mahatma Gandhi

In the past year, we have seen changes in APIC Research Foundation and especially in the fields of infection control and healthcare epidemiology.

The Foundation has noted almost double the amount of individual financial contributions and will also benefit from corporate pledges and donations made by Beckton-Dickinson, Cardinal Health, Kimberly-Clark, Infectious Awareables, and CR Bard. The CR Bard contribution elevates them to the 'Diamond' level and provides for a Trustee position on the Foundation Board. This contribution is representative of CR Bard's commitment to investigation and dissemination of research in the area of preventing device-associated urinary tract infections. CR Bard's financial support of the Foundation is essential for us to meet our goals as a resource of infection prevention information and as an advocate for the importance of infection control research.

In the area of research, a report on the 'Economic Impact of Nosocomial Infections' supported by a grant from the Foundation will be presented in 2005. The Foundation continues to review and finalize plans for a surveillance project utilizing infection control professionals to determine MRSA prevalence in the United States.

This year all of us working in infection control and healthcare epidemiology programs became aware of states passing legislation requiring the public reporting of healthcare infection rates. For many programs to meet this goal, we must consistently collect and report data to make meaningful comparisons. We know from literature that device-associated infections in critical care units are a measurable outcome and that is currently part of this legislative agenda in public reporting. At our November meeting, the Foundation began the process of addressing this research need.

For the APIC Foundation to be successful, we must be open to opportunities for research in areas of infection control and healthcare epidemiology and be able to show how research can improve the outcomes in our healthcare settings.

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CBIC Exploring Feasibility of Advanced Certification Exam

By Darnell Dingle, RN, MPH, CIC
2004 CBIC President

Another successful year for certification in infection control and epidemiology has been completed, and I wanted to touch upon several accomplishments that have occurred during the past 12 months.

In 2003, CBIC?s Board of Directors voted to add a Governmental Affairs Committee to the organization. This committee, although relatively new for CBIC, has already been successful in keeping the Board of Directors up-to-date on the current legislative and regulatory issues affecting certification and enhancing communication between APIC and CBIC regarding appropriate responses to these issues.

On August 2, CBIC?s Testing Agency, Applied Measurement Professionals (AMP), announced the availability of international computer-based testing in Auckland and Christchurch, New Zealand; Berlin, Germany; Dhahran, Saudi Arabia; Guam; Juarez, Mexico; Pretoria, South Africa; and Tokyo, Japan. Earlier in the year, seven sites were announced in Canada stretching from Halifax, Nova Scotia to Calgary. More sites in Canada and around the world are being researched and will be publicized as they become available. In response to the newly expanding market, CBIC has added an ad hoc taskforce to develop an implementation plan for international expansion and communication.

The CBIC Board of Directors thoroughly investigated and reviewed the issue of adapting (translating) the certification exam into one or more foreign languages based upon the request from the Community and Hospital Infection Control Association-Canada (CHICA). The process of adapting an examination has many ramifications both in utilizing financial resources as well as volunteer resources. Unfortunately, the return on investment for adapting the exams both initially and for every revision along with all the accompanying materials that would need to be translated and published were considered to be too costly for CBIC to undertake at this time.

At the request of the APIC Board of Directors, CBIC has been investigating the possibility of an advanced certification exam for those who have successfully passed the initial entry-level exam. CBIC?s work continues on this subject through both the Test Committee?s recent meeting and direction from AMP. Recommendations from the Test Committee on this opportunity are slated for full Board discussion at the next Board meeting.

Quarterly deadlines were eliminated, effective January 2004, and as expected, there has been a small drop in the number of individuals who have certified. If your certification expired on December 31, 2004, you will have to apply as a new certificant and sit for the Computer Based Test (CBT). The application process including payment by credit card and setting a date for taking the exam can be accomplished online (www.goAMP.com.) In today?s ever-evolving world of infection control requirements, becoming certified and maintaining your certification is more important than ever. The newly published 2005 Joint Commission for Accreditation of Healthcare Organizations has included certification by CBIC as one method?and the simplest-of showing that the facility?s infection control programs are managed by individuals with the appropriate education and experience.

Alaska
Washington
Oregon
California
Arizona
Nevada
Idaho
Montana
Utah
New Mexico
Colorado
Wyoming
North Dakota
South Dakota
Nebraska
Kansas
Oklahoma
Minnesota
Iowa
Missouri
Arkansas
Louisiana
Texas
Mississippi
Alabama
Tennessee

10
62
35
304
57
21
19
9
17
22
51
5
14
17
36
37
49
68
45
101
26
65
221
31
65
83

Kentucky
Indiana
Illinois
Wisconsin
Michigan
Ohio
West Virginia
Florida
Georgia
South Carolina
North Carolina
Virginia
Maryland
Delaware
New Jersey
New York
Vermont
Connecticut
Rhode Island
New Hampshire
Maine
Pennsylvania
Massachusetts
Hawaii
Washington DC

63
78
149
78
142
150
29
210
122
54
111
86
98
18
151
308
13
56
19
25
19
208
122
12
1

Please note in the sidebar the number of certified individuals per state. If you haven?t taken the certification exam, go to www.cbic.org and download the Candidate Handbook. Register online, arrange the date, time, and location that are most convenient for you, sit for the test, and learn your score at the end of the exam. What could be easier? If 2005 is your year for recertification, it is not too soon to begin thinking about the SARE as a recertification tool. Again, information about the SARE is available on the CBIC website.

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Find a Mentor and You Will Find Motivation and Support

By Vickie Moore, BS, CLS, MA, CIC
Infection Control Coordinator, Overton Brooks VA Medical Center, Shreveport, LA

"Why reinvent the wheel?" is the expression that came to mind when I decided to submit an abstract to the APIC Annual Conference. So instead of the "trial and error" method, I decided to go with the "ask someone who knows" method. As a member of APIC’s Ark-La-Tex Chapter 37, I had met Kathy Brooks, RN, PhD, CIC, Chief of Performance Improvement at Overton Brooks VAMC and member of the APIC Board of Directors. Since Kathy has published at least one abstract, article, or book every year since 1996, I contacted her and asked for advice about writing and submitting an abstract. Fortunately for me, I not only got some expert advice, but a wonderful mentor.

Merriam-Webster defines mentor as a trusted counselor or guide. Kathy, has mentored at least 10 practitioners during her 19 year career in infection control as well as others thru her volunteer activities with the American Red Cross, HIV outreach, Childcare Centers, and Louisiana Office of Public Health.

Having worked with Kathy on several Chapter projects, I came to appreciate her skill in team development. However, it was not until I volunteered for APIC’s National Education Task Force that I began to understand that Kathy’s approach to success includes the motivation of others to help create the product she envisions. For those of you who use APIC’s Ready Reference to Microbes in your practice, imagine coordinating the work of 43 contributing authors, then editing their work to produce that helpful little book. That is the type of talent and commitment Kathy fosters in others. When talking with Kathy about mentoring, she says that mentoring is a way to continue to help others and that she enjoys watching her peers grow and learn. Let me share with you the advice she frequently gives me: "Don’t ever be afraid to ask a question."

The infection control professionals I know are all willing to offer a word of advice when asked; or are happy to just listen as you talk yourself around to a good answer. So, my advice to you is, "Don’t be afraid to ask a question, especially if you are asking someone to mentor you!"

CBIC is proud to announce the new CBIC Board appointees for 2005. They are Jacqueline Butler, Virginia Beach, VA, Angella Goetz, Pittsburg, PA, Deanie Lancaster, Nashville, TN, Pam Vaccaro, Hammond, LA, and Matthew Wallace, Baltimore, MD. We look forward to their participation on the CBIC Board.

We will also miss those members whose terms ended December 2004, and we thank Kathy Roye-Horn, Jeanette Daniel, Barbara Cochrane, and Barbara Goldrick for their outstanding contributions. Best wishes and many thanks are extended to them for their service in promoting certification in infection control.

As this is my last message as the 2004 CBIC President, I want to take this opportunity to say how much I have enjoyed this experience and to wish each of you a happy and healthy 2005.

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