Infection Control Today

DEC 2018

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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14 ICT December 2018 www.infectioncontroltoday.com She continues, "Proponents of automated surveillance technology cite standardization of IP workfow and consistent and accurate case fnding as a solution to potentially biased manual processes. A recent qualitative analysis of the evolving role of IPs concluded that data standardization would lessen the tension that IPs experience due to expanding responsibilities that outstrip resources. The authors noted that streamlining surveillance would aid IPs in achieving a better balance with competing priorities. An equally important advantage to automated surveillance is the capture of discrete data elements from the electronic medical record that prevents the reliability problems inherent in traditional surveillance based on human interpretation." Many practitioners still engage in "shoe leather epide- miology," and even in the age of automation, Borlaug observes, "IPs must remain skilled and knowledgeable 'detectives,' that is, they must walk the foors, see with their own eyes how patients are cared for, observe the environment of care, and evaluate infection prevention practices on an ongoing basis." Hebden (2015) alludes to the tension that exists between old-school epidemiology and the use of ESS for IPs that are caught in the middle: "Although IPs are familiar with the tasks associated with traditional manual surveillance—reviewing microbiology reports and using the electronic medical record to obtain additional information for decision making—many are unfamiliar with the tasks of data retrieval and management inherent to automated systems and must adapt their workfow to a different way of doing things. In a recent report examining IPs' awareness of and engagement in health information exchange to improve public health surveillance, <20 percent of respondents with access to an electronic health record reported being involved in the design, selection, or implementation of the system. The authors concluded that these fndings may limit an IP's ability to infuence or utilize key information technologies to facilitate transition to paperless surveillance processes. Further, an essential but unfamiliar task when using an automated system is the need for data validation that must be performed at start-up and whenever upgrades or changes are made to the foundational databases. Validation is necessary to ensure that the received data are complete and accurate and establish trust in the system. Most programs in use currently by IPs are semiautomated surveillance systems that deliver user alerts based on large inputs of data and require additional tasks for HAI classifcation. When multiple IPs are using the system, it is imperative that the surveillance process be standardized to ensure that each user can easily identify which tasks need to be completed to avoid duplication of work." Automated HAI and infectious disease surveillance does not take the place of 'shoe leather' epidemiology, but rather can help reduce the time and effort needed to conduct routine surveillance, allowing more time for the IP to investigate, observe, and interact with facility staff and colleagues, thus enhancing HAI prevention efforts and outbreak detection capacity," says Borlaug. To that end, IPs should possess certain skills relating to surveillance for infection that don't change, regardless of paper or digital facilitation. "IPs should have a basic knowledge of microbiology, infectious disease epidemiology, and the infectious disease process," Borlaug advises. "They must also be able to conduct systematic and reliable HAI data collection and be able to summarize, analyze, interpret, validate, and present HAI surveillance data to their colleagues in meaningful ways. And whether HAI surveillance is conducted manually or electronically, the IP must have a thorough knowledge and understanding of HAI surveillance defnitions, because by either method, the IP ultimately has the last word in determining whether an HAI is present." Hebden (2015) notes, "As described in the Association for Professionals in Infection Control and Epidemiology competency model, professional and practice standards assume that IPs will have access to information technology hardware and some degree of experience in the use of software applications. However, it is recognized that the IPs performing surveillance will have varying degrees of competency and it is profcient IPs who can integrate both manual and electronic fndings for comprehensive reporting and expert IPs who can apply principles of information management to emerging technology. Before implementing the system, the experience and skill set of each IP should be assessed because one or more members of the team may be at the profcient or above competency level and could be identifed as 'superusers' to assist the other team members with the workfow transition. The team also needs to discuss who has the authority to make decisions regarding system design and confguration; for example, modifcations to the data feeds, revision of user alerts, and report development." Despite competing priorities, cost-cutting and other challenges faced by front-line clinicians and IPs, surveillance remains the key intervention relating to the identifcation, management and prevention of outbreaks. "In many ways, modern technology such as molecular laboratory diagnostic methods that provide rapid, nonculture-dependent results have greatly enhanced early detection and prompt response to outbreaks and incidents of infectious disease transmission in healthcare facilities," says Borlaug. "I think one of the main barriers to effective outbreak response, however, is that many IPs do not possess the tools and resources available to conduct a systematic, methodical investigation of outbreaks and incidents of infectious disease transmission in their facilities. To bridge that gap, I recommend a review of the Centers for Disease Control and Prevention web-based course, "Investigating an Outbreak," [https:// www.cdc.gov/ophss/csels/dsepd/ss1978/lesson6/ section2.html] which describes a step-by-step outbreak investigation process and provides tools IPs should have available to maintain outbreak response readiness." Borlaug shares her personal experiences with surveillance as she matured in her work as an IP. "In refecting on my early years as an infection control practitioner, as we were called back then, I realize my initial approach to HAI surveillance was to conduct it as a soloist, without discerning the important roles of the laboratorians, pharmacists, physicians, nurses, IT staff, and other colleagues in the facility," she says. "Of course, Ò IPs must remain skilled and knowledgeable 'detectives,' that is, they must walk the foors, see with their own eyes how patients are cared for, observe the environment of care, and evaluate infection prevention practices on an ongoing basis.

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