Pharmacy, Microbiology & Environmental Services: Engaging Critical Partners

Ruth Carrico PhD RN FSHEA CICAssociate Professor

Division of Infectious DiseasesUniversity of Louisville

Ruth.carrico@louisville.edu

Objectives

• Review aspects of critical partnerships in addressing the challenges of infection prevention

• Identify methods to engage those partners and capitalize on individual and combined strengths

Current Realities in Infection Prevention

Emerging Infection

Rapid Detection of organisms

Impact on the

Environment

Response to

Pathogens

Staff Training and

Education

Interdependence

Preventing Infection

Interdependence

Preventing Infection

Pathogen Detection

Interdependence

Preventing Infection

Pathogen Detection

Pathogen Treatment

Interdependence

Preventing Infection

Pathogen Detection

Pathogen Eradication

Pathogen Treatment

Interdependence

Preventing Infection

Pathogen Detection

Pathogen Eradication

Pathogen Treatment

Rapid detectionRapid communication

ReportingFeedback

Interdependence

Preventing Infection

Pathogen Detection

Pathogen Eradication

Pathogen Treatment

Drug selectionDrug use

InvestigationFeedback

Rapid detectionRapid communication

ReportingFeedback

Interdependence

Preventing Infection

Pathogen Detection

Pathogen Eradication

Pathogen Treatment

Drug selectionDrug use

InvestigationFeedback

Rapid detectionRapid communication

ReportingFeedback

Product UseStaff performance

Process efficacyLocal engagement

Feedback

Current Urgent Issue

• CRE– Emerging pathogen– Detection challenging– Treatment options are limited– Persistent in the environment– Rapid isolation necessary– Communication internally and externally– Staff performance critical

Collaborative Efforts

• Recognizing the interdependence• Shared responsibilities• Shared mission and vision• Mutual respect• Communication• Support

Infection Control Committee

• Action or reporting function• Premise should be “no free lunch”• Every member or attendee has a specific purpose• Provide information and develop interventions• Evaluate effectiveness• Determine course adjustments• Enable the facility to be nimble in responses• Feedback methods

How does your facility integrate infection control reporting of activities?

A. We have a specific infection control committee

B. Infection control included in the performance improvement committee

C. Infection control included in the patient safety committee

D. Do not knowE. Other process used

How does your facility committee function?

A. It is only a place for reporting

B. It is only a place for developing action plans

C. If is a combination of reporting and action

D. Do not know

E. Other

How is microbiology information shared ?

A. In the committee

B. Not part of the committee process

C. Do not know

D. Other process used

How is pharmacy information shared ?

A. In the committee

B. Not part of the committee process

C. Do not know

D. Other process used

How is environmental services information shared ?

A. In the committee

B. Not part of the committee process

C. Do not know

D. Other process used

Pharmacy Reports

• Antimicrobial utilization outside of guidelines– Dose, duration, timing

• Variation in antimicrobial use– Outside formulary, new additions, non-traditional

use• Pharmacy and Therapeutics Committee updates– Formulary updates/revisions– Discussion of new agents

• Performance improvement initiatives

• Antimicrobial utilization outside of guidelines– Dose, duration, timing

• Variation in antimicrobial use– Outside formulary, new additions, non-traditional

use• Pharmacy and Therapeutics Committee updates– Formulary updates/revisions– Discussion of new agents

• Performance improvement initiatives

Microbiology Reports

• Organisms of interest• Emerging pathogens• Antibiograms• Report adjustments (e.g., susceptibilities)• New/alterations in testing methods• Performance improvement initiatives

• Organisms of interest• Emerging pathogens• Antibiograms• Report adjustments (e.g., susceptibilities)• New/alterations in testing methods• Performance improvement initiatives

Environmental Reports

• Current environmental hygiene approaches• Current disinfectants used• Products under evaluation• Employee health issues• Environmental situations (e.g., construction,

water damage)• Performance improvement initiatives

• Current environmental hygiene approaches• Current disinfectants used• Products under evaluation• Employee health issues• Environmental situations (e.g., construction,

water damage)• Performance improvement initiatives

Active Engagement

Case Scenario64 year old female, identified with CRE in her urine. Patient is symptomatic with elevated temperature and CRE was identified in a urine culture.

How can we expect that pharmacy, microbiology, and environmental services will be working together with infection prevention and control on this issue?

Active Engagement

Carbapenem-resistant Enterobacteriaceae (CRE)– Pharmacy• Current treatment options• Obtaining medication• Ensuring appropriate use of the selected agents• Intervening when treatment outside guidelines• Feedback of results of appropriate use and

interventions• Identification of treatment failures

Active Engagement

Carbapenem-resistant Enterobacteriaceae (CRE)– Pharmacy– Why is this important to infection control?• Additional way to identify cases• Overall adherence with infection prevention activities• Opportunity to heighten impact of infection prevention• Identification of educational needs

– New drug, new methods for administration?– What will administering staff need to know?– Who else needs to be involved (e.g., IV therapy team?)

Active Engagement

Carbapenem-resistant Enterobacteriaceae (CRE)– Microbiology• Current detection methods• New methods or improvements• Ensuring appropriate sample collection• Feedback of results • Feedback of results and how collection methods

impacted results• Identification of trends

Active Engagement

Carbapenem-resistant Enterobacteriaceae (CRE)– Microbiology– Why is this important to infection control?

• Additional way to identify cases• Overall adherence with infection prevention activities• Opportunity to heighten impact of infection prevention• Identification of educational needs

– Specimen collection– Recognition of the abnormal– Responding to the abnormal– Reflexive implementation of control and containment methods

Active Engagement

Carbapenem-resistant Enterobacteriaceae (CRE)– Environmental Services• Current cleaning and disinfection methods• Current disinfectants used• Changing methods or agents• Staff performance• Feedback of results • Identification of trends

Active Engagement

Carbapenem-resistant Enterobacteriaceae (CRE)– Environmental Services– Why is this important to infection control?

• Staff performance• Who else assists with environmental hygiene• Overall adherence with infection prevention activities• Opportunity to heighten impact of infection prevention• Identification of educational needs

– Cleaning and disinfection processes– Who else can help– Barriers to environmental hygiene– Understanding the impact of current pathogens– Transmission issues– Patient and family involvement

Objectives

• Review aspects of critical partnerships in addressing the challenges of infection prevention

• Identify methods to engage those partners and capitalize on individual and combined strengths