Poster Abstracts / American Journal of Infection Control 42 (2014) S29-S166S90

and maintaining temperatures, and deficiencies in maintenance ofequipment.PROJECT: The CMS survey Results stressed the importance oftraining staff to prevent foodborne illnesses. Infection Preventionrounded with management daily in order to help identify areas ofimprovement, and offer guidance to management in an effort tobetter protect our patients, visitors, and staff from behaviors thatcould result in foodborne illnesses. They became certified foodmanagers, assisted in the development of an audit tool, ensuredproper maintenance of equipment, and providing “just in time”training on the federal and state food code.RESULTS: Critical food code violations were identified during thedaily rounds. These findings prompted immediate process changesand staff education with ongoing monitoring and feedback toensure retention and implementation of knowledge. Other in-terventions included more effective labeling, maintaining propertime and temperature controls, developing a pest control plan, andenhanced cleaning and sanitizing in nutrition services.LESSON LEARNED: Regular infection prevention rounding ofNutrition Services Departmentwill continue to ensure that the foodproducts provided to our patients, visitors, and staff is safe toconsume. By increasing the rounding and providing immediateintervention, with routine checks, the systematic approach to foodpreparation, service, and storage has improved, which creates asafer facility for patients and employees alike.

Publication Number 7-218

Impact of a Practical Training Programfor Hospital Cleaning Staff onPrevention of Hospital AcquiredInfection.

Adriana Felix, Nursing Researcher- Infection Control andPrevention, Hospital do Coração- HCor; Karoline Mello Gama RN,Nurse, Infection Control Department, HCor; Maria Clara PadovezePhD, MsC, RN, Professor, School of Nursing at University of SãoPaulo; Evandro Penteado Villar Felix MD, Quality Manager, HCor

ISSUE: It is well known that healthcare professionals as well ascleaning staff have important role in the pathogens dissemination;therefore education of cleaning staff is highly relevant in the pre-vention of nosocomial infections. The aim of this study was toassess the degree of knowledge regarding infection preventionamong cleaning staff in a hospital in São Paulo, Brazil, before andafter a training program.PROJECT: This study was performed between July 2013 andOctober 2013, and included all the cleaning staff of the hospital. Weused a questionnaire with 20 questions that was filled in during aninterview with each cleaning staff before and after training pro-gram. As for the degree of knowledge it was considered as thepercent of correct answers. After this procedure, cleaning staff wastrained regarding importance of nosocomial infections, cleaningand disinfection principles, hand hygiene and isolation precautions.As for statistical analysis, we used the Student t test. A P value ofless than .05 was considered statistically significant.RESULTS: Sixty-three cleaning staff (51 women and 12 men) aged21-56 years (mean age+- SD, 37,8 +- 8,19 years) participated in thestudy. The degree of knowledge before training programwas 68,6%and three months after the training program the degree ofknowledge was 91,3% (P¼ 0.0001).LESSON LEARNED: In our hospital, cleaning staff are responsiblefor cleaning, environmental surfaces and waste collection and

APIC 41st Annual Educational Conference & Interna

management; so they are expected to be familiar with measures toprevent infections. Our Results revealed that education increasedthe knowledge of the cleaning staff regarding this Issue, which willcontribute to the improvement in the infection prevention pro-gram.

Healthcare Worker Safety/Occupational Health

Publication Number 8-219

Improved Employee InfluenzaVaccination Rates After Standardizationof Two Healthcare Systems’ InfluenzaPolicies

Brenda B. Ehlert MT (ASCP), MBA, CIC, Infection PreventionCoordinator, Affinity Health System; Terri Dums RN, MSN, CIC,Infection Prevention and Control Manager, St. Joseph’s Hospital

ISSUE: Influenza is a serious disease that can result in hospitali-zation and even death. The Centers for Disease Control and Pre-vention recommends an annual influenza vaccination forhealthcare workers. Historically health system A and health systemB had less than optimal rates of vaccination against influenza. A’semployee influenza vaccination rate was 65% for the 2011/2012influenza season and B’s rate was 71%, significantly below the 100%rate recommended.PROJECT: In early 2012, A and B merged into a single systemcomposed of 15 hospitals, both small and large, and clinics, all inWisconsin. The goal to standardize and improve the influenzavaccination requirements for more than 10,000 employees startedwith the development of the Influenza Vaccine Initiative. Initiativemembers came from both systems and included a physicianchampion, human resources members, infection preventionists,and marketing. Teleconference meetings began in May 2012,occurring weekly or bi-monthly. The collaborative drafted a morerestrictive, standardized policy, requiring employees to vaccinate ormask when within 6 feet of others.RESULTS: Employee influenza vaccination rates increased. Legacyhealth system A reported a vaccination rate of 92%, while legacyhealth system B obtained a rate of 96%.LESSON LEARNED: Some required practices, such as masking fornon-vaccination and button wearing designating vaccination

tional Meeting j Anaheim, CA j June 7-9, 2014

Poster Abstracts / American Journal of Infection Control 42 (2014) S29-S166 S91

compliance were difficult to monitor and so ineffective. In addition,masks were often used inappropriately. Intranet use for employeecommunications about the new requirements was fast and simple.We learned a focused, multidisciplinary group-developed processfor increasing employee vaccination rates a larger system iseffective.Expanding the requirements to students and licensed independentpractitioners would be an improvement opportunity.

Publication Number 8-220

Using LEAN Methodology to Fix aBroken Process: Meningitis Post-exposure Prophylaxis

Angela Vassallo MPH, MS, Director, Infection Prevention, SaintJohn’s Health Center; Lindsay Barker MPH, Director, EmergencyPreparedness, Saint John’s Health Center; Dawna Hendel MSN,CNO, Saint John’s Health Center; Maura Winesburg MT, Director,Risk Management, Saint John’s Health Center; Vicky Peraino,Manager, MIcrobiology, Saint John’s Health Center; Pema Dolkar,Lean SIx Sigma, Saint John’s Health Center; Tanya ElgourtPharmD, Clinical Coordinator, Pharmacy, Saint John’s HealthCenter; Sanjeev Seth MD, Doctor, Emergency Medicine, SaintJohn’s Health Center; Russ Kino MD, Medical Director, EmergencyMedicine, Saint John’s Health Center

ISSUE: In 2012, Saint John’s Health Center experienced several truemeningococcal meningitis staff exposures. In particular, staff whoprovided critical treatment and care in the ED and ICU wererepeatedly exposed to meningococcal droplets.PROJECT: A multi-disciplinary team set out to improve the hos-pital’s ability to respond to staff meningitis exposures. The firststep was to determine the root of the problem. The team deter-mined that there was no clear understanding of a true exposureto meningitis by hospital staff, as well as no clear understandingof who does and does not need post-exposure prophylaxis (PEP).A critical exposure algorithm was created to determine whoactually merits PEP if exposed to bacterial meningitis patients. Ahousewide exposure protocol was created for use in futureoutbreaks.RESULTS: All staff were educated to use the critical exposurealgorithm and the exposure protocol in any outbreak situation.Everbridge and Command Aware automated messaging systemswere initiated to provide email, text, and voice message alertswhen potential exposures or outbreaks occur. Exposure educa-tion and messaging was shared with all staff: “A meningitis

APIC 41st Annual Educational Conference & Interna

exposure is defined as anyone without a surgical mask who:performed or assisted with endotracheal intubation, performeddeep suctioning, performed unprotected mouth-toemouthresuscitation, or spent 4 hours with the patient in a closedroom.”LESSON LEARNED: A Los Angeles County mock emergency drillwas performed at Saint John’s Health Center on September 13,2012 - a few months after the LEAN Project was initiated. Duringthis drill, it was determined that the hospital’s response to mockmeningitis patients was efficient, well organized and staff werevery educated about exposures. This exposure process has sincebeen implemented for other events and no major exposures haveoccurred since implementation.

Publication Number 8-221

The Evolution of HIV Post-exposureProphylaxis (PEP): One Large AcademicMedical Center’s Experience

Alexandra Derevnuk FNP-C, MEd, Infection Control & Blood &Body Fluid Exposure Coordinator, Mount Sinai Medical Center;Lori Finkelstein-Blond MA, RN, CIC, Director, QualityManagement & Performance Improvement, The Mount SinaiHospital; Michell Reyes BS, MT, CIC, Infection Preventionist,Mount Sinai Hospital; Marybeth Attanasio BS, ManagementEngineer, The Mount Sinai Hospital; Frances Wallach MD, DirectorInfection Control and Hospital Epidemiologist, Mount SinaiHospital

BACKGROUND/OBJECTIVES: To compare tolerability of 4 HIV PEPregimens used for occupational blood and body fluid exposures(BBFE) and impact of source patient viral load (VL) on PEP dura-tion. With the goal of improving PEP completion following highrisk BBFE, Mount Sinai Hospital (MSH) updates standard PEPregimens reflecting changes in HIV treatment guidelines. Since2010, source patient HIV VL was incorporated into a follow-up riskassessment, with non-detectable VL suggesting low risk of HIVtransmission.METHODS: Retrospective analysis of BBFE at Mount Sinai Hos-pital (MSH) for which PEP was prescribed during 4 time periodswas done: 2004 (AZT/3TC/nelfinavir), 2008-09 (FTC/tenofovir/lopinavir/ritonavir), 2010-12 (FTC/tenofovir/atazanavir/ritona-

tional Meeting j Anaheim, CA j June 7-9, 2014