APIC
Chicago is a local Chapter of the Association for Professionals in Infection Control
and Epidemiology, Inc. (APIC). APIC is a multi-disciplinary voluntary international
organization with over 10,000 members. The purpose of the organization is to influence,
support and improve the quality of healthcare through the practice and management
of infection control and the application of epidemiology in all healthcare settings.
APIC Chicago has approximately 200 members. Educational meetings
are held at least four times per year with an all day conference held in the fall.
The annual business meeting is held the first Wednesday in December. Visit the
meetings tab to find out more about local, regional and national educational meetings. If
you would like to learn more about the organization, contact any member of the
APIC Chicago Board of Directors or visit the membership section tab. What's
New!
Save The Date!
September 11th
6:30-8PM MRSA
in Healthcare Worker with speaker Dr. Weber
Elmhurst Memorial Hospital
200 Berteau Avenue
Elmhurst
Click
here to read more | September
2008
IL Reporting per NHSN: CLABSI Training (Webcast)
Memo and Schedule
Read
more here.... August 2008
APIC
Issues Infection Prevention Tips For Flood Clean-Up 8
August 2008 On July 31, 2008, the Centers for Medicare and
Medicaid Services (CMS) released the final rule on the fiscal year 2009 Inpatient
Prospective System (IPPS). The rule is expected to be published in the Federal
Register on August 19th. As a result, we wanted to ensure that
APIC Members have information on the agency's decisions related to hospital-acquired
conditions (HACs). As you may know, APIC submitted comments to CMS when the rule
was proposed and those comments may be found here. We
hope this information is helpful. Sincerely, APIC
Government Relations Department
CMS Issues Final IPPS
Rule for Fiscal Year 2009
CMS has added three of the nine
proposed HACs to the existing eight for which the agency will pay the lower DRG
amount if the complications was acquired at the hospital and the patient has no
other complications or comorbidities. Below are the three conditions being added,
and those not being added, along with direct excerpts from the CMS rule on the
subject. Conditions Being Added: •
Manifestations of Poor Glycemic Control We believe that extreme
manifestations of poor glycemic control are reasonably preventable through the
application of evidence-based guidelines and sound medical practice while in the
hospital setting; specifically, we believe that they are preventable through the
use of routine serum glucose measurement and control which are basic elements
of good hospital care. We are finalizing manifestations of poor glycemic control
as an HAC because we have determined after considering the comments received that
these conditions meet the statutory criteria. • Surgical
Site Infections We are selecting surgical site infections
following certain orthopedic procedures. The category of surgical site infection
following certain orthopedic surgeries (includes selected procedures that are
often elective and that involve the repair, replacement, or fusion of various
joints including the shoulder, elbow, and spine) AND bariatric surgery for obesity.
These procedures will join mediastinitis following coronary artery bypass graft
(CABG), which was selected in the FY 2008 IPPS final rule with comment period,
as surgical site infection HACs. We look forward to working with stakeholders
to identify additional procedures, such as device procedures, in which surgical
site infections can be considered reasonably preventable through the application
of evidence-based guidelines. • Deep Vein Thrombosis (DVT)/Pulmonary
Embolism (PE) We agree with commenters that DVT/PE is reasonably
preventable in specific subpopulations, and we are therefore selecting DVT/PE
following certain orthopedic surgeries, specifically certain hip and knee replacement
surgeries, as HACs.
Conditions Not Being Added: •
Delirium After consideration of the public comments received,
we have decided not to select delirium as an HAC in this final rule. We will continue
to monitor the evidence-based guidelines surrounding prevention of delirium. If
evidence warrants, we may consider proposing delirium as an HAC in the future. •
Ventilator-Associated Pneumonia (VAP) In light of the public
comments that we received, we are not selecting VAP as an HAC. We will work in
partnership with the CDC and closely monitor the evolving literature addressing
the prevention of VAP through the application of evidence-based guidelines. If
evidence warrants, we may consider proposing VAP as an HAC in the future. •
Staphylococcus aureus Septicemia In light of these public comments,
we are not selecting Staphylococcus aureus septicemia as an HAC in this final
rule. If evidence warrants, we may consider proposing Staphylococcus aureus septicemia
as an HAC in the future. We note that several commenters recognized that Staphylococcus
aureus septicemia cases are being addressed through the vascular catheter-associated
infection HAC that was selected in the FY 2008 IPPS final rule with comment period. •
Clostridium difficile-Associated Disease (CDAD) In light of
these public comments, we are not selecting CDAD as an HAC in this final rule.
However, we continue to receive strong support from consumers and purchasers to
include CDAD as an HAC, and we will continue to consult with the CDC regarding
the evidence-based prevention guidelines and coding for CDAD. If evidence warrants,
we may consider proposing CDAD as an HAC in the future. •
Legionnaires' Disease In light of these public comments, we
are not selecting Legionnaires' Disease as an HAC in this final rule. Although
we are not selecting Legionnaires' Disease as an HAC in this final rule, we will
continue to consult with the CDC about the evidence-based prevention guidelines.
If evidence warrants, we may consider Legionnaires' Disease and other water-borne
pathogens suggested by commenters and noted in section II.F.9. of this preamble
(Enhancement and Future Issues) as HACs in the future. •
Iatrogenic Pneumothorax In light of these public comments,
we are not selecting iatrogenic pneumothorax as an HAC in this final rule. Although
we are not selecting iatrogenic pneumothorax as an HAC in this final rule, we
do recognize this as an adverse event that occurs frequently. We will continue
to review the development of evidence-based guidelines for the prevention of iatrogenic
pneumothorax. If evidence warrants, we may consider iatrogenic pneumothorax as
an HAC in the future. • Methicillin-resistant Staphylococcus
aureus (MRSA) Though we did not propose MRSA as a candidate
HAC in the FY 2009 IPPS proposed rule, MRSA can trigger the HAC payment provision.
For every infectious condition selected as an HAC, MRSA could be the etiology
of that infection. For example, if MRSA were the cause of a vascular catheter-associated
infection (one of the eight conditions selected in the FY 2008 IPPS final rule
with comment period), the HAC payment provision would apply to that MRSA infection.
As we noted in the FY 2008 IPPS final rule with comment period (72 FR 47212),
colonization by MRSA is not a reasonably preventable condition according to the
current evidence-based guidelines. Therefore, MRSA does not meet the "reasonably
preventable" statutory criterion for an HAC. For additional
information, please see the links below: Click
here to view the Final Rule
Click
here to view Press Release related to the Final Rule
20
July 08 :: IMPORTANT IDPH REPORTING UPDATE
Re:
REPORTING CLABSI per HOSPITAL REPORT CART ACT From:
GALE ELDER
Sent: Friday, July 18, 2008 10:54 AM
Subject: Hospital Report
Card Act The enclosed memorandum
and attachments contain very important information regarding Public Act 93-563,
the Hospital Report Card Act, and mandated reporting of infection indicators.
The Public Act requires that all general acute care hospitals in Illinois submit
data using methodology based on a scientifically valid national reporting system.
The Department has decided to use the National Health Safety Network (NHSN) of
the Centers for Disease Control (CDC) for reporting of central line bloodstream
infection (CLABSI) in the MICU, SICU or combined ICU's. At this time, the Department
is not requiring reporting from the NICU or PICU. The rationale for using the
NHSN reporting system is outlined in Attachment I to the memorandum.
Please read the memo and attachments and insure they are distributed to the appropriate
hospital personnel. The Department looks forward to working with you and your
organization to continue to provide safe and quality patient care.
If
you have any questions concerning this communication, please do not hesitate to
contact Mary Driscoll, Chief of the IDPH Division of Patient Safety and Quality,
at 312-793-2051 or mary.driscoll@illinois.gov.
Sincerely,
Damon T. Arnold, M.D., M.P.H.
Director Gale Elder
IL Dept. of Public Health
Division of Health Policy
Phone: 217-782-6235
Fax: 217-785-4308
gale.elder@illinois.gov :: CMS-ProposeHospAcqConditions2009 :: CMS-1390-Proposed Changes to
the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009
(Display Date: 04/14/2008; Publication Date: 04/30/2008)
http://www.cms.hhs.gov/AcuteInpatientPPS/
April
15, 2008 :: IMPORTANT MESSAGE FROM NATIONAL
APIC
Dear APIC Member:
A hearing entitled
"Healthcare Associated Infections: A Preventable Epidemic" will be held
on Wednesday, April 16th at 11:00 a.m. Eastern Time before the
U.S. House of Representatives Committee on Government Oversight and Reform.
The committee, chaired by Representative Henry Waxman, will examine the problem
of Healthcare Associated Infections (HAIs) and whether the U.S. Department of
Health and Human Services (HHS) is providing the leadership necessary to combat
this public health threat. Reade More Here: March
14, 2008 :: Amendment to IL Control of Tuberculosis Code
(77 Ill. Adm. Code 696) Illinois Register Citation: 32 Ill. Reg. 4010)
The rules previously required the use of the Mantoux tuberculin skin test (TST)
as the only test approved for screening for LTBI. The amendment allows the use
of a newly developed FDA-approved blood test for the detection of patients with
active TB disease or LTBI. Click
here to read more APIC National Convention
2008: Denver Colorado
Register by April 14, 2008
to save on registration fees!
Conference Dates: June 15 – 19
Pre-conferences:
June 13 – 14
Exhibition Dates: June 15 – 17
Register Online
at www.apic.org
MRSA in Illinois:
Descriptive Analysis of Hospital Discharge Data 2002-2006 "Increasing reports
and growing public concern about MRSA have prompted IDPH to publish the following
study depicting the burden of MRSA infections in Illinois hospitals."
http://www.idph.state.il.us/health/infect/MRSA_Data_02-06.pdf
February 15 :: Chicago Tribune article "Staph infections
rising in Illinois: 'Urban phenomenon' spreading throughout rural hospitals now”
By Judith Graham
www.chicagotribune.com/features/lifestyle/health/chi-mrsa_15feb15,1,1466221.story
:: OSHA Annual TB
fit test requirement: Lisa Tomlinson, APIC Director of Government Affairs, has
confirmed that the requirement for ANNUAL FIT TEST (TB) is enforceable on October
1, 2007 despite much effort to change and prevent this requirement.
>>
Read more here
:: The Governor signed both HB 192 and SB 233 on 8/20/07. What that means is not
clear, since the bills are very different in the approach to controlling MDRO’s.
As we learn more about the implementation we will share the information. Click
here to read the article in the Chicago Tribune. The IL Hospital Report Card Act became effective March 28, 2007. IHA
will establish a website for member questions, and is also offering educational
conference calls related to the Hospital Report Card Act. Slides from one of those
presentations with a letter from IDPH's Eric Whitaker, MD, MPH.can be accessed
here. Read
more here
"The Guideline for Isolation Precautions: Preventing Transmission of Infectious
Agents in Healthcare Settings 2007" (1.39MB, 219 pages) updates and expands
the 1996 Guideline for Isolation Precautions in Hospitals. This guideline can
be accessed at http://www.cdc.gov/ncidod/dhqp/gl_isolation.html
or http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf.
This document is associated with the Management of Multidrug-Resistant Organism
2006 PDF (233 KB, 74 page) guideline published last year http://www.cdc.gov/ncidod/dhqp/pdf/ar/MDROGuideline2006.pdf.
To strengthen
the collaboration between IDPH and public health partners in efforts to prevent
community-associated methicillin resistant Staphylococcus aureus (CA-MRSA), IDPH
has published a memo (6/7/07) that includes many useful CA MRSA references. Click
here for the IDPH memo The healthcare provider guidelines
highlighted in the memo is entitled “Methicillin-Resistant Staphylococcus
aureus in Illinois: Guidelines for the Primary Care Provider”. It can be
accessed on the web at http://www.idph.state.il.us/health/infect/MRSA_Provider.htm Special
CDC Clinician Communication Update: Interim Guidance for the Use of Facemasks
and Respirators in Public Settings During an Influenza Pandemic - Facemasks
and Respirators Could Provide Added Value When Used in Combination with Other
Preventive Measures
- This week, the Illinois House and Senate hear testimony regarding
pending bills related to MRSA. During live testimony, view or listen by opening
the following links or visiting the Illinois General Assembly webpage http://www.ilga.gov/
and finding "House" on the top blue bar. Click on Audio/Visual. - Chicago Tribune Commentary ‘Keeping patients safe’
by Michael O. Vernon, President, APIC Chicago (Association for Professionals in
Infection Control and Epidemiology); Director, Communicable Disease Control, Cook
County Department of Public Health. >>
Read More
- Chicago Tribune 'Super bug' bill targets hospitals: State measure could dictate
fight against deadly bacterium’
>>
Read More (from
current issue of APIC Epdate) CMS Proposes Changes For Hospital
Inpatient Prospective Payment System The FY08 Inpatient Prospective
Payment System Proposed Rule, released on April 13, 2007, contains six proposed
conditions of which three are HAI related conditions and three serious preventable
events for which CMS will not provide higher payments if the selected condition
was not present upon admission. While these changes won't take effect until FY
2009, CMS will finalize its conditions by October 1, 2007. It is noteworthy
that use of "Present on Admissions Codes" also take effect on October
1, 2007. Proposed conditions that will not
be covered include HAI related issues: Catheter-associated urinary tract infections;
pressure ulcers; Staphylococcus aureus septicema; and "serious preventable
events:" object left in surgery; air embolism, and blood incompatibility.
APIC plans to respond to this proposal in collaboration
with key stakeholders and will provide its members with access to key comments
for their use if they choose to respond from their respective organizations. http://www.apic.org/EUpdate Recommendations
for Surveillance of Clostridium difficile-Associated Disease McDonald
LC, et.al. (Ad Hoc Clostridium difficile Surveillance Working Group) ICHE 2007
Feb;28 (2):140-5 An ad hoc C. difficile surveillance working group was formed
to develop interim surveillance definitions and recommendations based on existing
literature and expert opinion that can help to improve CDAD surveillance and prevention
efforts. Tracking of healthcare facility–onset, healthcare facility–associated
CDAD is the minimum surveillance required for healthcare settings; tracking of
community-onset, healthcare facility–associated CDAD should be performed
only in conjunction with tracking of healthcare facility–onset, healthcare
facility–associated CDAD. Recommended definitions for surveillance and for
calculation of rates are included in the article. In an effort to create a nationwide commitment to the elimination
of MRSA transmission, APIC has launched and continues to build a comprehensive
program to aid its members in overcoming barriers to the elimination of this deadly
organism. Available now on APIC web site (under Government
Advocacy): Guide
to the Elimination of Methicillin-Resistant Staphylococcus aureus in Hospital
Settings, created by the MRSA Task Force and released on March 14,
2007, provides infection prevention and control professionals with a step-by-step
approach to battle MRSA transmission. A range of approaches has been included
to make the guide appropriate for any size or type of facility. Home
Government Advocacy Methicillin-Resistant Staphylococcus Aureus (MRSA) >MRSA
Initiatives (link to document is found under Guide to the Elimination of Methicillin-Resistant
Staphylococcus aureus) MRSA Legislative Issues
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