Background: Mandatory reporting of all healthcare-associated infections (HAIs) leads to substantial surveillance volume for infection prevention and control (IPC) programs. Prior to 2019, 6 infection preventionists were performing system-wide surveillance for all infection types using NHSN definitions at a large quaternary-care center in Pennsylvania. Limited surveillance validation was performed. With the continued expansion of the health system, increased demands for IPC expertise, and a growing team, the need for streamlined surveillance, and a validation program were identified. Methods: A surveillance training program for novice team members was developed and implemented. Infection prevention associates (IPAs), whose primary role was data management, began training. The new program included NHSN training videos, direct observation of surveillance with infection preventionists and practice case studies. Following training, IPAs performed surveillance for experienced infection preventionists covering high-risk inpatient units. To ensure high reliability, surveillance validation was initiated. Each month, ~10% of investigated infections were randomly pulled from the electronic surveillance system and divided among experienced infection preventionists. These validators performed unbiased reviews of the charts based on limited data, including patient demographics and culture results. Validation documentation included noting whether an infection was reportable to NHSN and a rationale. Data on whether or not each patient had a complex medical history and time spent validating each case were collected. Compliance of validator documentation aligning with original documentation was tracked. Discrepancies were discussed as a team and were adjudicated as needed. IPAs tracked hours spent on surveillance to capture effort transitioned from infection preventionists. Results: Between March and July 2019, an average of 223 (range, 178–261) potential infections were reviewed per month. From March through June 2019, 61 infections were selected for validation, with 98% compliance with original documentation. One minor discrepancy was attributed to interpretation of documentation in the medical record. Medical complexity accounted for 78% of reviews and validation time spent averaged 12 minutes per infection (range, 3–28 minutes). Self-reported effort directed from infection preventionists to 2 IPAs for surveillance was ~20 hours per week. An additional IPA was hired to perform surveillance in addition to other job responsibilities. Conclusions: Centralized surveillance programs can promote high reliability and cost-efficient IPC staffing for large healthcare systems, especially those with mandatory reporting requirements or medically complex patient populations. Improving surveillance skills among associate staff can increase experienced infection preventionist bandwidth for project management, staff supervision, and other leadership responsibilities. Lastly, validation programs are crucial to ensuring quality assurance of data reporting to both internal and external stakeholders.Funding: NoneDisclosures: None
Background Contact tracing is a critical component in controlling the spread of infectious diseases. During the COVID-19 pandemic, the demands for contract tracing far exceeded the resources available to infection prevention and control (IPC) programs. Leveraging our Poison Control Center, our organization established a Contact Tracing Center (CTC) with content expertise and oversight by IPC and Occupational Health. The CTC identifies exposed patients and employees, provides testing guidance and scheduling, and offers post-exposure recommendations for employees. We describe patient outcomes due to employee exposures in a pediatric healthcare system. Methods Exposure data about employee to patient exposures (EPE) were captured real-time by scripted telephone interviews by our CTC. Chart review was performed to determine outcomes of exposed patients. A concerning exposure from a direct patient care provider to a patient was defined as unprotected contact at less than 6 feet for greater than 5 minutes in the 24 hours prior to developing symptoms. Data were analyzed to determine COVID-19 conversion rates for children exposed to pre-symptomatic and symptomatic employees based upon exposure risk stratification, window of exposure, and employees who worked with symptoms. Results From March 2020 – present, we identified 38 EPE that involved 10 employees; 26 EPE were pre-symptomatic and 12 EPE symptomatic exposures. The average number of EPE per employee was 3.8 (SD 3.01). There were no secondary transmission events to patients from either pre-symptomatic or symptomatic employees. After instituting universal masking, the number of concerning exposures to patients were 3 compared to 35 prior to universal masking. Conclusion We describe the experience of a novel Contact Tracing Center, leveraging alternate staffing pools to track EPE resulting in no secondary transmission to patients either before or after universal masking. We credit sick policy adherence, high hand hygiene compliance, use of standard precautions, universal masking, robust contact tracing operations and a strong data collection system to identify process gaps. Disclosures All Authors: No reported disclosures
Background Infection prevention and control (IPC) is a potential area of career specialization for infectious diseases (ID) fellows. However, ID fellows are not consistently involved in IPC operations or content expertise. IPC education for ID fellows at Children’s Hospital of Philadelphia relied upon lectures, self-study, and some in-person shadowing. ID fellows had few experiences engaging in surveillance, working with data, or discussing approaches to common clinical IPC scenarios. We aimed to develop an IPC curriculum for pediatric ID fellows focusing on experiential learning relevant to clinical and operational practice as an ID physician. Methods We used the Kern model to systematically design a curriculum addressing identified gaps in IPC education. Areas of need included: aligning IPC curriculum content with the physician role, improving tracking of core IPC experiences (e.g. surveillance, bedside reviews), incorporating education on IPC operations, and enhancing connection between ID fellows and IPC non-physician team members. We partnered an ID fellow and an IPC program manager to lead development of the new IPC curriculum. The designed curriculum consists of 3 weeks separated throughout fellowship focusing on: 1) IPC core concepts, and 2) IPC operational skills. Weeks 1 and 2 are a primer on IPC as a field including emphasis on the multidisciplinary roles involved. Week 3 focuses on the role of IPC within overall hospital operations. An optional 4th week is available for those pursuing a career in IPC. Results We have implemented 2 weeks of the new curriculum. The post-implementation feedback is still in progress as only 2 of the 3 weeks has been implemented. Initial feedback highlighted the interactive nature of the curriculum and organized delivery. Additionally, feedback from IPC team members highlighted the improved communication with fellows and better understanding of a fellow’s role. IPC Curriculum Overview An overview of the newly developed IPC curriculum for pediatric ID fellows. Week 1 and 2 are focused on IPC fundamentals, Week 3 is dedicated to operational knowledge and skill, and an optional week 4 exists for those particularly interested in IPC as a career. IPC Foundations "Passport" This is an example of the passport tool for tracking experiences during the IPC rotation weeks. This is used by both the fellow and the IPC division to help create shared awareness of a fellow's experiences and better identify any gaps. Key Elements of Operations Week. This schematic illustrates the key components of week 3 (Operations) of the IPC curriculum. The 3 main elements include collaborating on an IPC-related project, didactics of IPC emergencies (with opportunity to answer IPC calls with infection preventionists and IPC medical directors), and a focus operational skills essential to being a leader within IPC. Conclusion Through collaboration between the ID fellowship program and IPC, we redesigned the IPC curriculum for fellows. While implementation of the curriculum is still in progress with ongoing plans for evaluation, we have demonstrated success in engaging a multidisciplinary team to develop a curriculum for ID fellows focused on an operational (rather than strictly content) field. Disclosures All Authors: No reported disclosures.
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