Winter 2008 Winter Vol. 23 No. 4 indicator for a hospital chemical as a quality Use of a fluorescent INSIDE Publications Mail Agreement #40065075 control: it’s contagious E-learning of infection success story A residential care 2006 and 2007: Influenza campaign cleaning program The official journaloftheCommunity andHospitalInfection ControlAssociation –Canada Association pour la prévention des infections à l’hôpital et dans la communauté – Canada : prévention des infections Revue canadienne de Infecti The Canadian Journal of on Control

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EDITOR-IN-CHIEF The Canadian Journal of Patricia Piaskowski, RN, HBScN, CIC EDITORIAL BOARD Joanne Braithwaite, RN, BAA, CHPIc, CIC Toronto, Ontario INFECTIONINFECTION CONTROLCONTROL Sandra Callery, RN, HHSc, CIC Toronto, Ontario Revue canadienne de prévention des infections David (Greg) Gamble, MD, FRCPC Thunder Bay, Ontario Elizabeth Henderson, PhD Calgary, Alberta Louise Holmes, RN, CIC Vancouver, British Columbia Use of a fluorescent chemical as a quality Lori Jessome-Croteau, RN, BScN,CIC Halifax, Nova Scotia indicator for a hospital cleaning program______216 Shirley McDonald, ART, CIC Bath, Ontario Influenza campaign 2006 and 2007: Allison McGeer, MD, FRCPC Toronto, Ontario A residential care success story______222 Cathy Munford, RN, CIC Victoria, British Columbia Nicole Tittley, HBSc, CIC, CRSP E-learning of infection control: it’s contagious______228 Thunder Bay, Ontario Liz Van Horne, RN, CIC Mississauga, Ontario Dick Zoutman, MD. FRCPC Kingston, Ontario DEPARTMENTS: EDITORIAL OFFICE Patricia Piaskowski, RN, HBScN, CIC Editor’s Message______210 Network Coordinator Northwestern Ontario Infection Control Network President’s Message______212 289 Munro Street, Thunder Bay, ON P7A 2N3 (807) 683-1747 Fax: (807) 683-1745 Message de la Présidente______214 E-mail: [email protected] WEB COMMUNICATION MANAGER Association News______238 Shirley McDonald, ART, CIC [email protected] Reach Our Advertisers______252 CHICA CONNECTIONS - WEB DISCUSSION BOARD Jim Gauthier, MLT, CIC [email protected] VISION POSTING EMPLOYMENT CHICA-Canada will lead in the promotion of excellence OPPORTUNITIES/OTHER INFORMATION in the practice of infection prevention and control. CHICA-Canada Membership Services Office [email protected] MISSION Website: www.chica.org CHICA-Canada is a national, multidisciplinary, voluntary association of professionals. CHICA-Canada is committed to improving the health of Canadians by promoting PUBLISHER excellence in the practice of infection prevention and control by employing evidence-based practice and application of epidemiological principles. This is accomplished through education, communication, standards, research and consumer awareness.

3rd Floor, 2020 Portage Avenue The Canadian Journal of Infection Control is the official publication of the Community and Hospital Winnipeg, MB R3J 0K4 Infection Control Association (CHICA)-Canada. The Journal is published four times a year by Craig Tel: (204) 985-9780 Kelman & Associates, Ltd. and is printed in Canada on recycled paper. Circulation 3000. Fax: (204) 985-9795 www.kelman.ca ©2008 Craig Kelman & Associates Ltd. All rights reserved. The contents of this publication, which does E-mail: [email protected] not necesserily reflect the opinion of the publisher or the association, may not be reproduced by any means, in whole or in part, without the written consent of the publisher. EDITOR - Cheryl Parisien ISSN - 1183 - 5702 DESIGN/PRODUCTION - Theresa Kurjewicz Indexed/abstracted by the Cumulative Index to Nursing and Allied Health Literature, SilverPlatter SALES MANAGER - Aran Lindsay Information Inc. and the International Nursing Index (available on MEDLINE through NLM MEDLARS advertising coordinator - Lauren Campbell system). The Canadian Journal of Infection Control is a “Canadian periodical’ as defined by section 19 of the Send change of address to: Canadian Income Tax Act. The deduction of advertising costs for advertising in this periodical is therefore CHICA Canada not restricted. P.O. Box 46125, RPO Westdale, Winnipeg, MB R3R 3S3 [email protected]

SUBSCRIPTIONS Publications Mail Agreement #40065075 Subscriptions are available from the publisher at the following rates: Return undeliverable Canadian addresses to: All Canadian prices include GST. Prices are listed as personal/institutional. [email protected] Canada: $30/$38 (GST # 100761253); USA (in US funds): $28/$36; Other countries: $45/$60. Do your part for the environment, reuse and recycle. PLATINUM: • BD CHICA–CANADA Ph: (905) 855-4640 Fax: (905) 855-5515 GOLD: 2008 Board of Directors

MEMBERS • Ecolab Healthcare Ph: (651) 293-2914 (800) 352-5326 Fax: (651) 204-7372 Executive Officers SILVER: President President-elect Secretary/Membership Director • 3M Healthcare Marion Yetman, RN, BN, MN, CIC Cathy Munford, RN, CIC Bern Hankinson, RN, BN, CIC Ph: (519) 452-6069 Infection Control Practitioner Infection Prevention & Control Pract Fax: (519) 452-6597 Provincial IC Nurse Specialist Government of Newfoundland Victoria General Hospital Wetaskiwin Hospital • Vernacare Labrador 1 Hospital Way 6910 47th Street Ph: (416) 661-5552 ext. 232 Dept. of Health & Community Services Victoria BC V8Z 6R5 Wetaskiwin AB T9A 3N3 Cell: (416) 580-9301 1410 West Block, Confederation Bldg Tel: 250-727-4021 Tel: 780-361-4398 PO Box 8700 Fax: 250-727-4003 Fax: 403-361-4107 • Virox Technologies St John’s NL A1B 4J6 [email protected] [email protected] Ph: (800) 387-7578 Tel: 709-729-3427 (905) 813-0110 Fax: 709-729-7743 Fax: (905) 813-0220 Past President Director of Finance CHICA-CANADA INDUSTRY CHICA-CANADA [email protected] Joanne Laalo, RN, BScN, CIC Cynthia Plante-Jenkins, MLT, BRONZE: Infection Control Consultant BSc(MLS), CIC • Abbott Laboratories Central South Infection Control Clinical Informatics Specialist - Lab Ph: (800) 465-8242 Network Trillium Health Centre Fax: (514) 832-7837 56 Governor’s Road 100 Queensway W Dundas ON L9H 5G7 Mississauga ON L5B 1B8 • ArjoHuntleigh Canada Phone: 905-627-3541 x 2484 Phone: 905-848-7580 ext.2927 Ph: (800) 665-4831 Fax: 905-804-7772 Fax: (800) 309-7116 Fax: 905-627-6474 [email protected] [email protected] • Covidien Ph: (514) 695-1220 ext. 3471 Fax: (514) 695-4261 Directors • Deb Canada Director of Education Director, Programs & Projects Director, Standards & Guidelines Ph: (519) 443-8697 Donna Moralejo, PhD Karen Clinker, MEd, BScN, Bonnie Henry, MD, MPH, FRCPC Fax: (519) 443-5160 Memorial University School of Nursing CCOHN, CIC Physician Epidemiologist 300 Prince Philip Drive Infection Control Consultant BC Centre for Disease Control • Ethicon, a Division of St. John’s NL A1B 3V6 Northwestern Ontario IC Network 655 West 12th Ave Johnson & Johnson Inc. Tel: 709-777-6527 100 Casimir Ave, Suite 217, Box 116 Vancouver BC V5Z 4R4 Ph: (905) 946-2065 Fax: (905) 946-3735 Fax: 709-777-7037 Dryden ON P8N 3L4 Phone: 604-660-1823 [email protected] Tel: 807-223-4408 Fax: 604-660-0197 • Laura Line Fax: 807-223-4139 [email protected] Ph: (519) 748-9628 [email protected] Fax: (519) 895-2374 Physician Director Dick Zoutman, MD, FRCPC • Les Enterprises Solumed Medical Director, IC Service Ph: (450) 682-6669 Other Positions Kingston General Hospital Fax: (450) 682-5777 Archivist Clinical Editor 76 Stuart Street Mary LeBlanc, RN, BN, CIC • Medline Canada Canadian Journal of Kingston ON K7L 2V7 Ph: (800) 396-6996 ext.7021 RR#2, Civic #11763 Infection Control Phone: (613) 549-6666 Ext. 4015 Fax: (950) 502-5779 Tyne Valley, PE C0B 2C0 Pat Piaskowski, RN, Fax: (613) 548-2513 [email protected] HBScN, CIC [email protected] • Maxill Regional Coordinator Ph: (519) 631-7370 Web Master Northwestern Ontario IC Ph: (800) 268-8633 Shirley McDonald, ART, CIC Network (toll-free) RR 3, 4759 Taylor-Kidd Blvd 289 Munro Street Fax: (519) 631-3388 Bath ON K0H 1G0 Thunder Bay ON • Pharmax Limited Tel: 613-389-9810 P7A 2N3 Membership Ph: (416) 675-7333 Fax: 613-389-8468 Tel: 807-683-1747 Fax: (416) 675-9176 [email protected] Fax: 807-683-1745 Services Office [email protected] MEMBERSHIP SERVICES OFFICE • Rubbermaid Canada Distance Education Coordinator Executive Administrator/ Ph: (905) 281-7324 Karen Dobbin-Williams, RN, BN Conference Planner Fax: (905) 279-1054 28 Dalhousie Crescent Gerry Hansen, BA Mount Pearl NL A1N 2Y4 • Sci Can PO Box 46125 RPO Westdale Tel: 709-745-7341 Ph: (416) 446-2757 Winnipeg MB R3R 3S3 [email protected] Fax: (416) 445-2727 Phone: 204-897-5990/866-999-7111 Fax: 204-895-9595 • Smith & Nephew Inc. [email protected] Ph: (514) 956-1010 Fax: (514) 956-1414 Professional Agents Deliveries only: • Steris Corporation Legal Counsel Auditor 67 Bergman Crescent Ph: (905) 677-0863 Elliot Leven, LLB Philip Romaniuk CA Winnipeg MB R3R 1Y9 Fax: (905) 677-0947 Elliot Leven Law Corporation Stefanson Lee Romaniuk

204-100 Osborne Street 1151 Portage Avenue • Wood Wyant Administrative Assistant Winnipeg MB R3L 1Y5 Winnipeg MB R3G 0S9 Ph: (800) 361-7691 Kelli Wagner Phone: (204) 944-8720 Phone: (204) 775-8975 Fax: (450) 680-9735 [email protected] Fax: (204) 944-8721 [email protected] [email protected]

208 WINTER 2008 • The Canadian Journal of Infection Control Click Here to return to Table of Contents Enhanced Efficacy

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Succession planning: replenishing the ranks

ith many infection con- ICP may start weeks after the trol professionals being position is vacated. registered nurses and the • Newer generations of ICPs may average age of a nurse have a different perspective on Wbeing in the mid-40s, one could surmise the work and personal life bal- that the average age of an ICP is similar. ance. They may be more willing Pat Piaskowski, RN, HBScN, CIC There are also estimates that about 15- to assert their need for a more Clinical Editor, 20 per cent of the health care workforce structured work environment Canadian Journal of is now over 50 years of age. with regular hours and consis- Infection Control From these figures it is a likely tent breaks and time off. This projection that we could see many ICPs may mean that when ICPs who retiring in the next five to 10 years. worked day and night in their There has also been an influx of new roles leave it may be difficult for ICPs hired with additional funded new ICPs to fulfill these demands. positions in some provinces, some of What is the answer? Obviously there whom are in the same age cohort. is no one clear answer. However, What will this mean to our profession? there needs to be dialogue among • Likely there will be an increased the members of the profession at need for training programs across the the local, regional, provincial, and country to support the learning needs national level. This will form a first of the new ICP positions including step in the development of a plan for those who replace retired ICPs. the eventual succession of new ICPs. • Along with training, these new ICPs can help with solving this ICPs will need mentoring and looming issue, at the local level, by support to take on their new roles. actively promoting infection pre- • With the constant barrage of new vention and control as a profession and re-emerging organisms and and supporting local, regional, and greater public accountability for national efforts to bring new recruits prevention of infections there will into the field. be increasing pressure to ensure that new ICPs are “up to speed” and fully functioning in a shorter time. • Certification in Infection Control (CIC) will increase in importance as ICPs face greater public scrutiny

and an increased accountability in their key roles in patient safety. Correction: • More attention will be required for Unfortunately the wrong Aramark succession planning. This will be advertisement was placed in the critical especially in settings where Fall issue. Please find the correct there is only one ICP and the new ad in this issue on page 236. We apologize for any inconvenience this may have caused Aramark and its clientele.

210 WINTER 2008 • The Canadian Journal of Infection Control Click Here to return to Table of Contents

PRESIDENT’S MESSAGE

A great year

in membership, a greater number of method of conference planning. This attendees at the national education confer- process also lessens the workload ence, and an increase in readership of the for individual chapters who have had Canadian Journal of Infection Control. primary responsibility for planning the One of our proudest achievements national conferences in the past. has been our pursuit of educational CHICA-Canada has embraced excellence for our members. This research this year with the membership year the widely recognized university supporting the allocation of $50,000 Marion Yetman, RN, BN, MN, CIC credit web-based course sponsored by toward a study to increase our knowl- President, CHICA-Canada CHICA-Canada has been reviewed by edge of the prevention, control and the Distance Education Coordinator, eradication of Clostridium difficile. Dr. Karen Dobbin Williams. This evaluation Vivian Loo, McGill University Health will ensure that the course continues to Centre, Montreal, has been awarded “If you are planning for a year, provide a curriculum which meets the the research grant and will commence sow rice; if you are planning for a needs of the Infection Prevention and work on her topic “Household Trans- decade, plant trees; if you are plan- Control Practitioners. In addition to this mission of Clostridium difficile.” ning for a lifetime, educate people.” entry-level course, CHICA-Canada is The strength of our organization is – Chinese proverb exploring the possibility of partnering reflective of the commitment of our with other Canadian universities in the volunteers. On behalf of all members, hope of developing post-graduate courses I would like to thank Dr. Dick s the end of my term as in infection prevention and control. Zoutman for his 12 years of dedication president nears it is with This year marks the third year the to the position of Physician Director pleasure that I reflect on National Scientific Program Committee for CHICA-Canada. Joanne Laalo, Past the accomplishments of our has developed the education program President, and Cindy Plante-Jenkins, Aorganization. This past year has been for the annual education conference. Director of Finance, have completed a period of growth with a number of Informal feedback has indicated that their terms on the board and have also highlights as evidenced by an increase the membership is satisfied with this served CHICA-Canada with enthusiasm and devotion. At the recent board meeting, Dr. Elizabeth (Betty Ann) Henderson, the past Director of Education, was awarded the designation of Honorary Member. This is in recognition of her contribution to infection prevention and control education. In fact, Betty Ann has been described as one who has raised the profile of CHICA-Canada as a leader worldwide “for its inno- vative and high caliber approach to educational development.” Indeed her focus on education has helped posi- tion CHICA-Canada in planning for a lifetime of infection prevention and control professionals. I would like to thank the members of the board of CHICA-Canada, the membership particularly the CHICA- NL group, and Gerry Hansen, who have provided me with support during the past year.

212 WINTER 2008 • The Canadian Journal of Infection Control Click Here to return to Table of Contents Buckling down on HAIs

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Une année exceptionnelle

Une des réalisations dont nous réduire la charge de travail des sections pouvons être le plus fier a été notre dont la responsabilité première consistait, quête de l’excellence en formation par le passé, à planifier les conférences Marion Yetman, Inf., B. Sc. inf., pour nos membres. Cette année, le nationales. M. Sc. inc., CIC President cours universitaire crédité sur le Web, Cette année, CHICA-Canada a CHICA-Canada commandité par CHICA-Canada et abordé la recherche avec les membres qui jouit d’une grande renommée, a en soutenant l’affectation de 50 000 $ été réexaminé par la Coordonnatrice en vue de la réalisation d’une étude de la formation à distance, Karen visant à élargir notre connaissance « Si vous planifiez sur un an, ense- Dobbin Williams. L’évaluation qu’elle de la prévention, du contrôle et de mencez du riz ; si vous planifiez sur a réalisée nous permettra de nous l’éradication du Clostridium difficile. une décennie, plantez des arbres ; assurer que ce cours continue d’offrir La docteure Vivian Loo, du Centre si vous planifiez sur toute votre vie, un programme répondant aux besoins de santé de l’Université McGill, à éduquez les gens. » des praticiens en prévention et contrôle Montréal, a reçu une bourse de recherche — Proverbe chinois des infections. En plus de ce cours de et entreprendra ses travaux sur son sujet, niveau d’entrée, CHICA-Canada étudie la transmission en milieu familial du la possibilité de créer un partenariat avec Clostridium difficile. d’autres universités canadiennes dans La vigueur de notre organisme lors que la fin de mon mandat l’espoir d’élaborer des cours d’études est le reflet de l’engagement de nos à la présidence approche, supérieures en prévention et contrôle bénévoles. Au nom des membres, je tiens c’est avec plaisir que je des infections. à remercier le docteur Dick Zoutman de repense aux réalisations de Cette année marque le troisième ses 12 années de dévouement au poste de Anotre organisme. L’année écoulée a été anniversaire de l’élaboration, par le Directeur médical de CHICA-Canada. une période de croissance marquée par Comité du programme scientifique Joanne Laalo, Présidente sortante, et un certain nombre de faits saillants, national, du programme d’enseignement Cindy Plante-Jenkins, Directrice des comme en font foi l’augmentation en vue de la conférence annuelle sur finances, qui terminent leur mandat du nombre de nos membres, celle du la formation. D’après les réactions respectif au conseil, ont également mis nombre de participants à la conférence informelles reçues, les membres leur enthousiasme et leur dévouement au nationale sur la formation et celle du sont satisfaits de cette méthode de service de CHICA-Canada. lectorat de la Revue canadienne de la planification de conférence. Ce Lors d’une réunion récente du conseil, la prévention des infections. processus a également l’avantage de docteure Elizabeth (Betty Ann) Henderson, Directrice de la formation sortante, a été nommée membre honoraire en reconnaissance de sa contribution à la formation en matière de prévention et de contrôle des infections. On a décrit Betty Ann comme une personne qui a attiré davantage l’attention sur le rôle de chef de file mondial de CHICA-Canada « en raison de son approche novatrice et de niveau élevé du perfectionnement de la formation ». Et il est vrai que l’importance qu’elle accorde à la formation a contribué à permettre à CHICA-Canada de planifier une vie entière de professionnels en prévention et contrôle des infections. En terminant, je tiens à remercier les membres du conseil de CHICA-Canada, les membres ordinaires, en particulier le groupe de CHICA-NL, ainsi que Gerry Hansen, pour son aide au cours de l’année écoulée.

214 WINTER 2008 • The Canadian Journal of Infection Control Click Here to return to Table of Contents

Use of a fluorescent chemical as a quality indicator for a hospital cleaning program

Abstract results were recorded on a standardized form. The rate of targets cleaned versus Jennifer Blue, BSc, RRT, Background: the targets missed was calculated. RPsgT, CIC Hamilton Health Sciences is a large Cindy O’Neill, MLT, ART, CIC teaching hospital with over 1,000 Paul Speziale, BA Results: beds and consists of three acute care The overall rate for daily cleaning Jeff Revill sites, one Regional Cancer Center Lee Ramage, RN, BScN, CIC, of bathrooms and cleaning of isolation and two Rehabilitation/Chronic Care rooms was poor with only 23% of COHN(C) facilities. An environmental cleaning Lisa Ballantyne, BA the targets cleaned. Based on these pilot project was initiated at the acute findings, several interventions were care Henderson site, following an Corresponding Author: implemented. This resulted in a outbreak of vancomycin-resistant Cindy O’Neill significant improvement in cleaning Hamilton Health Sciences Enterococcus (VRE). Healthcare- practices during the pilot project. Henderson Site associated infections (HAI) due to Greater than 80% of the targets were Tel: (905) 527-4322 ext. 43534 antibiotic-resistant organisms are cleaned compared to the baseline find- increasing in Southern Ontario. ings of 23%. Subsequently, nosocomial Environmental cleaning plays a key cases of VRE have declined despite role in eradicating resistant organisms the increased prevalence of VRE in the that live in hospital environments, Hamilton and surrounding regions. thereby helping to reduce HAIs.1,2,3,4 The environmental cleaning practices Conclusion: on the Orthopaedic Unit were identi- The GlitterBug® product is an effec- fied as a contributing factor to the tive tool to evaluate environmental VRE outbreak after visual assess- cleaning and adherence to policies ments were completed using a Brevis and procedures and this method was ® GlitterBug product, a chemical superior to previous visual inspec- that fluoresces under an ultraviolet tion methods. The use of GlitterBug® (UV) lamp. These findings led to a potion improved physical cleaning hospital-wide cleaning improvement and enhanced staff contribution. The initiative on all units except critical Brevis GlitterBug® product was ® care areas. The GlitterBug potion incorporated into the CSS was employed by Infection Control environmental cleaning program at and Customer Support Services Hamilton Health Sciences as a quality (CSS) as a tool to evaluate the daily indicator to monitor environmental cleaning of patient washrooms as cleaning practices. well as discharge cleaning of contact precaution isolation rooms. BACKGROUND In June 2007, an outbreak of Method: vancomycin-resistant Enterococcus Over a four-week period, the GlitterBug® faecium occurred on an Orthopaedic potion was applied to seven frequently Unit at the Hamilton Health Sciences touched standard targets in randomly Henderson site, a 300-bed acute care selected patient bathrooms on each hospital. A total of 25 nosocomial unit and 14 frequently touched targets cases were detected during the course prior to cleaning in the rooms used of the outbreak. As part of the for isolation. The targets were then intervention and audit process, the evaluated using the UV lamp to detect infection control (IC) team reviewed objects that were not cleaned and the hand hygiene, equipment disinfection

216 WINTER 2008 • The Canadian Journal of Infection Control Click Here to return to Table of Contents and environmental cleaning practices cord, call bell, drawer handle, over- RESULT on the unit. Environmental testing for bed table, metal television arm, bed A total of 364 targets were evaluated VRE was also conducted with limited rail, phone receiver) in the rooms used during the baseline data collection value, as all cultures yielded negative for patients in contact precautions. period from October to November. results. This reflects the information in The following day after cleaning, the The overall rate for cleaning of the the literature that does not support routine targets were evaluated by the infec- bathrooms and discharge cleaning of environmental testing for antibiotic tion control team using a UV lamp to isolation rooms was poor with only 81 resistant due to poor sensitivity.5,6 detect targets that were missed and (23%) targets cleaned. Following the Although multiple factors contribute not cleaned. The results were recorded implementation of the pilot project and to outbreaks, environmental cleaning on a standardized form. The rate of through the course of interventions, practices on the Orthopaedic Unit targets cleaned versus targets missed subsequent audits and evaluations were identified as a contributing factor were calculated and the results were showed a significant improvement to the VRE outbreak after further presented to the customer support of greater than 80% in cleaning, as visual assessments were completed service teams. shown in Figure 1. using a Brevis Gitterbug® potion. During the assessment, it was identified that the routine cleaning of patient rooms was unsatisfactory and likely a important factor in the ongoing spread of VRE. This resulted in the launch of a cleaning improvement project using a Brevis GlitterBug® product, a chemical that fluoresces under a UV lamp. All environmental cleaning Staff receives standard training on the hospital cleaning protocols and disinfectant products, which meet regulatory and professional standards. The pilot project focused solely on physical cleaning practices. This project was a collaborative initiative between the Henderson’s Infection Control and Customer Support Service teams and was launched on October 15, 2007. METHOD The GlitterBug® potion was used by infection control to evaluate the routine cleaning of patient washrooms and discharge cleaning of single rooms used for contact precautions isolation, on all units except critical care areas. The infection control team collected baseline data from October 18 to November 15, 2007. Patient rooms were randomly selected on each unit at the start of a shift prior to daily cleaning. A fingerprint-size amount of GlitterBug® Potion was applied to seven frequently touched standard targets in randomly selected patient washrooms (flusher handle, emergency call bell cord, light switch, grab bar, door handle, toilet paper holder, back of toilet seat) as well as an additional seven standard cleaning targets (light

Click Here to return to Table of Contents The Canadian Journal of Infection Control • Winter 2008 217 Overall, the labour required to initi- Figure 1 ate this process was minimal. It took approximately 2 minutes per room to apply the GlitterBug® Potion and 4-5 minutes per room to check results and review with front line staff. The cost of materials was minimal with less than $200(CA) to supply four team leaders with UV battery-operated lamps and GlitterBug® Potion.

DISCUSSION Based on the initial assessment and baseline results, several non-puni- tive measures and interventions were implemented for the pilot project. Key strategies included instituting formal education and review of infection control and hospital cleaning proto- cols into CSS monthly team meetings, of the pilot project. These findings SUMMARY conducting practical show-and-tell are consistent with the independent A protocol for audits using environmental exercises for the spot assessment conducted by infec- GlitterBug® products was developed frontline CSS Staff using GlitterBug® tion control team in April 2008 (see and incorporated as a quality indicator products, performing daily cleaning Figure 1). CSS Staff were provided tool into the CSS cleaning program. audits by CSS team leaders on units the positive feedback. This resulted Monthly statistics were tabulated and using GlitterBug® potion with imme- in a renewed excitement and aware- compared for trending purposes. Due diate feedback provided to frontline ness of the importance of the envi- to the overwhelming success of the cleaning staff. The environmental ronmental role and the impact it has project, a CSS employee rewards and roles and responsibilities were in the overall health and safety of recognition program was developed also reviewed. patients. According to the responses to acknowledge high performances. The ongoing audits performed by to a customer satisfaction survey, the Awards are presented to the frontline the CSS leaders showed a steady and program was also well received by cleaning staff who achieve 100% of all significant improvement of greater patients who were very supportive of audits completed in a month and the than 80% in cleaning since the start the initiative. award is displayed on the clinical units for everyone to celebrate. Active and passive surveillance for patients with VRE continues on a regular basis at Hamilton Health Sciences as part of the infection control program. The rate of nosocomial cases of VRE has decreased over the past five months since the implementation of the pilot project, as shown in Figure 2. Although it is premature to confirm a sustained VRE reduction, it appears from the conclusion of the outbreak and subsequent VRE statistics, that this hospital environmental cleaning program has been successful in reducing hospital-acquired VRE infections.

CONCLUSION The GlitterBug® products are an effec- tive tool to evaluate environmental cleaning and adherence to policies and procedures. This method is superior

218 WINTER 2008 • The Canadian Journal of Infection Control Click Here to return to Table of Contents Figure 2 J.Highlander D. Improved cleaning of patient rooms using a new target method. Clin Infect Dis 2006;42:385-388. 3. Carling PC; Briggs J, Highlander D, Perkins J. An evaluation of patient area cleaning in three hospitals using a novel targeting methodology. Am J Infect Control 2006;34:513-519 4. Drees M, Snydman DR, Schmid CH et al. Prior environmental contamina- tion increases the risk of acquisition of vancomycin resistant enterococci. Clin Infect Dis. 2008;46:678-685. 5. The Association for Professionals in Infection Control and Epidemiology to the previous visual inspection cleaning practices at all Hamilton Inc (APIC).Infection Control and method. The use of GlitterBug® Health Sciences Hospitals. Epidemiology 2nd edition, Washing- products improved cleaning and ton DC: 2005:Vol 1.3-11 enhanced staff contribution. There is Reference: 6. Sehulster L, Chinn RY; satisfaction for CSS leadership and 1. Haydon MK, Bonten JM et al. CDC;HICPAC, Guidelines for envi- staff and a renewed excitement for the Reduction in acquisition of vanco- ronmental infection control in health- environmental role. The Brevis mycin-resistant Enterococcus after care facilities. Recommendations of GlitterBug® product was incorporated enforcement of routine environ- CDC and the Healthcare Infection into the CSS environmental cleaning mental cleaning measures. Clin Control Practices Advisory committee program and is now used as a quality Infec Dis 2006;42:1552-1560 (HIPAC). MMWR recomm Rep 2003 indicator to monitor environmental 2. Carling PC, Briggs JL, Perkins Jun 6;52(RR-10):1-42.

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Click Here to return to Table of Contents The Canadian Journal of Infection Control • Winter 2008 219 2009 Virox Techologies Partners Scholarship

Through the financial support of the Virox Technologies Partnerships, 10 CHICA-Canada members were awarded scholarships to attend the 2008 CHICA/AIPI Education Conference in Montreal. CHICA-Canada and its members thank Virox Technologies and their partners Deb Canada, JohnsonDiversey, Steris Corporation, Virox Technologies, and Webber Training for their initiative to make the national education conference accessible to those who may not have otherwise been able to attend. The Virox Technologies Partnership will again provide a scholarship to assist CHICA-Canada members with attending the 2009 Education Conference in St. John’s, Newfoundland Labrador. The 2009 Virox Technologies Partnership Scholarship application is available on www.chica.org. The deadline date for applications is January 31, 2009.

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DFMMT 7300 Trans-Canada Pointe-Claire, QC H9R 1C7 COVIDIEN, COVIDIEN with logo and TM marked brands are trademarks of Covidien AG or its affiliates. © 2008 Covidien AG or its affiliates. All rights reserved. 877-664-8926 [t] 800-567-1939 [f] Currently licensed under Tyco Healthcare with Health Canada. www.covidien.com (1) Zoutman, DE, Ford DB, Bryce E et al; The state of infection surveillance and control in Canadian Acute Care Hospitals; Am J Infect Control, 2003; 31:266-73. (2) The Reduction of Vascular Surgical Site Infections with the Use of Antimicrobial Gauze Dressing; Robert G.Penn, MD. Sandra K Vyhlidal, RN, MSN, CIC, Sylvia Roberts, RN, Susan Miller, RN, BSN, CIC. Dept. of Epidemiology, Nebraska Methodist Hospital, Omaha, NE, USA.Observation of Nosocomial Surgical-Site Infection rates with Utilization of Antimicrobial Gauze Dressing in an Acute Care Setting: Mary Jo Beneke, RN BS, CWOCN: Josephine Doner, RN BSN MA CIC. Yuma Regional Medical Center, Yuma AZ. (3) Observation of Nosocomial Surgical-Site Infection Rates with Utilization of Antimicrobial Gauze Dressing in an Acute Care Setting Mary Jo Beneke, RN, BS, CWOCN; Josephine Doner, RN, BSN, MA, CIC Yuma Regional Medical Center, Yuma, AZ NEWS FROM THE FIELD Influenza campaign Cathy Munford, RN, CIC, Infection Prevention and Control Practitioner, Continuing 2006 and 2007: Care, Vancouver Island Health Authority South A residential care Shirley Finnigan, RN, BScN, GNC(C), CNL Extended Care success story Units Saanich Peninsula Hospital, Vancouver Island Health Authority Abstract: Corresponding Author: Results: C. Munford Objective: There was an increase in influenza Infection Control Practitioner On July 7, 2000, the BC Ministry of awareness both among health care Victoria General Hospital Health announced a comprehensive workers and the general public. In SPH 1 Hospital Way influenza campaign for British Columbia extended care staff there was115% Victoria, BC V8Z 6R5 (BC). The Ministry’s goals were: to increase in staff immunization rates Tel: (250) 727-4021 reduce illness and death associated over the 2005 campaign. A 90% Fax: (250) 727-4003 with influenza in the most vulnerable immunization rate among residents [email protected] populations; to reduce predictable in residential care facilities was seen. preventable additional pressures on the There were no reported outbreaks of health care system that occur during influenza in residential care facility influenza season; and to achieve an within the SPH during the 2006 and 80% immunization rate in health 2007 influenza seasons. care workers. Since 2000, the staff influenza numbers continue to remain Discussion: around 45%, with a number of identified Despite the increase in immunization influenza outbreaks. Saanich Peninsula rates among health care workers, in Hospital (SPH), a150-bed extended general, the overall rate within the care unit, challenged their staff to health authority remains low. The success improve and sustain their immunization of the SPH extended care campaign numbers to 80% for the protection of may have been a result of the climate their residents. of the facility and the commitment of the manager and key staff to the Method: initiative. Future campaigns will be In response, SPH developed an directed to the entire facility, including integrated influenza management plan. acute care. It will be interesting to see The plan focused on an enhanced if these immunization numbers can be ability to prevent and control sustained in other areas. influenza. This would involve a targeted immunization campaign for Conclusion: high-risk groups, including enhanced In order to be successful, influenza ability to quickly identify outbreaks, immunization campaigns must involve and to implement control measures. management and numerous depart- SPH along with the Vancouver Island ments. Early planning is important and Health Authority, south island (VIHA- must start as soon as the previous year’s si), used a campaign that involved the campaign concludes. A key component development of staff policies around to any plan is communication, staff influenza immunization and outbreak incentives and staff belief in the program. management, an enhanced media The success or failure of a plan is depen- campaign, incentive program for staff dant on the message about immunization and refinement of protocols for quick that gets out to the at-risk populations. access and testing of isolates during This will continue to be a key component an outbreak. of future influenza campaigns.

222 WINTER 2008 • The Canadian Journal of Infection Control Click Here to return to Table of Contents On July 7, 2000, after consultation announcement in anticipation of the with the British Columbia Center for Dis- upcoming flu season. The work around ease Control, the BC Ministry of Health the campaign involved Occupational announced a comprehensive influenza Health, Seniors’ Health Program, campaign for British Columbia. The Regional Infection Prevention and Ministry’s goals were three-fold: Control Program, Communications, • To reduce illness and death Human Resources, and the Office of associated with influenza, the Medical Health Officer. The main particularly among the most focus of the VIHA Flu Campaign was vulnerable populations. to inform the high-risk groups, including • To reduce predictable, health care workers, about influenza preventable additional pressures and to provide easy access on the health care system which to immunization. occur during flu season. Despite the campaign, influenza • To enhance British Columbians’ rates only went up slightly among the capacity to successfully fight the staff of VIHA, averaging around 43% next influenza pandemic. immunization rates over all, with a The Ministry’s campaign involved slightly higher rate seen in residential targeted influenza immunization aimed influenza management plan. The plan care at approximately 60%. VIHA especially at those at risk: focused on an enhanced ability to prevent continued to see outbreaks of influenza • Community dwelling seniors an and control influenza. This would involve in its high-risk group. individuals with chronic a targeted immunization campaign for By 2005, Epidemiology and health conditions. high-risk groups, including an enhanced Disease Control, under the Medical • Health care workers. ability to quickly identify outbreaks, and Health Officer, took the lead for the • Emergency and first responders. to implement control measures. influenza programs under VIHA. The The Ministry’s campaign was to focus The VIHA plan began in May program expanded to include nurse on health care worker immunization, 2000, prior to the Ministry’s champions on every unit who were public education about influenza, integrated planning to protect British Columbians in the future, and enhanced influenza surveillance. The aim was to achieve 80% vaccination of people at most risk for influenza and its complications as well as those that provide care and support to them.

Vancouver Island The Good Samaritan Society has over 55-years of experience in providing Health Authority complex/continuing care, assisted living and other specialized health and The Vancouver Island Health Authority community care services. We are one of the largest not-for-profit, voluntary care (VIHA) provides hospital, community, providers in Alberta and British Columbia serving over 4400 individuals. home, environmental and public We are currently recruiting for various positions throughout health services including education our organization including those for Registered Nurses, Licensed Practical and prevention, to the people living in Nurses and Certified Health Care Aides. and around Vancouver Island, Canada in over 138 locations by over We offer our employees competitive wages, comprehensive benefits packages, a 17,000 staff. wide variety of shifts, professional development opportunities, numerous locations The region serves over 752,000 and the opportunity to improve the quality of life of individuals and their families. To apply, please submit your resume to: residents in an area that stretches the entire Vancouver Island, the islands The Good Samaritan Society of the Georgian Strait, and mainland 8861-75 Street communities North of Powel River and Edmonton, AB T6C 4G8 South of Rivers inlet. Phone: (780) 431-3600 In response to the Ministry of Health’s Fax: (780) 431-3735, E-mail: [email protected] announcement for Influenza Campaign To view all of our job opportunities, please visit www.gss.org 2000, VIHA developed an integrated

Click Here to return to Table of Contents The Canadian Journal of Infection Control • Winter 2008 223 able to offer education as well as associated with the unit. The manager inexpensive gifts up to the top prize immunization to staff. A coordinated and the clinical nurse leader (CNL) which was a dinner for two (value effort to rapidly diagnose and offer treat- committed to change the immunization $150). The very supportive Saanich ment or prophylaxis was established. rates for 2006/07. Peninsula Hospital Foundation Despite these efforts, staff rates remain SPH ECU began their flu-campaign generously donated the top prize. low and outbreaks of influenza A discussion by acknowledging their The Activation Department and the continued to be seen in residential care. meagre 37% immunization rates by CNL made two large fun, colourful After one such influenza nursing staff in 2006 for influenza posters with picture cartoons and outbreak in 2005-2006 seasons, a vaccine. Staff held discussions on how percentage scales; one on each unit novel approach was taken to improve they could improve and reach the target that allowed all staff to track the immunization rates among staff in a of 80%. progress as a team with each ECU particular residential setting. challenging the other unit. Method The first draw was held when they Flu-campaign The CNL emailed all the other resi- had passed the previous year’s immu- dential care facilities within the area, nization rate of 37%. Subsequent summary: Saanich requesting information about their 2006 draws were held at rates of 50%, 60%, Peninsula Hospital staff immunization rates, and sugges- 75% and over 80%. All draws were tions for how they increase compliance. held with pomp and fanfare, just what Extended Care Unit After completing this research, the was needed during the long winter CNL concluded that all units have a months. Small prize draws were held Background culture unique to them; determine what in between milestones just to keep the In early 2006, the Extended Care Unit makes your culture happy and your staff interested. (ECU) at Saanich Peninsula Hospital immunization rates will go up. The Other factors contributed to SPH- (SPH) had an outbreak of influenza CNL, with the support of her manager, ECU success: A on the unit. This resulted in a harsh decided to run a campaign offering • CNL worked closely with impact on staff, residents and families draws of excellent gifts, starting with Infection Prevention and

224 WINTER 2008 • The Canadian Journal of Infection Control Click Here to return to Table of Contents Control, who supported their despite influenza outbreaks confirmed With any endeavour, evaluation of campaign from the beginning. within the community. There were past practice is important to improve • The CNL was available to all the no reported cases of influenza in the future programs. Despite the increase staff to drop in to the office and residential care area within the SPH in immunization rates among health get their influenza vaccination. during the 2006 and 2007 care workers at SPH ECU, the This proved to be highly influenza season. overall rate within the health authority effective since the drawing barrel remains low averaging 43%. The was located in this office, and Discussion success of the SPH extended care names would only be entered after The success of the influenza campaign campaign may have been a result of the proof of vaccination. The barrel can be attributed to an excellent climate of the facility and the was handsomely handcrafted by communication campaign and the commitment of the manager and key the units’ social worker. introduction of novel unit-specific staff to the initiative. • Staff encouraged fellow staff activities. The campaign provided Following are some recommendations members to get their shot, so information about influenza which require review and consideration: another drawing could be held. immunization and information • Offer prize draws as an incentive • Phone calls to casual staffs that regarding the availability of clinics. to become immunized. Prize do not work at the facility very The Influenza Prevention Program draws were only offered at SHP often were made by the CNL. Policy established a protocol for ECU. The manager at SPH ECU This was to inform them about reducing transmission and clarified provided some funding, while the possibility of winning a prize the importance of health care worker staff and the residents’ families if they could show the CNL of influenza immunization as integral to donated other prizes. For a small proof of immunization. this process. amount of funding it would be • The manager ensured the current Continued on page 227 staff listings were up to date. Good, clear communication with the housekeeping supervisor was essential Table 1 to success with over 90% immunization within this group.

Results There was an increase in influenza awareness both among health care workers, families, residents and the general public. There was a marked increase in use of alcohol-based hand sanitizer by both staff and visitors. There was a marked increase in immunization of SPH extended care staff. In 2005/2006 the immunization rate among staff was 39%; this increased to 84% in 2006/2007 and was maintained in 2007/2008 at 83%. This represents a 115% increase in staff influenza immunization rates over the 2005 campaign. The immunization rate among the residents in the facilities remained constant at 87.6% in 2005/2006, 83.2% in 2006/2007 and 90.4% in 2007-2008 (table 1). In the 2005/2006 season, 41 respiratory cases were reported among the approximately 150 residents at SPH ECU including one confirmed influenza A outbreak. Within the 2006/2007 the respiratory cases dropped to 11, with seven cases in the 2007/2008 season

Click Here to return to Table of Contents The Canadian Journal of Infection Control • Winter 2008 225 “Bug a Doc!” “Bug a Doc” contest closes March 1, 2009. They have a specialty – infectious disease, microbiology, epidemiology – that enhances CHICA-Canada Member______the practice of infection prevention and control. Address______They should be part of CHICA-Canada. Telephone______If you have a ‘Doc’ in your department who is Email______not yet a CHICA-Canada member, encourage your ‘Doc’ to join CHICA. Their immediate benefit is an expansion of their professional New ‘Doc’ Member______resources and networking opportunities. Go to our website and see the many benefits Address______available to membership so you will have the ______information on hand when the discussion comes up! Telephone______Email______Send us the name of your ‘Doc’ when he or she joins CHICA. You and your Doc could each win a free 2010 membership (value $125). Forward to CHICA-Canada, Fax 1-204-895-9595 or email [email protected]

YOU ARE INVITED to design a poster that will be used for Host Chapter: Infection Control Week 2009 using the following theme: CHICA Manitoba Send submissions to: THE POWER OF ONE! Mail: Your Role in Infection Control Director of Programs Prize: Waived registration to and Projects PO Box 46125 2009 CHICA-Canada Conference plus $500 RPO Westdale REMINDER: Posters should have meaning for patients Winnipeg MB R3R 3S3 and visitors as well as all levels of staff in both acute and

Fax: 204-895-9595 community settings. The poster should be simple and Email: chicacanada@ uncluttered, with strong visual attraction and few if any mts.net additional words. Judging will be on overall content. Artistic talent is helpful Courier: but not necessary. The winning entry will be submitted c/o CHICA-Canada 67 Bergman Crescent to a graphic designer for final production. Your entry will Winnipeg MB R3R 1Y9 become the property of CHICA-Canada.

Include your name, address and telephone number on the back of your entry.

DEADLINE: January 31, 2009

226 WINTER 2008 • The Canadian Journal of Infection Control Click Here to return to Table of Contents possible to have regional prizes immuno-compromised patients creative approaches and effective and provide some fun related to and residents) through out VIHA. marketing to achieve the desired partici- the clinics and other sites From an infection control perspec- pation. In order to be successful, influenza challenging each other. tive the intent of the Influenza campaigns must involve management • Future campaigns will be Prevention Program Policy is to and other key departments. Early plan- directed to the entire facility, reduce Influenza transmission ning is important and must start as soon including acute care. It will especially in high-risk areas. as the previous campaign concludes. A be interesting to see if these The high immunization rates key component to any plan is com- immunization numbers can be that continue to be seen in areas munications and meeting the specific sustained in other areas. such as Finance, IM/IT Systems cultural needs of individual units. The • Review locations and availability and Health Records can possibly success or failure of any campaign is in of influenza clinics to determine reduce absenteeism rates but is the message that gets to the consumer. if the schedule meets the needs of no significance in relation to In our case, it was important to provide of the employees. Balancing patient/resident/client safety. information on the risks and benefits of availability for employees and • Increase educational presentations immunization and influenza outbreaks utilization of resources for staffing so that employees understand the within VIHA and in particular SPH. of clinics is always challenging. intent and content of the policy. Review of other programs, consultation Creative alternatives should Education was an with managers and employees and a be explored to meet these two important part of the SPH ECU thorough review of all components of objectives such as having staff campaign so that staff understood the 2007 & 2008 influenza programs on units as influenza champions, the importance of immunization will provide the groundwork and and allowing easier access for and the results that low rates can building blocks for the development shift workers to vaccination. have on the work environment. of future programs. A comprehensive • Establish goals of 60%-80% communication and novel strategies immunization rates for Conclusion will continue to be a key component of employees working in high-risk Influenza immunization has always all future influenza strategies. areas (areas with potentially been a controversial issue requiring

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Click Here to return to Table of Contents The Canadian Journal of Infection Control • Winter 2008 227 E-learning of infection control: it’s contagious

Abstract Introduction Elizabeth Bryce, MD, FRCPC This article outlines the steps taken to Consistent application of infection Division of Medical Microbiology deliver standardized infection control prevention and control (IPAC) principles and Infection Control, Vancouver and occupational health training to all across the healthcare spectrum has Coastal Health Authority healthcare workers across a Cana- never been more important, particularly dian health authority, using an online with the emergence of SARS, hyper- Annalee Yassi, MD, MSc, FRCPC module developed by a multi- virulent strains of Clostridium difficile Division of Occupational disciplinary team. The course had to (CDAD), pandemic influenza and Medicine, Faculty of Medicine, meet a diverse variety of learner needs, other communicable diseases. Appro- University of British Columbia be relevant to day-to-day practice, be priately applied infection control and accessible, as well as fulfill healthcare occupational health (OH) practices Deirdre Maultsaid, MEd guidelines for both infection control protect patients and healthcare workers Department of Pathology, and occupational health. The course (HCWs) from exposure to these and University of British Columbia was designed to be interactive and uses other common health care-associated Bruce Gamage, RN, BSc a wide variety of techniques to engage infections (HAI) such as antibiotic- (Micro), BSN, CIC the learner such as video clips resistant organisms (ARO). Tools for Provincial Infection Control describing use of personal protective teaching and reinforcing IPAC Network, Provincial Health equipment, and drop-and-drag practices need to be effective, Services Authority technology. Since implementation in consistent, and accessible.1-6 2006, the course has been endorsed by Unfortunately, the methods used to Margaret Landstrom, MA stakeholders and used in staff clinical deliver IPAC and OH information vary Learning and Development, orientations, for residents, for student across health districts and even within Children’s and Women’s Health placements, and for physicians as part facilities. Demanding workload, shift Centre of British Columbia of their hospital privileges, as well as work and other time constraints limit healthcare workers across the health the amount of IPAC and OH information Justin LoChang, BSc authority. Results of the user satisfaction that can be presented at group sessions, Division of Occupational survey (N=280) showed that the course and information on websites or in Medicine, Faculty of Medicine, was relevant and simple to navigate. manuals does not always fully address University of British Columbia Observations (N=117) of personal the educational needs of HCWs on protective equipment donning and issues such as proper personal protective Chun-Yip Hon, MSc (A), CRSP, doffing of staff post-course showed equipment (PPE) selection and use. CIH that the module effectively transferred Computer-assisted learning has the Worksafe & Wellness, Vancouver Coastal Health knowledge. Analysis of the potential to overcome these limita- interview results (N=50) suggested tions through multi-disciplinary course Correspondence to: that making the course required would design, self-paced learning, flexibility Dr. Elizabeth Bryce be seen as an incentive and visible in scheduling time to learn, and by JPN 1111 Microbiology and sign of management commitment to breaking down the barriers of Infection Control safety. Development of the module geographical location, hours of work, Vancouver General Hospital was instructive both for the learners and professional domains. 899 West 12th Ave and the online infection control/educa- This article outlines the steps taken Vancouver BC V5Z 1M9 tion team. The implementation process to deliver standardized IPAC and OH provided insight into how best to training to all HCWs across a deliver and evaluate healthcare content Canadian health authority, using an while ensuring that the product is user multi-disciplinary team, from a variety friendly. The process underscored the of health settings. The goals of this importance of engaging key stakeholders. team were to: (a) create a module that With this course, learning of infection was relevant to day-to-day practice, control principles has been made more accessible, clearly understood, efficient and enjoyable. consistent, and effective in transferring

Continued on page 230

228 WINTER 2008 • The Canadian Journal of Infection Control Click Here to return to Table of Contents knowledge; (b) achieve acceptance • Advice from content experts Implementation and regular use of the course; and (c) and policy decision-makers. In 2004-2005, a multi-site pilot was demonstrate that the course transferred • Literature review of best conducted (in acute, long term, and knowledge effectively. practices in self-paced online community settings with funding learning and adult education. by the Canadian Nursing Advisory Planning • Baseline annual rates of Council) to analyze the technical and The online infection control module Clostridium difficile (CDAD), delivery challenges for the module as was developed collaboratively, in Methicillin Resistant Staphylo- well as knowledge transfer of content. a multi-agency team consisting of coccus aureus (MRSA), Van- Revisions and improvements to the educators, professionals from IPAC, comycin Resistant Enterococci module were made based on user OH, and continuing medical education. (VRE) in acute care facilities as feedback, and then launched on the The team agreed that: 1) healthcare documented in Infection learning management system in March acquired infections and outbreaks must Control reports and the 2006. In addition, a Canadian Institutes be efficiently controlled; 2) training of Canadian Nosocomial Infection of Health Research grant was received, all staff in infection control principles Surveillance Program. permitting a detailed evaluation of the and routine practices is imperative, and module over time (from 2005 to 2008). would be one useful way of prevent- Creation of the ModulE Ongoing evaluation resulted in a third ing transmission; and 3) any course Content for the module was originally revision to the module in March 2008, outcomes should match the overall developed by four members representing including a more rigorous pre and post infection control program expectations IPAC and OH and then disseminated quiz. At that time, the team assigned for healthcare worker competencies. to a larger group of Infection Control joint copyright and licensed the course In order to develop an appropriate Professionals (ICPs), Occupational through the Creative Commons™ so intervention that would meet a diverse Health Professionals (OHPs), educators that the module could be shared with variety of learner needs, as well as and physicians for critical review. The other healthcare providers. fulfill healthcare guidelines for both learning outcomes of the module were: 1) infection control and occupational be aware of the importance of infection Outcomes health, the team had to collate many control; 2) be familiar with and apply As part of the planning phase, four resources and confirm their philosophical routine infection control precautions outcomes were identified as indicators approach to the proposed training. The as part of daily practice; 3) know how of success of the online learning project. team used: and when to use personal protective These were: a) obtain and demonstrate • Educational evaluations from barriers; and 4) be able to describe the acceptance by key facility stakeholders; previous Infection Control edu- various types of isolation. b) assess, evaluate and document cational programs. The course was designed to be improvement in infection control • Staff orientation reports, from interactive and uses a wide variety knowledge after course completion; the Health Authority Employee of techniques to engage the learner c) document user satisfaction post-course; Engagement department. such as video clips describing appro- and d); increase the number of HCWs • Business intelligence on the priate selection and use of PPE, drop that are taught the basic principles of numbers and occupational and drag technology and animation infection control. distribution of staff. (Figures 1-3). The module chapters • Infection Control and Occupa- are: 1) Basic principles of Infection a) Obtain and demonstrate tional Health guidelines from Control; 2) Hand Hygiene; 3) Per- acceptance by key facility the Public Health Agency of sonal Protective Equipment; 4) Body stakeholders: Canada (PHAC), and Fluid Exposures and Clean Up; and 5) Endorsement to support the on-line WorkSafe BC. Isolation. Learning is self-paced and course was sought from various internal • Evidence on trends in infection the modular format allows learners to departments and partnership agencies control education from literature enter, exit and repeat any point in the in an effort to not only achieve but also searches of peer-reviewed course (through bookmarks). Learners demonstrate acceptance by key facility medical journals. are guided through the chapters with stakeholders. Vancouver Coastal Health • Fact-finding discussions with clearly marked navigation buttons (VCH) Learning and Development medical schools, nursing including help buttons. The module provided an hour of dedicated computer colleges, and allied health is hosted on the Vancouver Coastal time for the online course as new staff professionals regarding the Health Authority Course Catalogue clinical orientation sessions while the presence of infection control and Registration System, which allows each Health Services Placement Network occupational health material in learner to access their educational record of British Columbia made the course their programs. and permits tracking of participants.7 required reading for nursing and

230 WINTER 2008 • The Canadian Journal of Infection Control Click Here to return to Table of Contents 0806-2405E Avagard Ad:mj 6/18/08 3:05 PM Page 1

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Can otherSurgical Scrubs Say asmuch? PIDAC states “Perform surgical hand antisepsis using …an alcohol-based hand rub, with a product ensuring sustained Persistence activity…”1 AORN agrees that for surgical hand antisepsis “… I am made to last the antiseptic agent should be broad spectrum, fast acting, and have a persistent effect.”2 According to WHO and CDC guidelines, “Chlorhexidine has substantial residual activity. Addition of low concentrations Chlorhexidine (0.5% - 1.0%) of chlorhexidine to alcohol-based preparations I contain two active ingredients results in greater residual activity than alcohol alone.”3,4 It is well established that alcohol alone has no persistent effect. Both the WHO and the CDC state: “Alcohols are rapidly Alcohol germicidal when applied to the skin, but they have no I’m not just another alcohol appreciable persistent (i.e., residual) activity.”3,4 3MTM AvagardTM CHG has clinical studies demonstrating its fast, effective, persistent, and cumulative activity.5,6,7,8 Evidence Based This product has been issued the Drug Identification Number I’m clinically proven (DIN: 02246888) for the use as a Waterless Surgical Scrub. How does your surgical scrub compare?

References: 1. Best Practices for Hand Hygiene in all Health Care Settings, Provincial Infectious Diseases Advisory Committee (PIDAC) Ministry of Health and Long-Term Care, May, 2008. 2. Perioperative Standards and Recommended Practices, Association ofperiOperative Registered Nurses (AORN), 2008 Edition. Health Care Health Care 3. WHO Guideline on Hand Hygiene in Health Care (Advanced Draft) 2006 4. Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control 3M Canada Company 3M Centre, Building Practices Advisory Committee and the HICP AC/SHEA/APIC/IDSA Hand Hygiene Task Force (CDC MMWR October 25, 2002 / Vol. 51 / No. RR-16) Post Office Box 5757 275-4W-02 5. G. Mulberry et al, “Evaluation of a Waterless, Scrubless, Chlorhexidine Gluconate/Ethanol Surgical Scrub for Antimicrobial Efficacy”, Am. J. of Infection Control 29 (Dec 2001): 377-82. 6. E. Larson et al, “Comparison of Different Regimens for Surgical Hand Preparation”, London, Ontario N6A 4T1 St. Paul, MN 55144-1000 AORN Journal 73:2 (2001): 412-432. 7. Data on file (LIMS 8257), 3M Health Care. Canada U.S.A. 8. Data on file (LIMS 7801), 3M Health Care. 1 800-364-3577 3M and Avagard are trademarks of 3M. Used under license in Canada. 3 www.3M.com/ca/healthcare © 2008, 3M. All rights reserved. 0806-2405E

Click Here to return to Table of Contents The Canadian Journal of Infection Control • Winter 2008 231 allied health student placements. The Therefore, including physicians in the module. HCWs were evaluated in Dean’s Office for Undergraduate same policies that apply to other health a realistic setting for their ability Education at the University of British professionals was felt to merit serious to select the appropriate PPE, as Columbia required that the course be consideration. This was supported by well as don and doff the equipment completed prior to the third year of a the regional Medical Advisory Commit- in the correct sequence without medical student’s clinical rotation and tee who mandated the course as part of contaminating themselves. It was found the Medical Residency Committee yearly physician privileges. The Univer- that the module effectively transferred made the course a component of sity of British Columbia Department of knowledge on both PPE selection and the residents’ Final In-training Continuing Professional Development sequence of putting on and taking off Evaluation Report. The College of approved the course for Royal College equipment. The greatest improvement Registered Nurses of BC accepted the Maintenance of Certification (section 1; in PPE selection was in the droplet course for professional development 2007) physician credits providing addi- scenario group, the most complex credit towards recertification and tional incentive for doctors to complete of the clinical situations. An overall the Canadian Council on Health the module. improvement (35%) for all clinical Service Accreditation (Accreditation scenarios was found in those HCWs Canada) cited the course as a “leading b) Assess, evaluate and with less than one year’s experience. practice”.8 The team of infection document improvement Interestingly, the course had the added benefit of increasing awareness of control, occupational health and in knowledge after course education experts, who developed and the importance of hand hygiene in implemented the course, has won a completion: all professions regardless of years of 2008 Award of Merit for collaboration, Several targeted approaches were used experience.16-17 from the Health Employers to evaluate the course and to assess the Association of British Columbia. quality of the project. These included c) Document customer Physicians are one of the health- quizzes/tests and observations of satisfaction post-course: care professions known to have less participants. The pre- and post-test A generic user satisfaction survey was compliance with infection control results demonstrated a statistically employed as well as a survey specific practices.9-12 As noted by Fordis et al., significant increase in post-test scores for determining content relevance, evidence indicates that online learning (pre-average = 18.2, post-average intent to comply with infection control is increasing among physicians, and = 21.8, p<0.01). There were no procedures after taking the course, and that online continuing medical educa- significant differences in scores when barriers, and facilitators to adhering tion can produce changes in physi- stratified by age, occupation, or years to IC best practice. Results of the 14-15 cian knowledge comparable to those of experience. user satisfaction survey (n=280) achievable with appropriately designed During clinical orientation sessions showed that the course was relevant, live interventions and changes in for new hospital staff, 117 participants enjoyable, and simple to navigate.14-15 behaviour that have an impact on were asked to apply either airborne, The module was considered effective, patient care.5 Physicians can also serve droplet or contact precautions during able to sustain the participant’s interest as important role models for other mock clinical scenarios prior to and and indeed, scored high on almost all members of the healthcare team.13 immediately after taking the online aspects of user satisfaction. Of note,

Figure 1: Infection Control Basics Figure 2: Example of participant Figure 3: Example of embedded module (example of drag and paced learning (cursor-driven video demonstrations drop activity) explanations of hand hygiene)

Continued on page 235

232 WINTER 2008 • The Canadian Journal of Infection Control Click Here to return to Table of Contents

Hollister CDiff 909958_1007:Layout 1 11/21/08 11:46 AM Page 1

Clostridium difficile: Now New Strain, New Strategies Available On-Line!

Hollister Incorporated in conjunction with the American Association of Critical-Care Nurses (AACN) is proud to present:

Clostridium difficile: New Strain, New Strategies Susan Steele, RN, MS, CWOCN Paul Walaszek, Pharm.D.

This educational program was originally presented at AACN's 2007 National Teaching Institute and Critical Care Exposition and is now available on-line! This program is approved for 1.0 contact hour.*

After viewing this program, participants will be able to: • Explain the continuum of Clostridium difficile (C. diff) infection • Identify risk factors for the development of symptomatic C. diff infection • Discuss pharmacologic and non-pharmacologic research advances in the care of persons with C. diff infection

Visit www.aacn.org/hollisterce.htm to access this CE program.

* The American Association of Critical-Care Nurses (AACN) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. AACN has been approved as a provider of continuing education in nursing by the State Boards of Nursing of Alabama (#ABNP0062), California (#01036), and Louisiana (#ABN12). AACN programming meets the standards for most other states requiring mandatory continuing education credit for relicensure.

AACN is a trademark of the American Association of Critical-Care Nurses. Hollister and logo, and “Attention to Detail, Attention to Life.” are trademarks of Hollister Incorporated. ©2007 Hollister Incorporated. 909958-1007 www.hollister.com Hollister CDiff 909958_1007:Layout 1 11/21/08 11:46 AM Page 1

those who were mandated to take the team. During the development pro- Infection Control and Clostridium difficile: course stated that they were more cess, knowledge regarding delivery Epidemiology. 2nd ed. Now New Strain, New Strategies likely to comply with infection control of healthcare education using web- Washington, DC; 2005: 11-1-17. guidelines and rated the safety climate based technology and techniques, 4. Pullen D. An evaluative case study Available On-Line! in their organization as higher than and the use of learning management of online learning for healthcare those who took the course voluntarily, systems to convey material to a wide professionals. J Contin Educ Nurs suggesting that mandatory course audience was enhanced throughout the 2006; 37: 226-32. completion should only enhance the region. The implementation process 5. Fordis M, King J, Ballantyne C, Hollister Incorporated in conjunction with the American Association facility’s safety culture. also provided insight into how best to Jones P, Schneider K, Spann S, Key informant interviewees deliver and evaluate healthcare content Greenberg S, Greisinger A. Com- of Critical-Care Nurses (AACN) is proud to present: (N=50), praised the module’s utility while ensuring that the product is user parison of the instructional efficacy as both a refresher on IPAC and as friendly. It also underscored the of Internet-based CME with live a means of delivering new content. importance of engaging key stake- interactive CME workshops: a Clostridium difficile: Barriers to engaging in online holders, documenting their endorse- randomized controlled trial. JAMA education cited by interviewees ment of the course, and ensuring that 2005; 294: 43-51. New Strain, New Strategies included high workload, limited the various professions were aware of 6. Desai N, Philpott-Howard J, Wade Susan Steele, RN, MS, CWOCN availability of computers, and limited this support. User feedback illustrated J, Casewell M. Infection control technology based skills. The lack of the importance of careful construction training: evaluation of a computer- Paul Walaszek, Pharm.D. time available at work to engage in of quiz questions to accurately reflect assisted learning package. J Hosp education was identified as a pervasive course content and participant learn- Infect 2000; 44:193-9. organizational barrier. Analysis of ing. Receiving the grant to assess the 7. Vancouver Coastal Health Authority, This educational program was originally presented at AACN's 2007 National the interview results suggested that module was critical in evaluating the Occupational Health and Safety making the course required (seen key indicators, as fiscal restraints within Teaching Institute and Critical Care Exposition and is now available on-line! Agency for Healthcare in British as an incentive and visible sign the region would have otherwise Columbia, Provincial Health Ser- This program is approved for 1.0 contact hour.* of management commitment to made this impossible. vices Authority. Infection Control safety), providing dedicated time to Learning of infection prevention Basics [internet]. Creative Com- After viewing this program, participants will be able to: complete the course, and ensuring that and control principles has been made mons A, ND, NC, 2008. Available computers were available to take the more efficient, economical, effective • Explain the continuum of Clostridium difficile (C. diff) infection at: http://picnetbc.ca/page220.htm. module were important measures in and enjoyable, while minimizing the (Accessed November 3, 2008). • Identify risk factors for the development of symptomatic C. diff infection ensuring that HCWs completed the barriers of varying professional needs, 8. Accreditation Canada. Leading course.18-19 geographic barriers and time-con- • Discuss pharmacologic and non-pharmacologic research advances in Practices [internet]. Standard d) Increase the number of straints. The overwhelmingly positive Area: Environment; Organization: the care of persons with C. diff infection HCWs who are taught the response to the on-line module has Vancouver Coastal Health Authority. spread outside our Health Authority Ottawa: Accreditation Canada, basic principles of infection boundary – the module is now being Visit www.aacn.org/hollisterce.htm to control: 2006. Available from: http://www. used in other facilities – leading the cchsa.ca/LPSearch.aspx (Accessed Our target was to increase the access this CE program. team to believe that, at least in this November 3, 2008). number of learners accessing infection case, learning is contagious. 9. Michalsen A, Delclos G, Felknor control knowledge by 25% (N=300 S, Davidson AL, Johnson P, Vesley additional learners/year compared to References D et al. Compliance with universal 1500 HCWs reached by five minutes 1. Caffarella, RS. Planning Programs precautions among physicians. J of traditional teaching at orientation). for Adult Learners: A Practical Occup Environ Med 1997; 39:130-7. The team thus increased the uptake Guide for Educators, Trainers, and 10. Pittet D, Mourouga P, Perneger of new learners by a very gratifying Staff Developers. 2nd Ed; TV. Compliance with hand wash- 900 additional personnel a year, far in Hoboken, NJ: John Wiley and ing in a teaching hospital infection excess of the original target of a 25% Sons; 2001. control program. Ann Intern Med increase. Importantly, the material 2. Tilleczek K, Pong R and Caty 1999; 130:126-30. covered was much more comprehensive S. Innovations and issues in the 11. Afif W, Huor P, Brassard P, Loo V. and learners were provided with the delivery of continuing education Compliance with methicillin-resis- ability to self-assess through to nurse practitioners in rural and tant Staphlococcus aureus precau- online quizzes. northern communities. Can J Nurs tions in a teaching hospital. Am J Res 2005; 37(1): 146-162 Infect Control 2002; 30: 430-3. * The American Association of Critical-Care Nurses (AACN) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. Conclusion 3. Carr H, Hinson P. Education and 12. Lipsett P, Swoboda S. Handwashing AACN has been approved as a provider of continuing education in nursing by the State Boards of Nursing of Alabama (#ABNP0062), California (#01036), and Louisiana (#ABN12). AACN Development of the module was training. In: Association for Profes- Compliance Depends on Professional programming meets the standards for most other states requiring mandatory continuing education instructive both for the students and sionals in Infection Control and Status. Surg Infect 2001; 2: 241-245. credit for relicensure. the online infection control/education Epidemiology (Eds). APIC Text of 13. Lankford M, Zembower T, Trick AACN is a trademark of the American Association of Critical-Care Nurses. Continued on page 237 Hollister and logo, and “Attention to Detail, Attention to Life.” are trademarks of Hollister Incorporated. ©2007 Hollister Incorporated. 909958-1007 www.hollister.com Click Here to return to Table of Contents The Canadian Journal of Infection Control • Winter 2008 235

W, Hacek D, Noskin G, Peterson Association-Canada; 2007 June 18. Bryce E, Yassi A, Novak Lauscher L. Influence of role models and 9-14; Edmonton, Canada. H, LoChang J, Choi P. Evaluating hospital design on hand hygiene of 16. Bryce E, Hon C-Y, Yassi A, the effectiveness of an e-learning healthcare workers. Emerg Infect Gamage B, LoChang J, Maultsaid module. Annual Conference of Dis 2003; 9: 217-23. D, Yu S. Infection control elearning: the International Commission on 14. Bryce E, Choi P, Landstrom M, an assessment of the effectiveness Occupational Health; 2007 Oct. LoChang J. Using Online Delivery of an elearning module to transfer 26-28; Vancouver, Canada. for Workplace Training in knowledge on the proper use of 19. Novak Lauscher H, Bryce E, Healthcare. Journal of Distance personal protective equipment. Cressman C, Fong J, Killam R, Education 2008; 22(3): 149-56. Annual Conference of Association of Payne R, Weaver P, Ho K, Kidd C, Available at: http://www.jofde.ca/ Medical Microbiology and Landstrom M, LoChang J, Yassi A. index.php/jde (Accessed October Infectious Diseases; 2008; Feb Making healthcare safer: evaluat- 31, 2008). 27-29; Vancouver, Canada. ing online education to enchance 15. Choi P, Bryce E, LoChang J, 17. Hon CY, Gamage B, LoChang J, infection control practices among Landstrom M, Yassi A, Gamage Bryce E, Yassi A, Maultsaid D, Yu healthcare workers. Annual Con- B. Infection control elearning for S. Personal Protective Equipment ference of Canadian Association healthcare workers: analysis of in Healthcare: Can online infection for Continuing Health Education; learner demographic data. Annual control courses transfer knowledge 2007 Oct 13-15; Quebec City, Conference of Community and and improve proper selection and Canada. Hospital Infection Control use? Am J Infect Control (in press).

3M Canada Infection Prevention Research Grant

As part of an ongoing initiative to promote innovative infection control and prevention practices in Canadian health- care, 3M Canada has created a research grant through its Infection Prevention Platform. The research grant is targeted to individual members of the Community and Hospital Infection Control Association – Canada (CHICA–Canada) for use in research studies. The research grant will be a one-time payment offered on an annual basis.

One research grant of $6,000 to the Principal Investigator of the successful application will be presented at the 2009 CHICA–Canada National Education Conference in St. John’s, Newfoundland Labrador, May 9-14, 2009. Travel, accom- modations and meals will be provided by 3M Canada Company for the successful recipient.

An application form is available at www.chica.org. Deadline date for applications: March 1, 2009.

Applications must be sent to: Or courier to: Secretary/Membership Director Secretary/Membership Director CHICA-Canada, PO Box 46125 RPO Westdale CHICA-Canada, 67 Bergman Crescent Winnipeg MB R3R 3S3 Winnipeg MB R3R 1Y9

Click Here to return to Table of Contents The Canadian Journal of Infection Control • Winter 2008 237 ASSOCIATION NEWS Board of Directors elected Anne board with some trepidation and tremendous excitement. I am honoured to have been appointed president-elect and I Bialachowski, look forward to working with the board and membership. RN, BN, CIC President-elect Judith (Judi) B. (one-year term) Linden, RN, BN, Anne Bialachowski has COHN(C), CIC been a CHICA-Canada Director of Finance member since 1997 and (three-year term) was Chapter President of CHICA HANDIC in 2004- Judi Linden is an Infection 2006. In her current posi- Control Professional at the tion as Network Coordinator for the Central South Infec- Regional Health Authority tion Control Network, she contributes to and maintains of Central Manitoba, located the regional network infrastructure; creates, promotes and in Portage la Prairie. She fosters formal working relationships with stakeholders has been in infection control throughout the region; and assists the for 25 years and a member of CHICA-Canada for 18. Since Network Steering Committee in developing strategic joining the RHA in 1999, her responsibilities have been direction that is clear, measurable and fits within the to identify infection prevention and control training and regional needs. She provides direct supervision to the education needs for all health care settings; to plan, develop four Network staff. Prior to her current responsibilities, and provide programs designed to meet the needs; maintain she was an Infection Control Practitioner at Hamilton the regional Infection Prevention and Control/Occupational Health Sciences Centre. Manual; coordinate regional surveillance programs; act as She has been a member of the Ontario SARS Scientific IP&C resource to RHA Central programs; investigation and Committee in 2003, Chair of the Ontario Regional Infec- management of outbreaks; and follow-up of all occupational tion Control Development Working Group, and a member exposures to blood and high risk body fluids in accordance of the Ontario Provincial Infectious Diseases Advisory with Manitoba Health’s Integrated Post-Exposure Protocol. Committee (2004-present). A founding member of the Provincial Network of Infection Control Practitioners, Ms. Linden chairs the Central Manitoba Philosophy: CHICA-Canada and its chapters provide RHA Infection Prevention and Control Committee and is a a strong national voice for infection control across the member of several health promotion and wellness teams. She continuum of care. Its dedication to the development and is Past President of CHICA Manitoba and has held several implementation of Infection Prevention and Control (IPAC) executive and committee positions in that Chapter, including best practices have made the organization a recognized Treasurer and Finance Committee Chairperson. source of expert information and advice. As provin- cial governments move to implementing patient safety Philosophy: Working in infection prevention and control indicators and public reporting CHICA-Canada will need within a rural setting is challenging. CHICA Canada and the to ensure that their voice continues to be heard in the MB Chapter have allowed me to become involved with a emerging cacophony of information and government passionate and accomplished group of Infection Prevention legislation. I am committed to supporting the existing and Control Professionals. These mentors have been, and cooperative network of providers in our CHICA Chapters continue to be, of great value and assistance to me, dem- who are dedicated to improving the prevention and onstrating leadership while promoting the prevention and control of infections. Our chapters are our strength and control of infection. As CHICA has supported me through it is through them that we will mentor and develop the the years I believe it is important to give back to the organi- next group of IPAC professionals. I am also committed to zation. I have been able to assist the MB Chapter as Trea- the promotion of excellence, integration and continuous surer and Finance Committee Chairperson for nine years improvement in infection prevention and control activities and now I look forward to the challenge of Finance Director across the healthcare spectrum and will support the for CHICA-Canada. I believe the infection prevention and on-going growth of interest groups that support areas control challenges ahead will be less daunting through the where IPAC information continues to evolve such as collaborative efforts and commitment of members involved community settings. I look forward to my term on the locally and as well nationally. Ongoing financial support

238 WINTER 2008 • The Canadian Journal of Infection Control Click Here to return to Table of Contents from members through membership fees and conference a member of the Community and Hospital Infection Control involvement together with support from our industry part- Association Canada (CHICA) and the national lead for the ners will allow us to move forward as an organization in the Safer Healthcare Now! MRSA intervention. In 2008, Dr. commitment to improve health and promote excellence in Gardam became the Director of infectious diseases prevention the practice of infection prevention and control. and control at the newly formed Ontario Agency of Health Protection and Promotion. Michael Gardam, Dr. Gardam has acted as a consultant on infection control issues such as SARS, tuberculosis, pandemic influenza and MSc, MD, CM, C. difficile, at the provincial, national and international level. MSc, FRCPC Within Ontario, he has helped a number of hospitals control Physician Director outbreaks and develop their infection control programs. In terms of pandemic influenza, he is co-chair of the Toronto (three-year term) Academic Health Sciences Network pandemic influenza plan- ning task force as well as a member of numerous provincial Michael Gardam com- and regional pandemic planning committees. pleted his undergraduate Dr. Gardam’s research interests include the molecular and degree, master’s degree, and clinical epidemiology of infectious diseases, as well as health medical school training at policy and program evaluation. McGill University in Mon- treal. He completed training Philosophy: Patient safety has fortunately become a hot- in internal medicine and infectious diseases and became a button issue over the past decade, and finally, there is growing Fellow of the Royal College of Physicians and Surgeons of acceptance of healthcare-associated infections as true, often Canada in infectious diseases in 1998. preventable adverse events. We all know the important role He subsequently moved to Toronto to complete additional we have played in this. If it weren’t for our strong Canadian research training in infection prevention and control and approach to infection prevention and control over the years, completed a second master’s degree in Health Policy, Man- I believe our national situation would be far worse; however, agement, and Evaluation at the University of Toronto in 2003. our frequent reliance on pushing and cajoling will only take us Dr. Gardam has been Medical Director of the tubercu- so far. Infection prevention and control issues largely continue losis clinic at the Toronto Western Hospital since 2000, to remain the domain of ICPs. For our healthcare settings to and Director of the Infection Prevention and Control Unit become safer, infection prevention and control needs to be at the University Health Network since 2001. He is an owned by frontline healthcare workers. We need to explore assistant professor of medicine and faculty at the School of new ways of encouraging their engagement and helping them Public Health Sciences at the University of Toronto. He is discover and implement best practices.

The Registered Nurses’ Foundation of Ontario Molson Canada SARS Memorial Fund providing grants to ICPs

The SARS Memorial Fund for Infection Control Practitioners is a tuition/certification/professional development reimbursement program funded by Molson Canada SARS Concert (2003) and supported by the Ontario Ministry of Health and Long Term Care. RNFOO manages the SARS Memorial Fund, initiated in January 2005. The fund provides grants to Infection Control Practitioners from any discipline to support them in advancing their knowledge to lead infection control practices within their healthcare settings. Grants can be applied to continuing education, certification/re-certifica- tion and professional development. The fund of $175,000 is to be administered over three years, allowing for the allocation of approximately $58,000 per year in support of individual pursuing formal education and certification in the area of infection control. See www.rnfoo.org for details.

Click Here to return to Table of Contents The Canadian Journal of Infection Control • Winter 2008 239 ASSOCIATION NEWS

News from CBIC By Deanie Lancaster

New self-achievement Certification and you test available soon This past summer in Denver, I attempted to make the case The Certification Board of Infection Control and Epidemiology for the importance of certification in infection prevention and has been very busy this year. The Test Committee has worked control. Some of the examples I used were from the American to produce a new computerized Self-Achievement-Recertifica- Association of Critical Care Nurses (AACN), the American tion-Examination which will be made available as an option Board of Nursing Specialties (ABNS), and the American for those who are recertifying during spring of 2009. Since the Society for Clinical Pathology (ASCP). Each of these organi- SARE is a self-test, an attestation statement from the candidate zations actively promotes certification of their members as a will be required stating the answers are solely the work of the way to distinguish their dedication to continual improvement individual completing the test. The computer-based test (CBT) and a sense of professional accomplishment and credibility. will continue to be available at testing sites in the US According to the AACN, ABNS, and ASCP, some of the other and internationally. reasons for becoming certified include: • “State licensure provides the legal authority for an Revised wording on CIC certificates individual to practice nursing; certification…reflects Infection Preventionists (IP) who have recertified this year achievement of a standard beyond licensure for will notice a change in the wording on the certificate. The specialty nursing practice.” (ABSN) phrase “Board Certified in Infection Prevention and Control” • “Better job prospects, higher salaries, the respect of replaces the previous wording as a step toward congruency your colleagues, the confidence from knowing you’re with the changes made by APIC this past summer. fully qualified to be a top-notch laboratory professional… Additional changes to the CBIC name or designation of CIC ultimately the benefit is of course, the quality of care are not planned now but may be revisited in the future. that patients receive.” (ASCP) • “Certification can serve as a proxy for assessing continued competence since a nationally recognized Elimination of the two-year standard to do so has not been developed.” (AACN) practice requirement The American Nurses Credentialing Center website states CBIC members voted unanimously to eliminate the two-year that “Certification validates specialty knowledge, experience practice requirement for taking the initial certification exami- and clinical judgment.” The Canadian Nurses Association nation. Job responsibilities and tasks must still include those defines certification as the “periodic process by which an required for the clinical practice of infection prevention and organized professional body confirms that a nurse has control. Additionally, the initial examination will still be demonstrated competence in a nursing specialty by having aimed at the two-year IP. All material related to the two-year met the predetermined standards of that specialty.” practice requirement is undergoing revision and will be CBIC receives a number of questions about why the available after January 1, 2009. There are no changes related examination is required every five years rather than through to recertification examinations. the use of continuing education. Continuing education is not the same as competency; competence is an ongoing process requiring repeated measurement. There are advances in Practice analysis participation treatment and technology we must be familiar with and The announcement by CMS that US hospitals will no longer no oversight system exists to ensure continued growth in be reimbursed for certain hospital-acquired conditions, includ- knowledge, skills and performance. ing three infections, has intensified the need to concentrate Most of you are likely familiar with Drs. Elaine Larson on prevention. Our practice is changing at warp speed and we and William Rutala who are internationally recognized find we must continually reassess and update our knowledge of for their published research on topics related to infection what is included in our day-to-day activities related to infection prevention and control. Dr. Larson also edits the American prevention and control. Due to the evolving nature of our work, Journal of Infection Control (AJIC) is the Associate Dean CBIC is considering soliciting your participation in a Practice for Research and Professor of Pharmaceutical and Therapeutic Analysis during 2009. The importance of your participation Research at Columbia University School of Nursing. Dr. in this project cannot be overemphasized because the findings Rutala is a Professor of Infectious Diseases at the University of the Practice Analysis are used to develop the certification Of North Carolina (UNC) in Chapel Hill and also serves as examination questions. We will need to know the activities and Director of Hospital Epidemiology for the UNC Hospitals. knowledge required of you and your peers, so please watch for Barbara Soule, who was the APIC President in 2003, now future information about the Practice Analysis. serves as the Practice Leader in Infection Prevention and

240 WINTER 2008 • The Canadian Journal of Infection Control Click Here to return to Table of Contents Control for Joint Commission Resources. She was also the control. Why do they continue to maintain their certification first Editor in Chief of the APIC Curriculum and continues when each could probably rest on their past successes? They to serve on the AJIC Editorial Board. You will likely have respect the certification process and value the knowledge heard Louise Kuhny’s name mentioned in association with mastery it represents to their colleagues. The Joint Commission. She is the Senior Associate Director During the coming year, I encourage you to consider of Standards Interpretation at The Joint Commission and has taking the certification examination. Who wouldn’t want an MPH and an MBA. to be among those listed as certified in infection pre- What do Drs. Larson and Rutala, Barbara Soule and vention and control along with all these well-respected Louise Kuhny have in common? All of these well-known individuals? individuals are board certified in infection prevention and

The streams for the forum will fall under the following areas: • Applied Learning • Infection Prevention and Control • Medication Safety • Patients and Family Involvement • Patient Safety in Physician Practice • Technology and Patient Safety Save the date For further information, please visit our website at: Canada’s Forum on Patient http://www.patientsafetyinstitute.ca/news/canada_ Safety and Quality Improvement forum_2009.html April 28-30, 2009

With the increasing national and international focus on patient safety, the need for a broad forum for learning has been identified. Canada’s Forum on Patient Safety and Quality Improvement will provide multiple learning streams with a national and international flavour. The program for the forum will provide opportunity for a variety of professionals to participate, including, but not limited to, physicians, nurses, pharmacists, health care providers, educators, leaders, researchers, and board members.

A few of the exciting speakers you will see at this event are: Helen Bevan, Director of Service Transformation, NHS Institute for Innovation and Improvement; Lise Mathieu, Retired Major General, Canadian Forces; Commander of the Canadian Forces Health System.

Click Here to return to Table of Contents The Canadian Journal of Infection Control • Winter 2008 241 ASSOCIATION NEWS

Member Profile: Ramona Rodrigues, ICP investigator

orking as a nurse on Montreal colleagues the local CHICA last year. It is now up to the ministry to the infant medicine chapter. “At the time, we felt the best grant a pay scale and title. unit at Montreal way to get Quebec on board with “We’ve convinced the order, the Children’s Hospital CHICA was to create a Montreal chap- order has obtained the health minister’s Wgot Ramona Rodrigues interested ter.” She was on the chapter executive agreement to recognize the special- in infection prevention and control. from the beginning until last year. ization. Now we have yet to convince The McGill Infection Prevention and “The early days of infection con- the ministry to set a separate pay scale Control Program manager and assistant trol were tough. It took a lot of hard and title for the specialization. It’s professor was often the nurse in charge, work to be recognized. We weren’t frustrating when the rest of Canada is and also worked as a preceptor, so she given the same recognition as clini- not where we’d like to go. It’s a tough got to work closely with the specialists cal nurse specialists. Risk manage- battle, but I hope to see this happen in and consultants on the ward. One of ment and quality assurance weren’t my career.” these specialists was the ICP. being discussed then. It was hard to Rodrigues believes ICPs are spe- “I always worked very closely convince people to implement cialists and should carry the master’s with her, and she really got me prevention strategies.” degrees skill sets. It takes five years interested in infection control,” says Rodrigues credits her experience of experience to fully understand the Rodrigues. “One day she told me her in pediatrics for her smooth transition profession. Quebec also has some position was coming up, and asked if to adult care in infection control. She differences with regards to the profes- I was interested in applying. I got the found that in pediatrics, people were sion. “In Quebec, only nurses can be job, and that’s how I got involved.” more willing to listen and participate ICPs and the order has made this At the time, there were not any IC in making life for the child and family statement clear.” courses offered in colleges or uni- easy. In adult wards, she didn’t find Behaviour change is the biggest issue versities, so she was sent to the CDC the same willingness to look at risk facing ICPs today, says Rodrigues. in Atlanta for training. “That was and prevention. “I’m so glad I started “Knowledge isn’t the issue. People even more exciting to me; I couldn’t off in pediatrics, because you get a are knowledgeable about hand-wash- believe I was being sent there.” sense people are listening to you. ing, etc. Time and workload overtake Always interested in learning They integrate your recommendations behaviour. The challenge is to endorse and getting involved, Rodrigues got even though it was not vocalized in preventive behaviour practices.” involved with Health Canada work- the media or in guidelines. It gave me Life as an ICP is never boring. “It’s ing groups. “This was around the time understanding of behaviour change, like being an investigator,” she says. of blood-borne pathogens at the time so I had a tool in my back pocket “You meet professionals from the of AIDS and figuring out who was when I moved to adults.” hospital CEO to the volunteers and implementing what kind of precau- Outbreaks over the years have construction workers. You visit every tions – disease-specific isolation created an impetus for infection part of the hospital from the attic to the – universal vs. body substance isola- prevention and control to be seen as sub-basement. You have to know about tion.” Then came her involvement significant and important, Rodrigues ventilation and building function. The with Quebec’s expert group drafting says. She got involved in getting IC job is not about sitting and collecting guidelines and working on the recognized as a specialization with data. That’s part of it, but you have to provincial surveillance program. the Order of Nurses of Quebec. The see the bigger picture. And how you Rodrigues also pioneered with her order recognized the specialization use the data is exciting.”

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ASSOCIATION NEWS

Dr. Lynn Johnston receives Gold-Headed Cane Award

n September, Dr. Lynn Johnston of Dr. Johnston advocates evidence- Halifax received the Gold-Headed based medicine and maintains high Cane Award for medical profes- clinical standards. She is a respected sionalism from the College of Phy- voice of the profession and is highly Isicians and Surgeons of Nova Scotia. regarded by her patients, peers, Dr. Johnston is an infectious students, and co-workers. She has disease specialist, and has been a achieved national recognition as a faculty member of the Dalhousie leader, and is passionate about edu- University Department of Medicine cation and research. since 1987. She Professor of Medi- The Gold-Headed Cane is cine and Division Chief, Infectious awarded jointly by the College and Diseases and Hospital Epidemiologist at the Humanities in Medicine Program the Capital District Health Authority, at Dalhousie University. The award works with the department of Com- recognizes a Nova Scotia physician munity Health and Epidemiology, who exemplifies selflessness, excel- and consultants at the IWK Health lence, service and integrity in the Centre. Dr. Johnston is a former practice of medicine. CHICA-Canada board member.

Roadshows announced

HICA-CANADA is tions with the focus on Clostridium Blood Stream Infections (CR-BSIs). pleased to continue its part- difficile (C.diff) and Catheter-Related CHICA-Canada President Marion nership with BD Canada Blood Stream Infections (CR-BSIs). Yetman said, “The success of the 2008 to provide a series of Participants will gain knowledge and MRSA seminars is evidence of the need Ceducational webinars and roadshows. access to information that is accurate, for these types of educational opportu- BD and CHICA-Canada will launch a timely and useful for infection preven- nities. CHICA-Canada is pleased to be multi-pronged educational leadership tion and control practices within each able to provide these events to its mem- initiative, to include national webinars of their institutions. bers and colleagues through a strong and regional road shows, to help with In early 2009, roadshows will be collaboration with BD.” CHICA-Canada’s commitment to held in Halifax (Friday, February 20; The roadshows/webinars program, the reduction of Clostridium difficile venue to be announced) and North Bay sponsored by BD (Becton, Dickinson (C.diff ) and educate on the topic of (venue and date to be announced). The and Company), is aimed at both clini- Catheter-Related Blood Stream Infec- programs will feature nationally recog- cians and healthcare executives faced tions (CR-BSIs) in Canada. nized infection prevention and control with the clinical and financial impact of Following the success of the 2008 professionals and physicians/microbi- C. diff and CR-BSIs in their facilities. MRSA series, a new schedule of ologists discussing the consequences “BD is proud to work jointly with roadshows and webinars has been of healthcare-associated Clostridium CHICA-Canada on this important planned to provide information difficile, an increasingly prevalent and initiative,” said James Glasscock, around current issues in infection pre- deadly organism in healthcare facilities. Country General Manager of BD. “As vention and control. The roadshows/ In addition, CHICA-Canada and BD it is central to our commitment at BD to webinars are designed to educate will host a series of national webinars prevent healthcare-associated infections healthcare professionals and health- (tentatively scheduled for January, Feb- and help all people live healthy lives.” care administrators on decreasing the ruary and March 2009). The focus of For further information, visit rate of healthcare-associated infec- the webinars will be Catheter-Related www.chica.org

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2009 National Education Conference

Registration brochure Conference hotel Watch for the Registration brochure to be posted in December Delta St. John’s 2008 and mailed in January 2009. 120 New Gower Street ONLINE REGISTRATION IS COMING! WATCH FOR St. John’s, Newfoundland Labrador A1C 6K4 OUR ANNOUNCEMENT COMING SOON! Single/Double Occupancy: $163 2009 Scientific Program Committee Additional person sharing a room: $20 per night. No charge Conference Chair for up to two children 18 years old and sharing their parents’ Joanne Laalo, RN, BScN, CIC accommodation. The maximum legal number of occupants Central South Infection Control Network, Dundas, Ontario is four. (Plus Marketing Tourism Levy of 3% per room per night and Provincial Sales Tax of 13%.) Scientific Program Chair

Donna Moralejo, PhD Register online at www.deltastjohns.com/gcchica Memorial University School of Nursing, St. John’s, Newfoundland Labrador Individual reservations: 1-800-268-1133. Identify the 2009 Scientific Program Co-chair Community and Hospital Infection Control Association Jim Gauthier, MLT, CIC (CHICA). Deadline: March 13, 2009. Providence Care, Kingston, Ontario 2009 Education Conference exhibit Scientific Program Committee and sponsorship opportunities Molly Blake, BN, MNS, GCN(C), CIC An Industry Showcase will be held to give attendees the Health Sciences Centre, Winnipeg, Manitoba opportunity for further knowledge and education through Lee Hanna, RN, CIC viewing and discussion of products and services in the field Good Samaritan Society, Edmonton, Alberta of infection prevention and control. Exhibit information Penny Ralph, RN, CIC packages will be available in the autumn of 2008. Booth Central Health rentals are $1,800 each (6´x10´ booth) plus GST. Set up: Grand Falls-Windsor, Newfoundland Labrador Monday, May 11; tear down Wednesday, May 13. Guidelines for sponsorship of the conference are available Diane Roscoe, MD, FRCPC from CHICA-Canada. Sponsors of the conference benefit Vancouver General Hospital/Vancouver Coastal Health, from additional promotion of their company as well as direct Vancouver, British Columbia benefits through discounted booth fees, complimentary reg- Merlee Steele-Rodway, RN istration, and the opportunity to hold a mini symposium with City Hospitals – Eastern Health, St. John’s, Newfoundland specific product information. For more information, contact Labrador CHICA-Canada Conference Planner. Marion Yetman, RN, BN, MN, CIC Department of Health and Community Services Rally in the Alley Government of Newfoundland Labrador, St. John’s, Wednesday, May 13, 2009 Newfoundland Labrador You will be accompanied from the Delta St. John’s to famous George Street where you will: Experience the fun and cama- raderie of St. John’s. Enjoy a lobster dinner,* learn local step

246 WINTER 2008 • The Canadian Journal of Infection Control Click Here to return to Table of Contents dancing, learn some local songs and be welcomed into the House, and the history surrounding the Colonial Building. Order of Screechers! It is a time to be remembered for years Discover the history, legend and lore of St. John’s, the oldest to come. community in North America.

Fee $95.00 per person (includes HST) Fees include: opening SPEAKER, Tuesday, May 12 Lobster Dinner, entrance to pubs, one complimentary Linda Duxbury beverage at each location, a shot of Screech, musicians to lead each group, and entertainment at each venue. You, Me and Them - Understanding Generational *Chicken or vegetarian alternates available on request Differences In The Workplace (See Registration Form January 2009). (Lobster is traditionally served cold – banquet style). closing SPEAKER, Thursday, May 14 Michael Borg M.D., M.Sc. (Lond), DLSHTM, MMCPath Sightseeing tour President, International Federation of Infection Control City of Legends – The Far East of the Western World Overcoming Limited IP&C Resources: How IP&C is Tuesday, May 12, 2009 established and sustained when resources are limited – a Leaving from Delta St. John’s 6:00 p.m. Returning 8:30 p.m. global view. $50 per person plus HST (includes a brown bag snack) Visit the National Park at Cape Spear, the most easterly point of land in North America. See the original lighthouse portrayed in the conference logo. Stand with your back to the Atlantic and face every other being in North America – or turn your back on them. The choice is yours! In St. John’s, see the Cabot Tower, Signal Hill and Quidi Vidi. Hear the legends of Dead Man’s Pond, Government

CHICA-CANADA STRATEGIC PLAN 2010-2015

HICA-Canada is currently in the process of Dr. David Sheridan is a preparing for the next phase of strategic planning, seasoned management con- the 2010-2015 objectives. sultant, credentialed planner In 1989, a five-year strategic plan was estab- and accomplished process Clished. The board and chapter presidents have reviewed and facilitator with an international updated the plan regularly with major changes in the format profile in research, strategic occurring in 2000 and 2004. The 2010-2015 revision will planning and governance for require major input from both internal and external stake- public sector and non-profit holders. To assist with this project, Dr. David Sheridan of organizations. He has a strong Oakville, Ontario has been contracted to facilitate the project background in health care in liaison with Gerry Hansen, Executive Administrator. and has worked with count- Dr. David Sheridan Preparation for strategic planning discussions will include less human service organiza- surveys and interviews with representatives of membership, tions, educational institutions, municipalities, provincial and industry partners, and external stakeholders. The board and national associations, networks, community groups, regula- chapter presidents will participate in a two-day strategic tory bodies and all levels of government. planning retreat to take place May 7-8 immediately preced- His 1998 University of Toronto doctoral thesis on ing the 2009 National Education Conference. The proposed not-for-profit strategic planning won a major international approach calls for a well-researched, inclusive and concep- planning award and a prestigious Canadian research award. tually grounded process leading to a strategic plan that is The unique strategic planning model developed through that relevant, vital, realistic, and supported by the association’s research now been adopted by more than 50 not-for-profit internal and external stakeholders. and public sector organizations in Canada and the United More information on the process of strategic planning for States, ranging from small volunteer organizations to the 2010-2015 will be announced as plans progress. government of the State of Maryland.

Click Here to return to Table of Contents The Canadian Journal of Infection Control • Winter 2008 247

CHICA-CANADA PRODUCTS CHICA-Canada Infection Control Audit Toolkit ESBL TOOLKIT

Available from CHICA-Canada through the CHICA- Best Infection Control Canada Programs and Projects Committee, this series of Practices for Patients with infection control audit templates will assist you in your Extended Spectrum Beta practice of infection prevention and control in a variety Lactamase Enterobacteria- of health care settings. Topics include: cae – An infection control • Dental Audit toolkit developed by the • Endoscopy Audit International Infection • Haemodialysis Unit Audit Control Council (APIC, • High Level Disinfection - Outside SPD Audit CHICA-Canada, ICNA • Infection Prevention and Control Risk Assessment (UK, Ireland)). Guide • Hospital-wide Infection Control and Prevention Audit and Template • Opthalmology O.R. Cluster Investigation and Proce- dure Assessment “Just Wash ‘Em “Lavez les” • O.R. Audit • Patient/Resident Service Units Audit A 7 minute video directed to Elementary School aged children. • Renal Unit Infection Control Audit • Respiratory Outbreaks in Long Term Care Facilities Reaching today’s kids Audit with our all-important handwashing message is Enhanced Teleclass Recordings on CD a major step in preventing the spread of infection. Available exclusively from CHICA-Canada in partner- CHICA-Canada’s very ship with Webber Training Inc. Topics include: own Sudsy makes his Disinfecting Patient Care Equipment; Exploring CDC debut in a creative, fun- Hand Hygiene Guidelines; Airborne Spread of Human to-watch handwashing Pathogens; Disinfectants in Infection Control; Hands and video aimed at school-aged children. Great for school the Spread of Human Pathogens; Current Best Practices projects, seminars and demonstrations. in Hand Hygiene; Hand Sanitizers and their Effect on Viruses; Innovations in Hand Hygiene; Influenza Pan- demic on the Doorstep; Controlling MRSA and VRE; The Infection Control Toolkit: Scientific Solutions to the Norovirus Problem; Strategies Infection Control in Emergencies and Disasters for Norovirus Infection Control on Cruise Ships; Relative revised 2007 (formerly: Infection Control Toolkit: Strategies for Pandemics and Disasters) Impact of Hand Hygiene on Healthcare-Associated Infec- The only disaster planning document that presents tions; Evidence Behind Control Measures for MRSA information specific to the key issues of infection control. and VRE; Environmental Infection Control in Healthcare Includes all the tools and materials necessary for surveil- Facilities; Hand Hygiene – Different Approaches; Anti- lance, education, communication, laboratory, and man- septic Practice and Procedure; Glutaraldehyde Toxicol- agement of personnel and patients are included. Handy ogy and Management of Risk; New WHO Hand Hygiene forms, references, fact sheets, flowcharts, checklists, and Guidelines; Respiratory and GI Outbreaks in LTC; Bio- samples provide the framework to interface with health- films in our Environment; Infection Control in Day Care care facilities and local public health preparedness plans. Facilities; Disease Transmission in the Home; Hands and No other disaster planning document presents informa- Viral Infections; Infection Control in Long Term Care; tion specific to the key issues of infection control. Innovations in Hand Hygiene; Preventing MRSA and VRE; Advances in Global Infection Control; Bedside Hand Hygiene Products; C.difficile and Environmental ARO VIDEO Cleaning; Preventing Ventilator Associated Pneumonia – Applying the Science; C.difficile: Environmental Sur- A 15 minute educational video covering topics related to vival; The Toilet Bowl-Blues; Surface Disinfectants and AROs (epidemiology, surveillance and control). Pro- Environmental Impact; The Spectre of a Flu Pandemic: Is duced in cooperation with Wyeth, with assistance from it Inevitable? CHICA-Canada members.

Click Here to return to Table of Contents The Canadian Journal of Infection Control • Winter 2008 249 Some prices CHICA-CANADA Product Order Form reduced!

No returns except in the case of defective products when defectice product will be exchanged for corrected product. PRODUCT QUANTITY MEMBER RATE NON-MEMBER RATE TOTAL

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*GST/HST – GST 5% of total amount, including shipping & handling; HST 13% of total amount including shipping & handling (payable by residents of New Brunswick, Newfound- land, Nova Scotia). No GST/HST applicable on orders from outside Canada. BN 11883 3201 RT0001. Send order to: CHICA Canada, PO Box 46125 RPO Westdale, Winnipeg, MB R3R 3S3 • Email: [email protected] • Fax: 1-204-895-9595

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REACH OUR ADVERTISERS

COMPANY PAGE PHONE E-MAIL ADDRESS WEB SITE

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