Volume 17

Infection Control Passport Program Corinne Cameron-Watson Senior Infection Prevention & Control Nurse Barking Havering and Redbridge Acute NHS Trust

Also In This Issue: Over the last few years many hospitals in Eng- decontamination, appropriate use of personal land have seen increasing numbers of Clos- protective clothing, effective environmental hy- tridium difficile infection (CDI) with increased giene and decontamination, waste management, Best Practices for mortality rates. This trend has been reported including sharps and clinical equipment and Infection Prevention and similarly in America and Canada. practice. The epidemiologi and management of Control Programs infections of significance, such as Methicillin in Ontario in All Health Thus, Infection Prevention and Control (IP&C) resistant Staphylococcus aureus (MRSA) ,Clos- Care Settings ...... 2 has never had such a high profile globally, yet tridium difficile, norovirus and blood borne vi- so little of the basic issues are understood by ei- ruses are also covered with the principles of the A Case for Screening ...... 2 ther the public or practiced by clinical staff. The Standard applied to practice. In order to mini- high and mighty, the press, the politicians, they mize disruption to the clinical team, and maxi- Virox Update ...... 3 all have a view on IP&C. They speak with such expertise that Welcome to Our New the true experts appear mute. Home ...... 4 A subject that is based on sci- ence, knowledge and years of training is now used as a politi- The Ghost Map ...... 5 cal football to score points for political gain, sell newspapers Sustainable Facility and play games of “name, Care Forum ...... 6 shame and blame”. In early 2005, my hospital group - Barking Havering and Redbridge Acute NHS Trust (1500 beds) - experienced an average of 15 new CDI cases a day, and by necessity, a 14 bed ward was converted into a CDI isolation cohort area. This compelled us to address the training that nurses and other healthcare workers received in topics related to mize patient benefit, employees were given a infection prevention and control, and take a new six-week period to complete their Passport. On initiative that has proven very successful, the In- completion of the first 30 passports in the pilot fection Control Passport. project, and a comprehensive evaluation of the program, and documented evidence of a reduc- Development of the Infection Control tion in Clostridium difficile infection rates, the passport infection control team proposed an extension of As part of the management program to reduce the program to a further four clinical areas. the number of CDI within the trust and to im- Following the success of the revised program, prove patient care outcomes, the Infection Con- additional evaluation was undertaken and fur- trol Team (ICT) devised a nursing educational ther reduction of CDI, the Infection Control program – the Infection Control Passport - to Passport has now developed into a full day support the principles of standard infection con- of theory delivered by the infection control trol practice and precautions, which had hitherto team and consultant microbiologists. The par- not been fully understood or practiced by clini- ticipants still have six weeks to complete their “The secret of success is cal staff. competencies with an infection control nurse. constancy of purpose” On completion of the training, staff are viewed The program was originally developed to be as champions and role models for excellence in delivered over five non-consecutive days, a infection prevention and control within there Benjamin Disraeli one-hour session each day.Components of the Infection Control Passport include correct hand Continued©Virox Technologies on page 2007 6 Best Practices for Infection Prevention and Control Programs in Ontario in All A Case for Health Care Settings Mary Vearncombe Screening Medical Director, Infection Prevention and Control Sunnybrook Health Sciences Centre and Women’s College Hospital Chair, Provincial Infectious Diseases Advisory Committee (PIDAC) Subcommittee on Infection Prevention and Control

Health care-associated infections are an Committee important patient safety issue and repre- • IPAC program functions: surveillance, sent a signifi cant adverse outcome of the policies and procedures, compliance health care system. Infection prevention with legislation and accreditation stan- and control (IPAC) programs have been dards, occupational health and safety shown to be clinically effective, reduc- issues, education and training ing morbidity and mortality, as well as cost effective, providing important cost • Key components of the program: hand savings in terms of fewer health care- hygiene, Routine Practices and Ad- associated infections, reduced length of ditional Precautions, immunization, hospital stay, less antibiotic resistance cluster and outbreak investigation and and decreased costs of treatment for in- management, communications, envi- fections. ronment • Human resources for the IPAC program The Provincial Infectious Diseases Ad- including education, training and certi- visory Committee (PIDAC) Infection fi cation of IPAC professionals, ongoing Prevention and Control Subcommit- professional development, roles and re- tee has developed a document entitled: sponsibilities, staffi ng levels, adminis- “Best Practices for Infection Prevention trative assistance and IPAC physicians and Control Programs in Ontario in All Health Care Settings ”. This document • Laboratory and information technology provides a framework for Infection Pre- support vention and Control (IPAC) programs across the continuum of health care Recommendations made in the Best delivery in Ontario, and makes recom- Practice document are summarized in an mendations for specifi c activities, areas appendix, in tabular form, to assist IPAC of expertise and adequate and appropri- programs in self-evaluation. ate resource allocation on the basis of the type of institutional setting and size. The The best practices document is aimed at recommendations in this document re- senior administration, medical offi cers of fl ect the best evidence and expert opinion health and others in a management role available at the time of writing. In addi- in all health care settings. Infection pre- tion, the recommendations refl ect many vention and control programs will also best practices that are currently practiced fi nd these best practices useful for priori- in the fi eld and they should be seen as an tizing and developing their programs and enhancement to existing practices. This engaging in strategic planning activities document can be found on the PIDAC for the future. webpage: www.health.gov.on.ca/english/ providers/program/infectious/diseases/ It is expected that all settings in Ontario ic_ipcp.html where health care is provided, across the continuum of health care, will work Topics covered in this Best Practice towards implementing the basic infec- This letter to the editor was published document include: tion prevention and control practices in the September 6 issue of The Econo- and principles set out in this document. mist, and identifi es a need for expanded • Mandate and goals of the IPAC pro- This includes settings where emergency screening in healthcare facilities. This is gram (including pre-hospital) care is provided, a hotly debated point and as yet we take hospitals, long-term care homes, outpa- no position. • Structure and elements of the IPAC tient clinics, community health centres program and clinics, physician offi ces, dental of- Now, what can be done about ongoing • The Infection Prevention and Control fi ces, offi ces of allied health profession- screening of environmental surface con- als and home health care. tamination??

Volume 17 Page 2 ©Virox Technologies 2008 Virox Rescue is positioned as a safer and effective alternative to bleach as a C.diff Conference & Education Virox Update patient room disinfectant cleaner for hard Spring Schedule non-porous surfaces with reasonable sporicidal disinfection contact times and Virox representatives will be 2009 CHICA Scholarship also positioned as a task oriented product participating in the following functions Does your facility have limited funds for for C. diff outbreaks and containment in during the upcoming months: continued education? Don’t miss out on medical establishments. The Rescue C. the Virox Patron Scholarship and your difficile Intervention Program has suc- October 1st - York Region Public chance to receive funding to attend the cessfully been used by a number of facili- Health Education Day in Markham, 2009 CHICA-National Conference in ties to help combat C. difficile outbreaks. Ontario Newfoundland! For more information on the RESCUE C. difficile Intervention Program please October 2nd - IPAC Dancing with the The Virox Patron Scholarship is in its visit virox.com/medical/acute_care.asp Stars in Mississauga, Ontario 7th year and to date Virox and the Pa- or call 1-800-387-7578. October 2nd to 3rd - CIPHI Alberta tron Members (JohnsonDiversey, Butch- in Grand Prairie, Alberta ers, Deb, STERIS and Webber Training) have contributed $90 000.00 towards the Website Update: www.virox.com October 16th - Simcoe Muskoka LTC annual scholarship which has provided Virox prides itself on being a resource Education Day in Muskoka, Ontario the opportunity for over 50 Infection tool to the infection control community October16th - Lambton County Public Control Practitioners to attend the annual and will be unveiling a newly designed Health in Sarnia, Ontario CHICA-Canada Conference. The schol- website in mid-March. Some of the October 22nd - Chatham-Kent arship deadline is January 31, 2009 and exciting changes to the website include is open to all Infection Control Practitio- Infection Control Committee (CKICC) a section devoted entirely to Infection Conference in Chatham, Ontario ners across Canada. The application can Control that provides resource materials be downloaded from the CHICA website: such as Guidelines, Protocols, Outbreak October 24th - Infection Prevention & http://www.chica.org/opps_virox.html Information, Technical Bulletins etc as Control Resources Day at Credit Valley well as a section devoted to Hot Topics in Hospital in Mississauga, Ontario Study Sponsorship at SickKids Infection Control. November 2nd - Ontario Electrolysis Virox and JohnsonDiversey are excited Association in Toronto, Ontario to be partnering with Ann Matlow and the Infection Control Group at SickKids If you are interested in learning more November 7th - APIC Chapter for a study titled “Knowledge, Environ- about how the Professional and Techni- Meeting for Greater Las Vegas in Las ment and HAIs”. The study is focusing cal Services team at Virox can provide Vegas, Nevada on understanding the knowledge base educational or consulting opportunities November 4th to 5th - Saskatchewan and concerns of housekeeping staff and at your facility please contact Nicole Professional Education how this knowledge can be translated Kenny at 1-800-387-7578 x118 or via Development Seminar in Saskatoon, into creating education programs that email at [email protected]. Saskatchewan will lead to improved hospital cleaning and disinfection. November 13th to 14th - CHICA Nova Scotia Conference in Halifax, Nova Scotia RESCUE C. difficile Intervention Program We are very excited about participating With the increased prevalence of C. in each of these conferences & education difficile in healthcare facilities Virox days. We wish the best to all of the Research and Development staff were various organizers and would like to tasked to develop a surface sporicidal thank them for their dedication and agent. The challenge for us was how to effort in organizing these very important kill large amounts of spores, on an en- educational opportunities. We look forward to attending and talking to all of vironmental surface in realistic contact the participants. times and at the same time make it safer to use, and easier to work with than 5000 ppm of chlorine bleach. The end result after more than a year of R&D was a new Accelerated Hydrogen Peroxide prod- Eighty percent of success uct with a 10 minute contact time for a >6 log reduction of spores utilizing a is showing up. 4.5% hydrogen peroxide formulation that is available in a Gel, Pre-Moist- ened Wipe and a Ready-to-Use liquid. - Woody Allen

Volume 17 Page 3 ©Virox Technologies 2008 In August, Virox Technologies Inc. moved to its new corporate home in Oakville, Ontario. The purchase of the new building was testament to the increased demand and acceptance of the Accelerated Hydrogen Peroxide Technology. The 47,000 square Welcome to our foot building was recently put on display for over one hundred customers, partners, New Home! friends and family at the company’s open house held on September 4th. The open house also celebrated the 10 year anniversary of Virox and the AHP Technology. Since its creation in 1998, the once small Canadian Company has pioneered as an innovative industry leader and a true resource to infection control professionals. Through our partners, AHP products can be found in 56 countries around the globe. Thank you to all those attended in celebration of the growth of Virox and AHP! The future for Virox is promising as there are a number of newly registered products in commercialization (30 new EPA registered products alone, as well as an FDA registered high level disinfectant) in Canada, the United States, as well as Asian and European countries. Growth into new markets makes further expansion for Virox inevitable. Virox has also added to a list of growing accomplishments through the launch of a new surface disinfectant that is effective against C. diffi cile spores. This is the fi rst DIN registered surface sporicide in Canada and a true testament to the continued sustainability of Accelerated Hydrogen Peroxide in the Infection Control community and the war against microbes.

Engineering Revolutionary Disinfectants for the War Against Microbes

www.virox.com

Volume 17 Page 4 ©Virox Technologies 2008 The Ghost Map - A Review alone. , a local curate Nicole Kenny, Virox Technologies Inc. with uncommon access to the neighbor- hood and unquestioned empathy for its residents, went house to house collect- “If every great city resembles a living cause of disease was as plain as the nose ing data about residents’ daily habits and organism, then mid-19th century London on your face. The majority of physicians the incidence of the disease, information was an ungainly and careless youthful and scientists fi rmly believed that disease Snow used to shore up his controversial giant with appalling personal habits”. spread through polluted fumes and toxic theory of waterborne contagion. 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HHumanuman wwasteaste wwasas ssimplyimply knowledge.”knowledge.” thrownthrown ontoonto thethe streetstreet fromfrom up-up- stairsstairs windows,windows, oror dumpeddumped intointo WhenWhen hehe createscreates t thehe anan openopen pitpit inin thethe backyard,backyard, oror mapmap thatthat ttracesraces tthehe ppat-at- intointo ffetidetid ppoolsools iinn bbasements.asements. IInn terntern ofof outbreakoutbreak backback August 1854, “London“London isis a citycity toto iitsts ssource,ource, DDr.r. SSnownow of scavengers” – bone-pickers,bone-pickers, didn’tdidn’t j justust s solveolve t thehe rag-gatherers,rag-gatherers, p pure-fiure-fi nnders,ders, dredg-dredg- mostmost ppressingressing mmedicaledical ermen,ermen, m mud-larks,ud-larks, s sewer-hunters,ewer-hunters, riddleriddle ofof hishis time.time. 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B Beforeefore c cor-or- mentment ooff tthehe mmodernodern uurbanrban eenvironment.nvironment. soil) from the overfl owing cesspools rective action could be taken on a civic in their buildings. level, ’s biggest hurdle was to The Ghost Map is an endlessly compel- convince his peers and politicians of the ling and utterly gripping account of that Miasma vs. Contagion theory of contagion. London summer of 1854, from the mi- “All smell is disease” (Edwin Chadwick, crobial level to the “macrourban”-theory London’s sanitation commissioner at the Snow studied the Soho epidemic and level, including, most important, the hu- time of the 1854 outbreak). According eventually backtracked it to a water pump man level. to conventional wisdom of the day, the on Broad Street. But he wasn’t working

Volume 17 Page 5 ©Virox Technologies 2008 Infection Control C lo s trid iu m d iffic ile a t B HRT fro m J a n u a ry 2 0 0 4 to M a rc h 2 0 0 8

Passport Program 3 5 0 r Continued from page 1 3 0 0

2 5 0 clinical area. To date over 400 clinical staff out of a to- 2 0 0 tal of 2,000 have completed the passport and the passport has become a manda- 1 5 0 tory educational program for all newly 1 0 0 appointed nurses. Since June 2008 the Infection Control Passport has been 5 0 further developed in order to expand No. of new cases per quarte 0 into other departmental specialities and 4 4 4 5 5 6 6 6 7 7 7 grades of staff such as phlebotomy and junior doctors. Jan - Mar 0Apr - Jun 04Jul - Sep Oct0 - Dec 0Jan - Mar 0Apr - Jun 05Jul - Sep 05Oct - Dec 0Jan - Mar 0Apr - Jun 06Jul - Sep Oct0 - Dec 0Jan - Mar 0Apr - Jun 0Jul - Sep 07Oct - Dec Jan0 - Mar 08

“the challenge for us as an industry is to create opportunities for our own Sustainable Facility Care Forum businesses while protecting the welfare of the people in the facilities we man- More than 250 industry leaders came The morning keynote speaker, Kevin age. The more we can share best prac- together on April 30 for the fi rst Sus- Kamschroer, acting director for the US tices, the more we can do the right thing tainable Facility Care Forum, a one-day General Services Administration’s new by protecting our customers, preserving event designed to give members of the Offi ce of Federal High-Performance the environment and transforming the facility cleaning and management indus- Green Buildings, discussed the relation- industry. I think we can make a huge im- try as well as other interested parties an ship between human behavior, facilities pact on the world if we work together.” opportunity to better understand trends and business, and Yale University Pro- in sustainable facility care. The event fessor Daniel Esty, made the business The Sustainable Facility Care Forum is was co-hosted by JohnsonDiversey Inc. case for sustainability in his afternoon expected be an annual event. To stay in and the Leonardo Academy, a non-profi t keynote presentation. He discussed the the loop with the 2009 Forum, refer to organization dedicated to sustainability relationship between environment and www.facilitycareforum.com. in buildings. corporate strategy, and showed how leading-edge companies have leveraged The forum was held at the recently environmental commitment into busi- “We’re naturally inclined to opened Washington Neweum, the inter- ness development strategies consider these scavengers active museum of news. Attendees in- tragic fi gures. But ... cluded building service contractors and The forum also featured a panel discus- without any central planner in-house facility service providers from sion, featuring facility care leaders and coordinating their actions, higher education, health care, govern- industry experts from various North ment and retail, as well as distributors American organizations, including our without any education at and property managers. own Randy Pilon, president of Virox all, this itinerant underclass Technologies Inc. The panel developed managed to conjure up an “Our objective for this forum was to a defi nition and economic argument for entire system for processing and promote the exchange of practical ideas sustainable facility care through demon- sorting the waste generated by for sustainable facility care”, said John- strated best practices and metrics. two million people.” sonDiversey President and CEO Ed Longergan. “We were pleased to have “Green business is big news these days Steven Johnson some of the best minds in the sustain- and businesses with a corporate envi- The Ghost Map able facility care movement join us for ronmental strategy have a competitive this dialogue”. advantage in today’s marketplace.” Bill Taylor of JohsonDiversey concludes,

2770 Coventry Road, Oakville, ON L6H 6R1 Tel:(905) 813-0110 • Toll Free:1-800-387-7578 • Fax:(905) 813-0220 E-mail:[email protected]• Website:www.virox.com No fi nancial support has been provided by Virox Technologies Inc. to authors of articles included in this newsletter.

Volume 17 Page 6 ©Virox Technologies 2008