Industry Helps Infection Preventionists Address Knowledge Gaps

December 7, 2010

By Kelly M. Pyrek

In ICTs first-ever State of the Industry Report presented earlier this year, survey respondents reported that 77 percent of them participate regularly or frequently in educational events such as conferences, Webinars and self-study courses, in order to improve their knowledge about infection prevention and control.(1) But that leaves the 23 percent who indicated that they rarely engage in education-related activities are they becoming stagnant in their quest for life-long learning? And approximately one-third of survey respondents pointed to a lack of education as one of the biggest barriers to healthcare workers compliance with infection prevention practices.

Many obstacles lie in the path of continuing ones education, including literacy challenges as well as economic- and time-related factors. In the infection prevention and control profession, it is critical that practitioners stay current because they are the disseminators of essential information relating to proper principles and practice to other healthcare professionals. As part of their jobs in concert with staff development, infection preventionists are expected to assess needs, develop measurable objectives and prepare educational offerings, while applying the principles of adult learning to these educational in-services.(2) Additionally, they are expected to evaluate the effectiveness of education and learner outcomes (such as the compliance rate), as well as instruct patients, families, and other visitors about methods to prevent and control infections.(2) They must also apply their critical reading skills to evaluate research findings and incorporate this information into practice through education and consultation.(2)

Addressing gaps in knowledge is one of the steps toward elimination of healthcare-acquired infections (HAIs) as outlined in a new paper from APIC, SHEA, IDSA and the CDC.(3) In the paper, the authors note, "To develop and to test credible prevention strategies for HAIs, we need to better understand how and why these infections occur. Although there are successful prevention initiatives for some device-associated infections in ICUs, research is still needed to develop evidence-based prevention recommendations for many other HAIs. In some cases, additional research is needed to augment a limited understanding of the basic epidemiology of healthcare-associated pathogens, to inform development of rational prevention strategies. Research is also needed to assess the impact of existing prevention recommendations and policies. Experts in the field propose five phases of translational research to address gaps in knowledge: epidemiologic studies, discovery of potential interventions, evaluating promising interventions leading to the development of evidence-based guidelines, moving evidence-based guidelines into health practice, and evaluating the 'real world' health outcomes of population health practice. The current level of evidence for HAI prevention varies for each type of infection and also by type of healthcare setting."

The quality and quantity of education-related activities in which infection preventionists engage is unique to the individual and commensurate with the practitioners level of motivation, desire to learn, and passion about sharing knowledge with others. While myriad educational opportunities present themselves online and in person these days, many infection preventionists are turning to industry-based experts for guidance and instruction.

So what are some of the key areas that infection preventionists have identified as infection prevention-related knowledge gaps that they or that other healthcare workers have?

As Cheryl Pederson, RN, BA, customer education manager for 3Ms Infection Prevention Division, explains, "3M recently hosted a group of experts in all areas of infection prevention for the Infection Prevention Leadership Summit. During the summit, attendees were surveyed and indicated that educating staff on new standards, regulations, technologies and best practices was a challenge in addition to supporting all other infection preventionists responsibilities and priorities. The infection preventionists surveyed also expressed a need for more education in the areas of operating room protocols as well as sterilization and endoscopy processing recommended practices."

Wava Truscott, PhD, MBA, director of scientific affairs and clinical education in the Medical Sciences Department of Kimberly-Clark Health Care, points to the persistence of pathogens as a knowledge gap and notes, "Areas that have only recently resurfaced as potentially important reservoirs for nosocomial pathogen transmission include contaminated apparel and environmental surfaces. At first glance that may seem like a boring or even ridiculous statement, but when it is joined with the fact that many microorganisms survive on these surfaces for a very long time. For example, Staphylococcus (including MRSA) can survive on dry surfaces for seven days to seven months, Enterococcus (including VRE) for up to four months, Acinetobacter up to five months, Clostridium difficile spores five months or longer, and norovirus for many months. On textiles, MRSA can survive for seven weeks on the cotton-polyester fabric of lab coats and VRE can survive for four months."

Truscott says that another area that has become a concern is the inadequacy of healthcare cleaning and disinfection practices and techniques. "For example few facilities realize that the use of cotton rags and paper towels with hypochlorite (bleach) solutions, quaternary ammonium compounds (quats), hydrogen peroxides and several other disinfectants significantly reduces their effectiveness," Truscott explains. "Nor do very many realize how much harder some microorganisms are to kill than others. For instance, influenza and hepatitis viruses (enveloped) are easily destroyed with just detergent and water, while norovirus and papilloma virus (non-enveloped) are not even fazed."

Angela Jones, director of marketing for MedMined Services, and Gina Parson, senior manager of infection prevention, both of CareFusion, say, "We are constantly looking for new ways to ensure we provide the most accurate and tailored information to the infection prevention community. For instance, on behalf of ChloraPrep patient preoperative skin prep, we recently conducted a survey of infection preventionists on skin antisepsis best practices and found that there may be a gap between data and guideline recommendations as it relates to clinical practice. With information such as this, we are then able to create tailored educational initiatives to bridge the gaps." Jones and Parson add, " As part of CareFusions dedication to making healthcare safer and more productive, educating healthcare workers is a key priority and the company often provides grants and sponsorships to further this education and research. For instance, the speakers programs for ChloraPrep and MedMined are something that infection preventionists can use as part of their education efforts. The program offers respected thought leaders in the healthcare community to provide peer-to-peer education on best practices and the most recent data in the fight against HAIs. Similarly, MedMined services, infection surveillance technology from CareFusion, offer healthcare leaders to speak at statewide quarterly educational forums, providing an environment for professional networking and to learn from other industry experts about improving patient safety. In many states, the educational forums are held in partnership with the state hospital association, thereby drawing from their resources. In addition, the ChloraPrep team provides other educational offerings, such as a clinical education theater at medical meeting exhibit booths, in-service DVDs and manuals available online, and a wide array of CME programs focusing on HAIs. Additionally, the ChloraPrep and MedMined services team offer a group of clinical educators that partner with infection preventionists to hold training sessions onsite at the healthcare institution."

"We believe that a critical key to successful sustained compliance is knowledge and understanding," Truscott adds. "In other words, it is imperative to understand why a directive to reduce an HAI is effective. Once there is an understanding, compliance moves beyond the rote. It progresses from I am supposed to to I must be sure to. It also empowers and compels us to apply that knowledge and reasoning to additional practices where it makes sense while we await or perform studies to verify effectiveness."

"Education is absolutely critical to the healthcare worker and the healthcare industry," Pederson says. "During our Infection Prevention Leadership Summit, 3M hosted 85 thought leaders across epidemiology, infection control, the operating room and sterile processing, including leadership from SHEA, APIC, AORN and IAHCSMM. The summit provided an opportunity for these leaders to share best practices on how to eliminate healthcare-associated infections in an educational setting." Pederson continues, "3M customer research continues to demonstrate that the majority of healthcare professionals identify online learning as the most preferred format for education. As a result, 3M has designed its online learning to enhance and build upon classroom training, which is not always available to practitioners. 3M Infection Preventions website offers the 3M Attest Sterile U and Essentials EDU online, educational programs which provide an education network for clinical specialists. Through webinars, live seminars and social media, 3M provides ongoing linkage to relevant and up-to-date, evidence-based science and clinical data."

Richard Schule, director of clinical education for STERIS Corporation, says the company is able to address many infection-related issues with its technologies, services and education. "Our ultimate goal has always been to help hospital staff and practitioners achieve best practices for the optimal benefit of patients," Schule says. "We have developed many programs over the years to help healthcare providers learn about and commit to preventing HAIs, and many include useful tools that infection preventionists can use to help educate staff and visitors. One example is our All Hands Clean program, which offers clinically tested and scientifically formulated products placed where they can be most effectively used; engagement and empowerment materials such as compelling pamphlets, buttons and signage with visuals that remind everyone to clean their hands; and intervention, measurement and benchmarking: the AccuTrack Hand Hygiene Compliance Program is a proven method for increasing, monitoring, and measuring hand hygiene compliance."

Schule adds, "Because STERISs historic core expertise is infection prevention, we are able to address many infection-related issues with our technologies, services and education. Our ultimate goal has always been to help hospital staff and practitioners achieve best practices for the optimal benefit of patients. We have developed many programs over the years to help healthcare providers learn about and commit to preventing HAIs, and many include useful tools that IPs can use to help educate staff and visitors. One example is our All Hands Clean program, which offers clinically tested and scientifically formulated products placed where they can be most effectively used; engagement and empowerment materials - compelling pamphlets, buttons and signage with visuals that remind everyone (physicians, nurses, maintenance staff, patients, and visitors) to clean their hands; and intervention, measurement and benchmarking: the AccuTrack Hand HygieneSM Compliance Program is a proven method for increasing, monitoring, and measuring hand hygiene compliance."

The following additional query was posed to industry-based education experts:

ICT: What are some of the proven methods of educating healthcare workers on complex subject matter such as infection prevention, epidemiology and microbiology and how have you incorporated them into your education and training initiatives?

Wava Truscott: "We believe it is important to start educational programs from a general baseline knowledge and progress to deeper and more rigorous levels addressing both the scientific and practical side of infection prevention. Using this approach, no one is left behind and yet even the veterans will find new information and applications. Whether a live presentation, a recorded DVD or an archived webinar, we have incorporated different combinations of flash videos, black-light florescence tracking, demonstrations, do-it-yourself assessment techniques, glossaries, references, and other tools to put science into practice and keep the interest of even the exhausted care provider at the end of a shift. In live presentations we also take the opportunity to enlist the experiences of the participants in identifying the problems they have encountered and how they were solved, sharing their means of success with staff from other facilities present."

Cheryl Pederson: "Wherever possible, 3M works to incorporate adult learning principles into our education and training initiatives. For example, weve found in our research that professionals need to participate in the learning process for educational programs to be effective, so techniques such as small group exercises and panel discussions are used to accomplish this need. In addition, creative methods such as crossword puzzles and Jeopardy-style game shows are used to reinforce learning content as demonstrated throughout the 3M Attest Products Sterile U traveling education seminars. And, because many healthcare workers have accumulated a foundation of life experiences and knowledge throughout their time in the field, it is important to draw these experiences out and/or highlight them as a discussion topic through case studies and best practices. During our recent leadership summit, we provided case studies as well as small breakout sessions. 3M also provided an innovation experience which chronicled a patient from consultation to surgical recovery and focused on areas of new technology and how 3M technologies can assist with eliminating infections. Feedback from our summit attendees has been very positive due to these efforts."

Richard Schule: "Particularly for complex or new technologies, hands-on in-services can be a valuable training tool for those of us who learn best by concrete methods such as physical interaction and demonstration. Learning is also more impactful if it relates directly to the learners actual work situation. STERIS clinical education specialists conduct on-site in-servicing that is specific to the issues and needs of the individual facility. Working with staff in the facility, they can walk through every aspect of a process and provide opportunities for the staff to interact directly with a particular sterilizer, washer or chemistry until they have achieved a level of comfort. STERIS clinical educators also help hospital staff design and conduct their own trials and testing, which has two objectives: to help with learning the science behind a process, and to create the validation they need to justify use of a particular technology or piece of equipment. An example of this is the newest Class 6 sterility assurance products, which are radically different than previous integrators and indicators, so the science behind them requires explanation. STERIS clinical education specialists and other experts have spent time with SPD staff and infection preventionists explaining the science, but the most impactful learning is achieved when a facility decides to conduct its own trial and testing. This also applies to hand hygiene products, for which learning is the greatest with hands-on trials (no pun intended!) in the facility to prove the efficacy and likelihood of compliance with a particular hand hygiene formulation. The challenge of this type of learning is the time and effort it takes to achieve it. It may be worth the time if the learning is critical for meeting current guidelines and standards, or for achieving best practices."

Angela Jones and Gina Parsons: "Finding the balance between both peer-to-peer training and hands-on learning is crucial when educating healthcare workers on infection prevention. Our speakers program provides ample peer-to-peer educational opportunities where healthcare workers can receive the latest information about the most recent data and learn from others what has and hasnt worked for infection prevention. Additionally, CareFusion offers several hands-on educational opportunities, such as a computer-based simulator program to teach proper skin antisepsis techniques."

References: 1. State of the Industry Report. Infection Control Today. July 2010. 2. 3. Cardo D, et al. Moving toward elimination of healthcare-associated infections: A call to action. Hosp Infect Control Epidem. November 2010. Vol. 31, No. 11. Pages 1101-1106.