Excellentia Advisory Group
ImPaCTInfection Prevention and Control Trends for ASC's 
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About the Author
This Month's Training Opportunities
Surveyor's Corner
Hot Topics
Sterilization Follow Up
Critter Craze
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Robin Novak, RN, CIC
Director of Infection Prevention

636.875.5088 ext. 101
This Month's Training Opportunities

-Multiple Dates -

Over 70 Infection Prevention
 topics/presentations available in our library.
Surveyor's Corner
Cathy Montgomery, RN, CASC
AAAASF Surveyor
636.875.5088 ext 102

Tips for March.......
  • Most facilities are now doing a good job of checking mattress pads for tears - don't forget your pillows!
  • Glucometer control solutions expire after opening, make sure yours is dated and instructions followed.
  • Blood collection tubes often found on crash carts have expiration dates.
  • If your packs come out of the sterilizer wet, they are NOT sterile.
  • Endoscopes should hang free and not touch.
  • Laryngoscope blades must be stored in individual packages, not left open in the cart.
  • Cubicle drapes should be cleaned on some defined schedule as well as prn.
  • Check your sprinkler heads for dust.

Hot Topics

Volume 1, Number 5
March 2017

Can you believe it is March already! Many of your State ASC Associations have their Infection Prevention training meetings planned and I will be able to meet many of you there hopefully. So far I have plans to speak on IP topics at Indiana, Minnesota, Ohio and California in November.  This month's training topic is Normothermia and you can learn much more at my March webinar. See "This Month's Training Opportunities" in the side bar.                                       

Registered Nurse, Certified Infection Preventionist dedicated to disease prevention and high quality healthcare.  Strong decision maker who understands the importance of patient, visitor and staff safety following evidence based best practices.
Driven and compassionate healthcare professional with 30 years hands-on experience in fast-paced ambulatory surgery center and hospital environments.  Accountable and responsible with an additional focus on Quality Assurance Process Improvement .
In the past, Robin has served as the SGNA Carolina Chapter President, involved in SGNA Practice Committee as well as a Regional Committee member.  Robin has been active with APIC and is a current member of APIC PALMETTO. Robin was prior employed at the Ambulatory Surgery Center of Spartanburg since 2004 and held roles of Endoscopy Nurse, Endoscopy Charge Nurse and most recently the Quality Assurance Process Improvement Coordinator.  Robin has worked on several infection prevention projects for Excellentia Advisory Group including a key role as a faculty speaker at our annual Infection Prevention Strategies for ASC's conference in Las Vegas.  Robin is now Excellentia's Director of Infection Prevention & Endoscopy.
New quality measures are coming for the 2020 payment year.  This means data collection will begin in 2018 and reported via quality net in 2019.  It is not too early to begin thinking how your facility will gather the requested information. 

One of the identified quality measures is ASC-13: normothermia.  The proposed measure will quantify the percentage of patients having surgical procedures under general or neuraxial anesthesia of 60 minutes or more in duration who are normothermic within 15 minutes of arrival in the post-anesthesia care unit.  The numerator is the number of surgery patients with a body temperature equal to or greater than 96.8 degrees Fahrenheit/36 degrees Celsius recorded within 15 minutes of arrival in the PACU.  The denominator is all patients, regardless of age, undergoing surgical procedures under general or neuraxial anesthesia of greater than or equal to 60 minutes in duration.


The real question in the back of many minds is what does this have to do with the surgeries we perform?  As identified in the measure background and overview, hypothermia is linked to numerous adverse and undesirable outcomes, including surgical site infections.  Other types of adverse reactions include cardiac complications, impaired coagulation, and post-anesthetic shivering.
There is so much more to the story.  Join me for the March Webinar on "Temperature Regulation:  What is the fuss?"  We will discuss hypothermia and evidence based practices which may enhance normothermia efforts.  
Sterilization Follow Up

By Robin O. Novak, RN, CIC 

Last month our webinar was about sterilization.  I received several questions by email about different areas that were only touched briefly.  I would like to follow up on those questions here.


We want to adopt event related sterility as a policy.  What things should we include?


  a.  Event-related sterility assumes that the sterilized item remains sterile until the package/ container becomes compromised.

  b.  Types of events leading to container compromise:

      i.      Microbe invasion (soil from environment, etc.)
      ii.      Setting a sterilized item on a wet surface
      iii.      Temperature/ humidities outside of standardized parameters
      iv.      Improper air exchanges
       v.      High traffic in storage locations
      vi.      Frequent handling/ transport (dropping or compressing containment device revealing compromised packaging)
      vii.      Breach in aseptic technique

  c. Staff training regarding event related sterility. 

     i.      Transport should be in a covered or enclosed container with a solid bottom
     ii.      Reusable transport containers are decontaminated between uses
     iii.      Manufacturer established expiration dates should be adhered to unless an event occurs which compromises the packaging.  Then the event sterility would go into effect
    iv.      Stock rotation will still be necessary


What is the difference between gravity and prevac?

  a. Gravity:  most common and simplest.  Steam is pumped into a chamber and displaces the air by gravity through a drain port.  There is no mechanical assistance.

  b. Prevac:  Alternating steam injections and vacuum draws or pulses to remove the air.

Critter Craze
By Robin O. Novak, RN, CIC


Some may see this result on cultures performed at their facility.  This is a filamentous, gram-positive, non-acid fast, anaerobic-to- microaerophilic bacteria.  It can lead to either subacute to chronic bacterial infections.  It is most frequently seen in orocervicofacial (lumpy jaw) infections but can be thoracic or abdominopelvic.

     Actinomycetes is the causative agent and stand out among normal flora of the oral cavity.  These organisms are not contagious and require a break in the integrity of mucous membranes to cause illness.  They may also require additional cohort bacteria presence to enhance the invasiveness.

     These organisms are known to grow in the oral cavity.  They are frequently associated with dental plaque or tonsillar crypts.  The incubation period is random.  Infection can occur many years after colonized, or days to weeks after a mucosal event.

     There is no documented evidence of transmission person to person, except in rare cases of a human bite.  Once in the oral cavity, the organism has the potential to be aspirated into the lungs.  Those at risk include immune-compromised, trauma, females with prolonged IUD, as well as those with poor dental hygiene.
     Best practices to prevent actinomycosis is the maintenance of oral hygiene.  This includes regular removal of dental plaque.
Treatment is extensive and requires prolonged, high doses of penicillin.  In some cases, surgical drainage may be necessary.  Spontaneous recovery has not been achieved.

Heymann, D. L. (Ed.). (2015). Actinomycosis. Control of Communicable Diseases Manual (20th ed., pp. 1-2). Washington, DC: American Public Health Association.

Crossword Puzzle
By Robin O. Novak, RN, CIC
CLICK HERE to download bigger puzzle.
If you need the puzzle answers, EMAIL ME.
If you are in need of assistance with your infection prevention program, Robin will be able to assist with everything from setting up your program, training your Infection Preventionist, writing or editing Policies & Procedures or just simple telephonic consultation.  Robin is taking on-site requests for 2017 at this time.  Secure a date on her calendar now.

Please let us know how we can help.

Cathy Montgomery, RN, CASC                Robin Novak, RN, CIC
636-875-5088 extension 102                    636-875-5088 ext. 101

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