Agenda
| Table of Contents | Presenter |
|---|---|
| Introduction and HAIIP Program Objections | Leticia Eastland, HAIIP Program |
| Moving Forward Together: Strengthening Leadership Through Collaboration | Leticia Eastland, HAIIP Program Alia Caldwell, HAIIP Program |
| Learning From Within -Influencing Without Authority -CDPH Tools in Action -Supporting Ips in LTACHs and SNFs | Rashida A. Conway, APIC- IE Chapter Amanda Street, Community Hospital of San Bernardino Raquel Morales, Totally Kids Rehabilitation Hospital |
| Jeopardy Game | Chelsea Luong, SADE Program |
| Break | All |
| All Facilities Letter Summary | John Holguin, SADE Program |
| Public Health Lab Services and Request Forms | Tanya Martinez, HAIIP Program |
| Resources | |
| Contact Us! |
Program Objectives
Training: Infection control practices, use of personal protective equipment (PPE), Train-the-Trainer, and current guidelines on managing healthcare-associated infections (HAIs).
Surveillance: Identify and report HAIs.
Mitigation: Rapid response and support for facilities experiencing an outbreak.
Ongoing Support: Provide technical assistance and direct support with healthcare facilities.
Moving Forward Together: Strengthening Leadership Through Collaboration
Leticia Eastland, BSN, RN, Registered Nurse HAIIP Program, Department of Public Health and Alia Caldwell, MPH, PH Project Coordinator HAIIP Program, Department of Public Health
Facing Change Together
Adapting to budget reductions, streamlining processes, targeted support, high-impact infection prevention strategies (doing more with less)
Targeted support:
•Multidrug-resistant organisms (MDRO)/HAI Burden- frequency of outbreaks per year (in facility transmission history).
•Facility Size and Complexity- Number of beds (skilled nursing beds, subacute).
•Device Utilization- Central lines, ventilators, urinary catheters, other devices.
•Dedicated full-time infection preventionist vs. shared role or a part-time status IP.
•Capacity of rapid response (isolation, testing, staff surge)
Targeted Support Through Tiering
Tier 1: Low Risk
- Demonstrate consistently low MDRO/HAI rates
- Smaller bed count/ or larger facility with strong IP practices
- No ventilator services or use complex devices, but manage effectively & safely
- Dedicated, experienced full-time IP and engaged staff
- Require minimal direct HAIIP oversight; focus is on sustainability (May need only standard support /quarterly email check-ins, HAIIP Collaboration Meeting attendance)
STABLE AND SELF-SUSTAINING
Tier 2: Moderate Risk
- Moderate MDRO/HAI rates
- More beds/mixed acuity
- Use complex devices with generally good management, though opportunities for improvement remain
- Infection prevention practices in place, but may need reinforcement or consistency
- May have a newer IP or part-time still building experience and leadership
- Benefit from targeted HAIIP engagement, focused teaching and guidance. (May need more targeted interventions, monthly virtual check-in call, site visit if needed, HAIIP Collaboration Meeting attendance)
DEVELOPING AND STRENGTHENING
Tier 3: High Risk
- Demonstrates elevated or recurring MDRO/HAI rates, recent outbreaks
- Large bed count
- Manage complex devices and high acuity residents, but practices may need reinforcement
- Infection prevention systems may be inconsistent or still developing
- Full-time IP, may be newly established or working on staff IPC buy-in
- May benefit from frequent HAIIP support, site visit, isolation precautions, environmental cleaning, structured monthly follow-up with HAIIP RN/IP. (May require active support to stabilize infection trends and help build sustainable prevention systems.)
FOCUSED PARTNERSHIP AND GUIDANCE
Take Away:
Ultimately, the tiering framework isn’t about judgement, it’s about directing support where it is needed most, helping every facility advance along the continuum of infection prevention excellence.
Influencing Without Authority
Rashida A. Conway, MSN, RN, AL-CIP™, CIC, IPC Director, APIC President Elect
Kaiser Permanente San Bernardino County Service Area
Association for Professionals in Infection Control and Epidemiology (APIC) – IE Chapter
CDPH Tools in Action
Amanda Street, LVN, Infection Preventionist, Pediatric Sub-Acute Unit, Dignity Health Community Hospital of San Bernardino
Supporting Infection Preventionists in LTACHs and SNFs
Raquel Morales, LVN II, Infection Prevention & Control Nurse, Totally Kids Rehabilitation Hospital
Topics:
Who are Infection Preventionists in LTCH/SNFs?
IP resources
Communication and follow-through during Transfers and Admissions
Jeopardy
Chelsea Luong, BS, Public Health Fellow, Department of Public Health Spatial Analytics, Data, & Epidemiology
| 1. PPE and Hand Hygiene | 2. Cleaning and Disinfecting | 3. Cohorting | 4. Evidence-Based Practice | 5. Diseases-Diseases |
|---|---|---|---|---|
| $200 | $200 | $200 | $200 | $200 |
| $400 | $400 | $400 | $400 | $400 |
| $600 | $600 | $600 | $600 | $600 |
| $800 | $800 | $800 | $800 | $800 |
| $1,000 | $1,000 | $1,000 | $1,000 | $1,000 |
Answer: 20 Seconds
Answer: Light switch, bed rail, doorknob, toilet flusher, elevator buttons, stair rails, faucets, etc.
Answer: During outbreaks or when isolation rooms are limited.
Answer: CDC, APIC, SHEA, OSHA, and WHO.
Answer: Scabies
Answer: Before touching a patient, before a clean or aseptic procedure, after exposure to body fluid, after touching a patient, and after touching a patient’s surroundings.
Answer: We start by cleaning objects distant from the resident care area, such as the common surfaces like doorknobs or light switches, then move to items touched during resident care, like bedrails or tray tables.
Answer: If possible, cohort these patients or residents separately; however, if not possible because patients or residents have the same carbapenemase, you may cohort them together.
Answer: Don a gown and gloves before entering the room and discard them upon exit. Perform hand hygiene before donning gloves and after removing them, using spatial separation or cohorting.
Answer: By inhaling aerosolized water droplets containing Legionella (not person to person)
Answer: Enhanced Barrier Precautions (EBP) require the use of gowns and gloves for specific, high-contact resident care activities to prevent the transmission of multidrug-resistant organisms (MDROs). Other PPE, such as a mask or face shield, may be needed if there is a risk of splash or spray.
Answer: Routine cleaning, terminal cleaning, and scheduled cleaning.
Answer: High risk individuals, those with a confirmed infectious illness or a person under investigation for one should be placed in a private room to prevent transmission, or those who have had close contact with an infected person should also be isolated to prevent potential spread during the incubation period.
Answer: Wearing a well fitted mask or respirator to prevent respiratory droplets from spreading to others.
Answer: Cooling towers, hot water tanks, and decorative fountains.
Answer: N95 Mask
Answer: EPA List N disinfectants are effective against COVID-19.
Answer: If patients or residents with different MDRO status must share a bathroom, place disinfecting wipes in the room and bathroom to be used before and after every bathroom use.
Answer: Treat all potentially exposed residents and staff simultaneously to prevent reinfestation.
Answer: Urinary Antigen test for Legionella pneumophila serogroup.
Answer: Before care or entering a room, before task, after bodily fluids, after care, or upon leaving the room.
Answer: No, do not place dirty linens on the floor; this can transfer germs onto the floor, which can be tracked from room to room. Instead, place soiled linen in the soiled linen cart as they are removed from the bed.
Answer: Prioritize cohorting patients or residents with rare, highly resistant, or multiple carbapenemases or organisms. This includes patients or residents with C. auris; CPO with two or more carbapenemases; CP P. aeruginosa or A. baumannii1; NDM, VIM, IMP, or OXA-48-like CP Enterobacterales.
Answer: NAAT (Nucleic Acid Amplification Test), such as PCR.
Answer: Intense itching, especially at night, AND burrow tracks between fingers or wrists.
Public Health Lab Services and Request Forms
Tanya Martinez, B.A., Communicable Disease Investigator, HAIIP Program, Department of Public Health
Lab Fees
| Laboratory Services | Test Fees | CPT Code |
|---|---|---|
| Bacteriology | ||
| Salmonella/Shigella Stool Culture | $45.00 | 87045 |
| STEC Stool Culture | $47.00 | 87046 |
| Miscellaneous Bacterial Culture | $31.00 | 87070 |
| MALDI-Bacterial Identification | $50.00 | 87077 |
| CPO PCR | $68.00 | 87798 |
| Mycology/Fungus | ||
| Fungal Culture | $30.00 | 87102 |
| Yeast ID/Yeast MALDI | $50.00 | 87106 |
| Mold ID | $50.00 | 87107 |
| KOH Prep | $15.00 | 87220 |
| Candida auris PCR | $68.00 | 87798 |
| Mycobacteriology/TB | ||
| Acid-Fast Stain | $20.00 | 87206 |
| AFB Specimen Concentration | $24.00 | 87015 |
| Acid-Fast Culture- Mycobateria Screening (Negative) | $50.00 | 87116 |
| M. tuberculosis-NAAT | $100.00 | 87556 |
| AFB MALDI ID | $75.00 | 87143 |
| M. tuberculosis Susceptibility- MGIT method (per drug) | $25.00 | 87188 |
| Quantiferon | $65.00 | 86480 |
Lab Requistion Form
Resources
•cdph.ca.gov/Programs/CHCQ/HAI/Pages/MonitoringAdherenceToHCPracticesThatPreventInfection.aspx
•cdph.ca.gov/Programs/CHCQ/HAI/Pages/InterfacilityCommunication.aspx
Thank You
For being part of San Bernardino County Department of Public Health’s efforts in providing technical assistance and support for skilled nursing facilities (SNFs) and long-term care facilities (LTCFs) to keep patients, staff, and visitors safe from healthcare-associated infections.
Contact Us!
HAIIP Program Communicable Disease Section
800-722-4794
451 E. Vanderbilt Way, San Bernardino