closing keynote speaker offers innovation challenge: think ...€¦ · become complacent,” said...

ter how good things have been, we can’t become complacent,” said closing keynote speaker Josh Linkner.

Linkner, a renowned technology entre-preneur, venture capitalist, and bestsell-ing author, said this lesson is particularly important in healthcare, which is rapidly changing. To keep your facility’s infec-tion-prevention practice from becoming a cautionary tale like A&P, Linkner said, the key is to harvest innovation.

And the way to innovate is to think cre-atively.

This may seem counterintuitive in a sci-entific field like healthcare. After all, inno-vation and creativity can lead to mistakes. “And in clinical settings, we’re taught that mistakes are the worst things ever,” Link-

ner said. “But controlled mistakes can lead to better outcomes.”

Linkner cited recent innovations that save lives. For instance, a research com-pany has invented Photonic Fence—lasers that can zap a mosquito’s wings off in the air. The lasers are capable of killing dozens of mosquitos in seconds, and can desig-nate between biting female mosquitos and non-biting males. Other companies are in-venting ambulatory drones that can deliver medical supplies to victims before emer-gency workers get to the scene.

“You may say, ‘I don’t know anything about drones or lasers,’” Linkner said. But that’s not the point. What these inventions have in common is creativity. “All of us as human beings have enormous creative ca-pacity. Research shows 85 percent of cre-ativity is learned behavior,” he said. “But we don’t feel that way because many of us were socialized out of creativity.”

The key is to focus on what Linkner calls “everyday innovation.”

“You need not be a wild-haired inventor. Innovation applies to us all,” he said. “In other words, creativity is not a once-a-de-cade initiative; it’s an ongoing habit. I’ve seen again and again that the most success-ful people are the ones who embrace this creative process.”

In healthcare, “it’s our job to push the boundaries,” Linkner said. “I’d suggest along with your current title, you we need an additional title: disruptor, innovator, healthcare artist, provocateur.”

But how do you do that? Linkner said innovators have five obsessions in com-

Closing keynote speaker offers innovation challenge: Think of one new idea a week

Inside This Issue...Film Festival .......................3Opening Plenary ................4Evidence ............................8Spy for a Prize winners ......9Zika ..................................10 UV Cleaning .....................12MegaSurvey .....................14

»» CLOSING Page 22Click to view the conference highlights video.

In 1950, A&P was reportedly the larg-est retailer in the U.S. Now, the grocery chain is bankrupt because it didn’t adapt

to the changing demographics of food shoppers. “The lesson for us is that no mat-

Highlights Issue • 3APIC 2016 Annual Conference

A video created by the Wake Forest Baptist Medical Center’s video chronicling all of the things HCP

touch in one day from the perspective of various hands was named the winner of the sixth annual Film Festival at the APIC

2016 Film Festival Winner:Stopping Germs from Spreading

Annual Conference. As a part of Wake Forest Baptist’s

larger hand hygiene campaign, “Stop the Spread of Infection: It’s in Our Hands” was used to illustrate how easily germs are spread by hands.

APIC Film Festival: People’s Choice Award Winner

Conference attendees and APIC members had the opportunity to cast their vote for the APIC Film Festival’s People’s Choice Award. The winner was Wash Me, submitted by Children’s Hospi-tal Colorado.

»» PRIMARY CARE Page 16

Debra Johnson, Annual Confer-ence Commit-tee chair, left, presented John Stehle of Wake Forest Baptist Medical Center with the award for the institu-tion’s winning entry in the sixth annual Film Festival.

APIC President Susan Dolan, left, presents Kelly West, Children’s Hospital Colorado, with the People’s Choice Award for her winning sub-mission (inset)

Improving infection prevention in outpatient primary care settings

The Affordable Care Act is creating a surge in patient primary care, and that’s making infection prevention-

ists’ (IPs) jobs more challenging. The Mon-day morning session “Infection Prevention and Surveillance in Primary Care” focused on three key pieces of information de-signed to help IPs implement best practices in outpatient primary care settings.

“Primary care is exploding in the U.S. and becoming increasingly complex,” said Mary Lou Manning, PhD, CRNP, CIC, FAAN, FNAP, Thomas Jefferson University, Jefferson College of Nursing. “Primary care practices now see patients with many comorbidities, and therefore our job as infection prevention-ists is becoming more complicated.”

Manning and her colleague, Monika Pogorzelska-Mazlarz, PhD, MPH, conducted a literature review on infection surveillance in primary care post-Affordable Care Act. Out of the 225 titles and abstracts they screened, they found 18 full-text articles. Two of those studies met their criteria and were selected for inclusion in qualitative synthesis.

One study was about influenza-like illness surveillance at a large university healthcare system. The researchers found that a surveillance system could help IPs track ambulatory patients with influen-za-like illnesses, identify symptoms earlier, and intervene earlier. This led to quick in-fection control activities, including staffing changes and implementing a flu hotline.

The second study dealt with respirato-ry virus surveillance. The researchers an-alyzed the use of a clinical surveillance software at a university-based outpatient primary care clinic serving low-risk stem-cell transplant patients. Over the course of a year, the software helped the clinic detect-ed a human parainfluenza virus 3 outbreak outside of peak flu season. The conclusion was that the online surveillance was helpful in identifying the virus early.

Manning said the takeaway is that “de-spite increasing patient complexity and

https://www.youtube.com/watch?v=7ZMFdll8xxk&feature=youtu.be

https://www.youtube.com/watch?v=7ZMFdll8xxk&feature=youtu.be

https://www.youtube.com/watch?v=507lB4aFtsk

4 • Highlights Issue APIC 2016 Annual Conference

»» PLENARY Page 14

Keynote speaker highlights the similarities between Freakonomics and hand hygiene

Stephen Dubner drew a full house to Saturday’s Opening Plenary.

An economics journalist may not seem like a natural choice as APIC’s keynote speaker. But “you

all are after the same thing I’m after, which is how to solve a pretty tough problem,” said Stephen Dubner during Saturday morning’s Opening Plenary.

Dubner, author of the bestsellers Frea-konomics and SuperFreakonomics, shared the business and management lessons he’s learned with a ballroom full of APIC attendees. In an entertaining talk that in-cluded stories ranging from turkeys’ sexual escapades to monkeys’ shopping habits, Dubner discussed how obtaining data is similar, no matter what the discipline.

“When you want to get good data, sometimes you have to get crafty; you have to get a little clever,” he said.

Good data are necessary to determine the difference between declared preference and revealed preference, Dubner said. To illustrate, he asked attendees to raise their hands if they do not wash their hands after using a public restroom.

Not surprisingly, no hands went up. But even in a room full of infection prevention-ists, Dubner said he doubted that everyone was 100 percent hand-hygiene compliant. To illustrate, Dubner said he makes a hab-it of lingering at sinks in airport restrooms and noting how many men wash their hands after using the toilet. He’s found about 70 percent hand-washing compliance.

“But if we brought the 30 percent of those non-washers in here and sat them with their friends, colleagues, bosses, and asked them if they wash their hands, they’re not going to raise their hands along with everyone else,” Dubner said. In es-sence, their declared preference wouldn’t match their revealed preference.

“The lesson is that the circumstances under which you gather the data reflect that data,” he said. “We know that intellec-tually, but there’s good evidence that the smarter someone is, the more likely she or he is to seek out data and evidence that con-firm what they already believe to be true or that props up the decision they made or are about to make.” This bias also makes

a person unlikely to seek out contradictory data, he said.

As a result, “we have to train ourselves to be disciplined and agnostic when look-ing at data,” Dubner said.

He cited a study in which a group of doctors self-reported their individual rate of hand hygiene each day. The overall rate was 73 percent. “But the researchers didn’t stop there,” Dubner said “They deputized the nurses to spy on the doctors during the same observation period.” Those nurses re-ported the actual hand-washing rate was 9 percent.

“If you’re trying to solve a problem and there’s a gap that vast, you have to look at the root cause of the problem,” Dubner said. “A lot of times we believe the solution is to educate people about the risks, show them the risks, and then they’ll see the need to change. But experience shows that peo-ple don’t see the ‘why’ behind the data.”

This is no different in the infection pre-vention realm, Dubner said. For instance, Cedars-Sinai Medical Center found that hand hygiene among their doctors was about 60 percent. In an effort to get the rate to 100 percent, the hospital formed a com-mittee of about 20 of its top officials, many

of whom were MDs. Dubner said committee members were

tasked with determining the root cause of the hand-washing problem. They initially thought the problem may be a communi-cation failure—that they never stated their goal of 100 percent hand hygiene compli-ance.

“So they did what committees do, and issued a memo,” Dubner said as the audi-ence laughed. “That didn’t move the needle at all.”

The committee then came up with a plan of recruiting two to three clinicians who would hide in patients’ rooms and watch whether a doctor washed his or her hands. Dubner said this “Posse Patrol” was initial-ly going to jump out and glare at doctors who didn’t wash their hands, and then pub-licly post the doctors’ names.

But the committee realized that Ce-dars-Sinai’s doctors are essentially free-lancers and might just move to another hospital if they were publicly shamed. So committee members came up with a posi-tive incentive plan.

“The Posse Patrol would hide in a pa-


Endoscopes and the environment are ripe for improvements in reducing infections

Dr. William Rutala spoke during Sunday’s plenary session.

Using an old Western theme, Dr. William Rutala, PhD, MS, MPH, CIC, University of North Carolina

Health Care System, set a bold goal for the future: to prevent all infections associat-ed with instruments and the environment within five years.

Dr. Rutala termed it “our responsibil-ity to the future.” He framed his Sunday morning keynote lecture in terms of the old Western, The Good, the Bad, and the Ugly—and there was plenty of all three.

In the “good” section, Dr. Rutala ad-dressed forthcoming guidelines on endo-scopes. “We must educate and comply with those guidelines. But I am absolutely con-fident with every ounce of my being that if we only do that, we will continue to have outbreaks with endoscopy.”

He cited a study published in the Jour-nal of the American Medical Association which recommended a switch from dis-infection to sterilization for endoscopes. A Food and Drug Administration (FDA) panel agreed. “But we don’t have an FDA-cleared sterilization technology. It’s going to become available and we need to guide ourselves to these changes quickly,” Dr. Rutala said.

Reducing infections also will require using technology and automation to over-come human error. Endoscope reprocess-ing requires 12 essential steps. One study found that all 12 steps were performed ap-propriately 1.4 percent of the time.

Also in the “good” category is the push to eliminate the environment as a cause for

infectious disease transmission. Technol-ogies are showing improvements, ranging from UV and hydrogen peroxide mists. “This technology should be used for ter-minal room disinfection after discharge of patients on contact precautions,” Dr. Rutala said. “If you don’t have these systems, you should have them in your capital budget.”

As new technologies are developed, Dr. Rutala suggested that infection prevention-ists (IPs) make decisions based on peer-re-viewed literature.

He also pointed to visible light disin-fection, which has shown an 80 percent reduction in pathogens, but hasn’t yet been proven to reduce healthcare-asso-ciated infections. “The advantages of this technology can be accomplished 24/7 as long as the lights are on. The patients and staff do not have to leave the room.”

In terms of “the bad,” noncompliance tops the list. “Sometimes there are equip-ment failures and sometimes system fail-ures,” Dr. Rutala said. “We know in our hospital and in every hospital in the coun-try, there are human errors.”

He recommended auditing adherence to steps and providing feedback. “The Joint Commission surveyors will likely check on several high-visibility items. They will check on how you are reprocessing your semi-critical and critical items.”

At the University of North Carolina health system, high-level disinfection cer-tification classes are required. Attendees learn to perform disinfection, including the time, temperature, and concentration re-quired. They also learn about Occupational Health and Safety Administration (OSHA) requirements on chemical exposures. Em-ployees must demonstrate appropriate competencies upon hire and annually.

“Surveyors will be looking for demon-stration, observation, and documentation. That competency form has to be available and stored in the employees’ records,” Dr. Rutala said.

That may be “bad,” but the human pap-illoma virus lands in the “ugly” category. “We don’t yet know what kills HPV,” Dr. Rutala said. “We know medical devices can be contaminated, and inadequate re-

processing could contaminate the next pa-tient. There are currently no FDA-cleared high-level disinfectants that are cleared against HPV.”

A study is expected to begin in July to explore germicides that can kill HPV.

The other “ugly” is the technology haz-ard associated with endoscopes. “I don’t believe we are ever going to eliminate the microbial contamination of an endoscope in the absence of sterilization,” Dr. Rutala said. “We have to transition to sterilization. That is the only way that we’ll eliminate the outbreaks associated with scopes. We can’t do that today because we don’t have the technology.”

Currently, there is no gastrointesti-nal endoscope on the market that can be steam sterilized, Dr. Rutala said. “We have a bronchial scope that can be steam ster-ilized. Why don’t we have a gastro scope that can be?”

Dr. Rutala again pointed to the goal of eliminating infections from environment and endoscopes. “We have set our goal. We have made a plan and we have our purpose. We have to make this happen for our gener-ation, for our children’s generation, and our children’s children’s generation.”

“I don’t believe we are ever going to eliminate

the microbial contamination of an

endoscope in the absence of sterilization.”

– William Rutala, PhD, MS, MPH, CIC


Amelia Bumsted, DNP, RN, CRRN, CIC, FAPIC

Amelia is a recent DNP graduate from Loyola University Chicago’s graduate program in Infection Prevention. Her expertise is in both the use of informatics and electronic health records for decision support as well as clinical application of infection prevention strategies.

Amelia was part of the team at Rush University Medical Center which rapidly planned, built, and coordinat-ed the hospital’s Ebola response. She continues to build expertise in infectious disease preparedness at the local and state level.

Dr. Bumsted has made substantial contributions to the most recent APIC on-line text and was recently named an APIC Fellow. She shared her expertise by demonstrating doffing Ebola PPE at APIC 2016 Live.

We salute the knowledge and dedication of infection preventionists nationwide and invite others to devel-op their skills and create innovative projects within Loyola’s Master’s and DNP programs.

L O Y O L A U N I V E R S I T Y C H I C A G O M A R C E L L A N I E H O F F S C H O O L O F N U R S I N G

Supported by HRSA Grant 1-D09HP18997

Online Masters or Doctor of Nursing Practice in Infection Prevention Prepare for system-wide leadership with a MSN or the nation’s only DNP in Infection Prevention at

Loyola University Chicago’s Niehoff School of Nursing. Be the one to make a difference!

Learn More: LUC.edu/apic708.216.3751

Amelia Bumsted, DNP, RN, CRRN, CIC , FAPIC

APIC President Susan Dolan, RN, MS, CIC, kicked off Saturday’s opening session with a “Maxine”

cartoon that sums up many APIC mem-bers’ philosophy.

“I don’t see the glass as half full or half empty,” the cartoon read. “I see it as a glass somebody else has put his nasty germs on.”

For beleaguered infection prevention-ists (IPs), it can be hard to see a half-full glass. “There are some days when I leave my workplace and I wonder: Did I really make a difference? Did I prevent any in-fections?” Dolan asked.

“Zero infections and targeting zero are words many of us heard decades ago,” she added. “We focus on ‘Can we get there in our institution and stay there?’ But per-haps we don’t always stop to appreciate what zero looks like in our daily work.”

‘Faces of zero’ help keep the infection prevention glass more than half full

Dolan recounted her own “face of zero” infection experience. Last August, her husband, Tom, was diagnosed with multiple myeloma that affected his verte-brae. He endured a 10-hour surgery to sta-bilize his fragile spine, and was placed in a room previously occupied by a patient with carbapenem-resistant Enterobacteri-aceae (CRE). He then had a bone marrow transplant during flu season and a staff outbreak of norovirus.

“I was gut-wrenchingly consumed with Tom contracting an HAI. Each day during his journey, I was his advocate,” Dolan said. “I saw a glass that was more than half full, as evidenced by the state-of-the-art treatments and care he was receiving. With each passing day the glass became fuller and the germs were kept at bay.”

The upshot? “During this journey, Tom developed no infections,” Dolan said, as

the audience applauded.Dolan said the lesson she learned is

that “we need to keep plugging away to improve and elevate the science, so we can continue to create more faces of zero like Tom.”

Noting that APIC set a goal of 10,000 CICs by 2020, Dolan said the APIC Mega-Survey shows that the number of IPs with CICs has increased 25 percent over the past three years. And another 19 percent of IPs plan to obtain a CIC in the next 12 months.

“We are in this together as we share one defining vision that guides our work: healthcare without infection,” she said. “Yes, the glass is often only half full. But the faces of zero, like my husband Tom, remind us each and every day we have the opportunity to make a difference. Cheers, and dream big, my friends.”


Improve your practice by learning how to sift through the evidence

You don’t have to have a PhD or be a biostatistician to analyze new re-search and determine whether it

will work in your facility. “But you do need to understand the ba-

sics so you can evaluate someone else’s work,” said Terri Rebmann, PhD, RN, CIC, during the Saturday afternoon session “Understanding and Interpreting Research Studies for Deciding When to Integrate Ev-idence into Practice.”

Rebmann, professor and director of the Institute of Biosecurity, Saint Louis University, described the various types of evidence and how infection preventionists (IPs) can evaluate that evidence. The key, she said, is to focus on two underlying fac-ets: the strength of the evidence and the ef-fectiveness of the intervention.

According to the Centers for Disease Control and Prevention’s Continuum of Evidence of Effectiveness, there are three types of evidence. Research evidence is the gold standard. Experiential evidence includes professional insight, skill, and ex-pertise developed over time. And contextu-al evidence evaluates whether a strategy is useful, feasible, and accepted by a group.

Studies are either descriptive or analyti-cal. “If you don’t learn anything else today,

remember that descriptive studies are weak-er and don’t give you as much evidence as analytical studies,” Rebmann said.

Descriptive studies include case stud-ies, case reports, case series, and incidence studies. These types of studies examine pat-terns of occurrence, and focus on a person, place, and time. For instance, outbreak in-vestigations are descriptive studies. These types of studies are usually used early in a disease path, in unusual situations, or when little is known about the disease.

Analytical studies are observational or experimental. They’re bigger, more com-plex, and more resource-intensive than de-scriptive studies. They’re designed to test hypotheses, and focus on risk factors and potential causes of disease.

To evaluate these types of studies and any other evidence you come across, Reb-mann said it’s helpful to use the Hierarchy of Evidence.

This pyramid rates studies from weakest to strongest:

• Editorials and expert opinion are of-ten done in areas where research is lacking because it’s too expensive, dangerous or unethical, or there hasn’t been time to do the research.

• Case series, case reports, and case-con-

trol studies are retrospective, starting with the disease and looking backwards for the exposure.

• Cohort studies follow a cohort of indi-viduals and can either be done prospective-ly or retrospectively. Retrospective cohort studies are good for rare exposures, but the data may not be reliable. Prospective studies are more time consuming and expensive.

• Randomized control trials include community trials and clinical trials that randomize participants into intervention and non-intervention groups. Rebmann said these trials are expensive and time consuming, and are more effective for things like new drugs rather than vaccines.

• Systematic reviews are the strongest types of study. These reviews assess and evaluate all research that addresses a spe-cific concern or clinical issue. They include meta-analyses and are usually done by very experienced researchers.

Rebmann said when you’re evaluating a study, focus on the methods section.

You need to know what the researchers did and how they did it in order to under-stand how strong their evidence is,” she said. “I usually skip the abstract, skim the background and spend a great deal of time reading the methods.”

Look at what intervention the research-ers used, their sample size and type, and the time frame. “Be really picky and skeptical about that, and make sure they’re not mak-ing conclusions that aren’t based on the data,” Rebmann said.

It’s also important to remember “not everything published is correct or strong,” she said. The journal review process can be biased, and lower-ranked journals may have lower-quality research.

To determine a journal’s quality, Reb-mann suggested Googling the journal’s name and impact factor (IF). The higher the IF number, the more times the articles published in that journal have been cited in other journals.

Rebmann also recommended examining a study in context of existing research on the topic. “This will help you understand if an intervention will be feasible and useful in your setting and population,” she said.

APIC President Susan Dolan, left, presented the Carole DeMille Achievement Award to Georgia Dash during the Opening Plenary.


Did you Spy for a Prize?

The Welcome Reception on Friday, June 10, at Discovery Place was a great success. Attendees explored the museum while enjoyingan array

of food and beverages and played Spy for a Prize.

Congratulations to the winners:• One-year subscription to

APIC Text Online — Melissa Nelson

• APIC 2017 Hotel Stay — Ashley Rivera

• APIC Padfolio — Marilyn Burns

Learn More at AHEPP.ORG/CONFERENCE

Are you in charge of emergency preparedness at your hospital?Don’t miss this opportunity to learn, network and collaborate with top healthcare preparedness professionals.

ANNUAL

October 4–6, 2016 | Las Vegas,NevadaCONFERENCEAssociation of Healthcare Emergency Preparedness Professionals

Receive $50 OFF Conference RegistrationUse code at checkout: APIC2016NC Expires: 7/31/16


The statistics are sobering. In 2014, 75 million people visited the U.S. from abroad. Roughly 25 percent of

those people came from developing econ-omies where infectious diseases are more prevalent.

Overall, there are more than 1,500 in-fectious diseases in the world. “We’re all one plane ride away from an infectious disease. Anyone at any time can walk into your clinic with a highly communicable disease,” said David J. Weber, MD, MPH, University of North Carolina Health Care, during the Sunday afternoon session “Re-sponding to Emerging Infectious Diseases: Focus on Zika Virus and MERS-CoV.”

Most new infections aren’t caused by genuinely new pathogens but rather are agents that cross taxonomic lines, includ-ing exotic pets and other animals. HIV, for instance, started as a simian disease, Weber said.

Key issues for infection control in-clude geographic location, incubation pe-riod, clinical features, diagnosis, therapy, morbidity, and mortality. Infection con-trol treatment issues include transmission routes, infectivity, environmental survival, susceptibility to germicides, and post-ex-posure prophylaxis. “You’d want answers to all of these issues in your policies,” We-ber said.

Weber said hospitals’ two greatest vul-nerabilities in the face of infectious diseas-es are failure to screen and recognize that a patient has a communicable disease and failure to promptly institute proper isola-tion, and failure to have adequate personal protective equipment (PPE) or failure of healthcare professional (HCP) to properly don and doff PPE.

Studies show that HCPs who use only standard PPE are contaminated with infec-tious diseases 30 percent of the time. But Weber said that number drops substantially when HCPs use the more stringent Ebola PPE.

Among the current high-profile infec-tious diseases, “West Nile is now highly endemic in the U.S., and I would guess that Zika is here to stay as well,” Weber said.

Zika is similar to the yellow fever virus, dengue fever, and West Nile. The disease is endemic in Africa, Southeast Asia, and the Pacific islands. While it’s transmitted primarily via the bite of an infected Aedes mosquito, Weber said there is also report-ed transmission via mother to fetus, sexual contact from male to female (there are no known instances of female to male), blood products, and lab exposure.

There have been 691 travel-associated cases of Zika reported in U.S. states, in-cluding 206 pregnant women. So far, there are over 1,000 cases in U.S. territories, in-cluding 166 pregnant women. There have been no transmitted Zika cases via mos-quito bite in the U.S., but Weber said that’s expected this summer. And there are tens of thousands of cases expected in Puerto Rico. “All of us are probably going to see Zika,” he said.

Zika’s incubation period is three to 12 days. It’s asymptomatic in 80 percent of people. For the remaining 20 percent, Zika complications have been linked to micro-cephaly in infants and Guillain-Barre syn-drome in people of all ages.

Weber said Zika presents like dengue and Chikungunya fever, so a workup is vital. Clinically, rash and conjunctivitis is more common in Zika than in the other two diseases.

Weber recommends other hospitals follow the University of North Carolina (UNC) Hospital response to Zika: devel-opment of a Zika virus working group, disseminating information memos to clin-ic directors and clinicians, adding Zika to the epidemiology isolation policy, creat-ing a referral algorithm, posting signage from the Centers for Disease Control and Prevention (CDC), engaging in prevention counseling in pre-travel evaluations for employees, and developing a diagnostic testing algorithm.

For UNC healthcare profession-als, the hospital helps assure immunity through vaccines, keeping a log of HCPs who are caring for patients with highly communicable diseases, mandating co-hort caring for those types of diseases,

and screening for signs and symptoms of those diseases.

MERS-CoV is endemic in the Arabi-an Peninsula, where it was believed to be spread by a single South Korean man. In the U.S., there have been more than 1,700 lab-confirmed cases with more than 200 deaths. Weber said this droplet-related dis-ease can be transmitted after exposures as short as five minutes.

MERS’ incubation period is two to 15 days, and it can live more than 48 hours at 20 degrees centigrade. Consequently, We-ber said MERS patients need to be put in an airborne isolation room with direct-out ex-hausted air, negative air pressure, and more than 12 air exchanges per hour.

HCPs should use special airborne pre-cautions in PPE, including an N-95 respira-tor, gloves, gowns, and protective eyewear with a face shield.

For any sort of infectious disease con-trol, Weber said critical issues healthcare facilities need to address include surge ca-pacity, screening and recognition of cases, adequate training of HCPs in donning and doffing of PPE, adequate isolation facilities (sequestered or dedicated area), adequate staffing, and provision of essential services and supplies.

“Each of these needs to be detailed as best you can before you see that disease,” Weber said.

Latest data on Zika and MERS-CoV transmission and treatment

David J. Weber


Smile for the camera!Did you stop by the photo booth in APIC Live? Check out a few of

the great souvenirs that attendees took home from Charlotte. Thank you to Stericycle for sponsoring the photo booth.


How much did conference attendees want to hear about the first large, randomized controlled trail evaluat-

ing the effect of ultraviolet (UV) light on terminal room cleaning? Enough to pack a large room and an overflow room.

“I’ve never spoken to a sold-out arena,” joked Deverick J. Anderson, MD, MPH, Duke Center for Antimicrobial Steward-ship and Infection Prevention, as he gazed out at the audience of more than 500 peo-ple who attended the Monday afternoon session “New Insights into Environmental Disinfection.”

Anderson shared data from Duke’s BETR-Disinfection Study, which is the first multicenter, randomized control trial (RCT) comparing terminal room disinfec-tion strategies with or without UV light.

There are two main strategies for en-hanced terminal room disinfection: hydro-gen peroxide vapor (HPV) and UV light. Anderson discussed the one published study comparing the two strategies head-to-head. “To jump right to the punchline, HPV is better because it kills more bacte-ria. But it can take much more time than UV light,” he said.

A Johns Hopkins RCT found that HPV, which is an Environmental Protection Agency-approved sterilant, decreased mul-tidrug-resistant organisms (MDRO) by 64 percent in six high-risk units.

“But it took more than three hours to clean each room, and that’s a big deal,” Anderson said. “So this strategy works, but it’s really hard to pull off. And it’s logisti-cally challenging because you have to seal

New study shows UV cleaning can significantly reduce MDROs in patients

the rooms before cleaning. Plus, it requires specific, intensive education of staff.”

The BETR-Disinfection Study showed that adding UV light to terminal room cleaning increased overall cleaning time by 30 to 55 minutes—much shorter than HPV.

Anderson said UV light damages nucle-ic acid and destroys the ability of bacteria and viruses to replicate. Consequently, it removes 99 percent of microbial contam-ination from the air and on surfaces. And, unlike HPV, multiple companies make UV-emitting devices, which lowers cost and helps improve quality.

Does it make a difference which UV device you choose? One study showed that UV-C machines are more effective at reducing MDROs than PX-UV machines. But Anderson said there wasn’t much dif-ference in bacteria reduction between the various types of UV-C machines.

The 28-month BETR-Disinfection Study involved nine hospitals in North Carolina, randomized at the hospital level. It studied four different terminal cleaning strategies: quaternary ammonium cations (quats) in all non-Clostridium difficile rooms, quats with UV-C, bleach for C. diff rooms, and bleach with UV-C. Each strategy was used for sev-en months in each hospital.

The study only included “seed” rooms with documented infection or colonization with methicillin-resistant Staphylococcus

aureus (MRSA), vancomycin-resistant en-terococci (VRE), C. diff, or multidrug-resis-tant Acinetobacter. A new patient had to be put in a seed room within 24 hours. And the new patient’s potential incident case had to be the same organism as the patient in the seed room—plus a positive culture while in the room or a positive culture in a specified time after at least a 24-hour stay in the room.

The primary outcome data used quat as the reference. Quat-UV showed a 30 per-cent reduction in MDRO, but Anderson said both of the bleach interventions were not statistically significant.

Adding UV light to terminal cleaning hospital-wide led to an 11 percent reduc-tion in all target MDROs and an 11 percent decrease in C. diff.

“Our conclusion is these machines do improve care for the patients,” Anderson said.

Compliance with protocols was high, with no major differences between study arms. Anderson said the research team used the UV machines almost 21,000 times, and 97 percent of the time they were able to finish the cleaning cycle before a patient needed to be admitted to the room.

“We sat there with a timer and every time we found we could have run the UV machine three times before a patient from

Deverick Anderson discussed environmental disinfection on June 13.

»» UV CLEANING Page 20

“To jump right to the punchline, HPV is better

because it kills more bac-teria. But it can take much more time than UV light,”

- Deverick J. Anderson, MD, MPH,


The APIC 2016 Annual Conference was the site of the largest exhibit hall in APIC history:

• 266 companies•60first-time exhibitors• 52,400 sq. ft. of exhibit space

266 companies exhibit at APIC 2016!


Members of the APIC MegaSurvey Research Committee presented preliminary findings from the sur-

vey during a Sunday afternoon session. The goals of the MegaSurvey are to

describe the current practice environment; identify gaps and future direction in edu-cation, policy outreach, and advocacy; and empirically validate the APIC IP Compe-tency Model, said Timothy Landers, PhD, RN, CNP, CIC, The Ohio State University.

The survey was emailed to 13,000 do-mestic APIC members, “and then every possible moment afterward we were ask-ing people to participate,” Landers said with a smile.

The result was 4,078 responses, or 31.2 percent of APIC members.

Landers and James Davis, MSN, RN,

MegaSurvey preliminary data is revealedCCRN, CIC, HEM, Pennsylvania Patient Safety Authority, listed the preliminary findings in the domains identified in the MegaSurvey. These include:

Demographics• Sex: 92 percent female• Ethnicity: 83 percent white, 4 per-

cent African American, 4 percent Asian, 3 percent Hispanic

• Background: 82 percent have a nurs-ing background

• Education: 45 percent have a bach-elor’s degree, and about one-third have a master’s.

• Experience: Categories ranged from 0 to 16-plus years’ experience; each cate-gory included about 20 percent of respon-dents.

• Of respondents, 49 percent had 16-

plus years’ experience before becoming an IP. Landers said this is disturbing because the goal is to encourage long careers. He believes this data will prompt APIC mem-bers to think about what they can do to en-courage students to look at infection pre-vention as a career track.

• CIC certification: 47 percent, with another 19 percent planning to certify in the next 12 months.

Practice and competencies• Practice setting: 67 percent work in

an acute-care setting. “This shows us we need to be doing more for the one-in-three members who are not in acute-care set-tings,” Landers said.

tient’s room. If they heard water going on or sounds of hand washing, they would jump out and clap for the doctor and give them a $10 Starbucks card as a reward,” Dubner said. “I thought it was stupid—you’re trying to change the behavior of the highest earners in your hospital with $10?”

But the doctors loved the Starbucks card. “Not one of them said, ‘Uh, you’re paying me 500 grand; why not put the card in a coffee fund for the nurses,’” Dubner said. “I learned to never underestimate the power of ‘free’—if you dangle something free in front of someone, they want it.”

But even the free Starbucks card didn’t noticeably improve hand hygiene. Instead, Dubner said, it became an exciting game. Doctors would run up to floor if they heard a Posse Patrol was there. And if they’d just encountered the posse, they would maybe subconsciously skip hand hygiene in the next room because they knew the posse wouldn’t be there.

“So now the hospital is out of ideas,” Dubner said. “But the hero of the story is the staff epidemiologist.” He came up with the idea of asking everyone on the com-mittee to place their palms in petri dishes of agar. Lab tests showed that the majori-ty of the 20 handprints were covered with

Stephen J. Dubner delivered the Opening Keynote.

Plenary«« From Page 4

HAI-related bacteria. So the epidemiologist suggested taking

a photograph of one of those petri dishes, letting it be known that the handprint be-longed to a committee member, and mak-ing it the screensaver on all Cedars-Sinai computers.

“Overnight, doctors’ hand hygiene went up to almost 100 percent,” Dubner said.

This might never have happened had the epidemiologist not felt he could speak up, though. It takes courage to ask out-of-the-

box questions or come up with so-called “ridiculous” ideas, Dubner said. That’s why it’s necessary to have meetings that create psychological safety and encourage the quieter people to talk. This could be as simple as inviting each person in the room to speak, he said.

“The moral of the story is that behavior change is very hard,” Dubner concluded. “If hand hygiene were simple, thousands of you would not have to gather to come up with a solution for this.”

»» MEGASURVEY Page 18


On Saturday and Sunday during the APIC Annual Con-ference, attendees had the opportunity to review posters andspeakwiththeauthorsabouttheirfindings.

Attendees interact with poster authors


exploding patient numbers, few primary care sites are using infection surveillance systems.” The systems were limited to uni-versity healthcare systems using electron-ic medical records, and focused only on identifying respiratory tract symptoms and infections. “The question is will electronic surveillance systems work in smaller cen-ters,” Manning said.

There is preliminary evidence of the po-tential benefits of using targeted infection sur-veillance in primary care, she said, but there is very little published work. “So if you’re doing this type of work, please publish it.”

Pogorzelska-Mazlarz reported on a sur-vey her facility conducted focusing on pri-mary-care IPs’ roles, education, experience, responsibilities and activities, surveillance, resource priorities, and challenges.

The survey was conducted online in May 2016, and 109 chapter members participat-ed. Sixty-one percent were certified in infec-tion prevention and control, 30 percent had less than five years’ experience, and 50 per-cent worked in adult acute-care hospitals.

Of the IPs who worked in acute care, 62 percent spent 5 percent or less of their time in primary care. The majority of their pri-mary care time was spent on development and maintenance of infection prevention policies and procedures, infection control training and competency for primary care staff, and high-level disinfection of devices.

Only 42 percent said they monitor or observe environmental cleaning practice. And only 8 percent reported that their pri-mary care offices had designated staff for infection prevention activities.

The survey did find that 87 percent of the IPs provide education to primary care facili-ty staff. Top topics were personal protection equipment (PPE), basic principles for infec-tion prevention, and hand hygiene. Eighty percent used computer-based training, and 50 percent did face-to-face training.

The IPs identified their top issues as en-vironmental cleaning, lack of knowledge among primary care staff, and machine and device cleaning and sterilization.

They listed their challenges as limited staffing and time, oversight issues in terms of geographic spread of facilities, lack of basic knowledge of infection prevention

and staff turnover in primary-care facil-ities, lack of standardization of infection prevention policies, and lack of knowledge about what type of infection surveillance is appropriate in the primary-care setting.

“We think developing risk assessments in the primary-care setting and helping IPs build a business case for surveillance will really alleviate some of the challenges we were told about,” Pogorzelska-Mazlarz concluded.

Rebecca Fitzpatrick, DNP, RN, CIC, Hospital of the University of Pennsylvania, followed with an examination of the busi-ness plan she developed to add a dedicated IP for her facility’s more than 150 outpa-tient primary-care settings.

“In many cases, we found the facili-ties developed infection-prevention plans without IP input. The facilities were so scattered that we could only have an IP at a practice once a month, at best. She would do training and then find the next time she went out, there was a brand-new person in the job,” Fitzpatrick said. “We found while we had gone out and done a lot of work in these practices, there was no structure of leadership to keep that work ongoing.”

Fitzpatrick’s business plan incorporated standards in the published guidelines for ambulatory care practices. It also incor-porated Joint Commission visit findings showing the need for standardization of pre-cleaning processes for scopes in all of the hospital’s locations, including ambula-tory care practices.

Additionally, the plan defined who had daily accountability for infection-preven-tion activities. There was also identification of risk—who will drive the infection pre-vention practices and the scope of services provided.

“What we learned from all of this is to be consistent across all of our practic-es. The outpatient settings didn’t have the same infection prevention support as our in-patient facilities,” Fitzpatrick said.

The presenters wrapped up the session with a list of their favorite resources for in-fection prevention and surveillance in pri-mary care facilities.

“Don’t try to reinvent the wheel. These publications cover much of what you need,” Manning said.

• The Centers for Disease Control and Prevention’s Guide to Infection Preven-tion for Outpatient Settings (downloadable from the CDC website)

• APIC Text chapter on ambulatory care• CDC’s Outpatient Settings Policy Op-

tions for Improving Infection Preventions (downloadable from the CDC website)

• American Academy of Pediatrics Policy Statement, 2007: Infection Prevention and Control in Pediatric Ambulatory Settings

• A June 2016 article in the Joint Com-mission Journal on Quality and Patient Safety: “Assessment of Endoscope Repro-cessing Using Peer-to-Peer Assessment Through a Clinical Community.” “If you need an assessment tool quickly, this one is really lovely,” Manning said.

Primary Care«« From Page 3

Renee Fusco, Palmyra, NJ, second from left, posed a question to the panelists.


Lots of action at APIC Live!APIC Live was abuzz with activity throughout the conference, as the host to the PPE Fashion Show and the APIC Film Festival. Experts gathered to answer questions at the Knowledge Bar and social media stars met up at the Tweet-up. And then there was the chance to dress up to take a souvenir home at the APIC photo booth.


MegaSurvey«« From Page 14

• Time spent on various job duties: Surveillance/investigation: 25 percent; pre-vention/control transmission: 16 percent; infection identification: 14 percent; man-agement/communication: 12 percent; edu-cation/research: 10 percent; environment: 10 percent; cleaning/sterilization: 9 percent; employee/occupational health: 8 percent. “We’re spending more time on surveillance

and investigation, but our facilities aren’t putting more resources into that,” Davis noted. “How can we influence our systems about how they can do better when it comes to development and supporting us?”

• Patient safety: Most IPs’ time is spent in performance improvement and imple-mentation science, followed by leadership and management, infection prevention and control, and technical activities.

Davis said this MegaSurvey preliminary data show that APIC has the opportunity to engage early-career professionals, identify

CIC-ready IPs, direct future education ac-tivities outside of acute care, address mem-bership needs at all levels, and do outreach to other groups. Other priorities include looking at compensation associated with CIC certification; and analyzing recruitment and retention strategies based on IPs’ back-ground, education, and practice setting.

The next step is distributing the Mega-Survey data as quickly and widely as possi-ble, Landers said. This includes manuscript development within the next three to four months.

The call for antimicrobial stewardship isn’t new, said Rita Olans, DNP, RN, CPNP-PC, APRN-BC, MGH,

during the Sunday morning session “The Role of the Staff Nurse in Antimicrobial Stewardship.”

In fact, during his 1945 acceptance speech for the Nobel Prize in medicine, penicillin discoverer Sir Alexander Flem-ing warned about the dangers of the drug.

Today, the Centers for Disease Con-trol and Prevention (CDC) and the World Health Organization have declared an an-tibiotic resistance crisis, Olans said. Ac-cording to the CDC, antibiotics account for more than 2 million infections in the U.S. and 23,000 deaths a year. And a 2010 CDC survey revealed that more than 50 percent of hospital in-patients received an-tibiotic therapy—37 percent of which were deemed unnecessary or inappropriate.

Olans said antibiotic stewardship helps prevent or slow antimicrobial resistance, optimize selection-dosing duration, and re-verse adverse events, including secondary infections.

Hospital antimicrobial stewardship pro-grams have existed for two decades, but the role of nurses is often ignored or dis-couraged, Olans said—despite the fact that nurses already perform many antimicrobial stewardship activities, including:

• Patient admission. Triage and appro-priate isolation, accurate allergy history, ear-ly and appropriate cultures, timely antibiotic institution, medication reconciliations.

• Daily clinical progress monitoring and reporting. Preliminary micro results and antibiotic adjustment, antibiotic dos-

ing, de-escalation. • Patient safety and quality moni-

toring. Adverse events, change in patient condition, final culture report and antibiotic therapy, antibiotic resistance identification.

• Clinical progress, patient education, and discharge. Intravenous-to-oral antibiot-ic adjustment, outpatient antibiotic therapy, patient education, length of stay, outpatient management, long-term care, readmission.

Olans said infection preventionists (IPs) need to be educators about antimicrobial re-sistance and antibiotic stewardship because they appreciate the importance of antibiot-ic resistance, are used to multidisciplinary linkages, know their hospitals, and are expe-rienced at operationalizing critical interven-tions for healthcare-associated infections.

“You won’t wash your hands of this problem,” she said.

Following her presentation, Olans an-swered audience questions, including:

How can nurses get more involved in antibiotic stewardship?

The CDC had a big meeting last July to

Nurses have a key role in antimicrobial stewardshipdiscuss this topic. Since then, Olans held a call with about 30 nurses around the coun-try to further brainstorm.

How can overworked nurses find time for antimicrobial stewardship?

One idea is to carve out protected time in nurses’ schedules that is specifically for antibiotic stewardship.

How can we excite nurses about anti-microbial stewardship?

Olans and nurses who spoke during the Q&A suggested making antimicrobial stewardship part of new-hire orientation, and taking nurses on antimicrobial stew-ardship rounds.

“I’ve found that nurses are very un-comfortable talking to doctors about an-tibiotics,” Olans said. One reason is be-cause nurses don’t know the difference between colonization and infection. Ed-ucation on this topic can help build the confidence to engage with physicians, she said. “Or if you’re not comfortable with physicians, try talking to the clinical pharmacist.”

Miss a Session?Did you miss any of these sessions? Click on the title to read the recap in APIC

Daily News. • 1503 – The 2016 Reign of Elizabethkingia in Wisconsin

• 1500 – Creating Successful and Collaborative Relationships Between Infection Preventionists and Infectious Disease Physicians

• 2104 – Implementing a Severe Sepsis Improvement Program: The Role of the Infection Preventionist

• 2307 – The Top 10 Infection Prevention Articles of 2015

http://www.pageturnpro.com/CustomNEWS/72846-APIC-Daily-News-Monday/index.html#2






44th Annual ConferenceWednesday-Friday, June 14-16Portland, Oregon Oregon Convention Center

Sign up now to receive an early alert when registration opens in December.


Attendee Q & AWhat is your biggest takeaway from this year’s conference?

“Learning about legionella prevention, includ-ing looking at the role of handheld shower heads in causing legionella in facilities.”

Frank MyersUC San Diego Healthcare Systems

San Diego, California

“The need to share more of what we’re doing—whether it’s good or bad—and get it published.”

Karoline SperlingPark Nicollet Health Services

Minneapolis, Minnesota

“This is only my second APIC conference, and it’s really showing me the significance of being knowl-edgeable about standards of practice, whether it’s in a small or large healthcare facility. I think sharing what I learned here will make a big impact at my facility.”

Shavonna WhiteIHS-Chinle Service Unit

Chinle, Arizona

“The sense of community with other IPs and the fact that we’re all facing the same issues. We have multiple approaches to infection prevention problems, and the fact that we’re sharing our solutions is major. C. diffi-cile is an issue in my facility, and I’ve heard five or six new ideas at this conference about how to approach it.”

Marian PokrywkaUPMC Mercy Hospital

Bethel Park, Pennsylvania

the emergency department was admitted into the room,” he said.

Still, the machines do add 30 to 55 min-utes to cleaning time, and Anderson said room turnover time was a key point of con-tention. Environmental services (EVS) em-ployees believed that delays in the emer-gency department were the primary cause for delays in hospital room turnover, while nurses thought delays in room disinfection were the principle source.

“We confronted this issue by developing a strategy for daily communication between EVS and Bed Control,” Anderson said. In some cases, it was as simple as knowing which rooms would be eligible for terminal cleaning each day, and when. To accom-plish this, the research team developed a redundant, “Swiss cheese” system to iden-tify eligible rooms: electronic notification, EVS-nursing communication, and signs on room doors. This achieved about 90 per-cent compliance, Anderson said.

Anderson said the pros of UV cleaning are that it’s highly effective, doesn’t require extensive training, and can clean many rooms per day. The cons are that the units are costly, UV cleaning increases room turnover time, and it can only be used at terminal cleaning.

“And if you’re not doing a good job of cleaning, you still need to focus on your cleaning before you can get a lot of bang for your buck with these machines,” he said.

UV Cleaning«« From Page 12

Miss an issue of APIC Daily News?

Digital versions of the APIC Daily News onsite issues can be viewed online. Issues contain im-portant news about APIC, session recaps, attendee interviews, onsite photos, and much more.

FridaySaturdaySundayMonday

http://www.pageturnpro.com/CustomNEWS/72812-APIC-Daily-News--Friday/index.html#1

http://www.pageturnpro.com/CustomNEWS/72837-APIC-Daily-News-Saturday/index.html#1

http://www.pageturnpro.com/CustomNEWS/72843-APIC-Daily-News-Sunday/index.html#1



Exhibitor News Exhibitor News features press releases submitted by exhibitors at the APIC 2016 Annual Conference that advertise in APIC Daily News.

Although all advertising mate-rial is expected to conform to ethical (medical) standards,

inclusion in APIC’s publication does not constitute a guarantee or endorsement of the quality

or value of such product or of the claims made of it by its

manufacturer.

The Association of Healthcare Emergency Preparedness Profession-als (AHEPP) was formed in 2014 to provide healthcare preparedness pro-fessionals with opportunities for net-working, resource sharing, continuing education, and scholarly exchange. AHEPP aims to achieve our mission, “Moving Preparedness Forward” by meeting the education, networking, and information needs of healthcare preparedness professionals across the U.S.

AHEPP members enjoy benefits of discounted AHEPP Annual Confer-ence registration, monthly education-al webinars, mentorship programs, professional networking and collab-oration, leadership opportunities, and more.

Each year, AHEPP hosts a na-tional conference, AHEPP Annual, providing healthcare preparedness professionals with information, skills and networking opportunities to help guide and refine disaster planning ef-forts in various healthcare settings. AHEPP Annual 2016 will be held at the Treasure Island Convention Cen-ter, Las Vegas on October 4-6, 2016.

Join AHEPP before June 30 to save $200 off conference registration! Visit www.ahepp.org for more information.

Moving preparedness forward

By Megan J. DiGiorgio MSN, RN, CIC

Alcohol-based hand rub (ABHR) is the global standard for hand hygiene, but soap and water plays an important supporting role when hands are visibly soiled or contaminat-ed. However, soap can have profound effects on healthcare worker (HCW) skin condition.

A general misconception is that soap is gentler to skin than ABHR, but the opposite is true. Soap and water can remove the lipid layer of the stratum corneum, causing loss of water and ultimately creating dry, flakey, and irritated skin. ABHR can cause burning and stinging when skin is already damaged and nerve receptors are activated, even though it

is not the source of the damage. Prevention is key and choosing the right

soap is important. A well-formulated soap is efficacious, helps maintains healthy skin, and has good aesthetic properties during use such as adequate lather and easy rinsing. In high-use environments such as healthcare, mildness is critical to HCW acceptance and long-term skin health. Not all soaps are cre-ated equal, so it’s important to solicit data on efficacy and skin tolerability from the product manufacturer.

Poor product choices can adversely impact a facility’s hand hygiene compliance rate. A well-formulated soap should be a comple-ment to a well-formulated sanitizer.

Selecting the right soap for your facility

Now is the time to advance your career to the next level through graduate nursing educa-tion at Loyola University Chicago. The APIC Competency Model stresses the acquisition of advanced clinical expertise, understanding of implementation science and leadership skills to effect system-wide change.

Graduate education in infection preven-tion needs to build on existing knowledge and skills and be tailored to individual learning needs and career goals. Loyola University Chicago School of Nursing has a well-es-tablished, nationally ranked graduate nurs-

Advance your career with a Masters or DNP in infection preventionOnline Program at Loyola University Chicago that Meets National Criteria for Excellence

ing program, originally funded by a HRSA Grant, which offers a variety of online gradu-ate nursing degrees in the specialty area of in-fection prevention. These include the MSN, BSN to DNP, and MSN to DNP in Infection Prevention as well as a 15 credit hour certifi-cate program.

Coursework is taught by nationally rec-ognized faculty, and mentors/preceptors are identified to work with students in clinical practica near where they live and work.

Graduate education at Loyola prepares nurses to be managers and leaders who truly make a difference. Join together with other busy IP students from all over the country who are already successfully attaining grad-uate education at Loyola University Chicago.

For more information and to meet Loyola faculty, visit Luc.edu/apic.

EPI® Intensive is a novice-level course that compresses infection prevention funda-mentals from the EPI® 101 and 102 classes into a 5-day interactive intensive learning experience. The course is a great introduc-tion to the roles and responsibilities of the infection preventionist. Areas of emphasis include how to prepare surveillance and risk assessment plans, regulatory compliance, preventing transmission of infectious diseas-es, and how to handle employee exposures and evidence-based interventions to prevent

Extend your learning with an EPI® Intensiveor reduce risk. A certified and experienced faculty team presents the course with a hands-on training approach to ensure active learning and encourage networking.

The next EPI® Intensive course takes place in Sioux Falls, South Dakota, July 25-29. Additional upcoming courses in in-clude Burlington, VT (August); Dallas, TX (September); St. Louis, MO (October) and Anchorage, AK (October).

For more information visit www.apic.org/Intensive.

http://www.ahepp.org

http://Luc.edu/apic

http://www.apic.org/Intensive

http://www.apic.org/Intensive


mon. “Think specifically how you can ap-ply each of these principles directly to the work you do fighting infection,” he said.

Get curious. The more curious you are, the more creative you become, Linkner said. To spur curiosity, ask more questions like “why,” “what if,” “why not?” This challenges you to think of what can be rath-er than what already is.

Crave “what’s next.” Instead of cling-ing to the past, examine what’s possible in the future. “Software companies are great at this. Version 5.0 puts version 4.0 out of business,” Linkner said. “In in-fection prevention, there are many best practices, but with the rate of change we’re experiencing in healthcare and dis-ease today, the shelf life on best practices may be shorter than you think. So replace ‘best practices’ with ‘next practices’—new tweaks and adaptations to improve best practices.”

For instance, Linkner said Henry Ford Hospital in Detroit hired a CEO from Ritz-Carlton instead of someone with a healthcare background. He built a new hos-pital with plant-lined atria and food so good that people in the community go there for dinner. Other hospitals thought the CEO was crazy, but now Henry Ford has one of the top five revenues per square foot of any facility in the U.S.

“Sometimes the most poignant inspira-tion comes from afar. You can borrow ideas from nature, music, fashion, technology, or anywhere else and apply it to healthcare,” Linkner said.

Defy tradition. “Too often, we do things the ways they’ve always been done. In healthcare, the traditional approach is not always the best,” Linkner said.

He told the story of a woman working on her graduate thesis in industrial design who decided to flip pill bottles so the cap is on the bottom. This creates room for large, easy-to-read instructions. And the caps fea-ture color-coded bands for each member of the household.

“There are a lot of things in healthcare we can’t control, so let’s focus on things we can control. Patient experience can be a big, big, opportunity,” Linkner said. For instance, Children’s Hospital of Pittsburgh recently

hired window washers who wear superhero costumes. Children who see Batman clean-ing the windows of their room feel like they went to the hospital for something fun rather than painful. “The cost to the hospital sys-tem? Zero. The window-care company paid for the uniforms,” he said.

Get scrappy. “The real ingredients of in-novation and creativity are grit, determina-tion, tenacity, resilience. We all have these attributes,” Linkner said. There are never enough resources, time, or talent, so he suggests channeling your inner MacGyver to solve complex problems in innovative ways with limited resources.

Adapt fast. “There’s a big myth that we must come up with some giant, cure-cancer idea or we’re not creative,” Linkner said. Another myth is that ideas come forth like a single bolt of lightning. The reality, he said, is that most ideas are deeply flawed and need micro-innovations along the way to be successful.

Linkner closed his talk with a story that embodies all five of his innovation obses-sions.

Tom Lix started a business, and lost everything. He felt hopeless, depressed, ashamed, and scared. His first instinct was to take a job and hide for the rest of his ca-reer. But Lix decided instead to follow his passion for fine whiskey and start a whis-key company. The only problem? Good whiskey is aged in charred oak barrels for 10 years or more. And Lix didn’t have that kind of time.

So he asked why whiskey had to be made that way. And he thought about what’s next, and how he could defy whis-key-distilling tradition. He got scrappy, and he thought quickly. The result? Instead of putting whiskey in barrels, he came up with the idea of putting barrels in whisky.

Lix developed a process that chops up pieces of barrel wood and mixes them with whiskey in stainless tanks. The tanks apply and release pressure to the mixture over and over. In one week, they create whiskey that tastes finely aged.

Lix named his invention Cleveland Whiskey, after his home town. Not only does he flaunt how he makes it, but he charges a 30 percent premium. Today, he can’t make enough Cleveland Whiskey to meet customer demand.

“This is what Tom did in his darkest hour. Think about what we can do in our finest,” Linkner said.

He sent the audience home with an in-novation challenge: “In the next seven days, see if you can uncover one idea for creative disruption. It can be big or small—just think of one idea,” he said. “You’ll find that just like disease, ideas are contagious. One idea becomes six ideas, and starts to spill over to those around you. At this event next year, you could be enjoying a freight train of progress.”

After all, he said, “the challenges and complexities in healthcare are bigger than ever, but the opportunities are also bigger than ever.”

Author and entrepreneur Josh Linkner closed out APIC 2016.

Closing«« From Page 1

closing keynote speaker offers innovation challenge: think ...€¦ · become complacent,” said...

Documents