CDC Guidelines and Infusion Therapy Standards of Practice

CDC Guidelines and Infusion Therapy Standards of Practice: Defining the Difference Session 207 Panel Discussion

Learning Outcomes • Learners will be able to apply the 2016 INS Infusion Therapy Standards of Practice and the 2011 CDC Guidelines for the Prevention of Intravascular Catheter-Related Infections to clinical practice. • Learners will be able to analyze the difference between the two documents.

Panel Session • This is an open discussion and participation by the audience is important. • As each topic is discussed please feel free to come up to the mic for questions to the panel or submit questions to the NCOE member at the back and they will be answered.

Mark E Rupp, MD Professor and Chief, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE Medical Director, Dept of Infection Control & Epidemiology Research Interests: Healthcare-Associated Infections, Staphylococcal Disease, Antibiotic Resistance/Antimicrobial Stewardship Major Accomplishments: Over 400 papers/chapters/abstracts published; Editor of 3 textbooks; 3 US patents; Past-president SHEA; Past-president ASM Division L, Consultant: CDC, FDA, NIH, VA

Guidelines Co-Author: 2011 CDC/HICPAC Guidelines for the Prevention of Intravascular Catheter-Related Infections. O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett P, Maki DG, Masur H, Mermel LA, Pearson ML. Raad II, Randolph A, Rupp ME, Saint S. Co-Author: SHEA/IDSA/AHA/APIC/TJC Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 Update. Marschall J, Mermel LA, Fakih M, Hadaway L, Kallen A, Pettis AM, Rupp ME, Sandora T, Yokoe DS, Maragakis L. In progress: Co-Author: IDSA Practice Guideline for the Management of Intravascular Catheter-Related Infections. (Chair: Nasia Safdar)

Mary Alexander, MA, RN, ® CRNI , CAE, FAAN • Chief Executive Officer, INS and INCC • Editor-in-Chief – Journal of Infusion Nursing – Core Curriculum for Infusion Nursing – Infusion Nursing: An Evidence-Based Approach – Policies and Procedures for Infusion Therapy

Infusion Therapy Expertise • INS representative, 2011 CDC Guidelines for the Prevention of Intravascular Catheter. Related Infections • Reviewer/editor, Infusion Therapy Standards of Practice (1998, 2000, 2006, 2011, 2016) • National and international speaker on specialty practice of infusion nursing, standards development, and patient safety

Mary Hagle, Ph. D, RN-BC, FAAN • Nurse Scientist at Milwaukee VA medical center • Member of Standards of Practice Committee: 2010 & 2015 • Prior member of INCC for two terms • Adjunct faculty at University of Wisconsin. Milwaukee

Infusion Therapy Expertise • Co-Author of 2011 and 2016 Infusion Therapy Standards of Practice • Co-editor, co-author, author of infusion therapy books, chapters and papers • Focused on quality improvement and best evidence for infusion therapy and its data retrieval in electronic medical records • Interests include quality indicators and prevention of adverse events, implementation science • Extensive previous experience as oncology clinical nurse specialist in academic and community medical centers

Barb Nickel, APRN-CNS, NP-C, CCRN, CRNI® • Critical Care CNS for community hospital in Nebraska • Was member, then chair/lead nurse planner for the INS National Council on Education from 2011 -2016 • Reviewer for 2011 and 2016 Infusion Therapy Standards of Practice

Infusion Therapy Expertise • • Works extensively in CNS role to assure quality infusion related care at CHI Health St. Francis in all clinical areas Is co-chair of the statewide Infection Prevention Council for Catholic Health Initiatives NE (16 facility) division, including CLABSI prevention Participated in multiple local, state, and national infusion related initiatives related to: evidence based practice, documentation, drug library standardization, product selection and standardization Recently authored article on application of Infusion Therapy Standards of Practice to: – Quality and Safety in Education (QSEN) competencies • Contributing Editor for Critical Care Nurse’s, with focus on infusion therapy – Recent article submitted on Peripheral IV access in critical care

Loretta K Dorn, MSN, RN, CRNI® • Director of Clinical Operations Lake County IL Health Department • Member of National Council on Education for the Infusion Nurses Society • Past INS Illinois Chapter President • Reviewer of the 2016 Infusion Nurses Standards of Practice • Major Accomplishments: Published journal articles on LADs, Infection control, Pulmonary Arterial Hypertension, Human Factors study for the small bore ISO committee, and co-author of the small bore ISO standards. • Moderator for the session

Guidelines versus Standards • Guidelines: – General statements, recommendations, or administrative instructions designed to achieve the policy's objectives by providing a framework within which to implement procedures. • Standards: – Acceptable level of quality or attainment. Standards are professionally developed expressions of the range of acceptable variations from a norm or criterion. – Standards may be defined as “Benchmark of achievement which is based on a desired level of excellence”. • http: //currentnursing. com/nursing_management/nursing_standards. html

Question 1 • While we have reviewed the definition of a standard versus a guideline, after having worked on the creation of the 2011 CDC Guidelines or the 2016 INS Standards, how do you see the definition of a guideline versus a standard from a practical perspective?

Question 2 • In looking at CDC and INS, what is the difference in the role and the focus between the two organizations? • How does each organization address issues such as catheter occlusion, device dwell time and venous access options?

Question 3 • When would a clinician decide to follow the 2011 Guidelines for the Prevention of Intravascular Catheter-Related Infections AND/OR • 2016 Infusion Therapy Standards of Practice?

Question 4 • How is the committee selected for writing the INS Standards or the CDC Guidelines? • How would someone go about being on the committee for the INS Standards or the CDC Guidelines?

Question 5 • Can you describe the pathway used to determine the strength of the evidence and the decision to include certain evidence to create the Standards? • What is the process for the literature search and criteria to discover new evidence? • How is industry-sponsored research considered within the Standards?

Question 6 • What happens if there is no randomized controlled trial (RCT) available to make the decision? • Why are RCTs hard to complete for infusion therapy?

Question 7 • How does the evidence grading system support the Guidelines or Standards ?

Question 8 • Do other organizations provide input into the Standards or Guidelines? • What are the other organizations that may be included in the process?

Question 9 • How are the comments by reviewers used to evaluate the documents before publication? • How does a clinician get to be on the list of reviewers?

Question 10 • There are many different products in the market used in infusion care, how are products in the field discussed in the Standards or Guidelines? • How do standards/guidelines influence buying decisions?

Question 11 • There is a difference between the publication dates of the INS Standards (2016) versus the CDC Guidelines (2011), does that have an impact on how the documents are used?

Question 12 • How often should a standard be updated? • How often should a guideline be updated? • How have we seen guidelines/standards stimulate new research? • How should they inform research priorities?

Question 13 • Many MDs do not necessarily recognize the INS Standards, how do we ensure that we are all working to the same level of care as created in the Standards or the CDC Guidelines? • There has been discussion that the Standards are for nurses only while the Guidelines is used more broadly, what is your opinion about the statement?

Question 14 • When would a clinician decide to follow the INS guidelines versus the CDC standards

Question 15 • How would a healthcare organization write policies and procedures to incorporate both the CDC Guidelines and the INS Standards? • How do we ensure that our clinicians’ practice adheres to guidelines and standards?

Thank-you Questions?