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Special Issue for Infection Prevention Week

SHOW ME THE EVIDENCE:

Conversations with Dr. Günter Kampf
and Dr. Didier Pittet on Hand Hygiene

ARE YOU READY

FOR H1N1?
Planning for a Pandemic

PLUS:
FREE Hand Hygiene
and CAUTI Prevention
Learning Opportunities
IPnow.mg:Layout 1 10/12/09 4:33 PM Page 2

IN THIS ISSUE
Joint Commission: Patient Safety . . . . . . . . . . . 2

H1N1: Planning for a Pandemic . . . . . . . . . . . . . 3

Show Me the Evidence: A Conversation . . . . . 9

with Two Hand Hygiene Experts

Hand Hygiene: New Discoveries . . . . . . . . . . . 15

SPECIAL WEBCAST EVENT

HHS: 4 Categories of Infections . . . . . . . . . . . . 16

Innovation in the Prevention of CAUTI . . . . . . 17

FREE WEBINAR

CAUTI Prevention Today . . . . . . . . . . . . . . . . . . 17

ERASE CAUTI Program. . . . . . . . . . . . . . . . . . . 18

Joint Commission Center for Transforming

Healthcare Takes Aim at Patient Safety Failures
Teaming up with top hospitals and health systems across the country to use new methods to find
the causes of and put a stop to dangerous and potentially deadly breakdowns in patient care,
The Joint Commission is launching the Center for Transforming Healthcare.

The Center’s first initiative is tackling hand washing failures that contribute to healthcare-
associated infections that kill nearly 100,000 Americans each year and cost U.S. hospitals
$4 billion to $29 billion annually to combat.

Eight leading hospitals and health systems volunteered to address hand washing failures as a
critical patient safety problem–one that requires fixes far more complex than just putting up signs
urging caregivers to wash their hands. The Center’s work to identify and measure poor quality
and unsafe healthcare will lead to the development and testing of targeted, long-lasting patient-
safety solutions.

Hand washing is the Center’s first patient-safety challenge. Future projects will focus on improving
other aspects of infection control, mix-ups in patient identification and medication errors.

2 Infection Prevention Now • Special Edition

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H1N1 I n t e r v i e w b y H a y d n B u s h

Deborah Levy is the chief of healthcare

preparedness activity for the Centers for
Disease Control and Prevention.

PLANNING FOR A PANDEMIC

Better communication critical for hospitals if H1N1 returns this fall

ast spring's outbreak of the H1N1 flu virus flooded hospital emergency departments
L with potentially infected patients and their families. Hospitals scrambled to meet
increased demand for services and critical supplies. The episode overwhelmed some
hospital supply chains, as materials like masks and ventilators were suddenly in short
supply. Often, hospitals weren’t able to get enough supplies from manufacturers because
of allocation agreements, says Deborah Levy, chief of Healthcare Preparedness Activity
for the Centers for Disease Control and Prevention (CDC). “This spring, a lot of facilities
seemed to struggle with getting the supplies they wanted,” Levy says.
With the H1N1 virus expected to return to North America this fall—potentially in
stronger form than in the spring—Levy says hospitals should be working now to improve
lines of communication with their local public health departments, manufacturers and
their states to adequately prepare the proper supplies and protocols. Better information,
Levy says, is the key to coping with a potential pandemic.

Reprinted from Materials Management in Health Care, by permission, August 2009, Copyright 2009, by Health Forum, Inc.
This article first appeared in the August 2009 issue of Materials Management in Health Care.

Infection Prevention Now • Special Edition 3

IPnow.mg:Layout 1 10/12/09 4:34 PM Page 4

What is the most important thing hospitals

can do right now to prepare for the possible
return of H1N1 this fall?
They definitely need to plan for surge capacity
because there is that concern it will come back
in a stronger way this fall and there will be more
cases. Given the demographics—and we have
no way of knowing for sure how the virus will
come back in the fall, which is why the CDC
is watching what’s happening in the Southern
Hemisphere—but if it continues to hit the
same demographics, then a lot more attention
to pediatrics and young adults is needed.
The pediatric hospitals got pushed quite a bit
during this not-ultra-severe pandemic. A lot
of times, pediatricians and pediatric hospitals
don’t focus on influenza as much. It’s still
sometimes seen as an older person’s disease,
and if this virus stays the way it is, that’s not
what’s happening.

Was that something the providers weren't

prepared for?
It’s not that they weren’t exactly prepared
for it, but I don’t think the preparedness was
specifically targeted to a surge in younger
adults and children. Because children don’t
just automatically go to any hospital, you try
and take them to pediatric hospitals, and
this fall that could put a bigger burden on
those hospitals.

What are the areas where materials and

supplies might be specific to a pediatric facility?
Masks and respirators aren’t made for
the pediatric population. With ventilators,
you have some that work for both adults
and children, and others that work just
for children.

4 Infection Prevention Now • Special Edition

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Were there supply shortages this spring?
There were different rumors. It’s hard to say
what exactly was really true and what different
groups were putting out there, but we started
getting a lot of messaging around “Oh well, we
can’t give you more supplies because we’re
holding them for the federal government,” which
was incorrect. We made it clear that was not
what we were doing. The rumors tended to be
across the board, so it was a lot on medical
supplies but we even saw some of that with
diagnostic kits.
Sometimes the confusion might be around the
fact that a hospital might have an order, but the
companies moved to allocation-only. So you
might have put in an order for X amount for an
entire year. And now, because of H1N1, you
were asking for your full order, and the company
said no, you’re going to get your monthly alloca-
tion. I think some facilities didn’t realize that
manufacturers and distributors started going
to allocation only. Even though they agreed to
supply you with X amount, you could only get
it by your monthly allotment.
I think sometimes the language gets confusing.
When you hear there’s a shortage, is it really a
shortage, or is it just that you want more than
what was planned at this particular time? There
wasn't a shortage this time, and yet we continu-
ally heard there was. Most states didn’t end up
having to dig into their stockpile. The CDC
pushed out 25 percent of the stockpile to the
states. It was sufficient, and yet you kept hear-
ing about shortages. There was no shortage.
Sometimes it’s communication, and sometimes
it’s the fact that you suddenly want everything
and the manufacturer or distributor is saying no,
you’re going to get your monthly allotment the
way you always have.
Infection Prevention Now • Special Edition
What should hospitals do to build surge
capacity for next fall?
Our group at CDC focuses on the linkages
between health care, public health and
emergency management. You have Joint
Commission requirements for exercise and
planning. Some of the funding is based on
your hazard vulnerability assessment. So they
tend to do that and focus on what they need
for their hospital. Under surge capacity
conditions, especially if it were to get severe,
if you’re planning by yourself in a silo, that is
not the right approach.
Hospitals need to work with their clinicians,
other hospitals in the community and other
components of the health care sector. You’re
trying to use all the resources in your community
so you don’t have everybody rushing to the
hospital. Hospital emergency departments got
overwhelmed in some cases. It was parents
bringing their children in who might not have
been really severely ill, but they were coming
in saying, “I want you to check my child out.”
As a parent, if your child starts getting sick,
even if they're not severely ill, you’re going to
take them to the health care system. Even
though if H1N1 was not happening and your
child had a sore throat, you’d tell them to stay
in bed and give them two Tylenol and that would
have been the end of the story. Because H1N1
was circulating around, now suddenly your
child has a temperature you think, “Oh my
God it’s H1N1, I need to have my child tested”
and off you go and there you are in the ED.
5
 “ ”
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It’s not that they weren’t exactly prepared for it,

but I don’t think the preparedness was specifically targeted
to a surge in younger adults and children.

Who do you need to work with outside
of your facility?
You also need to get your messaging straight.
Work with public health, because public health
is going to do a lot of directing and messaging.
In severe cases, if you haven’t done any kind of
planning with emergency management, that’s
a problem. Think about an ice storm or a tornado
coming through. Which group within your
community helps manage that incident and helps
with resources? It’s emergency management. They
don’t necessarily always understand the details
of what goes on in a hospital and in the clinics that
support the hospital. Those dialogues shouldn’t
start happening in the middle of an incident.
“In case of a full-blown pandemic, will hospitals have enough
beds or need to find additional space to house patients?”
When we work with communities and conduct
workshops, we require about 15 sectors to show
up. That's how we work with them to think about
the model of care delivery—everything from
supplies down to managing your staff and your
beds. How do you reduce demand, and once
you’re in the hospital how do you deal with a
surge? We want 911, other urgent call centers,
EMS, emergency departments and hospital
administrators, your private providers, clinic
officers, outpatient and other urgent care clinics,
public health, emergency management, hospice,
long-term care, palliative and pharmacies. If you
want to do your ideal planning to respond to
H1N1 or any other scenario, all of those folks
should be at the table.
You still need a core team within that, and that’s
where we put health care, public health and
emergency management as the triad to drive the
planning. In case of a full-blown pandemic, will
hospitals have enough beds or need to find
additional space to house patients? It’s a matter
of space and crowding, but it’s also a matter of
doing the triage. You may end up having to think
about cohorting patients. As patients come into
the emergency room, it’s not like you’re just going
to have H1N1. You have other illnesses. If you do
end up having a lot of the mildly ill still trying to
get into the hospital, you really don’t want them
exposing their illnesses to your other, chronically
ill patients. Thinking about how you would do
that initial triage when all these people are trying
to get into your facility is really important. And
then it’s important to think about where you put
all these patients in hospitals.
What were some of the problems hospitals
ran into in the spring?
The difficulty in the spring was somewhat artificial.
It was related to communications and some

6 Infection Prevention Now • Special Edition

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confusion as to what you could get when.
Clearly, you need your infection control materials.
There’s always the possibility if the virus changes
that you would have bacterial infections over and
above what you're getting with the flu. It’s also
the chronic disease medications and the things
that people tend to run out of.
Facilities need to make sure they understand what
their state and local public health department is
going to do with the stockpile. When the CDC
arrives and turns it over to the state, that’s it. Each
state has a different strategy. The lesson is, don’t
start to ping the public health department in the
middle of the surge. You should have that all fig-
ured out already. Know what’s happening to the
stockpile, and also know what you’re not getting.
Sometimes, there’s also a false assumption that
you don’t really need to get all of these materials
because in a push, you think you’ll get it in from
the stockpile. Everybody’s thinking the same
thing, and what’s in the stockpile is not sufficient.
That was never the intent of the stockpile, to
support pandemics indefinitely.
Infection Prevention Now • Special Edition
“Everybody thought a pandemic would begin overseas, and so
you would have X amount of weeks to prepare for its arrival
in the United States. Of course, that’s not at all what happened.”
How much flexibility should hospitals build
into their response plans?
They should go back and see how their plans
lined up with what happened with H1N1.
For some of the states and some facilities,
it didn’t go the way they thought it was going
to go. Everybody thought a pandemic would
begin overseas, and so you would have X
amount of weeks to prepare for its arrival in
the United States. Of course, that’s not at all
what happened.
Your plans need to allow flexibility. Plans need
to outline everything, but they shouldn’t be rigid.
You need to look at what went well and what
didn’t go well, and then start making changes.
Part of what allows flexibility is to build in
triggers to implement certain aspects of the
plan. That way, you can watch what happens
and when it hits a certain trigger, then you need
to implement it. ■
7
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8 Infection Prevention Now • Special Edition

IPnow.mg:Layout 1 10/12/09 4:35 PM
Show me the evidence:
A conversation with two hand hygiene experts
The interview with Dr. Didier Pittet,
Hospital Epidemiologist and Director
of the Infection Control Program at
the University of Geneva Hospitals.
Pages 6-8.
The interview with Dr. Günter Kampf
of the German Association for Infection
Control and a lecturer at the Ernst
Moritz University in Germany.
Pages 9-11.
Infection Prevention Now • Special Edition
Page 9
Recent news stories on global health issues such
as H1N1 Influenza and MRSA, as well as the cost of
hospital-acquired infections, have brought infection control into
a leading role in healthcare. As the number one defense against
healthcare-acquired infections, hand hygiene has an important role
to play in the prevention of infections. The CDC estimates that
adherence to handwashing procedures alone could prevent the
deaths of 20,000 patients each year. Studies have shown, however,
that despite being a proven-effective practice, hand hygiene compli-
ance among healthcare workers is poor, with the World Health
Organization reporting an average compliance rate of 40 percent.
Hospitals and healthcare facilities are adopting new tools, products
and techniques that enhance infection-control efforts, such as
waterless hand sanitizers that make it easier for physicians and
nurses to practice optimum hand
hygiene. But while most hand “…not all alcohol hand
sanitizers contain isopropanol,
ethanol, or a combination of
sanitizer formulas are the
these ingredients, not all alcohol same, and confusion remains
hand sanitizer formulas are over recommendations
the same, and confusion
and guidelines.”
remains over recommendations
and guidelines.
ABC News contributor and author John Nance recently sat down
with two world-renowned experts – Dr. Didier Pittet, Hospital
Epidemiologist and Director of the Infection Control Program at the
University of Geneva Hospitals and Dr. Günter Kampf of the German
Association for Infection Control and lecturer at the Ernst Moritz
University in Germany – to discuss some of the current issues in
hand hygiene.
9
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D r. P i t t e t
Nance: Dr. Pittet, hand washing and hand
hygiene are among the simplest, most effective
methods that we know of for preventing nosocomial
infections, and yet, there is a struggle that has
been going on for a long time to gain a level of
compliance worldwide. It’s got to be frustrating
for somebody who has done the kind of research
that you’ve done.
Pittet: Yes. It’s very frightening first to realize that
the compliance is so low. On average it’s around
40%, at the best, and it’s not rare that when you
come in a unit or a ward the average compliance
will be around 20%.
Nance: Well, what was the reason for the lack
of compliance? I’m assuming that there weren’t
people running around healthcare who thought
that the laws of microbiology had somehow been
suspended for hands?
10 Infection Prevention Now • Special Edition
Dr. Pittet discusses the
updated WHO Guidelines
on Hand Hygiene
in Healthcare and the
recommendations for
alcohol-based handrub
formulations.
Pittet: (chuckles) Yeah, that’s a good point.
Actually, when we did our very first study – the
largest epidemiological study that was ever
conducted on hand hygiene practices – we realized
that there were several parameters that could
explain the lack of compliance. And the most
important parameter, the one that stays on all the
models that we have developed, is the lack of
time. So time constraints for healthcare workers
was really the most important issue for them.
Nance: So this is not a complaint that you
hear universally here in the United States; this
is worldwide?
Pittet: This is absolutely worldwide. You know,
for example, when we monitor hand hygiene
practices in the intensive care unit, we could
really see that nurses had at least 20 opportunities
to clean hands every hour of patient care. And if
IPnow.mg:Layout 1 10/12/09 4:36 PM Page 11

you do it with soap and water, it will take you
almost half an hour, each hour, to clean your
hands. So it means that it is absolutely impossible
for a regular nurse in the ICU to clean his or her
hands on an appropriate timing. Now, with the
use of the alcohol-based hand rub to clean
your hands, we bypass the
time constraint.
Nance: Let me ask you this: there is a differentia-
tion in what the World Health Organization has as
a range for alcohol content in terms of percentage.
There’s an 80-90 percent that’s being recom-
mended, I think by WHO and by others for more
developing nations.
Pittet: Yes.

Nance: But that brings me to Nance: And there are some

a question—and you touched
on it earlier—there certainly has
been some feedback, or push
back shall we say, of saying
“Well, if I wash my hands X
number of times per day, I’d
have no oil left on my hands.”
And in other words, we’ve got
all the soaps and all the other
emollients and then we’ve got
alcohol-based. Is alcohol-based
really that much better – both
in effectiveness and in terms of
what it does for your hands?
Pittet: Yes. It is more effective –
really more effective. We are
talking about log reductions,
differences in the efficiency and
the efficacy between alcohol
and soaps. And of course it’s
a lot better for your hands.
Why? Because you know, in
your hands we have lipids. If you
apply soap on your hands, it actually kills the lipids
and some of the cross-links between different
parts of the skin.
“…your product should
contain at least 80 percent
ethanol alcohol or ethyl
alcohol. Or you can use
isopropyl alcohol, and
there you need to have at
least 75 percent isopropyl
alcohol or isopropanol…”
around the world. Developed, under-developed,
developing countries – they should all apply the
same rule.
who believe that it should be
lower. And over in the United
States, for instance, it is usually
lower. Where’s the breakpoint
on all of this?
Pittet: There is an important
misunderstanding. When we
wrote, together with this group
of international experts, the
WHO guidelines, we made
it universal. So the rule is the
following: There are two types
of alcohols; one is based on
ethanol or ethyl alcohol, and
your product should contain at
least 80 percent ethanol alcohol
or ethyl alcohol. Or you can use
isopropyl alcohol, and there
you need to have at least 75
percent isopropyl alcohol or
isopropanol in your product.
This is a universal rule that is
true and applicable and should
be applied in all countries

And because of the lipids, you keep actually your
water in your skin. If you remove the lipids, then
you let the water evaporate from you skin and
from your hands. So at that point your hands
become really, really damaged.
Now, at the time we produced the guidelines,
some people said “Well, but what about the
products that are currently on the market? There
are good products and there are less good products.
Some of the products do not meet the norms.
Some meet the norms.”

Infection Prevention Now • Special Edition 11

IPnow.mg:Layout 1 10/12/09 4:36 PM Page 12
So we say, “Yes, if you have a good product that
meets the norms, then you can continue using
this product, providing that the company that
is producing the product could really show you
the results of the testing by the norms.
The testing by the norms should be performed
for every compound. So the misunderstanding
is that the WHO didn’t want to say that you have
to replace all the products, all over the world,
but that they say if there is a product that is
commercially available that meets the norms,
you could use this product.
Now, usually a product with 60 percent alcohol
will not meet the norms – you are better to test
the product, make sure it meets. There are two
norms that are available internationally. There
are those that are used in the North America,
which is the ASTM norms, and those that are
used in Europe, the European norms. The
European norms are more stringent. With a 60
percent ethanol solution, you will never pass the
European norms.
Nance: Yet in the U.S. we have that 60 percent.
Pittet: In the U.S. sometimes the product may
meet the norms, but not always. So when
you choose a product, you are better first of
all to choose a product with a higher content
“It’s hard to believe that there have been
so many products that have been used
in the United States that will never pass
the European norms. So some of the
products that you are using in the United
States have not made anything on the
European market, because they just
don’t pass the norms.”
12 Infection Prevention Now • Special Edition
in alcohol. It will be much more efficient on some
microorganisms that require a higher content in
alcohol like some viruses.
Nance: I would assume, not to put words in your
mouth, that it would almost be a rhetorical question
to say that you and WHO would probably like to
see a higher level in the United States?
Pittet: Of course, of course. It’s hard to believe
that there have been so many products that have
been used in the United States that will never
pass the European norms. So some of the products
that you are using in the United States have not
made anything on the European market, because
they just don’t pass the norms. So can you imagine
that the quality of the level of care that is demanded
in some European hospitals is higher than in some
U.S. hospitals? It doesn’t make sense, speaking
of patient safety, right?
Nance: Yes, absolutely. And do you see a trend
over North America, Canada, United States,
Mexico in terms of understanding this, because
we are still at a low compliance level in individual
hospitals.
Pittet: We see a trend. We see more and more
compliance improvement. Also in the U.S. we see
a lot of change in the products that have been
used in the U.S. There are many people asking
these questions. And this is more important –
many of the so-called inefficient products or bad
products are just going out of market because
they are not appropriate for use in healthcare.
Nance: Dr. Pittet, thank you so much for coming
in today.
Pittet: Thank you. It’s my pleasure.
IPnow.mg:Layout 1 10/12/09 4:36 PM Page 13
D r. K a m p f
Nance: Dr. Kampf, there are alcohol-based
foams that are popular, but the question is really
are they as effective? Do they do the same thing?
Do you use the same method of application as
you do for a hand rub?
Kampf: The foams that I have seen so far
contain around 60, 62 percent ethanol. And when
you look at the WHO guideline for hand hygiene,
this concentration is too low for use in hospitals.
At the same time we’ve just finished a study
where alcohol-based foams were applied to dry
skin, and we measured how long it would take for
the skin to dry. We found out that if you have a
30-second time for the hands to be covered by
the foam, you need a rather small amount, which
is 1.6 grams. And when you apply this small
amount the efficacy is even lower. So overall you
have two problems to face. One is the concentra-
tion of the ethanol is too low, and the other is that
Infection Prevention Now • Special Edition
Dr. Günter Kampf
discusses the importance
of technique when using
alcohol-based hand sanitizers.
if you apply an amount in clinical practice which
keeps hands moist for around 30 seconds, the
total amount of foam which is applied is in
addition too low.
Nance: What studies have you either conducted
or seen in regards to the foams?
Kampf: To my knowledge, the alcohol-based
foams have not really been studied in the
scientific literature. That is why we have done a
trial this year to find out how effective the ethanol-
based foams really are. And we have used foams
based on 62 percent ethanol because they are
commonly used in hospitals.
Nance: These results will be forthcoming soon?
Kampf: Yes. They have been summarized
and written up already, but have not been
published yet.
13
IPnow.mg:Layout 1 10/12/09 4:36 PM Page 14
Nance: Let me ask you this: Are all alcohol-
based rubs used in a similar fashion, and if
not, how do you distinguish between them
and among them?
“Now when the surgeon is in the
operating theater, he usually wears
a pair of sterile gloves. And you want
to make sure that the bacterial load
under the surgical glove is as low as
possible during the entire operation.
That is why you do surgical hand
antisepsis before donning sterile gloves.”
Kampf: That is an excellent question. In the
United States you can have rubs based on
ethanol in the concentration between 60 and
95 percent ethanol. The WHO recommends
80 percent ethanol, so you see already
some of the preparations may have a lower
concentration in comparison to the WHO
guideline. Some of them may have even a
higher concentration in comparison to the
WHO guideline. And then you may have liquid
hand rubs. You may also have hand rubs with
a higher viscosity. And then you often have gels.
Nance: If you have the same level of alcohol, is
it a level playing field if they are used in different
ways? In other words, you adjust the utilization
for one and it becomes as if you utilize another
a different way?
Kampf: No, unfortunately not. You have to know
the efficacy of the final formulation. And when you
have skin care components or other ingredients,
they may enhance the efficacy of the ethanol, but
14 Infection Prevention Now • Special Edition
they may also reduce the efficacy of the ethanol.
That is why you need to know how effective is the
preparation which is actually used.
Nance: The alcohol rubs that are out there
now—and just the element for alcohol rubs
for hands in general, is this the final answer in
chasing down and getting rid of hospital-acquired
infections?
Kampf: It’s not the final answer, I’m afraid, but
it is a very important step forward. It is believed
that about one third of the hospital-acquired
infections are preventable, and it is also believed
that hand hygiene plays the major role, but it does
not cover all the possibilities for infection preven-
tion. But it is certainly the major part to control
the spread of microorganisms in the hospital.
Nance: But if we did this right, we would
reduce by a tremendous degree the number of
hospital-acquired infections?
Kampf: Definitely, definitely.
Nance: Let me ask you this: Alcohol rubs are
also used in the surgical setting. And theirs is
kind of a different world. There’s a concept known
as persistence – could you tell me the definition
of that as you see it?
Kampf: This is a very interesting question.
Persistence is not clearly defined to my knowl-
edge. My perception is that persistence is seen
as the level of efficacy measured over six hours.
Now when the surgeon is in the operating theater,
he usually wears a pair of sterile gloves. And you
want to make sure that the bacterial load under
the surgical glove is as low as possible during the
entire operation. That is why you do surgical hand
antisepsis before donning sterile gloves. You have
the immediate effect, and then you can measure
the bacterial count also after three hours or after
six hours. To my knowledge persistence means
that the number of bacteria under the surgical
glove is still below baseline level after six hours.
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bring you critical information on the updated WHO Guidelines on Hand Hygiene in
Health Care, the recommendations for alcohol-based handrub formulations and the
importance of technique when using alcohol-based hand sanitizers.

This exclusive series is “essential viewing.”

Learn from the world’s foremost experts:
Dr. Günter Kampf is a member of
the German Association for Infection
Control and a lecturer at the Ernst
Moritz University in Germany. He is
the author or co-author of 119 mainly
peer-reviewed scientific papers
published in international and national
journals on infection control.
Dr. Didier Pittet is the Hospital
Epidemiologist and Director of the Infec-
tion Control Program at the University of
Geneva Hospitals and Faculty of Medicine
in Switzerland. He is also a member
of the Advisory Board of the WHO
World Alliance for Patient Safety and
Lead of the First Global Patient Safety
challenge “Clean Care is Safe Care.”

This webcast will be shown exclusively through Medline University’s website only
during Infection Prevention Week October 18-24. One CE credit per presentation is
available through Medline University.

For more information, go to www.medlineuniversity.com

Nance: Within that definition, are persistent
ingredients required if we are going to get the
effect in the OR for persistent activity?
Kampf: From my point of view, not. There is a
debate currently going on, especially in the United
States, whether it is necessary or not to have
chlorhexidine as an additional active ingredient.
But so far the data that I have seen is not
convincing in terms of an additional benefit when
you have chlorhexidine in addition to ethanol in
the formulation.
because you are saying that it has not been
proven—it might be that the same alcohol rubs
that we’re talking about as a potential world
standard could also be perfectly acceptable in
the operating theater.
Kampf: Absolutely. The efficacy requirements are
also fulfilled by preparations which are only based
on ethanol – the efficacy requirements which are
laid down by the FDA.
Nance: Dr. Kampf, thank you very much.

Nance: So it might be—this is just postulating Kampf: My pleasure. ■

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H H S A c t i o n P l a n

4INFECTIONS CATEGORIES OF
ACCOUNT FOR APPROXIMATELY
3 QUARTERS OF ACUTE CARE HAIs

According to the plan, four categories of infections

E arlier this year, the Department of Health and
Human Services (HHS), in conjunction with
experts, developed an “Action Plan to Prevent
account for approximately three quarters of HAIs
in the acute care hospital setting:
Healthcare-Associated Infections” that identified
➤ Surgical site infections;
the key actions needed to achieve and sustain
progress in protecting patients from the ➤ Central line-associated bloodstream infections;
transmission of serious, and in some cases,
➤ Ventilator-associated pneumonia, and;
deadly infections.
➤ Catheter-associated urinary tract infections.

In addition, infections associated with Clostridium

difficile and MRSA also contribute significantly to
Other the overall problem. The frequency of HAIs varies
(22%)
CAUTI by location. Currently, urinary tract infections
(34%) comprise the highest percentage (34%) of HAIs
followed by surgical site infections (17%), blood-
Bloodstream stream infections (14%), and pneumonia (13%).
(14%)

Surgical
Site For additional details on what is in the Action Plan,
Pneumonia
(13%) (17%) visit hhs.gov/ophs/initiatives/hai/infection.html

Causes for Acute Care HAIs

16 Infection Prevention Now • Special Edition

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Opportunities to learn more on CAUTI prevention.

To learn more, visit www.medline.com/ERASE.

FREE WEBINAR

INNOVATION IN THE PREVENTION OF CAUTI

With CMS’s emphasis on prevention of hospital-

acquired conditions, there is no better time to
examine systems to help prevent CAUTI. Join in
with your colleagues from around the country
to learn more about strategies to prevent
catheter-acquired urinary tract infections as well
as Medline’s ERASE CAUTI system.
Alecia Cooper, Lorri Downs,
RN, MBA, CNOR RN, BSN, MS, CIC

OCTOBER NOVEMBER DECEMBER

16th 12:00 - 1:00 pm 3rd 11:00 - 12:00 pm 3rd 11:00 - 12:00 pm
19th 2:00 - 3:00 pm 5th 12:00 - 1:00 pm 8th 9:00 - 10:00 am
21st 12:00 - 1:00 pm 9th 2:00 - 3:00 pm 11th 12:00 - 1:00 pm
29th 3:00 - 4:00 pm 17th 9:00 - 10:00 am 14th 2:00 - 3:00 pm
20th 12:00 - 1:00 pm 17th 12:00 - 1:00 pm
23rd 2:00 - 3:00 pm 30th 11:00 - 12:00 am

COMING JANUARY 11, 2010

John Nance hosts the four-part interview series:
CAUTI PREVENTION TODAY
ABC News contributor and author John Nance will be hosting a four-
part interview series exploring prevention strategies and interventions
for catheter-associated urinary tract infections. The series, CAUTI
Prevention Today, features a diverse cross-section of experts who
share insights into each facet of the prevention equation — from
highlighting best practices to education and training. Also included
are interviews with clinicians who are focusing on culture change
and alternatives to catheterization as part of their prevention efforts.

CAUTI Prevention Today is sponsored by Medline Industries, Inc. in conjunction with

its Race to ERASE CAUTI awareness campaign to reach 100,000 nurses with CAUTI
prevention education. The series is currently available on DVD and is being distributed
to hospitals during infection prevention week, and will be available online January 11, 2010.

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We didn’t just design a new tray,

we designed a way to make it
hard for healthcare workers to do
the wrong thing.
The new ERASE CAUTI program combines design,
education and awareness to tackle catheter-
associated urinary tract infection – the most common
hospital-acquired infection.1

Design
The innovative one-layer tray design guides the
clinician through the process of placing a catheter
to ensure aseptic technique.

Education
The acronym ERASE is easy to remember, reminding
the clinician to:

Evaluate indications – Does the patient really

require a catheter?

R ead directions and tips – Follow evidence-based

insertion techniques

Aseptic techniques – Key design solutions

support aseptic technique
Design
Secure catheter – A properly secured catheter Open up the
innovative one-layer
will reduce movement and urethral traction
catheter tray and
E ducate the patient – Printed materials tell the
see the intuitive
design for
patient how to reduce the likelihood of infection yourself.

Awareness
Join the Race to ERASE CAUTI! The current state of
health care demands that nurses play a leading role
in identifying and implementing CAUTI risk reduction
strategies. Help us reach our goal to introduce
100,000 nurses to the ERASE CAUTI system.

Ask your Medline representative

about the new ERASE CAUTI Program,
call 1-800-MEDLINE (633-5463),
or visit www.medline.com/erase

Reference
1. Catheter-related UTIs: a disconnect in preventive strategies.
Physicians Weekly. 25(6), February 11, 2008.

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Education
Click here for
details on nursing
education materials
that promote Awareness
evidence-based Visit this section
practice. to join 100,000
nurses in the
Race to ERASE
CAUTI.

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Sterillium® Comfort Gel™

Your hands will
love you even
more.

Also available:
Sterillium Rub
for surgical hand
antisepsis

Do more with less Comfort drives compliance

Sterillium Comfort Gel delivers greater efficacy
than other alcohol-based hand antiseptics* by
virtue of its 85% ethyl alcohol concentration. Due
to the high alcohol content it does more for your
infection control efforts by using up to 50 percent
less volume per application.* Independent in vitro
testing demonstrated that Sterillium Comfort Gel
achieves reductions of ≥ 5 log10 (≥ 99.999 percent)
on a broad range of nosocomial pathogens.*
Sterillium Comfort Gel’s incredible bactericidal
effect doesn’t matter if the product isn’t being Increa
used! You’ll want to reach for Sterillium Comfort
Gel again and again because it leverages a
proprietary blend of moisturizers similar to those
found in NIVEA® and Eucerin® skin care products.
The result is a product proven to increase skin
hydration by 14 percent in just two weeks.*

For more information on Sterillium Comfort Gel,

contact your Medline sales representative,
visit www.medline.com, or call 1-800-MEDLINE.

Sterillium Comfort Gel is available in three packaging styles

to suit any need, including a touchless dispensing option.

*Data on file. ©2009 Medline Industries, Inc. Medline® is a registered trademark of Medline Industries, Inc. Sterillium® is a registered trademark of BODE
Chemie GmbH. NIVEA and Eucerin are registered trademarks of Beiersdorf AG. Sterillium® Comfort Gel® is a registered trademark of Bode Chemie GmbH.