From Airways to Outbreaks: A State’s Journey Strengthening Respiratory Care Assessments

Session Description: While respiratory care practices can be critical components in the transmission pathways of certain healthcare-associated infections like Group A Streptococcus pyogenes (GAS), multidrug-resistant organisms (MDROs), and other respiratory pathogens, there is currently no standardized tool from the Centers for Disease Control and Prevention (CDC) to assess these practices during healthcare-associated infection investigations. This presentation shares the experience of one state health department in developing and implementing a respiratory care assessment tool for use during field investigations.

The tool was created through a comprehensive review of CDC infection control guidance, professional society practice guidelines, and the Centers for Medicare & Medicaid Services (CMS) Hospital Infection Control Worksheet. The tool was designed to support infection prevention and control assessments when respiratory care is identified as a potential risk factor based on the organism involved or patient care activities.

Key components of the tool include structured interviews of respiratory care leadership and frontline staff. The importance of reviewing facility-specific protocols with assessments is emphasized. Direct observations are included for respiratory care practices and respiratory device use (e.g., endotracheal tubes, tracheostomies, ventilators), along with hand hygiene and personal protective equipment (PPE) use during respiratory procedures. Special considerations are included for patient populations across the age spectrum, recognizing differing clinical practices for neonatal, pediatric, and adult populations.

This presentation will provide attendees with an overview of the tool and its development, examples of how it has been used in the field, and insights into practical implementation. Attendees will gain ideas and strategies for incorporating respiratory care assessment into investigations as well as prevention-based assessments.

Carolyn Kiefer

HAI/AR Nurse Epidemiologist, Virginia Department of Health

Carolyn Kiefer, MSN, RN, CIC, FAPIC, is the Nurse Epidemiologist with the Virginia Department of Health’s Healthcare-Associated Infections/Antimicrobial Resistance Program. With over 14 years of experience in infection prevention and control (IPC) across healthcare and public health, she coordinates statewide initiatives, supports local health departments with investigating outbreaks, and develops evidence-based resources and education to support healthcare facilities and public health partners. Carolyn has presented at multiple regional, state, and national platforms. She is a published author and a dedicated collaborator and mentor, Carolyn has held various leadership roles in the Virginia Chapter of APIC and is passionate about advancing IPC across the continuum of care.

Karen McGoldrick

Infection Preventionist, Sentara Leigh Hospital

Karen McGoldrick, MT (ASCP), CIC, CHOP, Infection Preventionist, Sentara Leigh Hospital in Norfolk, Virginia Karen has 18 years of experience in the field of Infection Prevention & Control with Sentara Healthcare, 14 of those years at Sentara Leigh Hospital and and the other four at Sentara Williamsburg Regional Medical Center. Karen has a BS degree in Microbiology from Texas A&M University and a BS in Medical Technology from the University of Texas at Tyler. She has been a member of the APIC Virginia Chapter Board for 16 years serving in multiple postions, incuding Chapter President in 2017, and is currently Awards chair. Karen is also a currently chair of Coastal Virginia Infection Preventionists and Epidemiologists and is serving a three year term on APIC's Annual Conference Committee. Her passion is partnering with healthcare workers to prevent healthcare associated infections and improving patient safety.