Lesson Learned:  Developing a team with a staff nurse and physician as champions is essential to facilitate successful buy-in from all physicians, nurses, and support personnel  Ongoing education is the foundation of successful outcomes  Peer to peer accountability promotes ownership of patient care and outcomes, as well as allows real-time feedback on bundle noncompliance  Frequent audits quickly identified real-time opportunities for reinforcement and improvement, but also celebration of individual staff successes as it related to bundle compliance  Ventilator associated pneumonia rates reported to staff monthly showing the results of their efforts and celebrate successes Presentation Number 8-117 Building and Maintaining Best Practices to decrease Vascular Access-Associated Infections in the Use of Peripherally Inserted Central Catheters Joanna Acebo MD, Pediatric Infectious Diseases Physician, Hospital SOLCA-Núcleo de Quito; Dr. Carlos Vicuna MD, Pediatric Oncology Surgeon, Hospital SOLCA-Núcleo de Quito; Dr. Jose M. Eguiguren MD, Chief of Pediatrics, Hospital SOLCA-Nú e cleo de Quito; Mr. Don Guimera BSN, RN, CIC, CCRP , International Epidemiology Coordinator, St. Jude Childrens Research Hospital; Dr. Kyle M. Johnson PhD, CCRP , Clinical Research Associate II, St. Jude Children's Research Hospital; Dr. Miguela Caniza MD, Director of Infectious Diseases-International Outreach Division, St. Jude Children's Research Hospital Background/Objectives: Central venous catheters are indispens- able devices in oncology that are used to administer intravenous therapies, parenteral nutrition or blood products. The advantages of PICC include: easy insertion and removal, long term usability (up to six months), and insertion with local anesthesia. In this study we ascertain infection rates of PICCs, and report the results of intro- ducing best practices and continuous quality improvement in inserting and caring for this type of catheter. Methods: We prospectively evaluated all PICCs inserted between July 2009 and December 2011 among pediatric oncology patients in a 160-bed oncology hospital in Quito, Ecuador. In the 30-bed pedi- atric wards, 14 nurses and five physicians care for children. A multidisciplinary vascular care team includes nurses, physicians, a surgeon, and a pediatric infectologist. Best practices in the use of PICCs were: 1) develop institutional policies and procedures for insertion and maintenance of a PICC, such as performing hand hygiene before handling and inserting the catheters, using appro- priate barrier methods for insertion, and doing skin antisepsis before the procedure; 2) train all care providers in the policies and proce- dures; and 3) monitor performance continuously through a surveil- lance system. We analyzed two periods. During the first period, July 2009 to June 2010, the devices were inserted in the outpatient procedure room and polyvinyl pyrrolidone was used for skin anti- sepsis. In the second period, July 2010 to December 2011, insertion was done in the operating room, using 2% chlorhexidine for skin antisepsis. The evaluation of infection rates in the two groups ensued. Bed rate occupation in the first and second period were 61.4% and 66.7% respectively. During the study, 58.4% of children with cancer had central venous access and 2.5% corresponded to PICC. Care post-insertion remained similar between the two periods and all other periodic education and training remained unchanged. Results: The total number of PICCs inserted was 58, with 442 catheter-days. The global PICC infection rate during the observation period was 1.8 infections per 100 catheter days. Comparing the first with the second period, we observed 3 catheter infections during 120 catheter days (2.5 infections per 100 catheter days) vs. 5 infections during 322 catheter days (1.5 infections per 100 catheter days) with RR¼1.6 (95% CI 0.39-6.63). Conclusions: Infection complications rates of PICCs are similar to those published in the literature. PICC insertion in the operating room resulted in a decreasing trend for infection, though not statistically significant. Possible reasons for this outcome are better compliance with barrier precautions and use of chlorhexidine. Ongoing surveillance is an integral part of best practices for continuous quality control in vascular access and outcomes. Presentation Number 8-118 Implementing Mandatory Influenza Vaccination Policy for Health Care Workers at a Long Term Acute Care Facility Olufemi Jegede MPH, Epidemiologist/Infection Preventionist, Kindred Hospital Detroit; Olufemi Jegede, Epidemiology/Infection Preventionist, Kindred Hospital Detroit; Andrew Escamilla, Chief Executive Officer, Kindred Hospital Detroit; Felecia James RN, Special Procedure Nurse, Kindred Hospital; Mary Patton RN, Infection Preventionist, Kindred Hospital; Keith Kaye MD, MPH, Corporate Director of Infection Prevention, Hospital Epidemiology and Antimicrobia Stewardship at Detroit Medical Center. He is a Professor of Medicine at Wayne State University School of Medicine; Teena Chopra MD, MPH, Director of Infection Prevention, Hospital Epidemiology and Antimicrobia Stewardship at Kindred Hospital Detroit, MI. She is an Assistant Professor of Medicine at Wayne State University School of Medicine Background/Objectives: Although annual influenza vaccination is recommended for healthcare workers (HCW) by the Center for Disease Control and Prevention (CDC), the rate of HCW who receive vaccination continue to be low. Whereas, many acute care centers have mandated influenza vaccination policy, scant data exits on such policy in long term acute centers (LTACs). This study deter- mined the effect of implementation of a mandatory influenza vaccination at a long Term Acute Care hospital in Detroit, Michigan. Methods: Annual influenza vaccination data from 2008 to 2011 was reviewed to identify vaccination rates among different job categories in HCWs at Kindred hospital, a 77 bed LTAC in Detroit Michigan. In 2011, with support from administration, mandatory influenza vaccination and educational campaigns were included as part of annual mandatory competency health fair. At competency fair, employees who received flu shot or showed proof of vaccination from somewhere else were given stickers that identified them as being compliant with the mandatory flu vaccination. Employees who declined vaccination were required to wear a mask within six feet of patient care during influenza season. Vaccination data from 2008 to 2011 was analyzed using descriptive statistics. Results: Influenza vaccination rate increased from 25% (n¼272) in 2008-2009 to 65% (n¼279) in 2010-2011 influenza season (p<0.05). Of all the health care workers, significant increase was seen amongst nursing staff from 22 % (n¼155) in 2008-2009 to 52% (n¼ 145) in 2010 - 2011 (p >< 0.05). However, rate among physi- cians in 2008-2009 was not significantly different from rate in 2010 - 2011 [27% (n¼ 23) vs 29% (n¼ 19]. The reasons for declination as given by some HCWs included fear of needle (6%), fear getting Poster Abstracts / American Journal of Infection Control 40 (2012) e31-e176 e102 APIC 39th Annual Educational Conference & International Meeting j San Antonio, TX j June 4-6, 2012