APIC WEST VIRGINIA
APPLICATION FOR 2011 SHINING STAR AWARD FOR EXCELLENCE IN
INFECTION CONTROL AND PREVENTION
The application consists of:
1. This completed application form.
2. The nominator’s (who must be a member of APIC WV) written explanation for
choosing the candidate (candidates may nominate themselves).
3. A written explanation (500 words or less) of how you or the individual you have
nominated met the criteria for selection.
Candidate’s name and credentials:____________________________________________
Address: ________________________ __________________ ______ ___________
Street Addresss City State Zip Code
Employer:_____________________________ Business Phone___________________
APIC WV member submitting nomination: ____________________________________
Address:_________________________ ____________________ ______ _________
Street Address City State Zip Code
Phone #:______________________________ Email____________________________
1. Must be a APIC West Virginia member
2. Must be currently practicing in Infection Control and Prevention
3. Promotes and advances the goals of APIC:
a) Volunteers when the need arises
b) Promotes Infection Control and Prevention in the community (example:
drive by flu vaccinations)
SEE BACK OF PAGE
c) Has developed Infection Control and Prevention related activities that
1) Process/systems improvement, i.e., changed the way we do
something that has improved outcomes.
2) Educational programs: for your facility or the community—
have you reduced adverse events by use of an educational
3) Patient safety: What are you doing that has improved patient
safety, i.e., reduced VAPs, BSIs, decubiti, SSIs, etc.
4) Cost savings: What have you done to save dollars for your
facility and at the same time maintain the quality of patient care?