Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Before and After the Storm- Hurricane Irma 2017 Miss ssion on to Care e FHA HIIN Cha hasi sing g Zero Inf nfec ection ons Conne onnecting ng the Dot ots s to o Redu duce Patient Harm: Hot ot Top opics s in Infection n Pr Prevention n No November er 16, 2017 017 Sign gnature e Gran Grand, Davi vie, FL FL Barb rb Wegener erBS BSN, RN RN, MPA, CHE, NE NEA-BC BC Geor Ge orgine e Krued edelbach MSN,RN,CI CIC 2 hospitals (715 beds) and a Free-Standing ED. Alliance of 732 physicians and medical facilities throughout Collier County and Southwest Florida. Non-profit, Healthcare Mayo affiliated Teaching Facility in 2016 and Member System in Naples, FL of the Mayo Clinic Care Network since 2013. 30,000 admissions. 111,500 ED visits. 3,600 births. 400 open heart surgeries. 4,300 staff members. Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 1
Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Industry Recognition First in state of Florida and Southeast Only organization in country Region, Aug. ‘12 certified as “Blue Zone”. NCH Cardiac Surgery rated 3-Stars and Top 10% in nation, for 10 of Official GME Affiliation with Mayo Clinic 12 years. School of Medicine - 2016 “A” Rating – Highest “Grade” in Region, 2014, 2015 JC Primary Stroke Center and JC Hip & Knee Center certified since ‘14 August 2014 Ranked as regional best hospital Hospital and Healthcare’s MOST WIRED since ’12 and top 10 in FL for 3 yrs. since 2012 Commission on Cancer: Accredited w/Commendation since 1982 Hurricane Irma’s Category 5 predications resulted in over 1,200 individuals being sheltered in our two hospitals, with over 9,000 meals served. NCH remained open for the duration and aftermath of the hurricane. Individuals sheltering at NCH Included- Medical / Surgery Providers and families Hospital employees and immediate family Special Needs Patients/caretakers Admitted patients and a family member Pets at off site location Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 2
Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention NCH Hospital Staff was stationed at the Collier County Emergency Operations Center pre and post storm. NCH Staff’s role was a liaison for storm information, hospital operations, and to support community needs (donations, patient placement). Joint Commission Hospital Accreditation Requirements EM.01.01.01 The hospital engages in planning activities prior to developing its written Emergency Operations Plan. EM.02.01.01 The hospital has an Emergency Operations Plan. EM.02.02.03 As part of its Emergency Operations Plan, the hospital prepares for how it will manage resources and assets during emergencies……. EM.03.01.03 2017 Joint Commission Standards Manual/ E-dition Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 3
Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention https://www.cms.gov/Medicare/Provider-Enrollment-and- Certification/SurveyCertEmergPrep/Emergency-Prep-Rule.html Preparations checklist created by CMS/DHHS 1. Develop all hazards plan 2. Collaborate with local Emergency Management 3. Taylor plans for each type of hazard considering vulnerabilities and geographic location Include- • Specific actions for type of hazard • Key staff • How staffs will be allocated • Supplies for 3-10 days (based on hazard) • Communication plan for staff/ families, patients/families before and after emergency • Critical staff designation and coverage (A and B teams) • Collaboration with vendors for supplies pre-post storm • Community support, collaboration, affiliation, transfer agreements Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 4
Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Considerations for Pharmacy Dept. Department Hurricane Plan-order supplies in May, housed to be delivered within 72hrs. Pharmacy met with buyers for supplies week before storm Supplies- IV solutions and Irrigation Solutions Antibiotics Pain medications Premixed IV/Antibiotic drugs to decrease need for compounding Substitute meds that were on national shortage before hurricane Hurricane Irma Challenges- Local retail Pharmacies closed days before hurricane placing burden on hospitals Pharmacy manufacturing shortages before hurricane (single, generic, injectable) Supply truck did not arrive 3 days before hurricane, ran out of gas Pharmacy shortages related to products coming from Puerto Rico post hurricane Critical meds on ‘allocations’ post storm, IV fluids Increased community need for Methadone Vaccine storage during hurricane Numerous ambulatory sites required housing of vaccines in hospital facility with ‘emergency generator power’ Vaccines transported to a central location pre-storm CDC Guidance for vaccine management at https://www2a.cdc.gov/nip/isd/ycts/mod1/courses/sh/11080.asp Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 5
Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Considerations for Surgery Department-Disaster Staffing- Environment- Temperature and Humidity, air pressures Med Gases High Level Disinfection (HLD) Endoscopes, TEE Supplies- IV and Irrigation Solutions Antibiotics Pain medications Oxygen/med gases Sterile supplies Paper forms for documentation Hurricane Specific Challenges- Ensure integrity of supplies Ensure HLD Instrument processing challenges due to boil water Issues with diminished water pressure- Surgical Hand Hygiene Pre-Event Surgical/Procedural Areas 1. Supplies 3-10 days 2. Linens (scrubs) supplies protect in plastic 3. Cover all computers, screens in plastic 4. Cover OR packs plastic 5. Protect /relocate Surgical Support Diagnostic machinery lab, CT, MRI 6. Potable water for HLD/Instrument rinsing 7. HLD- 1. Contact manufacturer for consideration of loss of potable water, water main breaks on HLD equipment 2. Consider Cidex- HDL, thermometers, timers, containers, logs, staff competency 3. Supply of Ready to Use HLD scopes for emergency use 8. Sterilization- manufacturer instructions, steam heat temperature achieved? 9. Surplus Biologicals/Potable water to rinse instruments post washer 10. Hand scrub soap and alcohol hand rub availability Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 6
Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Post Event Procedure Rooms/Surgical Suites- Temperature and Humidity, Air Changes per Hour and Pressures Engineering/Facilities role: Maintain Temp/Humidity/Pressures throughout event and aftermath * Re-open unit checklist If water intrusion, determine source/repair Mold remediation Determine if (sterile or other ) need to be discarded/re-sterilized If water service interruptions/boil water- flush all spigot 3-5 minutes Assure sewage disposal is adequate for operations Terminal cleaning of rooms, all equipment Med gases: determine safe operation Prioritize operations to create viable ‘suites’ meeting standards - bring in chillers, dehumidifiers etc. Ensure staff/volunteers are credentialed (other states?) https://www.cdc.gov/disasters/reopen_healthfacilities_checklist.html CMS Supporting Resources and References Emergency Preparedness Rule (CMS 3178-F) Website Resources (To include on SCG EP Website in lieu of in Interpretive Guidelines) Health Lawyers’ Public Information Series. (2004). Emergency Preparedness, Response & Recovery Checklist: Beyond the Emergency Management Plan . http://www.in.gov/isdh/files/AHLAEmergency_Preparedne ss_Checklist.pdf Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 7
Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention http://www.euro.who.int/__data/assets/pdf_file/0008/268766 /Hospital-emergency-response-checklist-Eng.pdf QUESTIONS? Barbara.Wegener@nchmd.org Georgine.Kruedelbach@nchmd.org Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 8
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