Managing Infection Control Off the side of your desk Avril Taylor - - PowerPoint PPT Presentation

Managing Infection Control “Off the side of your desk” Avril Taylor - DOC Fraserview Intermediate Care Mary Vachon – ICP Good Samaritan Society

PPE

LTC Infections • MRSA (stats doubled between 1999-2006) • VRE (stats tripled in same time frame) • This generation of clients/residents come with more resistance to antibiotics and more susceptible to C-Diff

Contributing Factors in LTC • Sharing of rooms • Progressive stages of Dementia in clients (compliance) • Decreased ability to cohort (wandering) • Many liaisons wear many hats

Task Force Results (PICNET 2008) • 188 facilities were invited to participate in survey • 86/188 (46%) responded to the survey • 68/188 (36%) Completed the survey fully • 58% no physician support for infection related issues • 18% had no ICP support • 25% had no access to infection control committees

Infection Control Gaps in LTC • No designated facility IC champion/liaison • Decreased physician support onsite • Access to Infectious Disease physicians • Communication breakdown between community, acute care and LTC. • Lack of regular HH audits

Gaps cont • Many facilities have liaisons that are responsible for other daily activities • Wound nurse • Care coordinators • Some facilities may have managers not medically or healthcare trained.

Gaps Cont • Little communication regarding the actual costs that infections and outbreaks have on facilities • Prevention is difficult to put a price tag on when doing annual budgets. • “Winging it” can cause an increase in Healthcare Dollars. • Do staff know what they are looking for?

Doctoring by Fax • Eg. UTI’s • samples are sent before other measures are started. • Can be a contributing factor to ARO’s

If you’re contagious, fax us your symptoms, and Dr. Seus will e-mail his diagnosis.

Day to Day If no ICP as a resource, manager or the nurse of the day, becomes • the “Stand in ICP” These “stand in’s” may not have infection control specific education • Rashes, diarrhea, respiratory illness get reported, but investigations • maybe done but with less priority if wearing many hats Frontline staff could be trained to do the investigations or outbreak • management but… Line lists drive recommendations made by the MHO •

Day to Day • Frontline staff are rushed • Rescue Me • Limited time to review policies and do Paperwork.

Hand Hygiene • HH audits is a priority but can be a challenge • Staff perceive they do not have time to do it for the required amount of time • Need to be creative to audit all shifts.

Excuses for Improper HH • Supplies at point of care. • Dry Skin or Occupational Dermatitis • Feel ABHS is more drying (untrue) • May not have immediate access to lotions • Use gloves as a substitute • Take short cuts when rushed

Staff Education • Education becomes a “fringe benefit” with budget cuts. • Education becomes very focused • Education competes with posters, email, internet.

Education cont • Education has to be kept short, to the point. • The need to knows, rather than the nice to knows. (No puff and fluff) • Frontline staff feel they cannot take time away from caring for the clients/residents. • Be creative with education

Education cont • Education has to be fun and with a reward attached (pizza, lunch, prizes) • Staff attendance is dependant on staffing levels. • Education has to be supported from the top down • Many adult learners are visual/demo learners which is more time consuming.

Off the side of the desk • Armed and Aware! • provincial, region, health authority and national guidelines • Very difficult if there are other priorities • We refresh our memories during the crisis situation • Health Authority Websites

Off the side of your desk • Some websites are not user friendly • If you wear many hats • Who do you call if you have not had the time to network? • Use it or Loose it • Information overload.

Disseminating info • To the Frontline staff – Where is the best place to hang a memo???

Outbreak Management • Be proactive not reactive • Reliance on our external experts • Public Health • Licensing • MHO office • Support Service Managers

Outbreak cont • Multi-hat ICP’s • Be prepared and well organized • The line lists – How reliable are these lists – Often need to review them before sending.

Line list challenges • The ICP has to be aware of statements staff use when assessing the outbreak • Need to coach staff to provide definitive information • The ICP must also have a rehearsed script • Getting definitive information can be difficult

Outbreak Cont • You will need the Flexibility to address issues that are a result of staff shortages while minimizing the spread of infections.

Case Scenario A confirmed Norovirus outbreak called in an affiliate facility of a Health Authority. • 30 residents • 31 staff off sick • Stat holiday • Site nurse claims limited outbreak experience • Next day new shift • Little communication from previous shift • Line lists confusing

Keys points outbreak management • Education of staff daily • Review of line lists • Assisting with priorizing • Morning outbreak meetings and reinforcement • Arranging a debriefing

Debriefing • Estimated costs: – $30,000 • majority of that being staff sick time utilized/overtime. • WCB claims for those that contracted the disease on site • Supplies • Travel cost to the site – Approx $500.00/sample (courier to Vancouver.) – Does not include the loss of resident quality of life. » Lack of visitors » Isolation » Deaths

Debriefing cont • GET EVERYONE INVOLVED • Identify areas for improvement • Debriefing does not need to be lengthy

Being an Effective ICP • Basic education • Basic ICP Course is a must • Orientate with a regional ICP • Know your resources/contact numbers • Link with community organizations. • Attend conferences • Network with Regional Health Authorities, CHICA Chapters, and PICNET.

Support Needs for the ICP • Up to date policies supporting infection prevention and control • Get involved in development of policies. • A mentor that has their CIC certification.

TIPS of the TRADE • A good sturdy desk • Be Proactive, avoid reactive • Consistency with follow up • Be well Organized • Be able to Juggle the world • Educate yourself and network with others. • Ask for help!

Questions?