Objectives Discuss the basic elements of an effective infection - PDF document

Infection Prevention Boot Camp for Novice Infection May 30, 2019 Preventionists Elements of an Effective Program Linda R. Greene, RN, MPS,CIC, FAPIC Manager, Infection Prevention UR Highland Hospital Rochester, NY linda_greene@urmc.rochester . edu Objectives  Discuss the basic elements of an effective infection prevention program  Describe how to conduct a risk assessment  Identify key strategies related to improving hand hygiene  Explain surveillance essentials Let’s Start at the Beginning Why do a risk assessment ? Types of Risk assessment – annual Targeted – new procedures, equipment, guidelines FHA Mission to Care HIIN 1

Infection Prevention Boot Camp for Novice Infection May 30, 2019 Preventionists FHA Mission to Care HIIN 2

Infection Prevention Boot Camp for Novice Infection May 30, 2019 Preventionists Why do a Risk Assessment ? In order to set priorities, we must first assess the current status Mandated by regulatory and accrediting agencies Should be considered in all patient care settings What is a Risk Assessment This is a process that examines recognized and potential risks for acquiring and transmitting infections in a healthcare system. It identifies evidence-based measures to reduce these risks. It prioritizes risk based upon the potential or actual impact on care. FHA Mission to Care HIIN 3

Infection Prevention Boot Camp for Novice Infection May 30, 2019 Preventionists Performing a IC Risk Assessment Leadership Identify Risk Targets For Analysis Determine Goals •Local Community Strategies •Organizational Evaluation •Societal Process Risk Involve Others Assessment Establish Priorities Cycle Qualitative or •ICC Quantitative •Leadership •Key Staff •Health Dept Perform Develop Methods Assessment •Quantitative •Qualitative Establish •SWOT Priorities Templates •Gap Analysis Establish Timelines Consider This  Some risks are common in all healthcare settings  Others occur in special settings  The risk assessment takes into account: - Geographic location - Care and services offered - Population served Check List  What age patients do you see?  What services are provided?  Does site see a varied population?  What procedures and treatments do you perform? Endoscopy? Vaginal ultrasound? Minor suturing?  Do you do any sterilization or high level disinfection? FHA Mission to Care HIIN 4

Infection Prevention Boot Camp for Novice Infection May 30, 2019 Preventionists Applying the Definition Example – Tuberculosis Population- Small rural hospital in Montana Community cases past 2 years – none Risk ? Example- Finland Components of a Risk Assessment Populations served- identify the demographics of the population Consider Age Immune Status Race and ethnicity Special non immunized populations ie. Amish Services Provided Long Term Care- Ventilator, Rehab Inpatient vs. Outpatient Cancer Care Medical and Surgical Special Services FHA Mission to Care HIIN 5

Infection Prevention Boot Camp for Novice Infection May 30, 2019 Preventionists Procedures Performed Surgical Procedures High Risk, High Volume, Problem Prone Endoscopy, Interventional Radiology Geographic Location Texas vs. Montana NYC vs. Olean, NY Surveillance Data C Difficle Rates MRSA Surgical Site Infections ESBL Central Line Bloodstream Infections Urinary Tract infections FHA Mission to Care HIIN 6

Infection Prevention Boot Camp for Novice Infection May 30, 2019 Preventionists New Procedures or Devices Consider the Learning curve Examples : Robotic surgery , Other Types  Legionella Risk assessment  Fans in patient rooms  Construction Disease and Conditions In the Community TB Legionella Meningitis Community-Acquired MRSA Listeria Hepatitis A FHA Mission to Care HIIN 7

Infection Prevention Boot Camp for Novice Infection May 30, 2019 Preventionists Sample FHA Mission to Care HIIN 8

Infection Prevention Boot Camp for Novice Infection May 30, 2019 Preventionists Hand Hygiene FHA Mission to Care HIIN 9

Infection Prevention Boot Camp for Novice Infection May 30, 2019 Preventionists Literature Findings FHA Mission to Care HIIN 10

Infection Prevention Boot Camp for Novice Infection May 30, 2019 Preventionists Face to Face interviews with 13 senior managers at a large university hospital Seven distinct themes :  Culture change starts with leaders  Refresh and Renew the message  Connect the 5 moments to the whole patient journey  Actionable audit results  Empower patients  Reconceptualize non compliance  Start the hammer FHA Mission to Care HIIN 11

Infection Prevention Boot Camp for Novice Infection May 30, 2019 Preventionists Participants All affiliated nurses of the nursing wards. Wards were randomly assigned to either the team and leaders-directed strategy (30 wards) or the state-of-the-art strategy (37 wards). Methods The control arm received a state-of-the-art strategy including education, reminders, feedback and targeting adequate products and facilities. The experimental group received all elements of the state-of- the-art strategy supplemented with interventions based on social influence and leadership, comprising specific team and leaders-directed activities. Strategies were delivered during a period of six months Results 10,785 opportunities for appropriate hand hygiene in 2733 nurses. The compliance in the state-of-the-art group increased from 23% to 42% in the short term and to 46% in the long run. The hand hygiene compliance in the team and leaders-directed group improved from 20% to 53% in the short term and remained 53% in the long run. The difference between both strategies showed an Odds Ratio of 1.64 (95% CI 1.33–2.02) in favor of the team and leaders-directed strategy. Conclusions Our results support the added value of social influence and enhanced leadership in hand hygiene improvement strategies. The methodology of the latter also seems promising for improving team performance with other patient safety issues FHA Mission to Care HIIN 12

Infection Prevention Boot Camp for Novice Infection May 30, 2019 Preventionists UC insertion and maintenance Central line Prevention of insertion and MDRO Maintenance Hand Hygiene Prevention of diarrheal Surgical scurb outbreaks Prevention of c difficile 37 Engaging Patients Wash Your Hands  With alcohol-based hand rub:  When??? FHA Mission to Care HIIN 13

Infection Prevention Boot Camp for Novice Infection May 30, 2019 Preventionists Five Moments for Hand Hygiene  World Health Organization:  1. Before touching a patient  2. Before aseptic/clean procedure  3. After body fluid exposure risk  4. After touching a patient  5. After touching patient surroundings WASH YOUR HANDS!!  With Soap and Water:  When? Literature FHA Mission to Care HIIN 14

Infection Prevention Boot Camp for Novice Infection May 30, 2019 Preventionists Findings  Compliance  Measurement Measurement  Direct observation  Product use  Electronic systems FHA Mission to Care HIIN 15

Infection Prevention Boot Camp for Novice Infection May 30, 2019 Preventionists Discussion Surveillance FHA Mission to Care HIIN 16

Infection Prevention Boot Camp for Novice Infection May 30, 2019 Preventionists Prioritize Assess the Population and determine those at greatest risk Examples: Select surgical Site Infections Pneumonia Patients ICU Patients Determine the Type of Surveillance Process vs. Outcome  Outcome – Healthcare acquired Infections  Process- Patient Care Practices aimed at preventing HAI’S Utilize Standardized Definitions Process Identify the process to be measured Identify the methodology for collection Outcome Utilize standard definitions- generally accepted, published i.e. NHSN FHA Mission to Care HIIN 17

Infection Prevention Boot Camp for Novice Infection May 30, 2019 Preventionists Standardized Criteria Needed to :  Identify an event  Monitor trends over time  Compare rates between groups Select Appropriate Denominator Data Outcome – Device days Process- Compliance rates Immunization rates Advantages to Process Indicators Work well in long term care and outpatient setting [ Infection rate vs. Immunization rate] FHA Mission to Care HIIN 18

Infection Prevention Boot Camp for Novice Infection May 30, 2019 Preventionists Process Indicators Methods to collect data Observation vs. Chart Review Give examples of process indicators Difficulty with Process Indicators Reliability / Inter-rater reliability Difficulty with observing processes If measuring by documentation – may not adequately reflect the care provided i.e. Surgical prophylaxis FHA Mission to Care HIIN 19

Infection Prevention Boot Camp for Novice Infection May 30, 2019 Preventionists Regulatory/ Accrediting Agencies Frequently use Process Indicators  State Dept. of Health  Joint Commission, DNV  CMS Observations FHA Mission to Care HIIN 20

Infection Prevention Boot Camp for Novice Infection May 30, 2019 Preventionists When all else Fails You have to be Kidding! FHA Mission to Care HIIN 21

Infection Prevention Boot Camp for Novice Infection May 30, 2019 Preventionists Data Reporting Spreading the Message to Key Stakeholders Communication Data Dissemination FHA Mission to Care HIIN 22