4/1/2016 WI Re ‐ energizing Clostridium difficile Infection(CDI) Webinar January 26, 2016 Presented by DeAnn Richards, MetaStar and Jill Hanson, WHA Objectives for Today • Wisconsin’s CDI plan for 2016 • Link between CDI and Antimicrobial Stewardship • Review the CDC Targeted Assessment for Prevention (TAP) tool • Highlight best practices of top performers in CDI reduction 1
4/1/2016 Wisconsin’s Plan for 2016 • Based upon Standard Incidence Ratio across the state, facilities with the greatest needs will be offered an opportunity to attend a co ‐ sponsored CDI workshop on April 12, 2016. • Encouraging all facilities to enhance their organizations antibiotic stewardship efforts. • Provide tools for the organization to utilize. Developing CDI Toolkit & Resources WHA/MetaStar are working to enhance: • CDI Facility TAP assessment tool • Capture and share best practices • Identify barriers to expanding CDI prevention beyond Infection Prevention • Electronic resources to meet facilities needs • Review how to run a NHSN TAP report for CDI 2
4/1/2016 Poll Question 1 What are your greatest needs related to CDI? • Testing sequence and interpretation • Tracking tool for retrospective review of cases to try to pinpoint a cause/issues • Hand hygiene compliance • Environmental cleaning and disinfection • Isolation initiation and maintenance • Antibiotic stewardship • Other • I am not sure yet Evaluate Existing Processes for CDI Do your policies/procedures/protocols ensure accuracy, completeness, and usability: • Are staff aware of CDI protocols of when testing should be requested? • Are staff aware of isolation protocols if CDI is suspected or confirmed? • Is isolation correctly identified on the patient room, chart, and EMR? • Are staff aware of hand hygiene requirements if CDI is suspected or confirmed? 3
4/1/2016 Evaluate Existing Processes for CDI • Are staff aware of cleaning requirements if CDI is suspected or confirmed? • How are staff are aware of patients with suspected or confirmed CDI? • Are patients, families, and visitors of potential or confirmed CDI patients provided education on how to prevent transmission? Defined Roles for Staff Nurse ‐ initiated actions: Physician ‐ initiated actions: • Assess patient • Assess patient • Determine potential reasons for diarrhea • Determine potential reasons for diarrhea • Inform physician that patient has • Evaluate for CDI diarrhea as well as assessment and any potential reasons. • Order appropriate laboratory tests • Follow through on any orders provided. • Validate appropriate isolation precautions • Initiate contact (or facility specific) isolation precautions • Document isolation in EMR • Validate receiving departments are aware of the need for isolation precautions. 4
4/1/2016 Let’s Talk Stool – Bristol Stool Chart If your facility does not have a ready reference for staff to have a visual reference for charting, we encourage you to modify adding when to initiate isolation and contact for stool testing – the sign from our website, laminate, and post on the units. Let’s all talk the same language. Cool Stool Tool https://www.lsqin.org/initiatives/hai/ 5
4/1/2016 Cool Stool Tool https://www.youtube.com/watch?v=b ‐ iOgv7uEsU&list=PL5ITOxWOe7JqcSZ ‐ UfgBRg8Bui1lfahKS&index=21 CDI Test Type 6
4/1/2016 CDI Test Type Patient Education • Share information regarding CDI and its transmission with patients and families • Instruct patients and families on hand hygiene and personal hygiene • Instruct patients and families regarding the importance of daily bathing and clean garments, providing assistance as needed 7
4/1/2016 Administrative Support • Share CDI rates and infection prevention interventions with senior leadership • Include senior leadership in communications regarding adherence monitoring • Communicate expectation of support and accountability regarding prevention activities to key leadership and provide concrete examples of ways they can support infection prevention Antimicrobial Stewardship and CDI • Antibiotic exposure is the single most important risk factor • 2014 meta ‐ analysis on the impact of ASP on CDI included 16 studies and found that ASP were significantly protective against CDI. • Up to 85% of patients have had antibiotic exposures in the 28 days before infection • The 75% of pediatric CDI were found to have recent antibiotics prescribed in outpatient settings 8
4/1/2016 Antimicrobial Stewardship Strategies Patient Evaluation Education/Guideline for Staff & Patients Choice of Antibiotic Formulary Restriction and Education/Guideline for Staff & Patients Pre ‐ Authorization Prescription Ordering Computer ‐ assisted Strategies Dispensing Antimicrobial Computer ‐ assisted Strategies Review and Feedback Antimicrobial Stewardship Program (ASP) • Primary goal is to improve patient safety. • Reducing antibiotic use and saving $ are not the primary goals. • Ensuring that every patient receives the right agent, right purpose, right dose, for the right duration • Monitors and evaluates antimicrobial use • Feedback mechanism to medical staff and leadership 9
4/1/2016 Team Members for ASP Infection Control Department Director, Information Pharmacy Systems Antimicrobial Stewardship P & T Microbiology Committee Program (ASP) Infectious Disease Patient Safety Division Hospital Leadership Do you know where your facility is compared to the Nation and State? Data Is Knowledge 10
4/1/2016 Poll Question 2 Where does your facility fall for CDI (check all that apply)? • We are below National SIR • We are above National SIR • We are below Wisconsin SIR • We are above Wisconsin SIR • I have no idea, but I do want to find out • I am not sure where to find the National or State comparison Targeted Assessment for Prevention (TAP) Report What Is a NHSN Targeted Assessment for Prevention (TAP) Report? • Allows ranking of location to ID and target area of greatest need for improvement. • Can be ran for CLABSI, CAUTI, and CDI LabID • Will provide a facility cumulative attributable difference (CAD) which is the number of infections which must be prevented to achieve a reduction assuming no changes to the population at risk since the time period of the report. 11
4/1/2016 NHSN NHSN TA TAP Re Report NHSN NHSN TA TAP Re Report 12
4/1/2016 NHSN NHSN TA TAP Re Report NHSN NHSN TA TAP Re Report 13
4/1/2016 NHSN NHSN TA TAP Re Report NHSN NHSN TA TAP Re Report 14
4/1/2016 TAP Report Cheat Sheet https://www.lsqin.org/initiatives/hai/ Comparison of Known Data National Standardized Infection Ratio (SIR) is 0.904 WI SIR 1st Quarter 2014 to 2 nd Quarter 1st Quarter 2015 – 1.03 2015 WI had: 2 nd Quarter 2015 – 1.00 • 2364 HO Lab ID events 3 rd Quarter 2015 – 0.92 • 2523 were expected • Group CAD was 83 • SIR 0.94 15
4/1/2016 Upcoming Webinars How to Positively Influence Individuals to Participate in HAI Prevention Webinar January 28 from 1 to 2 p.m. Registration link: https://qualitynet.webex.com Hand Hygiene – Still King of the Hill Webinar February 25 from 1 to 2 p.m. Registration link: https://qualitynet.webex.com 2016 CDI Educational Offerings Dates Topics Tues, Apr 26 10 am Best Practice Showcase Tues, Jul 26 10 am Best Practice Showcase Tues, Oct 25 10 am Best Practice Showcase 16
4/1/2016 Resources • Link to MetaStar – will already be highlighted during presentation but is at https://www.lsqin.org/initiatives/hai/ • Link to WHA – TAP cheat sheet & Bristol stool tool Any Questions? Thank you for attending DeAnn Richards (drichard@metastar.com) Jill Hanson (jhanson@wha.org) This material was prepared in part by the Lake Superior Quality Innovation Network, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The materials do not necessarily reflect CMS policy. 11SOW ‐ MN ‐ C1 ‐ 16 ‐ 07 012516 17
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