1 LEADERSHIP Philosophy -Reflect facility mission & vision Administrative accountability Whom...
-
Upload
violet-kennedy -
Category
Documents
-
view
214 -
download
0
Transcript of 1 LEADERSHIP Philosophy -Reflect facility mission & vision Administrative accountability Whom...
1
LEADERSHIP • Philosophy -Reflect facility mission & vision
• Administrative accountability Whom responsible for employee compliance to policy/protocol, standards of care?
2
• Authority to take action - Designate person/position to act when indicated
Responsibility * Designate scope of responsibility and program management * Infection Control position description * IC professional development plan * Competency measurement/performance evaluation * Time allocation for program functions
3
Responsibility, continued
• Policy, procedure, protocol development* Determine need/title* Research* Prepare* Seek approval* Education employees affected* Implement* Assess
4
• Oversight: Function/committee Infection Control Committee? Quality Committee?
* Multi-disciplinary membership* Reporting structure* Goals and objectives* Program evaluation
5
Performance Improvement
* Performance measures consistent with goals/objectives * Process/methods for data collection, data analysis description, reporting formats, improvements/recommendations, intervention/follow-up
6
Regulatory compliance and/or Community standards of care Reflect in policy, procedure, protocols
• Bloodborne pathogens• Clinical laboratory improvement amendments (CLIA) - waived testing• Communicable disease reporting• Construction and renovation standards• Dietary practices• Employee health and safety
7
Regulatory Compliance and/orCommunity Standards of Care (continued)
• First responder notification• Hand hygiene• Housekeeping and building maintenance• HIV: resident or employee• Vaccinations: resident, employee• Isolation/precautions
8
Surveillance of Nosocomial Infections: Long Term Care
Gail Bennett, RN, MSN, CIC
www.icpasssociates.com
9
Surveillance: The Method
“The ongoing, systematic collection, analysis, and interpretation of health data essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those who need to know.”CDC Definition
10
Reasons for Surveillance Activities
Establish baseline endemic nosocomial infection rates
Facilitate early awareness of epidemics or clusters of nosocomial infections
Identify problems for which there is action that may decrease rates and actions that may lead to prevention of future infections
11
Types of Surveillance
Traditional, total house surveillance– Finding ALL nosocomial infections ALL of
the time Useful to establish endemic rates Time consuming
12
Types of Surveillance Targeted Surveillance
Geographic locations or types of nosocomial infections may be targeted for review May consider: High risk High volumeProblem prone
Be alert to your state surveyors’ expectations re: type of surveillance
13
Methods of Finding Infections/Data Sources
Microbiology (culture) reports Unit generated report forms 24 hour report Antibiotic monitoring Unit rounds/communication forms/verbal reports Medical record review Review should be concurrent, not retrospective
14
Data to Collect What is essential to your analysis?
Some facilities collect:
Resident name Record number Physician Admission date Symptoms & onset
Site Culture
date/pathogen Risk factors Other
15
Making an Infection Determination
Is infection present?– Definitions of infection
If yes, is it nosocomial?– Based on time (48 hour rule)
16
Definitions of Infections for LTC
McGeer definitions
American Journal of Infection Control, 1991; 19;1-7.
17
Methods of Presentation of Data
Line listing Monthly summary of
infections Tables, graphs,
charts
18
Data Interpretation
Clusters of infections (closely grouped series of infections)
Outbreak (excess cases over normal) Sentinel events (single occurrence
which requires action) Trend (increase in specific infections
over time) Seasonal occurrence
19
Outbreaks
Require quick identification and action 10 published steps for outbreak
investigation (see outbreak investigation form)
You may need to seek assistance Report to the health department as
required by your state law
23
Nosocomial Infection Rates
New cases of infection
________________X 1000=
Total resident days
# infections/1000 resident days
[This has become the preferred method of calculation if you choose to do an overall rate.]
24
Nosocomial Infection Rates using Device Days
New cases of UTI
________________ X 1000=
Total urinary device days
# UTIs per 1000 urinary device days
25
Forms
Example forms provided:
Monthly summary Summary of device
related infections Line listing Outbreak investigation
26
Surveillance resources
Bennett, G. Infection control manual for long term care. 2004 edition. HCPro, Marblehead, MA. $199.00
Lee TB, Baker OG, Lee JT, Scheckler WE, Steele L, Laxton CE, APIC Surveillance Initiative Working Group. Recommended Practices for Surveillance. American Journal of Infection Control 1998;26:277-288.
27
Surveillance resources
McGeer A, Campbell B, Emori TG, Hierholzer WJ, Jackson MM, Nicolle LE, Peppler C, Rivera A, Schollenberger DG, Simor AE, Smith PW, Wang E. Definitions of Infection for Surveillance in Long Term Care Facilities. American Journal of Infection Control 1991;19(1):1-7.
Nicolle, L. Preventing infections in non-hospital settings: long term care. EID, vol. 7, no. 2, Mar/Apr, 2001. www.cdc.gov/ncidid/eid/vol7no2/nicolle.htm
Smith, P. and Rusnak, P. Infection prevention and control in the long term care facility. AJIC, 1997; 25; 488-512.
28
EDUCATION
• New-hire orientation: All employees * Hand hygiene * Infectious Disease model * Exposure Control Plan: Bloodborne * Tuberculosis * Work restriction policy * Immunization program
29
EDUCATION, continued
• New-hire: certain employees * Information specific to responsibility• Annual * Bloodborne Pathogen * Others, as/if required by regulationOn-going * Change in policy/procedure/protocol * IC/ID information, if indicated
32
Assess:
General health History of communicable diseases Immunization status
– Hepatitis B– Measles, mumps, rubella– Varicella– Tetanus– Influenza if hired during flu season
33
Employee Health: Bloodborne Pathogens and TB
Governed by OSHA regulations
Potential for OSHA fines for non-compliance
36
Hepatitis Immunization
Training must occur – prior to offering immunization– Prior to obtaining consent or declination
Training must include a qualified person available to answer questions if video is used
37
Hepatitis Immunization 10 working days from hire
to offer and administer Schedule of immunization:
0,1,6 months Deltoid muscle Post testing – antibody
– Can be fined by OSHA if not done – not following PHS recommendations
If 3 immunizations with negative titer, repeat series
38
Form
A sample consent/declination form is included in handouts
Form includes up to six immunizations and antibody screens
40
BBP Exposures
OSHA requires detailed actions and documentation of BBP exposures.
Handout: Comprehensive form for documenting exposures.
Must maintain exposure records the length of employment plus 30 years! Mark those files - “may destroy 2033” (example).
41
BBP Exposures
If we have documented + antibody to Hepatitis B, do not have to test associate for Hepatitis B. Still test for Hepatitis C and HIV.
If Hepatitis B status not documented, test. Test resident for Hepatitis B, C, HIV unless
positive status is already known Follow state regulations regarding obtaining
consent Follow CDC guidelines for subsequent testing
42
HIV exposure
Exposure to a known positive resident with HIV, follow the CDC guidelines
Timeliness of follow-up is critical Many LTCFs have a relationship with a
hospital to assess HIV exposures and intitiate appropriate prophylaxis
44
PPD Skin Testing
Employees:– 2 step on hire (unless tested in last
12 months and documented)– Requirement for annual PPDs (or
more often based on annual facility TB risk assessment)
– Test after exposure (immediately then in 10-12 weeks)
45
PPD Skin Testing
Employees:– If positive prior to hire - have them
bring x-ray results and documentation of no active disease
– If they do not have an evaluation, we must get one.
– If positive, assessment for symptoms on hire and annually.
46
PPD Skin Testing
Employees:
– If convert during employment, have an evaluation done (PHD should do this and give free INH as indicated)
– Report on OSHA 300 log
– Start annual assessment for symptoms
47
Training of all Associates
All associates should receive orientation and annual training on bloodborne pathogens and TB
48
TB Risk Assessment
Must be done every each year
Determines if we can continue annual PPDs on associates vs. more frequently
49
Employee Illnesses
Maintain a log of associates with infections.
Requires all department heads to assist.
Many facilities have the logs turned in to IC/EH.
50
Work Restrictions
Policy on work restrictions – CDC occupational health guidelines have a work restrictions table.
Adopt a policy for your facility.
Enforce it.
52
Resident Immunizations
National recommendations: Pneumonia vaccine on admission if has
not had it since age 65– If prior to age 65, give a dose once every 5
years until 65 - then lifetime immunity.
53
Resident Immunizations
Influenza vaccine: give each fall when vaccine arrives
Continue to vaccinate through March 31 Many LTCFs now vaccinate under
standing orders – refusal of care form signed if refuse vaccine
56
References Bolyard, EA, et al. Guideline for infection control in
health care personnel, 1998. CDC/ HICPAC. AJIC, 26(3):289-354, 1998.
CDC. Updated public health service guidelines for the management of occupational exposures to HBV, HCV, HIV and recommendations for post-exposure prophylaxis. MMWR, 6/29/01/Vol.50/No.RR-11.
CDC. Guidelines for preventing transmission of Mycobacterium tuberculosis in healthcare facilities, 1994. MMWR 43(RR13); 1-132.
Core curriculum on tuberculosis: what the clinician should know. CDC, 3rd edition, 1994.
59
HAND HYGIENE, WHY?
Reduce risk of morbidity, mortality, and cost associated with healthcare associated infections
Eliminate transient organisms andreduce resident hand flora
60
INDICATIONS FOR HANDWASHING
1. Between patient contacts 2. After contact with blood, body fluids, excretions, secretions, contaminated equipment, mucous membrane, non-intact skin. 3. After glove or any PPE removal 4. Between task/procedures on same patient 5. When visibly soiled/dirty 6. Before and after eating or handling food 7. After coughing or sneezing After using a handkerchief / tissue 8. After using the toilet and helping others in the bathroom 9. Before and after smoking
61
HOW TO WASH HANDS
Turn on faucet
Wet hands
Apply cleanser
Friction, at least 15 seconds
Rinse well
Pat dry
Use towel to turn off faucet
62
Involves use of waterless alcohol-based agent
Purpose: reduction of bacterial counts on hands when handsare not visibly soiled
Available when sink not available or water supply disruption
HAND RUB
63
HAND HYGIENE WITH ALCOHOL-BASED HAND RUB
Apply product to one hand
Rub hands together
Cover all surfaces of hands and fingers
Rub until the hands are dry
64
DISPENSER PLACEMENT AND STORAGE (1)
Michigan CIS Office of Fire Safety
Dispensers containing this product are prohibited from being located in a required corridor or exit, or any area open to a required corridor or exit
This product must be isolated from high temperature and possible ignition sources such as , but not limited to, open flame, electrical equipment, switches or receptacles.
65
DISPENSER PLACEMENT AND STORAGE (2)
The storage of quantities (10 gallons or more), and
dispensing of this product shall comply with the requirements of NFPA BASE 30, FLAMMABLE AND COMBUSTIBLE LIQUIDS, Chapter 4, and or the Michigan flammable and combustible rules and NFPS Base 99, N-7.2.2.
66
SURGICAL HAND ANTISEPSIS
Remove watches rings braclets
Use nail cleaner and running water to remove debris under fingernails
Antimicrobial soap-scrub 2 to 6 minutes, or manufacturer’s directions
Alcohol based surgical hand scrub, prewash hands and forearms with plain soap.
Dry completely, apply product, allow to dry, don sterile gloves
68
BARRIERS
Lack of knowledge that guidelines for hand hygiene exist
Not recognizing opportunities during the performance of ones duties
Lack of awareness for the risk of cross contamination of organisms