PPE. LTC Infections 3/27/2013. Managing Infection Control. MRSA (stats doubled between ) VRE (stats tripled in same time frame)

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1 Managing Infection Control Offtheside of your desk Avril Taylor DOC Fraserview Intermediate Care Mary Vachon ICP Good Samaritan Society PPE LTC Infections MRSA (stats doubled between ) VRE (stats tripled in same time frame) This generation of clients/residents come with more resistance to antibiotics and more susceptible to C Diff 1

2 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 i support for infection related ltd 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 2

3 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? Eg. UTI s Doctoring by Fax samples are sent before other measures are started. Can be a contributing factor to ARO s 3

4 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. 4

5 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 nothave 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, , internet. 5

6 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 6

7 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 7

8 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. 8

9 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 9

10 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. i A mentor that has their CIC certification. 10

11 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! 11

12 Questions? 12