2/23/2017. Preparing to Meet New Infection Prevention Requirements in Skilled Nursing Facilities. Objectives

Transcription

1 Preparing to Meet New Infection Prevention Requirements in Skilled Nursing Facilities Aimee Ford, Qualis Health Patricia Montgomery, WA State Department of Health Washington Health Care Association Winter Conference February 24, 2017 Qualis Health A leading national population health management organization The Medicare Quality Innovation Network - Quality Improvement Organization (QIN-QIO) for Idaho and Washington The QIO Program One of the largest federal programs dedicated to improving health quality at the local level 2 Objectives Review CMS key proposed changes to Infection Control requirements Identify the relationship between infection prevention and an overarching quality assessment, performance improvement (QAPI) approach Discuss key strategies for building a sustainable and robust infection prevention program 3 1

2 Regulatory Changes for Nursing Homes Source: 4 Implementation In Three Phases Phase I (November 28, 2016) Phase II (November 28, 2017) Phase III (November 28, 2019) 5 42 CFR Infection Control (a) Infection prevention and control program (b)infection preventionist (c)ip participation on quality assessment and assurance committee (d)influenza and pneumococcal immunizations (e)linens (f)annual review 6 2

3 Other Pertinent Requirements Nursing Services: Need both sufficient and competent staffing based on resident population (Phase I) Administration: SNF must conduct a Facility Assessment (Phase II) and review/update at least annually Quality Assurance and Performance Improvement: Infection Preventionist must be a member of the QAA committee (Phase III) Training requirements: Mandatory training on infection prevention (Phase III) (a) Infection Prevention and Control Program (IPCP) a) Infection prevention and control program. The facility must establish an infection prevention and control program (IPCP) that must include, at a minimum, the following elements: (1) A system for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases for all residents, staff, volunteers, visitors, and other individuals providing services under a contractual arrangement based upon the facility assessment conducted according to (e) and following accepted national standards; 8 (2) Written standards, policies, and procedures for the program, which must include, but are not limited to: (i) A system of surveillance designed to identify possible communicable diseases or infections before they can spread to other persons in the facility; (ii) When and to whom possible incidents of communicable disease or infections should be reported; (iii) Standard and transmission-based precautions to be followed to prevent spread of infections; (iv) When and how isolation should be used for a resident; including but not limited to: 9 3

4 (3) An antibiotic stewardship program that includes antibiotic use protocols and a system to monitor antibiotic use. (4) A system for recording incidents identified under the facility s IPCP and the corrective actions taken by the facility. 10 Risk Assessment (b) Infection Preventionist (IP) The facility must designate one or more individual(s ) as the IP, who is responsible for the IPCP 12 4

5 Primary training in nursing, medical technology, microbiology, epidemiology Qualified by education, training, experience, or certification Work at least part-time at the facility, and Completed specialized training in infection prevention and control 13 LTCF reporting compliance Infection Control Program and Infrastructure ICAR assessments WA and CDC 12/2/ % 100% 95% 95% 91% 85% 87% 80% 80% 76% 70% 60% 46% 40% 40% 20% 10% 0% Facility has an IP is trained Reviews Has written Polices are Facility has IP surveillance evidence reviewed written data and based annually disaster plan infection infection activities prevention policies Elements Assessed WA n=20 CDC n= Infection Preventionist: The Current State Hours Allocated Median 8.5 hours Range 0-30 hours/week Who? Usually a Nurse (RN,LPN) in LTC ADON Staff Development Employee Health 15 5

6 IP Training and Education On-line webinars Local Chapter Meetings Network Equip for Long-Term Care 16 APIC Training IDSA Events/Course- Catalog/Course?id=0dd7229e-b200-4eaa- 9f ce66f urse/ 17 Infection Prevention Compentency 18 6

7 483.80(c) Participation on the QAA Committee The individual designated as the IP, or at least one of the individuals must be a member of the facility s quality assessment and assurance committee and report to the committee on the IPCP on a regular basis (d) Influenza and Pneumococcal Immunizations Each resident is offered the immunization, unless medically contraindicated Before offering the vaccine, each resident/representative receives education on its risks/benefits; this must be documented including whether the vaccine was/not received Right to refuse immunization (e) Linens Personnel must handle, store, process, and transport linens so as to prevent the spread of infection. 21 7

8 483.80(f) Annual Review The facility will conduct an annual review of its IPCP and update their program, as necessary. 22 The Current State of Infection Prevention in WA LTCF Infection Control Assessment and Response (ICAR) ICAR assessments in Long term Care Note: CDC timeline different from DOH No other demographics provided 24 8

9 Healthcare Personnel Safety ICAR assessments WA and CDC 12/2/2016 LTCF reporing compliance 100% 100% 100% 99% 100% 100% 94% 96% 98% 100% 90% 92% 89% 83% 85% 85% 85% 80% 80% 82% 80% 60% 50% 40% 20% WA n=20 CDC n=264 0% Has work Personnel Conducts Performs TB Offers Hep Offers Tracks Has a BBP All receive All receive exclusion are employee Risk B vaccine at employee employee exposure BBP training training at policies encouraged baseline TB assessment hire influenza vaccine control plan at hire 12 months to report screening for exposure vaccine compliance illness to TB Elements Assessed 25 Disease Surveillance and Reporting ICAR assessments WA and CDC 12/2/2016 LTCF reporting compliance 100% 80% 60% 40% 20% 0% 87% 90% 85% 88% 81% 80% 76% 75% 78% 75% 76% 78% 70% 70% Has written System notifys Has a written Has system to The facility has a Has a current list of Can provide point(s) admission intake Infection Prevention surveillance plan follow up on clinical written plan for diseases reportable of contact at the procedures to Coordinator of outlining information when outbreak response to public health local or state health identify potentially MDROS (Lab or other monitoring/tracking residents are which includes a authorities. department for infectious persons. facility) infections occurring transferred to acute definition, assistance with in residents. care hospitals for procedures for outbreak response. management of surveillance and suspected infections, containment, and a including sepsis. list of syndromes or pathogens for which monitoring is performed. Elements Assessed WA n=20 CDC n= Antibiotic Stewardship ICAR assessments WA and CDC 12/2/2016 LTCF reporting compliance 100% 80% 60% 40% 20% 0% 78% 70% 70% 61% 60% 55% 56% 53% 50% 45% 44% 40% 31% 30% 25% 26% 27% 29% 18% 15% Can Has identified Has access to Has written Has Has a report Has a report Provides clinical Has provided Has provided demonstrate individuals individuals with policies on implemented summarizing summarizing prescribers training on training on leadership accountable for antibiotic antibiotic practices in antibiotic use antibiotic with feedback antibiotic use antibiotic use support for leading prescribing prescribing place to from pharmacy resistance (i.e., about their (stewardship) (stewardship) efforts to antibiotic expertise (e.g. improve data created antibiogram) antibiotic to all nursing to all clinical improve stewardship ID trained antibiotic use. within last 6 from the prescribing staff within the providers with antibiotic use activities physician or months. laboratory practices. last 12 months. prescribing (antibiotic pharmacist). created within privileges stewardship). the past 24 within the last months. 12 months. Elements assessed WA n=20 CDC n=

10 What Is Competency-Based Training? The verification of competency through the use of knowledge-based testing and direct observation. If direct observation is not included, an alternative method to ensure that healthcare personnel possess essential knowledge, skills, and abilities should be used Competency-Based Training Adherence Staff competency based training adherence % Observed Compliance All personnel receive All personnel receive The facility audits training and competency training and competency adherence to practices validation at time of hire 12 months Elements Assessed The facility provides feedback to personnel regarding their performance Supplies and resources are available Hand Hygiene PPE Injection Safety Environmental Cleaning 29 Lessons from the ICAR Results Strengths Has IP Has written disaster plan Reportable conditions list Evidence of beginning stewardship activities New Employee Orientation training Hand Hygiene Audits Opportunities IP Training Written policies and 12 month Review Written surveillance plan Offer and track employee influenza vaccine Training at 12 months Audits and Feedback Communication 30 10

11 EQuIP Gap Survey vs. Infection Control and Response Assessments 31 Healthcare is Complex! Long term care Long term care Critical Access Hospital Long term care Critical Access Hospital Influenza Season 2017 Staff and resident vaccination Identification of ill/ line list Treatment Chemoprophylaxis Decrease transmission Isolation and Co-horting Hand hygiene/standard and transmission based precautions 33 11

12 Did Your Infection Prevention System Work As Intended? Outbreaks reported in 167 facilities Median attack rate 11% Attack Rate Range <2%-60% Employee Vaccine Coverage Median 63% 84 (50%) reporting Range 2%-100% Most common response UNK 34 Leadership s Role in Infection Prevention Leadership is a process whereby an individual influences a group of individuals to achieve a common goal (Northouse, P. (2016). Leadership: Theory and Practice SAGE Publications, 7 th edition) 35 Take Home Points SNFs are expected to develop and implement a formal program designed to prevent infection The IPCP must be developed, implemented, and evaluated in a systematic fashion that sustains organizational changes Infection prevention and control is the job of a team, not an individual An effective IPCP begins with leadership commitment 36 12

13 Q & A 37 Action / Next Steps What will you do with this information when you return to your building? What is one action you can implement in one week? What is one change you might try? 38 References and Resources Advancing Excellence infection control toolkit: g=inf Agency for Healthcare Quality and Research (AHRQ) Nursing Home Antimicrobial Stewardship Guide: Centers for Disease Control (CDC) toolkit for longterm care facilities: Centers for Disease Control (CDC) Core Elements of Antibiotic Stewardship for Nursing Homes c-stewardship.html 39 13

14 Federal Emergency Management Agency (FEMA): Guide for All-Hazard Emergency Operations Planning Federal Register Reform of Requirements for Long- Term Care Facilities (10/4/16): /medicare-and-medicaid-programs-reformof-requirements-for-long-term-care-facilities S. Schweon, D. Burdsall, M. Hanchett, S. Hilley, D. Greene, I. Kenneley, J. Marx, P. Rosenbaum (2013). The Infection Perfectionist's Guide to Long-Term Care. Association for Professionals in Infection Control (APIC). 40 Contact Aimee Ford, MS, RN QI Consultant Qualis Health Patty Montgomery, RN, MPH, CIC Nurse Consultant Washington State Department of Health wa.gov For more information: This material was prepared by Qualis Health, the Medicare Quality Innovation Network - Quality Improvement Organization (QIN-QIO) for Idaho and Washington, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. WA-C2-QH