Infection Prevention and Control and Antibiotic Stewardship: More than Counting Beans

Transcription

1 Infection Prevention and Control and Antibiotic Stewardship: More than Counting Beans Teresa Fox, CIC Quality Improvement Advisor

2 Welcome Beth Greene, Quality Improvement Advisor Facilitator Teresa Fox, CIC Quality Improvement Advisor Slides and a recording from today s session can be found at the atom Alliance Leading and Sustaining Systemic Change Collaborative (LSSCC) webpage at 2

3 3 atom Alliance Partners

4 Meet the atom Alliance Nursing Home Team 4

5 Objectives Identify key components (elements) of an infection prevention and control program in Long-Term Care Facilities (LTCF) Identify the newly updated Centers of Medicare and Medicaid Services (CMS) regulatory requirements as related to infection prevention and control Identify the key components for CMS infection prevention and control focus survey activities 5

6 Why Infection Prevention and Control in LTCF? More than 1.5 million residents reside in the US in nursing homes Recently, the acuity of illness of nursing home residents has increased with risk for developing a healthcare-associated infection (HAI) approaching that of acute care hospital patients In US nursing homes, 1.6 million to 3.8 million infections are identified each year 6 Source: Smith PW, Bennett G, Bradley S, et al. SHEA/APIC Guideline: Infection Prevention and Control in the Long-Term Care Facility. Infection Control and Hospital Epidemiology. 2008;29(9): doi: /

7 CMS s Infection Prevention and Control Requirements: Final Rule

8 Key Components SHEA and APIC SHEA Society for Healthcare Epidemiology of America APIC Association for Professionals in Infection Control 8

9 Key Components of IPCP: System Infection Prevention and Control Program (IPCP) The facility must have 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 9 Source: CMS. Final Rule Medicare and Medicaid Programs; Reform of Requirements for Long-Term Care Facilities: Infection Control. Federal Register. October 4, 2016; Document Citation 81 FR

10 Key Components of IPCP: QAPI Quality Assurance and Performance Improvement (QAPI) System for reporting of identified events along with corrective actions Outbreak investigation Infection Preventionist (IP) identified and responsible for the IPCP Phase 3 Member of QAPI Committee (multi-disciplinary in structure) Primary professional training in nursing, medical technology, microbiology, epidemiology, or other related field Qualified by education, training, experience or certification Has completed specialized training in infection prevention and control 10

11 Key Components of IPCP: Assess Policies and procedures supporting the IPCP Current policies, e.g., hand hygiene, standard and transmissionbased precautions, environmental cleaning and disinfection Updated and additional policies Facility Assessment including Infection Control Risk Assessment Annually (at least) Required staff education Resident health and populations served Employee health 11

12 12 IPCP/Surveillance Process

13 IPCP Risk-Assessment Tools 13 Source: CDC. Infection Control Assessment Tools: LTCF. CDC Infection Control Tools for Healthcare Settings.

14 How does my facility identify my focus? Do you have a facility risk assessment? What do you know about your community and infections occurring in your community? Do you know what Multi-drug resistant organisms (MDROs) have been identified in your facility? (Community onset/facility onset) Have you had an outbreak? Do you care for residents on ventilators, dialysis, etc? What percentage of your residents are on isolation precautions? Do you have policies and procedures to address your identified risks? What are the facility s priorities? 14

15 Environmental Cleaning and the Use of Transmission Based Precautions Jim Elrod atom Alliance Advisory Council Member 15

16 Prevention and Control of C. diff Isolation Precautions (Special) Signage Soap and water for hand hygiene Private room, if possible Cohort residents should have separate toileting facilities Shared medical equipment must be cleaned and disinfected with appropriate wipes Terminally clean when removing resident from isolation precautions 16 Clostridium difficile, abbreviated as C. difficile and commonly known as C. diff

17 Key Components of IPCP Antibiotic Stewardship (AS) A system to monitor the facility s use of antibiotics Policies and procedures Management Preparedness Regulatory Compliance 17

18 IPCP/Surveillance Plan Summary Developed as per findings of Facility (Risk) Assessment Prior to outbreaks Uses facility findings and data analysis Establishes measurable outcome and process goals Evaluates the effectiveness of the processes and interventions 18

19 Antibiotic Resistance 19 Source: Villavicencio CE, Kwek MP. Antimicrobial Stewardship [PowerPoint slides]. Philippine Hospital Infection Control Nurses Association (PHICNA) Inc. March 8, Retrieved from

20 Antibiotics in Nursing Homes 20 Source: CDC. The Core Elements of Antibiotic Stewardship for Nursing Homes. Atlanta, GA: US Department of Health and Human Services, CDC; 2015, p.4. Available at:

21 Antibiotic Stewardship in LTCF Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms. 21

22 Antibiotic Stewardship Bill Gossard atom Alliance Advisory Council Member 22

23 What is C. diff? Gram-positive, anaerobic, spore forming Toxin A and B causing disease Transmitted fecal-oral RISK FACTORS for C. diff Antibiotic exposure Acquisition of C. diff Gastric acid suppression/proton pump inhibitors Advanced age Underlying disease Immunosuppression Tube feedings 23

24 Antibiotic Risk Factors for C. diff 24 Source: Hou C, Kraemer M. Kennedy Health: Our Sepsis Initiatives [PowerPoint slides]. February 17, Retrieved from uality/documents/sepsis/ohiosepsis-kennedyfinal-pdf.pdf

25 25 Antibiotic Stewardship Choices

26 CDC s SevenElements 26 Source: Nori P, Bartash R, Ostrowsky B. Editorial: Keys to successful ASP development. Infectious Disease News. February Available at disease/antimicrobials/news/print/infectious-disease-news/%7b34c5f8bf-fdcc- 4c92-b3a3-6e33cf9deefb%7D/keys-to-successful-asp-development

27 Checklist for AS Core Elements 27 Available at

28 Surveyor Expectations for Training What is expected by surveyor related to staff training? Blood borne pathogen Respiratory hygiene Standard and Transmission-based precautions IP-specific training IP job description describing the scope, purpose and accountability of the position AS training for all nursing and clinical providers Local antibiogram, antibiotic usage and protocols for appropriate prescribing 28

29 Infection Prevention Guide for LTC The Infection Prevention and Control Program Employee Health OSHA Bloodborne Pathogens Exposure Control Program Tuberculosis Infection Prevention Program Isolation Precautions Outbreak Prevention and Investigation Nursing Policies Other Departments Inservice Slides 29 Non-member price: Discounted member price: 89.00

30 a well-functioning IPC program is fundamental to the success of an AS strategy 30 Source: Society for Healthcare Epidemiology of America. Infection prevention and control programs are essential to antibiotic stewardship efforts. March 26, Available at

31 Next Steps

32 Train the Trainer Series to View During Action Period 3 (May Oct, 2018) 1. TeamSTEPPS in LTC: Communication Strategies to Promote Quality and Safety 2. Exploring Antibiotics and their Role in Fighting Bacterial Infections 3. Antibiotic Resistance: How it Happens and Strategies to Decrease the Spread of Resistance 4. Antibiotic Stewardship 5. Clostridium difficile Part One: Clinical Overview 6. Clostridium difficile Part Two: Strategies to Prevent, Track, and Monitor C. difficile Located on the LSSCC dedicated webpage at 32

33 Learn More Visit the atom Alliance LSSCC website at 33

34 Resources 1) The Core Elements of Antibiotic Stewardship for Nursing Homes-CDC 2) National Healthcare Safety Network (NHSN) 3) CDC and National Nursing Home Quality Care Collaborative (NNHQCC) Nursing Home and LTCF Prevention Tools (Checklist) 4) CDC Core Elements of Antibiotic Stewardship for Nursing Homes 5) Beyond CDI Basics Prevention Strategies: Reaching Across the Continuum of Care to Decrease CDI Events 34

35 Thank you Questions? 35

36 Connect with Us Facebook omalliance Twitter _alliance LinkedIn mpany/atom-alliance Pinterest omalliance/ 36 This material was prepared by the atom Alliance, the Quality Innovation Network-Quality Improvement Organization (QIN-QIO), coordinated by Qsource for Tennessee, Kentucky, Indiana, Mississippi and Alabama, under a contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. Content presented does not necessarily reflect CMS policy. 18.ASC