CDI Preventing and Managing Clostridium Difficile - A Provider's Perspective

Transcription

1 Thank You for Joining! CDI Preventing and Managing Clostridium Difficile - A Provider's Perspective New England Nursing Home Quality Care Collaborative Webinar Will Begin Shortly. Call-In Number: (888) Access Code: This material was prepared by the New England Quality Innovation Network-Quality Improvement Organization (NE QIN-QIO), the Medicare Quality Improvement Organization for New England, 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 CMSQINC

2 Jane Steele RN, IP, WCC Infection Prevention Specialist Athena Healthcare System Dolores Savage RN, BSN, MS Clinical Education Specialist Athena Healthcare System 2

3 ATHENA HEALTHCARE STRATEGIES TO CONTROL CDIFF TRANSMISSION

4 WEBINAR OBJECTIVES Provide examples of CDIFF concerns in long term care. Discuss barriers to the prevention of CDIFF transmission Describe prevention measures for transmission Describe the implementation of the Athena program 4

5 ATHENA HEALTHCARE Athena Health Care System is a Connecticut-based management company established in Throughout New England, Athena Health Care System is known as a leader in providing quality health care services and is recognized as one of the region's largest managers of skilled nursing facilities located in Connecticut, Massachusetts and Rhode Island. Our managed facilities offer short-term rehabilitation, long-term, respite and hospice care. Athena also offers home health care as well as many other services. 5

6 ATHENA S MISSION TO PROVIDE THE HIGHEST QUALITY OF CARE AND CUSTOMER SERVICE TO OUR RESIDENTS AND THEIR FAMILIES THROUGH THE USE OF BEST PRACTICES, HIGHLY TRAINED STAFF, AND INOVATIVE PROGRAMS AND SERVICES DESIGNED TO MEET THEIR NEEDS. 6

7 WHY THE FUSS ABOUT CDIFF?? Spore forming bacteria- difficult to kill Antibiotics most common cause of CDIFF Most common cause of acute infectious diarrhea in LTC Disease can be life threatening especially to the elderly Large number of LTC residents thought to be colonized with it Dirty hands and environmental surfaces biggest reason for the spread of C diff 7

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9 BARRIERS TO SUCCESSFUL PREVENTION OF CDIFF TRANSMISSION Non-compliance with Hand hygiene Limited supplies Lack of understanding on transmission Inappropriate cohorting 9

10 What was our plan at Athena? 10

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12 STEPS TO SUCCESS Facilities joined in the CDI initiative through QIN-QIO and Qualidigm to report our Cdiff data Several homes participated in ICAR surveys with DPH Review new admissions for presence of any infections/abt usage Initiated competencies on PPE removal and hand hygiene (on hire and annually) Monthly hand hygiene observations-involve all depts. Audit of practices in isolation rooms with feedback to staff 12

13 ANTIBIOTIC STEWARDSHIP PROGRAM DEVELOPMENT NEW CMS REGULATIONS HAVE REQUIRED THE INITIAITION OF AN ANTIBIOTIC STEWARDSHIP POLICY DEVELOPED OUR NEW ANTIBIOTIC STEWARDSHIP POLICY WE TRACK ALL ABT USE IN THE FACILITY OUR FACILITIES AUDIT ALL IN HOUSE ORDERED ABTS TO ENSURE CRITERIA IS MET FOR ORDERING AND THAT ALL ORDERS INCLUDE DOSE, DURATION AND INDICATION WILL BE INITIATITING ABT PRESCRIBER REPORT CARDS FOR RESP/UTI INFECTIONS IN 2018 DATA IS REVIEWIED AT MED STAFF/QA MEETINGS 13

14 ANTIBIOTIC STEWARDSHIP PROGRAM DEVELOPMENT FACILITIES HAVE ESTABLISHED ANTIMICROBIAL STEWARDSHIP TEAMS AND DOCUMENT QUARTERLY MINUTES WHICH INCLUDE CDIFF AND MDRO TRANSMISSION DATA OUR FACILITIES UPDATE A CDIFF/MDRO LOG WEEKLY AND PROVIDE TO ALL DEPTS TO ENSURE PROPER COHORTING 14

15 NOW TO THE NITTY GRITTY WHAT WERE OUR UNIT PRACTICES THAT NEEDED CORRECTING?? 15

16 OBSERVATIONS INADEQUATE HAND HYGEINE GLOVES WORN IN HALLWAY IMPROPER LINEN HANDLING ISSUES WITH COHORTING ISOLATION CARTS NOT STOCKED 16

17 WHAT DID WE DO? IT ALL STARTED WITH EDUCATION 17

18 STARTED WITH STAFF EDUCATION ON TRANSMISSION 18

19 COMPETENCIES AND EDUCATION ALL STAFF WERE EDUCATED ON NEED FOR HAND WASHING IN CDIFF ROOMS APPROPRIATE STORAGE OF PERSONAL ITEMS LINEN HANDLING COMPETENCIES WERE CONDUCTED WITH ALL STAFF ON HAND HYGIENE AND PPE USAGE 19

20 DIETARY EDUCATION EDUCATION ON PRECAUTION ROOMS NO NEED FOR PAPER PRODUCTS EDUCATED ON NEED FOR FREQUENT HAND WASHING WHEN HANDLING TRAYS 20

21 HOUSEKEEPING EDUCATION EDUCATION CONDUCTED ON THE FOLLOWING: CDIFF IS A SPORE THAT IS RESISTANT TO HEAT AND CHEMICALS USING APPROPRIATE PRODUCTS WHEN CLEANING THE ROOMS RESIDENT S WITH CDIFF SHOULD HAVE THEIR ROOM CLEANED LAST WATER AND MOP HEAD NEED TO BE CHANGED UPON CLEANING OF ROOM One good housekeeper can prevent more infections than a dozen doctors can cure. Eric Rose 21

22 REHAB AND RECREATION EDUCATION EDUCATED ON NEED TO WEAR GOWNS AND GLOVES WHEN PROVIDING REHAB SERVICES IF RESIDENT ON PRECAUTIONS EDUCATED ON NEED FOR HAND WASHING IN CDIFF ROOMS EDUCATED ON NEED TO PROVIDE THERAPY AND REC ACTIVITIES IN RESIDENT ROOM IF ACTIVE INFECTION OR TREAT LAST FOLLOWED BY TERMINAL CLEANING OF EQUIPMENT 22

23 AUDIT OF PRACTICES HAND HYGIENE OBSERVATIONS ARE CONDUCTED ON A MONTHLY BASIS BY ALL DEPTS PPE USAGE IN CDIFF/ISOLATION ROOMS DAILY AND TERMINAL ROOM CLEANING 23

24 AUDIT FOLLOWUP HAND HYGIENE-FINDINGS ARE REVIEWED BY THE IP AND MONTHLY COMPLIANCE RATES ARE CALCULATED FEEDBACK AND RE-EDUCATION (IF NECESSARY) IS PROVIDED TO STAFF AT TIME OF OBSERVATION AND SHARED WITH APPROPRIATE DEPARTMENT HEADS 24

25 PREPARING FOR THE DIFF STAFF IS EMPOWERED TO INITIATE CONTACT PRECAUTIONS FOR ANY RESIDENT WITH LOOSE STOOLS ISOLATION CARTS ARE STOCKED AND READY TO GO WITH DOOR SIGNAGE AND ISOLATION GUIDELINES BLEACH PDI WIPES ARE AVAILABLE FOR CLEANING EQUIPMENT DEDICATED EQUIPMENT IS AVAILABLE FOR THE RESIDENT ASSIGNMENTS ARE UPDATED TO REFLECT NEED FOR PRECAUTIONS 25

26 COMMODE VS TOILET ENCOURAGE USE OF SANI BAGS WHAT TO DO IF NOT AVAILABLE? 26

27 COMMUNICATION NOTIFY DEPTS OF ISOLATION NEEDS-HOUSEKEEPING, REHAB, REC SIGNAGE PROVIDE EDUCATIONAL MATERIALS TO FAMILIES MONITOR VISITOR ACTIVITY AND PRACTICES 27

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29 WHEN TO DISCONTINUE PRECAUTIONS? C Difficile precautions may be discontinued 48 hours after resolution of diarrhea symptoms. Maintaining isolation longer than needed can adversely affect the resident s psychosocial well-being. Follow up stool cultures are not necessary. (It is important to be aware that a resident may test positive on toxin assay even after infection resolution. Base isolation on presence or absence of symptoms). Residents are closely monitored for recurrence of diarrhea. 29

30 WHAT TO DO WITH THE RESIDENT WITH CHRONIC CDIFF?? Residents with chronic CDIFF will always test positive, as the spores will always be present in their stool. Work with your Medical Director, DNS, and Administrator to create a plan of care Remember, in house positive tests need to be reviewed to see if should be reported as an event to NHSN 30

31 FACILITY EXAMPLES Recent increased ordering of Cdiff stools: It smells like Cdiff They are having mucousy stools They are having increased soft stools An abundance of specimens were ordered-all were negative 31

32 FACILITY EXAMPLES In 2016-one of our facilities had an elevated rate of Cdiff occurrences in the facility: Total of 8 cases between a 3 month period on one unit Assignments reviewed for trends Contact precaution observations were reviewed HK procedures monitored QAPI was initiated to address the elevation and the plan to correct 32

33 IN CONCLUSION Educate prescribers, staff and families on antibiotic stewardship to prevent overuse of ABTs Observe and audit hand hygiene, PPE and room cleaning practices in your facility Collaborate and communicate with all departments. 33

34 Questions 34

35 State Contacts for the Clostridium difficile Initiative Connecticut Cynthia Hayle Maine Danielle Watford Massachusetts Ileizy Victor New Hampshire Margaret Crowley Rhode Island Janet Robinson Vermont Regina Cooper 35

36 Mark Your Calendars Upcoming NE-NHQCC Events FEB 8 FEB 13 WEBINAR: Making the Numbers Count - Using your Pharmacy data to support Antibiotic Stewardship and Infection Control Feb 8 th from 11:00am - noon WEBINAR: Introduction to Antimicrobial Stewardship in Long Term Care - What is Antimicrobial Stewardship and Why is it Important? Feb 13 th from 11:00am - noon 36

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38 The Learning Center Captures valuable data such as: Pre and post tests Knowledge checks Surveys Learners course specific reports: Test responses Activity completions Feedback Number of Attempts Access at Learning4Quality.org Questions, comments, or concerns, 38

39 Connect with the New England QIN-QIO on Social Media! 39