The Linders Health Institute. A Division of Philders Group Intl Inc MTA NYC 2014

Transcription

1 The Linders Health Institute A Division of Philders Group Intl Inc MTA NYC 2014

2 LEARNER OBJECTIVES Today s indoor environmental pollutants bring greater risk and threats to all public spaces The facts about infectious diseases in the HC environment--now in public places How these risk factors and legal issues apply to public safety Due diligence and management of risk Recommendations PHILDERS GROUP INTL INC

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4 MAJOR ISSUE IN HEALTHCARE Adults who developed HAIs due to medical or surgical care while in the hospital in 2007 had to stay an average of 19 days longer than adults who didn't develop an infection, (24 days versus five days), according to the latest News and Numbers from the Agency for Healthcare Research and Quality. (AHRQ) Patients with an HAI, average death rate was 6x as high as rate for those without (9 percent versus 1.5 percent). Average cost of stay of an adult patient who developed an HAI was about $43,000 more expensive than the stay of a patient without an HAI ($52,096 versus $9,377). PHILDERS GROUP INTL INC

5 Increasing Risks Major concern with increased liabilities and risk Frequency of HAI litigation is drastically increasing 1 out of 4 claims of hospital liability are from HAI Emergence of Super Bugs C-Diff, MRSA We are becoming a sicker patient population and more high risk units will be built (BMT, CCU, NICU etc.) Construction in healthcare facilities contributes to over 10,000 HAI (Healthcare Acquired Infection) related deaths per year PHILDERS GROUP INTL INC

6 JOINT COMMISSION/DNV Accrediting agencies for HC APIC INFECTION CONTROL RISK ASSESSMENT ICRA PHILDERS GROUP INTL INC

7 ICRA Matrix PHILDERS GROUP INTL INC

8 ICRA MATRIX ONE METHOD PATIENT RISK GROUP CONSTRUCTION PROJECT TYPE TYPE A TYPE B TYPE C TYPE D LOW RISK I II II III/IV MED RISK I II III IV HIGH RISK I II III/IV IV HIGHEST RISK II III/IV III/IV IV PHILDERS GROUP INTL INC

9 The When and the Where ICRA MUST BE performed from the beginning for all healthcare projects PHILDERS GROUP INTL INC

10 The How of ICRA AIA does not define directives ICRA in Specs ICRA on drawings Part of Bid documents PHILDERS GROUP INTL INC

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13 CATHETERIZATION LAB OR CATH LAB High Touch (surface): Cath table Overhead lamp table Overhead handle Bedside table tray Remote control for computer Bed remote control Sink counter top Sink basin PHILDERS GROUP INTL INC

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20 PPE HC Ebola Training 20% 60% 20% No Training Optional Ebola related PPE Training Required Ebola related PPE Training

21 CDC RECOMMEDS DONNING 1. Engage Trained Observer 2. Remove Personal Clothing and Items 3. Inspect PPE Prior to Donning 4. Perform Hand Hygiene 5. Put on Inner Gloves 6. Put on Boot or Shoe Covers 7. Put on Gown or Coverall 8. Put on Outer Gloves 9. Put on Respirator 10. Put on Outer Apron (if used) 11. Verify 12. Disinfect Outer Gloves PHILDERS GROUP INTL INC

22 CDC RECOMMEDS DOFFING Engage Trained Observer Disinfect Outer Gloves: Remove Apron (if used) Disinfect Outer Gloves Remove Boot or Shoe Covers Disinfect and Remove Outer Gloves Inspect and Disinfect Inner Gloves Remove Respirator (PAPR) Remove Gown or Coverall Disinfect Inner Gloves and Washable Shoes Disinfect Inner Gloves Remove Respirator Disinfect and Remove Inner Gloves Perform Hand Hygiene Scrubs Shower Protocol Evaluation/Medical Assessment

23 WHAT WORKS FOR DISINFECTANTS? CDC Alcohol based hand rubs EPA registered disinfectant wipes Label for non-enveloped viruses EPA registered surface disinfectants Label for non-enveloped viruses PHILDERS GROUP INTL INC

24 RULES FOR WASTE DISPOSAL Packaging and transport of Ebola waste is governed by federal (Department of Transportation DOT) but the disposal is governed by state and local law Ebola waste that has been appropriately disinfected, autoclaved, or otherwise inactivated is NOT infectious and is NOT considered regulated medical waste or hazardous material waste PHILDERS GROUP INTL INC

25 Environmental Hygiene Implement specific cleaning techniques that prevent cross contamination Use products that are EPA registered for the outcome required Use equipment that doesn t re-entrain pathogens into the environment Make ID education an ongoing part of your safety program PHILDERS GROUP INTL INC

26 Conclusions for Emerging Microbial Threats Trends in factors favor microbes New threats will emerge, many zoonotic HC workers will continue to have a critically important role in the recognition of emerging diseases History: travel, work, hobbies, animal contact Surveillance is critical to achieve public health security Helping countries improve surveillance capacities will benefit all James Hughes MD Emory University November 2014 PHILDERS GROUP INTL INC

27 RECOMMENDATIONS Assess vulnerability of transport Systems from POU PHILDERS GROUP INTL INC

28 RECOMMENDATIONS Review current policy and application Work with those who have experience & expertise for desired outcomes Training PHILDERS GROUP INTL INC

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30 ECA PGI LHI ECA PGI LHI formed alliance Specialized training and credentialing Developed CEP or Critical Environment Professional to include the GA Individual is credentialed Renewed every two years PHILDERS GROUP INTL INC

31 LEARNER OBJECTIVES Today s indoor environmental pollutants bring greater risk threats to all public spaces The facts about infectious diseases in the HC environment Risk factors and legal issues Due diligence and management of risk Recommendations PHILDERS GROUP INTL INC

32 AS A THANKS FOR YOUR TIME Glossary of Terms The New Environmental Toxins Donning and Doffing Recommendations-CDC info@phildersgroup.net PHILDERS GROUP INTL INC

33 HOW TO CONTACT ECA 5 Penn Plaza NY, NY Philders Group International Inc Madison Ave. NY, NY PHILDERS GROUP INTL INC

34 A note from the Speaker THANK YOU CES MARK DROZDOV MTA FOR THIS PRIVILEGE PHILDERS GROUP INTL INC

35 Pandemic Flu Humor PHILDERS GROUP INTL INC

36 Questions & Answers

37 Glossary For Infectious Diseases CONDENSED GLOSSARY FOR HEALTHCARE RELATED TERMS ACO: Accountable Care Organization ACA: Affordable Care Act AEC: Architects, Engineers, Contractors AII: Airborne Infection Isolation APIC: Association for Professionals in Infection Control and Epidemiology ASHRAE: American Society of Heating Refrigeration and Air Conditioning Engineers BMT: Bone Marrow Transplant CA-MRSA: Community Acquired Methicillin Resistant Staphylococcus Aureus CCU: Critical/Cardiac Care Unit CLOSTRIDIUM DIFFICILE: Also known as C-Diff. C. difficile is the most serious cause of antibiotic-associated diarrhea (AAD) and can lead to a severe infection of the colon. CMS: Centers for Medicare and Medicaid Reimbursement EC: Environment of Care-Patient environment for Health, Safety and Welfare ED: Emergency Department EPIDEMIOLOGY: A branch of medicine that investigates the causes and control of HA-MRSA: Healthcare acquired Methicillin Resistant Staphylococcus aureus HAI: Healthcare associated/acquired infection (Nosocomial) HCW: Healthcare Worker ICP: Infection control practitioner THE LINDERS HEALTH INSTITUTE PHILDERS GROUP INTERNATIONAL, Inc. Copyright

38 Glossary For Infectious Diseases ICRA: Infection Control Risk Assessment Construction guideline for all healthcare projects which designate the type and category of at risk patient populations and the containment required ID: Infectious disease MRSA: Methicillin Resistant Staph Aureus NICU: Newborn, or Neonatal, Intensive Care Unit, an intensive care unit designed for premature and ill newborn babies. Less often, NICU may refer to a Neurologic Intensive Care Unit NOSOCOMIAL: An infection that is acquired hours after hospital admission which is unrelated to the admitting diagnosis (HAI) PATHOGEN: microbe or microorganism such as a virus, bacterium, prion, or fungus that causes disease VIRUS: A microscopic particle composed of DNA or RNA surrounded by a protein coat. Viruses replicate by entering a cell, releasing their own DNA or RNA, and controlling the VOC: Volatile organic compound THE LINDERS HEALTH INSTITUTE PHILDERS GROUP INTERNATIONAL, Inc. Copyright

39 FROM THE CDC 1. Engage Trained Observer: The donning process is conducted under the guidance and supervision of a trained observer, who confirms visually that all PPE is serviceable and has been donned successfully. The trained observer uses a written checklist to confirm each step in donning PPE and can assist with ensuring and verifying the integrity of the ensemble. No exposed skin or hair of the healthcare worker should be visible at the conclusion of the donning process. 2. Remove Personal Clothing and Items: Change into surgical scrubs (or disposable garments) and dedicated washable (plastic or rubber) footwear in a suitable clean area. No personal items (e.g., jewelry, watches, cell phones, pagers, pens) should be brought into patient room. 3. Inspect PPE Prior to Donning: Visually inspect the PPE ensemble to be worn to ensure that it is in serviceable condition, that all required PPE and supplies are available, and that the sizes selected are correct for the healthcare worker. The trained observer reviews the donning sequence with the healthcare worker before the healthcare worker begins the donning process and reads it to the healthcare worker in a step-by-step fashion. 4. Perform Hand Hygiene: Perform hand hygiene with ABHR. When using ABHR, allow hands to dry before moving to next step. 5. Put on Inner Gloves: Put on first pair of gloves. 6. Put on Boot or Shoe Covers. 7. Put on Gown or Coverall: Put on gown or coverall. Ensure gown or coverall is large enough to allow unrestricted freedom of movement. Ensure cuffs of inner gloves are tucked under the sleeve of the gown or coverall a. If a PAPR with a self-contained filter and blower unit that is integrated inside the helmet is used, then the belt and battery unit must be put on prior to donning the impermeable gown or coverall so that the belt and battery unit are contained under the gown or coverall. b. If a PAPR with external belt-mounted blower is used, then the blower and tubing must be on the outside of gown or coverall to ensure proper airflow. 8. Put on Outer Gloves: Put on second pair of gloves (with extended cuffs). Ensure the cuffs are pulled over the sleeves of the gown or coverall 9. Put on Respirator: Put on PAPR with a full face-shield, helmet, or headpiece a. If a PAPR with a self-contained filter and blower unit integrated inside the helmet is used, then a single-use (disposable) hood that extends to the shoulders and fully covers the neck must also be used. Be sure that the hood covers all of the hair and the ears, and that it extends past the neck to the shoulders. b. If a PAPR with external belt-mounted blower unit and attached reusable headpiece is used, then a single-use (disposable) hood that extends to the shoulders and fully covers the neck must also be used. Be sure that the hood covers all of the hair and the ears, and that it extends past the neck to the shoulders. 10. Put on Outer Apron (if used): Put on full-body apron to provide additional protection to the front of the body against exposure to body fluids or excrement from the patient. 11. Verify: After completing the donning process, the integrity of the ensemble is verified by the trained observer. The healthcare worker should be comfortable and able to extend the arms, bend at the waist, and go through a range of motions to ensure there is sufficient

40 FROM THE CDC range of movement while all areas of the body remain covered. A mirror in the room can be useful for the healthcare worker while donning PPE. 12. Disinfect Outer Gloves 1. DOFFING Engage Trained Observer: The doffing process is conducted under the supervision of a trained observer, who reads aloud each step of the procedure and confirms visually that the PPE is removed properly. Prior to doffing PPE, the trained observer must remind the healthcare worker to avoid reflexive actions that may put them at risk, such as touching their face. Post this instruction and repeat it verbally during doffing. Although the trained observer should minimize touching the healthcare worker or the healthcare worker s PPE during the doffing process, the trained observer may assist with removal of specific components of PPE, as outlined below. The trained observer disinfects the outer-gloved hands immediately after handling any healthcare worker PPE. 2. Inspect: Inspect the PPE to assess for visible contamination, cuts, or tears before starting to remove. If any PPE is potentially contaminated, then disinfect using an *EPA-registered disinfectant wipe. If the facility conditions permit and appropriate regulations are followed, an *EPA-registered disinfectant spray can be used, particularly on contaminated areas. 3. Disinfect Outer Gloves: Disinfect outer-gloved hands with either an *EPA-registered disinfectant wipe or ABHR, and allow to dry. 4. Remove Apron (if used): Remove and discard apron taking care to avoid contaminating gloves by rolling the apron from inside to outside. 5. Inspect: Following apron removal, inspect the PPE ensemble to assess for visible contamination or cuts or tears. If visibly contaminated, then disinfect affected PPE using an *EPA-registered disinfectant wipe. 6. Disinfect Outer Gloves: Disinfect outer-gloved hands with either an *EPA-registered disinfectant wipe or ABHR. 7. Remove Boot or Shoe Covers: While sitting down, remove and discard boot or shoe covers. 8. Disinfect and Remove Outer Gloves: Disinfect outer-gloved hands with either an *EPA-registered disinfectant wipe or ABHR. Remove and discard outer gloves, taking care not to contaminate inner glove during removal process. 9. Inspect and Disinfect Inner Gloves: Inspect the inner gloves outer surfaces for visible contamination, cuts, or tears. If an inner glove is visibly soiled, cut, or torn, then disinfect the glove with either an *EPA-registered disinfectant wipe or ABHR. Then remove the inner gloves, perform hand hygiene with ABHR on bare hands, and don a clean pair of gloves. If no visible

41 FROM THE CDC contamination, cuts, or tears are identified on the inner gloves, then disinfect the inner-gloved hands with either an *EPA-registered disinfectant wipe or ABHR. 10. Remove Respirator (PAPR)***: a. If a PAPR with a self-contained filter and blower unit integrated inside the helmet is used, then wait until Step 15 for removal and go to Step 11. b. If a PAPR with an external belt-mounted blower unit is used, then all components must be removed at this step. i. Remove and discard disposable hood. ii. Disinfect inner gloves with either an *EPA-registered disinfectant wipe or ABHR. iii. Remove headpiece, blower, tubing, and the belt and battery unit. This step might require assistance from the trained observer. iv. Disinfect inner gloves with either an *EPA-registered disinfectant wipe or ABHR. v. Place all reusable PAPR components in an area or container designated for the collection of PAPR components for disinfection. 11. Remove Gown or Coverall: Remove and discard. a. Depending on gown design and location of fasteners, the healthcare worker can either untie fasteners, receive assistance by the trained observer to unfasten the gown, or gently break fasteners. Avoid contact of scrubs or disposable garments with outer surface of gown during removal. Pull gown away from body, rolling inside out and touching only the inside of the gown. b. To remove coverall, tilt head back and reach under the PAPR hood to reach zipper or fasteners. Use a mirror to help avoid touching the skin. Unzip or unfasten coverall completely before rolling down and turning inside out. Avoid contact of scrubs with outer surface of coverall during removal, touching only the inside of the coverall. 12. Disinfect Inner Gloves: Disinfect inner gloves with either an *EPA-registered disinfectant wipe or ABHR 13. Disinfect Washable Shoes: Sitting on a new clean surface (e.g., second clean chair, clean side of a bench) use an *EPA-registered disinfectant wipe to wipe down every external surface of the washable shoes. 14. Disinfect Inner Gloves: Disinfect inner gloves with either an *EPA-registered disinfectant wipe or ABHR. 15. Remove Respirator (if not already removed): If a PAPR with a self-contained filter and blower unit that is integrated inside helmet is used, then remove all components. a. Remove and discard disposable hood

42 FROM THE CDC b. Disinfect inner gloves with either an *EPA-registered disinfectant wipe or ABHR c. Remove and discard inner gloves taking care not to contaminate bare hands during removal process d. Perform hand hygiene with ABHR e. Don a new pair of inner gloves f. Remove helmet and the belt and battery unit. This step might require assistance from the trained observer. 16. Disinfect and Remove Inner Gloves: Disinfect inner-gloved hands with either an *EPA-registered disinfectant wipe or ABHR. Remove and discard gloves taking care not to contaminate bare hands during removal process. 17. Perform Hand Hygiene: Perform hand hygiene with ABHR. 18. Inspect: Perform a final inspection of healthcare worker for any indication of contamination of the surgical scrubs or disposable garments. If contamination is identified, immediately inform infection preventionist or occupational safety and health coordinator or their designee before exiting PPE removal area. 19. Scrubs: Healthcare worker can leave PPE removal area wearing dedicated washable footwear and surgical scrubs or disposable garments. 20. Shower: Showers are recommended at each shift s end for healthcare workers performing highrisk patient care (e.g., exposed to large quantities of blood, body fluids, or excreta). Showers are also suggested for healthcare workers spending extended periods of time in the Ebola patient room. 21. Protocol Evaluation/Medical Assessment: Either the infection preventionist or occupational safety and health coordinator or their designee on the unit at the time should meet with the healthcare worker to review the patient care activities performed to identify any concerns about care protocols and to record healthcare worker s level of fatigue