Introduction to Infection Prevention and Control (IPC) Open Call Series #1 Surveillance

Transcription

1 Introduction to Infection Prevention and Control (IPC) Open Call Series #1 Surveillance Diane Dohm MT, IP, CIC, CPHQ MetaStar February 6, 2018 IPC Open calls: Bi-weekly Series Surveillance What data should we collect? Data What do we do with the data? Outbreaks Identification and management Transmission Precautions Least restrictive Common Citations What are we missing? Training Opportunities Where can I learn more? 1 Disclaimer ***These calls are not meant to be a substitute for completing specialized training in Infection Prevention and Control (as required in Phase 3 of Final Rule). They are meant to introduce the basic concepts of Infection Prevention and Control and discuss common issues found during the survey process. 2

2 3 Session #1 Objectives Discuss content of a surveillance plan Discuss Infection log and specific infection worksheets Identify sources of data Use standard case definitions Calculate infection rates MetaStar represents Wisconsin in Lake Superior Quality Innovation Network. Surveillance Definition Surveillance is the ongoing systematic collection, analysis, interpretation and dissemination of data to identify infections and infection risks. Association for Professionals in Infection Control & Epidemiology (APIC) Why? Reduce morbidity and mortality from infections Improve resident health and wellbeing 4 Data Collection Surveillance plan, based on facility assessment, for identifying, tracking, monitoring, and reporting of infections Early detection, management of a potentially infectious, symptomatic resident and implementation of appropriate transmission-based precautions Uses evidence based surveillance criteria: National Healthcare Safety Network (NHSN) Long Term Care (LTC) or revised McGeer Criteria Infection Prevention, Control & Immunizations, Critical Element Pathway, CMS

3 6 Data Collection Reportable Communicable Diseases Staff must be able to identify to whom and when communicable diseases, healthcare associated infections and potential outbreaks must be reported (What happens when Infection prevention is not in house? Prohibit employees with a communicable disease or infected skin lesion from direct contact with residents or their food. Infection Prevention, Control & Immunizations, Critical Element Pathway, CMS Surveillance Log (master line list of all infections) Resident number or medical record number Location in facility Date of current admission Date symptoms began Date culture collected (if done) Invasive device insertion/removal date Organism identified - Was it a Multidrug Resistant Organism (MDRO)? 7 Surveillance Log Facility Onset vs. Community Onset Infection Worksheet completed Criteria met (McGeer s) Transmission Precaution start date / end date Provider notified Antibiotics: date started / discontinued Part of outbreak Public Health reporting requirement 8

4 9 Surveillance Log Antibiotic stewardship may also be recorded separately elsewhere including: Antibiotic prescribed Dose, route, frequency Start date End date Total number days of therapy Appropriate use met criteria Surveillance Log Additional information related to infection Notes Sample log Your state Division of Public Health may also have sample log. 10 What do I track on log? Urinary Tract Infections (UTI) Catheter present No Catheter Gastrointestinal Illness (GI) Norovirus C. difficile Wounds Organism - MDRO 11

5 12 What do I track on log? Influenza like Illness Pneumonia Conjunctivitis Scabies Other infections identified on Risk Assessment Ventilator Associated Event Pneumonia Central Line Associated Blood Infection (CLABI) Surgical Site Infections (SSI) Standard case definitions What does your facility use? McGeer s criteria (2012) Lobes criteria (2001) NHSN definitions for reporting purposes Be consistent for comparison internally and externally Identification of infection is not based on single piece of evidence usually multiple criteria 13 How do I get infection data? What is your facility process? Automatic electronic medical record (EMR) trigger Culture and laboratory reports Antibiotic starts Symptom reporting morning huddle Rounding visiting the units 14

6 15 Calculating Infection Rates Infection Rate Number of infections x constant = Rate of infection Population at risk Population at risk may be expressed as total resident days (Norovirus) or specifically as residents with a urinary catheter (Urinary Catheter Infection) Constant may be expressed as relationship to units of population during that time such as 100, 1000 or 10,000 (consistent case definition) Outcome measure surveillance Considered the result of the LTC facility practices Infection Rates Urinary Tract Infection (UTI) for example Provider Rates If applicable to your facility 16 Process measure surveillance: Auditing Hand Hygiene Glove and gown use - adherence to policy Cleaning of resident rooms, terminal cleaning Cleaning and disinfection of shared equipment Glucometer, podiatry and dental equipment Blood pressure cuffs, rehab and therapy Inspection of shared bath pads and wheelchair pads for breaks Point of care testing 17

7 18 Process measure surveillance: Auditing Medication administration Injection safety practices Wound care Oral care Perineal care Catheter care Vascular access device care Outbreak Surveillance Will be discussed on later call What is your facility s definition? Once case of highly communicable infection Infection trends that are 10 percent higher than historical rate of infection Three or more cases of the same infection over a specific length of time on the same unit or other defined area 19 Antibiotic usage Important part of Surveillance Cornerstone of Antibiotic Stewardship What antibiotics are being prescribed? How many antibiotics are being prescribed? Are they appropriate? Are there differences between providers? 20

8 21 Next call. Now that you have collected the data, what does it mean, and what do you do with it? Certificate of Attendance Certificate of Attendance will be provided after you complete the evaluation. 22 Resources Wisconsin Healthcare-Associated Infections (HAIs) in Long-Term Care Coalition Resources Center for Disease Control (CDC) Links for LTC Settings The National Nursing Home Quality Improvement Campaign 23

9 24 Resources McGeer Criteria for Long Term Care Surveillance 8/nh-hac_mcgreercriteriarevcomp_2012.pdf Infection Preventionists Guide to Long Term Care APIC Store/MyStore.aspx?hkey=8351e67f-e04b-472e-a30d- 37fcd8eac518&id=SLS6008 Lake Superior Quality Innovation Network (QIN) Questions? Diane Dohm MT, IP, CIC, CPHQ Project Specialist Nursing Home Quality All questions and answers will be compiled into a Q & A document after completion of series. MetaStar represents Wisconsin in Lake Superior Quality Innovation Network. 25 This material was prepared by the Lake Superior Quality Innovation Network, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The materials do not necessarily reflect CMS policy. 11SOW-WI-C