2018 BSI QIA. Kick off Part 1. Annabelle Perez Quality Improvement Director

Transcription

1 2018 BSI QIA Kick off Part 1 Annabelle Perez Quality Improvement Director

2 Outline 2018 BSI QIA Overview What does it really mean to follow the CDC Core Interventions Next Steps

3 2018 BSI QIA Overview

4 BSI QIA Selection Criteria 50% of NW facilities with highest BSI rates per NHSN baseline data (Jan-Jun 2017) Facilities were selected into three groups: BSI Education BSI Reduction BSI LTC focus (Six facilities are in more than one group.) CMS expects all groups will implement all CDC Core Interventions.

5 QIA Aims 1. All facilities in the BSI QIA shall work toward fully implementing all CDC Core Interventions. 2. Achieve a 20% reduction in BSIs (in the BSI reduction group.) 3. Reduce LTC rates by 2 percentage points (in the LTC Reduction QIA group.) 4. Assist 20% of BSI QIA facilities to obtain access to an HIE or hospital EMR.

6 Facility Requirements 1. Facilities will compare current practices to the CDC recommended Core Interventions. 2. Facilities will develop and implement a plan to improve processes and adherence to evidence based practices. Plan shall include the completion of CDC Prevention Process Measure (PPM) audits and the reporting of results to NHSN.* 3. Participation on Network and CMS calls. 4. All BSI QIA facilities will participate Network 3 s Beyond Engagement Program.* 5. Provide Feedback via Network 3 s Quality Monitoring System.* * Details to be provided during the Kick off Part 2 call.

7 NW Actions Monthly monitoring of data completeness and quality Monitor compliance with the completion and reporting of PPM audit results to NHSN Monitor facility progress using NHSN data and facility reports Random review of completed audit forms Facilitate CDC resources and make recommendations Conduct facility visits Assist facilities with QAPI plan, upon request. Report monthly results to CMS

8 NHSN Annual Facility Practices Survey Core Intervention Responses # of Facilities in NJ with completed AFS for # of facilities that responded Yes- All when asked if following 100 (62.9%) Core Interventions # of facilities that responded Yes-All when asked if following 72 (72%) Core Interventions and based on follow up questions below have not implemented All Core Interventions # of facilities that responded Yes- Some when asked if following 58 (58%) Core Interventions # Responded No to following Core Interventions 1 (6.2%)

9 NHSN Annual Facility Practices Survey - Prevention Process Measures Responses Question % Responded Yes Hand Hygiene Staff Audits 96.8% Observe Staff VA Care and CVC Accessing Practices 99.3% Staff Competency Assessment for VA Care and Cath Access 96.2% Ointment Applied to HD Cath During Dressing Change 5.6%

10 Does my facility really follow all of the CDC recommended Core Interventions? The CDC Core Interventions are evidence-based and considered a bundle. All interventions need to be implemented in order to be effective at reducing BSIs Incomplete or inconsistent practices will decrease the impact these will have on facility outcomes.

11 Evidence that increased adherence to CDC recommended practices can prevent infections Outpatient hemodialysis facilities that implemented the package of CDC recommended practices saw a 32% reduction in BSIs and a 54% reduction in accessrelated BSIs. Am J Kidney Dis. August 2013, 62(2):

12 CDC Core Interventions

13 #1. Surveillance and feedback using NHSN Conduct monthly surveillance for BSIs and other dialysis events (DE) using CDC s National Healthcare Safety Network (NHSN). Calculate facility rates and compare to rates in other NHSN facilities. Actively share results with front-line clinical staff.

14 Do you follow Core Interventions #1? Surveillance and feedback using NHSN Is the person responsible for Infection Prevention knowledgeable on the DE Protocol? Has this person completed the NHSN DE surveillance and Reporting training? Do you review NHSN BSI rates? Do you present the NHSN BSI rate report in QAPI? Do you post NHSN infection results for frontline staff?

15 #2. Hand hygiene observations Perform observations of hand hygiene opportunities monthly and share results with clinical staff. Do you observe for trends: same staff repeating bad practice same patients not performing hand hygiene same specific steps missed- For example, hand hygiene before donning clean gloves

16 Do you follow Core Intervention #2 Do you perform Hand Hygiene observations? (Patients and staff?) Do you share results with all frontline staff?

17 #3- Catheter/vascular access care observations Perform observations of vascular access care and catheter accessing quarterly. Assess staff adherence to aseptic technique when connecting and disconnecting catheters and during dressing changes. Share results with clinical staff.

18 Do you follow Core Intervention #3? Do you perform vascular access care observations? Do you assess staff adherence to aseptic technique during dressing changes? Do you assess staff adherence to aseptic technique when connecting and disconnecting catheters and during dressing changes? Do you share results with clinical staff?

19 4. Staff education and competency Train staff on infection control topics, including access care and aseptic technique. Perform competency evaluation for skills such as catheter care and accessing every 6-12 months and upon hire.

20 Do you follow Core Intervention #4 Have all direct patient care staff (including part time/per diem) received training provided on aseptic technique and access care? Does your facility policy follow the recommendation that competencies are completed upon hire and every 6-12 months?

21 #5- Patient Education and Engagement Provide standardized education to all patients on infection prevention topics including vascular access care, hand hygiene, risks related to catheter use, recognizing signs of infection, and instructions for access management when away from the dialysis unit.

22 Do you follow Core Intervention #5? Provide standardized education to all patients on infection prevention topics including: 1. Vascular access care, 2. Hand hygiene, 3. Risks related to catheter use, 4. Recognizing signs of infection, and 5. Instructions for access management when away from the dialysis unit.

23 #6. Catheter Reduction Incorporate efforts (e.g., through patient education, vascular access (VA) coordinator) to reduce catheters by identifying and addressing barriers to permanent vascular access placement and catheter removal.

24 Do you follow Core Intervention #6 Do you have a designated vascular access coordinator? Does the VA coordinator review catheter patients, at least monthly, to identify and address barriers to access placement and catheter removal? Does the QAPI team establish plans to address identified barriers?

25 #7- Chlorhexidine for skin antisepsis Use an alcohol-based chlorhexidine (>0.5%) solution as the first line skin antiseptic agent for central line insertion and during dressing changes.*

26 Do you follow Core Intervention #7 Do you use an alcohol-based chlorhexidine (>0.5%) solution as the first line skin antiseptic agent during dressing changes?* *Do you use Povidone-iodine (preferably with alcohol) or 70% alcohol as alternative for patients with chlorhexidine intolerance.

27 #8- Catheter Hub Disinfection Scrub catheter hubs with an appropriate antiseptic after cap is removed and before accessing. Perform disinfection every time catheter is accessed or disconnected.*

28 Do you follow Core Intervention #8 Does your policy include staff scrub catheter hubs with an appropriate antiseptic after cap is removed and before accessing? Do you monitor staff adherence to scrub the hub every time a catheter is accessed? ** If closed needleless connector device is used, disinfect device per manufacturer s instructions.

29 #9- Antimicrobial Ointment Apply antibiotic ointment or povidoneiodine ointment to catheter exit sites during dressing change.*

30 Do you follow Core Intervention #9 Do you apply antibiotic ointment or povidone-iodine ointment to catheter exit sites during dressing change?* *** See information on selecting an antimicrobial ointment for hemodialysis catheter exit sites on CDC s Dialysis Safety website ( Use of chlorhexidine-impregnated sponge dressing might be an alternative.

31 Core Intervention 1 Surveillance and feedback using NHSN Description Related Actions Yes Always 1a. Is the person responsible for Infection Prevention knowledgeable on the DE Protocol? Conduct monthly surveillance for BSIs and other dialysis events (DE) using CDC s National Healthcare Safety Network (NHSN). Calculate facility rates and compare to rates in other NHSN facilities. Actively share results with front-line clinical staff. 1b. Has this person completed the NHSN DE surveillance and Reporting training? 1c. Do you review NHSN BSI rates? 1d. Do you present the NHSN BSI rate report in QAPI? 1e. Do you post NHSN infection results for frontline staff? No or Not Always 2 Hand hygiene observations Perform observations of hand hygiene opportunities monthly and share results with clinical staff. 2a. Do you perform Hand Hygiene observations? 2b. Do you share results with all frontline staff? Catheter/vascular access care observations Staff education and competency Perform observations of vascular access care and catheter accessing quarterly. Assess staff adherence to aseptic technique when connecting and disconnecting catheters and during dressing changes. Share results with clinical staff. Train staff on infection control topics, including access care and aseptic technique. Perform competency evaluation for skills such as catheter care and accessing every 6-12 months and upon hire. Patient Provide standardized education to all patients on infection education/engagement prevention topics including vascular access care, hand hygiene, risks related to catheter use, recognizing signs of infection, and instructions for access management when away from the dialysis unit. 3a. Do you perform vascular access care observations? 3b. Do you assess staff adherence to aseptic technique during dressing changes? 3c. Do you assess staff adherence to aseptic technique when connecting and disconnecting catheters and during dressing changes? 3d. Do you share results with clinical staff? 4a. Is staff training provided on aseptic tecnique and access care? 4b. Are competencies completed upon hire and every 6-12 months? 5. Is patient education is provided on the following: 5a. Vascular access? 5b. Hand Hygiene? 5c. Risks related to catheter use? 5d. Recognizing the signs and symptoms of infection? 6 Catheter reduction Incorporate efforts (e.g., through patient education, vascular access (VA) coordinator) to reduce catheters by identifying and addressing barriers to permanent vascular access placement and catheter removal. 5e. How to change their dressing at home? 6a. Do you have a designated vascular access coordinator? 6b. Does the VA coordinator review catheter patients, at least monthly, to identify and address barriers to access placement and catheter removal? 6c. Does the QAPI team establish plans to address identified barriers? 7 Chlorhexidine for skin antisepsis 8 Catheter hub disinfection Use an alcohol-based chlorhexidine (>0.5%) solution as the first line skin antiseptic agent for central line insertion and during Scrub catheter hubs with an appropriate antiseptic after cap is removed and before accessing. Perform every time catheter is accessed or disconnected.* 9 Antimicrobial ointment Apply antibiotic ointment or povidone-iodine ointment to catheter exit sites during dressing change.* *Refer to the CDC Approach to BSI Prevention in Dialysis Facilities (Core interventions) for additional information. 7a. Do you use an alcohol-based chlorhexidine (>0.5%) solution as the first line skin antiseptic agent during dressing changes? 8a. Does your policy include staff scrub catheter hubs with an appropriate antiseptic after cap is removed and before accessing? 8b. Do you monitor staff adherence to scrub the hub every time a catheter is accessed? 9a. Do you apply antibiotic ointment or povidone-iodine ointment to catheter exit sites during dressing change? Review all areas selected as "Yes" for opportunities to improve. Totals All areas marked as "No or Not Always" shall be included in your improvement plan.

32 Next Steps- All groups Complete Facility Self- Assessment by Jan 30 th. Beyond Engagement Submit the Registration Form and Task A (Facility Contact Form and Commitment of Support Form) by January 30 th. Attend Kick off Part 2 call on January 30th

33 Questions?