PIDAC: Best Practices for Environmental Cleaning. Francine Paquette Team Lead - IPAC West Regional Office

Transcription

1 PIDAC: Best Practices for Environmental Cleaning Francine Paquette Team Lead - IPAC West Regional Office

2 PIDAC Best Practices for Environmental Cleaning COMING SOON! 2

3 For today: Why revise? What s new? How s that done? Who s behind the scene? When is it coming? 3

4 Why revise the document? >3 years old New technologies Gaps in existing document Evolving trend in guideline development 4

5 What s new? Document layout Implementation tools Evidence strategies Methodology Evidence-informed Stakeholder engagement: scoping & review Forming recommendation Consensus Recommendations 5

6 Applicability Provides Advice and/or Tools on How Recommendations Can be Put Into Practice Be disseminated and implemented with additional materials Summary document Quick reference guide Educational tools Results from a pilot test Patient leaflets Computer support Brouwers M, et al for the AGREE Next Steps Consortium. AGREE II: advancing guideline development, reporting and evaluation in healthcare. Can Med Assoc J Dec 2010; 182:E ; doi: /

7 Implementation tools 7

8 Evidence-informed Based on the best available evidence All relevant evidence should be identified, synthesized and presented in a comprehensive and unbiased manner Based on a systematic review of the scientific literature guided by specific key questions World Health Organization. WHO handbook for guideline development. 2nd ed. Geneva: WHO,

9 Evidence Base: 2 systematic reviews What Is the role of antimicrobial materials and/or antimicrobial surfaces in reducing HAI within the health care environment? 6,011 citations retrieved 235 reviewed in full text 11 included for data extraction What Is the role of no-touch disinfection systems in addition to, or as compared with, standard methods of cleaning and disinfection? 3,899 citations retrieved 238 reviewed in full text 31 included for data extraction 9

10 Rigour of Development Systematic Methods Used to Search for Evidence Details be provided: Search terms used Sources consulted Dates of literature covered As comprehensive as possible Free from potential biases Sufficiently detailed to be replicated Brouwers M, et al for the AGREE Next Steps Consortium. AGREE II: advancing guideline development, reporting and evaluation in healthcare. Can Med Assoc J Dec 2010; 182:E ; doi: /

11 Evidence Base Narrative search in PubMed/MEDLINE, Google, relevant agencies, including scanning citations backward and forward Disinfectant wipes: 24 articles reviewed Microfibre: 16 articles reviewed Cleaning for Contact Precautions CDI: 52 articles reviewed VRE: 19 articles reviewed Norovirus: 25 articles reviewed CPE: 20 articles reviewed Sinks: 31 articles reviewed ATP: 37 articles reviewed 17

12 Evidence Base Additional random search of PubMed (some examples) Occupational asthma and dermatitis among cleaners Environmental surfaces role in HAI transmission Privacy curtains and HAI Electronic equipment and HAI Hemodialysis unit outbreaks and cleaning ES human resources and HAI Health care waste management Laundry EC audit methods Human resources for EC Biofilm 18

13 Key principles in guideline development Based on best available evidence Developed by independent and unbiased committees of experts Include people with personal experience of using health care services or from a community affected by the guideline Regular consultation allowing organizations and individuals to comment on the recommendations National Institute for Health and Care Excellence. Developing NICE guidelines: the manual. London: NICE, Last updated April

14 Who s behind the scene? PIDAC committee IPAC experts (acute care, LTC, community, PH) Epidemiology specialist Ex-officio (MOL and MOHLTC) PHO External consultants (CAEM and OHHA) 21

15 Stakeholder consultation Scoping Regular consultation with stakeholders CAEM conferences OHHA conference IPAC-Canada Environmental Hygiene Interest Group Enquiries PHO IPAC-Canada IPAC CHAT on Environment IPAC projects 22

16 Reducing bias Preparation of external consultants 2 months ahead for fuller participation in evidence review Reading materials on guideline methodology and literature review Anonymous voting on recommendations Wording Ranking 23

17 Intended audience Those who have a role in the management of cleaning or ES for the health care setting: administrators, ES supervisors, IPAC professionals, CRMD project supervisors, Public Health those responsible for overseeing EC in clinical office setting CHC, clinics, IHF, OHP, dental offices 24

18 Stakeholder consultation Final draft review IPAC & ES professionals ICP & ES contacts on SRM; IPAC Canada Environmental Hygiene IG; Association Hygiène et Salubrité en Santé; PICNet Health care providers & administrators Health regulatory colleges in Ontario and CPSO; OLTCA & AdvantAge; OHA Regulatory bodies alpha, CIPHI OH&S experts PHO/EOH; PSHSA Patients advocacy group Patients Canada Environmental health organizations Environmental Health Foundation of Canada; National Collaborating Centre for Environmental Health 25

19 Stakeholder input Overall objectives of document specifically described? Target users of document clearly defined? Strengths and limitations of evidence clearly described? Methods for formulating recommendations clearly described? Desirable and undesirable effects considered in formulating recommendations? Explicit link between recommendations and supporting evidence? Options acceptable? Recommendations specific and unambiguous? 26

20 Stakeholder input Options clearly presented? Facilitators and barriers to application described? Advice and/or tools for putting recommendations into practice provided? Potential resource implications for applying the recommendations considered? Monitoring and/or auditing criteria presented? Options feasible? Any other issues for PIDAC to consider? 27

21 Forming recommendations Quality of evidence Balance of benefits and harms Values and preferences Feasibility, equity and acceptability Resource use 28

22 Forming recommendations Aerosol or trigger sprays for cleaning chemicals must not be used. Comment from anonymous ranking exercise: Can we review the evidence on this item? Getting some recent challenges on this item from chemical providers Ample evidence of hazards from aerosol or trigger sprays ES workers and HCPs need protection Public health hazards for patients Consensus: RECOMMENDATION STAYS! 29

23 Forming recommendations Free-standing clinical office settings should use observational assessment to audit environmental cleaning (i.e., visual assessment, performance observation and feedback.) Feasibility concern! Consensus: RECOMMENDATION DROPPED! 30

24 Forming recommendations There is insufficient evidence to recommend for or against the installation of copper surfaces. In a systematic review, these studies demonstrated a consistent but modest (<1 log) reduction in bacterial load on Cu surfaces as compared to standard surfaces. 24% in HAI in a chronic care ward using CuO impregnated linens 44% in HAI in the acute care setting among patients admitted to a room containing 6 Cu items as compare to patients admitted to a room with non-cu items. Both studies show promise but at high risk of bias. 31

25 Forming recommendations Facilities should weigh the cost, functionality, the limitation of copper against its known antimicrobial properties, and low quality evidence suggesting it may impact infection rates when considering the use of copper surfaces or linens. Confidence in effect estimates so low that a recommendation is too speculative. The values and preferences and resource implications are not known or too variable. Consensus: Recommendation dropped! 32

26 Recommendations 21 new in 2017 s 85 modified from 2012 s 57 strengthened 14 elaborated 14 adjusted 37 same as 2012 s 21 removed from 2012 s 33

27 Ranking of recommendations A. Best practices that must be followed in all health care settings. The benefits of these practices outweigh the risks. Note that for interventions with no or trivial associated risks (e.g., always move from cleaner to dirtier areas when cleaning; perform hand hygiene prior to contact with the P/R/C environment), even weak supportive evidence can result in an A-level recommendation as benefits will clearly outweigh risks. B. Best practices that should be followed in most health care settings. The benefits of these practices likely outweigh the risks in most, but not all, settings and situations 34

28 Taking a closer look 35

29 Privacy curtains Cloth privacy curtains must be removed, cleaned and disinfected immediately if they become contaminated with blood or body fluids, or are visibly soiled. Cloth privacy curtains used for C/P/R requiring AP must be removed, cleaned and disinfected following discharge or transfer of the C/P/R and before a new C/P/R is admitted to that room/bed space. Privacy curtains must be changed after all discharges or when visibly soiled. 36

30 Carpets Do not carpet areas that house or serve immunocompromised patients or where there is a high likelihood of contamination with blood or body fluids. carpeting that remains wet after 72 hours must be removed. Carpeting must not be used in all care areas within HCFs. If moisture persists beyond 48 hours, carpeting in a care area must be removed and should not be replaced with carpeting. For facilities that have not yet removed all carpeting from care areas, there should be a plan for permanent removal of carpeting. 37

31 Electronic equipment Equipment that cannot be adequately cleaned, disinfected or covered, including EE, should not be used in the care environment. When selecting EE, it is important that it be compatible with the cleaning and disinfecting agents used in the health care setting and that manufacturer s recommendations for cleaning are followed. EE that cannot be cleaned and disinfected must not be purchased, installed or used in health care settings. EE used in care areas must be cleaned and disinfected with the same frequency as non-ee. 38

32 Auditing Results of cleaning audits should be collated and analyzed with feedback to staff, and an action plan developed to identify and correct deficiencies. Aggregate results must be presented to relevant stakeholders, e.g., ES leadership, IPAC, and administration. 39

33 When is the document available? PHO approval: done MOHLTC notification: done Posting for stakeholder review: done PIDAC review: September!!! PHO approval MOHLTC notification RELEASE! 40

34 Take home message PIDAC s goal: to update the document based on advances in the field while maintaining a practical and evidence-based approach Mandate to produce best practice documents Responsible and responsive use of resource 41

35 Questions? Comments? Thank you! 42

36 For More Information About This Presentation, Contact: Francine Paquette at Public Health Ontario keeps Ontarians safe and healthy. Find out more at