Infection Prevention and Control

Infection Prevention and Control

Infection Control in the Healthcare Setting Chain of Infection Hand Hygiene Hospital Acquired Infections Isolation Exposures Tuberculosis

Chain of Infection

Most Common Mode of Pathogen Transmission HANDS!

Specific Indications for Hand Hygiene Before: Patient Contact After: Patient Contact Contact with body fluids or excretions, nonintact skin, wound dressings Removing gloves Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.

When must we wash our hands? When hands are visibly dirty, contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water If hands are not visibly soiled, use an alcohol-based hand rub for routinely decontaminating hands For patients with C. Diff use soap and water Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.

Efficacy of Hand Hygiene Preparations in Killing Bacteria Good Better Best Plain Soap Antimicrobial soap Alcohol-based handrub Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.

Recommended Hand Hygiene Technique Hand rubs Apply to palm of one hand, rub hands together covering all surfaces until dry Volume: based on manufacturer Handwashing Wet hands with water, apply soap, rub hands together for at least 15 seconds Rinse and dry with disposable towel Use towel to turn off faucet

Types of Bacteria Gram Positive staph epi, aureus Gram Negative e. coli, Klebsiella Gram Positive Resistant - MRSA Gram Negative Resistant - VRE ESBL + (e. coli, klebsiella) Centers for Disease Control and Prevention, 2008

Blood and Body Fluids Exposure Transmission is rare but possible High risk procedures, splash or aerosolized procedures Wear gloves, give patient a plastic bag or basin, get them admitted quickly Use the spill kit, followed by sanitizing the area with hospital disinfectant Report exposures within 2 hours to University Health, Nursing Admin after hours

Infection Prevention and Control Sandy Hensley RN, MS, CIC Dowling Hall Extension 5006 Andrea Cropcho RN, MPH, CIC Dowling Hall Extension 5134

Quality Management and Performance Improvement

Quality Management Dowling Hall, 2 nd floor Phone: 419.383.3621 Fax: 419.383.3274 http://utmc.utoledo.edu/depts/quality/index.html

Why Performance Improvement (PI)? So if 99.9% is good enough for you 22,000 checks will be deducted from the wrong bank account every hour 20,000 incorrect drug Rx s will be written in the next 12 months 107 incorrect medical procedures will be performed in one day 12 babies will be given to the wrong parents each day

Goals of Performance Improvement (PI) Improve processes Improve teamwork Increase patient satisfaction Meet Joint Commission requirements Align with the mission of UTMC

Tools for Performance Improvement (PI) External Benchmarks CDC Center for Disease Control and Prevention CMS Center for Medicare and Medicaid Services NCDR American College of Cardiology National Cardiovascular Data Registry NDNQI National Database of Nursing Quality Indicators OHA Ohio Hospital Association STS Society of Thoracic Surgeons National Database UHC University Health Systems Consortium

Sample of Website

The Joint Commission The Joint Commission on Accreditations of Health Care Organizations

Tools of Performance Improvement (PI) Core Measures Examples of measures SCIP Surgical Care Improvement Project AMI Acute Myocardial Infarction CHF - Congestive Heart Failure Pneumonia

National Patient Safety Goals The purpose of the Joint Commission s National Patient Safety Goals (NPSGs) is to promote specific improvements in patient safety Updated annually

2011 National Patient Safety Goals Improve the accuracy of patient identification Goal 1 NPSG.01.01.01: Use at least two patient identifiers when providing care, treatment, or services. For inpatients, we use patient s name and date of birth. NPSG.01.03.01: Make sure the correct patient gets the correct blood type when they get a blood transfusion. Improve the effectiveness of communication among caregivers Goal 2 NPSG.02.03.01: Report critical results of test and diagnostic procedure on a timely basis. Improve the safety of using medications Goal 3 NPSG.03.04.01: Label all medications, and medication containers. Medication containers include syringes, medicine cups and basins. NPSG.03.05.01: Take extra care with patients who take medicine to thin their blood. Reduce the risk of health care-associated infections Goal 7 NPSG.07.01.01: Use hand cleaning guidelines from Centers for Disease Control and Prevention (CDC) hand hygiene guidelines or World Health Organization (WHO). NPSG.07.03.01: Use proven guidelines to prevent infections. NPSG.07.04.01: Use proven guidelines to prevent invection of the blood from central lines. NPSG.07.05.01: Implement evidence-based practices for preventing surgical site infections. Accurately and completely reconcile medications across the continuum of care Goal 8 NPSG.08.01.01: A process for comparing the patient s current medications with those ordered for the patient while under the care of the hospital. NPSG.08.02.01: When a patient is referred to or transferred from one hospital to another, the complete and reconciled list of medication is communicated to the next provider of service, and the communication is documented. Alternatively, when a patient leaves the hospital s care to go directly to his or her home, the complete and reconciled list of medications is provided to the patient s known primary care provider, the original referring provider, or a known next provider of services. NPSG.08.03.01: When a patient leaves the hospital s care a complete and reconciled list of the patient s medications is provided directly to the patient, and as needed, the family, and the list is explained to the patient and/or family. NPSG.08.04.01: In settings where medications are used minimally, or prescribed for a short duration, modified medication reconciliation processes are performed. The organization identifies safety risks inherent in its patient population Goal 15 NPSG.15.01.01: Identifies patients at risk for suicide. Note: This requirement only applies to psychiatric hospitals and patients being treated for emotional or behavioral disorders in general hospitals. Introduction to the Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery TM Universal Protocol UP.01.01.01: Conduct a pre-procedure verification process. UP.01.02.01: Mark the procedure site. UP.01.03.01: A time-out is performed before the procedure.

UTMC Performance Improvement PMAAR Performance Improvement Cycle Review ü Did actions produce desired results? ü Why or why not? ü Are additional actions necessary? ü Is the right thing being measured? ü What has been learned? ü Continue the cycle; modify based on findings ü Define opportunities ü Determine what is to be accomplished ü Identify performance indicators, how they will be obtained, how frequently they will be measured, what comparison values will be used ü Identify responsible parties Plan Act ü Determine an action that will impact the trend in the desired direction ü Plan for actions to be executed appropriately ü Communicate, initiate ü Conduct quantitative analysis v How much which direction? v How does this compare to benchmark? v Is the process in control or is variation excessive? ü Conduct qualitative analysis v Why is this happening? v What are contributing factors? v What does this mean? ü Collect measurement data ü Display data over time on a run chart ü Comparative data displayed simultaneously Measure 3/8/2006 tm Analyze

Occurrence reports Used to document an event when it occurs To be completed within 24 hours of the event Used to identify and reduce risk

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