Page 001 Joint Commission Infection Control Infection Control Standards If you need assistance call: Helpdesk (319) 626-6129 file:///x /instruct/ngd1572/slide001.htm [11/16/2011 3:59:26 PM]
Page 002 Speaker Sue Dill Calloway, RN Esq. CPHRM AD, BA, BSN, MSN, JD President Patient Safety & Health Care Consulting 5447 Fawnbrook Lane Dublin, Ohio 43017 614-791-1468 sdill1@columbus.rr.com file:///x /instruct/ngd1572/slide002.htm [11/16/2011 3:59:28 PM]
Page 003 Headlines We Don t Want to See file:///x /instruct/ngd1572/slide003.htm [11/16/2011 3:59:29 PM]
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Page 005 Infection Control Back to Basics It is important to get back to basics in infection control1 Education & training is imperative to learn each person s role in preventing infections What practices & constant reminders do you use to remind staff during patient care encounters? Basic hand hygiene is one of the most important ways to prevent infections CMS announces unannounced surveys to evaluate infection control standards in 2012 1 www.jcrinc.com/infection-prevention-back-to-basics file:///x /instruct/ngd1572/slide005.htm [11/16/2011 3:59:29 PM]
Page 006 Infection Control CDC says there are 2 million healthcare infection (HAI) in America every year There are 100,000 deaths in American hospitals every year Leadership need to make sure there is adequate staffing & resources to prevent & manage infections Healthcare-Associated Infections (HAIs) are one of the top ten leading causes of death in the US1 1 www.cdc.gov/ncidod/dhqp/hai.html file:///x /instruct/ngd1572/slide006.htm [11/16/2011 3:59:30 PM]
Page 007 Healthcare-Associated Infections Infection control is a big issue with CDC, CMS, TJC, & also Department of Health & Human Services (HHS) 32% of all healthcare-associated infection are urinary tract infections (UTIs) 22% are surgical site infections 15% are pneumonia (lung infections) 14% are bloodstream infections Source: CDC website at www.cdc.gov/ncidod/dhqp/hai.html See CDC 2009 Guideline for the Prevention of Catheter Associated UTI & Guidelines for Prevention of Intravascular Catheter Related Infections 2010 file:///x /instruct/ngd1572/slide007.htm [11/16/2011 3:59:31 PM]
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Page 009 HHS Action Plan to Prevent HAIs Estimated that HAIs incur nearly $20 billion in excess healthcare cost each year1 Top priority of HHS now & states many are preventable Develop HHS Action Plan to Prevent HAIs Every hospital should have a copy of this document 1 http://hhs.gov/ophs/initiatives/hai/index.html file:///x /instruct/ngd1572/slide009.htm [11/16/2011 3:59:32 PM]
Page 010 HHS Action Plan to Prevent HAIs file:///x /instruct/ngd1572/slide010.htm [11/16/2011 3:59:32 PM]
Page 011 Infection Control & CMS HAC CMS came out with 10 adverse events or Healthcare-Acquired Conditions (HACs) in which no additional payment is made for Medicare patients Many states agree not to bill for any or all of the 28 never events CMS memo to extend to Medicaid patients Insurance companies are putting it into their contracts you do not bill for any of 28 never events There are several HAC related to infections file:///x /instruct/ngd1572/slide011.htm [11/16/2011 3:59:32 PM]
Page 012 Infection Control This will cost hospitals a lot of money if they don t do it right Make sure you have a qualified infection control coordinator, nurse, or epidemiologist (now called Infection Preventonist by APIC) Make sure you have enough FTEs devoted to the area of infection control There will be no additional payment if patient gets a Hospital- Acquired Conditions (HAC) file:///x /instruct/ngd1572/slide012.htm [11/16/2011 3:59:33 PM]
Page 013 CMS Hospital-Acquired Conditions Vascular catheter-associated infection Surgical-site infection such as mediastinitis after coronary artery bypass graft surgery Catheter-associated urinary tract infections Surgical-site infections following certain orthopedic surgeries (repair, replacement or fusion of joints such as shoulder, elbow, & spine) file:///x /instruct/ngd1572/slide013.htm [11/16/2011 3:59:33 PM]
Page 014 CDC Cost of HAI CDC published 16 page document in 2009 on the direct medical costs of HAI in US Hospitals & Benefits of Prevention1 4.5 HAIs per 100 admissions Direct medical costs ranges from $28.4 to $33.8 billion a year Benefit of prevention range from $5.7 to $6.8 billion based on 20% are preventable 1 www.cdc.gov/ncidod/dhqp/pdf/scott_costpaper.pdf file:///x /instruct/ngd1572/slide014.htm [11/16/2011 3:59:33 PM]
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Page 016 Number of HAIs by Site file:///x /instruct/ngd1572/slide016.htm [11/16/2011 3:59:34 PM]
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Page 019 Infection Control Video HHS has published a training video that every nurse, physician, infection preventionist & healthcare staff should see This includes risk managers It is an interactive video Called Partnering to Heal: Teaming Up Against Healthcare-Associated Infections1 HHS wants to decrease HAI by 40% in 2013, want 1.8 million fewer injures & can save 60,000 lives 1 www.hhs.gov/partneringtoheal file:///x /instruct/ngd1572/slide019.htm [11/16/2011 3:59:35 PM]
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Page 021 CMS Conditions of Participation (CoPs) TJC accredits 82% of hospitals in United States (about 4,200)1 Most hospitals receive Medicare so hospital needs to follow CMS hospital CoPs CMS has 12 pages of infection control standards which were revised in 11-21-07 in Memo 08-04 & in current CoP2 Reflected in 6-5-09 CMS Hospital Manual3 1 www.jointcommission.org/aboutus/fact_sheets/facts_jc_acrr_cert.htm 2 www.cms.hhs.gov/surveycertificationgeninfo/pmsr/list.asp 3 www.cms.hhs.gov/manuals/downloads/som107_appendicestoc.pdf file:///x /instruct/ngd1572/slide021.htm [11/16/2011 3:59:36 PM]
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Page 024 CMS Updates The best place to check for updates & changes with CMS is the Survey & Certification General Information website & transmittals Every hospital should have one person check this website once a month1 Flash sterilization is a hot issue with CMS & memo issued & TJC writes article on rapid cycle sterilization of surgical equipment 2 Also memo on cleaning glucose meters 1 www.cms.hhs.gov/surveycertificationgeninfo/pmsr/list.asp & www.cms. gov/transmittals/01_overview.asp 2 www.jcrinc.com/common/pdfs/fpdfs/pubs/pdfs/jcreqs/jcp-07-09-s8.pdf file:///x /instruct/ngd1572/slide024.htm [11/16/2011 3:59:37 PM]
Page 025 CMS Survey & Certification Memos file:///x /instruct/ngd1572/slide025.htm [11/16/2011 3:59:38 PM]
Page 026 file:///x /instruct/ngd1572/slide026.htm [11/16/2011 3:59:39 PM]
Page 027 CMS Memo on Point of Care Devices file:///x /instruct/ngd1572/slide027.htm [11/16/2011 3:59:39 PM]
Page 028 Glucometer Is considered a point of care testing device Finger stick devices can never be used on more than one patient Blood glucose meters must be cleaned between patient use If manufacturer does not provide guidance then device can be used for only one person CMS issues a memo on this Good toolkit at ASC Collaboration file:///x /instruct/ngd1572/slide028.htm [11/16/2011 3:59:39 PM]
Page 029 Glucose Meters Lancing Devices file:///x /instruct/ngd1572/slide029.htm [11/16/2011 3:59:40 PM]
Page 030 Point of Care Devices Toolkit file:///x /instruct/ngd1572/slide030.htm [11/16/2011 3:59:40 PM]
Page 031 CMS & CDC Resources www.cdc.gov/injectionsafety/fingerstick-devicesbgm.html www.cdc.gov/injectionsafety/blood-glucose-monitoring.html www.fda.gov/medicaldevices/safety/alertsandnotices/ucm224025.htm ASC Collaboration toolkit on Point of Care Devices at http://ascquality. org/advancing_asc_quality.cfm file:///x /instruct/ngd1572/slide031.htm [11/16/2011 3:59:41 PM]
Page 032 file:///x /instruct/ngd1572/slide032.htm [11/16/2011 3:59:41 PM]
Page 033 Flash Sterilization (Immediate-Use) file:///x /instruct/ngd1572/slide033.htm [11/16/2011 3:59:41 PM]
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Page 035 file:///x /instruct/ngd1572/slide035.htm [11/16/2011 3:59:42 PM]
Page 036 Now Called Immediate-Use Steam file:///x /instruct/ngd1572/slide036.htm [11/16/2011 3:59:43 PM]
Page 037 Immediate-Use Steam Sterilization file:///x /instruct/ngd1572/slide037.htm [11/16/2011 3:59:44 PM]
Page 038 Endoscope Reprocessing Toolkit file:///x /instruct/ngd1572/slide038.htm [11/16/2011 3:59:44 PM]
Page 039 Additional Resources See CDC Guideline for Disinfection & Sterilization in Healthcare Facilities, 20081 AORN in Perioperative Standards & Recommended Practices has a chapter on sterilization & disinfection including many on steam sterilization2 See updated policy on surgical attire recommended practices & no home laundering of scrubs for OR staff (also jewelry, footwear, cleaning stethoscopes & ID badges, fanny packs, reusable head coverings, etc.) APIC is good source of information3 1 www.cdc.gov/ncidod/dhqp/pdf/guidelines/disinfection_nov_2008.pdf 2 www.aorn.org 3 www.apic.org file:///x /instruct/ngd1572/slide039.htm [11/16/2011 3:59:44 PM]
Page 040 Additional Resources Reporting central line infections to CMS through CDC National Healthcare Safety Network (NHSN) in ICUs & high risk nurseries (1-1-11 discharges) & SSI (1-2-12 data collection) At 2010 APIC conference a survey over 2,000 infection preventionist shows that about half are too busy working on surveillance to do interventions to prevent Central Line Associated Bloodstream Infections (CLABSIs)1 APIC issues an informational memo2 Hospitals need to use automated surveillance technology 1 www.cdc.gov/nhsn 2 www.apic.org file:///x /instruct/ngd1572/slide040.htm [11/16/2011 3:59:45 PM]
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Page 047 CMS Infection Control CMS has 12 pages of standards in the hospital CoP Updated to reflect changing infectious & communicable disease threats Including current knowledge & best practices and many policies & procedures required Requires active infection control program with investigations & control of infections Requires infection control log CEO, CNO, & MS must ensure hospital-wide training program & correction plan for problem areas file:///x /instruct/ngd1572/slide047.htm [11/16/2011 3:59:48 PM]
Page 048 TJC Infection Prevention & Control TJC has a chapter on Infection Prevention (IC) & Control that is 8 pages long 11 standards with 60 EPs Also important ones in 2011 NPSGs on reduce the risk of HAIs (Goal 7) hand hygiene, prevent surgical site infections, MDROs, & central line infections Need to be aware of both & most stringent applies TJC IC standard makes top 10 problematic standards in 2011 file:///x /instruct/ngd1572/slide048.htm [11/16/2011 3:59:48 PM]
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Page 051 TJC has 11 Standard in the IC Chapter file:///x /instruct/ngd1572/slide051.htm [11/16/2011 3:59:50 PM]
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Page 053 Cleaning of Medical Equipment file:///x /instruct/ngd1572/slide053.htm [11/16/2011 3:59:50 PM]
Page 054 Infection Preventionist IC.01.01.01 Hospital identifies person responsible for infection prevention & control APIC calls them infection preventionists or IPs EP1 Identify the person with clinical control over this area EP2 If person does not have expertise then they consult with someone who does file:///x /instruct/ngd1572/slide054.htm [11/16/2011 3:59:51 PM]
Page 055 Infection Preventionist (IP) file:///x /instruct/ngd1572/slide055.htm [11/16/2011 3:59:51 PM]
Page 056 Infection Preventionist (IP) EP3 Hospital assigns responsibility to someone for daily management of infection control & communicable diseases Number of IPs & skill mix will depend on goals & objectives of the infection control program See HR.01.02.01 EP1 & LD.03.06.01 EP3 EP4 IP is responsible to develop IC P&P, implement P&Ps, & develop a system to identify, report, investigate & control infections & communicable diseases (DS) file:///x /instruct/ngd1572/slide056.htm [11/16/2011 3:59:52 PM]
Page 057 Infection Control Resources IC.01.02.02 Hospital leaders need to provide resources for infection control EP1 Hospital need to provide access to information needed to support IC program See IM.02.02.03 where data is given in useful formats EP2 Lab resources are provided when needed EP3 Equipment & supplies are provided to support infection control program file:///x /instruct/ngd1572/slide057.htm [11/16/2011 3:59:52 PM]
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Page 059 Identify Risks for Transmitting Infections IC.01.03.01 Hospital identifies risks for acquiring & transmitting infections EP1 Hospital identifies risks based on geographic location, community, & population served NPSG.07.03.01 EP1 Conduct periodic risk assessments in time frames set by hospital for MultiDrug-Resistent Organisms (MDRO) acquisitions & transmission MDRO includes Methicillin-Resistant Staphylococcus Aureus (MRSA), Vancomycin-Resistant Enterococcus (VRE), Klebsiella, & Acinetobacter CDC has free MDRO infection (& CDAD) surveillance & training on National Healthcare Safety Network (NISN)1 1 www.cdc.gov/nhsn/wc_mdro_cdad.html file:///x /instruct/ngd1572/slide059.htm [11/16/2011 3:59:53 PM]
Page 060 Acinetobacter is on the Rise file:///x /instruct/ngd1572/slide060.htm [11/16/2011 3:59:53 PM]
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Page 063 Identify Risks for Transmitting Infections EP2 Hospital identifies risk for acquiring & transmitting infections based on the care & treatment it provides (on MDRO) EP3 Look at risk for acquiring or transmitting an infection by doing an analysis of surveillance activities & other infection control data (including MRDO & adverse tissue reactions) EP4 Review & identify risks annually & when there is a significant change & get input from IP, MS, nursing, & leadership including MRDO EP5 Prioritize these risks & document this file:///x /instruct/ngd1572/slide063.htm [11/16/2011 3:59:55 PM]
Page 064 Bacterial Meningitis & Hospital Fined file:///x /instruct/ngd1572/slide064.htm [11/16/2011 3:59:55 PM]
Page 065 Identify Risks for Transmitting Infections Hospital & ASC in Colorado where surgery tech with Hepatitis C infection steals Fentanyl & replaces it with used syringes of saline infecting 18 patients as of 10-30-09 & 5,206 patients tested1 Federal officials investigate dozens of blood infections linked to medical syringes contaminated with the bacteria Serratia marescens 1 www.krdo.com/global/link.asp?l=399119 file:///x /instruct/ngd1572/slide065.htm [11/16/2011 3:59:56 PM]
Page 066 Identify Risks for Transmitting Infections Doctors & nurses in Nevada ASC reuse syringes & at least 105 cases of Hepatitis C were linked to the clinics & more than 12,000 patients have been tested1 State health investigators find 25 out of 49 outpatient surgery centers in Nevada have infection control deficiencies CMS issues memo 5-16-09 on Safe Injection Practices in ASCs2 CDC issues Resources on Unsafe Injection Practices3 1 www3.signonsandiego.com/stories/2009/mar/10/ nv-hepatitis-exposure-031009/?zindex=64635 2 www.cms.hhs.gov/surveycertificationgeninfo/pmsr/itemdetail.asp?filtertype= dual,%20date,%20keyword&filtervalue=2 yyyy injection &filterbydid=-1&sortby DID=4&sortOrder=ascending&itemID=CMS1210928&intNumPerPage=10 3 www.cdc.gov/ncidod/dhqp/coca_unsafe_injection_practices.html file:///x /instruct/ngd1572/slide066.htm [11/16/2011 3:59:56 PM]
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Page 074 Advancing ASC Quality ASC Quality Collaboration has ASC tool kit for infection prevention Includes one on hand hygiene and safe injection practices Includes a basic and expanded version of the toolkit These are available on-line1 1 www.ascquality.org/advancing_asc_quality.cfm file:///x /instruct/ngd1572/slide074.htm [11/16/2011 4:00:00 PM]
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Page 079 Identify Risks for Transmitting Infections Outbreak of Hepatitis C among 99 outpatients in oncology clinic from catheter flushes after having chemo1 Nurse drew blood from indwelling IV catheter then reused same syringe to perform saline flush with the same 500 cc bag was used for multiple patients Also problems with doing Accucheck so must be cleaned between patient use 1 Macedo de Oliveira et al., Annals of Internal Medicine, 2005, 142:898-902 file:///x /instruct/ngd1572/slide079.htm [11/16/2011 4:00:02 PM]
Page 080 Set Goals to Minimize Risk IC.01.04.01 Hospital sets written infection & control goals to minimize the possibility of transmitting infections which include the following: EP1 Prioritize the risks (including hand hygiene guidelines NPSG.07.01.01) EP2 Limit unprotected exposure to pathogen EP3 & EP4 Limit transmission associated with procedures & use of medical devices, equipment & supplies EP5 Improve compliance with hand hygiene file:///x /instruct/ngd1572/slide080.htm [11/16/2011 4:00:02 PM]
Page 081 APIC s Targeting Zero Campaign Targeting Zero is the philosophy that every hospital should be working toward a goal of zero HAIs While not all HAIs are preventable, APIC believes we should strive for the goal of elimination & strive for zero infections Association for Professionals in Infection Control & Epidemiology (APIC) put together many resources to help hospitals to start to meet this goal Prompt investigation of HAIs of greatest concern to the hospital (like MRSA, CDiff surgical-site infections, catheter associated UTIs) Needed because of our declining arsenal of antibiotics to treat infections file:///x /instruct/ngd1572/slide081.htm [11/16/2011 4:00:03 PM]
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Page 083 Hand Hygiene Resources CDC Guidelines for Hand Hygiene in Health-Care Settings1 CDC has a website with other resources on hand hygiene2 TJC has many resources including Measuring Hand Hygiene Adherence: Overcoming the Challenges3 & Hand Hygiene Project as part of Transforming Healthcare4 WHO has A 2009 Guidelines on Hand Hygiene in Health Care5 1 www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm 2 www.cdc.gov/handhygiene 3 www.jointcommission.org/patientsafety/infectioncontrol/hh_monograph.htm 4 www.centerfortransforminghealthcare.org/projects/display.aspx?projectid=5 5 http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf file:///x /instruct/ngd1572/slide083.htm [11/16/2011 4:00:04 PM]
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Page 088 Hand Hygiene Measurement Periodically monitor & record adherence as the number of hand hygiene episodes performed by staff over the number of opportunities (direct observation) Provide feedback to the staff Monitor the volume of alcohol-based hand rub or detergent used per 1000 patient days file:///x /instruct/ngd1572/slide088.htm [11/16/2011 4:00:06 PM]
Page 089 Infection Control Plan IC.01.05.01 Hospital has a written infection prevention & control plan that includes the following: EP1 Use evidence-based national guidelines or if none then expert consensus EP2 Include surveillance to minimize or eliminate the risk of infection EP3 Have a process to evaluate the infection control plan Documentation requirement added May 2009 file:///x /instruct/ngd1572/slide089.htm [11/16/2011 4:00:06 PM]
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Page 092 Infection Control Plan IC.01.05.01 Hospital has a written infection control plan that includes the following (continued): EP5 Process in writing to investigate outbreaks of infectious diseases EP6 Hospital components & functions are integrated into IC activities (staff are educated on IC before the provide care & this must be documented) EP7 Hospital communicates preventing & controlling infection to LIPs, staff, patients & visitors EP8 Identify method to report infections to external organizations See IC.02.01.01, EP9 file:///x /instruct/ngd1572/slide092.htm [11/16/2011 4:00:07 PM]
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Page 094 APIC Brochures APIC has a number of educational brochures that hospitals can download & provide to staff and patient1 Includes 10 tips to prevent the spread of infection & hand hygiene for patients & one for healthcare workers Information to patients is on standard precautions (hand hygiene) & transmission precautions for patients with certain diseases (contact precautions) 1 www.apic.org/am/template.cfm?section=education_resources&template=/ TaggedPage/TaggedPageDisplay.cfm&TPLID=91&ContentID=8738 file:///x /instruct/ngd1572/slide094.htm [11/16/2011 4:00:08 PM]
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Page 096 Influx of Infectious Patients IC.01.06.01 Hospital prepares for an influx of potentially infectious patients EP1 Identify resources about infections that could cause this such as state, federal or local public health systems EP2 Obtain current clinic & epidemiological information from the resources EP3 Have a method for communicating critical information to LIPs & staff about emerging infections that could cause this (H1N1 flu, bioterrorism, SARS, drug-resistant TB, measles, plague, et al.) file:///x /instruct/ngd1572/slide096.htm [11/16/2011 4:00:09 PM]
Page 097 Influx of Infectious Patients IC.01.06.01 Hospital prepares for an influx of potentially infectious patients (continued) EP4 Describe in writing how hospital will respond & one may be not to accept any more patients (do hazard vulnerability analysis) EP5 If hospital decides to accept influx of patients then put in writing methods on how to manage these patients over an extended period of time EP6 Activate response system when needed in response to influx of patients file:///x /instruct/ngd1572/slide097.htm [11/16/2011 4:00:10 PM]
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Page 099 Preparing for a Pandemic Have a Plan Have an infectious disease disaster or emergency management plan Plan includes triaging in a surge incident Plan to increase bed capacity & cancel elective procedures Have a policy in place Make sure staff are aware & educated on policy file:///x /instruct/ngd1572/slide099.htm [11/16/2011 4:00:10 PM]
Page 100 Have a Plan Review & revise plan & policy annually Hospitals should have minimum number of airborne infection isolation rooms (All) as per AIA & negative pressure surge capacity rooms (NPSC) Protocols to transfer patients to another hospital with these rooms Hospital with NPSC rooms needs policy on deployment of these rooms file:///x /instruct/ngd1572/slide100.htm [11/16/2011 4:00:11 PM]
Page 101 Have a Plan Identify what medical equipment needs to be stockpiled (respirators, gloves, antibiotics, anti-virals, etc.) Coordinate with community disaster agencies, local & state public health departments Assess levels of medications that may be needed to treat an influx of patients file:///x /instruct/ngd1572/slide101.htm [11/16/2011 4:00:11 PM]
Page 102 Implement Your IC Plan IC.02.01.01 Requires hospitals to implement their infection prevention and control plan EP1 Implementation of the plan includes surveillance to reduce or eliminate the risk of infection EP2 Use standard precautions during all patient encounters such as the use of PPE, hand hygiene, gloves, & gowns as indicated1 EP3 Implement transmission-based precautions when patient is known or suspected to be colonized or infection with infectious agent (contact as with C-Diff & MRSA, droplet, & airborne precautions as with TB) EP5 Investigate outbreaks of infectious disease (No EP 4 for hospitals) 1 www.cdc.gov/ncidod/dhqp file:///x /instruct/ngd1572/slide102.htm [11/16/2011 4:00:12 PM]
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Page 104 Implement Your IC Plan 02.01.01 EP6 Minimize risk of infection when storing & disposing of infectious waste EP7 Communicate responsibilities for preventing & controlling infection to MS, staff, patients and visitors Include hand & respiratory hygiene (cover your cough campaign) EP8 Report infection control information to appropriate staff within the hospital EP9 Report also to local, state, & federal authorizations as required by law (See IC.01.05.01, EP8 to identify methods for reporting) file:///x /instruct/ngd1572/slide104.htm [11/16/2011 4:00:13 PM]
Page 105 Cover Your Cough Posters file:///x /instruct/ngd1572/slide105.htm [11/16/2011 4:00:13 PM]
Page 106 Implement Your IC Plan EP10 A hospital must inform a receiving hospital if it learns a patient that was transferred has an infection that needs monitoring, treatment or isolation EP11 If the receiving hospital discovers a patient they received has an infection requiring action the sending hospital must be notified if not aware See CDC Guidelines for Isolation Precaution in Hospitals1 1 www.cdc.gov/ncidod/dhqp/gl_isolation.html file:///x /instruct/ngd1572/slide106.htm [11/16/2011 4:00:14 PM]
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Page 112 APIC Elimination Guides file:///x /instruct/ngd1572/slide112.htm [11/16/2011 4:00:17 PM]
Page 113 Other APIC Elimination Guides Catheter-Associated Urinary Tract Infections Clostridium Difficile CRBSIs Mediastinitis MRSA in Hospital Settings MRSA in Long-Term Care Ventilator-Associated Pneumonia file:///x /instruct/ngd1572/slide113.htm [11/16/2011 4:00:17 PM]
Page 114 CDC has Dialysis Resources, also file:///x /instruct/ngd1572/slide114.htm [11/16/2011 4:00:18 PM]
Page 115 file:///x /instruct/ngd1572/slide115.htm [11/16/2011 4:00:18 PM]
Page 116 Risk of Infections With Equipment TOP 10 IC.02.02.01 (36% in 2011, 29% in 2010) Hospital reduces risk of infections associated with medical equipment, devices, & supplies Also IC.02.01.01 had 12% in 2011 & 2010 Make sure you clean those glucometer between cases, clean scopes well, use immediate use stream sterilization according to manufacturer instruction, & clean laryngoscopes file:///x /instruct/ngd1572/slide116.htm [11/16/2011 4:00:19 PM]
Page 117 Medical Equipment, Devices, & Supplies IC.02.02.01 Hospital reduces the risk of infections associated with medical equipment, devices, & supplies Rationale CDC states about 46.5 million surgical procedures are done in hospitals & ASCs every year including 5 million GI endoscopies Procedures can introduce pathogens that can lead to infection if not cleaned or sterilized properly Critical that employees follow standardized practices to minimize infection & have proper education & supervision Have placards that lists the steps to follow according to manufacturers guidelines file:///x /instruct/ngd1572/slide117.htm [11/16/2011 4:00:19 PM]
Page 118 Medical Equipment & Supplies IC.02.02.01 EP1 Implement infection control activities when cleaning & performing low-level disinfection of medical equipment & supplies Low level disinfection is used for stethoscopes & blood glucose monitors Additional cleaning & disinfection may be needed for patients in isolation to clean equipment, devices, & supplies (June 2010) EP2 Implement infection control activities when performing intermediate & high level disinfection & sterilization of medical equipment & supplies Sterilization for implants & surgical instruments High level disinfection for respiratory equipment & flexible endoscopes file:///x /instruct/ngd1572/slide118.htm [11/16/2011 4:00:20 PM]
Page 119 CDC Guideline for Disinfection & Sterilization file:///x /instruct/ngd1572/slide119.htm [11/16/2011 4:00:20 PM]
Page 120 file:///x /instruct/ngd1572/slide120.htm [11/16/2011 4:00:21 PM]
Page 121 file:///x /instruct/ngd1572/slide121.htm [11/16/2011 4:00:22 PM]
Page 122 Point of Care Devices Point of care testing occurs at or near the side of patient through the use of portable & handheld devices Includes blood glucose meters, lancing devices & INR meters Must clean blood glucose meter after every use APIC recommends with a bleach solution 1:10 dilution of water & bleach Make sure you use a new single-use, auto-disabling lancing device for each patient See free toolkit with detailed cleaning information file:///x /instruct/ngd1572/slide122.htm [11/16/2011 4:00:22 PM]
Page 123 Toolkits file:///x /instruct/ngd1572/slide123.htm [11/16/2011 4:00:23 PM]
Page 124 ASC Collaboration Free Toolkit file:///x /instruct/ngd1572/slide124.htm [11/16/2011 4:00:23 PM]
Page 125 file:///x /instruct/ngd1572/slide125.htm [11/16/2011 4:00:24 PM]
Page 126 Have a P&P on Point of Care Testing file:///x /instruct/ngd1572/slide126.htm [11/16/2011 4:00:24 PM]
Page 127 file:///x /instruct/ngd1572/slide127.htm [11/16/2011 4:00:25 PM]
Page 128 file:///x /instruct/ngd1572/slide128.htm [11/16/2011 4:00:26 PM]
Page 129 Medical Equipment & Supplies EP3 Implement infection control activities when disposing of medical equipment & supplies EP4 Implement when storing medical equipment, devices, & supplies EP5 Implement infection control activities consistent with regulatory & professional standards when reprocessing single-use devices (SUDs) SUDs are devices labeled by the original equipment manufacturer for use in one procedure on one patient & not for reuse file:///x /instruct/ngd1572/slide129.htm [11/16/2011 4:00:27 PM]
Page 130 Infections Many infections in acute care occur as a result of an invasive procedure or device Many of these infections occur in ICU such as surgical-site infections, catheter-induced urinary tract infections (80%) & VAP Central line associated bloodstream infections & the use of a bundle of interventions has reduced the incidences Also be aware of CMS memo & TJC position on steam sterilization file:///x /instruct/ngd1572/slide130.htm [11/16/2011 4:00:27 PM]
Page 131 Steam Sterilization Flash sterilization is used to describe certain types of steam sterilization that do not use a full cycle or terminal cycle Originally flash sterilization (FS) meant sterilizing unwrapped instruments with steam for 3 minutes at 27 to 28 pounds of pressure New improvements have been made to this process such as longer exposure to steam, special trays & packs to hold the instruments & the routine use of biological indicators file:///x /instruct/ngd1572/slide131.htm [11/16/2011 4:00:28 PM]
Page 132 CDC Guidelines for Disinfection/Sterilization file:///x /instruct/ngd1572/slide132.htm [11/16/2011 4:00:28 PM]
Page 133 Steam Sterilization Surveyors are looking closely into all aspects of sterilization including the sterilization logs Make sure instrument is cleaned before sterilization with all visible soil removed before sterilization (brush, dissemble some, soak in enzymatic solution as applicable) Make sure steam sterilization meets the manufacturers parameters (time, temperature, & pressure) Use chemical or biological indicators as directed by the manufacturer Each newly sterilized instrument must to protected so it not re-contaminated (use flash pans if not full cycle sterilization) file:///x /instruct/ngd1572/slide133.htm [11/16/2011 4:00:29 PM]
Page 134 file:///x /instruct/ngd1572/slide134.htm [11/16/2011 4:00:29 PM]
Page 135 file:///x /instruct/ngd1572/slide135.htm [11/16/2011 4:00:30 PM]
Page 136 Medical Equipment & Supplies Resources Multi-Society Guidelines for Reprocessing Flexible Gastrointestinal Endoscopes by APIC1 Disinfection of Healthcare Equipment Chapter in Guidelines for Disinfection & Sterilization in Healthcare Facilities Nov 20082 Single Use Device Reprocessing3 1 www.apic.org/am/template.cfm?section=guidelines_and_standards& template=/cm/contentdisplay.cfm§ion=topics1&contentid=6381 2 www.cdc.gov/ncidod/dhqp/pdf/guidelines/disinfection_nov_2008.pdf 3 http://cms.h2e-online.org/ee/waste-reduction/waste-minimization file:///x /instruct/ngd1572/slide136.htm [11/16/2011 4:00:31 PM]
Page 137 Prevent Transmission of Infections IC.02.03.01 Hospital works to prevent the transmission of infection among patients, staff, & LIPs EP1 Hospital makes screening available for staff or LIPs exposed to infectious diseases in the workplace EP2 Hospitals provides testing, counseling & assessment if LIP or staff has an infectious disease that puts others at risk EP3 Hospital provides employee or LIP who is exposed in the workplace an assessment, potential testing, prophylaxis, or counseling EP4 Hospital provides patients with same if exposed to an infectious disease file:///x /instruct/ngd1572/slide137.htm [11/16/2011 4:00:32 PM]
Page 138 Flu Vaccine for Staff & LIPs IC.02.04.01 Hospital offers flu vaccine to staff & LIPs EP1 Establish an annual flu vaccination program that is offered to staff & LIPs EP2 Educate them about the flu vaccine, non-vaccine control & diagnosis & transmission of the flu EP3 Offer flu vaccination sites accessible to staff EP4 Evaluate the vaccination rates & reasons for declining annually EP5 Take steps to increase flu vaccine rates file:///x /instruct/ngd1572/slide138.htm [11/16/2011 4:00:32 PM]
Page 139 file:///x /instruct/ngd1572/slide139.htm [11/16/2011 4:00:33 PM]
Page 140 file:///x /instruct/ngd1572/slide140.htm [11/16/2011 4:00:34 PM]
Page 141 Evaluate Your IC Plan IC.03.01.01 Hospital evaluated the effectiveness of its infection control plan EP1 Evaluate the effectiveness of the plan annually & whenever risks change significantly EP2 Review the plan s prioritized risks EP3 Evaluate the plan s goals Set goals for improving compliance with hand hygiene guidelines under NPSG.07.01.01 EP2 file:///x /instruct/ngd1572/slide141.htm [11/16/2011 4:00:34 PM]
Page 142 CMS Quality Measures FY2013 file:///x /instruct/ngd1572/slide142.htm [11/16/2011 4:00:35 PM]
Page 143 CMS Proposes Cleanliness of Hospital file:///x /instruct/ngd1572/slide143.htm [11/16/2011 4:00:35 PM]
Page 144 CMS FY2013 Proposed HACs file:///x /instruct/ngd1572/slide144.htm [11/16/2011 4:00:36 PM]
Page 145 CMS Proposed Patient Safety Indicators file:///x /instruct/ngd1572/slide145.htm [11/16/2011 4:00:37 PM]
Page 146 Evaluate Your IC Plan EP4 Review implementation of the infection prevention & control plan s activities (No EP5) EP6 Findings from the evaluation must be communicated at least annually to individuals or the group that manages the patient safety program EP7 Use the finding of the evaluation when revising the infection control plan file:///x /instruct/ngd1572/slide146.htm [11/16/2011 4:00:37 PM]
Page 147 TJC Other Infection Control Standards EC.02.05.01 Hospital manages risks associated with its utility systems & maintains a written inventory based on risks for infection EC.02.05.05 Hospital inspects & maintains infection control utility systems EC.02.06.05 When planning demolition or new construction conduct a risk assessment for air quality & infection control file:///x /instruct/ngd1572/slide147.htm [11/16/2011 4:00:38 PM]
Page 148 TJC Other Infection Control Standards EM.01.01.01 Hospital conducts a hazard vulnerability analysis (HVA) to identify potential emergencies & if hospital identifies a surge in infectious patients then this is addressed in IC chapter HR.01.02.01 Hospital defines staff qualification specific to their job responsibilities & qualification for infection control are met through education, training, experience &/or certification file:///x /instruct/ngd1572/slide148.htm [11/16/2011 4:00:38 PM]
Page 149 TJC Other Infection Control Standards HR.01.04.01 Hospital determines safety content of orientation provided to staff including infection control HR.01.04.01 Staff must be oriented to infection prevention & control LD.03.06.01 EP3 Leaders provide sufficient number & mix of individuals to support safe & quality care & this includes the infection preventionist file:///x /instruct/ngd1572/slide149.htm [11/16/2011 4:00:38 PM]
Page 150 Keep Up with the Literature CDC comes out with Guidelines for Prevention of Associated Urinary Tract Infections 2009 67 page document that every hospital should have1 Watch for Guidelines for the Prevention of Intravascular Catheter Related Infections from CDC 1 www.cdc.gov/ncidod/dhqp/dpac_uti_pc.html file:///x /instruct/ngd1572/slide150.htm [11/16/2011 4:00:39 PM]
Page 151 file:///x /instruct/ngd1572/slide151.htm [11/16/2011 4:00:39 PM]
Page 152 file:///x /instruct/ngd1572/slide152.htm [11/16/2011 4:00:40 PM]
Page 153 file:///x /instruct/ngd1572/slide153.htm [11/16/2011 4:00:40 PM]
Page 154 file:///x /instruct/ngd1572/slide154.htm [11/16/2011 4:00:41 PM]
Page 155 2010 IDSA Guidelines file:///x /instruct/ngd1572/slide155.htm [11/16/2011 4:00:42 PM]
Page 156 Toolkit on Preventing UTI file:///x /instruct/ngd1572/slide156.htm [11/16/2011 4:00:42 PM]
Page 157 Keep Up with the Literature Preventing Surgical-Site Infections in Nasal Carriers of Staph Aureus Do rapid screen nasal swab & if positive decolonize nasal to reduce surgical-site infections January 7, 2010 NEJM, No. 1. Vol. 362:9-17 Chlorahexidine instead of Povidone-Iodine for surgical-site antisepsis reduces surgical-site infections January 7, 2010 NEJM, No. 1, Volume 362:18-26 file:///x /instruct/ngd1572/slide157.htm [11/16/2011 4:00:42 PM]
Page 158 Sepsis Screening In ICU July 2010 article in Archives of Surgery said hospitals are not adequately screening for sepsis in the ICU Reviewed 364,000 general surgery cases in ACS National Surgical QI Program Need to identify early Occurred in 2.3% of patients & has doubled in the past 2 years Need to look at 4 early indicators every day: HR, respiratory rate, temperature & WBC file:///x /instruct/ngd1572/slide158.htm [11/16/2011 4:00:43 PM]
Page 159 file:///x /instruct/ngd1572/slide159.htm [11/16/2011 4:00:43 PM]
Page 160 8 Things to Reduce Post-operative Pneumonia Researchers from VA Palo Alto Healthcare System & Stanford University employed 8 things to reduce pneumonia on the surgery floor 1. Education of all surgical & ward nursing staff about their role in pneumonia prevention 2. Cough & deep-breathing exercises with incentive spirometer 3. Twice-daily oral hygiene with chlorhexidine swabs 4. Ambulation with good pain control file:///x /instruct/ngd1572/slide160.htm [11/16/2011 4:00:44 PM]
Page 161 8 Things to Reduce Post-operative Pneumonia 5. Head-of-bed elevation to at least 30 degrees & sitting up for all meals ( up to eat ) 6. Quarterly discussion of the progress of the program & results for nursing staff 7. Pneumonia bundle documentation in the nursing documentation 8. Computerized physician pneumonia prevention order set in the physician order entry system Wren SM, Martin M, Yoon JK, & Bech F. Postoperative Pneumonia-Prevention Program for the Inpatient Surgical Ward. J Am Coll Surg; April 2010, Vol. 210, Issue 4: 491-495 file:///x /instruct/ngd1572/slide161.htm [11/16/2011 4:00:44 PM]
Page 162 In Summary Review CMS & TJC standards on infection control Develop & implement a comprehensive infection control program Have a well trained & educated infection preventionist with adequate resources to get the job done Ensure P&P are consistent with these standards & state, local & federal regulations & national guidelines Educate staff on signs of patient infections & take appropriate steps once a possible infection is identified file:///x /instruct/ngd1572/slide162.htm [11/16/2011 4:00:44 PM]
Page 163 SHEA C-Diff Guidelines file:///x /instruct/ngd1572/slide163.htm [11/16/2011 4:00:45 PM]
Page 164 Preventing Infections in the Outpatient Unit 2011 CDC has a new guide & checklist for preventing infections in the outpatient setting free off the website1 Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care Infection Prevention Checklist for Outpatient Settings; Minimum Expectations for Safe Care 1 www.cdc.gov/hai/settings/outpatient/ outpatient-settings.html?source=govdelivery file:///x /instruct/ngd1572/slide164.htm [11/16/2011 4:00:45 PM]
Page 165 CDC Guide Infection Control Outpatients file:///x /instruct/ngd1572/slide165.htm [11/16/2011 4:00:46 PM]
Page 166 Communicable Disease Outbreaks Community-wide outbreaks of communicable diseases present many of the same types of issues as hospital infection disease threats Understand the epidemiology Know how it is transmitted & the clinical course of the disease in order to manage the outbreak Pandemics, or widespread outbreaks of an infection require back-up resources Hospitals need to work with state, federal, & local health agencies file:///x /instruct/ngd1572/slide166.htm [11/16/2011 4:00:47 PM]
Page 167 Communicable Disease Outbreaks There are at a minimum four things that must be addressed: Preventing transmission among patients, healthcare personnel, & visitors Identifying persons who may be infected & exposed Providing treatment or prophylaxis to large numbers of people Logistical issues (staff, medical supplies, resupply, continued operations, & capacity) file:///x /instruct/ngd1572/slide167.htm [11/16/2011 4:00:47 PM]
Page 168 IP Tools Website file:///x /instruct/ngd1572/slide168.htm [11/16/2011 4:00:48 PM]
Page 169 Are you up to the challenge? The End Following are some additional resources including information about the CDC National Healthcare Safety Network A Risk Assessment TJC Speak Up with Five Things to Reduce Infections file:///x /instruct/ngd1572/slide169.htm [11/16/2011 4:00:49 PM]
Page 170 The End Questions? Sue Dill Calloway, RN Esq. CPHRM AD, BA, BSN, MSN, JD President of Patient Safety & Education Chief Learning Officer Emergency Medicine Patient Safety Foundation www.empsf. org 5447 Fawnbrook Lane Dublin, Ohio 43017 614-791-1468 sdill1@columbus.rr.com file:///x /instruct/ngd1572/slide170.htm [11/16/2011 4:00:49 PM]