Control Practices for. Mary McGoldrick, MS, RN, CRNI

Essential Infection Control Practices for Home Infusion Nurses Mary McGoldrick, MS, RN, CRNI

Top 5 Things to Know for CE: Make sure your BADGE IS SCANNED each time you enter a session, to record your attendance. Carry the Evaluation Packet you received on registration with you to EVERY session. If you re not applying for CE, we still want to hear from you! Your opinions about our conference are very valuable. Pharmacists, Pharmacy Technicians and Nurses need to track their hours on the Statement of Continuing Education Certificate form as they go. FOR CE: At your last session, total the hours and sign both pages of your Statement of Continuing Education Certificate form. Keep the PINK copies for your records. Place the YELLOW and WHITE copies in your Evaluation packet. Make sure an evaluation form from each session you attended is completed and in your Evaluation packet (forgot to pick up an evaluation form at a session? (Extras are available in an accordion file near the registration desk.) Put your name and unique member ID number (six digit number on the bottom of your badge) on the outside of the packet, seal it, and drop it in the drop boxes in the NHIA registration area at the convention center.

Disclosures Mary McGoldrick is a consultant for Home Health Systems, Inc. The conflict of interest was resolved by peer review of slide content. Cli i l t i l d ff l b l ill t b Clinical trials and off-label uses will not be discussed during this presentation.

Home Health Care Services: Total Employement, 1996-2007 1,000,000 900,000 800,000 700,000 600,000000 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Source: U.S. Department of Labor, Bureau of Labor Statistics: Employment, Hours, and Earnings from the Current Employment Statistics Survey (National), www.bls.gov (May 2008) Copyright 2011 Home Health Systems, Inc. All Rights Reserved. 5

Patient Safety and Preventing Infections 1 out of every 20 hospitalized patients will contract Healthcare-associated infection (HAI) 2 million people develop a HAI per year 98,000 deaths per year Copyright 2011 Home Health Systems, Inc. All Rights Reserved. 6

Risks for HAI in Home Infusion Patients Most common device related infections Bloodstream infection Pneumonia Urinary tract infections Administration of intravenous medication Central line catheter care and maintenance Copyright 2011 Home Health Systems, Inc. All Rights Reserved. 8

Infection Prevention Challenges in Home Infusion Lack of control over the home environment Environmental contamination Human body fluids and excrement Pet excrement Copyright 2011 Home Health Systems, Inc. All Rights Reserved. 9

Infection Prevention Challenges In Home Infusion Lack of control over caregiver: Not sole provider of health care Inconsistency in patient care practices Copyright 2011 Home Health Systems, Inc. All Rights Reserved. 13

Performing Hand Hygiene in the Home Setting 14

Hand Hygiene: We ve Come A Long Way... 1847: Semmelweis 1961: U.S. Public Health Service 1975,1985, 1985 2002: CDC 1995: APIC 2004: TJC NPSG 2009: WHO Copyright 2011 Home Health Systems, Inc. All Rights Reserved. 15

Hand Hygiene Data Review Association between increased hand hygiene adherence and reduced HAIs >20 studies showed significant association Interventions used multimodal approach 96 studies in industrialized nations show 40% overall adherence rate B. Allegranzi, D. Pittet. Journal of Hospital Infection, 2009 V. Erasmus et al. Infection Control and Hospital Epidemiology, 2010 Copyright 2011 Home Health Systems, Inc. All Rights Reserved. 16

The Joint Commission: 2011 National Patient Safety Goals NPSG.07.01.01: Reduce the risk of health care- associated infections EP1: Implement a program that follows categories 1A, 1B and 1C of either the current CDC or WHO hand hygiene guidelines EP2: Set goals for hand hygiene compliance EP3: Improve compliance with hand hygiene goals based on hand hygiene goals Copyright 2011 Home Health Systems, Inc. All Rights Reserved. 17

Hand Hygiene: Using the Patient s Soap Bar soap vs. liquid soap Liquid soap refill technique Plain soap vs. antibacterial soap Ingredients not recommended in health care Cloth towels Copyright 2011 Home Health Systems, Inc. All Rights Reserved. 19

Hand Hygiene with Soap & Water 1. Wet the hands 2. Apply soap 3. Rub the hands together vigorously for a minimum of 15 seconds 4. Rinse the hands 5. Dry the hands 6. Turn off the faucet Copyright 2011 Home Health Systems, Inc. All Rights Reserved. 20

Handwashing Superior to ABHR in Presence of C. Difficile C. difficile spores readily transferred through hand-to-hand contact subsequent to hand hygiene with ABHR Oughton et al. Infect Control Hosp Epidemiol, 2009 Jabbar et al. Infect Control Hosp Epidemiol, 2010 Copyright 2011 Home Health Systems, Inc. All Rights Reserved. 21

Measuring Hand Hygiene Compliance Direct observation Measuring product use Surveys: Self-reported Patient/family Technology http://www.jointcommission.org/patient safety/infection control/ hh_monograph.htm Copyright 2011 Home Health Systems, Inc. All Rights Reserved.

Management of Equipment and Supplies 26

Nursing Bag Contamination Outside nurses bags: 83.6% positive for human pathogens; 15.9% MDROs Cloth nurses bag surface material 3 times more likely to have an MDRO isolate Inside nurses bag: 48.4% positive for human pathogens; 6.3% MDROs Patient care equipment inside nurses bags 43.7% positive for human pathogens; 5.6% MDROs Source: Bakunas-Kenneley, I., Madigan, E., (2009). Infection prevention and control in home healthcare: The nurse s bag. Am J Infect Control. 37: 687-8 Copyright 2011 Home Health Systems, Inc. All Rights Reserved. 33

Hazards Using Cleaners/Disinfectants on Electronic Medical Equipment Review manufacturer s cleaning and maintenance instructions and train staff. Strictly adhere to all chemical manufacturer s warnings, precautions and cautions, and follow directions for use. Clean equipment surfaces in accordance with equipment and chemical manufacturer s instructions. Keep the item/surface wet for specified contact time. Avoid wetting the circuitry. Copyright 2011 Home Health Systems, Inc. All Rights Reserved. 34

Management of Multidrug-Resistant Organisms (MDROs) in the Home Care Setting 35

Cartoon by Dave Harbaugh 36

Management of MDROs: Staff Education Risks and prevention of MDRO transmission during orientation and periodic updates Organizational experience with MDROs and prevention strategies Compliance with standard precautions and hand hygiene Criteria for implementation of additional precautions Copyright 2011 Home Health Systems, Inc. All Rights Reserved. 40

Management of Home-generated Medical Waste 42

Occupational Exposures Blood/body fluid exposure and exposure reporting in HHC RNs 76 percutaneous injuries per 1000 home health care RNs 45.8% of percutaneous injuries not reported Adverse working conditions uniquely associated with home health care Source: Gershon, R., Pearson, J., Sherman, M., Samar, S., Canton, A., Stone, P. (2009). The prevalence and risk factors for percutaneous injuries in registered nurses in the home health care sector. Am J Infect Control. 37:525-33 Copyright 2011 Home Health Systems, Inc. All Rights Reserved. 45.

Occupational Hazards in Home Care Strong odors Cigarette smoke Traveling alone in high-crime neighborhoods Drug- or alcohol-impaired and aggressive family members, family arguments Guns or drugs present in the home Source: NIOSH Hazard Review: Occupational Hazards in Home Healthcare. January 2011 Copyright 2011 Home Health Systems, Inc. All Rights Reserved. 46

Home Infusion Nursing Surveillance Activities 47

Monitoring HAIs in Home Infusion Surveillance - Monitoring and controlling HAIs in Home Infusion: Select based on risk assessment and program evaluation Surveillance definitions from APIC CDC HICPAC Surveillance Definitions for Home Health Care and Home Hospice Infections vs. CDC National Healthcare Safety Network (NHSN) Copyright 2011 Home Health Systems, Inc. All Rights Reserved. 48

HAI Surveillance Challenges in Home Infusion Lack of designated Infection Preventionist Lack of surveillance data in national database Inconsistency in surveillance definitions Analysis of data Care provided by caregiver Patients served by more than one healthcare provider Publish surveillance data Copyright 2011 Home Health Systems, Inc. All Rights Reserved. 50

Essential Infection Control Practices for the Home Infusion Nurses: Summary The specific infection prevention and control challenges when providing care in the home setting. Ways to reduce the risk of infection transmission by implementing infection prevention and control strategies in the home. Issues specific to patients with MDROs and CDI receiving care in the home and how to prevention and control transmission. How to strengthen the infection prevention and control program for care provided in the home setting. Copyright. 2011 Home Health Systems, Inc. All Rights Reserved. 51