Download Infection Control

ASDIN 8th Annual Scientific Meeting
Feeling a
bit like
this right
now?
• Disclosure:
Infection Control:
- Employed by Lifeline Vascular Access & Davita, Inc.
- Have financial interest in Davita, Inc.
- Member and Committee Member – Medical Group
Management Association
SOS Module 4 of 6
Challenges, Requirements,
& Why It’s Important
_____________________
Organization
Kevin Graham, MBA, LVN, CHDN, CASC, FACMPE
2
Requirements:
Infection Control Standards & NPSG’s
Infection Control – A Journey
Worried a
Surveyor will
walk in your
door and you
won’t be
ready?
3
Success....
• TJC Standards for Infection Control in
Ambulatory Care (AC)
- Eleven Standards
• National Patient Safety Goal (NPSG)
- Four (4) apply to AC
- One (1) of the 4 applies to Infection Control in AC
8Goal 7 – Reduce the risk of health care-associated
infections
ƒ NPSG.07.01.01 – Comply with either the current CDC hand
hygiene guidelines or the current WHO hand hygiene guidelines
ƒ NPSG.07.05.01 – Implement evidence-based practices for
preventing surgical site infections
“Success is a journey, not a destination”
4
-Bill Sweetland
5
6
ASDIN 8th Annual Scientific Meeting
Infection Control
Standards, NPSG’s & HAI’s
NPSG.07.01.01 Hand Hygiene
In the Beginning
• TJC Standards are Center for Disease Control (CDC) &
Healthcare Infection Control Practice Advisory Committee
(HICPAC) based
- Risk Assessment
Association of Professionals in Infection Control &
Epidemiology (APIC)
Geography, Scope of Services, Outcomes, and Populatino
served
Quantifiable and Prioritized
• Healthcare Associated Infections (HAI’s) are the focus and on
the radar screen with CMS, TJC, & all regulatory agencies
• Five (5) categories of IC are highlighted
- Hand Hygiene and PPE
- Injection Safety and Medication Handling
- Equipment reprocessing (sterilization, High Level Disinfectant
[HDL])
- Environmental Cleaning
- Handling of Blood Glucose Monitoring Equipment
• NPSG.07.01.01
- Comply with either the current Centers for Disease
Control and Prevention (CDC) hand hygiene
guidelines or the current World Health Organization
(WHO) hand hygiene guidelines
- Infection Control Plan
- Who, What, When, How, Why
- Patients & Teammates
- Designee trained in Infection Control
- Policies & Procedures
- Surveillance
7
8
NPSG.07.01.01 Hand Hygiene
Monthly Surveillance
NPSG.07.01.01 Hand Hygiene
Program
NPSG.07.01.01 Hand Hygiene
Monthly Surveillance cont.
• Monthly Observation
• Hand Hygiene Policy
- Training: What is enough?
• Monthly Observation
8How – observing proper technique
8Gloves – changed appropriately
- Facility Designee & manager responsibility
• Fostering a culture of Hand Hygiene
• “Secret Observer” (secret shopper philosophy)
- How good are you doing, really?
- Posters, available supplies, engaging patients, feedback
• Calculate hand hygiene %
- Unannounced observation of all teammates monthly
- Observe hand hygiene
• Monitoring Compliance
- Surveillance
- Missed opportunities & success
•Document on trending log
8When
ƒ
ƒ
ƒ
ƒ
8Frequency
8Inventory Utilization Review
8Observation
9
Assisting patients
Touching equipment, bedside rails, curtains, etc
After taking off and before donning new gloves
Before and after procedures
•QA Meeting – discuss corrective action plan
ƒ Quantitative (checklist/ scorecard)
ƒ Qualitative (Glo-germ)
10
11
12
ASDIN 8th Annual Scientific Meeting
NPSG.07.01.01 Hand Hygiene
Quarterly Surveillance
Infection Control
Personal Protective Equipment (PPE)
Infection Control – NPSG.07.05.01
Lifeline’s Surgical Site Infection (SSI) Surveillance
• Standard Precautions
- Routine Care that is provided to all patients
- Required when blood exposure may occur
• Quarterly - GLO-GERM
- Facility designee & manager responsibility
- Conduct quarterly
- Includes all teammates and physicians
- Demonstrates evidence of compliance with hand
hygiene
- Document results on the Hand Hygiene
Compliance Form
- Manager to maintained Compliance Form in the
in-service file
• NPSG.07.05.01 – Implement evidence-based practices for
preventing surgical site infections
- Components of the SSI Surveillance Program
8Safety/Infection Prevention Flip Chart
ƒ Coordinator presents to patient and family at registration
ƒ Attestation Form – review, Q&A, signature
ƒ Performed each visit
8Patient Self-reporting SSI survey – 30 day
ƒ Educate and present form to patient during nursing in-take
ƒ Highlight the 30-day date of requested return
848-72 Post Procedure Follow Up Calls
ƒ Triage assessment for S/Sx of infection
ƒ Remind patient to return 30-day surveillance form
81 Year Surveillance on Implantable Devices
ƒ Change made August 2011 related to catheters
• Gown
• Impervious barrier
• Mask
- Must be kept over nose
• Eye Protection
-
Goggles
Face Shields
Safety Glasses
Full-face Respirators
• Gloves
13
14
Equipment Reprocessing – Disinfection and
Sterilization
Injection Safety & Medication Handling
• Expiration Dates – 28 Day rule
Rubber Meets the Road – Disinfection and
Sterilization – cont.
• CRITICAL- objects which enter normally sterile tissue
or the vascular system or through which blood flows
should be sterile
- Surgical Instruments
- Cardiac Catheters
- Implants
EH Spaulding believed that how an object will be
disinfected depended on the object’s intended
use.
• High Alert & Look Alike/ Sound Alike Medications
- List, Designated, & Managed
• Scope of Practice
• Can anyone tell me what it means when an
object is defined as:
- State specifics for who can handle, administer, and how
medication is classified
- CRITICAL
- SEMICRITICAL
- NONCRITICAL
• Verification between nurse drawing medication and
qualified person who administers to the patient
- Great scrutiny on process & maintaining IC
- Visual and verbal verification required per JC
16
15
• Methods
- Steam
- Gas
- Hydrogen Peroxide Plasma
- Chemical Sterilization
17
18
ASDIN 8th Annual Scientific Meeting
Rubber Meets the Road – Disinfection and
Sterilization – cont.
Rubber Meets the Road – Disinfection and
Sterilization – cont.
Rubber Meets the Road – Disinfection and
Sterilization – cont.
• NONCRITICAL – objects that touch only intact skin
require low-level disinfection [LLD]
• SEMICRITICAL – objects that touch mucous membranes or skin that is
not intact require a disinfection process (high-level disinfection) that kills
all microorganisms but leaves high numbers of bacterial spores
- Respiratory Therapy and anesthesia equipment
- GI Endoscopes
- Thermometers
- Bedpans
- Crutches
- Bedrails
• Method
- High Level Disinfectant (HLD) (exposure time is important)
8Glutaraldehyde
8Hydrogen Peroxide
8Hydrogen Peroxide & peracetic acid
8Hypochlorite ( free chlorine)
8Glutaraldehyde and phenol/phenate
EKG leads
BP Cuff/Steth
Furniture
• Your Center
- What is used?
- How is it maintained?
- Who is responsible?
- What is their training & competency?
- Which BI’s are used? What if the test fails?
- How are reprocessed instruments tracked for IC
investigation?
Bedside Tables
Walls
Floors
• Method
- Low Level Disinfectant (exposure time is important)
8Ethyl or isopropyl alchol (70-90% concentration)
8Chlorine [100ppm] (1:500 dilution)
8Phenolic
8Iodophor
8Quaternary ammonium
19
20
Rubber Meets the Road – Disinfection and
Sterilization – cont.
Environmental Cleaning – LLD
• EPA- approved products
Rubber Meets the Road – Planning
• Common Surveyor Questions:
• What should the process be if a patient presents with
an open decubitis that you were unaware of prior to
appointment?
- What is the correct concentration of LLD to use
when cleaning up a blood spill?
- How do you mix to obtain that concentration?
- What is the correct concentration of LLD to use
when cleaning up a major blood spill?
- How do you mix to obtain that?
• Terminal Cleaning
- Policy
- When is it done?
- How documented?
• Staff knowledge
- Concentrations, dilutions, & how to mix
- Contact time for effectiveness
- Cutting corners
21
• When we transferred patient to the table, patient
wheelchair has evidence of bowel contamination,
what do we have to do?
• Should you accept patients that are known positive for
presence of a Drug Resistant Organism (DRO)?
• Adequate and Appropriate Supplies
• When should these patients be scheduled?
- Location of use for accessibility
• What process do you follow after treating a known
MRSA positive patient?
22
23
24
ASDIN 8th Annual Scientific Meeting
Infection Control
Oversight and Reporting
Waived Testing – Blood Glucose Monitoring
Most Frequently Cited Issues by JC
• Oversight
• Equipment
• Staff training
- Policies and Procedures
- IC Plan-review it with your team!
- Surveillance
- Training/ Education requirements
- Single or Multiple-patient use
- QA: prior to patient use
- Cleaning
• Staff
- Training & Competency
- Documentation
• Review of infections in QA
• Designee with signed job description on file
• Lack of evidence of surveillance
• Reporting
• Incorrect technique/ practice (DME)
- Internal: Surveillance reports (HH, SSI, Implantables)
8CQI activities
- External: Required reporting to government agencies in
some states (e.g., adverse events, HAI’s, Tb)
• Record of Care
- Noted reference range
- Physician order for intervention & treatment
25
• Expired medications/ supplies
26
Infection Control: Takeaways & Homework
Takeaways & Homework (cont’d)
• Risk Assessment
• Who is an appropriate deignee for Infection Control?
• A Plan for a Plan to implement a Plan
• Review the IC policies and training in your facility
27
Q&A
• Observe care in the facility
• Review infections - QA
• Assess where you stand today with compliance
• Testing & vaccination policies
• What will it take for you to start your journey?
• Reporting
Reference Materials and Resources:
• Observe, Observe, Observe
28
•
ASDIN: www.asdin.org (<Resources)
•
APIC: www.apic.org
•
CDC: www.cdc.org
29
30