IPAC IT: Infection Prevention and Control Information Transfer - - PowerPoint PPT Presentation

IPAC IT: Infection Prevention and Control Information Transfer

September 22, 2015

• Last season (2014-2015):

– Total cases = 1,378 (previous season 1,085)

• 1194 Influenza As (previous season 572)
• 182 Influenza Bs (previous season (513)

– Median age = 66 (previous season 40) – Hospitalizations = 563 (previous season 581) – Outbreaks = 57 (53 influenza A)

• Previous season = 23 (5 influenza A; 18 influenza B)

– Median staff influenza immunization rate:

• LTC = 82
• RH = 77

• Interactive workshop style
• New Outbreak Toolkit

– Available electronically at www.peelregion/cleanhands – Found in the “Outbreak Control” section

• Action cards & notepads
• Facilitators & microphones
• Group work & construction sound
• Prizes

Survey the Landscape

Outbreak Season Reflection

In your groups:

– Introduce yourself – Discuss:

• Challenges with outbreaks
• Successes/creative strategies
• Things you’ll do differently this outbreak season

– Use the flipchart & title it “Outbreak Reflection” – Include your table number for reference 10 Minutes

Group Discussion

Blueprint for Preventing Outbreaks

• Sept. 1 is start of the new season
• Over the last 5 years:
• Earliest influenza A case: Sept. 10
• Earliest respiratory outbreak: Sept. 3
• Public Health preparations include finalizing policy

changes, vaccine management, new directives, IPAC education

Planning for Outbreak Season

In your groups, answer:

– What do we need to do to prepare for outbreak season? – Consider:

• What needs to be done to prevent outbreaks?
• What can be prepared prior to an outbreak to better

manage one when it does occur?

– Title your flipchart “Pre-Outbreak Season Planning” & use it to record your thoughts 15 minutes

Planning for Outbreak Season

Find the Pre-Outbreak Season Planner in your toolbox.

Planning for Outbreak Season

It may be helpful to plan when you will start and finish each component!

Update and Review Policies and Procedures Education Antiviral Preparation Influenza Immunization Program Gather Tools Communicate

Planning for Outbreak Season

• Did anyone have any other activities that were

not listed?

• Post your flipcharts on the wall
• Update your action cards with great ideas

https://www.youtube.com/watch?v=2Mt8kPZG1oQ

Outbreak Checklist

• Outbreak season has arrived!
• Your blueprint is the OB checklist

– Open the envelope marked “Blueprint for Managing Outbreaks”

• This is a DRAFT – we need your feedback!
• Please use it throughout the day
• Evaluation on back
• Give us your feedback!
• Leave behind today

Rainbow Springs LTC

• Sept. 21, 2015

225 residents 6 units 200 staff

Laying the Foundation

Being Concrete in Case Identification

As a group:

– Use the weekend report & cut outs to decide who is a:

• Part of the cluster of symptomatic residents & staff
• Not related to the cluster

– Use the bristol board template* to separate residents and staff cut outs into the two groups above – Decide if you need to call Public Health * This represents the creation of an internal line list 10 minutes

Who would you put on your internal line list?

Being Concrete in Case Identification

Internal Line List (part of the cluster) Not part of the cluster

Hank Hammer (cough + nasal congestion) Nancy Nail (cough) Linda Level (cough + fever) Betty Bolt (cough) Alan Axe (cough & fever) Nurse Jackie (cough + fever) Paul Pliers (fatigue only) Sarah Shovel (chronic cough)

Would you call Public Health? What residents would you report?

Being Concrete in Case Identification

Outbreak Scenario

You have decided to call your Public Health Nurse to report the cluster of residents & staff with respiratory symptoms. You provide all the information to PHN Jane Wrench. She requests that you complete a Public Health Line List. Before completing a Public Health Line List, you collaborate with PHN Jane Wrench to develop a case definition.

Being Concrete in Case Identification

Case Definition: Two or more respiratory symptoms including fever, cough, and nasal congestion, on Sunnyside Unit on or after Sept. 19 Key elements: symptoms, unit, onset date Remember your case definition can change over time throughout the outbreak.

Being Concrete in Case Identification

Using the case definition:

Two or more respiratory symptoms including fever, cough, and nasal congestion, on Sunnyside Unit on or after Sept. 19

As a group:

• Determine who is a case, a possible case, not a
• case. Check off your choice on the cut-outs.

– Place each cut-out in the appropriate smaller envelopes (found in the large cut-out envelope) for use later today. 5 minutes

Being Concrete in Case Identification

It’s time to complete a Peel Public Health Line List

At your tables: – Open envelope marked “Line Lists”. – Each person complete a Line List for staff and resident cases – Notice some fields at the top have been completed for you – Fill out as much as you can with the information that has been provided on the cut-outs 15 minutes

Work Together!

Being Concrete in Case Identification

Demographics Onset date Symptoms Date precautions initiated Date of Flu vaccination

Being Concrete in Case Identification

Onset date & symptoms Name Work location & last date worked Date of flu vaccination

Being Concrete in Case Identification

Peel Public Health Line Lists:

• Always fill out as much information as you can
• Send your Line List daily (M-F) to Public Health even if

there are no changes

• Additional symptoms can be added. Do not remove

symptoms or cases once they have resolved

• These are ongoing lists (chronological order)
• For residents, complete one Line List per unit
• For staff, record all cases on one list

After completing the Peel Public Health Line Lists you fax them to your Public Health Nurse and call her back. Public Health Nurse Jane Wrench has reviewed your Line Lists. She confirms based on the MOHLTC respiratory outbreak definition that….

What do you think? Is your facility in outbreak?

Yes, the Sunnyside unit is in respiratory outbreak!

Peel Public Health On-Call Number: 905-799-7700 for reporting outbreaks on evenings, weekends and holidays

PHN Jane Wrench provides you with an outbreak number: 2253- 2015- 999. Together, you discuss what case to take a specimen from: – Decision: Linda Level and Alan Axe

• Take a minute to update your Public Health Line List

– Hint: The date is September 21, 2015

• Add: outbreak number, date outbreak declared and date of

specimen collection for Linda Level & Alan Axe

5 minutes

You have declared the outbreak on Sunnyside, what other outbreak interventions need to be put into place?

Don’t forget to update your action cards with great ideas!

Refer to the Outbreak Checklist

https://www.youtube.com/watch?v=FMMnJk2Ki5k

Recap from this Morning…

• Reflected on the past season
• Prepared for the upcoming outbreak season

(Pre-Outbreak Season Checklist)

• Looked at a tool to help manage outbreaks

(Outbreak Season Checklist)

• Classified cases, line list, case definition, and

declared an outbreak

Building Codes:

Requirements for the Perfect Specimen

Requirements for the Perfect Specimen

Outbreak Scenario:

September 22, 2015 at 9am: PHN Jane Wrench calls to inform you the Public Health Lab has found the following:

• Linda Level’s preliminary direct antigen test result is

negative for Influenza A and B

• Alan Axe’s specimen has been rejected

Requirements for the Perfect Specimen

In your groups:

– Open the envelope marked “Mr. Axe’s rejected specimen” – Review both the rejected specimen and requisition – Identify the reasons it was rejected (record answers on your notepads) 10 minutes

• What was wrong with the specimen?

– Specimen:

• Expired
• Name does not match requisition
• Missing date collected

– Requisition:

• Missing DOB
• Requisition did not have outbreak number
• No date of collection or onset date
• First name does not match specimen

Tool in toolbox: Respiratory Outbreaks – Specimen Collection Guide and Sample Respiratory Requisition

Requirements for the Perfect Specimen

Requirements for the Perfect Specimen

• Rejected specimen! What next?

– Submit a new specimen! – Consult with your Public Health Nurse to decide who would be best to take a specimen from

• Who should we choose?

– Have there been any new cases? – Any suspect cases become confirmed?

Requirements for the Perfect Specimen

Outbreak Scenario:

September 22, 2015, 10am Based on today’s surveillance, the charge nurse on Sunnyside reports that Betty Bolt has developed a fever. Since Betty is now a case, you ask the nurse to collect the new NP swab from her.

Specimen Labelling

After collection, you verify the specimen is labelled correctly, complete with:

• the correct name and
• date collected.

*If you would like to use a label with demographics, be sure not to cover the expiry date. The information must match the requisition.

Requirements for the Perfect Specimen

Name matches requisition Swab is not expired

Requirements for the Perfect Specimen

In your groups:

– Take a moment to update your line list & Betty’s cut out – Open the envelope “Blank Requisitions”. There is a new requisition for each person. – Complete a new requisition form for Betty Bolt’s specimen Note: The test required is: Respiratory Outbreak Panel.

15 minutes

Reminders: Date of collection is: September 22, 2015 Betty Bolt’s symptoms:

• Cough: Sept. 20, 2015
• Fever: Sept. 22, 2015

Requirements for the Perfect Specimen

• Line List:

– Add Betty to the Peel Public Health Line List

• Include: demographics, onset, symptoms, and dates

additional precautions initiated, flu vaccination and specimen collection

– What is her onset?

• September 20, 2015
• Update Betty’s Cut Out:

– Check “case” in the case status box

Requirements for the Perfect Specimen

All demographics match specimen Outbreak number & Peel Public Health information Highlighted information will be completed for you now Highlighted information will be completed for you now Date of collection &

• nset date

Requirements for the Perfect Specimen

Why are we aiming for the “perfect specimen”?

• Lab will only test 4 specimens per outbreak
• Determine the organism:
• length of additional precautions and the outbreak,
• if antiviral treatment and prophylaxis are available,
• Collection, storage and transport are all equally

important in creating the perfect specimen!

• Any discrepancies in these processes can lead to a

delay in antiviral treatment and prophylaxis

Requirements for the perfect specimen

Use our tools to help you!

Ordering Specimen Kits and Blue Bags

• Respiratory and enteric kits must be ordered from

Public Health Ontario Lab

• Order your own Blue Bag from the lab

– Be sure to label it with your facility’s name and address so it gets returned to your facility

Additional information in your toolbox: “Ordering Specimen Kits and Blue Bags” & Sample Ordering Requisition

September 22nd, 4pm:

PHN Jane Wrench calls you to report the lab has confirmed the following:

– Linda Level is positive for Influenza A – Betty Bolt’s specimen is positive on direct antigen test for Influenza A – Take a moment to update Linda & Betty’s cut-outs and the Line List

• Line List: Add positive result for Linda & Betty
• Cut-out: check the “Positive” check box on both

Site Safety: Using the Right Equipment (appropriate antiviral use)

Using the Right Equipment (appropriate antiviral use)

Outbreak Scenario:

Since Linda Level and Betty Bolt have laboratory confirmed influenza, PHN Jane Wrench has recommended to start antivirals on Sunnyside Unit. You must determine who gets antiviral treatment and prophylaxis.

Using the Right Equipment (appropriate antiviral use)

In your groups:

– Open the envelope labelled “Additional Cut-Outs” to find more people cut-outs – Use the two Bristol boards marked Resident & Staff Antivirals – Place each resident or staff cut-out in the correct quadrant of the Bristol board – Use the antiviral algorithm in your toolbox if needed – If you have additional time, update your line list

20 Minutes

Site Safety: Using the right equipment (appropriate antiviral use)

Resident Answers

Residents – No Antivirals

Nancy Nail (symptomatic, does not live on OB unit, does not meet case defintiion )

Residents – Antiviral Prophylaxis Only Residents – Antiviral Treatment followed by Antiviral Prophylaxis

Paul Pliers (lives on unit, not a case) Sarah Shovel (lives on OB unit, not a case) Hank Hammer (case , onset within 48 hours, not lab confirmed) Residents – Consult the Physician Regarding Treatment

Residents - Antiviral Treatment Only

Alan Axe (case, onset greater than 48 hours) Linda Level (lab confirmed) Betty Bolt (lab confirmed)

Site Safety: Using the right equipment (appropriate antiviral use)

Staff Answers

Staff – Can Continue to Work As Usual No Antivirals Required Staff– Must take Antiviral Prophylaxis to Continue to Work

Charge Nurse Cindy (does not work on the Outbreak Unit) RPN Joe (not vaccinated, willing to take prophylaxis)

Staff – Must be Redeployed to Continue Working during the Outbreak

Staff – Excluded from Work for 5 days

Therapist Bob (unvaccinated & unable to take antiviral prophylaxis – must wait 72 hours since last worked on Sunnyside unit before working in other areas of the home) Nurse Jackie (a staff case)

Site Safety: Using the right equipment (appropriate antiviral use)

Key Concepts with Antiviral Use in Residents:

– All non-cases (do not meet case definition) in outbreak area receive prophylactic dose – Treatment for cases is at the discretion of the physician. – Public Health guidance for cases (residents that meet the case definition) related to treatment: 1. If results are received within 48 hours of case onset, provide treatment for 5 days. 2. If results received greater then 48 hours, physician to determine if they should be treated based on clinical presentation. 3. Lab confirmed cases: Antiviral treatment for 5 days only (no prophylaxis after) 4. Cases without lab confirmation: Antiviral treatment followed by prophylaxis until the outbreak is declared over.

Site Safety: Using the right equipment (appropriate antiviral use)

Key Concepts with Antiviral Use in Staff:

• Unit specific outbreak:

– Antiviral prophylaxis for all unimmunized staff on outbreak unit* – Unimmunized staff unwilling to take prophylaxis can be redeployed to another unit after 72 hours without developing symptoms or excluded from work depending on the policy of the facility.

• Facility-wide outbreak:

– Antiviral prophylaxis for all unimmunized staff in the facility – Unimmunized staff unwilling to take prophylaxis may be excluded from work at the discretion of the LTCH

• Working at other facilities:

– Unimmunized staff not taking prophylaxis can work in another healthcare setting if three or more days have past since their last day

• f activities in the outbreak facility.

*Vaccine is well matched to circulating strain

September 24, 2015; 9:30am: During the Outbreak Management meeting, the charge nurse from Sunnyside unit reports some cases are no longer symptomatic. She asks what cases can be taken off additional precautions:

September 24, 2015; 10am:

You return to your office after the Outbreak Management meeting and your phone rings. Charge nurse Cindy on Cloudy unit reports two residents have developed cough and fever

• vernight. What are your next actions?

– Call PPH to report the additional cases on a new unit – Modify the case definition – Start a new line list for cloudy unit – Declare a facility-wide outbreak and start prophylaxis throughout the whole facility

https://www.youtube.com/watch?v=7-fBEJ-0k5I

Trades Collaboration: Working Together for Repatriation

Outbreak Scenario:

• Mrs. Linda Level (a case from the outbreak on Sunnyside Unit)

was sent to hospital during the outbreak, but is now ready to return home.

• Mrs. Wrench (not a case but lives on Sunnyside Unit) went to the

hospital before the outbreak for hip surgery, is also ready to return home from hospital

• Mr. Drill is a new admission needing a bed in Sunnyside Unit

Who can be repatriated?

Working Together for Repatriation

Repatriation During Outbreaks

• Hospital notifies LTCH of discharge readiness
• LTCH determines if resident is on outbreak line

list

• If yes, proceed with repatriation
• If no, hospital, LTCH and Public Health discuss the

situation and relevant factors to determine if the resident can be repatriated

Working Together for Repatriation

Who can be repatriated back?

• Mrs. Level is a case from the outbreak, and can be repatriated
• Mr. Drill is a new admission – Sunnyside Unit would be closed

to admissions during this outbreak

• Mrs. Wrench is not a case, but lives in Sunnyside Unit –

repatriation is not recommend while the outbreak continues; however on rare occasions it may be considered depending on:

• Outbreak status/organism (e.g. how late in the outbreak, how many

symptomatic residents)

• Health status of resident
• Vaccination status and vaccine match
• Consent of physician, resident/substitute decision maker
• Demand by the resident/family
• IPAC measures (e.g. cohorting, antivirals)
• If they can be accommodated (e.g. private room)

Working Together for Repatriation

Further discussion – MOHTLC Provincial Webinar September 29, 2015

www.oha.com Top toolbar: Education Select Event Directory

Working Together for Repatriation

Questions?

Declare the Outbreak Over!

October 10, 2015. All residents and staff have recovered and it has been eight days with no new resident cases. You fax in your final line lists (Sunnyside unit, Cloudy unit & staff) to PHN Jane Wrench. Jane confirms your outbreak is now over!

Take 5 minutes to put your final comments on the OB

• checklist. Consider the following:
• Today’s outbreak scenario
• You and your facility’s experiences with outbreaks

5 minutes

• Please take some time to fill out the IPAC IT

Evaluation found in your toolbox

• Final prize draw

Thank you!

***New Toolkit posted @ www.peelregion.ca/cleanhands***