Managing Infection Control Off the side of your desk Avril Taylor - - - PowerPoint PPT Presentation

Managing Infection Control

“Off the side of your desk”

Avril Taylor - DOC Fraserview Intermediate Care Mary Vachon – ICP Good Samaritan Society

PPE

LTC Infections

• MRSA (stats doubled between 1999-2006)
• VRE (stats tripled in same time frame)
• This generation of clients/residents come with

more resistance to antibiotics and more susceptible to C-Diff

Contributing Factors in LTC

• Sharing of rooms
• Progressive stages of Dementia in clients

(compliance)

• Decreased ability to cohort (wandering)
• Many liaisons wear many hats

Task Force Results (PICNET 2008)

• 188 facilities were invited to participate in survey
• 86/188 (46%) responded to the survey
• 68/188 (36%) Completed the survey fully
• 58% no physician support for infection related

issues

• 18% had no ICP support
• 25% had no access to infection control

committees

Infection Control Gaps in LTC

• No designated facility IC champion/liaison
• Decreased physician support onsite
• Access to Infectious Disease physicians
• Communication breakdown between

community, acute care and LTC.

• Lack of regular HH audits

Gaps cont

• Many facilities have liaisons that are

responsible for other daily activities

• Wound nurse
• Care coordinators
• Some facilities may have managers not medically or

healthcare trained.

Gaps Cont

• Little communication regarding the actual

costs that infections and outbreaks have on facilities

• Prevention is difficult to put a price tag on

when doing annual budgets.

• “Winging it” can cause an increase in

Healthcare Dollars.

• Do staff know what they are looking for?

Doctoring by Fax

• Eg. UTI’s
• samples are sent before other measures are started.
• Can be a contributing factor to ARO’s

If you’re contagious, fax us your symptoms, and Dr. Seus will e-mail his diagnosis.

Day to Day

• If no ICP as a resource, manager or the nurse of the day, becomes

the “Stand in ICP”

• These “stand in’s” may not have infection control specific education
• Rashes, diarrhea, respiratory illness get reported, but investigations

maybe done but with less priority if wearing many hats

• Frontline staff could be trained to do the investigations or outbreak

management but…

• Line lists drive recommendations made by the MHO

Day to Day

• Frontline staff are rushed
• Rescue Me
• Limited time to review policies and do

Paperwork.

Hand Hygiene

• HH audits is a priority but can be a challenge
• Staff perceive they do not have time to do it

for the required amount of time

• Need to be creative to audit all shifts.

Excuses for Improper HH

• Supplies at point of care.
• Dry Skin or Occupational Dermatitis
• Feel ABHS is more drying (untrue)
• May not have immediate access to lotions
• Use gloves as a substitute
• Take short cuts when rushed

Staff Education

• Education becomes a “fringe benefit” with

budget cuts.

• Education becomes very focused
• Education competes with posters, email,

internet.

Education cont

• Education has to be kept short, to the point.
• The need to knows, rather than the nice to knows. (No

puff and fluff)

• Frontline staff feel they cannot take time away

from caring for the clients/residents.

• Be creative with education

Education cont

• Education has to be fun and with a reward

attached (pizza, lunch, prizes)

• Staff attendance is dependant on staffing

levels.

• Education has to be supported from the top

down

• Many adult learners are visual/demo learners

which is more time consuming.

Off the side of the desk

• Armed and Aware!
• provincial, region, health authority and national

guidelines

• Very difficult if there are other priorities
• We refresh our memories during the crisis situation
• Health Authority Websites

Off the side of your desk

• Some websites are not user friendly
• If you wear many hats
• Who do you call if you have not had the time to

network?

• Use it or Loose it
• Information overload.

Disseminating info

• To the Frontline staff

– Where is the best place to hang a memo???

Outbreak Management

• Be proactive not reactive
• Reliance on our external experts
• Public Health
• Licensing
• MHO office
• Support Service Managers

Outbreak cont

• Multi-hat ICP’s
• Be prepared and well organized
• The line lists

– How reliable are these lists – Often need to review them before sending.

Line list challenges

• The ICP has to be aware of statements staff

use when assessing the outbreak

• Need to coach staff to provide definitive

information

• The ICP must also have a rehearsed script
• Getting definitive information can be difficult

Outbreak Cont

• You will need the Flexibility to address issues

that are a result of staff shortages while minimizing the spread of infections.

Case Scenario

A confirmed Norovirus outbreak called in an affiliate facility of a Health Authority.

• 30 residents
• 31 staff off sick
• Stat holiday
• Site nurse claims limited outbreak experience
• Next day new shift
• Little communication from previous shift
• Line lists confusing

Keys points outbreak management

• Education of staff daily
• Review of line lists
• Assisting with priorizing
• Morning outbreak meetings and

reinforcement

• Arranging a debriefing

Debriefing

• Estimated costs:

– $30,000

• majority of that being staff sick time utilized/overtime.
• WCB claims for those that contracted the disease on site
• Supplies
• Travel cost to the site

– Approx $500.00/sample (courier to Vancouver.) – Does not include the loss of resident quality of life.

» Lack of visitors » Isolation » Deaths

Debriefing cont

• GET EVERYONE INVOLVED
• Identify areas for improvement
• Debriefing does not need to be lengthy

Being an Effective ICP

• Basic education
• Basic ICP Course is a must
• Orientate with a regional ICP
• Know your resources/contact numbers
• Link with community organizations.
• Attend conferences
• Network with Regional Health Authorities, CHICA

Chapters, and PICNET.

Support Needs for the ICP

• Up to date policies supporting infection

prevention and control

• Get involved in development of policies.
• A mentor that has their CIC certification.

TIPS of the TRADE

• A good sturdy desk
• Be Proactive, avoid reactive
• Consistency with follow up
• Be well Organized
• Be able to Juggle the world
• Educate yourself and network with others.
• Ask for help!

Questions?