Objectives Discuss the basic elements of an effective infection - - PDF document

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 1

Elements of an Effective Program

Linda R. Greene, RN, MPS,CIC, FAPIC Manager, Infection Prevention UR Highland Hospital Rochester, NY linda_greene@urmc.rochester.edu Barbara Russell, MPH, BS, RN, CIC, FAPIC Consultant BarbararRussell627@gmail.com

Objectives

 Discuss the basic elements of an effective infection

prevention program

 Describe how to conduct a risk assessment  Identify key strategies related to improving hand

hygiene

 Explain surveillance essentials

Let’s Start at the Beginning

Why do a risk assessment ? Types of Risk assessment – annual Targeted – new procedures, equipment, guidelines

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 2

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 3

Why do a Risk Assessment ?

In order to set priorities, we must first assess the current status Mandated by regulatory and accrediting agencies Should be considered in all patient care settings

What is a Risk Assessment

This is a process that examines recognized and potential risks for acquiring and transmitting infections in a healthcare system. It identifies evidence-based measures to reduce these risks. It prioritizes risk based upon the potential or actual impact

• n care.

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 4

Performing a IC Risk Assessment

Identify Risk Targets For Analysis

• Local Community
• Organizational
• Societal

Involve Others

• ICC
• Leadership
• Key Staff
• Health Dept

Develop Methods

• Quantitative
• Qualitative
• SWOT
• Gap Analysis

Perform Assessment Establish Priorities Templates Establish Timelines Establish Priorities Qualitative or Quantitative Determine Goals Strategies Evaluation Process

Risk Assessment Cycle

Leadership

Consider This



Some risks are common in all healthcare settings



Others occur in special settings

 The risk assessment takes into account:

• Geographic location
• Care and services offered
• Population served

Check List

 What age patients do you see?  What services are provided?  Does site see a varied population?  What procedures and treatments do you perform?

Endoscopy? Vaginal ultrasound? Minor suturing?

 Do you do any sterilization or high level disinfection?

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 5

Applying the Definition

Example – Tuberculosis Population- Small rural hospital in Montana Community cases past 2 years – none Risk ? Example- Finland

Components of a Risk Assessment

Populations served- identify the demographics of the population Consider Age Immune Status Race and ethnicity Special non immunized populations ie. Amish

Services Provided

Long Term Care- Ventilator, Rehab Inpatient vs. Outpatient Cancer Care Medical and Surgical Special Services

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 6

Procedures Performed

Surgical Procedures High Risk, High Volume, Problem Prone Endoscopy, Interventional Radiology

Geographic Location

Texas vs. Montana NYC vs. Olean, NY

Surveillance Data

C Difficle Rates MRSA Surgical Site Infections ESBL Central Line Bloodstream Infections Urinary Tract infections

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 7

New Procedures or Devices

Consider the Learning curve

Examples : Robotic surgery ,

Other Types

 Legionella Risk assessment  Fans in patient rooms  Construction

Disease and Conditions In the Community

TB Legionella Meningitis Community-Acquired MRSA Listeria Hepatitis A

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 8

Sample

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 9

Hand Hygiene

Ignaz Semmelweis, 1815-1865

• 1840’s: General

Hospital of Vienna

• Divided into two clinics,

alternating admissions every 24 hours:

– First Clinic: Doctors and medical students – Second Clinic: Midwives

2 4 6 8 10 12 14 16 Maternal mortality, 1842 First Clinic Second Clinic

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 10

Hand Hygiene: Not a New Concept

Maternal Mortality due to Postpartum Infection General Hospital, Vienna, Austria, 1841-1850

2 4 6 8 10 12 14 16 18 1841 1842 1843 1844 1845 1946 1847 1848 1849 1850

Maternal Mortality (%)

MDs Midwives

Semmelweis’ Hand Hygiene Intervention

~ Hand antisepsis reduces the frequency of patient infections ~

Adapted from: Hosp Epidemiol Infect Control, 2nd Edition, 1999.

Literature Findings

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 11

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 12

Face to Face interviews with 13 senior managers at a large university hospital Seven distinct themes:



Culture change starts with leaders



Refresh and Renew the message



Connect the 5 moments to the whole patient journey



Actionable audit results



Empower patients



Reconceptualize non compliance



Start the hammer

BR1

Participants All affiliated nurses of the nursing wards. Wards were randomly assigned to either the team and leaders-directed strategy (30 wards) or the state-of-the-art strategy (37 wards). Methods The control arm received a state-of-the-art strategy including education, reminders, feedback and targeting adequate products and facilities. The experimental group received all elements of the state-of- the-art strategy supplemented with interventions based on social influence and leadership, comprising specific team and leaders-directed activities. Strategies were delivered during a period of six months Results 10,785 opportunities for appropriate hand hygiene in 2733 nurses. The compliance in the state-of-the-art group increased from 23% to 42% in the short term and to 46% in the long run. The hand hygiene compliance in the team and leaders-directed group improved from 20% to 53% in the short term and remained 53% in the long run. The difference between both strategies showed an Odds Ratio of 1.64 (95% CI 1.33–2.02) in favor of the team and leaders-directed strategy. Conclusions Our results support the added value of social influence and enhanced leadership in hand hygiene improvement strategies. The methodology of the latter also seems promising for improving team performance with other patient safety issues

Slide 34 BR1

Barbara Russell, 1/10/2020

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 13

Wash Your Hands

 With alcohol-based hand rub:  When???

Five Moments for Hand Hygiene

 World Health Organization:  1. Before touching a patient  2. Before aseptic/clean procedure  3. After body fluid exposure risk  4. After touching a patient  5. After touching patient surroundings

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 14 40

Hand Hygiene

UC insertion and maintenance

Prevention of MDRO Surgical scrub

Prevention

• f c difficile

Prevention

• f diarrheal
• utbreaks

Central line insertion and Maintenance

FACTS ABOUT ALCOHOL BASED HAND SANITIZERS

 Everyone should know the truth about hand hygiene and alcohol-

based hand sanitizer:

 Alcohol-based hand sanitizer kills most of the bad germs that

make you sick and is the preferred way to clean your hands in healthcare settings.

 Alcohol-based hand sanitizer does not kill C. difficile or

rotovirus are common community and healthcare-associated infection that causes severe diarrhea. Patients with these

• rganisms should wash their hands with soap and water and

make sure their healthcare providers always wear gloves when caring for them.

 Alcohol-based hand sanitizer is more effective and less drying

than using soap and water, and does not create antibiotic- resistant superbugs.

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 15

WASH YOUR HANDS!!

 With Soap and Water:  When?

Hands are visibly soiled After any contact with

• C. diff or Rotovirus

After using the restroom

 Compliance  Measurement

Measurement

 Direct observation  Product use  Electronic systems

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 16

Engaging Patients Discussion

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 17

Surveillance Prioritize

Assess the Population and determine those at greatest risk Examples: Select surgical Site Infections Pneumonia Patients ICU Patients

Determine the Type of Surveillance

Process vs. Outcome

• Outcome – Healthcare acquired Infections
• Process- Patient Care Practices aimed at preventing

HAI’S

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 18

Utilize Standardized Definitions

Process Identify the process to be measured Identify the methodology for collection Outcome Utilize standard definitions- generally accepted, published i.e. NHSN

Standardized Criteria

Needed to :

• Identify an event
• Monitor trends over time
• Compare rates between groups

Select Appropriate Denominator Data

Outcome – Device days Process- Compliance rates Immunization rates

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 19

Advantages to Process Indicators

Work well in long term care and outpatient setting [ Infection rate vs. Immunization rate]

Process Indicators

Methods to collect data Observation vs. Chart Review

Give examples of process indicators

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 20

Difficulty with Process Indicators

Reliability / Inter-rater reliability Difficulty with observing processes If measuring by documentation – may not adequately reflect the care provided i.e. Surgical prophylaxis

Regulatory/ Accrediting Agencies Frequently use Process Indicators



State Dept. of Health



Joint Commission, DNV



CMS Observations

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 21

When all else Fails

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 22

You have to be Kidding! Data Reporting Spreading the Message to Key Stakeholders Communication

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 23

Data Dissemination

Unit-Based Reporting on Process and Outcome Metrics

Data Display

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 24 70

Why is Education Important?

 Evolving and emerging best practices  Attention to basics erode over time  IP no longer the “Cinderella” program

“Teaching can occur without learning and learning can occur without teaching”

anonymous

The IP as Content Expert

 A crucial part of our role:

 Develop, facilitate, evaluate teaching and learning  Create an environment for participation and interaction  Stimulate reflective and critical thinking to promote good

practice

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 25

Opportunities abound

National conferences State and local conferences Annual competencies Special topics of interest: H1N1, NPSGs Grand rounds Orientation APIC webinars CDC, OSHA, WHO, etc

Orientation

 Diverse backgrounds and educational levels  Info overload

Focus on 1-3 key objectives Provide handouts & contact info Prepare questions to engage group Be creative (games, costumes, music)

Why do we educate HCPs? To improve job skills and competencies.

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 26

What is Learning?

“Learning is a persistent change in performance that results from experience and interaction with the world”

Driscoll 2000

Rapid change (regulatory, technology) Info overload Staff turnover Message not tailored to audience

Barriers to Effective Education

Welcome to 2020!

Basic Theory of Learning

Receive a stimulus:

experiencing (concrete) vs. thinking (abstract) Then

Process information gained:

experimentation (active) or reflection (passive)

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 27

Malcolm Knowles

Andragogy study of adult learning Pedagogy study of how children learn a continuum of learning HCPs must pursue a lifetime of learning

Pedagogy vs. Andragogy

Learning Styles

Kolb 1980s

 Activists- hands on/role playing/games  Reflectors-watch AV/discussion  Theorists- complex situations/problem

solving

 Pragmatists -practical situations with goals

DON’T PIGEON HOLE!

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 28

Sit up front Take notes Repeat verbal directions Graphic illustrations

Visual Learners

Lecture Group discussion Oral reports

Auditory Learners

Hands on experience Gestures to make a point Role playing Frequent breaks “just do it”

Kinesthetic Learners

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 29

Adult learners are self directed.

Who Are Adult Learners?

 Adult learners are unique.

Their readiness to learn is affected by their need to know

• r do something.

Infection Prevention Boot Camp I for the Novice Infection Preventionist January 16‐17, 2020 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 30

Adult learners can get BORED EASILY!

Must be relevant to content Not sarcastic Relieves tension and breaks the ice Increases motivation, interest, comprehension Can bridge cultural gap….or not

Humor as a Tool Hand Hygiene