Infection Prevention Boot Camp I for the Novice January 16 ‐ 17, 2020 Infection Preventionist 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 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 1
Infection Prevention Boot Camp I for the Novice January 16 ‐ 17, 2020 Infection Preventionist Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 2
Infection Prevention Boot Camp I for the Novice January 16 ‐ 17, 2020 Infection Preventionist 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 on care. Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 3
Infection Prevention Boot Camp I for the Novice January 16 ‐ 17, 2020 Infection Preventionist Performing a IC Risk Assessment Leadership Identify Risk Targets For Analysis Determine Goals •Local Community Strategies •Organizational Evaluation •Societal Process Risk Involve Others Assessment Establish Priorities Cycle Qualitative or •ICC Quantitative •Leadership •Key Staff •Health Dept Perform Develop Methods Assessment •Quantitative •Qualitative Establish •SWOT Priorities Templates •Gap Analysis Establish Timelines 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? Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 4
Infection Prevention Boot Camp I for the Novice January 16 ‐ 17, 2020 Infection Preventionist 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 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 5
Infection Prevention Boot Camp I for the Novice January 16 ‐ 17, 2020 Infection Preventionist 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 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 6
Infection Prevention Boot Camp I for the Novice January 16 ‐ 17, 2020 Infection Preventionist 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 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 7
Infection Prevention Boot Camp I for the Novice January 16 ‐ 17, 2020 Infection Preventionist Sample Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 8
Infection Prevention Boot Camp I for the Novice January 16 ‐ 17, 2020 Infection Preventionist Hand Hygiene Ignaz Semmelweis, 1815-1865 • 1840’s: General 16 Hospital of Vienna Maternal mortality, 1842 14 12 • Divided into two clinics, 10 alternating admissions 8 6 every 24 hours: 4 2 – First Clinic: Doctors 0 First Clinic Second and medical students Clinic – Second Clinic: Midwives Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 9
Infection Prevention Boot Camp I for the Novice January 16 ‐ 17, 2020 Infection Preventionist Hand Hygiene: Not a New Concept Maternal Mortality due to Postpartum Infection General Hospital, Vienna, Austria, 1841-1850 18 Semmelweis’ Hand Maternal Mortality (%) 16 Hygiene Intervention 14 12 10 8 6 4 2 0 1841 1842 1843 1844 1845 1946 1847 1848 1849 1850 MDs Midwives ~ Hand antisepsis reduces the frequency of patient infections ~ Adapted from: Hosp Epidemiol Infect Control, 2 nd Edition, 1999. Literature Findings Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 10
Infection Prevention Boot Camp I for the Novice January 16 ‐ 17, 2020 Infection Preventionist Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 11
Infection Prevention Boot Camp I for the Novice January 16 ‐ 17, 2020 Infection Preventionist 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 BR1 Start the hammer 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 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 12
Slide 34 BR1 Barbara Russell, 1/10/2020
Infection Prevention Boot Camp I for the Novice January 16 ‐ 17, 2020 Infection Preventionist 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 Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 13
Infection Prevention Boot Camp I for the Novice January 16 ‐ 17, 2020 Infection Preventionist UC insertion and maintenance Central line Prevention of insertion and MDRO Maintenance Hand Hygiene Prevention of diarrheal Surgical scrub outbreaks Prevention of c difficile 40 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 organisms 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. Florida Hospital Association | Mission to Care Hospital Improvement Innovation Network 14
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