WI Re energizing Clostridium difficile Infection(CDI) Webinar - - PDF document

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WI Re‐energizing Clostridium difficile Infection(CDI) Webinar

January 26, 2016 Presented by DeAnn Richards, MetaStar and Jill Hanson, WHA

Objectives for Today

• Wisconsin’s CDI plan for 2016
• Link between CDI and Antimicrobial Stewardship
• Review the CDC Targeted Assessment for Prevention (TAP)

tool

• Highlight best practices of top performers in CDI reduction

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Wisconsin’s Plan for 2016

• Based upon Standard Incidence Ratio across the state, facilities with

the greatest needs will be offered an opportunity to attend a co‐ sponsored CDI workshop on April 12, 2016.

• Encouraging all facilities to enhance their organizations antibiotic

stewardship efforts.

• Provide tools for the organization to utilize.

Developing CDI Toolkit & Resources

WHA/MetaStar are working to enhance:

• CDI Facility TAP assessment tool
• Capture and share best practices
• Identify barriers to expanding CDI prevention beyond

Infection Prevention

• Electronic resources to meet facilities needs
• Review how to run a NHSN TAP report for CDI

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Poll Question 1

What are your greatest needs related to CDI?

• Testing sequence and interpretation
• Tracking tool for retrospective review of cases to try to pinpoint a

cause/issues

• Hand hygiene compliance
• Environmental cleaning and disinfection
• Isolation initiation and maintenance
• Antibiotic stewardship
• Other
• I am not sure yet

Evaluate Existing Processes for CDI

Do your policies/procedures/protocols ensure accuracy, completeness, and usability:

• Are staff aware of CDI protocols of when testing should be

requested?

• Are staff aware of isolation protocols if CDI is suspected or

confirmed?

• Is isolation correctly identified on the patient room, chart,

and EMR?

• Are staff aware of hand hygiene requirements if CDI is

suspected or confirmed?

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Evaluate Existing Processes for CDI

• Are staff aware of cleaning requirements if CDI is

suspected or confirmed?

• How are staff are aware of patients with suspected or

confirmed CDI?

• Are patients, families, and visitors of potential or

confirmed CDI patients provided education on how to prevent transmission?

Defined Roles for Staff

Nurse‐initiated actions:

• Assess patient
• Determine potential reasons for diarrhea
• Inform physician that patient has

diarrhea as well as assessment and any potential reasons.

• Follow through on any orders provided.
• Initiate contact (or facility specific)

isolation precautions

• Document isolation in EMR
• Validate receiving departments are aware
• f the need for isolation precautions.

Physician‐initiated actions:

• Assess patient
• Determine potential reasons for diarrhea
• Evaluate for CDI
• Order appropriate laboratory tests
• Validate appropriate isolation precautions

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Let’s Talk Stool – Bristol Stool Chart

If your facility does not have a ready reference for staff to have a visual reference for charting, we encourage you to modify adding when to initiate isolation and contact for stool testing – the sign from our website, laminate, and post on the units. Let’s all talk the same language.

Cool Stool Tool

https://www.lsqin.org/initiatives/hai/

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Cool Stool Tool

https://www.youtube.com/watch?v=b‐iOgv7uEsU&list=PL5ITOxWOe7JqcSZ‐UfgBRg8Bui1lfahKS&index=21

CDI Test Type

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CDI Test Type Patient Education

• Share information regarding CDI and its transmission

with patients and families

• Instruct patients and families on hand hygiene and

personal hygiene

• Instruct patients and families regarding the

importance of daily bathing and clean garments, providing assistance as needed

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Administrative Support

• Share CDI rates and infection prevention interventions

with senior leadership

• Include senior leadership in communications

regarding adherence monitoring

• Communicate expectation of support and

accountability regarding prevention activities to key leadership and provide concrete examples of ways they can support infection prevention

Antimicrobial Stewardship and CDI

• Antibiotic exposure is the single most important risk

factor

• 2014 meta‐analysis on the impact of ASP on CDI

included 16 studies and found that ASP were significantly protective against CDI.

• Up to 85% of patients have had antibiotic exposures

in the 28 days before infection

• The 75% of pediatric CDI were found to have recent

antibiotics prescribed in outpatient settings

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Antimicrobial Stewardship Strategies

Dispensing Antimicrobial

Computer‐assisted Strategies Review and Feedback

Prescription Ordering

Computer‐assisted Strategies

Choice of Antibiotic

Education/Guideline for Staff & Patients Formulary Restriction and Pre‐Authorization

Patient Evaluation

Education/Guideline for Staff & Patients

Antimicrobial Stewardship Program (ASP)

• Primary goal is to improve patient safety.
• Reducing antibiotic use and saving $ are not the primary goals.
• Ensuring that every patient receives the right agent, right purpose,

right dose, for the right duration

• Monitors and evaluates antimicrobial use
• Feedback mechanism to medical staff and leadership

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Team Members for ASP

Antimicrobial Stewardship Program (ASP)

Infection Control Department Pharmacy Microbiology Infectious Disease Division Hospital Leadership Patient Safety P & T Committee Director, Information Systems

Do you know where your facility is compared to the Nation and State?

Data Is Knowledge

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Poll Question 2

Where does your facility fall for CDI (check all that apply)?

• We are below National SIR
• We are above National SIR
• We are below Wisconsin SIR
• We are above Wisconsin SIR
• I have no idea, but I do want to find out
• I am not sure where to find the National or State comparison

Targeted Assessment for Prevention (TAP) Report

What Is a NHSN Targeted Assessment for Prevention (TAP) Report?

• Allows ranking of location to ID and target area of greatest need for

improvement.

• Can be ran for CLABSI, CAUTI, and CDI LabID
• Will provide a facility cumulative attributable difference (CAD) which

is the number of infections which must be prevented to achieve a reduction assuming no changes to the population at risk since the time period of the report.

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NHSN NHSN TA TAP Re Report NHSN NHSN TA TAP Re Report

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NHSN NHSN TA TAP Re Report NHSN NHSN TA TAP Re Report

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NHSN NHSN TA TAP Re Report NHSN NHSN TA TAP Re Report

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TAP Report Cheat Sheet

https://www.lsqin.org/initiatives/hai/

Comparison of Known Data

National Standardized Infection Ratio (SIR) is 0.904 1st Quarter 2014 to 2nd Quarter 2015 WI had:

• 2364 HO Lab ID events
• 2523 were expected
• Group CAD was 83
• SIR 0.94

WI SIR 1st Quarter 2015 – 1.03 2nd Quarter 2015 – 1.00 3rd Quarter 2015 – 0.92

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Upcoming Webinars

How to Positively Influence Individuals to Participate in HAI Prevention Webinar January 28 from 1 to 2 p.m.

Registration link: https://qualitynet.webex.com

Hand Hygiene – Still King of the Hill Webinar February 25 from 1 to 2 p.m.

Registration link: https://qualitynet.webex.com

2016 CDI Educational Offerings

Dates Tues, Apr 26 10 am Tues, Jul 26 10 am Tues, Oct 25 10 am Topics Best Practice Showcase Best Practice Showcase Best Practice Showcase

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Resources

• Link to MetaStar – will already be highlighted during presentation but

is at https://www.lsqin.org/initiatives/hai/

• Link to WHA – TAP cheat sheet & Bristol stool tool

Any Questions?

Thank you for attending  DeAnn Richards (drichard@metastar.com) Jill Hanson (jhanson@wha.org)

This material was prepared in part by the Lake Superior Quality Innovation Network, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The materials do not necessarily reflect CMS policy. 11SOW‐MN‐C1‐16‐07 012516