So where do we go wrong?

Transcription

1 GI Suite Cmpliance Review S where d we g wrng? Presented by: Tim Muller Sr. Manager, Clinical Technlgies Octber 16, 2014 The individual respnsibility fr prtecting patients frm infectin isn t new it s always been at the cre f healthcare practice The funders f the prfessins f medicine and nursing stressed the essential need fr patient safety: Primum nn ncere - (First, d n harm) riginated frm the writings f Hippcrates, the father f medicine, where he said: As t diseases, make a habit f tw things t help, r at least t d n harm. Cmplacency: A feeling f cntentment r selfsatisfactin, especially when cupled with an unawareness f danger, truble, r cntrversy Healthcare wrkers MAY see bvius harm when it ccurs but mre ften than nt staff d nt see the near misses and this feeds the cmplacency

2 Cmplacency prevents us frm seeing: Surces f harm Near misses Ourselves as surces f harm What else are we up against? Emerging & New Technlgies are excellent fr advancing ur diagnstic and therapeutic ptins BUT cmplexity f healthcare interventins = risk f persnal failures that can harm patients GI Autmatin in cleaning, disinfectin & sterilizatin as well as mre cmplex medical devices intrduce tremendus training & cmpetency requirements If yu are ging t autmate it... There has t be smene t run it I hear yu but is it really a prblem? Why des Dr. Jnes still d brnchscpy prcedures in a rm that has n negative air exchange n a TB psitive patient? Why des nurse Betty still nt wear PPE r a face shield when assisting fr endscpy prcedures? Why des technician Bb still nt d a prper leak test prir t disinfectin r use glves when handling disinfected instruments? Why are cntaminated instruments nt labeled and transprted prperly t decntaminatin? Human factrs Intense wrklads Cntinuing high prcedure cunts Staff fatigue & shrtage f staff Length f time emplyed & practicing in a given psitin Cmpliance with hand washing, unifrm and hygiene equipment safety & surface disinfectin

3 Hspital Acquired Infectin (HAI) r Nscmial infectins Infectin acquired in hspital where the patient was admitted fr reasns ther than the infectin HAI s are amng the leading causes f death in Canada Mre than 200,000 patients get infectins every year while receiving healthcare in Canada; mre than 8,000 f these patients die as a result Each persn wrking in healthcare, whether it be in a clinical r nn-clinical rle, is respnsible fr taking active measures t minimize the risk f HCAI by mdifying ingrained behavirs and t break the chain f infectin Hspital Acquired Infectins (HAI s) The rate f preventable healthcare-assciated infectins (HCAI) is unacceptable and it must be reduced hwever and whatever it takes: Mrtality rates attributable t Clstridium difficile infectin have mre than tripled in Canada since 1997 The healthcare-assciated methicillin-resistant Staphylcccus aureus infectin rate increased mre than 1,000% frm 1995 t 2009 Abut 80% f cmmn infectins are spread by healthcare wrkers, patients and visitrs Prper hand hygiene can significantly reduce the spread f infectin Best practices in preventing infectin can reduce the risk f sme infectins t clse t zer -Public Health Agency f Canada HAI The Mde f Transmissin is the Key Cmpnent Cntact Susceptible Hst Prt f Entry Drplet Infectius Agent Chain f Infectin Airbrne Reservir Prtal f Exit Vehicle Vectr

4 Fr an infectin t ccur 3 criteria must be met: A. Sufficient number f pathgenic micrrganisms must invade the bdy B. The pathgens must find an apprpriate prtal f entry C. The target hst must be susceptible The Big Fur Pathgens in GI Clstridium difficile Pseudmnas aeruginsa Methicillin resistant Staphylcccus aureus (MRSA) Vancmycin resistant Entercccus (VRE) Types f Micrrganisms THE OFFENDERS Bacteria Viruses Fungi Prins Bifilms within GI Endscpy A bifilm is a structured cmmunity f micrrganisms encapsulated within a self-develped plymeric matrix and adherent t a living r inert surface. Frmatin f a bifilm begins with the attachment f free-flating micrrganisms t a surface If the clnists are nt immediately separated frm the surface, they can anchr themselves mre permanently using cell adhesin Staphylcccus aureus Staphylcccus aureus bifilm Explysaccharide (EPS)

5 Rutine infectin preventin and cntrl practices within GI endscpy: 1) The apprach t infectin cntrl in which all human bld and bdy fluids are treated as if knwn t be infectius Many rganisms have been shwn t prduce bifilms Staph aureus (MRSA), Pseudmnas. aeruginsa, Klebsiella pneumniae Bifilms are a ptential surce f infectin when the bifilm-assciated cells detach Bifilms have been fund in AER s & high level disinfectant slutins 2) All medical devices received fr reprcessing are cnsidered ptentially infectius Why AUDIT in GI? Disease transmissin has ccurred via endscpy Endscpes are cmplex and difficult t reprcess Bifilms present added challenge Reprcessing persnnel Shrtcuts due t high prcedure vlume, rapid turnarund, shrt staffing Training certificatin required On-ging cmpetency & Recertificatin Manager respnsibilities Autmated Endscpe Reprcessrs, accessries & filters are a significant surce f failure during high level disinfectin, PM Strage cabinets & cnditins ut f cmpliance Drying f instruments is prly understd Design f MDRD department (separatin f clean/dirty) Transprtatin f medical devices cntinues t be a prblem

6 Why AUDIT in GI? Infectin Cntrl Practitiners audit GI infrequently if at all Accreditatins are nt dne frequently enugh t ensure that the GI suite is meeting all f the guidelines Vendr partners can prvide specific infrmatin regarding their equipment but ften times this infrmatin cnflicts with hspital plicies & prcedures this leads t cnfusin and auditing can identify discrepancies Bibligraphy CAMDR - GI Cmpliance Audit Public Health Agency f Canada - Infectin Preventin and Cntrl Guideline fr Flexible Gastrintestinal Endscpy and Flexible Brchscpy The Chief Public Health Officer s Reprt n the State f Public Health in Canada, 2013 Infectius Disease The Never-ending Threat 2007 Guideline fr Islatin Precautins: Preventing Transmissin f Infectius Agents in Healthcare Settings - Healthcare Behavirs and Risky Business: First, D N Harm. David K. Hendersn, MD Infectin Cntrl and Hspital Epidemilgy, Vl. 26, N. 9 (September 2005) (pp ) Health Canada Infectin Cntrl Guidelines: Hand Washing, Cleaning, Disinfectin and Sterilizatin in Health Care. Canada Cmmunicable Disease Reprt (CCDR). Supplement, Vl. 24S8. Health Canada Infectin Cntrl Guidelines: Preventin and Cntrl f Occupatinal Infectins in Health Care. Canada Cmmunicable Disease Reprt (CCDR). Vl. 28S1. Sterilizatin: Wuld Yur Facility Pass a Standards Audit SPS Medical