Outbreak Preparedness Project for Long Term Care
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1 Outbreak Preparedness Project for Long Term Care Ruth Collins, RN, BScN, CIC Infection Control Specialist, Peel Public Health 17 th Annual Infection Prevention and Control Conference - May 13, 2011
2 Overview Outbreaks Historically Long Term Care in Peel The Project The Results Next Steps
3 Outbreaks of the Past NUMBER OF CONFIRMED OUTBREAKS BY OUTBREAK SEASON, NURSING HOMES IN PEEL 35 NUMBER OF CONFIRMED OUTBREAKS # ENTERIC OUTBREAKS # RESPIRATORY OUTBREAKS OUTBREAK SEASON (SEPT - AUG)
4 Outbreaks of the Past AVERAGE LENGTH OF OUTBREAK BY OUTBREAK SEASON, NURSING HOMES IN PEEL 50 AVERAGE LENGTH OF OUTBREAK AVG ENTERIC LENGTH OF OUTBREAK AVG RESPIRATORY LENGTH OF OUTBREAK OUTBREAK SEASON (SEPT - AUG)
5 Retirement Home Outbreaks NUMBER OF CONFIRMED OUTBREAKS BY OUTBREAK SEASON, RETIREMENT HOMES IN PEEL 35 NUMBER OF CONFIRMED OUTBREAKS # ENTERIC OUTBREAKS # RESPIRATORY OUTBREAKS OUTBREAK SEASON (SEPT - AUG)
6 Retirement Home Outbreaks AVERAGE LENGTH OF OUTBREAK BY OUTBREAK SEASON, RETIREMENT HOMES IN PEEL AVERAGE LENGTH OF OUTBREAK AVG ENTERIC LENGTH OF OUTBREAK AVG RESPIRATORY LENGTH OF OUTBREAK OUTBREAK SEASON (SEPT - AUG)
7 Preparation is Key! Quote - It s too late to drain the swamp when you are up to you re a** in alligators! Presentation: Joann Braithwaite CIC Public Health Division, MOHLTC
8 Pre-Outbreak Season Primer Proposal: to reduce the frequency, duration and severity of outbreaks Plan: Survey of ICPs/designate Educational sessions to staff Audit for key outbreak elements Kit Ready to go!
9 The Project Stage Description/Details Lit Review and historical review of outbreaks in Peel Develop survey and introductory package, including cover letter and consent Distribute Survey/Introductory Package to all 28 LTCHs Prepare database and analysis systems Obtain results of participating LTCHs and contact LTCHs (site visit) Begin analysis of surveys Site Visit review outbreak preparedness with ICP audit facility IPAC needs provide education Feedback to facility rate (%) of preparedness and recommendations September 30, 2010 LTC Education Day - share preliminary results Provide outbreak management kits to all LTCH facilities Produce draft report on findings from survey and site visit Complete final report, including whether the frequency, duration and severity of LTC outbreaks was reduced compared to previous years Timeline June 2010 June 2010 July 2010 July 2010 July 2010 August 2010 Sept 2010 Sept 2010 Oct 2010 May 2011
10 Outbreak Primer/Survey and Audit Results!
11 Survey says. Of the 28 LTCHs in Peel Oldest is 112 yrs old! Size ranges from beds Staff time dedicated to IPAC 5-70% (average 33.7%) 4% of ICPs are CIC certified 19.3% have no designated backup when ICP absent
12 Audit showed 21 out of 21 LTCHs in Peel have: Outbreak policies and procedures Surveillance conducted daily Process for OTM and debrief Plan to use outbreak signage A plan to revise social activities Tray service for residents on precautions A process in place for antiviral treatment/prophylaxis for residents *Note: 100% represents 21 out of 21 audits performed
13 Audit showed All dining areas are cleaned and sanitized Most had routine cleaning schedules and resources in place Most used a hospital grade disinfectant and a higher level of disinfectant if needed Cleaning resources vary by facility
14 Audit showed Not all LTCHs use daily surveillance tool PPE was available and accessible Visitor restrictions vary drastically Staff self screen but come to work ill Supervision of meals for isolated residents difficult Facility design is challenging
15 Recommendations Clean multi-use equipment Enhanced/terminal clean of resident rooms on precautions Audit environmental cleaning CAEM and RICN environmental tool kit Know cleaning and disinfection products Separate clean and dirty items/areas Reduce clutter especially in outbreaks
16 Recommendations Improve visitor screening and education More accessible ABHR Outbreak education for staff Training in identifying symptoms and initiating additional precautions
17 But the Good News Is.. Most of the LTCHs in Peel are: Outbreak ready (73-100%)! Have communication plans (internal and external) Implementing hand hygiene programs (Just Clean Your Hands) Comfortable with line listings
18 Great Ideas Out There! Personal nail clipper cabinet Precautions cart stocked and ready to go! Personal use slings for residents Environmental auditing with Glo germ and ATP Virox wipes containers with multiuse equipment
19 Great Ideas Innovative hand hygiene for wanderers Volunteers screen and educate others during an outbreak Communication: telephone fan outs, multimedia ( s, fact sheets, flip charts at entrances, newsletters, meetings, signage, internal TV channel) Hand hygiene tree (RICN)
20 Results were shared at: PEEL LONG-TERM CARE INFECTION CONTROL EDUCATION DAY Thursday, September 30th, 2010 Outbreaks, We re Ready!
21 The Kit
22 Summary Some good innovations There s always room for improvement Health unit and facility collaboration
23 Next steps Will we do it again next year? Final results & analysis of impact Follow up on usefulness of outbreak kits
24 Questions?
25 References A Guide to the Control of Respiratory Infection Outbreaks in Long-Term Care Homes, Ministry of Health and Long Term Care Public Health and Long Term Care Homes Branch, October 2004 Control of Communicable Diseases Manual, David Heymann, 19 th edition, 2008 Long-Term Care Act 2007 Health Protection and Promotion Act (HPPA), 1990 Ontario Pubic Health Standards
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