Increased Risks Working in Healthcare Facilities. Healthcare Construction Certificate - Level 1

Transcription

1 Increased Risks Working in Healthcare Facilities

2 WHY Infections are Common in Healthcare Surgical procedures Compromising a persons natural defenses Inserting foreign items into the body Compromised immune system Influenza Elderly and young HIV Drug resistant bacteria and mutated viruses

3 Statistical Data 2014 Approximately 75,000 patients die in hospitals each year due to hospital acquired infections (HAI). Estimated 1 in 25 patients will become infected in the hospital. Estimated Total Cost for Hospital acquired infections exceed $35.7 billion to $45 billion annually.

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5 2020 National Acute Care Hospital HAI Metrics Measure (and data source) Progress made by Target (from 2015 baseline) CLABSI (NHSN) 1 10% reduction 50% reduction CAUTI (NHSN) 1 6% relative reduction 25% reduction Invasive MRSA (NHSN/EIP 2 ) 8% reduction 50% reduction Hospital onset MRSA (NHSN) 6% reduction 50% reduction Hospital onset CDI (NHSN) 7% reduction 30% reduction SSI (NHSN) Data released in % reduction Clostridium difficile Data pending release 30% reduction hospitalizations (HCUP) 3

6 Nursing Home and Assisted Living Over 4 million Americans are admitted each year Nearly one million reside in assisted living facilities. 1 3 million serious infections occur every year in these facilities. 380,000 people die of the infections in LTCFs every year.

7 HAI Statistical Data 2014 The report also includes HAIs in long term acute care hospitals (LTACHs) and inpatient rehabilitation facilities (IRFs). LTACHs: % decrease in central line infections 11% decrease in urinary tract infections (UTI) IRFs: % decrease in urinary tract infections.

8 HAI Infections (CDC 2014) Site Estimated Number All 721,800 Pneumonia 157,500 Gastrointestinal illness 123,100 Urinary Tract Infection (UTI) 93,300 Primary Bloodstream Infections 71,900 Surgical Site Infections (SSI) 157,500 Other 118,500

9 CMS takes HAI seriously CMS announced 751 hospitals are seeing Medicare payments cut in fiscal year 2018 for high rates of hospitalacquired conditions as part of the HAC Reduction Program. Additional 1% in reimbursement Hospitals that serve poorer and sicker patients are at a higher risk

10 Understanding the Fiscal Year 2019 Hospital Value Based Purchasing Program Measures

11 Grading on a Curve

12 CMS takes HAI seriously Number of hospitals with deductions in payment in 2018 Illinois 21 Indiana 17 Iowa 7 Michigan 19 Minnesota 7 Wisconsin 13

13 Infection Host Pathogen Comorbidity Heart disease Diabetes Cancer Vaccines Passive and Active Immunity Susceptibility Exercise Diet Smoking Alcohol How much Inhalation Injection Ingestion Likely to cause disease or death

14 Further Analysis of Infections 10% of the deaths are caused by airborne infections, This is 10,000 people dying each year! This is why we are here today. Bacteria and Viruses Molds and Fungus

15 How Construction Contributes to Hospital Acquired Infections Lack of knowledge to implement process to reduce risks to patients. Lack of adequate barriers/safeguards. Lack of control of dust/debris. Lack of communication/coordination with occupants. Improper shutdowns or start up of systems.

16 What causes infections? Bacteria: microscopic living organisms, usually one celled, found everywhere. They can be dangerous, such as when they cause infection, or beneficial, as in the process of fermentation (such as in wine) and that of decomposition. Virus: small infectious agent that replicates only inside the living cells of other organisms. Viruses can infect all types of life forms, from animals and plants to microorganisms, including bacteria

17 What causes infections? Fungus: a diverse group of organisms that live by decomposing and absorbing the organic material in which they grow. These include mushrooms, molds, mildews, smuts, rusts, and yeasts. Molds: living organism that are neither plant nor animal. It cannot make its own food like plants do. Mold must absorb nutrients from other organic substances. To do this, mold secretes enzymes that break down the food substance into smaller organic molecules that can then be absorbed

18 Bacteria Bacteria many types are dangerous Tuberculosis Airborne (33% world Population) 3 Strains drug resistant E Coli Contact Fecal contamination, under cooked meat Methicillin Resistant Staph Aureus (MRSA) Contact lesions lung infections Urinary Tract Infections Legionella Droplet cooling towers water systems

19 Bacteria that grows in water Legionella slime in pipes, multiplies in stagnant water dead legs Mortality rate 46% Transmitted by aerosols or aspiration deaths from water shut down and not flushed prior to start up infections due to sheet/waterfall fountain in hospital lobby people infected and 3 patients died in outbreak linked hospital s water system

20 Water Features Where was this hospital? Southeast Wisconsin

21 Outbreak Investigation CDC recommends that public health officials perform a full investigation for the source of Legionella in a facility upon identification of: 1 case of definite healthcare associated Legionnaires disease at any time 2 cases of possible healthcare associated Legionnaires disease within 12 months of each other

22 Legionella Since 2014 there have been more than 50 outbreaks world wide 5 were in healthcare IN hospital 2 infected both died plumbing treated AL Hospital 8 infected 2 died water system treated RI Hospital 2 infected 0 deaths plumbing treated NC Mental Health 2 infected 0 deaths plumbing WA Hospital 5 infected 2 died ice and plumbing

23 How to Reduce Risk of Legionella Remove sources of soil and contamination Enforce cleaning and disinfection protocols Do not allow soil into water system Keep all ducts and piping sealed to prevent contamination before and during construction Flush all water lines prior to utilization WI Dept of Health issued guidelines for Decorative Fountains in Hospitals in April 2010 Thomas E. Haupt, MS, an epidemiologist with the Wisconsin Division of Public Health

24 Mold Molds: a fungus, secretes chemicals, and spores 100 s of thousands types of mold. Few are dangerous: Histoplasmosis (pigeons) Coccidioides (Valley Fever: desert SW) Blastomycosis (rotting wood)

25 Mold the big killer! Aspergillus (everywhere) A fungus whose spores are present in the air we breathe, but does not normally cause illness. In people with a weakened immune system, damaged lungs or with allergies, Aspergillus can cause disease.

26 Aspergillosis A disease that can affect the lungs, brain, liver or skin, caused by this invasive mold 50% fatal in normal populations Almost 100% fatal in immune compromised individuals Hard to treat under ideal situations This is the major concern with construction in healthcare DUST...

27 Aspergillus Present almost everywhere Extremely common in: Soil, Decaying matter, wet plaster and gypsum Demolition dust carries/releases spores into the environment (especially if previously wet) deaths in ICU due to an elevator project ill and 4 deaths due to construction dust in a Rheumatology Unit project pediatric oncology deaths

28 Mucorales Mortality rates that exceed 50% Average costs per hospitalization double those of aspergillosis ($152,954 in 2017) Outbreaks of healthcare associated mucormycosis can be difficult to recognize 3 outbreaks were linked to contaminated healthcare linens

29 How Clean Is the Linen at My Hospital?

30 How to Reduce Mold Spore Concentrations Filtration HEPA filter units Cleaning and Decontamination 10 % Bleach is very effective Implementing safe work methods Wetting demolition debris to keep from becoming airborne Transporting debris in tightly covered containers Transporting debris in non patient occupied routes Maintain barriers between patients and work areas Protective clothing or methods to protect occupied areas

31 Chain of Infection Germ or Infectious Agent Ceiling tile Drywall dust Debris Water droplets Unwashed hands Susceptible Host Source Portals : Skin: Cuts, Tears, Abrasions Respiratory System : Cough, Sneeze, Inspiration Touch Entry Mode/ Transmission Contact Transmission MRSA, E. Coli, C. Diff. Blood Borne: HIV, Hepatitis B Droplet Transmission Influenza Airborne Transmission Tuberculosis, Aspergillus

32 Define Expectation Prior to Starting Project Define barriers Types and locations Who is responsible to construct Who is responsible to maintain Define when erected Define when can be removed

33 Work methods Clarify Expectations Negative pressure verification Dust/debris control and removal process Define cleaning methods/frequencies How to turn off/on systems Time Schedules Noise/vibrations Closures/system shut downs

34 Follow Plan Request a copy of the Infection Control Risk Assessment Implement measures as defined to limit liability Monitor barriers/measures for protection of patients Review the plan as the project progresses EVERYONE on the jobsite should know and follow the plan Post Plan Every person, every task, every day!!

35 Post Plan Best practice to have the plan posted Prominent location Highly visible Contacts Signature Date

36 Hand Washing for the Contractors Single most effective means to eliminate transmission of infections At start of shift, prior to meals or eating, after using restroom, and at end of shift. Protect you, your family, our patients!

37 Questions?