Home Care Infection Prevention and Control Program, 2017 Table of Contents

Transcription

1 INFECTION PREVENTION AND CONTROL PLAN Section I: Infection Prevention and Control Program... 4 Infection Prevention and Control Program Goals... 4 Infection Prevention and Control Objectives... 4 Infection Prevention and Control Strategies... 5 Section II: Infection Prevention and Control Risk Assessment... 6 Infection Prevention and Control Risk Assessment... 6 Scope of Services... 6 Service Duration... 7 Patient Demographics... 7 General Patient Population Served... 7 Specialty Patient Population Served... 7 Patient Diagnoses... 8 High-risk Patients... 8 Treatment and Procedures Performed... 9 Geographic Location Served... 9 Community Environment and Health Indicators for Counties Served Medical Devices, Equipment or Supplies Noncritical Items Soft Surface Items Semicritical Items Critical Items Medical Waste Occupational Exposures and Risks Epidemiologically Important Issues Infection Prevention and Control Data Analysis Outbreak Investigation Risk of Infection Transmission Evaluation of the Patient and Environment Section III: Strategies to Minimize, Reduce, or Eliminate the Prioritized Risks Evidenced-based Infection Prevention and Control Operating Guidelines Infection Prevention and Control Strategies Strategies for Minimizing Infection Risks and Occupational Exposures Staff Strategies for Preventing and Controlling Infection Transmission Page 1 of 16

2 Patient and Caregiver Strategies for Preventing and Controlling Infection Transmission in the Patient s Care Setting Strategies for Preventing and Controlling Infection Transmission in the Office Environment Section IV: Structure and Resources for the Infection Prevention and Control Program Organization-wide Collaboration Infection Prevention and Control Program Management Authority and Responsibility for the Infection Prevention and Control Program Governing Body: Infection Prevention and Control Duties and Responsibilities Administrator: Infection Prevention and Control Duties and Responsibilities Clinical Manager: Infection Prevention and Control Duties and Responsibilities Infection Preventionist: Duties and Responsibilities Patient Care Providers/Field Staff: Infection Prevention and Control Duties and Responsibilities.. 19 Integration into Infection Prevention and Control Activities Infection Prevention and Control Oversight References SURVEILLANCE, IDENTIFICATION AND REPORTING OF INFECTIONS Surveillance Activities... 4 Identifying a Home Care-onset Infection... 5 Healthcare-associated Infection... 5 Home Care-onset Healthcare-associated Infection... 5 Healthcare Facility-onset Infection... 5 Community-onset Infection... 6 Infection Present on Admission... 6 Date of Event... 6 Infection Window Period... 6 Repeat Infection Timeframe... 7 Transfer Rule... 7 Secondary Bloodstream Infection Attribution Period... 8 Excluded Infections... 8 Calculating the Metrics for a Home Care-onset Infection Incidence Rate Collecting Denominator Data for Device-associated Infections Conducting Surveillance Activities for a Urinary Tract Infection Calculating the Metrics for a Urinary Tract Infection Page 2 of 16

3 Conducting Surveillance Activities for a Central Line-associated Bloodstream Infection Calculating the Metrics for a Central Line-associated Bloodstream Infection Conducting Surveillance Activities for a Skin and Soft Tissue Infection Calculating the Metrics for a Skin and Soft Tissue Infection Outbreak Surveillance Activities Collecting, Aggregating and Analyzing Surveillance Data Criteria for Internal Reporting of Infections Criteria for External Reporting of Infections Protocol for Contacting Public Health Agencies Appendix Site-specific Infection Criterion Laboratory-Confirmed Bloodstream Infection (LCBI) * Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infection (MBI-LCBI) Venous Infection * Influenza-like Illness (ILI) Lower Respiratory Infection (LRI) Symptomatic Urinary Tract Infection (SUTI) and Catheter-associated Urinary Tract Infection (CA- SUTI) ± Fungal Skin Infection Cellulitis, Soft Tissue, Non-surgical Wounds, Decubitus Ulcer, Foreign Body Site, and Around Foreign Bodies Surgical Site Infection (SSI) * Herpes Simplex or Zoster Infection Gastrointestinal Infection Clostridium difficile Infection (CDI) * Sinusitis Conjunctivitis Ear Infection Oral Infection Outcome Measures to Calculate a Home Care-onset Infection Process Measures to Calculate a Home Care-onset Infection Home Care and Hospice Surveillance Reporting Worksheet Skin and Soft Tissue Infection Surveillance Worksheet Urinary Tract Infection Surveillance Worksheet Central Line-associated Bloodstream Infection Surveillance Worksheet Central Line-associated Bloodstream Infection Line List Page 3 of 16

4 Urinary Tract Infection Line List Skin and Soft Tissue Infection Line List Surveillance Denominators Home Care Surveillance Report Home Care Surveillance Report Summary Home Care Infection Prevention and Control Transfer Summary Multidrug-resistant Organism and C. difficile Prevalence and Incidence Log State Reportable Disease/Conditions Web Sites HAND HYGIENE Hand Hygiene Plan... 3 Indications for Hand Hygiene... 4 Hand Hygiene Using an Alcohol-based Hand Hygiene Product... 5 Hand Hygiene Using Soap and Water... 6 Hand Hygiene Products... 7 Product Selection... 7 Alcohol-based Hand Hygiene Product... 7 Soap... 7 Hand Lotion or Cream... 7 Hand Hygiene Supplies... 8 Towels... 8 Nursing Bag Hand Hygiene Contents... 8 Management of Product Dispensers... 8 Other Hand Hygiene Considerations... 9 Artificial Fingernails or Enhancements... 9 Nail Length... 9 Nail Polish... 9 Hand and Forearm Bandages, Casts and Splints... 9 Hand Care Program Alcohol-based Hand Hygiene Product Storage Storage in the Office Storage in a Vehicle Storage and Placement in a Hospice Care Facility Page 4 of 16

5 CDC vs. WHO Hand Hygiene Guideline Comparison CLEANING AND DISINFECTION Principles of Cleaning and Disinfection... 3 Soft Surface Sanitizing... 4 Medical Equipment: Noncritical Items... 5 Vital Sign Equipment... 6 Electronic Medical Equipment Used by Patients... 8 Portable Electronic Devices: Laptop Computer, Tablet, and Peripherals Bag Technique Decontaminating and Cleaning the Nursing Bag Core and Supplementary Contents in the Home Care Nursing Bag Children s Toys and Rehabilitation Equipment Medical Bed Mattress Cover Cleaning and Storing a Bath Basin Medical Equipment: Semicritical Items Point-of-Care Device: Prothrombin Monitoring Device Medical Equipment: Critical Items Linen Handling, Storage, and Cleaning Cleaning Spills of Non-regulated Medical Waste Cleaning Spills of Medical Waste on a Hard, Non-porous Surface Cleaning Spills on a Porous Surface Cleaning Environmental Surfaces Storing Patient Care Supplies in a Vehicle Inspecting and Maintaining Patient Care Supplies Stored in a Vehicle Medical Equipment and Supply Storage Staff Member Attire Labeling a Secondary Cleaning Product Container Refrigerator Temperature Monitoring Refrigerator Cleaning Medication and Vaccine Refrigerator Temperature Log Page 5 of 16

6 Food Refrigerator Temperature Log Equipment and Supplies Storage: Vehicle Inspection Checklist PATIENT CARE PRACTICES Sterile Technique... 4 Aseptic Technique... 5 Wound Care... 6 Irrigation Solution Storage and Use... 7 Access Device and Phlebotomy: Skin Antisepsis... 8 Venous Access Device: Changing the Dressing... 9 Needleless Connector Disinfection Technique Needleless Connector Disinfection Technique: Disinfection Cap Needleless Connector: Indications and Frequency for Changing Needleless Connector: Clamping and Disconnecting Sequence Venous Access Device: Flushing and Locking Central Venous Access Device: Infection Prevention Strategies Central Venous Access Device: Evaluation and Criteria for Removal Removing a Midline or Non-tunneled Central Venous Catheter Peripheral Venous Access Device: Infection Prevention Strategies Subcutaneous Access Device: Infection Prevention Strategies Infusion Therapy Equipment and Supplies Collecting Blood for Culture and Other Tests Single and Multi-dose Vials and Containers IV Push Medication Preparation and Administration Patient Vaccination: Influenza and Pneumococcal Vaccines Medication and Vaccine Storage Medication Storage During Transport to the Home Refrigerated Vaccine Storage During Transport Medication Storage in the Patient s Home Point-of-Care Device: Blood Glucose Meter Respiratory Therapy Page 6 of 16

7 Preventing Ventilator-associated Pneumonia: Oral Care Enteral Therapy Urinary Tract Care Appropriate Urinary Catheter Use Alternatives to Indwelling Catheterization Proper Techniques for Urinary Catheter Insertion Proper Techniques for Urinary Catheter Maintenance Catheter Material Collecting and Transporting a Urine Specimen Using an Intermittent In-and-Out Catheter Midstream Clean Catch Specimen Using an Indwelling Catheter Collecting and Transporting a Stool Specimen Collecting and Transporting a Rectal Swab Collecting and Transporting a Nasopharyngeal Swab Animal-Assisted Activities Definition Animal Restrictions Criteria for Participating in Animal-assisted Activities General Infection Control Measures for Animal Encounters Care and Handling of Animals in a Hospice Care Facility Guidelines for Service Animals in a Facility General Guidelines for Animals Encounters Guidelines for Personal Pets in a Facility Infection Control Measures for Animal Encounters in a Facility Reducing the Risk of Transporting Bed Bugs and Other Pests Protective Equipment Before the Home Visit Patient Assessment Home Environment Assessment In the Patient s Home with a Known Infestation After the Visit In the Vehicle and Office Page 7 of 16

8 ISOLATION PRACTICES Standard Precautions... 5 When to Implement... 5 Gown... 5 Gloves... 6 Mouth, Nose and Eye Protection... 7 Resuscitation Equipment... 8 Respiratory Hygiene/Cough Etiquette... 8 Patient-care Equipment and PPE... 8 Care of the Environment... 9 Textiles and Laundry... 9 Safe Injection Practices... 9 Post-mortem Care Transmission-Based Isolation Precautions Airborne Precautions When to Implement When to Discontinue Respiratory Protection Patient Care Practices Staff Assignment and Visitors Patient Placement Additional Precautions for Preventing the Transmission of M. tuberculosis Post-mortem Care Droplet Precautions When to Implement When to Discontinue Patient Placement Respiratory Protection Staff Assignment and Visitors Contact Precautions When to Implement Page 8 of 16

9 When to Discontinue Patient Placement Gloves Gown Patient Transport Patient-care Equipment Environmental Measures Caring for a Patient with a Multidrug-Resistant Organism When to Follow Standard Precautions When to Implement and Discontinue Contact Precautions Equipment and Environmental Measures Staff and Patient Education Caring for a Patient with a Clostridium difficile Infection When to Implement Contact Precautions When to Discontinue Contact Precautions Patient Placement in the Home Patient Placement in the Hospice Care Facility Hand Hygiene Personal Protective Equipment (PPE) Equipment and Environmental Measures Equipment: Commode and Bedpan Environmental Controls Linen and Laundry Staff and Patient Education Caring for a Patient with Zika Virus Disease Management of the Individual in the Home Suspected of Having Exposure to the Ebola Virus Caring for a Patient with Confirmed or Suspected Pandemic Influenza or Emerging Pathogen Isolation in the Home Staff Assignment Patient Placement in the Home Patient Placement in the Hospice Care Facility Page 9 of 16

10 Standard Precautions Respiratory Protection Eye Protection When to Discontinue Isolation Precautions Patient Transport Linen and Clothing Dishes and Eating Utensils Pandemic Preparedness Plan and Managing an Influx of Infectious Patients Definition Mitigation Community Mitigation Measures Preparedness Planning for Surge Capacity Education and Training Resource Management Prepandemic and Pandemic Phases Staffing Resources Durable Resources Medical Consultation Patient Management Responding to and Recovering from an Influx of Infectious Patients Communication and Reporting System Risk Communication and Pre-event Messaging Transportation Sanitation Recovery and Evaluating the Effectiveness of the Plan Appendix Sequence for Putting on Personal Protective Equipment Sequence for Removing Personal Protective Equipment: Option One Sequence for Removing Personal Protective Equipment: Option Two Management of MDROs in the Home and Facility-based Hospice Setting When to Implement Standard Precautions vs. Contact Precautions for a Patient Infected or Colonized with a Multidrug-Resistant Organism Pandemic Preparedness Self-Assessment Page 10 of 16

11 Category A Bioterrorism Agents Recommended Isolation Precautions for Selected Infections and Conditions MEDICAL WASTE MANAGEMENT PLAN Categories of Waste... 3 Regulated Medical Waste Generated by Staff... 4 Disposal and Transport of Medical Waste Generated by Staff... 5 Sharps Waste Generated by Staff... 6 Sharps Waste Management... 7 Disposal and Transport of Sharps Generated by Staff... 8 Medical Waste Storage Area... 9 On-Site Medical Waste and Sharps Storage Container BLOODBORNE PATHOGENS EXPOSURE CONTROL PLAN Administrative... 3 References... 3 Accessibility... 3 Responsibility... 4 Exposure Definition... 4 Exposure Determination... 5 Occupational Exposure Classifications... 5 Tasks Contributing to Occupational Exposure... 5 Engineering and Work Practices Controls... 6 Housekeeping... 6 Transporting Lab Specimens and Blood Products... 6 Labeling... 6 Personal Protective Equipment... 7 Definition... 7 Safety Devices... 7 Selecting Safety Devices... 8 Recordkeeping... 9 Education Records... 9 Hepatitis B Vaccination Status... 9 Page 11 of 16

12 Exposure Control Records... 9 Sharps Injury Log Transfer of Records Bloodborne Pathogen Exposure Control Plan Evaluation Appendix Sharps and Safety Device Evaluation Blood and Body Fluid Exposure Sharps Injury Log Source Patient Blood Test Consent/Declination RESPIRATORY PROTECTION PLAN Administrative... 4 Accessibility... 4 Assignment of Responsibility... 4 Staff Members Included in the Respiratory Protection Program... 4 Exposure Determination... 5 Occupational Exposure Classifications... 5 Tasks Contributing to Occupational Exposure... 5 Exposure Definition... 6 TB Risk Assessment Activities... 7 TB Risk Classification... 8 Low Risk... 8 Medium Risk... 8 Potential Ongoing Transmission... 8 TB Screening Program... 9 TB Screening Procedures for Low Risk Classification... 9 TB Screening Procedures for Medium Risk Classification TB Screening Procedures for Potential Ongoing Transmission Patient Identification and Management Persons at Higher Risk for Infection with M. tuberculosis Airborne Precautions Particulate Filtering Facepiece Respirator Criteria for Selecting a Respiratory Protective Device Page 12 of 16

13 Respirator Selection Respirator Inspection and Maintenance Respirator Reuse Respirator Storage Respirator Disposal Fit Testing Staff Requiring Fit Testing Frequency of Fit Testing How to Perform Qualitative Fit Testing User Seal Check How to Properly Don the Filtering Facepiece Respirator How to Conduct a User Seal Check Positive Pressure Seal Check Technique Negative Pressure Seal Check Technique How to Properly Doff (Remove) the Filtering Facepiece Respirator Recordkeeping TB Screening Records Fit Testing Records Education Records Exposure Control Records Transfer of Records Respiratory Protection Program Evaluation TB Risk Assessment Tool Incidence of TB Risk Classification Statistics M. tuberculosis Infection Screening Respiratory Protection Program TB Infection Control Program Implementation of the TB Infection Control Program Laboratory Processing of TB-related Specimens, Tests and Results Reassessment of TB Risk Risk Classification Frequency of TB Screening Depending on Risk Page 13 of 16

14 OCCUPATIONAL HEALTH PROGRAM Health Screening... 4 Hepatitis B Vaccination... 6 Administering the Hepatitis B Vaccine... 7 Influenza Vaccination Program... 8 Influenza Vaccination Acceptance Administering the Influenza Vaccine Influenza Vaccination Declination Influenza Vaccination Rate Methodology Calculating the Influenza Vaccination Rate Influenza Vaccination Program Evaluation Testing for M. tuberculosis Infection Administering and Interpreting the Tuberculin Skin Test Serial TB Screening Staff Members with a Newly Recognized Positive Test Result for M. tuberculosis Infection or Signs or Symptoms of TB Disease Respirator Medical Questionnaire and Examination Occupational Exposure to M. tuberculosis Occupational Exposure to Blood and Body Fluids Follow-up of Staff Exposed to Known or Suspected Human Immunodeficiency Virus (HIV) - Positive Sources and Postexposure Prophylaxis (PEP) Evaluating and Managing Staff with a Possible Occupational Exposure to Zika Virus Occupational Latex Allergies Actions to Take after an Animal Bite in the Home Work Restrictions Occupational Health Surveillance Activities Appendix Health Screening Hepatitis B Vaccination Acceptance/Declination Influenza Vaccination Acceptance/Declination Immunization and TB Screening Page 14 of 16

15 Tuberculin Skin Test Record Tuberculosis Symptom Screen Questionnaire Respirator Medical Evaluation and Questionnaire Verification of Qualitative Fit Test (QLFT) Observation Checklist for Placing a Tuberculin Skin Test Observation Checklist for Reading a Tuberculin Skin Test Work Restrictions for Staff Exposed to or Infected with Certain Diseases and Conditions Work Restrictions for Staff Exposed to or Infected with Certain Vaccine Preventable Diseases and Conditions Outcome Measures: Occupational Health Surveillance Occupational Illness/Injury Log QUALITY ASSESSMENT AND PERFORMANCE IMPROVEMENT (QAPI) Quality Assessment and Performance Improvement (QAPI) Program... 3 Infection Prevention and Control Program... 3 Plan... 4 Measure... 5 Infection Prevention and Control Program Data... 5 Process and Outcome Measurement... 5 Reasons for Data Collection... 6 Measures of Processes and Outcomes... 6 Data Sources... 6 Methods of Data Collection and Measurement... 7 Frequency of Data Collection... 7 Data Collection Uses... 8 Determination of Data Collected... 8 Assess... 8 Data Analysis... 8 Improve... 9 Infection Prevention and Control Program Evaluation Activities Infection Prevention and Control Program Targeted Goals Patient-Outcome Surveillance Activities Prioritized Risks Targeted, Prioritized Risk(s) Patient Surveillance Event(s) Limiting the Spread of Infections Associated with Procedures - Patient Surveillance Outcome Measures Staff-Directed Surveillance Activities Improving Compliance with Hand Hygiene Guidelines Hand Hygiene Adherence Page 15 of 16

16 Limiting Unprotected Exposure to Pathogens - Isolation Precautions Occupational Health Surveillance: Process Measures Improving Influenza Vaccination Rates Limiting the Spread of Infections Associated with Procedures - Occupational Health Surveillance Process Measures: Occupational Exposure to Pathogens During the Course of Care Limiting Unprotected Exposure to Pathogens: Occupational Health Surveillance - Outcome Measures QAPI: Infection Prevention and Control Program Data Collection Matrix Home Care Infection Prevention and Control Risk Assessment Tool Infection Prevention and Control Skills Review Data Summary Influenza Vaccination Summary: Influenza Season Occupational Illness/Injury Data Summary Infection Prevention and Control Program Targeted Goals Evaluation Page 16 of 16