YOU RE NOT ALONE.TOP 10 LTC ASK SPICE QUESTIONS. October 18, 2018 Evelyn Cook, RN, CIC

Transcription

1 YOU RE NOT ALONE.TOP 10 LTC ASK SPICE QUESTIONS October 18, 2018 Evelyn Cook, RN, CIC

2 Evelyn Cook, RN, CIC Associate Director Statewide Program for Infection Control and Epidemiology (SPICE) Moderator: Heather Ridge Nurse Consultant

3 Objectives Discuss 10 frequently asked question themes Hand Hygiene Transmission-based Precautions TB Screening Safe Injection Practices Influenza Administration Construction Activities Provide evidence based rationale for responses

4 NO DISCLOSURES

5 Have you ever submitted a question to Ask-SPICE? Never 1-5 times a month 1-5 times a week 1-5 times a day Only when the surveyors are here

6 What is the preferred method for performing hand hygiene? We wear gloves all the time so don t need to do hand hygiene Wash hands with soap and water for 1 minute Use an alcohol-based hand rub unless hands are visibly soiled Wash hands with soap and water for at least 15 seconds

7 OR

8 THE ROLE OF HAND HYGIENE Hand Hygiene Handwashing with soap and water Antiseptic handwash Antiseptic hand rub Surgical antisepsis

9 THE ROLE OF HAND HYGIENE

10 THE ROLE OF HAND HYGIENE Organisms must be: 1. Present on skin or nearby objects 2. Spread to caregiver hands 3. Endure on hands As well as: 4. Inadequate hand antisepsis 5. Direct contact with other patients or objects

11 Hand hygiene and clean procedures colony forming units of bacteria

12 Are We Compliant with Hand Hygiene Average Percent of Compliance = 40% Self-Perceived Barriers to Hand Hygiene % forgot to wash hands because they were busy 23% didn t wash hands because wearing gloves 28.5% didn t wash hands because ABHR not available 69% didn t wash hands because just went into room to talk 52% rarely to never got personal feedback regarding practice of HH Infection Control and Hospital Epidemiology July 2010 Vol.31, NO.7 HH in LTCF: A Multicenter Study of Knowledge, Attitudes, Practices and Barriers

13 THE ROLE OF HAND HYGIENE Reasons For Non Compliance 1. Inaccessible products 2. Skin irritation 3. Too busy 4. Glove use made it unnecessary 5. Didn t think about it 6. Lacked knowledge

14 THE ROLE OF HAND HYGIENE Potential Advantages of Alcohol-based Hand Rubs (ABHR) Requires less time than hand washing Acts quickly to kill microorganisms on hands More effective than hand washing with soap and water More accessible than sinks Less irritating to skin than soap and water and can even improve condition of skin

15 Are the recommendations for ESBL in LTCFs to isolate only when symptomatic? Yes No We are not allowed to isolate our residents I have no idea

16 Recommendations for transmission-based precautions

17 Recommendations for transmission-based precautions cont d

18

19 Resident characteristics to consider the 5 C s Cognitive function (understands directions) Cooperative (willing and able to follow directions) Continent (of urine or stool) Contained (secretions, excretions, or wounds) Cleanliness (capacity for personal hygiene) Kellar M. APIC Infection Connection. Fall 2010 ed.

20 Essential Practices Adhere to Standard Precautions continuously Use gown and gloves if potential contact with blood/body fluid, nonintact skin or mucous membranes Includes urine, feces, wound drainage Perform hand hygiene before and after all contact with resident and the environment Perform hand hygiene after glove removal or changing gloves when moving from a dirty body site to a clean body site

21 A resident has active shingles and is in a semi-private room with a roommate. Should one of the residents move to a private room and if so which one? No, shingles is not contagious Yes, the roommate should move Yes, the resident with shingles should be moved Not really sure what to do

22 Key points to remember Herpes zoster, also known as zoster and shingles is caused by the reactivation of the varicella zoster virus, the same virus that causes chickenpox People with herpes zoster, most commonly have a rash in one or two adjacent dermatomes (localized zoster); usually on the trunk along a thoracic dermatome. Does not usually cross the body s midline The rash can affect three or more dermatomes, a condition known as disseminated zoster ; also defined as appearance of lesions outside the primary or adjacent dermatomes

23 CDC Recommendations A=airborne C =contact DI=duration of infection

24 CDC Recommendations Documentation of age appropriate varicella vaccination Laboratory evidence of immunity or disease Diagnosis by a healthcare provider Birth in US before 1980 (not for HCP) Shingles cannot be passed from one person to another The virus that causes shingles can spread from a person with active shingles to cause chickenpox in someone who had never had chickenpox or received the chickenpox vaccine Lesions are infectious until dry and crusted To prevent healthcare associated spread, should ensure that all healthcare personnel have evidence of immunity CDC recommends shingles vaccine (Shingrix) for people aged 50 years or older

25 So, for PPDs for residents, is it true that everyone on admission has to have a 2-step done and they have to be exactly 2 weeks apart? No, residents only need a one-step PPD They no longer need to have a TST because they of their age Yes Not sure what they need

26 For employees, all have to have a 2 step and they have to be a week apart, correct? Yes No Not sure what they need

27 Determine your risk classification NC TB Manual

28 10A NCAC 41A.0205 Control measures -tuberculosis

29 What about frequency? Long Term Care Facility Employees: Screening based on risk assessment DFS requires annual screening which can be accomplished by a verbal elicitation of symptoms Residents in Long Term Care: Screening based on risk assessment DFS requires annual screening which can be accomplished by a verbal elicitation of symptoms

30 We will be receiving our flu vaccines on 9/26/18. I have heard different things on when to give the vaccines: as soon as you receive or wait until 10/1/18. I am wondering when is the best time to give them? Flu vaccine should not be given until October 1 st Give flu vaccine as soon as you get you supply You can give anytime, does not matter

31 Just the facts, ma am CDC recommends getting flu vaccine by the end of October, however getting vaccinated later is still beneficial and should be offered throughout flu season Vaccines available: Nasal spray flu vaccine (non-pregnant individuals and use in 2-49 years of age) Trivalent vaccine Quadrivalent vaccine High dose (Fluzone) for 65 and older Shot with adjuvant (FLUAD) 65 and older Protection from flu vaccination sets in after 2 weeks.

32 Do we still have to offer the influenza immunization if the resident declined last year? No, the resident and/or family has to ask for the vaccine Yes and tell them they have to take it this year Only if the resident has respiratory signs and symptoms Yes after providing education

33 F (d) Influenza and pneumococcal immunizations Influenza. The facility must develop policies and procedures to ensure that- (i) Before offering the influenza immunization, each resident or the resident s representative receives education regarding the benefits and potential side effects of the immunization; (ii) Each resident is offered an influenza immunization October 1 through March 31 annually, unless the immunization is medically contraindicated or the resident has already been immunized during this time period; iii) The resident or the resident s representative has the opportunity to refuse immunization; and (iv)the resident s medical record includes documentation that indicates, at a minimum, the following: (A) That the resident or resident s representative was provided education regarding the benefits and potential side effects of influenza immunization; and (B) That the resident either received the influenza immunization or did not receive the influenza immunization due to medical contraindications or refusal. 33

34 What is an approved cleaner for glucometer machines? How long should the machine be wrapped? If the glucometers are dedicated to a single resident they do not need to be cleaned Glucometers used on multiple residents should be cleaned daily and kept wrapped for at least one minute Always use a bleach wipe to clean glucometers Follow the manufacturer s guidelines and recommendations

35 We use dedicated glucometers for our residents. Can we store them on the medication cart? Absolutely No I don t think so Actually I am not sure No the family needs to take home and bring back

36 What is the big deal? Outbreaks of HBV (2 or more cases) reported to CDC /24 (75%) of Hepatitis B outbreaks occurred in LTCF 15/18 (83%) associated with ABGM 1,680 exposed 133 persons infected

37 What is the big deal? Five outbreaks of viral Hepatitis (B and C) between /5 in extended care 3/4 identified ABGM 1704 exposed 36 infections 6 deaths

38

39

40 Who should be involved at the facility if new construction and/or renovation is taking place? Director of Nursing, Administrator, Construction staff Medical Director, Construction staff, Administrator Construction staff, infection prevention, DON, Administrator Director of Nursing, construction staff

41 CONSTRUCTION INFECTION CONTROL RISK ASSESSMENT (ICRA)

42 When is this necessary? New construction Renovation Painting Changing carpet Water damage (clean or dirty) Mold remediation Asbestos removal HVAC replacement Infection Preventionist should be involved from the VERY beginning

43 Construction risk assessment elements Step 1: Identify type of project Excerpt obtained from on 8/3/18

44 Construction ICRA elements Step 2: Identify resident risk groups Excerpt obtained from on 8/3/18

45 Construction ICRA elements Step 3: Create matrix to determine class of precautions required Excerpt obtained from on 8/3/18

46 Construction considerations KEY elements to ensure resident safety Dust control (HVAC, sticky mats, mopping, vacuuming, etc.) Plastic and/or hard wall barriers (based on length of project) Limited ceiling tile removal permits Re-location of residents during project Interruptions to water, plumbing, power, etc. Re-location of patient care equipment, supplies, etc. Proper transport of construction debris (covering & route) Terminal cleaning and preparation for opening the area MONITOR for COMPLIANCE!!!

47 Questions? Un-mute your line Type in the chat box

48 Resources Tuberculosis.pdf

49 References Statewide Program for Infection Control & Epidemiology (SPICE) North Carolina Communicable Disease Rules: Title A-Health and Human Services, Chapter 41 Epidemiology Health Tuberculosis.pdf Centers for Disease Control & Prevention (CDC) Centers for Medicare & Medicaid Services (CMS) Certification/GuidanceforLawsAndRegulations/Nursing-Homes.html

50 THANK YOU FOR YOUR ICAR PARTICIPATION AND SUPPORTING RESIDENT SAFETY! i