Strategies for Successful Operationalizing Infection Prevention and Control for Today s Long-Term Care Facilities

Transcription

1 Strategies for Successful Operationalizing Infection Prevention and Control for Today s Long-Term Care Facilities SUSAN LAGRANGE, RN, BSN, NHA, CDONA, FACDONA, CIMT DIRECTOR OF EDUCATION PATHWAY HEALTH PATHWAY HEALTH 2017

2 Objectives Upon completion of this presentation, attendees should be able to: 1. Outline the recent industry expectations for Infection Prevention and Control. 2. Discuss the clinical processes affected by the industry updates. 3. List three leadership strategies for successful implementation of an Infection Prevention and Control Program.

3 INFECTION Prevention and Control HAI s (Healthcare-associated infections) have been estimated to account for minion infections and 388,000 deaths annually Additionally, infections have very high costs to LTC facilities: $38 to $137 million annually for antimicrobial therapy and $673 million to $2 billion for hospitalizations -guide.pdf

4 Change

5 INDUSTRY EXPECTATIONS

6 Readmission Measure and VBP Payer.pdf 6

7 CMS-State Operations Manual State Operations Manual, Appendix PP Guidance to Surveyors for Long Term Care Facilities Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf. pdf 7

8 Key Areas to Look at Updated F-Tags potentially associated with Infection Control F880: Infection Control F881: Antibiotic Stewardship Program F882: Infection Preventionist F883: Influenza and Pneumococcal Immunizations F690: Urinary Incontinence (UTI s) F757: Unnecessary Drugs 8

9 F880 Infection Control The facility must establish an infection prevention and control program (IPCP) that must include, at a minimum, the following elements: 1. A system for o o o o o preventing, identifying, reporting, investigating, and controlling infections and communicable diseases for all residents, staff, volunteers, visitors, and other individuals providing services under a contractual arrangement based upon the facility assessment conducted according to (e) and following accepted national standards; 9

10 F880 Infection Control 2. Written standards, policies and procedures to include: A system of surveillance designed to identify possible communicable diseases or infections before they can spread When and Whom possible incidents of communicable disease or infections should be reported Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf 10

11 F880 Infection Control (Continued) Policies and Procedures Standard and transmission-based precautions o Type and duration of isolation o The isolation should be least restrictive possible for the resident under the circumstances Circumstances when employees are prohibited to work with a communicable disease or infected skin lesions from direct contact with residents or their food, if direct contact will transmit the disease 11

12 F880 Infection Control (Continued) Policies and Procedures: Hand Hygiene for all staff involved in direct resident contact Antibiotic Stewardship Program (Phase 2-November, 2017) Protocols Monitoring A system for recording incidents identified under the facility s IPCP and corrective action taken Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf 12

13 F880 Infection Control Other updates to Infection Control Linens o Handling, storage, processing and transporting to prevent the spread of infection Annual Review: The facility will conduct an annual review of it s IPCP and update the program as necessary Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf 13

14 F880: Infection Control NOTE: Hand hygiene (HH) (e.g., hand washing and/or ABHR): consistent with accepted standards of practice such as the use of ABHR instead of soap and water in all clinical situations except when hands are visibly soiled (e.g., blood, body fluids), or after caring for a resident with known or suspected Clostridium (C.) difficile or norovirus infection during an outbreak, or if infection rates of C. difficile infection (CDI) are high; in these circumstances, soap and water should be used Addressing the provision of facemasks for residents with new respiratory symptoms

15 CMS: F880: Infection Control (a)(2)(iv)When and how isolation should be used for a resident; including but not limited to: (A) The type and duration of the isolation, depending upon the infectious agent or organism involved, and (B) A requirement that the isolation should be the least restrictive possible for the resident under the circumstances Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf 15

16 Balance! Keeping residents safe, with quality of care and isolating in the least restrictive manner for safety 16

17 ANTIBIOTIC STEWARDSHIP

18 CMS-State Operations Manual Appendix PP-Guidance to Surveyors for Long Term Care Facilities F (a) Infection prevention and control program. The facility must establish an infection prevention and control program (IPCP) that must include, at a minimum, the following elements: (a)(3) An antibiotic stewardship program that includes antibiotic use protocols and a system to monitor antibiotic use. Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf

19 F881: Antibiotic Stewardship INTENT The intent of this regulation is to ensure that the facility: Develops and implements protocols to optimize the treatment of infections by ensuring that residents who require an antibiotic, are prescribed the appropriate antibiotic; Reduces the risk of adverse events, including the development of antibioticresistant organisms, from unnecessary or inappropriate antibiotic use; and Develops, promotes, and implements a facility-wide system to monitor the use of antibiotics. Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf

20 CDC /prevention/antibioticstewardship.html 20

21 CDC 21

22 22

23 AHRQ - Another GREAT RESOURCE Catheter Associated UTI s

24 CAUTI-Catheter Associated Urinary Tract Infections AHRQ toolkit Developed based upon 500 nursing homes across the country Was a 3-year implementation project Toolkit is organized in 3 main sections o Implementation o Sustainability o Resources campaign=ahrq_cauti4ltc_2017

25 Legionella The CDC indicates: Legionnaires disease is a serious type of pneumonia caused by bacteria, called Legionella, that live in water. Legionella can make people sick when they inhale contaminated water from building water systems that are not adequately maintained. Unfortunately, Legionnaires disease is on the rise in the United States. To reverse this trend, we are asking for your help to manage the risk of exposure to Legionella from water in your building. /toolkit.pdf

26 Legionella Risk Enrollment-and- Certification/SurveyCertificationGenInfo/Do wnloads/survey-and-cert-letter pdf

27 Legionella - Continued Enrollment-and- Certification/SurveyCertificationGenInfo/Do wnloads/survey-and-cert-letter pdf

28 Legionella - Continued ce/wmp-toolkit.html

29 Legionella - Continued

30 Legionella - Continued dc.gov/legion ella/maintena nce/wmptoolkit.html

31 RESIDENT IMMUNIZATIONS AND VACCINATIONS

32 Vaccines - F883 Influenza and pneumococcal immunizations Influenza: The facility must develop P&P s to ensure that o o o Prior to offering the flu vaccine, the resident or representative receives education on the benefits and potential side effects of the vaccine Each resident, unless medically contraindicated or if already immunized, is offered the flu vaccine between 10/1 and 3/31 annually The resident (or representative) has the opportunity to refuse Documentation must include the education for the resident (and/or resident representative) on the benefits and potential side effects, if the resident received or did not and reason why not and administration 32

33 F883: Influenza and Pneumococcal Immunizations Influenza Immunization The influenza vaccine is given seasonally. The CDC indicates that administering the vaccine when it becomes available each season, rather than date specific, (i.e., October 1 ) is most effective. Facilities should administer the influenza vaccine when it becomes available to the facility. Residents admitted late in the influenza season (typically February or March) should be offered the influenza vaccine as late season outbreaks do occur. Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf

34 Pandemic Influenza vs. Seasonal Flu

35 CDC Toolkit - Influenza Clinical Information Diagnositc Tests Antiviral Drugs Vaccine Recommendations (ACIP) Institutional Outbreaks and Infection Control Influenza Activity and Surveillance Vaccination Patient Education Training Long-Term Care Facilities

36 Vaccines - F883 Pneumococcal Disease The facility must develop P&P s to ensure: Prior to offering the pneumococcal vaccine, the resident or representative receives education on the benefits and potential side effects of the vaccine Each resident will be offered the pneumococcal immunizations unless medically contraindicated or already immunized The resident or representative has the right to refuse Documentation must include the education, if the resident received or did not and reason why not and administration 36

37 Immunization/Vaccination Program Pneumococcal Vaccines: 2 Pneumococcal vaccines are licensed in the U.S.: o PCV13 and o PPSV23 37

38 CDC s ACIP Pneumococcal Recommendations 34.pdf#page=16

39 F883: Influenza and Pneumococcal Immunizations NOTE: A nursing home may encounter residents who do not have adequate documentation of vaccinations. With the exception of influenza vaccine and pneumococcal polysaccharide vaccine (PPSV), providers should only accept written, dated records as evidence of vaccination. Self-reported doses of influenza vaccine and PPSV are acceptable. CMS: State Operations Manual, Appendix PP, Guidance to Surveyors for Long Term Care Facilities Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf

40 CLINICAL PROCESSES INDUSTRY UPDATES

41 Policy and Procedures POLICY: It is the policy that this facility s Infection Prevention and Control Program (IPCP), is based upon information from the Facility Assessment and follows national standards and guidelines to prevent, recognize and control the onset and spread of infection whenever possible. The Infection Prevention and Control Program includes a system for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases for all residents, staff, volunteers, visitors, and other individuals providing services under a contractual arrangement based upon the facility assessment conducted according to regulatory requirements and following accepted national standards.

42 Policies and Procedures! General Infection Control Policy and then Procedures: Examples include: Accessing Vascular Devices Annual Review of the Infection Prevention and Control Program Antibiotic Stewardship Barber and Beautician Services Blood and Body Fluid Exposure Blood and Body Fluid Spill Clean up Cleaning, Disinfection and Sterilization

43 Procedures - Continued Cleaning and Disinfecting Blood Glucose Meters Cleaning and Disinfecting PT/INR Machine/Monitor Cleaning and Disinfecting Nebulizer Equipment Cleaning and Disinfecting Resident Care Equipment Dishwashing Machine Finger Stick Devices Hand Hygiene Humidifiers Ice Chests and Machines

44 Procedures - Continued Influenza Immunization Insulin Pens Linen (Handling, Storing, Processing and Transporting) Occupational Health Outbreak Management Personal Protective Equipment Pest Control Pets and Animals in the Long-Term Care Facility Pneumococcal Immunizations Point-of-Care Testing

45 Procedures - Continued Preadmission Process Reportable Diseases Reporting of Communicable Disease Respiratory Hygiene/Cough Etiquette Rotating Stock Supplies Safe Medication Administration Shelf Life of Sterile Items Standard Precautions Sterilization of Critical Devices Surveillance (Process and Outcome)

46 Procedures - Continued System for Recording Infection Prevention and Control Program Incidents System for Reporting Surveillance Information to Staff and Practitioners Transmission-Based Precautions Tuberculosis Screening (State Requirements) Use of Multi-Dose vials Visitors AND MORE!

47 Right from the Beginning! Do you have a comprehensive Preadmission Screening Process?

48 It Starts with Preadmission! 48

49 Preadmission Assessment Review the Medical Record Diagnosis(es) Antibiotic Use Vital Signs Lab Work (Results or Pending Tests) Imaging Ask the nursing staff at the hospital (or other entity) about infections or symptoms 49

50 Resident Transfer - CDC Resource tioncontroltransferformexample1.pdf 50

51 Admission Screening Risk Factors Antibiotic use past 30 days Current symptoms or diagnosis Cultures taken and results Immunization history Duration of indwelling catheter Presence of MDROs Prior infection 2-step Mantoux - history of positive reaction Vaccines **Facilities will be required to incorporate any infection-related care needs on the initial 48 hour baseline care plan 51

52 Criteria for Infection Process for Nurses Do your nurses have a process?

53 Do You Have Tools/Resources? Criteria for Infection Forms UTI Skin/Soft Tissue Respiratory GI **Evidence of adequate symptoms I.E. Loeb Minimum Criteria, McGeers Criteria Loeb M, Brazil K, Lohfeld L, et al. Effect of a multifaceted intervention on number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes: cluster randomised controlled trial. BMJ. 2005;331:669 Stone, N., Ashraf, M., Calder, J., Crnich, C., Crossley, K., Drinka, P.,... For the Society for Healthcare Epidemiology Long-Term Care Special Interest Group. (2012). Surveillance Definitions of Infections in Long-Term Care Facilities: Revisiting the McGeer Criteria. Infection Control and Hospital Epidemiology, 33(10), doi: /66774

54 LEADERSHIP STRATEGIES

55 Leadership Strategies 1. Review the following regulatory requirements: F880: Infection Control F881: Antibiotic Stewardship Program F882: Infection Preventionist F883: Influenza and Pneumococcal Immunizations F690: Urinary Incontinence (UTI s) F757: Unnecessary Drugs

56 Leadership Strategies 2. Utilize GOOD tools that will assist you to identify opportunities to improve your systems for quality and compliance! CMS Memo: Ref: S&C ALL entitled: Infection Control Pilot: 2017 Update Certification/SurveyCertificationGenInfo/Downloads/Survey-and- Cert-Letter pdf

57 Leadership Strategies The document identifies: Infection Prevention and Control Infrastructure Infection Preventionist Quality Assessment and Assurance Committee Infection Surveillance Antibiotic Stewardship Programs Hand Hygiene Standard Precautions Transmission Based Precautions Injection Practices and Sharps Safety Point of Care Devices Central Venous Line/Catheters Indwelling Urinary Catheters Respiratory Therapy Wound Management Environmental Cleaning and Disinfection HealthCare Personnel Safety Respiratory Disease Prevention Linen Management AND so much more!

58 Leadership Strategies Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter pdf

59 Leadership Strategies LTC Survey Pathways from CMS: Certification/GuidanceforLawsAndRegulations/Nursing-Homes.html

60 INFECTION PREVENTION, CONTROL & IMMUNIZATION CMS-20054

61 CMS (5/20/17) Hand Hygiene PPE Transmission-Based Precautions Laundry services Policies and Procedures Infection Surveillance Antibiotic Stewardship Program Influenza and Pneumococcal Immunizations Leadership Strategies

62 CDC - NHSN (National Healthcare Safety Network): Tracking Education Resources Leadership Strategies

63 Leadership Strategies-CDC-NHSN INFECTION PREVENTION AND CONTROL ASSESSMENT TOOL FOR LONG-TERM CARE FACILITIES

64 Leadership Strategies 3. Review State Specific Resources Memos related to Infection Prevention and Control Directives Reporting of Communicable Diseases Requirements Contacts for Local/Health Departments

65 Florida Communicable Disease Reporting -and-conditions/disease-reportingand-management/

66 Florida Reportable Diseases/Conditions s-and-conditions/disease-reportingandmanagement/_documents/reportable -diseases/_documents/reportablediseases-list-practitioners.pdf

67 Leadership Strategies 4. Review your current system! Policies and Procedures Forms/Systems Tracking Process Surveillance Documentation, Analysis and Reporting Staff Training Resident/Visitor training Documentation

68 Leadership Strategies 5. Make the MOST of the FACILITY ASSESSMENT! Risk Assessment Resources Equipment Staffing o Numbers o Types o Competencies Needs for the Program

69 Leadership Strategies 6. Put together a TEAM for Infection Prevention and Control: Nursing (Licensed, CNA s, all shifts) Dietary Housekeeping Laundry Maintenance Social Services

70 Leadership Strategies 7. Meet with the Medical Director and the Pharmacy Consultant: Regulation Review Policies and Procedures How to handle practitioner education Hospital admissions/transfers Diagnostic concerns Etc.

71 Leadership Strategies 8. Plan an all staff educational event!

72 Leadership Strategies 9. Use evidence-based or industry accepted best practice resources! Always watch for new updates!

73 Leadership Strategies 10. Understand AND Share your date with the Interdisciplinary Team!

74 Leadership Strategies 11. Never underestimate the power of solid communication systems!

75 Leadership Strategies 12. Audit, Audit, Audit and USE the information for Quality Improvement!

76 Well-trained and dedicated employees are the only sustainable source of competitive strength -Robert Reich

77 Questions?

78 Disclaimer This presentation provided is copyrighted information of Pathway Health. Please note the presentation date on the title page in relation to the need to verify any new updates and resources that were listed in this presentation. This presentation is intended to be informational. The information does not constitute either legal or professional consultation. This presentation is not to be sold or reused without written authorization of Pathway Health.

79 Sue LaGrange, RN, BSN, NHA, CDONA, FACDONA, CIMT