GI Suite Cmpliance Review S where d we g wrng? Presented by: Tim Muller Sr. Manager, Clinical Technlgies Octber 16, 2014 The individual respnsibility fr prtecting patients frm infectin isn t new it s always been at the cre f healthcare practice The funders f the prfessins f medicine and nursing stressed the essential need fr patient safety: Primum nn ncere - (First, d n harm) riginated frm the writings f Hippcrates, the father f medicine, where he said: As t diseases, make a habit f tw things t help, r at least t d n harm. Cmplacency: A feeling f cntentment r selfsatisfactin, especially when cupled with an unawareness f danger, truble, r cntrversy Healthcare wrkers MAY see bvius harm when it ccurs but mre ften than nt staff d nt see the near misses and this feeds the cmplacency
Cmplacency prevents us frm seeing: Surces f harm Near misses Ourselves as surces f harm What else are we up against? Emerging & New Technlgies are excellent fr advancing ur diagnstic and therapeutic ptins BUT cmplexity f healthcare interventins = risk f persnal failures that can harm patients GI Autmatin in cleaning, disinfectin & sterilizatin as well as mre cmplex medical devices intrduce tremendus training & cmpetency requirements If yu are ging t autmate it... There has t be smene t run it I hear yu but is it really a prblem? Why des Dr. Jnes still d brnchscpy prcedures in a rm that has n negative air exchange n a TB psitive patient? Why des nurse Betty still nt wear PPE r a face shield when assisting fr endscpy prcedures? Why des technician Bb still nt d a prper leak test prir t disinfectin r use glves when handling disinfected instruments? Why are cntaminated instruments nt labeled and transprted prperly t decntaminatin? Human factrs Intense wrklads Cntinuing high prcedure cunts Staff fatigue & shrtage f staff Length f time emplyed & practicing in a given psitin Cmpliance with hand washing, unifrm and hygiene equipment safety & surface disinfectin
Hspital Acquired Infectin (HAI) r Nscmial infectins Infectin acquired in hspital where the patient was admitted fr reasns ther than the infectin HAI s are amng the leading causes f death in Canada Mre than 200,000 patients get infectins every year while receiving healthcare in Canada; mre than 8,000 f these patients die as a result Each persn wrking in healthcare, whether it be in a clinical r nn-clinical rle, is respnsible fr taking active measures t minimize the risk f HCAI by mdifying ingrained behavirs and t break the chain f infectin Hspital Acquired Infectins (HAI s) The rate f preventable healthcare-assciated infectins (HCAI) is unacceptable and it must be reduced hwever and whatever it takes: Mrtality rates attributable t Clstridium difficile infectin have mre than tripled in Canada since 1997 The healthcare-assciated methicillin-resistant Staphylcccus aureus infectin rate increased mre than 1,000% frm 1995 t 2009 Abut 80% f cmmn infectins are spread by healthcare wrkers, patients and visitrs Prper hand hygiene can significantly reduce the spread f infectin Best practices in preventing infectin can reduce the risk f sme infectins t clse t zer -Public Health Agency f Canada HAI The Mde f Transmissin is the Key Cmpnent Cntact Susceptible Hst Prt f Entry Drplet Infectius Agent Chain f Infectin Airbrne Reservir Prtal f Exit Vehicle Vectr
Fr an infectin t ccur 3 criteria must be met: A. Sufficient number f pathgenic micrrganisms must invade the bdy B. The pathgens must find an apprpriate prtal f entry C. The target hst must be susceptible The Big Fur Pathgens in GI Clstridium difficile Pseudmnas aeruginsa Methicillin resistant Staphylcccus aureus (MRSA) Vancmycin resistant Entercccus (VRE) Types f Micrrganisms THE OFFENDERS Bacteria Viruses Fungi Prins Bifilms within GI Endscpy A bifilm is a structured cmmunity f micrrganisms encapsulated within a self-develped plymeric matrix and adherent t a living r inert surface. Frmatin f a bifilm begins with the attachment f free-flating micrrganisms t a surface If the clnists are nt immediately separated frm the surface, they can anchr themselves mre permanently using cell adhesin Staphylcccus aureus Staphylcccus aureus bifilm Explysaccharide (EPS)
Rutine infectin preventin and cntrl practices within GI endscpy: 1) The apprach t infectin cntrl in which all human bld and bdy fluids are treated as if knwn t be infectius Many rganisms have been shwn t prduce bifilms Staph aureus (MRSA), Pseudmnas. aeruginsa, Klebsiella pneumniae Bifilms are a ptential surce f infectin when the bifilm-assciated cells detach Bifilms have been fund in AER s & high level disinfectant slutins 2) All medical devices received fr reprcessing are cnsidered ptentially infectius Why AUDIT in GI? Disease transmissin has ccurred via endscpy Endscpes are cmplex and difficult t reprcess Bifilms present added challenge Reprcessing persnnel Shrtcuts due t high prcedure vlume, rapid turnarund, shrt staffing Training certificatin required On-ging cmpetency & Recertificatin Manager respnsibilities Autmated Endscpe Reprcessrs, accessries & filters are a significant surce f failure during high level disinfectin, PM Strage cabinets & cnditins ut f cmpliance Drying f instruments is prly understd Design f MDRD department (separatin f clean/dirty) Transprtatin f medical devices cntinues t be a prblem
Why AUDIT in GI? Infectin Cntrl Practitiners audit GI infrequently if at all Accreditatins are nt dne frequently enugh t ensure that the GI suite is meeting all f the guidelines Vendr partners can prvide specific infrmatin regarding their equipment but ften times this infrmatin cnflicts with hspital plicies & prcedures this leads t cnfusin and auditing can identify discrepancies Bibligraphy CAMDR - GI Cmpliance Audit Public Health Agency f Canada - http://www.phac-aspc.gc.ca Infectin Preventin and Cntrl Guideline fr Flexible Gastrintestinal Endscpy and Flexible Brchscpy The Chief Public Health Officer s Reprt n the State f Public Health in Canada, 2013 Infectius Disease The Never-ending Threat 2007 Guideline fr Islatin Precautins: Preventing Transmissin f Infectius Agents in Healthcare Settings - www.cdc.gv Healthcare Behavirs and Risky Business: First, D N Harm. David K. Hendersn, MD Infectin Cntrl and Hspital Epidemilgy, Vl. 26, N. 9 (September 2005) (pp. 739-742) Health Canada. 1998. Infectin Cntrl Guidelines: Hand Washing, Cleaning, Disinfectin and Sterilizatin in Health Care. Canada Cmmunicable Disease Reprt (CCDR). Supplement, Vl. 24S8. Health Canada. 2002. Infectin Cntrl Guidelines: Preventin and Cntrl f Occupatinal Infectins in Health Care. Canada Cmmunicable Disease Reprt (CCDR). Vl. 28S1. Sterilizatin: Wuld Yur Facility Pass a Standards Audit SPS Medical http://www.arnjurnal.rg/article/s0001-2092(07)00442-5/fulltext#sectin.0115