Vaccine Preventable Respiratory Infections and Tuberculosis Infection Prevention Essentials in Long-Term Care Spring 2019 Teri Hulett, RN, BSN, CIC, FAPIC Leading infection prevention education across the Rocky Mountain Region
Why immunize? Reducing the risk of infection through vaccination has been one of public health s greatest achievements. Immunization programs have been in existence for the long-term care population since 2005 without desired compliance. In an effort to improve immunization rates, resident influenza and pneumococcal immunizations have been identified as #3 of the 5 priority areas in the National Action Plan to Prevent Healthcare Associated Infections: Roadmap to Elimination Preventing infections in the LTC population is a patient safety issue leading to reduced resident harm and improved outcomes. https://health.gov/hcq/pdfs/hai-action-plan-ltcf.pdf
Immunization regulation 483.80(d) The intent of this regulation is to : Minimize risk of residents acquiring, transmitting, or experiencing complications Is informed about risks and benefits Has the opportunity to receive immunization, unless medically contraindicated, refused, or was already immunized Ensure documentation in the resident s medical record of the information and education provided https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/som107ap_pp_guidelines_ltcf.pdf
Immunizations Overview: Pneumococcal pneumonia is a common cause of hospitalization and death in older people. People >65 are two to three times more likely than the younger population to acquire pneumococcal infections Provision of immunizations: Education must have been provided and documented Contraindications would be: DOCUMENT Presence of moderate or severe acute illness End stages of terminal illness Severe allergic reaction refused https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/som107ap_pp_guidelines_ltcf.pdf
Procedure All new residents will should be screened and administered the vaccination unless specifically ordered otherwise by the primary physician on admission orders Standing orders part of admission order set (?) Annual review by Medical Director of influenza order set with master copy kept with Infection Control Every admission screened using criteria identified in standing order Licensed nursing staff perform screening and vaccination Document vaccination in medical record Pathway Health Services, Inc. Infection Prevention and Control Manual 2017 www.pathwayhealsth.com
Protocols and standing orders Pathway Health Services, Inc. Infection Prevention and Control Manual 2017 www.pathwayhealsth.com
Vaccine tid-bits Informed consent: there is no national requirement for vaccine consent but there may be a state requirement. Check with your public health department to verify consent requirement in your state. Vaccine adverse event reporting: the Vaccine Adverse Event Reporting System (VAERS) is a passive national reporting system that accepts reports on vaccine related adverse events report. anyone can https://vaers.hhs.gov/reportevent.html
TB Surveillance Persons > 65 constitute a large repository of Mycobacterium tuberculosis (TB) infection in the US CDC surveillance data indicate that most elderly tuberculosis patients have pulmonary disease Residents in long-term care facilities have been identified as a high-risk group for TB infection and spread within the facility In collaboration with the Facility Assessment, a communitybased risk assessment will include review of TB infection. Annual resident TB screening should be performed. Pathway Health Services, Inc. Infection Prevention and Control Manual 2017 www.pathwayhealsth.com
TB Spread by airborne droplet nuclei Talking Coughing Sneezing Two phases Latent TB infection (LTBI) (most common) Active TB disease Visitor compliance when resident in airborne precautions? Pathway Health Services, Inc. Infection Prevention and Control Manual 2017 www.pathwayhealsth.com
Annual TB screening tools https://www.cdc.gov/tb/publications/guidelines/appendixb_092706.pdf Pathway Health Services, Inc. Infection Prevention and Control Manual 2017 www.pathwayhealsth.com
TB policy elements Tuberculin Skin Test (TST) History of positive TST New positive TST Management of residents with positive TST Suspected active pulmonary TB disease Confirmed infectious pulmonary TB Reporting Tuberculin Skin Test (TST) administration and reading Tuberculin Skin Test (TST) interpretation QuantiFERON TB-Gold Test Pathway Health Services, Inc. Infection Prevention and Control Manual 2017 www.pathwayhealsth.com
Respiratory etiquette Respiratory hygiene and cough etiquette should be applied as a standard infection control precaution at all times. Covering sneezes and coughs prevents infected persons from dispersing respiratory secretions into the air. Post visual alerts at the entrances to healthcare facilities https://www.cdc.gov/flu/professionals/infectioncontrol/resphygiene.htm
Respiratory etiquette The following measures should be followed with any signs or symptoms of respiratory illness: Cover mouth and nose with tissue when coughing or sneezing Dispose used tissue in nearest trash Perform hand hygiene immediately after contact with respiratory secretions Practice is dependent on Plenty of available supplies Conveniently located for easy use Education to staff, residents, and visitors https://www.cdc.gov/flu/professionals/infectioncontrol/resphygiene.htm
Respiratory etiquette What is the primary prevention measure in the effort to prevent transmission of respiratory illness? Don t come to work sick Educate visitors not to visit when sick
References 1. National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination https://health.gov/hcq/prevent-hai-action-plan.asp#phase3 2. State Operations Manual Appendix PP-Guidance to Surveyors for Long Term Care Facilities (Rev. 173, 11-22-17) https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/som107ap_pp_guidelines_ltcf.pdf 3. CDC Appendix B. Tuberculosis (TB) risk assessment worksheet https://www.cdc.gov/tb/publications/guidelines/appendixb_092706.pdf 4. Pathway Health Services, Inc. Infection Prevention and Control Manual 2017 www.pathwayhealsth.com 5. CDC Respiratory Hygiene/Cough Etiquette in Healthcare Settings https://www.cdc.gov/flu/professionals/infectioncontrol/resphygiene.htm
Thank you