outcomes and save lives! - 3m...

3M™ Learning Connection 9/8/2014

1

3M Infection Prevention Solutions

A Day in the Life of an Ambulatory Surgery Infection Preventionist - We CAN Improve Outcomes and Save Lives!

Libby Chinnes, RN, BSN, CIC

IC Solutions, LLC

September 9, 2014

From the GoToWebinar page:

Click on the orange box with a white arrow to expand your control panel (upper right-hand Disclosure

House Keeping

panel (upper right-hand corner of your screen).

Type a question in the question box and click send.

Disclosure

House Keeping

Continuing EducationEach 1 hour web meeting qualifies for 1 contact hour for nursing. 3M Health Care Provider is approved by the California Board of Registered Nurses CEP 5770.

Post webinar email: Link to Course Evaluation CE Certificate Included Forward eMail to Others in Attendance


2

Disclosure

Potential Conflict of Interest

Objectives

1. Cite infection prevention challenges from admission through discharge at an ambulatory surgery center.

2 Describe some thoughtful solutions to2. Describe some thoughtful solutions to common concerns in ambulatory surgery

3. Discuss methods to engage staff and surgeons for patient safety

Polling Question

What best describes your role?

1. ASC Infection Preventionist

2. ASC Infection Preventionist/OR Nurse

3. OR Manager/Team Leader

4. OR Staff Nurse

5. Other


3

Real Life Scenarios

Patients exposed to life threatening infections, both bacterial and viral, as well as outbreaks in all healthcare settings

High percentages of ambulatory surgery centers (ASC ) ith t l t l i i f ti(ASCs) with at least one lapse in infection control practices per CMS surveys

Real Life Scenarios“ A patient developed an infection six days after post cataract removal, resulting in complete loss of vision.”

“Ten days post left foot bunionectomy, the patient d f l htested positive for osteomyelitis with a resistant

organism, requiring a great toe amputation.”

Bradley S. Strategies to fully implement infection control practices in Pennsylvania ambulatory surgery facilities. Pennsylvania Patient Safety Authority Advisory 2013 Sept;10(3):99-106.

Centers for Medicare and Medicaid Services (CMS)

Conditions for Coverage (CfC) effective since 2009:

‐Written infection control program

‐ To prevent, control, and investigate

infections and communicable

diseases

‐ Based on nationally recognized

guidelines

‐ Led by a licensed individual with training in

principles and methods of infection prevention

and control


4

Infection Control Training

• Physicians

• Nursing

• Environmental

(including contract • Personnel responsible for

workers)

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107_exhibit_351.pd

onsite high level

disinfection & sterilization

• Others, (physician

assistants, CRNAs, others

providing direct patient

care, etc.)

Infection Control Documentation

•Education of all personnel

•National guidelines chosen

•Infection control policies and•Infection control policies and procedures including handling of reportable diseases

Standards of Infection Control in Reprocessing of Flexible Gastrointestinal Endoscopes

Infection Control Documentation

•Risk Assessment

•Infection Control Plan

•Surveillance/reports, minutes, quality improvement Infection Control Risk Assessmentimprovement, Infection Control Risk Assessment (ICRA)

•Employee health issues (evals, exposures, vaccinations, etc.)


5

Centers for Medicare and Medicaid Services (CMS)

Infection control program must:

• Be an integral part of the ASC’s quality assessment

and performance improvement program

• Provide a plan of action for prevention, identifying,

and managing infections and communicable diseases

and for immediately implementing corrective and

preventive measures that result in improvement

In addition, per CMS:

•ASC must provide a functional and safe environment√ Food sanita on

√ Cleaning and disinfec on of MUSTg

environmental

surfaces, carpeting, and

furniture

√ Disposal of regulated and

non‐regulated wastes

√ Pest control

monitor

compliance

CMSEnvironmental policies/ procedures must

address:

•Ventilation and water quality control

including safety

•Maintaining safe air handling systems in areas of special

ventilation such asmeasures during

construction and

renovation

ventilation, such as

operating rooms


6

Tour of A Day in the Life…

Meet Mollie Brown….

AdmittingRespiratory etiquette/cough hygiene

Screening


7

The hands have it!Approximately 1 in 5 healthcare facilities (hospitals, long term care, ambulatory care) do notmake alcohol based hand sanitizer available at every point of care.

Allegranzi B, Conway L, Larson, E, Pittet D. Status of the implementation of the World Health Organization multimodal hand hygiene strategy in the United States of America health care facilities. AJIC 2014; 42(3);224‐230.

Hand Hygiene per CMS

In ALL patient areas, have:

1) Soap and water

available

2) Alcohol–based hand

b il blrubs available

3) If alcohol used, must

be installed as

required ‐ 42 CFR

416.44(b)(5); see

NFPA Life Safety Code®

Hand Hygiene per CMS

1) After removing gloves

2) Before direct patient

contact

3) After direct patient

5) After contact with blood, body fluids, or

contaminated

surfaces?3) After direct patient

contact

4) Before performing

invasive procedures

surfaces?

6) Additional breaches?


8

Preoperative Holding Area

Hand hygiene

Gloves

IV and medication handling (injection safety)

Sharps

Clean environment

Safe Injection Practice

oNurses, CRNA’s, anesthesiologists

oNeedles once?oSyringes once?

i l S d

oManufactured prefilled syringes used for only one patient?

oSingle dose vials used for only one patient?

oVials ALWAYS entered with new (sterile) needle AND new (sterile) syringe?

oPre‐drawn meds labeled?

oIV solution bags used for only one patient?

oAdministration tubing/connectors used for only one patient?


How are multidosevials handled?


9

Safe Injection Practice Rule of Thumb…

Best ‐‐ single dose vial for each patient

Second best – Dedicate multidose vial to one patient

lonly

Lastly –multidose vial for more than one patient must not go to immediate patient area (or must be discarded before next patient or at end of case)

Clean Medication Area


Hand hygiene and asepsis?

Rubber septum disinfected with alcohol prior to each entry? IV ports?


10


•Expiration dates of vials?

•Sharps disposed of in puncture resistantpuncture‐resistant sharps containers which are disposed of when full?

Polling Question

Does your facility hold educational updates on safe injection practices at orientation and at least annually?

1 Yes1. Yes

2. No

Restricted Area of the OR


11

Proper Attire in Semirestricted and Restricted Areas?•Facility approved, clean, freshly laundered (or disposable)

•Scrub top tucked into pants or close fit?close fit?

•All hair covered? Bald heads?

•Mask?

•Clean shoes?

•Warm up jacket (nonscrubbed)?

•Jewelry?

Hand Hygiene

‐Natural nails no more than ¼ inch long

‐No chipped polish

‐No artificial nails in perioperative environment

‐No jewelry

‐Approved hand lotions

‐No direct patient care if cuts, abrasions, weeping dermatitis or fresh tattoos on exposed skin

Surgical Hand Scrub


12

Sterile Surgical Attire

Sterile Technique

‐Sterile field prepared as close as possible to time of use

‐Sterile field constantly monitored

‐In certain situations, a prepared , p psterile field not immediately used may be covered

Breaks in technique – “call it”

‐How to “move” in the OR

Medication and Sharps Safety

‐Medications prepared as close to time of use as possible

‐Safe injection practices in OR

S f h‐Safety sharps

‐Safe work practices

‐Sharps disposal

‐Expired meds


13

Reprocessing of Instruments

‐If single‐use, reprocessed by third party, FDA‐reprocessor

‐Begins at point of use – the OR/ procedure room

‐Instruments opened & disassembled

‐Ready access to IFU

‐Instruments treated with instrument cleaner per device manufacturer’s instructions before transport

‐Transport to reprocessing area – timely; contained; clean and dirty separate

Decontamination Area

‐Physically separate from clean area and includes a door (NOTE: workflow pattern)

‐Negative air pressure

i d d h idi‐Monitored temperature and humidity

‐Doors and windows closed

Decontamination Area‐Proper attire

‐Sink to manually clean instruments

‐Handwashing facilities

Eyewash station‐Eyewash station

‐Automated decontamination equipment, adaptors, and accessories, PPE

‐Compressed air supply

•AORN Recommended Practices for Cleaning and Care of Instruments and Powered Equipment 2014

39


14

Decontamination Area

Follow device and equipment manufacturers‘ instructions for cleaning

agent and methodsagent and methods

Preparation and Packaging

•Positive pressure

•Packaging or rigid sterilization container compatible with specific sterilization method usedused

•Used per packaging manufacturer and sterilizer manufacturer’s written IFU

•Chemical indicators with each package (AORN)

•Each package labeled before sterilization

SterilizationPhysical monitors (printouts, digital readings, graphs, gauges) – each load

For dynamic air removal‐type sterilizers, a Bowie‐Dick test is performed each day the sterilizer is used to verify efficacy of air removal

Biological indicators ‐ at least weekly and preferably daily and with every load containing an implantable object

If physical, chemical, OR biological indicators fail, conditions for sterilization have not been met!

Recall procedure in place


15

Sterilization Documentation

Sterile Storage

‐Traffic control

‐Proper temp, air exchanges and humidity

‐18 inches below ceiling or sprinkler head8 inches below ceiling or sprinkler head

‐8‐10 inches above floor; solid bottom shelf

‐2 inches from outside walls

‐No cardboard boxes

‐No stacking of heavy packages

High Level Disinfection (HLD)

‐Policy and procedure

‐IFU

‐The “practice” ‐ supervision

‐The documentation

‐Competency validation for each employee performing HLD

‐Employee precautions


16

Polling Question

Does your ASC validate competency for each employee performing HLD?

1. Yes

22. No

Anesthesia‐Are meds drawn up ahead of timelabeled?‐Left unattended?‐Expired?‐Unwrapped laryngoscope pp y g pblades in anesthesia drawer oron top of cart?‐Proper storage?Dolan SA, Heath J, Potter‐Bynoe G, Stackhouse RA. Infection prevention in anesthesia practice: a tool to assess risk and compliance. Am J Infect Control 2013;41:1077‐82.

Anesthesia

Dirty Clean


17

Anesthesia

No multidose vial in immediate patient treatment areas (CDC) (eg the surgery or(eg., the surgery or procedure room where anesthesia is administered and any anesthesia cart used in and for these rooms)

Anesthesia

‐Observe!

‐Scrub the hub!

‐Closed catheter access systems

‐Aseptic technique

‐Sterile cap or syringe on stopcocks not in use

Anesthesia

Mask when placing a catheter or injecting material into the spinal canal or subdural space (i.e., during myelograms, lumbar puncture, and spinal or epidural anesthesia)spinal or epidural anesthesia)


18

AnesthesiaHand hygiene‐approved products available and easy to access?

Hand hygiene before donning sterile gloves?

Hand hygiene especially as move from dirty to clean?

Gloves used appropriately?

Hand hygiene after glove removal and before clean task

(keyboard, meds)

Anesthesia/Nursing/ Environmental Services

•Proper turnover and cleaning/disinfection of equipment?q p

•Proper turnover and cleaning and disinfection of room and surfaces?

PACUHand hygiene after gloves removed?

Safe injection practice?

Glucometer cleaning and disinfection??

Proper cleaning and disinfection prior to next patient?patient?

Discharge teaching about

infection control


19

Engaging Staff and Physicians

Communicate ‐ get buy‐in BEFORE implementation

Team collaboration

h i i i !Co‐Champions – recognition!

Physician champion for peer‐to‐peer communication

Tailored education and feedback of facility data

“Education is not the filling of the basket, but the lighting of a fire.”

W. B. Yeats

Difference Makers

Infection Preventionists can improve outcomes pand save lives!

Our patients are depending on it!


20

References• Bradley S. Strategies to fully implement infection control practices in Pennsylvania

ambulatory surgery facilities. Pennsylvania Patient Safety Authority Advisory 2013 Sept;10(3):99-106.

• Stackhouse RA, Beers R, Brown D, Brown M, Greene E, McCann ME, et al. and the ASA Committee on Occupational Health. Task Force on Infection Control. Recommendations for infection control for the practice of anesthesiology. (Third Edition). Available from: http://asahq.org/For‐Members/Standards‐Guidelines‐and‐Statements.aspx#rec (see infection control section).

• Dolan SA, Heath J, Potter‐Bynoe G, Stackhouse RA. Infection prevention in anesthesia practice: a tool to assess risk and compliance. Am J Infect Control 2013;41:1077‐82. CMS State Operations Manual Appendix L Guidance for Surveyors Ambulatory SurgeryCMS State Operations Manual, Appendix L ‐ Guidance for Surveyors: Ambulatory Surgery Centers. Rev. 1‐31‐14. Available at:http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107_

exhibit_351.pdf. Accessed: April 23, 2014. • CMS Ambulatory Surgical Center: Infection Control Surveyor Worksheet. Centers for

Medicare and Medicaid Services. Available at: http://www.cms.gov/manuals/downloads/som107_exhibit_351.pdf.

References• ST79 ‐ Comprehensive guide to steam sterilization and sterility assurance in health care facilities, ANSI/AAMI ST79:2010 & A1:2010 & A2:2011 & A3:2012 & A4:2013.

• ST58 –Chemical sterilization and high‐level disinfection in healthcare facilities, ANSI/AAMI ST58: 2013.

• Recommended Practices for Sterilization. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2014.

• Recommended Practices for Cleaning and Care of Surgical Instruments and PoweredEquipment. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN Inc; 2014AORN, Inc; 2014.

• Recommended Practices for Cleaning and Care of Flexible Endoscopes and Endoscope Accessories. In: Perioperative Standards and Recommended Practices.Denver, CO: AORN, Inc; 2014.

• Recommended Practices for High‐Level Disinfection. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2014.

• Recommended Practices for Surgical Attire. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2014.

• Recommended Practices for Environmental cleaning. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2014.

References

• Guideline for the Use of High Level Disinfectants and Sterilants for Reprocessing of Flexible Gastrointestinal Endoscopes (2011). Society of Gastroenterology Nurses

and Associates. Available from: www.sgna.org.

• Standards of Infection Control in Reprocessing of Flexible Gastrointestinal

Endoscopes (2012). Society of Gastroenterology Nurses and Associates. Available p ( ) y gy

from: www.sgna.org.


21

References• Recommended Practices for Sterile Technique. In: Perioperative Standards and

Recommended Practices. Denver, CO: AORN, Inc; 2014.

• Recommended Practices for Hand Hygiene. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2014.

• CDC Guideline for Decontamination and Sterilization in Healthcare Facilities, 2008.

• Lo E, Nicolle LE, Coffin SE, Gould C, Maragakis LL, Meddings J, Pegues DA, Pettis AM, Saint S, Yokoe DS. SHEA/IDSA Practice Recommendation. Strategies to prevent catheter‐associated urinary tract infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35(5):464‐479Hosp Epidemiol 2014;35(5):464 479.

• Zhaghi J, Zhou J, Graham DA, Potter‐Bynoe G, Sandora TJ. Improving stethoscope disinfection at a children’s hospital. Infect Control Hosp Epidemiol 2013; 34(11):1189‐1193.

• Allegranzi B, Conway L, Larson, E, Pittet D. Status of the implementation of the World Health Organization multimodal hand hygiene strategy in the United States of America health care facilities. AJIC 2014; 42(3);224‐230.

References

• Safe Injection Practices: Available from: http://www.cdc.gov/injectionsafety/IP07_standardPrecaution.html. Accessed April 23, 2014.

• CDC Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care. http://www.cdc.gov/HAI/pdfs/guidelines/standards‐of‐ambulatory‐care‐7‐2011.pdf. Accessed: April 23, 2014.

• CDC Infection Prevention Checklist for Outpatient Settings: Minimum Expectations for Safe Care. http://www.cdc.gov/HAI/pdfs/guidelines/ambulatory‐care‐checklist‐07‐2011.pdf. Accessed: April 23, 2014.

3M Infection Prevention Solutions

Questions?

Libby Chinnes, RN, BSN, CIC

IC Solutions, LLC

3M.com/IPEd


22

Thank you!

3M.com/IPEd

outcomes and save lives! - 3m...

Documents