sepsis prevention: three part series - part one · 2020. 7. 24. · chat box. 3 in chat type in the...
TRANSCRIPT
© 2019, Telligen, Inc.
This material was prepared by Telligen, the Medicare Quality Innovation Network Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. This material is for informational purposes only and does not constitute medical advice; it is not intended to be a substitute for professional medical advice, diagnosis or treatment. 12SOW-QIN-QIN-12/26/19-3552
© 2018, Telligen, Inc.
Gina Anderson, RN, BSN
Senior Quality Improvement Facilitator
Sepsis Prevention: Three Part Series - Part One
2
Zoom Chat Function
Open Chat
To open chat, hover over the bottom of the meeting screen
and click on the chat icon
Be sure to enter your name, title, and organization into the
chat box
3
▪ In chat type in the following:
– Organization name and state
– How many are in your group?
▪ Be engaged
▪ Limit multitasking
▪ Come prepared
▪ Be ready to share – use chat or press *6 to speak verbally
Sepsis Prevention Series: Part One
Housekeeping
4
5
Agenda
Topic Who Time
Introduction Gina 5 minutes
Presentation – Sepsis Overview
and Hand Hygiene
Gina 35 minutes
Discussion/Questions Everyone 15 minutes
Next Steps/Action Period Gina 5 minutes
6
▪ Understand the impacts of sepsis
▪ Identify measures to prevent sepsis
▪ Recognize hand hygiene as the number one prevention strategy
▪ Implement a program to improve hand hygiene compliance
▪ Provide tools to utilize during the action period
Objectives
7
CMS 483.80 Infection Control
▪ The facility must establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections.
▪ (a) Infection prevention and control program. The facility must establish an infection prevention program (IPCP) that must include, at a minimum, the following elements:
▪ (1) 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 §483.70(e) and following accepted national standards;
https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Nursing-Homes
8
CMS Infection Control (continued)
2) Written standards, policies, and procedures for the program, which must include, but are not limited to:
▪ 1. A system of surveillance designed to identify possible communicable diseases or infections before they can spread to other persons in the facility;
▪ 2. When and to whom possible incidents of communicable disease or infections should be reported
▪ 3. Standard and transmission-based precautions to be followed to prevent spread of infections;
▪ 4. When and how isolation should be used for a resident; including but not limited to:
– The type and duration of the isolation, depending upon the infectious agent or organism involved, and
– A requirement that the isolation should be the least restrictive possible for the resident under the circumstances.
▪ 5. The circumstances under which the facility must prohibit employees with a communicable disease or infected skin lesions from direct contact with residents or their food, if direct contact will transmit the disease; and
▪ 6. The hand hygiene procedures to be followed by staff involved in direct resident contact.
9
▪ Sepsis is the body's systemic inflammatory response to
an infection – bacterial, viral or fungal
▪ Sepsis happens when an infection you already have triggers a chain reaction throughout your body
▪ Sepsis is serious, overwhelming, and sometimes life-threatening
▪ Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death
Sepsis is:
https://www.cdc.gov/sepsis/what-is-sepsis.html
https://www.mayoclinic.org/diseases-conditions/sepsis/symptoms-causes/syc-20351214
10
▪ Sepsis is a toxic response to an infection
▪ Sepsis occurs when your body starts to attack itself rather than the infection
▪ You must have an infection to have sepsis, but the infection isn’t always identified
Why Does Sepsis Occur?
https://www.sepsis.org/sepsis-in-the-news/what-is-sepsis-what-it-is-and-what-it-isnt/
This Photo by Unknown Author is licensed under CC BY-ND
11
▪ When a resident is hospitalized with a primary diagnosis of
infection, the mortality rate can reach as high as
▪ Infections account for up to half of nursing home resident
to the hospital and cost between
$670 million to $2 billion each year
▪ Sepsis begins outside of the hospital for nearly of patients
▪ Sepsis is the leading cause of hospital
Infection and Sepsis Facts
http://www.cdc.gov/vitalsigns/sepsis/index.html
12
Among adults with Sepsis:
▪ 35 percent had pneumonia or respiratory infection
▪ 25 percent had a urinary tract infection
▪ 11 percent had a GI infection
▪ 11 percent had a skin infection
Sepsis Facts:
http://www.cdc.gov/vitalsigns/sepsis/index.html
13
▪ Many survivors of sepsis recover completely
▪ Consequences may include:
– Physical impairment
– Sepsis-induced inflammation and cardiovascular risk
– Sepsis-induced immunosuppression
– Long-term morbidity
– Loss – limb, self-esteem
Long Term Consequences of Sepsis
https://www.cdc.gov/sepsis/life-after-sepsis/index.html
This Photo by Unknown Author is licensed under CC BY-ND
14
▪ A number of infections, if caught early, may be treated in the nursing home
▪ Transfer to a hospital emergency department can cause problems including translocation trauma and colonization with drug resistant bacteria
Early Identification is Key
https://www.cdc.gov/media/releases/2017/p0831-sepsis-recognition-treatment.html
“The only way to prevent sepsis is to prevent infections from occurring in the first place.”
https://www.sepsis.org/news/what-is-sepsis-what-it-is-and-what-it-isnt/
15
Critical Element Pathways▪ Form-20053 Dining
▪ Form-20054 Infection Prevention and Control
▪ Form-20056 Med Administration
▪ Form-20061 Environmental
▪ Form-20062 Sufficient and Competent Staff
▪ Form-20066 Kitchen
▪ Form-20068 Urinary Catheters or UTI
▪ Form-20078 Pressure Ulcers
▪ Form-20123 Hospitalizations
Sepsis Prevention is Linked to the CEPs
https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Nursing-Homes.html
16
▪ Prevent infections by following infection control practices including:
– Hand hygiene
– Catheter removal
– Ensuring patients receive recommended vaccines
▪ Educate your patients and their families
▪ Initial screening by the nursing care staff is critical to determine if there are any sites for infection
Prevention Strategies
https://www.cdc.gov/sepsis/education/hcp-resources.html
17
Infection Prevention
18
Hand hygiene is one of the most important ways to prevent the spread of infections
Prevention Strategy and Hygiene
https://www.cdc.gov/sepsis/prevention/index.html
19
The most common mode of pathogen transmission is hands
▪ Infections acquired in healthcare
▪ Spread of antimicrobial resistance
Full adherence to hand hygiene standards is performed less than 40% of the time
An Uncomfortable Truth
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249958/
20
▪ Confirm staff has access to hand hygiene standards of practice
▪ Confirm hand hygiene performed appropriately for situations
Guidance to Surveyors for LTCF
https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Nursing-Homes.html
Did staff implement appropriate hand hygiene?
This Photo by Unknown Author is licensed under CC BY
21
▪ Before and after contact with a resident
▪ Before donning gloves
▪ Before performing an aseptic task
▪ Before meals
▪ After contact with blood, bodily fluids, visibly contaminated surfaces or objects in the resident’s room
▪ After removing personal protective equipment (gloves, gown, facemask)
▪ After using the restroom
▪ When hands are visibly dirty
When to Perform Hand Hygiene
World Health Organization 5 Moments for Hand Hygienehttp://www.who.int/gpsc/5may/background/5moments/en/
22
The rubbing hands together for 15-20 seconds with soap and water, followed by
rinsing under a stream of water
Hand Washing
Guideline for Hand Hygiene in Health-Care Settings https://www.cdc.gov/handhygiene/providers/guideline.html
CDC fight Germs. Wash Your Hands! video https://www.cdc.gov/cdctv/healthyliving/hygiene/fight-germs-wash-hands.html
This Photo by Unknown Author is licensed under CC BY-SA-NC
23
▪ A 60-95 percent ethanol or isopropyl alcohol containing preparation base designed for hand application to reduce the number of viable microorganisms
▪ Benefits to promote hand hygiene adherence:
– Less time
– More effective
– Greater decrease of bacteria on hands than soap and water
Alcohol Based Hand Rub
This Photo by Unknown Author is licensed under CC BY
24
Use Soap and Water▪ When hands are visibly dirty
▪ After known or suspected exposure to C-diff if your facility is experiencing an outbreak or higher endemic rates
▪ After known or suspected exposure to patients with infectious diarrhea during norovirus outbreaks
▪ Before eating
▪ After using the restroom
▪ If exposure to Bacillus anthracis is suspected or proven
Use an ABHR▪ For everything else
Soap and Water vs. Alcohol Based Hand Rub (ABHR)
https://www.cdc.gov/handhygiene/providers/guideline.html
25
▪ Handwashing agents cause skin irritation and dryness
▪ Sinks are inconveniently located, or lack of sinks
▪ Lack of soap and paper towels
▪ Too busy/insufficient time
▪ Understaffing/overcrowding
▪ Patient needs to take priority
▪ Perceived low risk of acquiring infection from patients
What Keeps Us From Adherence?
http://www.idpublications.com/journals/pdfs/jhi/jhi_mostdown_1.pdfhttps://apic.org/resources/topic-specific-infection-prevention/hand-hygiene/
26
Mitigation Steps to Your Hand Hygiene Program
Accessibility of hand hygiene
Facility policy
Staff training and competency
evaluation
Staff performance
Provide feedback
27
Assess the Accessibility of Hand Hygiene
▪ Soap, water and paper towels are available in all resident care areas
▪ ABHR is available in all resident care areas (place outside of each resident room/pocket sized containers)
▪ Other supplies necessary for standard precautions (i.e. gloves)
Step One
This Photo by Unknown Author is licensed under CC BY-SA-NC
28
Assess Facility Policy
▪ Make improved hand hygiene an institutional priority!!
▪ Policies promote use of alcohol-based hand rub over soap and water in most clinical situations
▪ Should follow evidenced based guidance (CDC Hand Hygiene Guidelines)
Step Two
This Photo by Unknown Author is licensed under CC BY-SA
29
Assess Staff Training and Competency Evaluation
▪ All personnel receive training and competency validation on HH at the time of employment
▪ All personnel received training and competency validation on HH within the past 12 months
Step Three
This Photo by Unknown Author is licensed under CC BY-NC
30
Hand Hygiene Training
CDC Hand Hygiene Traininghttps://www.cdc.gov/handhygiene/providers/training/index.html
Wash Your Hands: It Just Makes Sense https://www.youtube.com/watch?v=M8AKTACyiB0
Hand Hygiene and Glove Usage https://www.youtube.com/watch?v=9R8fHo6WfzY&feature=youtu.be
31
Hand Hygiene Competency
https://www.hse.ie/eng/about/who/healthwellbeing/infectcont/sth/resources/hhassess/knowledge-assessment-and-competency-tool-2014.pdf
https://spice.unc.edu/wp-content/uploads/2017/03/Hand-Hygiene-Competency-SPICE.pdf
32
Assess Staff Performance
▪ The facility routinely audits adherence to HH (monitors and documents)
▪ Performance is recorded
▪ Audits occur with all staff and all shifts for several activities
▪ Report of performance are provided to the QAPI committee to assist with necessary support
Step Four
This Photo by Unknown Author is licensed under CC BY
33
▪ Directly observing
▪ Measuring product use
▪ Conducting surveys
Methods for Measuring Hand Hygiene
34
Reporting both process and outcome measures to the QAA and QAPI team for hand hygiene practices
▪ Examples of process measures: – Compliance with educational program
– Compliance with documentation of hand hygiene audits
– Compliance with documentation of compliance with timing
▪ Examples of outcome measures:– Rates of hand hygiene compliance
– Rate of sepsis occurrences secondary to health-related infections
– Readmission rates secondary to health-related infections or sepsis occurrences
Internal Reporting
https://www.cdc.gov/infectioncontrol/guidelines/cauti/implementation-audit.html
35
Rate Equation Examples
Prevalence rates
(# of residents with infections) / (# of residents) X 100
= _____% of infections per # of residents
Calculation of infection rates
(# of infections) / (avg. # of resident census) X (days in the month) X 1000 =____infections per 1000 resident days
Compliance/performance rates
(# times practice is performed correctly) / (# of opportunities to perform the practice) X 100 =___% of compliance rate
36
Monitoring Tool
Download from the
App Store
https://vinci.cs.uiowa.edu/scrubwatch/iscrub.php
37
Entering Observations
38
Provide Feedback
▪ Provide feedback to personnel regarding their HH performance
▪ Provide just-in-time training for staff not following the policy
▪ Results from step four and five incorporated back into step three
Step Five
39https://www.vumc.org/handhygiene/23196
Vanderbilt Health Receives National Designation for Excellence in Infection Prevention https://www.newswise.com/articles/vanderbilt-health-receives-national-designation-for-excellence-in-infection-prevention
8 Ways Vanderbilt UMC Raised Hand Hygiene Compliance https://www.beckershospitalreview.com/quality/8-ways-vanderbilt-university-medical-center-raised-hand-hygiene-compliance.html
Hand washing: How one hospital achieved nearly 100% compliancehttps://www.healthcarebusinesstech.com/hospital-hand-washing/
40
Hand Hygiene Saves Lives
This Photo by Unknown Author is licensed under CC BY-NC
41
Questions
42
▪ Meet as a team – determine a time to meet one or two times per
week for discussion during action periods of the three-part series
▪ Review steps one through five of the handouts – determine
areas that need mitigation in gaps recognized
▪ Download the iScrub App – use this to monitor staff
performance during the action period as noted in step four
▪ Monitor 10 or more hand hygiene performances by sepsis series part two – determine who will do the ongoing monitoring
▪ Seek new opportunities - promote hand hygiene to residents,
their families, volunteers, and your staff using the resources provided in the slides
▪ Be prepared to share your action items during Sepsis Series part 2
Next Steps for Action Period
43
Hand Hygiene Resources
▪ Telligen Hand Hygiene resources https://www.telligenqinqio.com/?s=hand+hygiene
▪ Change Package Attachment 4 https://telligenqinqio.com/resource/national-nursing-home-
quality-care-collaborative-change-package/
▪ Hand Hygiene in Healthcare Settings https://www.cdc.gov/handhygiene/
▪ CDC Hand Hygiene: 5 Facts https://www.cdc.gov/handhygiene/patients/index.html
▪ Wash Hands Posters https://www.cdc.gov/handwashing/posters.html
▪ The Safety Stand-Down: a technique for improving and sustaining
hand hygiene compliance among health care personnel https://psnet.ahrq.gov/resources/resource/32190/The-safety-stand-down-a-technique-for-improving-and-
sustaining-hand-hygiene-compliance-among-health-care-personnel
44
▪ CMS Hand Hygiene Video https://www.cms.gov/Outreach-and-Education/Medicare-
Learning-Network-MLN/MLNProducts/MLN-Multimedia-Items/2017-06-28-Infection-Control.html
▪ Dirty Hands Can Be Scary http://www.dirtyhandscanbescary.com/
▪ How To Guide: Improving Hygiene http://www.ihi.org/resources/Pages/Tools/HowtoGuideImprovingHandHygiene.aspx
▪ Hand Hygiene Observation Training Toolkit http://atomalliance.org/wp-
content/uploads/2016/06/Hand-Hygiene-Observation-Training-Toolkit.pdf
▪ Measuring Hand Hygiene Adherence: Overcoming the Challenges https://www.jointcommission.org/topics/hai_hand_hygiene.aspx
Hand Hygiene Resources Continued
45
▪ Sepsis Among the Elderly Toolkit https://www.telligenqinqio.com/resource/our-work/sepsis/sepsis-resources/sepsis-among-the-elderly-toolkit/
▪ Telligen Sepsis Resources https://www.telligenqinqio.com/?s=sepsis
▪ Test Your Knowledge: Sepsis Quiz https://www.telligenqinqio.com/our-work/care-
coordination/sepsis-quiz/
▪ CHA Sepsis Training Suite https://cha.com/quality-patient-safety/sepsis/cha-sepsis-training-
suite/
▪ Stop Sepsis Now https://atlanticquality.org/initiatives/sepsis-initiative/
▪ The Rory Staunton Foundation for Sepsis Prevention https://rorystauntonfoundationforsepsis.org/
▪ Sepsis Alliance https://www.sepsis.org/itsabouttime/
▪ Agency for Healthcare Research and Quality https://www.ahrq.gov
Sepsis Resources
46
Benefits:
▪ Exclusive access to learning collaboratives, workshops, data tracking tools
▪ Optimize your improvement efforts to achieve your goals
▪ Free resources
Affinity Groups:
▪ Nursing Home Quality
▪ Care Transitions
▪ Opioid & Behavioral Health
▪ Chronic Disease Management
▪ Patient & Family Engagement
Join Telligen QI Connect™
Telligen QI Connect™ https://www.telligenqinqio.com/join-us/
47
Save the Date!▪ Community Coalition Kickoff Events
– January 8 @ 11:00am - 11:30am CST/10:00am – 10:30am MST https://www.telligenqinqio.com/event/community-coalition-kickoff-events/
– January 9 @ 8:00am - 8:30am CST/7:00am – 7:30am MST https://www.telligenqinqio.com/event/community-coalition-kickoff-events-2/
– January 15 @ 2:00pm – 2:30pm CST/1:00pm – 1:30pm MST https://www.telligenqinqio.com/event/community-coalition-kickoff-events-3/
– January 16 @ 12:00pm – 12:30pm CST/11:30am – 12:00pm MST https://www.telligenqinqio.com/event/community-coalition-kickoff-events-4/
▪ Sepsis Prevention: Three Part Series – Part 2– February 4 @ 1:30pm - 2:30pm CST/12:30am – 1:30pm MST
https://www.telligenqinqio.com/event/sepsis-prevention-in-your-nursing-home-three-part-series-2/
Upcoming Events
https://www.telligenqinqio.com/events/
48
49
Telligen QI Connect™ Team
https://www.telligenqinqio.com/contact/
Thank You!
www.TelligenQINQIO.com
Please complete the evaluation coming to you by email!
Gina AndersonSenior Quality Improvement Facilitator