Elements of an Effective Program

1. Elements of an Effective Program Linda R. Greene, RN, MPS,CIC, FAPIC Manager, Infection Prevention UR Highland Hospital Rochester, NY linda_greene@urmc.rochester.edu

2. Objectives • Discuss the basic elements of an effective infection prevention program • Describe how to conduct a risk assessment • Identify key strategies related to improving hand hygiene • Explain surveillance essentials

3. Let’s Start at the Beginning Why do a risk assessment ? Types of Risk assessment – annual Targeted – new procedures, equipment, guidelines

8. Why do a Risk Assessment ? In order to set priorities, we must first assess the current status Mandated by regulatory and accrediting agencies Should be considered in all patient care settings

9. What is a Risk Assessment This is a process that examines recognized and potential risks for acquiring and transmitting infections in a healthcare system. It identifies evidence-based measures to reduce these risks. It prioritizes risk based upon the potential or actual impact on care.

10. Performing a IC Risk Assessment Leadership Identify Risk Targets For Analysis Determine Goals Strategies Evaluation Process •Local Community •Organizational •Societal Risk Assessment Cycle Involve Others Establish Priorities Qualitative or Quantitative •ICC •Leadership •Key Staff •Health Dept Perform Assessment Develop Methods •Quantitative •Qualitative •SWOT •Gap Analysis Establish Priorities Templates Establish Timelines

11. Consider This • Some risks are common in all healthcare settings • Others occur in special settings • The risk assessment takes into account: - Geographic location - Care and services offered - Population served

12. Check List • What age patients do you see? • What services are provided? • Does site see a varied population? • What procedures and treatments do you perform? Endoscopy? Vaginal ultrasound? Minor suturing? • Do you do any sterilization or high level disinfection?

13. Applying the Definition Example – Tuberculosis Population- Small rural hospital in Montana Community cases past 2 years – none Risk ? Example- Finland

14. Components of a Risk Assessment Populations served- identify the demographics of the population Consider Age Immune Status Race and ethnicity Special non immunized populations ie. Amish

15. Services Provided Long Term Care- Ventilator, Rehab Inpatient vs. Outpatient Cancer Care Medical and Surgical Special Services

16. Procedures Performed Surgical Procedures High Risk, High Volume, Problem Prone Endoscopy, Interventional Radiology

17. Geographic Location Texas vs. Montana NYC vs. Olean, NY

18. Surveillance Data C Difficle Rates MRSA Surgical Site Infections ESBL Central Line Bloodstream Infections Urinary Tract infections

19. New Procedures or Devices Consider the Learning curve Examples : Robotic surgery ,

20. Other Types • Legionella Risk assessment • Fans in patient rooms • Construction

21. TB Legionella Meningitis Community-Acquired MRSA Listeria Hepatitis A Disease and Conditions In the Community

22. Sample

26. Hand Hygiene

28. Literature

29. Findings

33. Face to Face interviews with 13 senior managers at a large university hospital Seven distinct themes: • Culture change starts with leaders • Refresh and Renew the message • Connect the 5 moments to the whole patient journey • Actionable audit results • Empower patients • Reconceptualize non compliance • Start the hammer

34. Participants All affiliated nurses of the nursing wards. Wards were randomly assigned to either the team and leaders-directed strategy (30 wards) or the state-of-the-art strategy (37 wards). Methods The control arm received a state-of-the-art strategy including education, reminders, feedback and targeting adequate products and facilities. The experimental group received all elements of the state-of-the-art strategy supplemented with interventions based on social influence and leadership, comprising specific team and leaders-directed activities. Strategies were delivered during a period of six months

35. Results 10,785 opportunities for appropriate hand hygiene in 2733 nurses. The compliance in the state-of-the-art group increased from 23% to 42% in the short term and to 46% in the long run. The hand hygiene compliance in the team and leaders-directed group improved from 20% to 53% in the short term and remained 53% in the long run. The difference between both strategies showed an Odds Ratio of 1.64 (95% CI 1.33–2.02) in favor of the team and leaders-directed strategy. Conclusions Our results support the added value of social influence and enhanced leadership in hand hygiene improvement strategies. The methodology of the latter also seems promising for improving team performance with other patient safety issues

38. Engaging Patients

39. Wash Your Hands • With alcohol-based hand rub: • When???

40. Five Moments for Hand Hygiene • World Health Organization: • 1. Before touching a patient • 2. Before aseptic/clean procedure • 3. After body fluid exposure risk • 4. After touching a patient • 5. After touching patient surroundings

41. WASH YOUR HANDS!! • With Soap and Water: • When?

42. Literature

43. Findings

44. Compliance • Measurement

45. Measurement • Direct observation • Product use • Electronic systems

47. Discussion

48. Surveillance

49. Prioritize Assess the Population and determine those at greatest risk Examples: Select surgical Site Infections Pneumonia Patients ICU Patients

50. Determine the Type ofSurveillance Process vs. Outcome • Outcome – Healthcare acquired Infections • Process- Patient Care Practices aimed at preventing HAI’S