Implementation of best practice for HAI prevention

1. Implementation of best practice for HAI prevention Kim Delahanty, BSN,MBA/HCM, CIC Administrative Director IPCE May 2014 SFBA APIC

2. Magnet – Transformational LeadershipAdvocacy and Influence “The CNO influences organization-wide change beyond the scope of nursing” - TL3EO Innovate, Involve, Inspire

3. Nursing Cabinet • Approval of 3 HAI Prevention strategies for 2013-2014 • SBAR • Engage thought leaders and IC champions outside IPCE • Use data, science and evidenced based practice to drive process improvement recommendations • Support nursing at leadership level (SMT, Exe Board)when asking for approval een:K:\tip of the week\tip of the week program.pptx

4. SBAR Curos Daily CHG bathing een:K:\tip of the week\tip of the week program.pptx

5. SBAR 2 x a day environmental wipe down een:K:\tip of the week\tip of the week program.pptx

6. Background • RU Ready internal TJC survey findings • TJC Mock survey results • CMS & CDPH deficiencies • Organizational changes • Communication challenges een:K:\tip of the week\tip of the week program.pptx

7. Education Sharing for Stand-Up Huddles All leaders will participate in huddles een:K:\tip of the week\tip of the week program.pptx

8. FACE TO FACE!! • Process: • Conduct the education covering all topic points FACE TO FACE. • Keep an attendance sheet. • Engage staff in discussion and clarify questions. • Try to make it a fun process with rewards, raffles, candy bucket, etc. • Keep the weekly topics in a binder with the attendance sheet for staff to refer to. • Keep your audit results in a binder available for review. • Outcome Measurements • % of staff educated • A knowledge audit based upon the topic of the week will be conducted: • During handoffs • During caring rounds • Through prevalence studies • Through Epic audits een:K:\tip of the week\tip of the week program.pptx

9. Schedule of Topics een:K:\tip of the week\tip of the week program.pptx

10. een:K:\tip of the week\tip of the week program.pptx

11. Curos

12. Hospital Wide Implementation for Port Protectors to be used on Patients with Central Lines (ONLY)

13. Dates • November 1st: Nurse Leaders Meeting • Share roll-out plan and answer questions • Obtain buy-in for checking compliance • Obtaining unit’s sign-in sheets (electronically please) with staff names for in-service education • November 28th– December 7th: Education will take place, via roaming in-services on night and day shiftsto all areas. (see flyer) • November 28th: Product will be added to carts • January 1st: Start audits

14. How Curos Works • Passive Disinfection • Chemical agent – 70% Isopropyl Alcohol • Time of exposure – 3 minutes • Physical barrier – up to 7 days if not removed • No scrubbing necessary (for first access) • FDA 510(k)

15. Port Protector Guidelines • The Central and Midline Catheter Management and CarePolicy will be followed. See below for specific changes related to the port protector • The port protector • Will be applied to every available port (those that are open to be accessed) on all IV lines on all patients that have a central line. If a patient with a central line also has a PIV, that tubing should have a CUROS on the open ports • Needs a minimum of 3 minutes to complete the disinfection process • Can be left in place for up to 7 days • Is ONE TIME USE ONLY. Always replace with a NEW port protector. • Are NOT used on A-lines or VAMPs.

16. Port Protector Guidelines cont. • The port protector: • Do not fold or place in your pocket. Do not take home. • Strips will be hung on the IV poles of all patients with central lines, for easy access. Cut strips to avoid waste if a patient will be discharged soon. Only hang one strip at a time to avoid waste. • Continue to use the 15 second hub scrub when needed at other ports that were not covered with a CUROS or when disconnecting (blood drawing). • Never circle back into the IV tubing. Always use a red dead-ender. • For piggybacks, use the back flush method, instead of multiple secondary IV sets to avoid unnecessary disconnecting and reconnecting.

17. CUROS Port Protector Product Line Curos Singles 001-270 270 ea/box = $0.23 ea $62.10 a box 20 box/case = $1242 Outpatient & Procedural Areas ONLY! • Curos Strips 002-270 • 250 ea/box, 25 strips/box = $0.25 ea • $62.50 a box • 20 box/case = $1250 • Inpatient Units ONLY!

18. Details • LOCATION: on the IV Supply Cart right next to the alcohol wipes. Need space for a 4 inch bin (storehouse knows). • Will be providing a little tag for the bin as a reminder • Final Par levels to be determined after first few months of usage • Will send out notice for when this can be ordered to be stocked. (each department must place own order) • Estimates on spreadsheet (starting point) • Ordered by Box • Estimated usage for all units based on line days

19. Measuring Compliance – Zero Defect • Zero Defect – • Quality is conformance to requirements • Perform to the requirement you have agreed to and do it right every time. • Defect prevention is preferable to quality inspection and correction • More certain and less expensive to prevent defects than to discover and correct them. • Zero Defects is the quality standard • Aiming at an "acceptable" defect level encourages and causes defects. • Quality is measured in monetary terms – the Price of Nonconformance (PONC) • every defect represents a cost, which is often hidden (CLABSI)

20. Measuring Compliance – Zero Defect • Zero Defect – • Quality is conformance to requirements • Perform to the requirement you have agreed to and do it right every time. • Defect prevention is preferable to quality inspection and correction • More certain and less expensive to prevent defects than to discover and correct them. • Zero Defects is the quality standard • Aiming at an "acceptable" defect level encourages and causes defects. • Quality is measured in monetary terms – the Price of Nonconformance (PONC) • every defect represents a cost, which is often hidden (CLABSI)

21. Auditing • HIGH COMPLIANCE MINIMIZES RISK! • Keeps access ports clean and covered • Consistent disinfection process • Peer reviewed data • Saves time • Protects the patient Audits assess the true level of compliance. For this to be effective we need strict compliance, not just cooperation.

22. Audits for Inpatient Units for a 6 month period • This will be an all or none audit. • ADD TO SHIFT AUDITS/ROUNDS by January 1st • Curoson all unaccessed IV sites on pts with CVC. Y, N, or NA • Reference key: • Y = Yes: is that all unaccessed sites are covered with a curos. • N = No: there are 1 or more uncovered access sites on the IV line or CVC. Please have the auditor put no, even if they place a curos at the time of audit on the access port • NA = Not applicable: the patient does not have a central line • Compliance will be recorded on an ongoing basis for all inpatient patient care units. The shift totals will be sent to Aran Tavakoli monthly. • The goal is 100% compliance • Spreadsheet to be shared for how to calculate and record data

24. Leader Action Items • Send pre-populated unit sign-in sheets to Aran Tavakoli (via e-mail by November 8th please) • Communicate roll out to staff • Emphasize patient safety and expectation • Identify auditors & process for unit • Post results of audits for staff (send monthly to Aran T) • Share success stories • Create new culture • Continue Excellent Central Line Care

25. CHG daily bathing

26. Plan for Implementation • Education for RNs and CCPs required for safe practice, as per current guidelines and recommendations • Proper disposal must be ensured • Signage and patient/family education required • Delivery of warmer units, as required • Documentation of daily CHG bath in EPIC(revision needed) • Ongoing IPCE data; possible impact on CAUTI/SSI

28. 2 x a day environmental wipe down

29. Examples een:K:\tip of the week\tip of the week program.pptx

30. een:K:\tip of the week\tip of the week program.pptx

31. Next Steps • Topic library on the intranet • Inter-professional sharing of topics • Incorporation into Caring Rounds • Evaluation of communication strategy "We are what we repeatedly do. Excellence, then, is not an act, but a habit." – Aristotle een:K:\tip of the week\tip of the week program.pptx

32. een:K:\tip of the week\tip of the week program.pptx