Long-term Care Facility: Surveillance of MDRO and Clostridium difficile Infections

1. Long-term Care Facility: Surveillance of MDRO and Clostridium difficile Infections

2. Objectives After this session, the attendee should be able to: • Recognize patients with MDRO and/or Clostridium difficileinfections (or colonization) • Conduct surveillance (track and monitor reports) within the facility • Explain the role of data feedback • Identify best practices during transfer of a patient to another facility

3. Self-Assessment LTC Assessment Tool is found at http://www.cdc.gov/HAI/prevent/prevention_tools.html#ltc

4. Definition of Infection for Surveillance The following 3 conditions must apply: • All symptoms must be new or acutely worse • Non-infectious causes of signs and symptoms should always be considered before a diagnosis of infection is made • Identification of infection should not be based on a single piece of evidence Source: APIC, 1996

5. Some Infection Prevention and Control Policies and its Impact on Surveillance • Infection surveillance - either ‘whole-house’ (i.e. all residents) or ‘targeted’ toward high risk/high volume… • Note disease trends • Report data internally – weekly, monthly, quarterly and as needed

8. Sources of Surveillance Information • ??

9. Sources of Surveillance Information • Ward rounds / morning report • Laboratory results • Nurse or physician notes • Radiology findings • Referring and other HCF in the region • Facility transfer forms

10. Monthly Infection Log Exercise • You will need: • McGeer case definitions • Monthly infection log • Laboratory reports • Daily Unit Census

11. Patient 4 • 4/3/2012: Mr. Jerry J is admitted to the hospital with pneumonia • 4/5/2012: Hospital IP notifies you of the sputum culture result on Mr. Jerry J Modify your Monthly Infection Log to record this information.

12. Patient 4 lab result

13. Patient 5 Lab Result • Enter the laboratory result for patient # 5. • Classify the patient according to McGeer

14. Case Definition for CDI • the presence of diarrhea, defined as passage of 3 or more unformed stools in 24 or fewer consecutive hours; AND • a stool test result positive for the presence of toxigenic C. difficile or its toxins or colonoscopic or histopathologic findings demonstrating pseudomembranous colitis.

15. Patient 6 lab result 1. Record the lab result for patient # 6 on the monthly infection log. 2. Classify patients 6-9 according to the CDI definition

16. Patient 11 Laboratory Result

17. Classify Patients 11 and 12 • Mr. D (patient 11) has: • Fever • Hematuria • Flank pain • Confusion, loss of appetite • Mrs. D (patient 12) feels fine • Both have the identical organism in their urine. • Classify Mr. D and Mrs. D • What action should you take?

18. Patients 11-12 • Treat: symptomatic UTI • Do not treat: asymptomatic bacteriuria ACTION: notify hospital

19. Patient 13

20. Patient 14

21. Infection Rate Represents infection during a period of time in relation to a unit of population (percent or per n population) PERCENTAGE OF RESIDENTS WITH INFECTION = # of infection x 100 = Rate of Infection ave. resident census (for the month) = 4 CDI on WEST x 100 = 4% of residents had CDI in April 100 residents (on WEST)

22. Resident-days as a Denominator • Who records resident-days in your facility? • At the same time each day, the total number of residents is recorded. • At the end of the month, the total is added up for the month = resident days.

23. Estimation of Infection Rate • INFECTION (INCIDENCE) RATE • = Number of xxx infections x 1,000 days • Number of resident days in the month • Rate of CDI on WEST Unit: • = 4 x 1,000 = 1.33 CDI per 1000 resident-days • (3000)

24. Summary of Infection Rates

25. Summary of Infection Rates

26. Summary of Infection Rates

27. Data trends

28. Questions • What action should you take, given these data? • When should you take this action?

30. Questions • What action should you take, given these data? • Begin control measures • Outbreaks should be reported to the LHD • When should you take this action? • Control measures should be initiated ASAP • Outbreaks should be reported immediately

31. http://www.dhhr.wv.gov/oeps/disease/ob/Pages/default.aspx

33. Data Feedback Exercise Findings and Conclusions Feedback means sharing the CDI data in the previous graph with important people in your Long Term Care Facility: Housekeeping Medical Director Quality Improvement Committee West nursing staff 33

34. Homework Evaluate your patient transfer form to assure notification of facilities when transferring a patient with CDI / MDRO

35. Found at http://www.cdc.gov/HAI/prevent/prevention_tools.html#ltc

36. Conclusions • We have learned • How to get surveillance information • How to review laboratory slips and define cases • How to record cases systematically • How to calculate infection rates • How to feed back surveillance data • Some ideas for sharing information between facilities • Interfacility transfer forms

37. For Further Information • www.dide.wv.gov • ‘outbreaks’ • Outbreak toolkits • ‘healthcare associated infections’ • http://www.cdc.gov/hai/ • http://www.apic.org/