HAVE PARTICIPATED! WHAT NEXT?

1. LECTURE 8 HAVE PARTICIPATED! WHAT NEXT?

2. LECTURE OBJECTIVES • To describe how information can be used for action. • To outline how to feed back results. • Who should get feedback? • What information should be included? • To explain how feedback should be delivered. • When? • How? • To illustrate how care of residents can be improved. • To describe how the HALT study experience can be evaluated.

3. Information for action

4. SURVEILLANCE • Systematic collection and analysis of data and the use of this information for actione.g. • Improve care for residents • Reduce the occurrence of preventable HAI • Reduce inappropriate antimicrobial use • Compare with other facilities with same patient mix

5. AUDIT CYCLE

6. Preparing to report back results

7. Consult your local infection prevention and control team (IPCT) for assistance to: • Place your results in context with other local/national/international data • Targeting feedback to different staff groups • Explain risk factor data • Develop action plans to address any areas of concern

8. WHO SHOULD GET FEEDBACK? • Senior operational management team. • Infection prevention and control committee. • All relevant healthcare staff (medical, nursing, allied health, care assistants etc). • Residents and families/ carers. • External reporting may be required by some countries (e.g., public health departments, regulators).

9. WHAT INFORMATION? (1) • National coordinating centre may provide a local report. • If YOU create the report include: • Number of eligible residents • % of residents with an infection • Type of infections • % of residents were on antimicrobials • Include type of antimicrobials and why prescribed (therapeutic/prophylaxis) • % of residents have risk factors for infection • % of residents with urinary catheter/vascular catheters/wounds/pressure sores etc • Infection prevention and control resources • Antimicrobial stewardship resources

10. WHAT INFORMATION? (2) • Compare with similar facilities. • Compare with 2010 HALT study if undertaken in your facility. • Caution when comparing infection rates as definitions used in 2013 are not the same as 2010 • Antimicrobial and risk factor data largely unchanged in 2013 and can be compared. • Heudorf et al compared the data from 6 HALT studies in 2012 which may be useful.

11. Heudorf U et al. Eurosurveillance 2012;17(35)

12. Delivering the results

13. WHEN? • Quickly after the survey so action can occur. • Aim to have results available within 3-4 months and preferably not later than 6 months after the study.

14. HOW TO DELIVER FEEDBACK? • Each facility should decide how best to deliver the results to the different groups. • Formal and informal presentations • Written report • Leaflets • Include results in regular education programmes

15. How can resident care be improved?

16. AUDIT CYCLE

17. ACTION PLAN • Senior management of the LTCF must prepare and implement action plan. • Action plan should have time lines and named person(s) responsible for each element. • Senior management of the facility should: • Review implementation of the action plan. • Develop a plan to undertake repeat surveillance/audit to ensure that the action plan addressed the issues.

18. EXAMPLES OF ACTION PLANS • High level of antimicrobial use reported in Irish Long-term care facilities in 2010 & 2011.

19. Implement an audit and monitoring checklist to measure compliance with all infection prevention and control guidelines. • Empower nurses to review urine laboratory results. • Circulate national guidance to prescribers: Diagnosis & management of urinary tract infections in long-term care residents’. • Pilot an antimicrobial care bundle. Moran & Rooney; Patient Safety Conference, Royal College of Physicians, Dublin 2012

20. AUDIT CYCLE

21. EVALUATE HALT • Review your experience of undertaking the study in your facility. • Consider • Was training sufficient? • How long did the study take to complete? • What problems occurred? • How could the survey be improved? • Would your facility be interested in repeating the survey? • Feed back your comments to your national coordinator.

22. SUMMARY • Undertaking any surveillance project requires commitment and resources. • However, residents will only benefit if: • Results are communicated to staff. • An action plan is developed to address any gaps and deficiencies identified.

23. RESOURCES • Heudorf U et al. Healthcare-associated infections in long-term care facilities (HALT) in Frankfurt am Main, Germany, January to March 2011. Euro Surveill. 2012;17(35):pii=20256. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20256 • Bradley S. Strategies to improve outcomes in nursing home residents with modifiable risk factors for respiratory tract infections. Pennsylvania Patient Safety Advisory; 2011; 8 (4): 131-7 http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2011/dec8(4)/Pages/131.aspx • National Clinical Guideline Centre: Infection: prevention and control of healthcare-associated infections in primary and community care. 2012 http://www.nice.org.uk/nicemedia/live/13684/58654/58654.pdf • HSE/HPSC 2011. Diagnosis & Management of Urinary Tract Infection in Long Term Care Residents >65yrs. http://www.hpsc.ie/hpsc/A-Z/MicrobiologyAntimicrobialResistance/InfectionControlandHAI/Guidelines/File,12929,en.pdf