TJC Infection Control Standards 2011 Supplement Resources

1. TJC Infection Control Standards2011 SupplementResources

2. National Healthcare Safety Network (NHSN) • NHSN was previously known as the National Nosocomial Infection Surveillance System • It is a voluntary, web-based surveillance system by CDC Healthcare Quality Promotion • Goal to obtain national data on HAIs • Hospitals and ASCs may participate in the network • Available at www.cdc.gov/nhsn

3. Risk Assessment

4. Infection Preventionist Tools www.infectionpreventiontools.com/home

5. TJC Surveyor • May look at both the infection control plan and your risk assessment 1 • May look for local statistics and data, relationship with outside agencies and that you prioritized the risks • May look at your review of the last two years of interventions and program related to hand hygiene • May observe an OR cases and observe the processing of instruments in Central Supply 1 www.unc.edu/depts/spice/jcaho.html

6. Resources • TJC has Speak Up Initiatives including five things you can do to prevent infections • www.jointcommission.org/GeneralPublic/Speak+Up/about_speakup.htm • Options to Increase Isolation Surge Capacity • www.jcrinc.com/common/PDFs/document_collection/resources/collections/00032482/00032984-0001.pdf • Preparing for a Pandemic, EM Case Study, How the Health First Hospital Developed a Pandemic Influenza Plan • www.jcrinc.com/common/pdfs/qualityandsafety/preparing_for_a_pandemic_brevard_county_FL.pdf

9. Spice www.unc.edu/depts/spice

10. TJC Crosswalk http://www.jcrinc.com/common/pdfs/csr/forms%20and%20tools,%20newsletters/ic/CSR%20IC%20Self-Assessment%20June%20Update%20HAP%200709.doc

12. www.cdc.gov/nhsn/mdro_cdad.html

17. AORN Updated Surgical Attire • All hospitals should be aware of the updated AORN surgical attire recommended practice • Hospital must launder all scrubs • States wearing scrubs as street attire creates exposure to infectious pathogens in the community • Recommendations for safe footwear and wearing jewelry • Recommendation on cleaning of stethoscopes and ID badges

18. IV Spiking is 1 hour • IV should not spiked more than one hour before use • USP 797 requirement • APIC also has out a position paper that advices administering has soon as possible • Hospitals should also have a safe injection practices policy • Hospitals should follow the 10 CDC guidelines found in the isolation standards • CMS also has an infection control sheet (15 pages) that all ASCs must complete by the surveyor

20. Reducing Surgical Site Infections • Land mark trial shows that chlorahexidine reduces surgical site infections instead of povidone-iodine • This changes the standard of care • Same edition of NEJM shows you can prevent surgical site infections by swabbing nasal site (rapid screen) and if staph aureus then decolonize • This can be done by rinse with chlorahexidine soap and use mupirocin nasal ointment • NEJM 362;18-26 January 7

23. Recent Issues • June 2010 OSHA makes bold move to regulate infection prevention and publishes in FR (new IC police) Issued May 6, 2010 • June 2010 Environmental team at Mayo Clinic wipes out C-diff with bleach wipe program • June 2010 VA hospitals cut MRSA by 77% in ICUs with active surveillance • June 2010 SHEA and IDSA issues new C-diff guidelines

24. 8 Things to Reduce Post-operative Pneumonia • Researchers from VA Palo Alto Healthcare System and Stanford University employed 8 things to reduce pneumonia on the surgery floor • 1. Education of all surgical and ward nursing staff about their role in pneumonia prevention • 2. Cough and deep-breathing exercises with incentive spirometer • 3. Twice-daily oral hygiene with chlorhexidine swabs • 4. Ambulation with good pain control

25. 8 Things to Reduce Post-operative Pneumonia • 5. Head-of-bed elevation to at least 30 degrees and sitting up for all meals ("up to eat") • 6. Quarterly discussion of the progress of the program and results for nursing staff • 7. Pneumonia bundle documentation in the nursing documentation • 8. Computerized physician pneumonia prevention order set in the physician order entry system. • Wren SM, Martin M, Yoon JK, and Bech F. Postoperative Pneumonia-Prevention Program for the Inpatient Surgical Ward.J Am Coll Surg; April 2010, Vol. 210, Issue 4: 491-495

26. / 26 Institute for Healthcare Improvement

27. / 27 Source: www.shea-online.org

28. / 28 Source: www.his.org.uk

29. www.who.int/en

30. www.theific.org

31. / 31 Source: www.idsociety.org

34. / 34 PA Patient Safety Authority Source: www.patientsafetyauthority.org/Pages/Default.aspx

37. Sterilized Equipment Issue • Recent cases of improperly sterilized equipment. • PA Safety Authority reports number of reported cases of contaminated equipment from prior surgery • Portland VA sent out 2,270 letters of TRUS guided prostate biopsy equipment • FDA alert July 2006 and 2009 on prostate biopsy equipment • Called bioburden • Old dried blood and tissue came out of tissue protector on drill, triple trocar full of dried blood, suture remained on tunneler, and particles of tissue found on cannulated instruments / 37

38. / 38 Sterilized Equipment Issue (continued) • Adequate cleaning is required to remove all residual that remains, if not prevents sterilization • Many wipe instruments with wet lap or gauze sponge with sterile water during or after procedure • CMS and TJC issue information on flash sterilization so make sure you pay attention to this issue • Soaking instrument in enzymatic solution after procedure and follow manufacturers instructions • Immediately soak all instruments • May need to use brushes to remove material

39. Cleaning of Medical Equipment

40. / 40 MRDOs Resources • CDC MRSA resources • www.cdc.gov/ncidod/dhqp/ar_mrsa.html • Includes fact sheet on MRSA, MRSA in healthcare setting 2007, educational material, data, lab testing and practices, etc. • Isolation precaution 2007 • www.cdc.gov/ncidod/dhqp/gl_isolation.html • VRE resources • www.cdc.gov/ncidod/dhqp/ ar_vre.html • Guidelines for Prevention of Surgical Site Infections

41. / 41 Resources • APIC resources at www.apic.org and see standards and guidelines • Guidelines for Environmental Infection Control in Health Care Facilities • Guidelines for Prevention of Surgical-Site Infections • Recommendations for Preventing the Spread of VRE • Guidelines to Prevent Intravascular Catheter Related Infections

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43. / 43 TJC NPSGs • Many are on infection control • Implement best practices to prevent multiple drug resistant organisms MDROs • Educate staff and patients about MDRO and necessity for prevention • Measure MRSA and CDAD (C-diff associated disease) • Clean and disinfect equipment and patient care environment

44. / 44 IHI ICU Improvements • VHA united with IHI to improve ICU care • Better control of blood sugars with glucose monitoring protocols1 • Aggressive treatment of sepsis/blood stream infections (see central line bundle) • Prevention of ventilator associated pneumonia (see VAP bundle), surgical infections • Developed toolkits (order sets, protocols, daily goal sheets), report templates for monthly reporting of change 1 www.ihi.org

45. / 45 Ventilator Bundle • Head of bed (HOB) elevation > 30 degrees • Deep venous thrombosis (DVT) prophylaxis • Peptic ulcer disease (PUD) prophylaxis • Daily sedation vacations • Assessment of readiness of wean • Oral care • Use a checklist and document each!

46. / 46 Central Line Bundle • Hand hygiene • Maximal barrier precautions upon insertion • Chlorhexidine skin antisepsis • Optimal catheter site selection with subclavian vein as the preferred site for non-tunneled catheters • Daily review of line necessity with prompt removal of unnecessary lines

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48. / 48 Sepsis Bundle • Over 750,000 patients a year develop sepsis or septic shock in the US • Severe sepsis will kill 30% of infected patients and another 20% will die within six months • Surviving sepsis campaign • Can listen to presentations • Sepsis bundle lists seven tasks to be done during first six hours

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