Presentation on theme: "Indiana Health Conference Indianapolis, Indiana March 2, 2010"— Presentation transcript:
1Indiana Health Conference Indianapolis, Indiana March 2, 2010 Barbara M. Soule, RN, MPA, CICPractice Leader, Infection Prevention ServicesJoint Commission Resources
2ObjectivesIdentify areas of risk related to healthcare associated infectionsDevelop a HAI prevention program including evidence based best practicesDevelop and implement an education program for staff using current infection prevention and control best practicesCreate a system for data collection and surveillance
3Identify areas of risk related to healthcare associated infections
4Why Perform An Annual Risk Assessment? Helps focus our activities on those tasks most essential to reducing critical infection control risks.Changes to guidelines related to infection control and prevention from CDC and other agencies and professional organizations.New technologies, procedures, medications, vaccines, populations served, services provided and planned collaborative research projects.
5Goal Of An Effective IC Program Reduce risk of acquisition and transmission of health care-associated infections (HAIs)Design and scope of program is based on risk that organization faces related to acquisition and transmission of infectious disease
6What do the Joint Commission Standards and CMS say about assessing risk? ICEPs 1-3 The hospital identifies risks for acquiring and transmitting infections based on the following:Its geographic location, community, and population served.The care, treatment, and services it provides.The analysis of surveillance activities and other infection control data.
7What do the Joint Commission Standards and CMS say about assessing risk? EP 4 The hospital reviews and identifies its risks at least annually and whenever significant changes occur with input from, at a minimum, infection control personnel, medical staff, nursing, and leadership.EP 5 The hospital prioritizes the identified risks for acquiring and transmitting infections. These prioritized risks are documented. (Not CMS)
8What do the 2010 NPSGs 7 say? Assess risk for MDROs (.07.03.01) Assess risk for central line infections ( )Assess risk for surgical site infections ( )Periodic risk assessments; intervals to be determined by the organization
9What is a risk assessment? Assessment performed to determine potential infection threats associated with equipment and devices, treatments, location and patient population served, procedures, employees, and environment.Infection Control Program Risk AssessmentInfection Control Risk Assessment (ICRA)Focus Risk Assessments (MDROs)Hazard vulnerability analysis (HVA)
11Infection Control Program Risk Assessment Identifying Risks for Acquisition and Transmission of Infectious Agents – Select Targets or Groups for AssessmentExternalCommunity-relatedDisaster-relatedRegulatory and Accreditation RequirementsInternalPatient-relatedEmployee-relatedProcedure-relatedEquipment/device-relatedEnvironment-relatedTreatment-relatedResources
12External Risks Natural disasters Tornadoes, floods, hurricanes, earthquakesBreakdown of municipal services (i.e., broken water main, strike by sanitation employees),AccidentsMass transit (i.e., airplane, train, bus)Fires involving mass casualtiesIntentional actsBioterrorism“Dirty Bomb”Contamination of food and water supplies
13External RisksCommunity outbreaks of transmissible infectious diseasesInfluenza, meningitisOther diseases linked to food and water contamination, such as salmonella and hepatitis AMay be linked to vaccine-preventable illness in unvaccinated populationAssess risks associated with primary immigrant populations in geographic area
14Regulatory and Accreditation Requirements External RisksRegulatory and Accreditation RequirementsReporting of Infection RatesData requirementsOther requirementsMeeting old and new regulatory standards and accreditation requirements
15Patient-Related Risks Characteristics and behaviors of populations servedType of patientsWomen and childrenAdult acute careSpecial needs populationsBehavioral HealthLong Term CareRehabilitation
16Patient-Related Risks Age of patientsInherent risksExamples:Children:Immunologic status, socialization-related illnesses, diseases associated with lifestyle issuesAdults:Diseases associated with lifestyle issuesFrail Elderly:Predisposition for illnesses due to cognitive and physical changes
17Equipment-Related Risks Cleaning, Disinfection and Sterilization processes for equipmentScopesSurgical instrumentsProsthesesPrepackaged devicesReprocessed single-usedevices
18Employee-Related Risks Personal health habitsCultural beliefs regarding disease transmissionUnderstanding of disease transmission and preventionDegree of compliance with infection prevention techniques, e.g., personal protective equipment, isolation techniqueInadequate screening for transmissible diseasesHand HygieneSharps InjuriesEach year 800,000 needle stick injuries are reported by healthcare workers in the United States. However, when asked, most healthcare workers say they do not report all needle stick or other sharps injuries. Therefore, most researchers feel that this number is under reported.
20Procedure-Related Risks Degree of invasiveness of procedure performedEquipment usedKnowledge and technical expertise of those performing procedureAdequate preparation of patientAdherence to recommended prevention techniques
21Invasive Device-Related Risks e.g., central lines Complexity of deviceSkill and experience of userSafety features: user dependent or automatic
22Environmental RisksConstructionSupplies and EquipmentCleaning
23Disposal of Sharps and Needles Overfilled Sharps Box
24Resources Staffing of patient care personnel Environmental services staffCommunication support
25Strategies for Success Get leadership’s support and endorsement for assessmentEducate Leadership, ICC, OthersDevelop Methods to Obtain Organizational and Community DataAccess to key reportsPast surveillance dataTap into organizational data (medical records, lab records, admission and discharge numbers)Community resources for data and informationCreate a Risk Assessment Team or Advisory CouncilForm partnerships with those who have information you needFind some opinion leaders in organization to work with you3-5 key staff to work as a team or advisory groupInvolve patient safety and performance improvement staff or committees to assist
26Strategies for Success Take time to develop systematic methods, templates, and timelinesDetermine what will be assessed using quantitative methods vs. qualitative methodsWhen is a SWOT needed?Conduct risk assessment based on:Populations servedHigh-volume, high-risk proceduresInformation re: community risks, e.g., local health department, others
28Probability of Occurrence Risk Assessment GridEventProbability of OccurrencePotentialSeverity/Risk Levelof FailurePotential Change in Care, Treatment, ServicesPreparednessRisk LevelHighMedLowNoneLife ThreateningPermanent HarmTempHarmModPoorFairGoodScore:321GEOGRAPHY AND COMMUNITYIncreasing Population with TB8Hurricanes10POTENTIAL INFECTIONSurgical Site InfectionVent Associated PneumoniaCentral Line Related Blood Stream Infection (CLBSI)11VRE (hospital acquired)6COMMUNICATION
29X 6 27 8 12 Risk Assessment Grid Emergency preparedness H 4 M 3 L 2 N EventProbability of Event OccurrencePotentialSeverity/Risk Levelof FailureCurrent State of PreparednessRisk LevelFor OrgEmergency preparednessH4M3L2N1Life ThreateningPermanent HarmTempHarmNonePFGWater Supply UnavailX6Patient Care Supplies Unavail27Evacuation Required8Hi Risk Procedures and ProcessesHand Hygiene Compliance <90%12Endoscope ContaminationUnauthorizedUse of SUDsInadequateCleaning/Disinfection of patient care equipmentInappropriate use of IsolationRisk Assessment Grid
30Probability the Risk will Occur MDRO RISK ASSSESSMENTRisk EventProbability the Risk will OccurPotentialSeverity if the Risk OccursHow Well Prepared is the Organization to Address this Risk?Risk PriorityHighMedLowNoneLife ThreateningPermanent HarmTempHarmPoorlyFairly WellWellScore:4321Increasing incidence of Infections with MDROsMethicillin Resistant Staphylococcus aureus (MRSA)X16Vancomycin Resistant Enterococci (VRE)18Clostridium difficile36Multidrug Resistant(MDR) Pseudomonas12MDR Enterobacter ssp6MDR KlebsiellaMDR Acinetobacter24
31Risk Assessment Grid RISK ISSUE / EVENT______ PROBABILITY OF RISK OCCURENCE:__FrequentOccasionalUncommonRareRisk Severity ATIENTS_____CatastrophicMajor RiskModerate RiskMinor RiskNo RiskRisk Severity__STAFF___________RISK RATING FOR PROBABILITY PLUS SEVERITY BYGROUPPts StaffACTION PLAN TO PREVENT, MONITOR, REPAIR, IMPROVE:P = PolicyPI = Process ImprovementQC = Quality Control / AuditICC = CommitteeO = OtherCATASTROPHICMAJORMODERATEMINORFREQUENT161284OCCASIONAL963UNCOMMON2RARE1Adapted from Detroit Receiving Hospital and University Health Center - with Permission
33SWOT ANALYSIS – Catheter Related Bloodstream Infections OPPORTUNITIESEducation of staffIdentify nurse and physician champions- empowerRevise procedure and supplies to enhance complianceRequire physicians to adhereTHREATSAbuse to nurses who use authorityLack of insertion technique in subclavian vein – patient safetyInterruption of supplies from vendorsSTRENGTHSICU Staff CompetentPolicy evidence-based and currentHand hygiene compliance goodWEAKNESSESEquipment not always availablePhysicians do not adhere to maximal sterile barriersMany non subclavian sites selectedStrengths, Weaknesses, Opportunities, Threats
34Action Plan and Evaluation Infection Prevention Gap Analysis for Risk AssessmentArea/Issue/Topic/StandardCurrentStateDesired StateGap Between Current and Desired(Describe)Action Plan and EvaluationThe Infection Program is based on current accepted practice guidelinesWHO Hand Hygiene Guideline approved by ICC. Not fully implemented in organizationFull implementation throughout the organization by December 09Only 40 % of units and services are following the CDC Hand hygiene guideline.Develop proactive implementation planMake leadership priorityGet all necessary suppliesMonitor and provide feedback to staff every 2 weeksEvaluate existing hand hygiene compliance with WHO guideline against participation in the hospital in 4 months.There is systematic and proactive surveillance activity to determine usual endemic rates of infectionsCurrent surveillance is periodic retroactive chart review of a few infections.Proactive surveillance for selected infections an populations on an ongoing basisLack of IC staff and computer support to perform ongoing surveillance.Absence of well designed surveillance planDifficult to access laboratory dataInvolve ICC in designing surveillance plan, methods for analysis.Request computer and software to enter and analyze dataTeach IC staff about surveillance methodologiesWork with Laboratory Director to design access system for microbiology and other reports.Determine if program exists in 6 month.Catheter-related bloodstream infections (CRBSI) are very high.Catheter-related bloodstream infections in medical ICU at 75% percentile of the NHSN benchmarkReduce CRBSI to 10th NHSN benchmark or lower.Strive for zero BSI in MICU for a period of at least 6 monthsProcesses to prevent CRBSI are not followed consistently among staffImplement the BSI Bundle from IHI.Form team with MICU, IC, MDs, OthersEvaluate the bundle processes and the outcomes and report to leadership and ICC monthlyNeedle sticks in EmployeesThe incidence of needle sticks among environmental services staff is 3% for all personnel. Analysis shows that greatest risk is during changing of needle containers.Reduce needle sticks overall to equal to or less than 1% during next 6 months and.5% thereafter among all environmental services staffObservations show that needle containers are overflowingThere is confusion among nursing and housekeeping staff about responsibility and timing for emptying or changing containersNursing supervisors not aware of issueClarify the policy and repeat education to staff about criteria for filling /changing needle containersDiscuss situation with nurse managers- emphasize responsibilityDisplay ongoing data to show number of weeks without needle sticksCelebrate successes
35High Priority Risk Issues for IPC Fill in the blanks for your organization….MDROsStaffEnvironmental ServicesSSI, CLABSI, CAUTIInfrastructurePhysician InvolvementLeadership Support
36From Risks to Priorities to Plan AssessmentPrioritiesIC Plan
37Develop a HAI prevention program that includes evidence-based best practices
38Your Hospital Infection Control Plan for 2010 PriorityOrg Goals/StrategiesIC GoalMeasurable ObjectiveMethod(s)EvaluationParticipatingStaffVAP Rates Exceed NHSNProvide safe, excellent quality of care for all patientsReduce VAPS in SICUAchieve zero VAPs for at least 90 sequential days in the SICUUse evidence -based bundle for VAPSPI TeamMonitor monthly – report quarterly to Staff and ICCICU StaffRT StaffMed StaffICPOtherIncrease in sharps Injuriesamong OR staffProvide Safe Work Environ for EmployeesReduce Sharps injuriesfrom scalpels in OR staffReduce from 20/qtr to < 2 /qtr scalpel injuriesMonitor monthly – report weekly to OR staffOR StaffEmployee HealthSurgeonsInf ControlLack of readiness forInflux ofPatientsWithCommDiseasePrepare Organ forEmergencySituationsDevelop and test plan for influx of infectious patientsTriage and care for up to 100 pts per day for 3 days with resp. illnessDevelop triage and surgecapacity planTest X3 by December 20, 2006=>90%EffectiveReport Dis Prep CommER StaffPhysiciansAdministrationAdmittingInfection Control
39The Components of an Effective IPC Program Clinically qualified staff to oversee the programPerform a risk assessmentDevelop a written risk based infection prevention and control plan with goals and measureable objectives, strategies and evaluation methodsDesign a surveillance programSystem for obtaining, managing, and reporting critical data and informationUse of surveillance findings in performance assessment and improvement activitiesFrom: Arias KM, Soule BM, APIC/JCR InfectionPrevention and Control Workbook, 2nd Edition 2010
40The Components of an Effective IPC Program Establish internal and external communication systemsDevelop written policies and procedures based on evidence-based practicesMaintain compliance with applicable regulations, standards, guidelines, and accreditation and other requirementsFrom: Arias KM, Soule BM, APIC/JCR InfectionPrevention and Control Workbook, 2nd Edition 2010
41Using Evidence-Based Policies and Procedures The Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals5
42Development of the Compendium The Compendium was developed for 6 common HAI including:Clostridium difficile infections (CDI)Methicillin-resistant S. aureus (MRSA)Central line-associated bloodstreaminfections (CLABSI)Catheter-associated urinary tract infections(CAUTI)Surgical site infections (SSI)Ventilator-associated pneumonia (VAP)
43Compendium and NPSG Comparison Compendium StrategiesHAI NPSGs(Full implementation 2010)1. Strategies to prevent Central line associated bloodstream infectionsNPSG Implement best practices or evidence-based guidelines to prevent central line–associated bloodstream infections.2. Strategies to prevent Ventilator associated pneumoniaNo3. Strategies to prevent Catheter-associated urinary tract infections4. Strategies to prevent Surgical site infectionsNPSG Implement best practices for preventing surgical site infections.5. Strategies to prevent Methicillin-resistant S. aureusNPSG Implement evidence-based practices to prevent health care–associated infections due to multidrug-resistant organisms in acute care hospitals.6. Strategies to prevent Clostridium difficile infections
44CDC/HICPAC Guidelines Catheter Associated Urinary Tract Infection (2010)Norovirus (2010)Disinfection and Sterilization (2008)Isolation Precautions (2007)Multi-Drug Resistant Organisms (2006)Influenza Vaccination of Healthcare Personnel (2006)Tuberculosis (2005)Healthcare Associated Pneumonia (2004)Environmental Infection Control (2003)Smallpox Vaccination (2003)Intravascular Device-Related Infections (2002)Hand Hygiene (2002)Infection Control in Healthcare Personnel (1998)Surgical Site Infection (1998)Immunization of Healthcare Workers (1997)IC EP 1-Guidelines
45The Components of an Effective IPC Program Develop the capacity to identify epidemiologically important organisms, outbreaks, and clusters of infectious diseaseDetermine who has the authority to implement infection prevention and control measuresIntegrate IPC with the employee health programFrom: Arias KM, Soule BM, APIC/JCR InfectionPrevention and Control Workbook, 2nd Edition 2010
46The Components of an Effective IPC Program Provide ongoing relevant education and training programsMaintain well-trained personnelAssure nonpersonnel resources to support the programIntegrate with emergency preparedness systems in the organization and communityCollaboration with the health departmentFrom: Arias KM, Soule BM, APIC/JCR InfectionPrevention and Control Workbook, 2nd Edition 2010
47Create a system for data collection and surveillance
48SurveillanceTo watchImplies systematic observation of the occurrence and distribution of a specific disease process
49What is Surveillance ?Continuous systematic collection of data on illness in a defined populationUses standard definitions for the outcome of interest; e.g., central line associated bloodstream infections (CLABSI), catheter associated urinary tract infection (CAUTI)
50What is Surveillance?Involves analysis, interpretation, & dissemination of data for the purpose of using it to improve health & prevent disease
51Purposes of Surveillance Get baseline and endemic rates of infectionsDetect/investigate clusters/outbreaksAssess effectiveness of patient care processesMonitor occurrence of adverse outcomes to identify risk factors
52Purposes of Surveillance Detect & report notifiable diseasesIdentify organisms and diseases of epidemiological importanceDetermine the need for educationDetect a bio-terrorist event or an emerging infectious disease
54Recommended Practices for Surveillance Assess populationSelect outcomes/processes to surveyApply surveillance definitionsCollect surveillance dataCalculate rates and analyze findingsApply risk stratification methodsReport and use surveillance findingsWebsite:
55Assessing the Population Data to describe your patients, (employees)Most frequent diagnoses, (injuries)Most frequent surgeries, invasive proceduresCommunity assessmentLooking for increased risk of infection (or other outcome)
56Assessing the Population : Acute Care Settings Examples Frequent DRGsMost frequent surgeriesICUsPatients with DevicesOncology, OrthopedicsVaccination Rates
57Assessing your population: Long Term Care Examples Catheterized Patients?Vaccination Rates?Pneumonia/InfluenzaSkin breakdown/infectionTB skin testing compliance
59Surveillance helps at your facility to: Direct your daily workDrive interventions to prevent/reduce infectionsGive valuable feedback to cliniciansi.e. surgeon-specific surgical site infection [SSI] rateReach administrators who pay/allocate $ for IC and HAI prevention
60SURVEILLANCE METHODsTotal house surveillanceTargeted surveillancePrevalence survey
61TOTAL HOUSE SURVEILLANCE Entire populationOverall infection rateNot sensitive to specific problem identificationDifficult to target potential performance improvement activitiesHospital InfectionRate 4.2%
62TARGETED SURVEILLANCE Particular care units, ie:ICUNurseryMedical device infections, ie:CathetersInvasive procedures, ie:SurgeryEpidemiologically significant organisms, ie:MRSAVREClostridium difficileOr clusters that may indicate an outbreak
63Determine the targetd surveillance indicators based on your assessed risks
64Choose the IndicatorsThe indicators chosen will depend on the type of healthcare setting, the population being studied, procedures performed, services provided, acuity of care, identified risk factors for infection
65Targeted Process indicators include: Aseptic technique during invasive proceduresHand HygieneIHI bundle compliance for central linesSurgical preparation of patientAntimicrobial prescribing and administrationHepatitis B immunity rates in personnelPersonnel compliance with protocols - isolation precautions, hand hygieneSterilization quality assurance testing,Environmental cleaning
68Your Hospital Surveillance Process Indicators AB Prior toIncisionNeedleSticksICRACompleteBBP SuppliesConstructionHealthCare WorkersSurgicalPatientsRoutine /Emergency
69Targeted Outcome Indicators for Surveillance Primary Bloodstream infectionsVentilator-associated pneumonia,Surgical site infectionConjunctivitisLocal IV site infectionsMRSA, VRERSVVascular access infection in hemodialysis patients
70Your Hospital Surveillance System Targets: VAPICUCLABSISSIVentilator-AssociatedPneumoniaMedical ICUIntensive CareUnit(Pediatric)Primary BloodStreamInfectionsPrimary OrthopedicNeurosurgicalProcedures
71Surgical Orthopedic Hip Procedures Primary and Repeat Total Hip ReplacementInfectionsOrganism, antimicrobial susceptibilityRisk adjustmentRisk Index: Surgical wound class, ASA score, Operation duration,Age, sex, trauma, emergency, multiple procedures through same incision, implant, general anesthesiaDevice exposure
72Trends in Surgical Site Infection (SSI) Rates By Risk Group* 48121619921993199419951996199719981999High riskMediumhigh riskSSIs per 100 operationsMediumlow riskLow riskYears*NNIS, Unpublished data.
73Surgical Antibiotic Administration Proportion of patients who receive prophylactic antibiotics within 1 hour before surgical incisionProportion of patients who receive antibiotics consistent with current recommendationsProportion of patients whose antibiotics were discontinued within 24 hours of the surgery end time
74Targeted Process Surveillance Timing of Perioperative Antimicrobial Prophylaxis IncisionHours afterincisionHours beforeincisionClassen DC, et al. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 1992;326:2812441
75Targeted Surgical Procedures CABGOther cardiac surgeryColon surgeryHip and knee arthroplastyAbdominal and vaginal hysterectomyVascular surgery (e.g., peripheral vascular surgery)
76Prevalence Surveillance Efficient – less time consumingPoint Prevalence – Period PrevalenceProcesses or Outcomes“Snapshot” at that timeCannot compare with incidence ratesMay miss clusters not present at time of surveillance
78Advantages/Disadvantages Adapted from Pottinger et al & Gaynes et al.
79How do you design the surveillance plan for your facility? Risk AssessmentSurveillance prioritiesSurveillance criteriaCollectable data elementsMethod of data collectionMethods of analysisProcess for display and disseminationTurn data into action
80Who can help provide surveillance data denominators? OR - surgeriesWard Clerks – admissions – device useICUs Number of ptsDevice daysPatient care days - finance
81Numerators and Denominators CALCULATING RATESNumerators and Denominators5 / 125 X 1000multipliernumeratordenominatorThe eventbeingmeasuredPopulation atrisk forThe event
82To Risk Adjust For: Varying length of stay Exposure to devices Surgical site differencesSeverity of illnessUse patient daysUse appropriate device-daysWound classification systemConsider available risk indices, not w/o discussion and literature review, validation neededPottinger et al, Infection Control Hosp Epidemiology 1997; 18:
83Analyzing Data Incidence = new cases x constant (1000) population at riskPrevalence = existing cases x constant
84Analyzing data ATTACK RATE: E.g Influenza attack rate 20/40 x 100 = 50 %
85Data Display Run charts – frequency polygons – Std Deviations HistogramsTablesBar ChartsPie ChartsStatistical Process Control Charts
86Catheter Associated BSI Rates ICU (2001-2004) Privileged and Confidential; Prepared by Hospital Epidemiology and Infection Control
87Nosocomial Infection Rates by Procedure Type Horan et al. ICHE 14:73-80, 1993
88Contribution of Nosocomial infections to mortality Horan ICHE 1993; 14: 73
90Med/Surg BSI Jan ‘98 - Dec ‘99 Intervention2015105Jan-98Apr-98Jul-98Oct-98Jan-99Apr-99Jul-99Oct-99BSI/1,000 LDMeanUCLLCLLD = central line daysSource: Infection Control Consortium, BJC
91Source: Barnes Jewish Consortium – St. Louis, Missouri 510152025JanAprilJulyOct'98'99'00SICU BSI Jan '98 - March‘00BSIInterventionRate per 1,000 line daysSource: Barnes Jewish Consortium – St. Louis, Missouri
92CDC Reports of Aggregated Data National Healthcare Safety Network (NHSN) report: Data summary for 2006 through 2008, issued December 2009Jonathan R. Edwards, MStat, Kelly D. Peterson, BBA, Yi Mu, PhD, Shailendra Banerjee, PhD, Katherine Allen-Bridson, RN, BSN, CIC, Gloria Morrell, RN, MS, MSN, CIC, Margaret A. Dudeck, MPH, Daniel A. Pollock, MD, and Teresa C. Horan, MPH Atlanta, GeorgiaPublished by the Association for Professionals in Infection Control and Epidemiology, Inc. (Am J Infect Control 2009;37: )
93Writing the surveillance report Purpose for surveillanceInterpret the findingsActions taken and recommendationsAuthor and dateRecipients of report
94Can you find the 25 breaks in technique in the AORN’s 2008 cartoon? Observational Surveillance Tells Many Stories….Can you find the 25 breaks in technique in the AORN’s 2008 cartoon?
97Surveillance can be overwhelming! Remember: It is only a means to an end !Keep it simpleFocus on highest risksUse it to know your:populationendemic ratesoutbreak investigation triggers
98So You Can: Improve Outcomes! Focus on interventions Improve patient care!ImproveOutcomes!
99Develop and implement an education program for staff using current infection prevention and control best practices
100Education Miscellaneous Outbreak Investigation Program Management SurveillanceEducationProgramManagementMiscellaneousEducating health care workers is a critical and necessary function of the infection control professional.Consultation
101Objectives of educational activities improve care practices and patient outcomesreduce risk of infectioncreate safer workplace for staff
102How do we know when is education “effective” ? When learning translates into behavior that results in the desired outcomes for patients or staffFor example, when a class on the timing of antibiotics before incision results in improved timing and decrease in surigcal site infections
103Our challenges as ICP Educators Adult Learners have special needs for learning !What are Effective Educational Strategiesfor Adult Learners?
105“At its best, an adult learning experience should be a process of self-directed inquiry, with the resources of the teacher, fellow students, and materials being available to the learner, but not imposed on him (sic).”AndragogyMalcolm Knowles. Modern Practice, 1950
106Core Principles of Adult Learning The learners “need to know.”What will make them successful in their workWhen new hand hygiene guidelines are issued and all staff must follow them, this it a time that workers “need to know” what to do.
107Self-directed learning Self- directed means the student participates in creating their own learning experience. They want to be treated with respect as an adult not a child
108It's in the Stars! The Need to Know What do the learners need and want to know about thestars ?
109Core Principles of Adult Learning Prior experiencesCreate biases, differences, values and perspectives that shape new learning.Prior experiences create a wide range of individual differences.Prior experiences provide a rich resource for learning, create biases that can inhibit or shape new learning
110Personal and Situational Influences on Readiness to Learn agehealthlife phasepsychological developmentself conceptGelula M. The Alan Stoudemire Lecture: residents, students, and adultLearning. Bull Am Assoc Acad Psychiatry. Spring 1998;26;1.
111Core Principles of Adult Learning Orientation to learning and problem solving
112Age and Generation Differences Books to ComputersPassive to InteractiveGenerational Learning Styles
113Core Principles of Adult Learning Motivation to learn
114Motivation to Learn Adults want to be successful have a choice learn something they valueexperience the learning as pleasure3 R’s relevancy, relationship, responsibility
115Educational Strategies that often fail Single approachNo assessment of learner needsNo customization to the specific audienceNo reinforcement of the informationNo feedback of resultsNo monitoring and evaluation after the education has occurred.
116Some tools to use for teaching adult learners about infection prevention and control principles and practices
117How do you prefer to learn? AloneIn a groupIn a hands-on situationIn the heat of the momentSlowly over timeBy reading, talking, doingOther
118Some Tools for To Consider for Enhanced Adult Learning Case StudiesScenario PlanningImageryRole PlayInteractive VideosFeedbackStorytellingBrainstorming / Six Hats ThinkingBlended LearningGamesArtMind mappingProgrammed InstructionWeb based programsInquiry TeamsE Learning Games
119ACTIVE LEARNING. TELL ME and I WILL FORGET TEACH ME and I WILL REMEMBERINVOLVE ME and I WILL LEARN
120An Outbreak of Cutaneous Aspergillosis Case StudyAn Outbreak of Cutaneous AspergillosisCluster of 4 cases in burn and surgical wounds.Traced to outside packaging of dressing supplies.Construction in central inventory control areaInoculation of large exposed surface areas of wounds by dressing materials.Here is one example of using a case study to involve learners in problem solving. This is a case of an outbreak of cutaneous aspergillosis. (Read case)Infect Control Hosp Epidemiol 1996;
121Tools for getting learners involved Learning partnersScenariosRole playFocus groupsFishbowl exerciseDemonstrations
122Scenarios ati.ucsd.edu/images/ group.jpg Develop a scenario of how the staff would prevent infections if there was a hurricane or a flood in the community. What preparations would be made for safe water, handwashing, supplies? Or Your hospital has an outbreak related to cleaning of endoscopes. You determine the problem involves improper use of a washing machine to clean the scope. What would you do in this situation.ati.ucsd.edu/images/ group.jpg
123Using Graphics and Triggers for Recall A good illustration helps gain the learner’s attention and helps recall information that supports and supplements the message.Choose the right graph, picture or graphics, still or moving, to make an impression and reinforce the material.
124Using images also helps drive home the point about construction risks.
126Storytelling Once upon a time . . . Tools for Bringing In Life ExperiencesStorytellingUses multiple aspects ofmemoryReaches into emotional memoryconflict or plot of the story.Storytelling is a dynamic way of tapping into past experiences and emotions through the conflict or plot of the story.Enhance memory – location and dress during the storyA staff nurse tells about the time she saw another nurse drop a sterile instrument on the floor and pick it up and use it.Once upon a time . . .
127STRATEGIES FOR EFFECTIVE DELIVERY OF EDUCATIONAL PROGRAMS
128Key Concept !! Many strategies Multiple approaches No single method The important point is to use many strategies and approaches to convey the critical information. This relates to the way different people learn and what cues they take from the environment.Many strategiesGross, PAPittet, D
129Multiple approaches to increase hand hygiene Memorandaregarding handwashing to all attending staff and departmentsPostersfor handwashing in MICUVisitors instructedClosed door to MICUHandwashing specifically requested to all entering
130For more information on Education and Training for Health Care Personnel: APIC Text of Infection Control and Epidemiology, 3rd EditionVolume 1; Chapter 11Education and Training
131With thanks to colleagues who have shared their work Trish Perl, MD, Epidemiologist- BaltimoreDenise Murphy, RN, VP for Quality- PhiladelphiaMarguerite Jackson, RN, PhD – San DiegoMarcia Patrick, RN, SeattleGwen Felizado, RN, Seattle