1) NHSN enrollment 2) Clostridium difficile 3) Resident influenza and pneumococcal vaccine 4) Health care personnel influenza vaccination 5) Urinary Tract Infections
5.5 /10,000 population in 2000 11.2 / 10,000 in 2005 Proposed Metric: Number of NH –onset events / 10,000 resident days Incident lab events are defined as no previous positive or last prior positive more than eight weeks ago. Only events occurring more than three calendar days after resident admission are considered NH-onset.
Using MDS data Current data Influenza 81.7% Pneumococcal 79.8% Goal 85% vaccination rates for both by 2018
Using National Health Interview Survey (NHIS) data Current LTC64.4% Acute Care71.1% New York State Goal 75% health care personnel vaccination by 2015; 90% by 2020
Proposed Metrics Non-catheter-associated symptomatic UTI incidence rate Number of events / 1,000 resident days Catheter-associated symptomatic UTI incidence rate Number of events / 1,000 catheter days Catheter utilization ratio Catheter days / Resident days
Provider workload Data collection methods and infrastructure Measure reliability Risk adjustment
38 outbreaks of viral hepatitis 2008-2013 36 (94%) occurred in non-hospital settings 20 related to Hepatitis B 15 outbreaks occurred in long-term care facilities 114 outbreak-associated cases of HBV 1,400 at- risk persons notified for screening 87% (13/15) of the outbreaks were associated with infection control breaks during assisted monitoring of blood glucose (AMBG)
Ideally, assign one meter per resident Read Instructions For Use (IFU) Check if designed for multiple patient use Use the approved disinfectant according to label directions Keep testing and injection supplies separately
40,000 deaths due to influenza annually in the United States Elderly are at highest mortality risk Elderly have low immune response to vaccination Vaccination of 100% of HCP resulted in a 60% risk reduction among nursing home residents Talbot, T. R., Babcock, H., Caplan, A. L., Cotton, D., Maragakis, L. L., Poland, G. A.,... & Weber, D. J. (2010). Revised SHEA position paper: influenza vaccination of healthcare personnel. infection control and hospital epidemiology, 31(10), 987- 995.
National average 32.6% LTC, 63.5% Acute If employer requirement then 98.1% Goals: 75% or higher by 2015 90% or higher by 2020
APIC LTC Guide, Chapter 8 What are the 7 symptoms of influenza? What percentage of the population gets seasonal influenza? How long does it take to develop immunity after vaccination? Who is recommended to get an annual influenza vaccine?
What are the 7 symptoms of influenza? Fever, sore throat, chills, headache/eye pain, myalgia, malaise, new cough What percentage of the population gets seasonal influenza? 5—20% How long does it take to develop immunity after vaccination? 2 Weeks Who is recommended to get an annual influenza vaccine? Everyone over age 6 months
Viral upper respiratory illness Transmission occurs person-to-person with large droplet exposure Person is infectious 1—2 days before symptoms, up to 4—5 days after symptoms start First 3 days are most infectious
Diagnosis by clinical symptoms and /or lab testing Request influenza rapid test from nasopharyngeal swab within 3 days of onset If lab test is positive, consider antiviral therapy Monitor respiratory illness from Nov-Apr Use written definition to define a case Define an outbreak in advance and follow-up protocols One laboratory confirmed case is commonly used
Planning Set vaccination goals and provide regular feedback Healthy People 2020 goal is 90% for residents and staff Consider signed declination and mask policy Education Link with local health department Individual case management Outbreak management
Trivalent flu vaccine (Two flu A, one flu B) Standard dose trivalent IM injection Egg based: Age 6 months and older Cell culture based: 18 years and older Egg free: Ages 18-49 years High-dose trivalent IM injection Age 65 and older Intradermal trivalent shot Age 18-64 years Quadrivalent flu vaccine (Two flu A and Two flu B) Standard dose quadrivalent IM injection: Age 6 months and older Nasal spray: Healthy people 2 through 49 years of age
19–21 million cases of acute gastroenteritis annually Over 2,000 outbreaks annually 50% of norovirus outbreaks occur in nursing homes 56,000—71,000 hospitalizations and 570—800 deaths
2011, New York anesthesiologists 3% did not use a new needle and syringe 28% accessed vials not using new needle and syringe 11% combined left over medication vials 49% use multidose vials on more than one patient Reasons: Medication shortage Reduce waste Cost Gounder, P., Beers, R., Bornschlegel, K., Hinterland, K., & Balter, S. (2013). Medication injection safety knowledge and practices among anesthesiologists: New York State, 2011. Journal of clinical anesthesia, 25(7), 521-528.
Single dose vials recommended Multidose Vials For single patient if possible Single syringe Single needle Single patient Do not store at point of care Insulin vials and pens One & Only Campaign
At the Point of Care Make alcohol-based handrub available at the exact place where care or treatment involving physical contact between a patient and a health-care worker takes place Point-of-care products should be accessible without leaving the patient environment Usually achieved through staff-carried handrubs (pocket bottles) or handrubs fixed to the patient's bed, bedside table, or to the wall next to the patient's bed Handrubs affixed to an object e.g. mobile carts, or dressing or medicine trays which are taken into the patient environment, can also fulfill this definition, if they are reliably taken into the patient zone in anticipation of contact (WHO, 2009)
Residents Before and after activities Before dining After using the bathroom Before and after therapy Compliance monitoring Observation Product use Electronic
Nimalie D. Stone et al., Surveillance Definitions in Long-Term Care Facilities: Revisiting the McGeer Criteria. Infection Control and Hospital Epidemiology. Vol. 33, No. 10 (October 2012), pp. 965--977. http://www.jstor.org/stable/10.1086/667743 Gounder, P., Beers, R., Bornschlegel, K., Hinterland, K., & Balter, S. (2013). Medication injection safety knowledge and practices among anesthesiologists: New York State, 2011. Journal of clinical anesthesia, 25(7), 521-528.
Benoit SR, Nsa W, Richards CL, Bratzler DW, Shefer AM, Steele LM, Jernigan JA: Factors associated with antimicrobial use in nursing homes. A multilevel model. JAGS 2008, 56:2039–2044 Jump RLP, Olds DM, Seifi N, Kypreotakis G, Jury LA, Peron EP, Hirsch AA, Drawz PE, Watts B, Bonomo RA, Donskey CJ: Effective antimicrobial stewardship in a long-term care facility through an infectious disease consultation service. Keeping a LID on antibiotic use. Infect Control Hosp Epidemiol 2012, 33:1185– 1192. Monette J, Miller MA, Monette M, Laurier C, Boivin J-F, Sourial N, LeCruguel J-P, Vandal A, Cotton-Monpetit M: Effect of an educational intervention on optimizing antibiotic prescribing in long-term care facilities. JAGS 2007, 55:1231–1235. Nicolle, Lindsay E. "Antimicrobial stewardship in long term care facilities: what is effective?." Antimicrobial resistance and infection control 3.1 (2014): 6. Smith, P. W., Watkins, K., Miller, H., & VanSchooneveld, T. (2011). Antibiotic stewardship programs in long-term care facilities. Ann Long-Term Care Clin Care Aging, 19(4), 20-5. Van Buul LW, van der Steen JT, Veenhuizen RB, Achterberg WP, Schellevis FG, Essink RTGM, van Benthem BHB, Natsch S, Hertogh CMPM: Antibiotic use and resistance in long term care facilities. JAMDA 2012, 13:568. ei-568e13.