Infection Prevention Foundations For Long Term Care Jamie Moran, MSN, RN, CIC Quality Improvement Consultant May 12, 2016

2 Qualis Health A leading national population health management organization The Medicare Quality Innovation Network - Quality Improvement Organization (QIN-QIO) for Idaho and Washington The QIO Program One of the largest federal programs dedicated to improving health quality at the local level

3 Objectives After this webinar series, you will be able to: 1.Relate the Chain of Infection to examples of infection transmission 2.Discuss the most common risk factors associated with infection transmission 3.Describe the most common evidence-based prevention practices used for specific infection types

4 Infection Risk Assessment

5 Risk Factors for Transmission Chain of Infection Infectious Agent Reservoir Portal of Exit Transmission Mode Portal of Entry Susceptible Host

6 Disruption of Transmission Chain of Infection Infectious Agent Reservoir Portal of Exit Transmission Mode Portal of Entry Susceptible Host Personal Hygiene Equipment maintenance Air/water quality tests Expiration dates Pest control Temp and humidity Cough etiquette Wound dressings Hand hygiene Clean-to-dirty workflow Cleaning and disinfecting Sterilizing Gowns, gloves Masks Eye protection N-95 respirators Safe sharps Skin care Vaccines Work restrictions Exposure Prophylaxis resident cohorting

7 Practices to Decrease Risk of Transmission Administrative Practices Surveillance Employee health Risk assessments Product evaluation Environmental Services Personal Hygiene Resident and Caregiver Education Healthcare Worker Practices

8 Standard Precautions

9 Hand hygiene Avoid touching surfaces Preferred hygiene method is alcohol-based sanitizer Wash with soap & water when visibly soiled or contaminated Soap & water for contact with spores Do not wear artificial nails

10 Standard Precautions Hand hygiene (WHO – 5 Moments)

11 Standard Precautions Hand hygiene (CDC, 2002) Before direct contact with residents After contact with blood, body fluids or excretions, mucous membranes, non-intact skin, or wound dressings After contact with resident's intact skin When moving from a contaminated-body site to a clean- body site during resident care After contact with inanimate objects (including medical equipment) in the immediate vicinity of the resident After removing gloves

12 Standard Precautions Personal protective equipment Wear PPE when anticipating contact with blood or body fluids Prevent contamination of clothing and skin during the process of removing PPE Before leaving the resident's room remove and discard PPE

13 Standard Precautions Personal protective equipment Gloves Gowns Mouth, Nose, Eye Protection

14 Standard Precautions Respiratory Hygiene

15 Standard Precautions Environmental Practices Housekeeping Engineering Laundry Dietary Construction

16 Transmission-Based Precautions Appendix A – 2007 HICPAC Guideline for Isolation Precautions

17 Transmission-Based Precautions Contact Precautions MRSA, VRE, C. difficile, diarrhea of unknown etiology, draining wounds, gastroenteritis Personal protective equipment Gloves Gowns Resident isolation Limit isolation to period of active, symptomatic disease Balance with psychosocial/safety needs Environmental services Equipment and medical devices Disposable Clean and disinfect between residents Handle contaminated equipment with standard precautions

18 Transmission-Based Precautions Droplet Precautions Influenza, pertussis, Streptococcal pneumonia, viral respiratory illnesses Resident isolation or mask Personal protective equipment Surgical mask upon entry into the room Visitor notification

19 Control of MDROs In YOUR facility: Type, number, and rate of MDROs Vulnerable residents Antimicrobial use Colonized vs. infected residents Adherence to hand hygiene, standard precautions

20 Control of MDROs Administrative Support Education Antimicrobial Stewardship MDRO Surveillance Environmental Cleaning Decolonization Standard Precautions Contact Precautions

21 Q & A

22 Action / Next Steps Review HICPAC Guideline Review your policies: Hand hygiene Standard precautions Transmission-based precautions

23 For more information: This material was prepared by Qualis Health, the Medicare Quality Innovation Network - Quality Improvement Organization (QIN-QIO) for Idaho and Washington, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. WA-C1-QH Contact Jamie Moran, MSN, RN, CIC Quality Improvement Consultant Qualis Health