Role of the Corporate Infection Preventionist in a Multi-Hospital System

1
(No Transcript)
2
Role of the Corporate Infection Preventionist in
a Multi-Hospital System
Maureen Spencer, RN, M.Ed., CIC Corporate
Infection Preventionist Consultant Universal
Health Services, a subsidiary of UHS of
Delaware King of Prussia, PA www.workingtowardzer
o.com
Nothing to Disclose
3
Universal Health Services

• 25 acute care facilities in
• Wash DC, So Carolina, Florida, Oklahoma, Texas,
  Nevada, California
• A for-profit system with corporate offices in
  King of Prussia, PA
• Infection Prevention is in the Quality and
  Patient Safety Department

4
Corporate Infection Preventionist

• An emerging role for Infection Preventionist (IP)
  in multi-hospital systems
• Corporate Infection Preventionist is an adjunct
  to the facility IPs
• Provides consultative and educational services
• Analyze facility-wide HAI data
• Implement infection prevention measures and
  standardize practices, policies, IC Plans, risk
  assessments
• Standardize IP Job Descriptions and pay scales

5
Key Role Networking and Consulting

• Due to the high workload of IPs today, it can
  prevent them from networking and attending local
  and national conferences
• They can feel isolated and lack a peer support
  group
• The Corporate Infection Preventionist serves as a
  facilitator to develop a cohesive relationship
  with Quality and Patient Safety at corporate
  office

6
Responsibilities

• Standardization of surveillance systems UHS
  corporate dashboard and NHSN data analysis
• Development of educational programs webinar,
  infection control training course and CIC prep
  course, annual infection prevention summit
• Facilitate communication with monthly IP
  teleconferences, frequent phone calls and
  consistent email communication
• Development and standardization of policies and
  procedures
• Collaboration with corporate Value Analysis Team
  on products
• Collaboration with corporate Process Improvement
  team
• Collaboration and participation with corporate
  Accreditation and Regulatory team on Full Book
  Surveys (evaluate continued readiness for TJC and
  CMS requirements)
• Consultation with Infection Preventionists,
  Quality Directors, OR Directors, Chief Nursing
  Officers, C Suite (CEO/COO/CMO/CFO) and medical
  staff in the development of a structured national
  infection prevention program

7
Webinar Topics 2011-2012

• Overview of Rapid Molecular Technology and Cost
  Effective Outcomes                 
                            
• Working Toward Zero SSIs 7 S Bundle
                        
• Overview of Dialysis and IC  Issues     
• Overview of Sterilization and Disinfection  
• Overview of Antiseptics                           
   
• Statistics and Epidemiology Beyond the 2 x 2
  Table
• Overview of MRSA and Prevention Measures
• Overview of C. difficile and Prevention Measures
• 2013 NHSN and UHS Requirements for Surveillance

8
Continued Readiness TJC and CMS

• Corporate Infection Preventionist participates in
  monthly Full Book Surveys where both The Joint
  Commission (TJC) and CMS standards are reviewed
  at the selected hospital
• The team is comprised of IC, Quality, Risk
  Management, Environment of Care and Emergency
  Management, Medication Safety Officer, Facilities
  and Life Safety
• Surveys are completed over a three day period for
  preparation of the facility

9
Standards

• CMS Condition of Participation for Infection
  Control
• CFR 482.42 (a)(1), (b)(1), etc
• Medicare standards TAG A-0747 - 0756
• Joint Commission Standards
• National Patient Safety Goals

10
A Picture Speaks Louder Than Words

• Photos of deficiencies are prepared in a
• PowerPoint presentation
• Photos illustrate the citations in the final
• report
• Allows the IP and other managerial staff
• to use the presentation in staff meetings
  
• to correct deficiencies and educate staff

11
Serve as a Resourcefor the Infection
Preventionists

• The Joint Commission (TJC)
• Association for Professionals in Infection
  Control and
• Epidemiology (APIC)
• Centers for Disease Control (CDC)
• National Health and Safety Network (NHSN)
• Centers for Medicaid and Medicare Services (CMS)
• HICPAC, EPA, FDA, AAMI, ASHE, AII, IHI, AORN

12
How To Keep Up With New Knowledge?

• Resources for Daily Research
• www.infectioncontroltoday.com
• www.sciencedaily.com (health daily update)
• www.hpnonline.com (daily update)
• www.apic.org
• www.ajicjournal.org/
• http//www.cdc.gov/Other/emailupdates/
• www.cdc.gov/hai/
• www.jointcommission.org
•   www.shea-online.org
• www.sentri7.com
•   www.pharmacyonesource.com

13
How To Keep Up With New Knowledge?

• Association of Perioperative Registered Nurses
  www.aorn.org
• Association for the Advancement of Medical
  Instrumentation
• www.aami.org
• American Institute of Architects - www.aia.org
• Quality Net http//www.qualitynet.org
• Federal Drug Administration www.fda.gov/MedicalDe
  vices
• PubMed http//www.ncbi.nlm.nih.gov/pubmed/
• MorbidityMortality Weekly Report
  http//www.cdc.gov/mmwr/
• IDSA http//www.idsociety.org/IDSA_Practice_Guidel
  ines/

14
Facility Unit-Based Champions (UBC)for Infection
Prevention

• Unit Based Champion are selected to collaborate
  with the Infection Preventionist
• Nursing Units, Environmental Services,
  Microbiology Lab, Surgical Services, Emergency
  Department, etc. The IP decides the team
  membership based on needs of facility
• Distribute educational materials on a routine
  basis for reinforcement that is shared at staff
  meetings newsletters, slides, eBug Bytes, new
  policies or practice change
• Conduct observational studies (secret shoppers)
  for compliance with hand hygiene and prevention
  measures (ex environmental cleaning, assessment
  of HAI bundles, precaution technique)
• IPs assist the UBC in preparing abstracts and
  posters and submit to national conferences to
  highlight team work, projects, etc.
• IP analyzes data and shares results with
  appropriate committees

15
Unit Based ChampionsInfection PreventioneBug
Bytes

• April 2013

16
Western NY Infection Rates

• The overall surgical-site infection rate in
  upstate New York declined 7.9 percent, from 2.14
  per 100 procedures in 2008 to 1.97 per 100
  procedures in 2011. Statewide, the infection rate
  decreased 3.2 percent, from 2.17 infections per
  100 procedures to 2.10 infections per 100
  procedures.
• Each year, surgical-site infection rates in
  upstate New York hospitals as a whole were lower,
  compared with statewide infection rates. The
  largest rate of decline - 32.9 percent - over the
  period examined for surgery-related infections
  occurred in Finger Lakes hospitals. The rate
  increased the most - 10.8 percent - in Central
  New York.
• Central line-associated bloodstream infections
  decreased in all upstate regions, and the rate
  was lower as a whole upstate compared with the
  statewide rate. In upstate New York, the
  central-line infection rate dropped 45.9 percent,
  from 2.07 infections per 1,000 days to 1.12 per
  1,000 days. It declined 42.4 percent statewide,
  from 2.38 infections per 1,000 days to 1.37 per
  1,000 days.
• Experts say that such simple steps as using
  checklists and ensuring employees, including
  doctors, wash their hands before touching a
  patient will lead to improvements..

17
Chinese told to change eating habits as H7N9
fatalities rise

• China asked its citizens to avoid contact with
  live poultry as it tries to stem a H7N9 bird flu
  outbreak whose death toll rose to seven today,
  with a further 17 people infected in three
  eastern provinces and Shanghai.
• Consumers should avoid markets where poultry are
  butchered as authorities increase monitoring for
  the new influenza strain, Feng Zijian, head of
  emergency response at the Chinese Center for
  Disease Control and Prevention, said in Beijing
  today. A vaccine is being prepared in case the
  virus starts spreading from human to human,
  health officials said.
• "Consumers should no longer pursue the kind of
  eating habits where they buy fresh chickens that
  are butchered on the spot," Feng told reporters
  at a briefing held jointly with the World Health
  Organization. "Stalls and markets in cities where
  live poultry is being butchered need to be
  closely monitored as possible venues of
  infection. Shares in Shanghai and Taiwan fell
  on concern that infections may become more
  widespread, with airlines leading the slump after
  trading resumed today following a two-day
  holiday. The H7N9 infections tally rose to 24
  after Chinese authorities reported three more
  cases today.

18
(No Transcript)
19
PowerPoint Presentations for UBC

• Implementing AORN Recommended Practices for
  Surgical Attire, 2012
• Prevention of Catheter Associated Urinary Tract
  Infections
• Prevention of Central Line Infections
• Prevention of Ventilator Associated Pneumonia
• Safe Needle and Medication Handling Practices
• Top 10 ways to prevent infection in 2013

20
Corporate IP surveys and issues evaluated
2011-2012

• MRSA Screening
• Immediate Use Steam Sterilization
• Privacy curtains changing policy and disposable
  curtain evaluation
• Procedures for handling Cidex OPA
• Endoscopy cleaning and reprocessing
• CT Scan Contrast Procedures
• Laryngoscope Disinfection
• Surgical Attire Policy
• VAP Prevention Bundle
• CLABSI Bundle standardized central line
  insertion tray
• Alcohol cap protectors for injection port
• CAUTI Prevention Bundle IC tray

• Biological Waste Management
• C.difficile and PCR, Precautions, Disinfection
• State reporting and new regulations
• Mandatory Flu Vaccinations
• Safe Medication and Injection Practices
• Employee Vaccines and Titers
• Reprocessing of Medical Devices
• Standardization of Germicidal Cloths
• Microfiber cloths and mops
• SSI Prevention Bundle
• Central Supply Service biological indicator
  logs, flash logs, manufacturers recommendations
• Dialysis procedures and equipment disinfection

21
Risk Assessments

• Medication safety evaluation handling of single
  use and multi-dose vials, USP 797, contrast
  media preparation
• Reprocessing of medical equipment operating
  room, CSS, endoscopy, radiology, labor and
  delivery, dialysis, wound care, ambulatory
  surgery
• Carbapenem-resistant Enterobacteriaceae (CRE) and
  infection prevention measures

22
Corporate Senior Data Analyst hired in 2012

• Manages the analysis of HAIs entered into NHSN
• Provides consultation to facilities and IPs
• Conducts webinars and teleconferences for
  training
• Trains new IPs in data systems and HAI dashboard

23
Standardization of HAI Surveillance

• Surveillance definitions use of algorithms
• Standardized methodology for corporate dashboard
  and entry of cases in NHSN
• UHS electronic medical record (Cerner)
  Implementation and IC module
• Healthcare acquired conditions (HACs) versus
  NHSN defined HAIs

24
(No Transcript)
25

• Next Step Calculate SIR by HAI by facility and
  compare to national data from NHSN

26

• Reduction in Healthcare Acquired Infections with
  corporate initiatives and standardization of
  practices, products, procedures
• 2011 - 2012

27
Healthcare Acquired Infections 2011- 2012 Reduction UHS 2012 Benchmark Rate Infection Prevention Measures in Process
Catheter Associated UTI (rate per Foley days) 57 2.0 Infection Control Foley Catheter Tray and Silver Foley Catheter, CHG washcloths
CLABSI (rate by catheter days) 54 0.0 Central Line Insertion Kits, Alcohol Caps for Injection Hub Protection, CHG washcloths, Central Line Checklist
VAP (rate by ventilator days) 11 0.0 CHG rinse with oral care kits, VAP bundle checklist, CHG washcloths, nebulizer cleaning procedures, VAP rounds
CABG SSI (overall rate by surgical procedures) 71 0.0 MRSA screening before surgery, CHG preop showers/cloths , Incisional sealants, CHG/alcohol skin prep
Total Hip (overall rate by surgical procedures) 15 0.0 MRSA screening before surgery, CHG preop showers/cloths , Incisional sealants, CHG/alcohol skin prep
Total Knee (overall rate by surgical procedures) 50 0.0 MRSA screening before surgery, CHG preop showers/cloths , Incisional sealants, CHG/alcohol skin prep
C.Difficile (rate per 10,000 patient days) 12 4.0/10,000 patient days Bleach wipes and bleach disinfectant solution, Rapid PCR Diagnostics for Early Diagnosis and Precautions, Enhanced environmental cleaning, cubicle curtain changes, room decontamination units for high rates
MRSA (rate per 1,000 patient days) 62 0.4 CHG Washcloths, Pre-admission and Pre-op Screening, Rapid PCR Diagnostics for Early Diagnosis and Precautions
28
2013 Initiative7 S Bundle to Prevent
SSIwww.7sbundle.com
SAFETY IN THE OPERATING ROOM
SCREEN FOR RISK FACTORS, PRESENCE OF MRSA MSSA
SHOWERS PRE-OP WITH CHLORHEXIDINE SOLUTION OR
BATH CLOTHS
SKIN PREP WITH ALCOHOL BASED SKIN PREPS
(CHLORHEXIDINE AND 70 ALCOHOL - IODOPHOR AND
ALCOHOL)
SOLUTION TO POLLUTION IS DILUTION CHLORHEXIDINE
INCISION IRRIGATION (0.05)
SUTURES ANTIMICROBIAL (WITH TRICLOSAN)
SKIN CLOSURE TOPICAL SKIN ADHESIVES OR
ANTIMICROBIAL DRESSINGS (PHMB), SILVER, AMD
29
(No Transcript)
30
IT TAKES INSPIRATIONAL LEADERSHIP
31
Principles of Social Learning Theory

• Albert Bandura, PhD
• Role Modeling (Unit Based Champions)
• Self-Efficacy (Posters, abstracts, lectures)
• BF Skinner, PhD
• Reinforcement (Consistent education, webinars,
  emails)
• Contracting (Risk Assessments, IP Plans)
• Reciprocity (Job Descriptions, IC Summit, IC
  Training and CIC Prep Course)

32
Conclusion

• Corporate team approach in a multi-hospital
  system is an excellent way to standardize
  practices, organize team work, provide expert
  consultation, survey hospitals in a systematic
  manner and provide inspirational leadership
• Monthly teleconferences and webinars enhance
  communication and education
• Annual training summit creates a cohesive group,
  networking and commitment to the infection
  prevention program
• Onsite surveys allow the corporate office to
  evaluate compliance with evidence based practices
  and local and national standards and regulations
• The Corporate IP Consultant position, under the
  umbrella of Quality and Patient Safety, is an
  excellent resource for large multi-hospital
  systems to reduce healthcare acquired infections.

33

• THANK YOU