increasing your infection prevention capacity ruth carrico phd rn fshea cic associate professor...
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Increasing Your Infection Prevention Capacity
Ruth Carrico PhD RN FSHEA CICAssociate Professor
Division of Infectious DiseasesUniversity of Louisville
Objectives
• Review the changing practices involved in infection prevention and control
• Explore strategies to increase your capacity and impact applicable to any healthcare setting
Increasing Capacity and Capability
Your skills
Skills you can obtain from other departments
Skills you can develop in others
Evolution of Infection Prevention: 1960s
• Era of Exploration– Advances in knowledge regarding relationships
between microbes, people and the environment– Field of public health focused on patients in
hospitals– Hospital epidemiologists– Nurses involved in case finding and surveillance– Basic CDC course
Garcia R, Bernard B, Kennedy V. The fifth evolutionary era in infection control: Interventional epidemiology. AJIC 2000;28:30-43.
Evolution of Infection Prevention: 1970s
• Era of Expansion– Medical devices– Research regarding risks of nosocomial infection– Focus on institutional capabilities for providing
and delivering quality care– Process evaluations began– Design of supplies and materials and their
relationships to infection– SENIC
Evolution of Infection Prevention: 1980s
• Era of Reaction and Response– HIV– Universal precautions– Antibiotic resistance recognized as major problem– Cost control and containment– JCAHO [TJC] Agenda for Change– Little focus on necessary resources
Evolution of Infection Prevention: 1990s
• Era of Regulation– HAI rates had been relatively “steady” from 1975 to
1990– JCAHO [TJC] introduces quality
assurance/performance improvement to Infection Control
– ABHRs hit the scene (culture change starting)– IOM To Err is Human– NNIS in 285 hospitals in 42 states– HICPAC
Evolution of Infection Prevention: 2000
• Era of Interventional Epidemiology– Patient safety movement (Root Cause Analysis, Failure
Modes and Effects Analysis, Sentinel Events)– AHRQ funds research– Advocacy– Bundles– NNIS becomes NHSN in 2005– NHSN- 3000 hospitals in all 50 states. 22 states
require use of NHSN to report HAIs (2011)– Surveillance guiding interventions
Infection Prevention in 2010 and Beyond
• Era of Transformation– Transparency and legislation– Approaches and initiatives questioned (e.g., MRSA)– CMS value based purchasing– Successes in elimination of HAI is now the expected– Getting to zero VS. Zero tolerance– Infection control continues its transformation to
Infection prevention – Links with quality and patient safety more evident
Existing Skill Set for the Function of Infection Prevention
• Clinical expertise• Knowledge of surveillance fundamentals• Identification of infectious disease processes• Preventing and controlling transmission• Employee/occupational health• Management and communication• Education
Feltovich F, Fabrey L. The current practice of infection prevention as demonstrated by the practice analysis survey of the Certification Board of Infection Control and Epidemiology, Inc. AJIC 2010;38:784-788.
New Skill Set for the Function of Infection Prevention
• Surveillance fundamentals• Epidemiology• Health behavior• Health promotion• Environmental sciences• Biostatistics• Collaborative practices• Educational techniques for instruction and design• Leadership
Increasing Capacity and Capability
• Include needs in risk assessment• Perform an inventory of your current skills and the
skills within your department• Clearly outline your weaknesses so you can
develop a plan to address them• Identify departments with similar responsibilities• Recruit unit-based champions• Develop an education plan for self and group• Develop an evaluation plan to guide your process
Increasing Capacity and Capability
• Include needs in risk assessment– Begin the process by including the need for more
capacity within the department in your risk assessment
– Be clear about your need and the impact this gap is having on systems and outcomes
– Make sure you share this information with your link to the facility executive team
Increasing Capacity and Capability
• Perform an inventory of your current skills and the skills within your department– This is difficult and humbling– Consider ‘grading’ yourself and your team in terms
of knowledge v. proficient v. expert– Take into consideration present and well as future
needs
Increasing Capacity and Capability
• Clearly outline your weaknesses so you can develop a plan to address them– Can keep this personal or ask for input from others– Outside opinion can be valuable from those you
trust. Also solicit feedback from those with whom you do not have a good working relationship
– Prioritize your weaknesses in terms of importance to you and your job roles
Increasing Capacity and Capability
• Identify departments with similar responsibilities– A first step in increasing your capacity is to identify
departments with shared interests and/or responsibilities
– Identify resources that may be able to be shared– Identify training that can be obtained from these
departments
Increasing Capacity and Capability
• Recruit unit-based champions– Liaison program– Individuals self-select based upon interest– Training provided to this group– Engagement in problem identification and
response– “Nobody knows the work better that those who
do the work” (Toyota production- Gemba: the place of the work)
Increasing Capacity and Capability
• Develop an education plan for self and group– Once you have identified strengths, weaknesses,
areas for assistance, begun the building of your liaison program, you must have a parallel education plan
– Prioritize topics according to need (look back at risk assessment)
– Develop the workers– Develop yourself
Increasing Capacity and Capability
• Develop an evaluation plan to guide your process– With your improvement plan, identify metrics for
success– Must evaluate your progress, the impact of new
resources (e.g., liaison program), and your interventions
– What is not working should be stopped or changed– Keep adequate evaluation records to justify activities
Increasing Capacity and Capability
• Include needs in risk assessment• Perform an inventory of your current skills and the
skills within your department• Clearly outline your weaknesses so you can
develop a plan to address them• Identify departments with similar responsibilities• Recruit unit-based champions• Develop an education plan for self and group• Develop an evaluation plan to guide your process
Objectives
• Review the changing practices involved in infection prevention and control
• Explore strategies to increase your capacity and impact applicable to any healthcare setting
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