core interventions february rollout...nhsn reportable infection processes three types of dialysis...
TRANSCRIPT
Core Interventions
February Rollout
Deb DeWalt MSN, RN Susan Swan-Blohm BS, OCDT
February 10, 2018
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p. 2
Agenda
Infection/ Sepsis
CDC Core Interventions /calendar of release
Hand Hygiene
Patient Engagement and Education
Catheter Care
Scrub the Hub
Patient Ambassadors
“Days Since Last Blood Stream Infection” Poster
p. 3
Infection An infection occurs when germs enter the body, increase in
number, and cause a reaction of the body.
Three things are necessary for an infection to occur:
• Source: is an infectious agent or germ and refers to a
virus, bacteria, or other microbe.
• Susceptible person: someone who is not vaccinated or
otherwise immune, or a person with a weakened immune
system who has a way for the germs to enter the body
• Transmission: refers to the way germs are moved to the
susceptible person
p. 4
Sepsis
• Sepsis is the body’s extreme response to an infection. It is
life-threatening and without timely treatment can rapidly
cause tissue damage, organ failure, and death.
• Sepsis is a medical emergency. Time matters
The Facts:
• 5% of all hospitalized patients will get an infection which
may lead to sepsis
• 12-25% of all diagnosed sepsis will end in death
• Over 80% of all sepsis deaths could be prevented
with rapid diagnosis and treatment
• Only 55% of all adults in the United States have heard of
sepsis
p. 5
Signs and symptoms Symptoms of sepsis can include a combination of any of
the following:
• Confusion or disorientation
• Shortness of breath
• High heart rate
• Fever, or shivering, or feeling very cold
• Extreme pain or discomfort
• Clammy or sweaty skin
• Hypotension (low blood pressure)
p. 6
What to
look
for……
Sepsis Identification https://www.cdc.gov/sepsis/get-ahead-of-sepsis/patient-resources.html
p. 7
NHSN Reportable Infection Processes
Three types of dialysis events that are reported
• IV antimicrobial start
• Positive blood culture
• Pus, redness, or increased swelling at the Vascular access site
p. 8
***One facility staff member must complete the
NHSN training an sign the attestation
May 1, 2018
https://nhsn.cdc.gov/nhsntraining/courses/2016/C18
CORE
Interventions
9 CDC Core Interventions
• Bloodstream infections are the number 2 killer of dialysis patients, and according to the CDC
• BSI could be reduced by half if dialysis facilities implemented the CDC Core Interventions for Dialysis Bloodstream Infection Prevention
• 75,000 people receive hemodialysis through a central line. Central lines have a higher risk of infection than a fistula or graft.
• The CDC estimates that 37,000 central line-associated bloodstream infections may have occurred in U.S. hemodialysis patients in 2008.
p. 10
Project Calendar / Core Interventions Rollout
p. 11
Month Core Intervention
February Patient Engagement/Handwashing
March Catheter Care/Scrub the Hub
April Vascular Access/NHSN Education
May Staff competency Audits/Antimicrobial Ointment
June Surface Disinfection/Chlorohexidine
Hand Hygiene
Hand Hygiene Observations
Perform observations of hand hygiene opportunities monthly and share
results with clinical staff. See Observation Protocols for Hand Hygiene &
Glove Use on the CDC website.
• Ten observation per month, document in NHSN
p. 13
Hand Hygiene Resources
CDC Clean Hands Campaign
https://www.cdc.gov/handhygiene/campaign/promotional.html
World Health Organization Five Moments for Hand Hygiene
CDC Clean Hands Save Lives
https://www.cdc.gov/handwashing/
p. 14
http://www.who.int/gpsc/tools/Five_moments/en/
Patient
Engagement /
Education
CDC Core Intervention – Patient education/engagement
Provide standardized education to all patients on infection
prevention topics including vascular access care, hand
hygiene, risks related to catheter use, recognizing signs of
infection, and instructions for access management when away from the dialysis unit. See Patient Education on this website.
16
Look, Listen and Feel
• Protect the access you have
• Identify changes to your
access
p. 17
https://esrdncc.org/contentassets/188bfd9be4a7
4cfca354d9dad6ee407a/70.-patient-complete-
guide_508.pdf
Links to Patient Education Information
https://www.cdc.gov/dialysis/prevention-tools/core-interventions.html
https://www.cdc.gov/dialysis/coalition/index.html
Forms and Informational CDC Publications
https://wwwn.cdc.gov/pubs/CDCInfoOnDemand.aspx?ProgramID=137
p. 18
Catheter Care
Catheter Care
Perform observations of vascular access care and catheter accessing
quarterly. Assess staff adherence to aseptic technique when connecting
and disconnecting catheters and during dressing changes. Share results
with clinical staff.
• Perform 10 observations per month
• Catheter dressing change technique – includes correct performance of
hand hygiene, and use of gloves, and correct use of antiseptics
(proper application and allow drying, etc).
https://www.cdc.gov/dialysis/prevention-tools/audit-tools.html
p. 20
Scrub the Hub
Scrub the Hub Scrub catheter hubs with an appropriate antiseptic after cap is removed and before
accessing. Perform every time catheter is accessed or disconnected. If closed
needleless connector device is used, disinfect connector device per manufacturer’s
instructions
• greater than 0.5% chlorhexidine with alcohol, 70% alcohol, or 10%
povidone-iodine
https://www.cdc.gov/dialysis/prevention-tools/audit-tools.html
https://www.cdc.gov/dialysis/PDFs/collaborative/Protocol-Hub-Cleaning-FINAL-3-12.pdf
p. 22
Policy Review
• Identify Facility Vascular access policies
• Review with staff
• Establish and sign off competencies
p. 23
Patient
Ambassadors
Patient Ambassador
Patient Ambassador Role
Patient, family member, or care giver that participate as members of the health care team achieve better clinical outcomes more readily
Facility Requirement
Facility required to designate a minimum of one patient, or preferably, one patient per shift to assist with this QIA project.
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Role of the Patient Ambassador
• Become a vital member of the healthcare team
• Perform CDC Core intervention Audits, reporting findings to QAPI
team and facility management
• Distribute materials: Look Listen and Feel, Sepsis Identification
• Assist with lobby days
• Prepare an educational bulletin board
• Attend National LAN calls, PAC calls, or Network educational calls
and share the information with the facility team and patients in the
facility
• Update the facility “Days Since Last Bloodstream Infection Poster”
with the help of the facility management
p. 26
Patient Story
Larrine Redmond
Days Since Last
Infection Poster
Days Since Last BSI Poster
• Maintain unit records of all infections
• Report NHSN numerator and denominator
monthly
• Display and Update “Days Since Last Blood
Stream Infection” Poster
• Perform an RCA for each infection identified
• Discuss results of RCA with facility staff and
QAPI team
• Determine barriers and plan interventions for
success
https://www.cdc.gov/dialysis/coalition/
p. 29
Thank You
for attending today’s
presentation
Deb DeWalt, MSN, RN Sue Swan-Blohm, BS, OCDT
Quality Improvement Director Quality Improvement Coordinator
216-755-3053 216-755-3054
[email protected] [email protected]
http://network9.esrd.ipro.org/