Presented by: Mary McGoldrick, MS, RN, CRNI

Transcription

1 Managing Infection Control Challenges in the Home Mary McGoldrick, MS, RN, CRNI Home Care and Hospice Consultant Saint Simons Island, GA CE Credit in Five Easy Steps! 1. Scan your badge as you enter each session. 2. Carry your Evaluation Packet to every session so you can add session evaluation forms to it. 3. Track your hours on the Statement of Session Attendance Form as you go. 4. At your last session, total the hours and sign both pages of your Statement of Session Attendance Form. Keep the PINK copy for your records. Put the YELLOW and WHITE copies in your Evaluation Packet. Make sure a completed Session Evaluation Form is in your Evaluation Packet for each session you attended. Missing one? Extras are in a file near Registration. 5. Complete the General Attendance Evaluation Form located in your Evaluation Packet and place it back in your envelope. Write your name on the outside of your Evaluation Packet envelope, seal it, and drop it in the box near Registration. Applying for Pharmacy CPE? If you have not yet registered for an NABP e Profile ID, please visit to do so before submitting your packet. You must enter your NABP e Profile ID in order to receive CE credit this year! 3/24/ Disclosure Slide The speaker is a consultant. Conflict of interest was resolved by peer review of slide content. Clinical trials and off label/investigational uses will not be discussed during this presentation. 3/24/

2 Session Objectives: At the conclusion of this session, the participant will be able to: 1. Describe the current status of antimicrobial resistance and effective treatment options, listing the organisms that currently pose the most significant threat to human health. 2. List and describe the types of precautions deployed to minimize the spread of infectious organisms in the home setting. 3. Describe the effective education strategies for patients and caregivers to minimize the spread of infectious organisms. 4. Explain the issues observed with hand hygiene, and strategies to overcome them. 4 The Emerging Threat of Antibiotic Resistance 2

3 National Data Summary Source: Centers for Disease Control and Prevention. (2013). Antibiotic Resistance Threats in the United States. 3

4 Antibiotic Resistance Threat Levels Urgent: Immediate public health threat that requires urgent and aggressive action. Serious: Serious concern and require prompt and sustained action to ensure the problem does not grow. Concerning: The threat of antibiotic resistance is low, and/ or there are multiple therapeutic options for resistant infections Antibiotic Resistance Threat Level: Urgent Clostridium difficile (C. difficile) Carbapenem resistant Enterobacteriaceae (CRE) Drug resistant Neisseria gonorrhoeae (cephalosporin resistance) Microorganism with a Threat Level: Urgent Source: Centers for Disease Control and Prevention. (2013). Antibiotic Resistance Threats in the United States. 4

5 Microorganism with a Threat Level: Urgent Source: Centers for Disease Control and Prevention. (2013). Antibiotic Resistance Threats in the United States. Microorganism with a Threat Level: Urgent Source: Centers for Disease Control and Prevention. (2013). Antibiotic Resistance Threats in the United States. Antibiotic Resistance Threat Level: Serious 1. Multidrug resistant Acinetobacter 2. Drug resistant Campylobacter 3. Fluconazole resistant Candida (a fungus) 4. Extended spectrum β lactamase producing Enterobacteriaceae (ESBLs) 5. Vancomycin resistant Enterococcus (VRE) 6. Multidrug resistant Pseudomonas aeruginosa 7. Drug resistant non typhoidal Salmonella 8. Drug resistant Salmonella Typhi 9. Drug resistant Shigella 10. Methicillin resistant Staphylococcus aureus (MRSA) 11. Drug resistant Streptococcus pneumoniae 12. Drug resistant tuberculosis (MDR and XDR) 5

6 Antibiotic Resistance Threat Level: Concerning Vancomycin resistant Staphylococcus aureus (VRSA) Erythromycin resistant Streptococcus Group A Clindamycin resistant Streptococcus Group B Four Core Actions to Prevent Antibiotic Resistance 1. Preventing infections and preventing the spread of resistance 2. Tracking 3. Improving antibiotic prescribing/stewardship 4. Developing new drugs and diagnostic tests Preventing Infections, Preventing the Spread of Resistance Patient interventions: Immunization Safe food preparation and handling Handwashing Using antibiotics as directed and only when necessary Infusion nurse interventions: Protect patients from drug resistant infections Follow relevant guidelines and precautions at every patient encounter Provide patient education 6

7 Tracking Resistance Patterns Emerging Infections Program (EIP): National Antimicrobial Resistance Monitoring System (NARMS) National Healthcare Safety Network (NHSN) Gonococcal Isolate Surveillance Program (GISP) National Tuberculosis Surveillance System (NTSS) Antibiotic Stewardship Developing New Drugs and Diagnostic Tests 7

8 The Role of the Home Infusion Nurse in Preventing the Spread of Resistant Microorganisms: Isolation Precautions 22 Isolation Precautions Signage 23 Isolation Precautions Standards precautions Transmission based precautions Airborne precautions Droplet precautions Contact precautions Appendix A of Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings

9 Standards Precautions: Personal Protective Equipment Gloves Gown Mouth, Nose and Eye Protection: Masks Goggles Face shields Combinations of each 25 Respiratory Hygiene/Cough Etiquette Educate staff on the importance of containing respiratory secretions to prevent droplet and fomite transmission Category IB 26 Airborne Precautions When to implement Personnel restrictions Use of PPE Patient placement Patient transport Additional CDC Guidelines: Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health Care Settings, 2005 Guideline for Environmental Infection Control in Health Care Facilities 27 9

10 When to implement Use of personal protective equipment Patient placement When to discontinue Droplet Precautions Droplet Precautions 28 When to implement Use of personal protective equipment Gloves Gown Patient care equipment Environmental measures Contact Precautions 29 Caring for a Patient with an Antibiotic Resistant Organism: Isolation Precautions When to implement: Standard precautions only Contact precautions, in addition to Standard Precautions 30 10

11 Caring for a Patient with an Antibiotic Resistant Organism: Isolation Precautions Isolation Criteria: Contained and controlled secretions and excretions Cognitively intact and competent Cooperative and compliant Clean Source: McGoldrick, M. (2014). Home Care Infection Prevention and Control Program. Isolation Precautions. Saint Simons Island GA: Author. Caring for a Patient with an Antibiotic Resistant Organism: Isolation Precautions Equipment Management: Limit equipment brought into home Whenever possible, leave dedicated equipment If noncritical patient care equipment cannot remain in the home, clean and disinfect items before taking them from home Place contaminated reusable items in a plastic bag for transport and subsequent cleaning and disinfection 32 Caring for a Patient with an Antibiotic Resistant Organism: Isolation Precautions Equipment management: Cleaning and disinfection Environmental measures Visit schedule 33 11

12 Caring for a Patient with a Clostridium difficile Infection When to implement standard and contact precautions When to discontinue contact precautions Patient placement in the home Personal protective equipment Environmental controls Equipment measures 34 Nursing Bag Contamination Outside nurses bags: 83.6% positive for human pathogens; 15.9% MDROs Cloth nurses bag surface material 3 times more likely to have an MDRO isolate Inside nurses bag: 48.4% positive for human pathogens; 6.3% MDROs Patient care equipment inside nurses bags 43.7% positive for human pathogens; 5.6% MDROs Source: Bakunas Kenneley, I., Madigan, E., (2009). Infection prevention and control in home healthcare: The nurse s bag. Am J Infect Control. 37: Nursing Bag: Fomite for Transmission of Antibiotic Resistant Organisms In home placement Surface barrier Hand hygiene Cleaning Source: McGoldrick, M. (January 2014). Bag Technique: Preventing and Controlling Infections in Home Care and Hospice. Home Healthcare Nurse. 32 (1): Philadelphia, PA: Lippincott, Williams & Wilkins

13 Pets: Vectors for Transmission of Antibiotic Resistant Organisms in the Home Setting Presence of domestic pets in the home: Dogs Cats 37 Hand Hygiene: Preventing the Spread of Antibiotic Resistant Organisms in the Home Setting 38 Top 5 Home Care Hand Hygiene Challenges 1. Technique 2. Indications 3. Product and storage 4. Other adjunct considerations 5. Measuring and monitoring hand hygiene compliance in the home setting

14 Hand Hygiene Guidelines CDC Released in 2002 Collaborative Development (HICPAC, SHEA, APIC, IDSA) WHO Guidelines: CDC Guideline for Hand Hygiene in Health Care Settings, 2002 CDC/HICPAC System for Categorizing Recommendations Category IA. Strongly recommended for implementation and strongly supported by well designed experimental, clinical, or epidemiologic studies. Category IB. Strongly recommended for implementation and supported by certain experimental, clinical, or epidemiologic studies and a strong theoretical rationale. Category IC. Required for implementation, as mandated by federal or state regulation or standard. Category II. Suggested for implementation and supported by suggestive clinical or epidemiologic studies or a theoretical rationale. No recommendation. Unresolved issue. Practices for which insufficient evidence or no consensus regarding efficacy exist. 41 Hand Hygiene Technique Soap and water: Rub hands together vigorously for a minimum of 15 seconds covering all surfaces. (CDC, IB) Vigorously perform rotational handrubbing on both hand palms and backs, interlace and interlock fingers to cover all surfaces. (WHO) Dry the hands with a disposable towel (CDC, IB) and single use towel. (WHO, IB) Use the towel to turn off the faucet/tap. (CDC and WHO IB) 42 14

15 Hand Hygiene Technique Alcohol based hand hygiene product: Covering all surfaces of hands and fingers, until hands are dry. (CDC, IB) Apply a palmful of the product in a cupped hand and cover all surfaces. (CDC, IB) Rub both hand palms and backs, interlace and interlock fingers to cover all surfaces until the hands are dry. (WHO, IB) 43 Hand Hygiene: Frequently Missed Locations 44 Hand Hygiene Indications Before having direct contact with patients (CDC IB, WHO IB) After contact with a patient's intact skin (CDC IB) After contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient (WHO IB; CDC II) After removing gloves (CDC IB, WHO IB) 45 15

16 WHO: 4 Moments in Health Care When to Perform Hand Hygiene 46 Hand Hygiene Challenges: Products Used by Staff Soap: Plain soap versus antimicrobial Alcohol based hand hygiene product Hand lotion or cream access (CDC IA; WHO IA) Evaluate dispenser systems (CDC II, WHO II) and storage needs Partially empty container refill technique (CDC IA) 47 Hand Hygiene: Using the Patient s Supplies in the Home Soap: Plain soap versus antimicrobial Liquid soap versus bar soap 48 16

17 Hand Hygiene: Using the Patient s Supplies in the Home Drying materials: Multiple use cloth towels not recommended for use (CDC II) Not used multiple times or by multiple people (WHO IB) 49 Hand Hygiene: Alcohol based Hand Rub Storage location: In home In vehicle Expiration dating When not to use Patient with C. difficile 50 Rings Jewelry Nail polish Artificial nails Nail tip length Hand Hygiene: Other Considerations 51 17

18 Monitoring & Measuring Hand Hygiene Compliance in Home Care Measuring product use Surveys: Self reported Patient/family Technology Direct observation 18/hh_monograph.pdf 52 Home Care Hand Hygiene Competence Assessment Tool Available for download at HomeCareandHospice.com 53 Strategies to Prevent The Transmission of Antibiotic Resistant Organisms in the Home: Patient and Caregiver Education 54 18

19 Preventing the Spread of Antibiotic Resistant Organisms in the Home: Patient Education Antibiotics: Self administration Sharing Disposal Requesting Follow up actions 55 Preventing the Spread of C. difficile in the Home: Patient Education When to perform hand hygiene Use a separate bathroom Clean bathroom well Items in the patient s room Screen visitors Physician follow up Source: McGoldrick, M. (2014). Home Care Infection Prevention and Control Program. Isolation Precautions. Saint Simons Island GA: Author. 56 Preventing the Spread of Antibiotic Resistant Organisms in the Home: Patient Education Respiratory secretions: How to contain: Cough or sneeze Placement of used tissue Hand hygiene When to wear a mask Maintain current vaccinations 57 19

20 Preventing the Spread of Antibiotic Resistant Organisms in the Home: Patient Education Hand hygiene: Insist performed prior to contact When to wash Personal hygiene: Bathe daily Don clean clothing after bathing Do not share hygiene products 58 Preventing the Spread of Antibiotic Resistant Organisms in the Home: Patient Education Home environment: Clean the home regularly and when soiled Disinfect surfaces in the kitchen and bathroom Linens: Wash linens routinely and when soiled Not share towels Use towels only once after use 59 Preventing the Spread of Antibiotic Resistant Organism in the Home: Patient Education Adhere to safe food handling practices: Avoid food preparation for others if ill Keep uncooked foods separate from ready toeat Wash hands, boards, utensils, and surfaces Use a food thermometer when cooking Keep refrigerator below 40 F and refrigerate food that will spoil 60 20

21 Preventing the Spread of Organisms in the Home: Patient Education Standard Precautions: Personal protective equipment: Wear disposable gloves when contact with body fluids is expected and wash hands after removing the gloves Cough etiquette/respiratory hygiene Adhere to safe injection practices Get immunized 61 Managing Infection Control Challenges in the Home Setting: Summary Current status of antimicrobial resistance How to implement isolation strategies and specifics strategies when caring for patients with antibiotic resistant organisms and CDI What patient education needs to be provided to minimize the spread of infectious organisms How to strengthen the infection prevention program through hand hygiene strategies 62 Questions? Mary McGoldrick, MS, RN, CRNI Phone: (912) Fax: (800) E mail: mary@homecareandhospice.com Web: HomeCareandHospice.com 63 21