An Infection Prevention Update Going Forward Marie Kassai RN, BSN, MPH, CIC June 2011

Objectives Upon completion of the presentation, the participant will be able to: List the overall practices for a comprehensive Infection Prevention Program State the infections that will be reported to NHSN List the current regulatory, licensure and CMS issues related to Infection Prevention in Ambulatory Surgery Recommend ways to achieve compliance

Infection Prevention Update Automatic faucets harbor legionella Bed bugs carry MRSA and VRE Toilet seat contains less bacteria than elevator buttons

Infection Prevention/Control Program - 2011 Oversight by the governing body Surveillance processes (hand hygiene and PPE monitoring) that can be accomplished through rounding Documented ongoing education and time spent on Infection Prevention Program for cleaning and reprocessing Compliance to required cleaning protocols and schedule

Infection Prevention Program Basis is nationally published guidelines Competent Staff and physicians Dedicated Infection Control Officer – CMS Hand Hygiene Program Risk Assessment Isolation Plan – includes standard precautions Mandatory OR traffic control program

Infection Prevention Program Process for following infections and reporting Employee Program Process for treating infections and helping patients with care Procedure for Immediate Use Steam Sterilization Collaboration of Infection Prevention and Central

Ways to Comply Organize your program Have a plan Timelines for review Schedules for housekeeping Logs – formalize and remind Examples included

Reporting of Infections in NJ Who will have to report? Licensed ambulatory surgery centers Infections to be reported? Laminectomy – High risk for infection Breast Surgery – High Volume Knee Arthroscopy – Comparison with acute care When ? January 2012

Reporting Infections How ? Data Enrollment in NHSN Training by NJDHSS and NHSN Consistent definitions Data NJ Published with comparisons/benchmarking

Hot Topics - Noted during tracer Expiration Dates – Check daily and with every delivery Tape - Gloves Electrodes ????? Anesthesia Carts - Observations Laryngoscope blades and suction apparatus Medications Hand Hygiene

Immunizations New Influenza Rules CMS – Proposed rule Emphasized patient and family education Need a plan and procedures for the FLU Vaccine Do not forget the employees TJC – a new standard Plan to increase Flu Vaccine access and use in employees Goals must be set and actions documented

Reemphasized Recommendations for Healthcare Workers Tdap Vaccine Recommended for employees with patient contact Not mandated One dose only – 2 years after last Tetanus injection

Vaccines – New Info - Adults 50 and over – Shingles Vaccine Pneumococcal Vaccine All persons 65 and older Persons with chronic diseases – 2 through 64 Smokers and persons with asthma – 19-64 Information on CDC/gov

The Environment

ANTISEPTICS/DISINFECTANTS UTILIZED Product Classification Principal Ingredient Use Where Used MSDS Sheet Expiration Date Contact Time Antiseptics Handwashing Products Disinfectants

The Environment WIPES Check products used - Housekeeping Clean first Then disinfect Contact – keep wet for duration of contact time Wet Task Bucket Check products used - Housekeeping Labeling – manufacturer’s instruction EPA Number Properly mixed and used Mops hung to dry

Cleaning the Environment Training for special areas Cleaning schedule Cleaning special items Keyboards Bed Bugs and exterminator

Cleaning the Environment Training of contracted staff Blood Borne Pathogen Hepatitis Vaccine Post exposure follow up Blood work Who to notify Where to go for treatment 14 day meeting to discuss follow up

AAMI – ST 79 Publication – Sterilization Guidelines Recently updated – need new version Input of AORN, Central Service Organizations, AAMI and APIC Education related to sterilization and disinfection is critical to Infection Prevention

IMPORTANT Policies and Procedures/ Manufacturer’s Instructions (IFU) Must be consistent Copies should be available for reference Read periodically Compliance at all times Manufacturer’s must validate You must verify that they have done so

Manufacturer’s Instructions - Instructions for Use (IFU) Instruments – Instructions from use to use Cleaning – enzymatic Sonic cleaner or both Disassembly Manual cleaning – even if automatic Rinse – special water or tap Monitoring tools

IFU continued Washer – disinfector Wrap or containers Read IFU carefully Maximum weight – 25 lbs Packaging – according to IFU not facility Transport In facility Out of facility

IFU Sterilization Process Monitoring Type of sterilization process Cycle Time Pressure Drying Aeration

Other Considerations - IFU Unloading the sterilizer Drying the packs Handling and distribution Inspection Storage Single stack if wrapped Temperature and humidity 18 “ – 6-10 ‘ and 2 “ Transport throughout the center Opening the packs

Equipment IFU for items – Glucometers, monitors, infusion devices Regular Maintenance Clean as directed Follow up any problems with validation

Monitoring – All Processes Each process must be monitored Each parameter must be evaluated Each machine must be monitored The test strips must have a quality check before use Each of these must be documented.

Loaners Must be delivered 24 - 48 hours before the case Manufacturer’s instructions must be on site Must be cleaned and sterilized according to manufacturer’s instructions by the facility Must be cleaned and disinfected prior to return

Manufacturer’s Instructions on File Log of Loaners Delivered to Facility - 2011 Date Rec’d Company Tray/s Manufacturer’s Instructions on File Case Time Time Delivered Processing Completed Case Completed Processing Completed Tray Pick up

Update – Surgical Attire Surgical Attire – facility laundered Clean shoes, head covering, masks, jackets and ID Badges – semi - restricted and restricted Change into street clothes when leaving OR Shoes – with backs, low heals, non-skid soles, no holes on tops and Hair should be completely covered – bouffant over other head coverings

Update – Surgical Attire Jewelry should be minimal Stethoscopes – clean between patients Fanny packs, backpacks, and briefcases should not be brought into the OR Surgical mask when opening sterile supplies Masks for spinal anesthesia

Collaboration With Central Request quality reports from Central Loaner information Equipment monitoring Infection evaluation Policies and Procedures Joint Education Outside Programs Webinars – APIC, AORN and Vendors

Recent Developments ASGE, SHEA – Updated previous Guideline on Reprocessing Flexible GI Endoscopes FDA – Goal – To improve design and cleaning instructions for reusable medical devices OSHA Monitoring Sharps Safety Policies in 4 states – Alabama, Florida, Georgia and Mississippi CMS – Two initiatives Quality Reporting Value-based purchasing system

Recent Developments