Core Interventions Rollout Part 2 Deb DeWalt MSN, RN Susan Swan-Blohm BS, OCDT April 2018

Meeting Reminders All phone lines muted upon entry to eliminate background noise/distractions Be mindful of muting your phone when not speaking Please don’t place the call on hold, instead disconnect your line and rejoin the call when able Be present and engaged in our topic presentations We will be monitoring our WebEx Q & A throughout the webinar for questions or comments

Agenda Infection/ Sepsis CDC Core Interventions Catheter Reduction Antimicrobial Ointment Chlorohexidine Skin Staff Education and Competencies Patient Ambassadors Project Obligation “Days Since Last Blood Stream Infection” Poster

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

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

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) What to look for……

Sepsis Identification https://www.cdc.gov/sepsis/get-ahead-of-sepsis/patient-resources.html

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 ***One facility staff member must complete the NHSN training an sign the attestation May 1, 2018 https://nhsn.cdc.gov/nhsntraining/courses/2016/C18 **Please note the NHSN site is down for maintenance until 3/30/2018 **

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.

Catheter Reduction

6. Catheter Reduction The Facts: Use of LTC has doubled over the last 2 decades 80% of all ESRD patients start dialysis with a catheter 51% increased risk of hospitalization primarily due to infection Leading cause hospitalization and death in ESRD patients 50% of the clinics identified in the project this year were in it last year. How: Permanent Access Placement Maintaining a Permanent Access The average LTC rate is 21.05% in the 75 clinics identified.

Managing Patients with LTC Algorithm

Resources https://esrdncc.org/en/fistula-first-catheter-last/ffcl-resources/ Maintaining an Access Access Placement

Updating your Vascular Access Information in CROWNWeb Review the CROWNWeb data definitions Run Vascular Access Data Report and verify current patient access- monthly Review batch submission for accuracy and make changes as necessary-monthly Review Vascular access facility reports provided by the network- quarterly

Chlorohexidine Skin Prep

Chlorohexidine for Skin Antisepsis Betasept Biopatch wChlorhexidine Gluconate Chlorostat Dyna-Hex Dyna-Hex2 Betasept Biopatch wChlorhexidine Gluconate Chlorostat Dyna-Hex Dyna-Hex2

Antimicrobial Ointment

Antimicrobial Ointment https://www.cdc.gov/dialysis/prevention-tools/catheter-compatibility-information.html Catheter Compatibility Chart

Staff Education and Competencies

Policy Review Identify Facility Vascular access and Disinfection policies Review with staff Establish and sign off competencies

Resources https://www.cdc.gov/dialysis/prevention-tools/audit-tools.html Infections in an outpatient Dialysis Settings https://www.cdc.gov/dialysis/clinician/index.html

CDC Audit tools and Checklists Catheter Care Connection and disconnection, audit tools and checklists Scrub the Hub Protocol and checklist Catheter Exit Site Care Audit tool and checklist AV Fistula & Graft Cannulation and Decannulation Audit tools and checklist Injection Safety Prep and Administration audit tool Medication Prep and Administration checklists Hand Hygiene Audit tool Dialysis Station Disinfection Notes For Clinical Managers

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/

Project Obligation

Project Obligation -What do you need to do Monthly - Complete the e-mail survey and return it to the Network, including barriers and best practices One time - Every all facilities must complete the e-mail attestation survey regarding education and implementation of the 9 CORE interventions. One Time - A minimum of one facility member must complete the NHSN surveillance Dialysis events Training and sign the attestation If your BSI pooled mean rate shows no sign of improvement your facility will be asked to complete an RCA for each BSI reported in NHSN Engage your Patient Ambassador in the infection control efforts – audits, posters etc…

Patient Ambassadors

Patient Ambassador Patient Ambassador Role     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. The singular most highlighted CMS goal and CDC Core Intervention is the involvement in patients as members in the health care team. It has been shown that clinics with patients active in their own care do achieve better clinical outcomes. With your project completion we added a role description for Patient Ambassador. We would like each unit to select a minimum of one patient to serve in this role. This patient will work with the Network to learn their role as it relates to BSI and work with the project lead to accomplish unit goals. Some activities we have planned to train the ambassador to do is handwashing audits for staff and patients. Provide educational material devleoped by the Network to the patients related to BSI areduction to improve facility outcomes and patient safety.

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

Any Questions ?

IPRO ESRD Network of the Ohio River Valley Contact Information Department Name / Title Email Direct Line Administrative Victoria Cash, Executive Director vcash@nw9.esrd.net 216-755-3051   Brittany Battle, Project Support Coordinator bbattle@nw9.esrd.net 216-755-3059 Quality Improvement Deborah DeWalt, Quality Improvement Director ddewalt@nw9.esrd.net 216-755-3053 Susan Swan-Blohm, Quality Improvement Coordinator sswan-blohm@ne9.esrd.net 216-755-3054 Amar Patole, Quality Improvement Data Specialist apatole@nw9.esrd.net 216-755-3052 Patient Services Andrea Bates, Patient Services Director abates@nw9.esrd.net 216-755-3055 Kenny Kinder, Patient Services Coordinator kkinder@nw9.esrd.net 216-755-3056 Information Management Jaya Bhargava, Operations Director jbhargava@nw9.esrd.net 203-285-1215 Jerome Jemison, Data Coordinator II jjemison@nw9.esrd.net 216-755-3057 Patient toll-free line: (844) 819-3010 General email: info@nw9.esrd.net Web: network9.esrd.ipro.org Network help desk: NW9help@iproesrdnetwork.freshdesk.com

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 ddewalt@nw9.esrd.net sswan-blohm@nw9.esrd.net http://network9.esrd.ipro.org/