Infection Prevention in Long Term Care: Navigating the New Rules Kate will kick off the call February 8, 2017

Welcome Kate intro self and QIO Hand off to Chris – intro self and then take it from here

For Today Review the new Rules and Regulations for Infection Prevention in LTC Discuss barriers and solutions to IP Hear best practices from those who are moving forward in IP How hospitals can support IP in LTC How to include residents and families What rules and regulation changes are coming in November 2017? Do you have an Infection Preventionist? How many hats does your IP wear? Have you started your Antibiotic Stewardship Program? How is participation from the medical director and pharmacist? Do you know who your hospital IP is and do you have their phone #? Does the hospital IP know who you are? Patient centered care – why should we care?

Why this matters now Residents admitted with higher medical acuity Co-morbidities of frail and elderly Nature of close living increases risks Protection of residents and staff No longer just a hospital issue but a community issue “Infections are a significant source of morbidity and mortality for nursing home residents and account for up to half of all nursing home resident transfers to hospitals. Infections result in an estimated 150,000 to 200,000 hospital admissions per year at an estimated cost of $673 million to $2 billion annually. “ – Centers for Medicare & Medicaid Services (CMS), November 26, 2014 “It is estimated that an average of 1.6 to 3.8 infections per resident occur annually in nursing homes.” – CMS, November 26, 2014.

Review the new Rules and Regulations for Infection Prevention in LTC Infections and communicable diseases ULTIMATE GOAL: Preventing, identifying, reporting, investigating and controlling infections and communicable diseases for residents, staff, visitors and volunteers Organized program that follows national guidelines Must be reviewed and updated regularly Written standards policies and procedures Development of tools Antibiotic Stewardship Antibiotic use protocol Monitoring of antibiotics used New rules for CMS F Tag 441 will start November 28, 2017 for Infection Prevention and Control Programs. So take a deep breath and relax, there is still time to get things into place. Name change: Infection Prevention and Control Program (IPCP) Written standards include: surveillance, reporting diseases, standard and transmission-based precautions, isolations, employee health & not working while sick, and hand hygiene. Antibiotic Stewardship Program: must meet the CMS Condition of Participation that include compliance with CDC: Core Elements of Antibiotic Stewardship Program.

Review the new Rules and Regulations for Infection Prevention in LTC Immunization policies Pneumococcal and influenza vaccine Details recorded for those not receiving the vaccine Education of staff Isolation types (Contact, Droplet, & Airborne) Hand hygiene (Soap and water and alcohol hand sanitizers) Transport of linens New employee orientation and annually there after – BBPs Must provide education to competent residents or family/guardians of incompetent residents, by using a vaccination information sheet. Documentation should include information regarding education provided, refusal of vaccination, or acceptance of vaccination. Use standardized immunization orders for simplifying the process. Prevnar 13: give at age 65 or before if meets chronic conditions Pneumovax 23: give at age 65, preferable to give after Prevnar 13, separated by 1 year, or before age 65 if meets chronic conditions, may have a 2nd dose 5 years after the first dose of Penumovax 23, and may have a 3rd dose 5 years after the 2nd dose, if the 1st 2 doses were given before age 65 Influenza: CMS/MDS requires the influenza vaccine to be given between October 1st to March 31st. Doesn’t matter which flu vaccine is used for residents: trivalent, quadrivalent, or high dose flu vaccine.

Review the new Rules and Regulations for Infection Prevention in LTC Antibiotic Stewardship Program – The Joint Commission Effective January 1, 2017 Under Medication Management: MM.09.01.01 Recommends the CDC’s Get Smart program and The Core Elements of Antibiotic Stewardship for Nursing Homes If you are surveyed by The Joint Commission, it is already in effect. You should have in place: Leadership on board Provide education to staff, residents, and visitors regarding Antibiotic Stewardship activities Multidisciplinary team (Infectious Disease Physician, Infection Preventionist, Pharmacist, and Practioner) Follow CDC Core Elements Uses multidisciplinary protocols Collects, analyzes, and reports data Takes action on improvement opportunities

Review the new Rules and Regulations for Infection Prevention in LTC Infection Preventionist Primary professional training in nursing, medical technology, microbiology, epidemiology, or other related field Qualified by education, training, experience, or certification Works at least part-time at the facility Completed specialized training in infection prevention and control Participates on Quality Assessment & Assurance Committee and report to on a regular basis Annual review of program Facility Risk Assessment Implement: November 28, 2019 Specialized training – not defined “Training should take place both on an ongoing basis on the basics of infection prevention and control and when need arises in response to incidents.” - Six Keys to an Effective Infection Preventionist, Amy Stewart RN, Long-Term Living Magazine, November 2, 2016. May have more than 1 person, which is recommended due to the high turnover in LTC.

Review the new Rules and Regulations for Infection Prevention in LTC Who should be an Infection Preventionist? A person who likes to learn Can communicate in front of groups and provide education to residents, staff, volunteers, and visitors – all need to be engaged Adept at data collection and analysis Able to track employee infections Very knowledgeable about drugs for an Antibiotic Stewardship Program Participates in Quality Assurance and Process Improvement Good with time management Six Keys to an Effective Infection Preventionist, Amy Stewart RN, Long-Term Living Magazine, November 2, 2016.

Review the new Rules and Regulations for Infection Prevention in LTC Facility Assessment F Tag 490 483.95(e) A facility must include as part of its infection prevention and control program mandatory training that includes the written standards, policies, and procedures for the program Implement: November 28, 2019

Barriers to implementation Put in chat box “what are your barriers to IP implementation?” Kate will take from here

Potential Solutions Community Coalitions Hospital Engagement Antibiotic Stewardship is a community issue – can’t be solved by one setting or organization Learn from others about best practices, sharing education materials Hospital Engagement Hospital IPs can support their area nursing homes for education, immunizations Communication at hand-off for already present infections Prescriber engagement

Best Practice Marshall County IP Care Coalition Focus of the group Central Iowa Health System Marshalltown area nursing homes New to the group: home health Focus of the group NHSN and C-diff reporting Infection prevention Immunizations UTI Antibiotic stewardship Improved communication

A State-wide training program designed for Long Term Care!! Potential Solutions Use already existing programs and materials CDC.gov IRIS NHSN Iowa APIC groups (Eastern Iowa, Central Iowa, Western Iowa, and Greater Omaha) And…coming soon…. A State-wide training program designed for Long Term Care!! Future Education: March 28 – 29, 2017 IHCA Spring Quarterly Education Conference Prairie Meadows Conference Center, Altoona, IA 6 different breakout education sessions!!! May 2 – 3, 2017 Iowa Infection Prevention and Control Conference Marriott Hotel and Convention Center Cedar Rapids, IA Sponsored by Iowa Department of Public Health and University of Iowa Healthcare Program and Hospital Epidemiology Details to come… APIC Long-term Care Certificate Program: LTC EPI 101 and LTC EPI 102 Both are 2 day events, and includes an on-line course Must pass a final test with 75% or greater This will meet your CMS education requirement Trying to get 2 locations in Iowa Possibly towards the end of summer, beginning of fall

How to include residents and families Share information with them Signage in room Care conferences Bulletin board Include them in care Hand washing Educate staff Share data Include front line staff on PIP teams Consistent messaging

Questions Drop off survey Q & A There is a survey after you click out. It asks questions about your IP plan and what you need going forward.

Thank you! Chris Barten Kate LaFollette Iowa Veterans Home 641-753-4533 chris.barten@ivh.state.ia.us Kate LaFollette Telligen 515-440-8210 kate.lafollette@area-d.hcqis.org This material was prepared by Telligen, the Medicare Quality Innovation Network Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. (11SOW-IA-C2-02/08/17-2016)