1. Infection Prevention and Control IPCNS Update for Long Term Care Patsy Rawding RN BScN CIC Provincial Infection Control Consultant IPCNS

2. Infection Prevention and Control Agenda Update Waste management MRSA C-Diff Upcoming projects Guidelines in the development/draft Feedback

3. Infection Prevention and Control Update We now live in Healthcare Quality, Safety & Wait Times Improvement New department that reports to Chief of Program Standards & Quality Director of IPCNS renamed to Director of Quality & Patient Safety (IC is captured in safety) Has slowed work a bit however better realigned

4. Infection Prevention and Control Recommendations Remove spray wands for hoppers & do not have staff pre-rinsing sheets Bedpans and urinals should be cleaned and air-dried after use & should not occur in the resident’s bathroom or room. Soiled utility rooms should contain a clinical sink (hopper) or other equivalent flushing rim fixture ( AIA, 2007 ). Bedpan sanitizers will ensure bedpans are safe to handle by staff after resident use & will limit the amount of exposure to body fluids of the health care worker. Clean bedpans will diminish the opportunity for bacterial growth. Appropriate personal protective equipment should be available and worn whenever staff are dealing with potential exposure to body fluids.

5. Infection Prevention and Control Waste Management IPCNS can only make recommendations…based on evidence Other departments (Continuing Care, Agriculture) may make this a requirement/legislate it. There are challenges with this recommendation however there are success stories. Get your staff involved this is to protect them!

6. Infection Prevention and Control AROs MRSA, VRE, E SBL Draft guidelines – Includes all care settings Screening- No Resident placement – Non ARO roommates ok

7. Infection Prevention and Control Resident Placement A single room, sharing a multi-bed room with other patients or residents also with the same or other AROs (cohorting), or sharing a multi-bed room with other persons not colonized. Regardless of room selection, adherence to routine practices is essential. Roommates and their families do not need to be advised of the status of the resident with an AR O - in fact this would constitute a breach of confidentiality The resident’s room door does not need to be closed-no activity restrictions

8. Infection Prevention and Control Resident Placement cont. Should not share a room: – Individuals who have open wounds, decubitus ulcers, or non- intact skin. – Individuals who have urinary catheters, feeding tubes, or other invasive devices. – If the client/resident has diarrhea, ostomy etc. they should be placed in a single room with a private bathroom. Clients/residents who are VRE colonized with good hygiene and have no diarrhea, no ostomy, etc, they may be cohorted with VRE- negative “low-risk” roommates. VRE positive clients/residents can share bathing facilities ensuring that there is the usual scrupulous disinfection after use.

9. Infection Prevention and Control AROs cont. How will you know you have a problem? What do you usually do? – ILI – Enteric – Monitor infections Skin Urinary Sputum

10. Infection Prevention and Control C-Diff Update Good reason to remove spray wands! Toxin positive Public Health will be making it notifiable. C-diff bacteria may remain in bowel forever – Only a problem when toxins are formed and symptoms Bristol stool chart Enteric Precautions…same as Norwalk

11. Infection Prevention and Control

12. Projects Risk Reduction in MRSA, VRE & ESBL Occupational Health LTC guidelines C-Diff

13. Infection Prevention and Control FLU Guide to Influenza Control For Long-Term Care Facilities and Adult Residential Centres with PHS: – Exclude HCW symptomatic/ infected with influenza from work: 1. until 7 days after onset of symptoms with the first day of symptoms being counted as day 1, OR – 2. they have been immunized at least two weeks previously and have started on antiviral therapy. – If the second criterion is met, a fitness-for-work assessment shall first be conducted through staff health. Fall Education sessions: Capital, DHA 1,2 & 3

14. Infection Prevention and Control Committees Working group Committee PHS, Agriculture, Continuing Care & Licensing – Clarify roles Infrastructure – Infection Control Infrastructure Standards Agriculture – SBAR spray wands & Tub testing

15. Infection Prevention and Control Committees Infectious Disease Expert Group Service provider Network – SPNs – IPCNS, Acute care ICP, LTC, EHS, PHS & MOH, Agriculture, Community Services (residential care & group homes), Home support – Former regions (pilot -1, 2 & 3 etc.) – Work on common issues, vet guidelines, escalate issues up to government, ensuring IPCNS is aligned with issues on the frontline.

16. Infection Prevention and Control Resources IPCNS – Website Resource staff – patsy.rawding@gov.ns.ca patsy.rawding@gov.ns.ca 430-2169 – suzanne.rhodenizer-rose@gov.ns.ca suzanne.rhodenizer-rose@gov.ns.ca 722-1244 – We do home visits!

17. Infection Prevention and Control Resources cont. Environmental cleaning toolkit: – http://ricn.on.ca/manualsandtoolkitsc3462.php http://ricn.on.ca/manualsandtoolkitsc3462.php Bristol Stool Chart – http://www.sthk.nhs.uk/library/documents/stoolchart.pdf http://www.sthk.nhs.uk/library/documents/stoolchart.pdf I P &C Best Practices for Long Term Care, Home and Community Care including Health Care Offices and Ambulatory Clinics: – http://www.phac-aspc.gc.ca/amr-ram/ipcbp-pepci/pdf/amr- ram-eng.pdf http://www.phac-aspc.gc.ca/amr-ram/ipcbp-pepci/pdf/amr- ram-eng.pdf CHICA Canada – www.chica.org www.chica.org

18. Infection Prevention and Control Audits CHICA Canada audits – Additional Precautions – Management of Cleaning and Disinfecting Products – Client/Patient/Resident Service Units – Housekeeping Supply Rooms – Linen and Laundry – Unit Kitchens – Cleaning Patient/Resident Bathing and Toileting Facilities – Routine Cleaning of Patient/Resident Rooms – Discharge Vacancy Room Cleaning – Contact Precautions – Routine and Discharge/Vacancy Room Cleaning