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

2. 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

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

4. 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

5. 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

6. 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

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

8. 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

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

10. 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

11. 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

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

13. 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

14. The Environment

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

16. 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

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

18. 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

19. 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

20. 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

21. 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

22. 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

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

24. 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

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

26. 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.

27. 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

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

29. 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

30. 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

31. 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

32. 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

33. Recent Developments