1. Agenda Time Agenda Item Leader 9:00-9:30
Reflection/Icebreaker/ Introductions
9:30 – 9:50
Background
HAI data/ cost
Region composition
IP staffing industry standards
9:50 – 12:00
Needs assessments
Hospital
Home Health/ Hospice
Ambulatory
Other
12:00 – 12:45
Lunch and math
12:45 – 2:00
Staffing model development
2:00 – 2:30
Creation of ideal and basic program options
2:30- 3:30
Report out
9/17/2018

2. Know me, care for me, ease my way… …keep me safe
Healthcare-acquired infections (HAI) are harming patients in our care every day
Tools to Prevent HAIs
Commitment to zero preventable harm
Leadership alignment, involvement, and accountability
Accurate, transparent, actionable data
Improvement capability and capacity
Competent, skilled and equipped workforce
A collaborative learning organization
More than 2,000 patients harmed each year
$30M in annual costs estimated and $5M in payment penalties
Loss of trust and harm to reputation

3. Cost of Infections Infection Type Number Cost per Infection
2015 Attributable Cost
C. Diff
$11,285
MRSA BSI
$14,655
CLABSI
$45,814
CAUTI
$896
SSI (NHSN reported procedures only)
$20,785
Total
9/17/2018

4. X Region – In scope/Out of scope
Acute care
# of tertiary care
# of community hospitals
# of CAHs
Ambulatory Clinics
# on TJC footprint
# not on footprint
Ambulatory Surgery Centers
Long term care facilities
Shared services /new locations?

5. IP Staffing Standards Current State: 2.8 FTE Guiding principles
Industry standards
Action OI (most recent, contains data from 119 facilities):
Average IP’s per 100 beds =
Delphi Study, 2002 – 1.0 FTE per 100 beds
NNIS Study, 2001 – 1.0 FTE per 115 beds
PNICE survey, 2011 – 1.2 FTE per 100 beds
Krein, et al, FTE per 100 beds
Compare Group
Percentile - 25th
Percentile - 50th
Percentile - 75th
Tot Op Beds 0-50
0.44
0.64
0.69
Tot Op Beds
0.68
0.92
1.01
Tot Op Beds 1
1.02
1.08
Tot Op Beds
1.26
1.48
Tot Op Beds
1.3
1.91
2.51
Tot Op Beds
2.52
2.7
3.15
Tot Op Beds
1.34
1.95
Tot Op Beds
2.22
2.59
2.98
Tot Op Beds
3.36
3.96
5.98
Tot Op Beds
5.04
5.58
6.6
Tot Op Beds
3.42
6.06
6.85
Guiding principles
Centralized, regional IP program
Regional leader/ cat herder
Communication/collaboration amongst all participants and care settings

6. IP Staffing Standards – Ideal Work Mix
 Activity IP
Working Manager
Regional Manager/ Director
Analyst
Prevention and Control of Infections
40%
30%
25% 0 
Leadership
10%
35-40%
Education and training of staff and patients 5%
Technical
15%
80%
Other ( )
20-25%
9/17/2018

7. Hospitals – SURVEYS AND ROUNDS
9/17/2018

8. Hospital Breakdown - # of units
Wards and Stepdown
ICUs
Inpatient Dialysis ED
Hospital #1
Hospital #2
Hospital #3
Total
9/17/2018

9. Needs by Care Setting – Hospital Inpatient Rounding and Surveys
Activity
Frequency
Estimated hours per each
# of units
Hours per week
Inpatient Units and stepdowns
Isolation/ Rounding to Influence
ICUs ED
Inpatient Dialysis
Environment of Care (EOC)
EOC

10. Needs by Care Setting – Hospital Ancillary Surveys
Larger Diagnostic Imaging
Smaller Diagnostic Imaging
Endoscopy
Interventional Radiology
Oncology
Pharmacy
Radiation Oncology
Sleep Medicine
Wound Care
Small lab
Comprehensive lab
Sports Medicine
PT/OT/Speech
Etc…

11. Needs by Care Setting – Hospital Ancillary Surveys
Activity
# of units
Frequency
Estimated hours per each
Hours per week
Larger DI
EOC survey
Smaller DI
Endoscopy
Interventional Radiology
Oncology
Pharmacy
Radiation Oncology
Sleep Medicine
Wound Care
Small lab
Comprehensive lab
Sports Medicine
PT/OT/Speech

12. Needs by Care Setting – Hospital OR/Other
Cardiac OR
C-section OR
Main OR
SDS
Ped OR
Outpatient Eye Surgery
Cath Lab
Interventional OR –aortic repair with fluoro
HLD locations
Sterilization locations
Kitchens
TeleHealth

13. Needs by Care Setting – Hospital OR /Other Surveys
Activity
# of settings
Frequency
Estimated hours per each
Hours per week
Cardiac OR
EOC survey
C-section OR
Main OR
SDS
Ped OR
Outpatient Eye Surgery
Cath Lab
EP lab
HLD locations
Sterilization locations
Kitchens
Interventional OR –aortic repair with fluoro
Telehealth

14. Ambulatory – SURVEYS AND ROUNDS
9/17/2018

15. Needs by Care Setting – Ambulatory Clinic Surveys
Clinic Name
Clinic Address
Distance from nearest PH&S hospital (miles)
Does the site conduct high level disinfection? (ex: Cidex OPA)
Does the site conduct sterilization?
Does the site use any type of endoscope?
Does the site perform surgical procedures (even minor ones, like biopsies)?
Travel
Frequency
Hours per visit
Time calculation (hours per week)
Clinic #1
On the foot print of the hospital campus y N 4
0.31
Clinic #2
Clinic #3
15 miles

16. HH/Hospice – SURVEYS AND ROUNDS
9/17/2018

17. Needs by Care Setting –Surveys and Rounds
Activity
Times per year
Hours per each
Hours per week
Home Health
Home visits with caregivers
Hospice

18. Long term Care Sites– SURVEYS AND ROUNDS
9/17/2018

19. Needs by Care Setting – Benedictine Survey and Rounds
Activity
Times per year
Estimated hours per each
# of units
Hours per week
SNF unit
Isolation/ Rounding to Influence
TCU unit
Environment of Care (EOC)
EOC
9/17/2018

20. SURVEILLANCE
9/17/2018

21. Needs by Care Setting –Hospital Surveillance and Reporting
Activity
Frequency
Estimated Time range per week
Hrs per week
Lab review without data mining – initial sort
Week days
Enter into local database
Deep dive HAI review
NHSN numerator
NHSN denominator
Monthly
Reportable diseases
Local reports and questions
Isolation verification and documenting
RCA

22. Needs by Care Setting – PSCS and Ambulatory Surveillance
Activity
Times per year
Hours per each
Hours per week
Home Health
Hospice
LTC
Ambulatory

23. Policies and Procedures
9/17/2018

24. Needs by Care Setting –Policy and Procedures
Activity
Times per year
Hours per year
Hours per week
IP policy upkeep –hospital
IP policy upkeep – ambulatory
IP policy upkeep – home health/hospice
IP policy upkeep – LTC

25. EDUCATION
9/17/2018

26. Needs by Care Setting –Education
Activity
Times per year
Hours per each
Hours per week

27. CONSULTATION
9/17/2018

28. Needs by Care Setting – Hospital Consultation
Activity
Times per year
Hours per each
Hours per week
Infectious disease exposure response and employee health support
Ebola assessment center upkeep
24/7 call (currently unpaid)
Construction
System work
Immediate response/ Special Pathogens – MERS, Ebola, Zika, leaks, disasters

29. Needs by Care Setting – Ambulatory Consultation
Activity
Times per year
Hours per each
Hours per week
Infectious disease exposure response
General Consultation

30. Needs by Care Setting – Home Health / Hospice
Activity
Times per year
Hours per each
Hours per week
Infectious disease exposure response
General Consultation
Transitions of Care

31. Needs by Care Setting – LTC
Activity
Times per year
Hours per each
Hours per week
Infectious disease exposure response
General Consultation
Transitions of Care

32. MEETINGS
9/17/2018

33. Needs by Care Setting – Hospital Meetings
Activity
Times per month
Hours per each
Hours per week

34. Needs by Care Setting – Ambulatory Meetings
Activity
Times per year
Hours per each
Hours per week

35. Needs by Care Setting – HH Meetings
Activity
Times per year
Hours per each
Hours per week

36. Needs by Care Setting – LTC
Activity
Times per year
Hours per each
Hours per week

37. MATH
9/17/2018

38. Staffing Model Regional Director Executive, ORQMMSS
Regional Medical Directors
Regional Director
System IP Director
Infection Prevention program manager
Infection Prevention project manager
Infection Preventionists
Surveillance IPs
Data Analysts
Ambulatory IPs
PSCS IPs
Sterile processing/HLD IPs
Admin support
Continuing education; development; paying for certification and training, APIC dues
On call
Surveillance Software
Existing IP
Existing IP
Existing IP
Existing IP .6
Existing IP
Existing IP
Existing IP
Existing IP
Existing IP
Manager
Acute IP (WF/ Milk)
Sterile Processing/ HLD
Admin Support
Existing IP
16.76 FTE per Action OI 50th Percentile
16 FTE per needs assessment
10.6 FTE current state
Long-term/ Sub acute
Ambulatory
9/17/2018

39. Prioritization with less resources
Outpatient surveys significantly reduced
SNF surveys replaced significantly reduced
Inpatient rounding reduced
Reduced education
9/17/2018