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

2. 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

3. 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

4. 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

5. 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

6. 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……

7. Sepsis Identification

8. 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
**Please note the NHSN site is down for maintenance until 3/30/2018 **

9. CORE Interventions

10. 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.

11. Catheter Reduction

12. 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.

13. Managing Patients with LTC Algorithm

14. Resources
Maintaining an Access
Access Placement

15. 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

16. Chlorohexidine Skin Prep

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

18. Antimicrobial Ointment

19. Antimicrobial Ointment
Catheter Compatibility Chart

20. Staff Education and Competencies

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

22. Resources
Infections in an outpatient Dialysis Settings

23. 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

24. Days Since Last Infection Poster

25. 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

26. Project Obligation

27. Project Obligation -What do you need to do
Monthly - Complete the survey and return it to the Network, including barriers and best practices
One time - Every all facilities must complete the 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…

28. Patient Ambassadors

29. 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.

30. 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

31. Any Questions ?

32. IPRO ESRD Network of the Ohio River Valley Contact Information
Department
Name / Title
Direct Line
Administrative
Victoria Cash, Executive Director
Brittany Battle, Project Support Coordinator
Quality Improvement
Deborah DeWalt, Quality Improvement Director
Susan Swan-Blohm, Quality Improvement Coordinator
Amar Patole, Quality Improvement Data Specialist
Patient Services
Andrea Bates, Patient Services Director
Kenny Kinder, Patient Services Coordinator
Information Management
Jaya Bhargava, Operations Director
Jerome Jemison, Data Coordinator II
Patient toll-free line: (844)
General
Web: network9.esrd.ipro.org
Network help desk:

33. Thank You for attending today’s presentation
Deb DeWalt, MSN, RN Sue Swan-Blohm, BS, OCDT
Quality Improvement Director Quality Improvement Coordinator