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

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

3. 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?

4. 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.

5. 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.

6. 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.

7. 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
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

8. 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.

9. 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.

10. Review the new Rules and Regulations for Infection Prevention in LTC
Facility Assessment
F Tag (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

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

12. 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

13. 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

14. 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

15. 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

16. 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.

17. Thank you! Chris Barten Kate LaFollette Iowa Veterans Home
Kate LaFollette
Telligen
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/ )