1. HAI DE QIA a.k.a. “InfectionWatch 2014”
April 3rd & 4th, 2014

2. *Please utilize the chat function for questions*
Objectives
Introduce focus facilities to Network 14 HAI team
What is the goal of InfectionWatch 2014?
Discuss how focus facilities were selected
Educate focus facilities to the project
Augment NHSN reporting rights
Review observation tools:
Hand Hygiene
Catheter Connection & Disconnection
AVF/G Cannulation
Best practices for reporting
Utilization of new technology
*Please utilize the chat function for questions* 2

3. Network 14 team Dana Sissung, RN, MSN Kelly Shipley, BS, RHIA
Kelly Shipley, BS, RHIA
Nathan Muzos, BS, MCSE, MCSD, MCDBA
Aparna Biradar, BDS, MPH
Jason Simmington, BS, MHS 3

4. Goals of this project
Reduce blood stream infections (BSI) in dialysis facilities by correctly implementing/performing infection control. Network 14 will do this by:
Encouraging/promoting CDC established BSI prevention practices and resources
Identify areas for improvements
Engage staff with regular feedback
Increase familiarity with CDC-recommended practices
Encourage habitual attention to and assessment of practices
Identify and address barriers to recommended practices 4

5. Strategy to bring national emphasis
This project is important because it is part of a strategy to bring national emphasis to several measures. These are the 5 year national metric and evaluation targets set forth by Dept of Health and Human Services, Assistant Secretary for Health, and the Office of Healthcare Quality. 5

6. Bloodstream infections and the QIP
BSIs are also part of your QIP. As you can see here, they are 1 of the 8 clinical measures that will make up 75% of your total performance score. Poor performance in this area could affect payment reimbursement in 2016 by up to 2%. 6

7. How facilities are selected
The selection of your facility into this project means your facility fell into one of these 3 groups.
You may have wondered how you could be so lucky to be selected for this project. Well, I’m going to turn the explanation over to Aparna, our Quality Improvement Analyst, to fill you in on how we selected our focus facilities. 7

8. Monthly facility actions
≥ 30 hand hygiene observations
Collect data using CDC audit tool or the iScrub app
Report data to Network via using Table 1 or via NHSN
≥ 10 catheter connection/disconnection observations
Collect data using CDC audit tool
Report data to Network via using Table 1
≥ 10 fistula/graft cannulation observations 8

9. Using nhsn for HH surveillance
All focus facilities must confer rights in NHSN
Users with administrator rights see new data sharing request upon login to NHSN
Must accept new “Confer Rights” to share these data
Facilities will report HH data in NHSN
May need to modify existing Reporting Plans to include “HH”
Report HH under “Summary Data” 9

10. Accept new Confer Rights in NHSN
Users with administrator rights will see the new data sharing request when they log in to NHSN. 10

11. Accept new confer rights to share hh data11

12. Accept new confer rights to share hh data

13. Add “HH” to monthly reporting plans
“HH” needs to be checked manually.
When the dialysis location is selected, “DE” is checked automatically.
*If a Plan has already been saved, it can be edited to include “HH.” 13

14. Report Hand hygiene data14

15. Report hand hygiene data

16. Benefits of NHSN for Hand Hygiene Surveillance
Single location for data
Allows for tracking of hand hygiene adherence over time
With Dialysis Event rate data
Networks have easier access to the data
Analysis options will be available in August 2014 16

17. Resources for NHSN Prevention process measures (PPM) 17

18. NHsn additional PPM
Collection of additional prevention process measure summary data (i.e., numerator/denominator) in NHSN are tentatively planned for January 2015
Hemodialysis catheter connection/disconnection
Hemodialysis catheter exit site care
Fistula and graft cannulation/decannulation
Environmental surface disinfection 18

19. Hand Hygiene observations
Hand hygiene audit tool can be printed from:
Data collection option: iScrub app for (iPhone & iPod Touch)
≥ 30 observations are required/facility/month
The audit tool has two pages:
Page 1: Facility auditor collects and tallies observations
3 copies to collect 30 observations
Page 2: Guide to hand hygiene opportunities in dialysis
Note: unit of observation is a hand hygiene opportunity 19

20. Hh: what facilities submit to the network
Facility monthly process:
Facility uses the hand hygiene audit tool to collect a minimum of 30 observations
Tallies numerator/denominator and either:
Submits this information to the Network via OR
Uses NHSN to report hand hygiene audit results (encouraged)
Number of successful hand hygiene opportunities observed
Total number of hand hygiene opportunities observed during audits
Numerator =
Denominator = 20

21. Hh audit tool: page 1
Numerator
Denominator

22. Hh audit tool: page 2
The tools was developed by the CDC and uses the HH procedures promoted by the WHO

23. Catheter Connection/Disconnection Observations
Catheter connection/disconnection audit tool can be printed from:
≥ 10 observations required/facility/month
The audit tool has one page:
Facility auditor collects and tallies observations
2 copies necessary to collect 10 observations 23

24. Cath Connect/Disconnect: What Facilities Submit to the Network
Facility monthly process:
Facility uses the catheter connection/disconnection audit tool to collect a minimum of 10 observations
Tallies numerator/denominator
Submits this information to the Network via
Number of procedures performed correctly
Total number of procedures observed during audits
Numerator =
Denominator = 24

25. Audit tool corresponds to CDC checklist

26. Cath connect/disconnect audit tool
C N P P P P P P P = P
Numerator
Denominator

27. Fistula/Graft Cannulation Observations
Fistula/ graft cannulation audit tool can be printed from:
≥ 10 observations required/facility/month
The audit tool has two pages:
Page 1: Cannulation observations
2 copies necessary to collect the minimum 10 observations
Facility auditor collects and tallies observations
Page 2: Decannulation observations
Decannulation auditing is NOT part of the QIA 27

28. Fistula/Graft Cannulation: What Facilities Submit to the Network
Facility monthly process:
Facility uses the fistula/graft cannulation audit tool to collect a minimum of 10 observations
Tallies numerator/denominator
Submits this information to the Network via
Number of procedures performed correctly
Total number of procedures observed during audits
Numerator =
Denominator = 28

29. Audit Tool Corresponds to the cdc AVF/G Cannulation Checklist

30. AVF/G cannulation audit tool
T P P P P P P P P P P = P
Numerator
Denominator

31. How will you submit to the Network?
Hand Hygiene
Catheter Connection/ Disconnection
Fistula/ Graft Cannulation
Numerator
# of Successful Hand Hygiene Opportunities Observed
# of Procedures Performed Correctly
Denominator   
Total # of Hand Hygiene Opportunities Observed During Audit
Total # of Procedures Observed During Audit OR
 NHSN Used
Comments (common breaches identified; challenges in implementing the audits): 31

32. 32

33. Suggestions for Facility Auditors
First, understand the recommended steps and then practice using the tools
Auditors should try to ensure that observations are as representative as possible of normal practice at the facility
E.g., observe different staff members on different days and shifts
For hand hygiene
Consider observing during busy times, such as during shift change
Try to select an area of the unit where staff interactions with patients are clearly visible 33

34. Implementation Guidance
There are multiple methods of auditing practices
E.g., for hand hygiene, focusing closely on patient stations at a time vs. broadly monitoring many stations at once
Covert monitoring may provide more realistic assessment of practices (for hand hygiene, e.g.)
But may be difficult or impossible to do for vascular access care audits
Auditors may have to experiment to find the observation methods that work best for them 34

35. Timeline for submissions
HAI DE QIA FOCUS FACILITY (FF) TIMELINE
PHASE DESCRIPTION
FF STAFF RESPONSIBLE
APR DUE
MAY DUE
JUNE DUE
JULY DUE
AUG DUE
SEPT DUE
OCT DUE
NOV DUE
DEC DUE
HAI DE QIA Roll-Out Webinar
NW 14 & FF
4/3 & 4/4
FF deadline to accept Network 14 NHSN confer rights template
4/7
FF Designate Auditors
FF Auditors Review CDC audit protocols/guidelines
Focus Facility HAI QIA audits begin
Hand Hygiene audit tallies due to NW
5/1
6/1
7/1
8/1
9/1
10/1
11/1
12/1
CVC audit tallies due to NW
AVF/G audit tallies due to NW
HAI QIA Project Wrap Up (Webinar)
12/18 35

36. Most important
Facilities must submit the required data on or before the stated deadline. Failure to do so can result in a facility being reported to CMS for failure to support Network Goals. 36

37. Ongoing communication
Network 14 will be setting up a communication process such as “lunch & learn” conferences where facilities can learn from one another
Share any suggestions with us regarding best practices or even failures. We can all learn from each other. 37

38. New Technology: iScrub Lite 1.5.1
A free hand hygiene application for the Apple iPhone/iPod Touch. You many download the app directly from the iTunes app store via your device or download via iTunes.
Gives you the ability to both record observations and them to a centralized account. (Not the Network) 38

39. Customizing the app 39

40. Recording observations40

41. Notes can be added 41

42. Email observations to yourself or to a central account42

43. Additional Resources for Facilities
Best Practices Video
Covers hand hygiene, catheter connection/disconnection, and fistula/graft cannulation
Procedure steps mirror the checklists
Catheter Scrub-the-hub Protocol
Key step in catheter connection/disconnection
Checklist tools
Hand Hygiene Observation Protocol 43

44. Thank you for participating
The webinar and audit tools will be on the Network 14 website, on the NHSN page that can be found under the “Professionals” tab. Or you can use the following web address: 44