HAI’s, MRDO’s, Fungi, Mold, Pollution

InfectionControlandPreventioninLong-TermCareFacilitiesandHealthcareLaundryJohnScherberger,HealthcareLaundryAccreditationCouncil

AWebberTrainingTeleclass

HostedbyDr.LynneSehulsterwww.webbertraining.com

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InfectionControlandPreventioninLong-TermCareFacilitiesand

HealthcareLaundryHandling,Storing,andTransportingHealthcareTextiles

inLong-TermCareFacilities

JohnScherberger,FAHE,CMIP,T-CSCT,VPEIHealthcareRiskMitigation

Past-President,HLACSpartanburg,SC864-208-5750

"Whatisdoneisimportant, butmoreimportantishowitisdone.”- JohnScherberger

HostedbyDr.LynneSehulsterEnvironmentalInfectionPrevention,LLC

www.webbertraining.com October7,2021

HAI’s,MRDO’s,Fungi,Mold,Pollution

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Reducethe...

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ProperProcesses=ProperResults

InfectionPreventionandControl(IPC)–IPCisapracticalmultidiscipline,multimodal,evidenceandscience-basedapproachtomitigatingandremovingtheopportunitiesforpatientsandhealthworkerstobeharmedbyavoidableinfectiousmicrobialpathogens.Thegoalistheeliminationofopportunisticinfectionsthroughthevigilantapplicationofpersonalandenvironmentalinfectionpreventionpractices.

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LaundryManagement-Laundrymanagementisintendedtoensure:1. Asufficientparlevelofhygienichealthcaretextiles

(HCTs)ismaintainedthatwillmeettheneedsofresidents.

2. AllhygienicHCTsarehandledandmaintainedinwaystomaintainthehygienicstateandtominimizetheopportunitiescontaminationofcleanHCTs

3. SoiledHCTsarehandledinwaysthatminimizeharmtoresidentsandstaff

4. Ensurethatcross-contaminationofHCTsdoesnothappen.

– CDCGuidelinesforEnvironmentalInfectionControlinHealthcareFacilities2003

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Hygienicallycleanlaundrycarriesnegligiblerisktohealth-careworkersandresidents,providedthatthecleantextiles,fabric,andclothingarenotinadvertentlycontaminatedbeforeuse.

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InfectionsandMortalityInfectionsaccountforuptohalfofallnursinghomeresidenttransferstothehospitalandcostbetween$670millionto$2billiontotreateachyear.Whenaresidentishospitalizedwithaprimarydiagnosisofinfection,themortalityratecanreachashighas40percent.Thetopthreeinfectionstonursinghomeresidentsareurinarytract,respiratoryandskin/softtissue.

F441§485.65InfectionControl,CMSManualSystem,Publication100-07StateOperationsProviderCertification,DepartmentofHealth&HumanServices,CentersforMedicare&MedicaidServices,Transmittal55:December2,2009.

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InfectionsandMortality

• TheoverallinfectionrateinLTCFsforendemicinfectionsrangesfrom1.8to13.5infectionsper1000resident-caredays.*• Forepidemics,goodestimatesaredifficulttoascertain,buttheliteraturesuggeststhatseveralthousandoutbreaksmayoccurinUSLTCFseachyear.*• 33%ofoverallendemicinfectionsisthoughttobepreventablejustbymaintaining infection surveillance**• TheseratesnonotreflecttherealitiesoftheCOVID-19pandemic

*Strausbaugh LJ,JosephCL.Theburdenofinfectioninlong-termcare.InfectControlHospEpidemiol2000;21:674-9.**https://journals.lww.com/journaloftraumanursing/Citation/2020/07000/The_Need_for_Actions_to_Protect_Our_Geriatrics_and.2.aspx

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CMS StateOperationsManualAppendixPP- GuidancetoSurveyors

forLongTermCareFacilities

§483.65InfectionControl§483.65(a)InfectionControlProgram§483.65(b)PreventingSpreadofInfection§483.65(c)Linens

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TheChallenges

Long-TermCareFacilities(LTCFs)are:Low-technologysettingsLengthofstayismeasuredinmonthsandyearsratherthandaysLTCFaretypicallyviewedascommunities,notpatientroomsResidentsaremoremobilethanpatientsPaymentsystemsaresignificantlydifferent

(Seenextslide)

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InadequatePayment/Reimbursement

• Section4432(a)oftheBalancedBudgetAct(BBA)of1997modifiedhowpaymentismadeforMedicareskillednursingfacility(SNF)services.EffectivewithcostreportingperiodsbeginningonorafterJuly1,1998,SNFsarenolongerpaidonareasonablecostbasisorthroughlowvolumeprospectivelydeterminedrates,butratheronthebasisofaprospectivepaymentsystem(PPS).ThePPSpaymentratesareadjustedforcasemixandgeographicvariationinwagesandcoverallcostsoffurnishingcoveredSNFservices(routine,ancillary,andcapital-relatedcosts).

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TheChallenges

•Staffing– cannotbeaccomplishedbytakingEVSstafffrompatientareastooperate• ”RobbingPetertopayPaul”isaPonzischeme

•Facilityspaceisinadequate•Machines- wrongtype,age,maintenance•Education– Operatinganon-premiseslaundryrequireseffort,time,investment• Training

• Insufficientinterestonthepartofowners

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Challenges

• F441• §483.65InfectionControl• Thefacilitymustestablishandmaintainaninfectioncontrolprogramdesignedtoprovideasafe,sanitary,andcomfortableenvironmentandtohelppreventthedevelopmentandtransmissionofdiseaseandinfection.

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§ 483.65(a)InfectionControlProgram• Thefacilitymustestablishandmaintainaninfectionpreventionandcontrolprogramdesignedtoprovideasafe,sanitary,andcomfortableenvironmentandtohelppreventthedevelopmentandtransmissionofcommunicablediseaseandinfection.• §483.65(a)InfectionControlProgram• Thefacilitymustestablishaninfectioncontrolprogramunderwhichit–• (1)Investigates,controls,andpreventsinfectionsinthefacility;• (2)Decideswhatprocedures,suchasisolationshouldbeappliedtoanindividualresident;and• (3)Maintainsarecordofincidentsandcorrectiveactionsrelatedtoinfections.

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§ 483.65(b)PreventingSpreadofInfection

• F442• (1)Whentheinfectioncontrolprogramdeterminesthataresidentneedsisolationtopreventthespreadofinfection,thefacilitymustisolatetheresident.

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§ 483.65(b)(2)PreventingSpreadofInfection

• F443• §483.65(b)(2)Thefacilitymustprohibitemployeeswithacommunicablediseaseorinfectedskinlesionsfromdirectcontactwithresidentsortheirfood,ifdirectcontactwilltransmitthedisease.

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§ 483.65(b)(3)PreventingSpreadofInfection

• F444• §483.65(b)(3)Thefacilitymustrequirestafftowashtheirhandsaftereachdirectresidentcontactforwhichhandwashingisindicatedbyacceptedprofessionalpractice.

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§ 483.65(b)Infectioncontrol

• (b) Infectionpreventionist. Thefacilitymustdesignateoneormoreindividual(s)astheinfectionpreventionist(s)(IPs)whoareresponsibleforthefacility'sIPCP.TheIPmust:• (1) Haveprimaryprofessionaltraininginnursing,medicaltechnology,microbiology,epidemiology,orotherrelatedfield;• (2) Bequalifiedbyeducation,training,experienceorcertification;• (3)Workatleastpart-timeatthefacility;and• (4) Havecompletedspecializedtrainingininfectionpreventionandcontrol.

• (c) IPparticipationonqualityassessmentandassurancecommittee. TheindividualdesignatedastheIP,oratleastoneoftheindividualsifthereismorethanoneIP,mustbeamemberofthefacility'squalityassessmentandassurancecommitteeandreporttothecommitteeontheIPCPonaregularbasis.•

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§483.65(c)Linens• F445• §483.65(c)Linens• Personnelmusthandle,store,process,andtransportlinenssoastopreventthespreadofinfection• Intent:§483.65(c)• Theintentofthisregulationistopreventthespreadofinfectionthroughlinens.• InterpretiveGuidelines:§483.65(c)• Soiledlinensshouldbehandledtocontainandtominimizeaerosolizationandexposuretoanywasteproducts.Soiledlinenstorageareasshouldbewellventilatedandmaintainedunderarelativenegativeairpressure.Thelaundryshouldbedesignedtoeliminatecrossingofsoiledandcleanlinen.

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TheChallenges

•Mostlong-termcarelaundryfacilitiesarenotaccreditedorcertifiedforadheringtoestablished,CMSFTag,CDCGuideline,OSHARegulations,HLACStandards,ofTRSAHygienicallyCleanCertification•CMSFTag,CDCGuideline,OSHAaremandatory,HLACandTRSAarevoluntary

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InfectionControlTodayMarch8,2011

“Ofallthesurfacesinahospital,apatientwillhavethegreatestdegreeofcontactwithhis

gownandthebedlinens.”LynneM.Sehulster,PhD,M(ASCP)(retired)

PreventionandResponseBranchDivisionofHealthcareQualityPromotionCentersforDiseaseControlandPrevention

Atlanta,GA 30329-4027

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InterpretiveGuidelines:§483.65(c)

•ThereareclearStandardsandguidelinesforhandlingcontaminatedHCTs,butnothingregardingthehandling,storage,anddistributionofhygienicallycleanHCTs.•Howdofacilitiescarryoutthosedirectiveswithoutstandardizedandacceptedprocesses?• Lefttotheirowndevices,facilitieswillinstituteappropriateprocesses,over-zealousprocesses,impotentprocesses,ornoprocessesatallleavingresidents,patientsandstaffexposed.

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MultimodalandMultidisciplinaryIntegrationofInfectionPrevention

Processes,IncludingTextiles•What’sMissing:•Communication,Cooperation,Collaboration

•Between:•Owners•Administration•Nursingleadership• InfectionPreventionist– ifthereisone•RiskManagement•QualityManagement•Front-LineStaff

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HealthcareTextiles(HCTs)Handling

CMS483.65(c)states:“Personnelmusthandle,store,processandtransportlinensoastopreventthespreadofinfection.”Applicabletocontaminatedand hygienicallycleanHCTs.Unfortunately,toomanyfacilitiesinterpretthisrequirementasapplicabletocontaminatedHCTsonly,nothygienicallycleanHCTs.

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MicroorganismSurvivalonClothingandUniforms

•NeelyandMaley:JClin Microbiol 2000;38:724-726•NeelyandOrloff:JClin Microbiol 2001;39:3360-3361•PerryC,etal.JHosp Infect2001;48:238-241•TakashimaM,etal.AmJInfectControl2004;32:27-30•Wiener-WellY,etal.AmJInfectControl2011;39:555-9

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SourcesofInfectiousMicrobes

• Patients• Staff• HandsandEnvironmentalsurfacesarethemaintransmittersofhealthcare-associatedinfections.• Followedbyworkclothingandotherinanimateobjects.

Bacteria,fungiandviruses,whichonlytransientlycolonizeontheskin,areeasilytakenupandpassedon,eitherthroughdirectcontact– fromtheskintotheskin– orthroughindirectcontact– fromsurfaces,objects,equipmentandsharedmedicaldevices.

F441§485.65InfectionControl,CMSManualSystem,Publication100-07StateOperationsProviderCertification,DepartmentofHealth&HumanServices,CentersforMedicare&MedicaidServices,Transmittal55:December2,2009.

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Trust,butVerify

• ENVIRONMENTALSERVICES• LAUNDRYMANAGEMENT• INFECTIONPREVENTION• RISKMANAGEMENT• QUALITYMANAGEMENT

• Eachhasaresponsibilitytovisitthehealthcarelaundryfacility,whethercontractedorin-house,toreviewprocessesandcleanliness.

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MECHANICALACTION

PRODUCTCONCENTRATION

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IndustryObservation

“Washing of the linen is only one part of theprocess of providing clean linens for storage.Each stage in the linen flow cycle from wash,finishing, transport, storage and point of useinvolves various opportunities for contaminationof linen if proper training, cleaning and processesare not enforced.”

• CarrieArmstrong,Ecolab,Eagan,MN

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BestPractice

Everysurfacethattouchesthehealthcaretextilemustbeashygienicallycleanasthetextileitself.

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HLACStandards• IncorporatesregulationsfromOSHA,FDA,andEPA• Evidence-based,peer-reviewedbestpracticesandrecommendationsforinfectionpreventionandlaundryproceduresfromfederalagenciessuchastheCDCandprofessionalentitiessuchas:• AssociationfortheAdvancementofMedical

Instrumentation(AAMI),• AssociationofperiOperativeRegisteredNurses

(AORN),• AssociationforProfessionalsinInfectionControland

Epidemiology(APIC),• FacilitiesGuidelinesInstitute(FGI)

• FreeStandardsDownload:HLACnet.org

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Bytheway...

•HCTsincludeEnvironmentalServicesinfectionpreventiontextilescommonlyreferredtoasrags,mops,anddusters.•TheseessentialinfectionpreventiontextilesareoftenprocessedinfacilitiesorinwaysthatdonotproducehygienicallycleanHCTs.•ThepotentialexistsforintroductionofnewpathogensintoapatientcareenvironmentandorexposuretotheEnvironmentalServicesstafftocontaminatedinfectionpreventiontextiles.

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Transportation,Distribution,andStorageofHCTs

•FacilitiestoinstitutePolicy&Procedurestoproperlyaddressthetransportation,distribution,andstorageofhygienicallycleanHCTs.•Facilitiestotrainstaffintheproperprocessestobefollowedinthetransportation,distribution,andstorageofhygienicallycleanHCTs.

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ProcessesforHandlingHygienicallyCleanHCTs

•AllcontactwithcleanHCTsandtheisolationgownneedstobeabovewaistlevel*•Thereisthepossibilityofcontactwithcontaminatedsurfacesandthegarmentinthethighandhipareas.

*NOTE:Forthestaffpersonmakingthebedinanoccupiedroom

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•Duetotheproliferationofpathogensonuniforms,staffshouldneverhugHCTstotheiruniform.• Unloadingfromlaundrybins/trucksontoracksinacleanlinenstoragearea;•MovingHCTsfromstorageareatocarts;• Removingfromlinencartstoapatientroom;•WhenHCTsarebeingusedtomakethepatientbed.

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•AllcleanHCTstorageracksorcartsmustbecoveredwithcommerciallyavailablecoverstopreventthecontaminationofhygienicallycleantextilesfromairbornedust,dirt,andpathogens.•StorageofcleanHCTcartsmustalwaysbesecuredinclosetsorroomstopreventpatients,familymembersandallotherpersonnelfromhandlingthetextileswithouttakingpropercontactprecautions.

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ProcessesforHandlingHygienicallyClean

• IfHCTsmustbeleftunattendedeitherincartsinthecorridorsoratachartingworkstation,thecartandworkstationshouldbecleaned,disinfectedandcapableofbeinglockedsoastoensurethehygienicintegrityoftheHCTs.

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ProcessesforHandlingHygienicallyClean

•HCTsshouldnotbestoredinpatientroomstominimizeexcesslaunderingexpenses.•AllHCTsplacedinthepatient'sroomshallbeconsideredreservedforuseforthatpatientandshallnotbetransferredtoanotherpatient'sroomwithoutlaunderingpriortouse).

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Considerations

• DoaValueCostAnalysisofhavingacommercialhealthcarelaundrylaunderallHCT’s– notresidentpersonalclothing• EnsuringallEnvironmentalServices(EVS)/HousekeepingstafftrainedbyanoutsideorganizationtolearnBestPracticesandIndustryStandards• DoawaywithragsandcottonstringmopsinEVSanduseHealthcareGradeUltra-Microfiber(HGUM)wipers,mops,andhigh-dusterssuppliedbyarentalcompanythatlaunderstheaccordingtoCDCLaundryGuidelines• IncorporatetheAssociationfortheHealthcareEnvironmenttrainingcertificationclassesforEVS• IfthefacilitycontinuestolaunderHCTsonsite,downloadtheHLACStandardsforFREEatHLACnet.org andincorporateasmanyoftheStandardsaspossible

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TheArtofProperLinenManagement

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ManagingLinensandLaundry

•UseStandardPrecautions.•Observehandhygienepractices.•Foldorrollheavilysoiledlaundry.•Avoidairborneparticulates– donotshake.•Holdsoiledlinenawayfromyourclothes.•Removelargeamountsofsolidwastefirst.•Placesoiledlaundryintobaginpatientroom.

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CleanLinen

•Cleanlinenshallbestoredinenclosedclosetorcoveredcarts.•Cleanlinenshallbecoveredwhilebeingtransportedindedicatedcarts.•Cleanlinensuppliesshallbespatiallyseparatedfromsoiledlinen.• Linenplacedinapatientroomistobeusedtomeetanimmediateneed.Itisnottobestockedintheroom.•Upondischarge,thelinenisconsideredcontaminatedandmustbehandledassuch.

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MobileCleanLinenCarts

• Smallmobilelinencartsmaybefilledandusedduringaworkshift.• Linencartsaretobecoveredatalltimes.• Linencartsaretocontainonlycleanlinen.• Noitemsaretobestoredontopofacart.• Alllinenstoragecartsmusthaveacartcoverandasolidbottom.

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• Soiledlinenshallbekeptinclosedorcoveredcontainerswhilebeingcollected,transportedorstored.• Shallbeseparatefromcleanlinens• Soiledlinenshallbeneithersortednorrinsedinpatientrooms.• Properstoragefacilitiesshallbeprovidedforkeepingcleanlineninsanitaryconditionpriortouse.• Cleanlinenshallbetransportedinclosedconveyanceusedonlyfortransportingcleanlinen.• Usedorsoiledlinenisconsideredcontaminated• Used,soiledorcontaminatedlinenisidentifiedaslineninauniquecoloredlinenbag• Soiledlinenshallbecovered(orbeinclosedbags)whilecollected,transportedorstored.• Shallbehandledaslittleaspossible• Duringremovalorbagging,soiledlinensshouldnotbeshaken,manipulatedorcarriedagainsttheclothing

ComplyWithStateorProvinceRegulations

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• Useleak-resistantbagsforlinenscontaminatedwithbloodorbodysubstances.• Bagscontainingcontaminatedlaundry mustbeclearlyidentifiedwithcolor-coding.• Handlecontaminatedlinenswithminimumagitationtoavoidcontaminationofair,surfaces,andpersons.• Donotsortorpre-rinsecontaminatedlinensinpatient-careareas.

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FreestandingHampers

• Freestandinghamperswithlidsorcoversmaybeusedforholdingsinglelinenbagstobefilledduringaworkshift.• Whenfilled,thebagsshouldberemoved,closedandplacedinthelargestoragecontainerinasoiledutilityroom.• Hampercoversmustbeclosedwhileholdingsoiledlinens.

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Soiledlinen

•Shallbebaggedatthepointofuse.•Shallbesinglebaggedinapprovedlinenbags.• Linenbagsshouldbenomorethan1/2- 2/3fullsothebagcanclosecompletelyandnotcausebodilyinjury.•Shallbedoublebaggediftheoutsideofthesinglebagiscontaminatedwithfluidsorsolids.•Shallbedoublebaggedifthelinenisblood-soakedandmaycausesoak-through.

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Reviewthefollowingslidesandidentifyall

violations

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Thank you for keeping residents

safe!




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References

www.osha.gov/SLTC/etools/hospital/laundry/laundry.html#ContaminatedLaundry

www.osha.gov/SLTC/etools/hospital/housekeeping/housekeeping.html#ContaminatedLaundry

www.cdc.gov/HAI/prevent/laundry.html

www.hlacnet.org/standards.php

www.ndhealth.gov/disease/hai/Docs/WebEx/NDHCFLaundry11162011.pdf

shea.confex.com/shea/2010/webprogram/Paper2072.htmlwww.chnola.org/Images/Interior/pdfs/mucormycosis%20pages/mucormycosis_outbreak_associated_with_hospital.98032.pdf

F441§485.65InfectionControl,CMSManualSystem,Publication100-07StateOperationsProviderCertification,DepartmentofHealth&HumanServices,CentersforMedicare&MedicaidServices,Transmittal55:December2,2009

EconomicBurdenofHealthcare-AssociatedInfectioninUSAcuteCareHospitals– SocietalPerspectiveAlbertMarchetti;RichardRossiterdoi:10.3111/13696998.2013.842922

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FormoreInformation

• JohnScherberger,FAHE,CHESP,CMIP,T-CSCT,VPEIHealthcareRiskMitigationPast-President,HLACSpartanburg,SC864-208-5750

"Whatisdoneisimportant, butmoreimportantlyishowitisdone.”- JohnScherberger

Thankyouforinvestingyourtimeviewingthispresentation.

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Documents

HAI’s, MRDO’s, Fungi, Mold, Pollution