Welcome and Introduction

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PresenterPresentation NotesGo over housekeeping for today’s presentation: 1 hour webinar presented by OFMQ and part of the Transforming Long Term Care Project funded by OSDH CMP ProgramThe event materials are available for download on the WebEx log in page by clicking on the “VIEW INFO” button or by going to the OFMQ website, then the Events tab, Nursing home and select today’s webinar. All lines are muted. We will have Q&A at the end and the operator will give instructions when the lines are open. Participants can submit questions in the chat box at any time

At the end we have an evaluation for you to give feedback about the webinar.

Webinar Speakers

Lynn Tabor, MS, RN, WCC, IP-BC, ASCOMDirector of Education and Training, American Medical Technologies

Jan Ruhl, BSN, RN, IPCOGolden Age Nursing Home, Guthrie

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PresenterPresentation NotesOur speakers today are:

INFECTION PREVENTION AND CONTROL:OVERVIEW OF THE NEW CMS RULES & SURVEY

PROCESS

Taking the Pressure Out of Wound Care Since 1994

Copyright © 2018 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

FacultyLynn Tabor MS, RN, WCC, IP-BC, ASCOM

Director of Education & TrainingAmerican Medical Technologies

PresenterPresentation NotesA lot of information in a little bit of time Get you aquainted with this information and provide you with the resources that you need to be successful in this hefty endeavor in your facilty.

http://www.amtwoundcare.com/

Disclaimer4

This information is provided for informational purposes only. Patient management decisions should be based on a number of factors, including (but not limited to) professional society guidelines and published clinical literature relevant to a patient’s condition. Providers are encouraged to rely on their training and expertise, as well as any and all available information, prior to making management or treatment decisions for any individual patient.

L

PresenterPresentation NotesIn addition we need to disclose that we work for AMT…a part B biller of dressings…and that these is no content in this this program that can perceived as a conflict of interest.

Review the new infection prevention and control regulations, and suggest facility actions for preparing for the survey process related to these federal guidelines

Objectives Overview

CMS Final Rule Requirements for Long-Term Care Facilities

• Long-Term Care (LTC) Facilities have health and safety standards that facilities must meet in order to participate in the Medicare or Medicaid Programs.

• These standards include new mandates and language related to Infection Prevention and Control and Antibiotic Stewardship

F441- Replaced with F880, F881, F882, F883

Former Tag # New Tag # Tag Title

F441 F880Infection Prevention and Control

New Tag F881 Antibiotic Stewardship ProgramNew Tag F882 Infection Preventionist

F334 F883Influenza and Pneumococcal

Immunizations

PresenterPresentation NotesIn November of 2017 F441, the infection control tag, was replaced with 3 tags and had significant updated language related to F883, formerly F334 assigned to Influenza and Pneumococcal Immunizations.

Minimum Elements for Compliance with Infection Control Mandates - F880

“Facility must establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections.

The facility must establish an infection prevention and control program (IPCP) that must include, at a minimum, the following elements:

A system for preventing, identifying, reporting, investigating, controlling infections and communicable diseases for all residents, staff, volunteers, visitors, and other individuals providing services under a contractual arrangement based upon the facility assessment…”

Appendix PP November 22, 2017 State Operations Manual (SOM)

PresenterPresentation NotesF Tag 880 is your Infection Control and prevention Tag and states:The facility must establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections.

The facility must establish an infection prevention and control program (IPCP) that must include, at a minimum, the following elements: A system for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases for all residents, staff, volunteers, visitors, and other individuals providing services under a contractual arrangement based upon the facility assessment conducted according to §483.70(e) and following accepted national standards;

[As linked to Facility Assessment, §483.70(e), will be implemented beginning November 28, 2017 (Phase 2)]

F881-Antibiotic Stewardship Mandate

“An antibiotic stewardship program that includes antibiotic use protocols and a system to monitor antibiotic use.

NEW ABX regulations implemented November 28, 2017 (Phase 2)

Resource Provided: State Operations Manual (SOM), Appendix PP-Revised Regulations and Tags, November 22, 2017

PresenterPresentation NotesF881 states facilities must have (3) An antibiotic stewardship program that includes antibiotic use protocols and a system to monitor antibiotic use. The updated F881 tag was implemented beginning November 28, 2017.

Ladies and gentlemen…I cannot stress how important it is for you to read EVERY word and understand each bullet in F880 and F881 Guidance to Surveyor for Infection control…this document provides many “how to” items you need to incorporate into your policies and procedures, in addition to exactly what the surveyors are looking to find related to your infection prevention and control program.

Again…this document was provided for you on the webinar and I am going to show you a snip from this document on the next couple of slides. This information can be extremely valuable to you when creating these programs.

Surveyor Infection Control Work Sheet for LTC-1

Surveyor Infection Control Work Sheet for LTC-2

PresenterPresentation NotesI think these surveyor Infection Control Work Sheet will be very valuable to a facility that is updating their Infection Prevention and Control Practices. These may be from a pilot project, but I can guarantee the items listed are verbatim from the Final Rule and the State Operations Manual Guidance for Surveyors

Antibiotic Stewardship Program As summarized by the CDC, the Core Elements for Antibiotic Stewardship in Nursing Homes include:

Facility leadership commitment to safe and appropriate antibiotic use; Appropriate facility staff accountable for promoting and overseeing antibiotic

stewardship; Accessing pharmacists and others with experience or training in antibiotic stewardship; Implement policy(ies) or practice to improve antibiotic use; Track measures of antibiotic use in the facility (i.e., one process and one outcome

measure); Regular reporting on antibiotic use and resistance to relevant staff such as prescribing

clinicians and nursing staff; and Educate staff and residents about antibiotic stewardship.

Centers for Disease Control and Prevention. (2015). The core elements of antibiotic stewardship for nursing homes. Accessed on 10/20/17 from https://www.cdc.gov/longtermcare/prevention/antibioticstewardship.html

Core ElementsAntibiotic

StewardshipCDC

Leadership Commitment

Accountability

Drug Expertise

ActionTracking

Reporting

Education

PresenterPresentation NotesListed here are the Core Elements for Antibiotic Stewardship in Nursing Homes?

Leadership commitmentThe CDC uses examples of Leadership commitment of facilities that select individuals and a leadership team committed to improving safe and appropriate antibiotic use in facilities.  Leadership teams can include infection control officers or key people along with owners, administrators, clinicians and other staff that would contribute to creating a culture and program for antibiotic stewardship.Accountability Accountability per the CDC includes setting standards and identifying specific physicians, nursing staff and pharmacy leads responsible for promoting and overseeing antibiotic stewardship activities in your facility. Drug expertise Entails establishing access and regular communication with consultant pharmacists or other individuals with experience or training in medication managemenet and antibiotic stewardship.  Pharmacists along with specialists at partner labs are extremely helpful sources of information related to antibiotic use.Action Action speaks for itself, but for the CDC considers action to involved implementation of at least one policy or practice to improve antibiotic use Tracking Tracking and Monitoring Antibiotic Use and Outcomes is one of the most important elements of Antibiotic Stewardship programs.  The CDC and CMS expect facilities to monitor at least one process measure of antibiotic use and one outcome. This basically means that facilities and clinicians will need to show that and at least one process and one outcome measure has been utilized to to measure how often and how many antibiotics are being prescribed and clinical outcomes.  Examples of clinical outcomes can be reductions in MRSA or C. Diff   This is closely related to…..Reporting Reporting in the eyes of the CDC and CMS entails providing feedback to the Antibiotic Stewardship team, and other relevant staff.  Reporting antibiotic resistant infections is already required and reporting will likely be a part of regulations and surveys in the future as it is how the CDC and CMS can track infections, antibiotic use and progress. Education Education is key component to any program, and especially with Antibiotic Stewardship.  And, education is not limited to facility staff, but also, as importantly residents and especially families for it is families that are often the ones exerting pressure on clinicians to prescribe antibiotics.The CDC has provided some wonderful information on each core element and also, specific tasks associated for implementation of a strong antibiotic stewardship program.  These are available through materials provided in this webinar and on the CDC site. 

Risks Associated with Lack of Preparedness for Infection Prevention and Control and Antibiotic Stewardship Programs

Risks

Clinical

Regulatory

Legal

Financial

PresenterPresentation NotesThis slide is meant to point out the different types of risks associated with facilities lack of preparedness for infection preventipon and control practices and includeClinical risks for individual patient or resident and for those exposed to infectious organismsRegulatory risks associated with not meeting regulatory mandates laid out in the State Operations Manual Guidance to surveyors…specifically 880Legal risks from lawsuits that may identify facility clinical and system performance below the standards of care and national guideline recommendationsFinancial risks from survey punitive damages set out by the survey process, the potential for lawsuit fines and settlements, and the direct costs to the facility associated with infection outbreaks.

Infection Preventionist - F882Qualifications of Infection Preventionist

November 28 2019

IP must:(1) Have primary professional training in nursing, medical technology, microbiology, epidemiology, or other related field;(2) Be qualified by education, training, experience or certification;(3) Work at least part-time at the facility; (4) Has completed specialized training in infection prevention and control. IP participation on quality assessment and

assurance committee. Copyright © 2017 Gordian Medical, Inc. dba American Medical Technologies.

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Who is currently an IPWho is interest in becoming an IP

PresenterPresentation NotesYou are now mandated to have an Infection Preventionist (tag 882). I am not going to talk about the specifics on this as your next speaker will delve into detail on this topic.

What to Do to Prepare for Your Infection Prevention and Control and Antibiotic Stewardship Programs???

Start gathering current resources CDC-documents

Agency for Healthcare Research and Quality-AHRQ - Great documents CMS-Final Rule and State Operations Manual-November 2017 Evidence based infection prevention and treatment guidelines Find champions in your buildings who want to grow and mentor others in these

areas-may become your infection preventionist Get your staff educated and skilled in infection prevention and control practices Ensure consultants/contract individuals familiar with IPCP and ASP Educate patients and families

PresenterPresentation NotesWhat to Do to Prepare for Your Infection Prevention and Control and Antibiotic Stewardship Programs!!!Start gathering current resources…some of which are provide to you todayGo to the Centers for Disease Control and download their free documents on infection control and antibiotic stewardship…AHRQ- has GREAT documents you can download on Infection prevention and Control that meet the standards of careCenters for Medicare and Medicaid Services has all the regulations and resources on the survey process There are national and international Evidence based infection prevention and treatment guidelines Find champions in your buildings who want to grow and mentor others in these areas-may become your infection preventionistGet your staff educated and skilled in IPEnsure consultants/contract individuals are familiar with IPCP and Antibiotic stewardshipEducate patients/residents and families

Prepare, Prepare, PrepareMake it your goal to overprepare your staff

CMS Survey Perspective on Infection in LTC Facilities

Factors for prevalence of infection in LTC buildingUnderstaffed facilitiesStaff without appropriate training, or time to prevent infections

earlyOvertreatment with antibioticsIncreasing clinician complexity of the average nursing home residentFrequent transitions between care settings leading to transmission of

HAIsLack of systematic approach to prevent and identify HAIs

PresenterPresentation NotesWe’ve discussed some of the reasons for issues related to infection control in the LTC setting.This slide lists CMS SOM Guidance to Surveyors perspective for the high incidence of Healthcare Associated Infections in nursing homes and states:

Healthcare associated infections (HAIs) are largely preventable, but occur far too often in nursing homes. The high incidence of HAIs in nursing homes is due to multiple factors including, but not limited to understaffed facilities, staff without the appropriate training or time to prevent infections early, overtreatment with antibiotics, the increasing clinical complexity of the average nursing home resident, and frequent transitions between care settings that lead to the transmission of HAIs. Additionally, nursing homes frequently lack a systematic approach to prevent and identify HAIs.

There are CMSs words, some of which we’ve already mentioned.

Commonly Cited Deficiencies

Hand hygiene Improper use of personal protective equipment (PPE) Isolation practices Dietary department sanitary issues Surveillance program Management of Clostridium difficile infection Environmental sanitation practices

Attribution: Boot Camp For Long-Term Care Facility Infection Preventionist-2017

PresenterPresentation NotesCheck on healthy hands

Be Prepared with Your Documentation

Infection prevention and control (IPC) policies Have you IPC risk assessment and plan available Infection preventionist job description Quality Assessment and Assurance plan Any Root Cause analysis related to infection prevention practice issues Last quarter IP Surveillance data Base P&Ps on the Regulations, Standards of Care, Guidelines (e.g.

CDC Core Elements)

Be Prepared with Policies

Antibiotic Stewardship Program (ASP) policy Reports summarizing antibiotic use Antibiogram Hand hygiene policies and documentation of AUDITS Calculated rates of compliance Point of care policies and AUDITS on adherence to policy Glucometer cleaning Cleaning of equipment e.g., B/P cuffs, gait belts, sling (ALL

equipment shared by residents!!!)

Be Prepared for Surveyor to Ask to See Your Policies

Urinary tract infection prevention policies and policy for catheter use Cleaning and disinfection policies and AUDITS Employee Health policies including work-exclusion, reporting illness to

supervisors, health screening for food handlers Influenza & Pneumococcal Vaccination Policy Vascular Access Policies Aerosol Transmissible Disease Policy and program

Documentation of Training

The following can be requested upon entrance of surveyors to be received by the team within first 1-2 hoursSpecialized training for Infection PreventionistPersonnel training on infection prevention (Standard Precautions,

Transmission-based Precautions, blood borne pathogens, hand hygiene)Training on antibiotic use/stewardship to nursing staff & clinical providersEducational materials on ASP for residents and families Injection safety training and competencies

Plan! READ the

REGULATIONS! Take actions! Review/know

your policies!!!

This is a LONG Road, no easy or fast way to accomplish. Lots of literature, webinars, courses, documents to assist with

designing the process. See Reference Section

Educate Observe – (each

other, competencies) Reach out for help

(e.g. State, HCA) YOU CAN DO

THIS!!!

Thank you!!!

PresenterPresentation Notesthank you for join us today.

References General Infection Prevention

CDC Infection Prevention Resources for Long-term Care: http://www.cdc.gov/longtermcare CDC/HICPAC Guidelines and recommendations:

http://www.cdc.gov/HAI/prevent/prevent_pubs.html State Operations Manual. Appendix PP-Guidance to Surveyors for Long Term Care Facilities.

Rev. 11-22-17 Healthcare Personnel Safety

Guideline for Infection Control in Healthcare Personnel: http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf

Immunization of HealthCare Personnel: http://www.cdc.gov/vaccines/adults/rec-vac/hcw.html CDC Influenza Vaccination Tool-kit for Long-term Care Employers:

http://www.cdc.gov/flu/toolkit/long-term-care/index.htm Occupational Safety & Health Administration (OSHA) Bloodborne Pathogen and Needlestick

Prevention Standard: https://www.osha.gov/SLTC/bloodbornepathogens/index.html

http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf

Hand Hygiene Guideline for Hand Hygiene in Healthcare Settings: http://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf Hand Hygiene in Healthcare Settings: http://www.cdc.gov/handhygiene Examples of Hand Hygiene

Auditing Tools: Measuring Hand Hygiene Adherence: Overcoming the Challenges:

http://www.jointcommission.org/assets/1/18/hh_monograph.pdf iScrub: http://compepi.cs.uiowa.edu/index.php/Research/IScrub

Personal Protective Equipment

2007 Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings: http://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html

Management of Multi-Drug Resistant Organisms in Healthcare Settings, 2006:http://www.cdc.gov/hicpac/pdf/guidelines/MDROGuideline2006.pdf

Guidance for the Selection and Use of Personal Protective Equipment in Healthcare Settings: http://www.cdc.gov/HAI/prevent/ppe.html

CDC Sequence for Donning and Removing Personal Protective Equipment: http://www.cdc.gov/hai/pdfs/ppe/PPE-Sequence.pdf DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Disease Control and Prevention

References

http://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html

References Safe Injection and Point of Care Testing Practices

2007 Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings: http://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html

CDC Injection Safety Web Materials: http://www.cdc.gov/injectionsafety CDC training video and related Safe Injection Practices Campaign materials: http://oneandonlycampaign.org Infection Prevention during Blood Glucose Monitoring and Insulin Administration:

http://www.cdc.gov/injectionsafety/blood-glucose-monitoring.html Frequently Asked Questions (FAQs) regarding Assisted Blood Glucose Monitoring and Insulin Administration:

http://www.cdc.gov/injectionsafety/providers/blood-glucose-monitoring_faqs.html Environmental Infection Control Guidelines for Environmental Infection Control in Healthcare Facilities:

http://www.cdc.gov/hicpac/pdf/guidelines/eic_in_HCF_03.pdf EPA Listing of disinfectant products with sporicidal activity against C. difficile:

https://www.epa.gov/sites/production/files/2016-06/documents/list_k_clostridium.pdf Options for Evaluating Environmental Infection Control: http://www.cdc.gov/HAI/toolkits/Evaluating-

Environmental-Cleaning.html Resources to assist with evaluation and response to breaches in infection control Patel PR, Srinivasan A, Perz JF. Developing a broader approach to management of infection control breaches

in health care settings. Am J Infect Control. 2008 Dec; 36(10); 685-90 http://www.ajicjournal.org/article/S0196-6553(08)00683-4/abstract

Steps for Evaluating an Infection Control Breach: http://www.cdc.gov/hai/outbreaks/steps_for_eval_IC_breach.html

Patient Notification Toolkit: http://www.cdc.gov/injectionsafety/pntoolkit/index.html

http://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.htmlhttp://www.cdc.gov/hicpac/pdf/guidelines/eic_in_HCF_03.pdf

References

Antimicrobial stewardship

CDC Implementation Resources for Antibiotic Stewardship: http://www.cdc.gov/longtermcare/prevention/antibiotic-stewardship.html

Respiratory Hygiene/Cough Etiquette

2007 Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings: http://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html

Respiratory Hygiene and Cough Etiquette in Healthcare Settings: http://www.cdc.gov/flu/professionals/infectioncontrol/resphygiene.htm

Recommendations for preventing the spread of influenza: http://www.cdc.gov/flu/professionals/infectioncontrol/

Literature and Tools on the CDC Website

https://www.cdc.gov/longtermcare/prevention/ Core Elements Checklist of Core Elements Leading Antibiotic Stewardship in Nursing Homes[PDF - 379 KB] Creating A Culture to Improve Antibiotic Use in Nursing Homes[PDF - 331 KB] Infection Prevention in Aging: Resources

These infection prevention and control resources were created for a patient-centered research study in nursing homes.

A Targeted Infection Prevention (TIP) Intervention in nursing home residents with indwelling devices: a randomized clinical trial.

AHRQ’s Nursing Home Antibiotic Stewardship Tools and Guide Project

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https://www.cdc.gov/longtermcare/prevention/https://www.cdc.gov/longtermcare/prevention/antibiotic-stewardship.htmlhttp://www.cdc.gov/longtermcare/pdfs/core-elements-antibiotic-stewardship-checklist.pdfhttp://www.cdc.gov/longtermcare/pdfs/factsheet-core-elements-leading-antibiotic-stewardship.pdfhttp://www.cdc.gov/longtermcare/pdfs/factsheet-core-elements-creating-culture-improve-use.pdfhttp://infectionpreventioninaging.org/resources/http://www.ncbi.nlm.nih.gov/pubmed/25775048http://www.ahrq.gov/nhguide/index.html

Resources

Advancing Excellence infection control toolkit: https://www.nhqualitycampaign.org/goalDetail.aspx?g=inf

S. Schweon, D. Burdsall, M. Hanchett, S. Hilley, D. Greene, I. Kenneley, J. Marx, P. Rosenbaum (2013). The Infection Perfectionist's Guide to Long-Term Care. APIC.

Centers for Disease Control (CDC) toolkit for long-term care facilities: http://www.cdc.gov/longtermcare/index.html

Centers for Disease Control (CDC) Core Elements of Antibiotic Stewardship for Nursing Homes http://www.cdc.gov/longtermcare/prevention/antibioticstewardship.html

National Healthcare Safety Network (NHSN): Tracking Infections in Long-Term Care Facilities http://www.cdc.gov/nhsn/LTC/index.html

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https://www.nhqualitycampaign.org/goalDetail.aspx?g=infhttp://www.cdc.gov/longtermcare/index.htmlhttp://www.cdc.gov/longtermcare/prevention/antibioticstewardship.htmlhttp://www.cdc.gov/nhsn/LTC/index.html

Federal Initiatives for Antibiotic Resistance

White House Forum on Antibiotic Stewardship National Action Plan for Combating Antibiotic-Resistant Bacteria Executive Order - Combating Antibiotic-Resistant Bacteria National Strategy to Combat Antibiotic-Resistant Bacteria PCAST Report on Combating Antimicrobial Resistance CDC report: Antibiotic Resistance Threats in the United States, 2013

Copyright © 2017 Gordian Medical, Inc. dba American Medical Technologies.

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PresenterPresentation NotesNational coordinated initiative

http://www.cdc.gov/drugresistance/federal-engagement-in-ar/index.html#tabs-835289-1http://www.cdc.gov/drugresistance/federal-engagement-in-ar/index.html#tabs-835289-2http://www.cdc.gov/drugresistance/federal-engagement-in-ar/index.html#tabs-835289-3http://www.cdc.gov/drugresistance/federal-engagement-in-ar/index.html#tabs-835289-3http://www.cdc.gov/drugresistance/federal-engagement-in-ar/index.html#tabs-835289-3http://www.cdc.gov/drugresistance/federal-engagement-in-ar/index.html#tabs-835289-4

INFECTION PREVENTIONIST IN LONG-TERM CAREBY JAN RUHL, RN, BSN, IPCO 2018

GOLDEN AGE NURSING FACILITY

JRUHL@GOLDENAGEGUTHRIE.COM

NEW CMS REQUIREMENTS OF PARTICIPATION FOR INFECTION CONTROL

Infection Prevention and Control Program (IPCP) must have:

• Required standards, policies and procedures 483.80 (Phase 1 – effective November 28, 2016)

• Alignment with facility assessment (Phase 2 – effective November 28, 2017)

• Antibiotic Stewardship Program (Phase 2 – effective November 28, 2017)

• Infection Preventionist with Participation in QAPI Committee (Phase 3 –effective November 28, 2019)

WHY IS INFECTION CONTROL A PRIORITY?

• Approximately 1 million individuals live in nursing center >100 days

• Increase risk of developing infections due to multiple chronic conditions, elderly, disabled

• 1-3 million serious infections occur every year in LTCF’s and 380,000 die every year

• Difficult to diagnose infections due to lack of specific S&S and dementia

• 50-70% will receive a systemic antimicrobial agent during a calendar year

• 20-30% may receive multiple courses of antibiotics

• Antibiotics can cause serious harm – MDRO’s, C difficile, Adverse Reactions

• Serious outbreaks reported in LTC facilities – norovirus, hepatitis, influenza, group A strep

INFECTION PREVENTIONIST (IP)

Must designate one or more individual(s) as the IP(s) who is responsible for the facility’s Infection Prevention and Control Program (IPCP)

1. Have primary professional training in nursing, medical technology, microbiology, epidemiology, or other related field

2. Be qualified by education, training, experience or certification (i.e., CIC or IP-BC)

3. Work at least part-time at the facility

4. Have completed specialized training in infection prevention and control

INFECTION PREVENTIONIST JOB DESCRIPTION

JOB DESCRIPTION

- Is responsible to plan, organize, develop, coordinate and direct the Infection Prevention and Control Program

- Include requirements for IP as per CMS guidelines (i.e, professional training, work PT at facility, education/training/certification/experience, specialized training ininfection control and prevention)

- Example provided

INFECTION PREVENTIONIST SPECIALIZED TRAINING CONTENT• Infection prevention and control program overview

• Infection preventionist responsibilities

• Quality assessment and assurance committee

• Infection surveillance

• Outbreaks

• Hand hygiene

• Principles of standard and transmission-based precautions

• Linen management

• Water management

• Medication and sharps safety

• Respiratory etiquette

• Device and wound management

• Environmental cleaning, disinfection, and sterilization

• Vaccine-preventable respiratory infections and TB

• Employee and occupational health considerations

• Antibiotic stewardship program

• Infection prevention and antibiotic stewardship considerations during care transitions

Organization Title On-line? Length Certificate provided

Cost

American Health Care Association

IPCO Infection Prevention Control Officer Training

Yes 23 hours Yes $450 member$650 non-member

APIC EPI in Long Term Care Certificate Series

2 day in person +3

on-line classes

16 + hours

Yes State Dept of Health to provide – unknown cost

NADONALTC Infection Control and Mastery Program

Yes 15 hours Yes $450

CMS Specialized IPC Training for NH Staff in the LTC Setting

Yes(on demand)

16-20 hours

Yes Free(Spring 2019)

INFECTION PREVENTIONIST PROFESSIONAL ORGANIZATIONS

• EPIC – Epidemiologists and Preventionists in Infection Control• Oklahoma City – www.epicokla.com• Monthly business meeting followed by educational presentation – 3rd Thursday of each month• EPIC membership cost $25 annually• Annual conference in OKC

• APIC – Association for Professionals in Infection Control and Epidemiology• National - https://apic.org• Long Term Care section • APIC membership cost $205 annually• Comprehensive clinical education and professional development programs, free and discounted member resources,

practical tips, and solutions.

• National annual conference

IP PARTICIPATION ON QUALITY ASSESSMENT AND ASSURANCE COMMITTEE

The individual designated as the IP, or at least one of the individuals if more than one IP:

1. Must be a member of the facility’s quality assessment and assurance committee

2. Report to the committee on the IPCP on a regular basis

3. To be implemented beginning November 28, 2019 (Phase 3)

ANTIBIOTIC STEWARDSHIP PROGRAM

Intent is to:

Optimize the treatment of infections by ensuring appropriate antibiotic prescribed

Reduce the risk of adverse events

Develop, promote and implement a facility-wide system to monitor the use of antibiotics

Shall include:

Antibiotic use protocols

A system to monitor antibiotic use

ANTIBIOTIC STEWARDSHIP PROGRAM (CON’T)

CDC 7 Core Elements

• Leadership commitment – demonstrate support and commitment – formal statement

• Accountability – identify leaders

• Drug Expertise – pharmacist and others with ABS experience or training

• Action – implement policies

• Tracking - measures of antibiotic use in the facility

• Reporting – regular feedback to physicians and staff

• Education – for residents, families, staff and physicians

ANTIBIOTIC STEWARDSHIP PROGRAM (CON’T)

Antibiotic Use Protocols

• Criteria met for clinical definition of active infection or suspected sepsis• Define which criteria you are using – i.e., NHSN, McGeer Revised 2012

• Pathogen susceptibility• Based on culture and sensitivity to antimicrobial (or therapy begun while culture is pending)

• Complete antibiotic orders • Drug, dose, frequency, duration of treatment, route, indication for use

• Infection assessment tool or management algorithm• i.e., SBAR

ANTIBIOTIC STEWARDSHIP PROGRAM (CON’T)

• Utilize communication tools to guide communication between nursing home staff and prescribing clinicians about the potential need for antibiotics for residents

• Examples of antibiotic use protocols, policies and practices developed by the Agency for Healthcare Research and Quality (AHRQ)

• http://www.ahrq.gov/nhguide/index.html

Nursing Home Antimicrobial Stewardship Guide

Toolkits - cover a variety of interventions that nursing homes can use to improve antibiotic use

SBAR forms (example)

• Situation

• Background

• Assessment

• Recommendation

ANTIBIOTIC STEWARDSHIP PROGRAM (CON’T)

A System to Monitor Antibiotic Use

• Reports related to monitoring antibiotic usage and resistance data• Summarize antibiotic use from pharmacy data such as the rate of new start or days of antibiotic treatment per

1,000 resident days (# of new starts or antibiotic days divided by # total patient days x 1000) or types of antibiotics prescribed

• Summarizing antibiotic resistance (e.g. antibiogram) based on lab data• Tracking measures of outcome surveillance related to antibiotic use (e.g. C difficile, MRSA, CRE))

• Feedback to prescribing practitioners on prescribing practices and compliance with facility antibiotic use protocols

• Include the mode and frequency of education for prescribing practitioners and nursing staff on antibiotic use and protocols

ANTIBIOTIC STEWARDSHIP PROGRAM (CON’T)

The assessment, monitoring, and communication of antibiotic use shall occur by a licensed pharmacist.

A pharmacist must perform a medication regimen review (MRR) at least monthly, including review of the medical record and identify any irregularities, including unnecessary drugs.

• Include the Pharmacy monthly review in your Infection Control Committee/QAPI meeting minutes (i.e.,The MRR by the consulting Pharmacist included the review of the Antibiotic Stewardship Program and is currently tracking antibiotic usage – and what irregularities were identified, if any.)

SURVEY OF ANTIBIOTIC STEWARDSHIP PROGRAM

Surveyors will determine whether the facility’s ABS program includes:

• Antibiotic use protocols addressing antibiotic prescribing practices (i.e., documentation of the indication, dose, and duration of antibiotic, review of laboratory reports to determine if the antibiotic is indicated or needs to be adjusted, an infection assessment tool or management algorithm is used when prescribing)

• A system to monitor antibiotic use (i.e., antibiotic use reports, antibiotic resistant reports)

RESOURCES FOR INFECTION PREVENTION AND CONTROL PROGRAM

• CDC – www.cdc.gov/longtermcare – an abundance of infection control information for long term care including staff, resident, and family educational handouts, facility assessment tool

• CMS – www.cms.gov – conditions of participation 483.80 Infection Control

• Oklahoma State Department of Health - www.ok.gov/health - Reportable Diseases list, TB assessment, multiple other infection control information for long term care

• Med-Pass – www.med-pass.com – Infection Control Policy and Procedure Manual for Long Term Care – a guideline in meeting compliance with OBRA, AHSA, CDC, FDA and JCAHO regulations

• Resources for Reform Requirements for Long-Term Care Facilities – 483.80 Infection Control -http://www.health.state.mn.us/divs/fpc/profinfo/022717callfile4.pdf

• Definitions of Infections in Long-Term Care Facilities: Revisiting the McGeer Criteria 2012 - http://www.jstor.org/stable/10.1086/667743

• ASAP Nebraska DHHS Epidemiology Unit Revised McGeer Criteria for Infection Surveillance Checklist -https://asap.nebraskamed.com/.../Revised-McGeer-criteria-for-infection-surveillance-c...

http://www.cdc.gov/longtermcarehttp://www.cms.gov/http://www.ok.gov/healthhttp://www.med-pass.com/http://www.health.state.mn.us/divs/fpc/profinfo/022717callfile4.pdfhttp://www.jstor.org/stable/10.1086/667743

Emergency Preparedness –It Doesn’t Have to be a Disaster

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PresenterPresentation NotesListen to what is being done on the nursing home front through participation in small group interactions, sharing of best practices, discussions of lessons learned, and the valuable opportunity to network with peers. These events are free to attend and six (6.0) hours of NAB Administrator CEUs have been applied for. On the day of the event, registration opens at 7:30 AM, with the meeting being held from 8:00 AM – 3:30 PM. Watch your e-mail as registration is opening soon.

Questions?

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Funding is provided by the Civil Monetary Revolving Fund (§63-1-107.4), grant number 3409021528, Office of Protective Health Services, Oklahoma State Department of Health (OSDH).

OSDH is an equal opportunity employer and provider. This publication is issued and authorized by OSDH. Copies have not been printed but are available on the OSDH website at www.health.ok.gov. |JAN 2018 |Graphics Design: OFMQ 52

Thank You

John Leon, RN MPHNursing Home Quality Improvement Specialist

405-302-3248jleon@ofmq.com

PresenterPresentation NotesThanks for our speakers for their great presentations and to you all for joining us on this webinar.When you close the webinar, a new window will open up with the evaluation questions. Please fill this out because your responses are very helpful in planning the next webinar. Enjoy the rest of your day.

http://www.health.ok.gov/

Slide Number 1Webinar Speakers Infection prevention and Control:�Overview of the New CMS Rules & Survey Process� Disclaimer Objectives OverviewCMS Final Rule Requirements for Long-Term Care FacilitiesF441- Replaced with �F880, F881, F882, F883Minimum Elements for Compliance with Infection Control Mandates - F880F881-Antibiotic Stewardship MandateSurveyor Infection Control Work Sheet for LTC-1Surveyor Infection Control Work Sheet for LTC-2Antibiotic Stewardship Program As summarized by the CDC, the Core Elements for Antibiotic Stewardship in Nursing Homes include: Slide Number 13Risks Associated with Lack of Preparedness for Infection Prevention and Control and Antibiotic Stewardship ProgramsInfection Preventionist - F882�Qualifications of Infection Preventionist�November 28 2019What to Do to Prepare for Your Infection Prevention and Control and Antibiotic Stewardship Programs???Survey Survival TipsCMS Survey Perspective on Infection in LTC FacilitiesCommonly Cited DeficienciesBe Prepared with Your DocumentationBe Prepared with PoliciesBe Prepared for Surveyor to Ask to See Your PoliciesDocumentation of TrainingThis is a LONG Road, no easy or fast way to accomplish. Lots of literature, webinars, courses, documents to assist with designing the process. See Reference SectionSlide Number 25ReferencesReferencesReferencesReferencesLiterature and Tools on the CDC WebsiteResourcesFederal Initiatives for Antibiotic Resistance Infection preventionist in �long-term careNew CMS Requirements of Participation for Infection controlWhy is infection control a priority?Infection Preventionist (IP)Infection preventionist Job descriptionInfection preventionist specialized training contentSlide Number 39Infection preventionist professional organizations�IP Participation on Quality assessment and assurance committeeAntibiotic stewardship programAntibiotic stewardship program (con’t)Antibiotic stewardship program (con’t)Antibiotic stewardship program (con’t)Antibiotic stewardship program (con’t)Antibiotic stewardship program (con’t)Survey of Antibiotic stewardship program Resources for infection prevention and control program�Emergency Preparedness –� It Doesn’t Have to be a DisasterQuestions?Thank You