Managing IPC and Lessons Learned COVID19 final (002 ...

11/12/2020

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Presented by:

Lori Davenport, Director of Regulatory Clinical Affairs

MAY 22, 2019

Managing Infection Prevention & Control Program

Lessons Learned – COVID-19

Nov 12, 2020

OVERVIEW

• Infection Prevention and

Control – history and

impact

• Lessons learned – COVID

• Moving foreword &

managing IPC

OUR DISCUSSION TODAY

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The Impact of Infections in Nursing Homes

Common Infections

• Respiratory

• Influenza

• Urinary Tract

• Skin – soft tissue and others

• Gastroenteritis

• COVID-19

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Prevention of Pneumonia

1. Immunizations 

2. Hand washing and sanitation 

3. Oral care 

4. Interventions for swallowing difficulties 

5. Good health and management of equipment and tubing 

Diagnosis and intervention quickly – Change of condition policy 

UTI’s

• Common cause of  infection 

• Adds risk • Cather assessment – upon admission, quarterly and with changes

• Acceptable medical diagnosis for the catheter ?• Verify the diagnosis and don’t guess • Take it out if the risk is greater than the benefit  • Document • Competency skill validation – policy and procedure 

Myth:  Once a resident has a catheter – it is forever 

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Skin Infections

• Bacterial or fungal infections – more common in those with diabetes 

• Cellulitis 

• Skin tears 

• Bruising

• Surgical wounds 

• Drug resistant infections – MRSA 

• Viral infections like herpes zoster – shingles 

• Pressure ulcers 

Gastrointestinal Infections

• Bacterial and viral 

• Norovirus 

• Clostridium difficile

Diarrhea causes dehydration  ‐ increasing the morbidity and mortality 

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COVID-19

Lesson 1

• Staff – Care givers spread COVID-19

• Staff are needed to care for our residents

• Sick staff impacts care

• Sick staff means sick residents

• Our staff depend on working to support their family

• Asymptomatic carriers are a challenge

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Lesson 2

• Response to nonspecific symptoms is needed

• They are warning signs!

• Decreased appetite

• Decreased energy

• Confusion

• Low grade fever

Lesson 3

• Testing is important

• Find a person with COVID-19 – Find more!

• Contact Tracing is important – Find exposures

• Isolate and quarantine quickly

Be conservative – COVID-19 is unforgiving

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Lesson 4

• Assume the worst and hope for the best

• TEST!

Lesson 5

• Focus on the basics!

• Social Distancing

• Break the chain of infection

• Hands – sanitizer and soap and water

• Wearing PPE properly

• Donning and Doffing

• Isolation

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Be Aware

• Break rooms

• Smoke areas

• Nursing stations

• Bathrooms

• House keeping – trash, chemicals,

• Laundry

Teach – Rinse and Repeat

This Photo by Unknown Author is licensed under CC BY

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Resources for Training

• https://youtu.be/etZK‐GrUYgM

• https://youtu.be/kX8k9JBJuVE

• https://youtu.be/iwvnA_b9Q8Y

Federal Tag’sInfection Control Group – see handout List of Revised FTags

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F880: Infection Control

• Resources:

• COVID-19 related: Stop Signs, COVID Antigen Guide,

Assessment-Tool and Return to Work Decision Tree

• General IPC resources: IPC Annual Risk

Assessment, and List of Revised FTags

F880: Infection Control

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F880: Infection Control

F880: Infection Control

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F880: Infection Control

(vi) The hand hygiene procedures to be followed by

staff involved in direct resident contact.

• http://www.cdc.gov/handhygiene/providers/index.html

Hand Hygiene

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Resident Hand Hygiene

• Remind residents to wash their hands too!

• Surveyors will be observing opportunities for resident hand washing

• AM

• Before and after meals 

• After toileting

• Before and after snacks 

• PM 

Management Systems

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F880: Infection Control

• Linens – personnel must handle, storage, process, and transport linens to prevent the spread of infection.

• Facemasks – The regulations also indicate that the facility needs to address the provision of facemasks for residents with new respiratory symptoms.

F880: Infection Control

Room Placement 

• Transmission‐based precautions – set up and take down 

• Orders – for isolation – its your documentation 

• Equipment – designated 

• Disinfection 

• Strict room isolation or not? 

• Single or double occupancy? 

Determining based upon the individual resident evaluation and type of organism. 

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F880: Infection Control

Decontamination 

What is your system for decontamination • Equipment 

• Medical devices 

• Shared items 

• People – Correct PPE – Medication and Treatment Administration

• What goes into an isolation room must come out. 

ICP Program

Infection Prevention 

Control Program 

Facility Assessment 

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Purpose of the Facility Assessment • To determine what resources are necessary to care for the residents of the facility competently during day‐to‐day operations and emergencies

• Note: Even though facilities are performing some type of assessment it may not be formal or documented

Purpose of the Facility Assessment • Provides record for staff and management to understand reasoning for decisions on staffing and other resources.

• Serves as a reference point when deficiencies are noted or when adverse events occur.

• Could be a useful tool for QAPI especially when assessing the facility’s performance on the elements required to include in the assessment

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Purpose of the Facility Assessment • The documented tool

• Performs a thorough assessment (big picture look) of entire facility in a formal process that is documented to address what resources are today and what resources are needed.

• Is a valuable tool (not just a process) to use for planning for and improving care.

• Should have representation from all areas of the facility 

Overview of the Regulation

• §483.70 (e) 

• A facility must conduct and document a facility‐wide assessment

• Define what resources are necessary to care for its resident competently during day‐to‐day operations and in emergencies. 

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Contents of the Facility Assessment – minimum • Revision to add the COVID‐19 specifics 

• Disease – COVID‐19 

• Special clinical needs (isolation and quarantine) – Red Yellow Green

• Training – COVID ‐19 Residents and Staff

• PPE – N59, Donning and Doffing 

• Physical environment – equipment – testing – ventilation 

• Equipment inventory 

• Added contracts – laboratories for testing added – telehealth 

• Ability to secure supplies – risk assessment during an emergency 

When to complete or update FA?

• At a minimum the facility assessment must be completed annually or when “significant” changes to the resident population occur

• Examples:  COVID‐19 and the pandemic • All the things added to our day – screening, zones, quarantine, isolation, social distancing, wearing of masks and face shields, visitor restrictions, use of technology, EMResource, laboratory agreements for testing, inventory of PPE –all the people local, state you communicate with and testing & equipment‐results withing 48 hours.

• Surveillance and Reporting – reportable disease • Staff Training and Competencies • Use the IPC Assessment Tool (handout) – to guide you 

• Update your facility assessment!• Facility Preventionist to conduct an ICP Risk Assessment – now and take it through QAPI with plan going forward  

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Infection Control Toolkit 

• November 1: Long‐Term Care Facility Toolkit [Updated Oct. 30, 2020]

It is update with a different URL each time.

Easy to have the wrong one – old toolkit 

IHCA – keeps the web site current 

www.IHCA.org

Testing – now what did you say again?

• https://www.ihca.org/resource/urgent‐cms‐issues‐guidance‐on‐covid‐19‐testing‐of‐nf‐staff‐residents‐routine‐testing‐to‐start‐september‐2‐2020/

• Return to work decision tree 

• Antigen decision tree 

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Interviews

• Availability of PPE: do all staff know who to contact for replenishment? Procedure to communicate low inventory?

• Do staff know who the Infection Preventionist is?

• If they are unsure of an answer – how do they proceed? 

• Do staff know how to protect themselves and others?

• Do actions and observations indicate competency? 

• Do you have a culture of it takes the village? 

• Handout – CMS Nursing Home Pathway for Infection Prevention, Control & Immunizations

Evaluate IPC Program

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Infection Control Focused Surveys (assessment tool)

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Resources 

• https://www.cdc.gov/vaccines/hcp/vis/vis‐statements/flu.pdf

• https://www.cdc.gov/vaccines/hcp/adults/downloads/fs‐pneumo‐hcp.pdf

• https://www.cdc.gov/flu/pdf/freeresources/general/brochure‐take‐3_color.pdf

• https://www.cdc.gov/flu/pdf/freeresources/general/strong‐defense‐against‐flu.pdf

F884 ‐COVID Reporting

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F885 – COVID Reporting to Residents & Families

F886 – Testing 

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Testing – now what did you say again?

• https://www.ihca.org/resource/urgent‐cms‐issues‐guidance‐on‐covid‐19‐testing‐of‐nf‐staff‐residents‐routine‐testing‐to‐start‐september‐2‐2020/

• Return to work decision tree 

• Antigen decision tree 

Resource

• Qsource Indiana – Kara Dawson • Assistance 

• Directed In-Services: Enforcement Remedy• Antibiotic Stewardship implementation• Facility designed plan • NHSN Application and reporting – trouble shooting

Kara Dawson, RN, BSN, RAC‐CTQuality Improvement AdvisorEmail: [email protected]

Phone:  (317)628‐1145

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Resource

• Indiana Health Care Association 

Lori Davenport Director of Regualtory Clinical Affairs 

Email:  [email protected]

Cell:  765‐516‐0148

This Photo by Unknown Author is licensed under CC BY‐SA‐NC

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MAY 22, 2019

THANK YOU!

IHCA.ORG

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