3/29/2018 1 Navigating through Frontline Competencies, Training and Audits Carol Vance MSN, RN, CIC Multi-site Director, Infection Prevention Advocate Children’s Hospital Objectives • Discuss the relationship between training, competency and audits. • Provide concrete and practical solutions to training and competency challenges. • Identify the key stake holders that are important for training and competency success.
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3/29/2018
1
Navigating through Frontline
Competencies, Training and Audits
Carol Vance MSN, RN, CIC
Multi-site Director, Infection Prevention
Advocate Children’s Hospital
Objectives
• Discuss the relationship between training, competency and audits.
• Provide concrete and practical solutions to training and competency challenges.
• Identify the key stake holders that are important for training and competency success.
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Infection Preventionist Daily Work
Infection Control Assessment and Response (ICAR) Program
• The Infection Control Assessment and Response Tools were developed by CDC
• Used by healthcare facilities to conduct internal quality improvement audits
• Assessment tools• Acute care (including short stay acute and long-
term acute care hospitals)• Outpatient• Long-term care• Hemodialysis
• Opportunity• Return demonstrations are not utilized to
demonstrate competency
• Recommendations• Risk assessment to review hand hygiene
compliance data to determine if instituting a return demonstration into position and/or department-specific annual competency/performance assessment checklists
Personal Protective Equipment (PPE)
• Opportunity• PPE training does not include information on or a
return demonstration of donning and doffing
• Recommendations• Training at hire and annually • Return demonstration
• validated by the preceptor in the clinical space
• Evaluate the benefit and feasibility of adding to annual skills day training and/or competency assessment
• CDC resources
PPE Utilization
• Opportunity• PPE selection and proper use are not monitored
• Recommendations• Hand hygiene compliance observers to collect PPE
compliance data• Utilize an app suggested for hand hygiene
observations that can also be used to collect PPE compliance data
• The University of Iowa. iScrub Lite. Available at: https://itunes.apple.com/us/app/iscrub-lite/id329764570?mt=8 Accessed August 11, 2017
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Prevention of CAUTI
Training
• Opportunity• Staff do not receive annual training on indwelling urinary
catheter insertion
• Recommendations• Minimum - include didactic information on insertion of
indwelling urinary catheters on an annual basis • The Joint Commission (TJC) National Patient Safety
Goal (NPSG) 07.06.01 • Annual insertion return demonstration for the
units/locations with the highest CDC National Healthcare Safety Network (NHSN) cumulative attributable difference (CAD) produced by the targeted assessment for prevention (TAP) report
Computer Based Training
• Opportunity• Annual training for insertion and maintenance of an
indwelling urinary catheter is computer based and does not include a return demonstration
• Recommendations• Utilize CAUTI outcome and process measures to
assess the need for return demonstration for insertion and maintenance on an annual basis
• Results may indicate that return demonstration would only be beneficial on certain units
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Insertion and Maintenance Audits• Opportunity
• Indwelling urinary catheter insertion and maintenance audits are not conducted and; therefore, feedback on performance is not provided to the frontline staff
• Recommendations• TJC NPSG.07.06.01 states that CAUTI process and
outcome measures should be collected • Infection prevention and control risk assessment
and/or the CDC NHSN CAD • Implementing a two-person • Feedback of the audit data and lessons learned
Prevention of CLABSI
Licensed Independent Practitioners (LIP)
• Opportunity• Licensed independent practitioners (LIP) do not
participate in an initial or annual standardized training and competency assessment program for insertion of central lines
• Recommendations• Standardizing central line insertion practices for LIPs• Central line insertion practices in the credentialing
process• Investigate the use of the simulation • The insertion checklist could be added to the LIPs
credentialing
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Audits and Maintenance
• Opportunity• Neither central line insertion nor maintenance audits are
conducted and; therefore, feedback on compliance with best practices cannot be provided
• Recommendations• Central line insertion checklist • TJC has examples of insertion checklists in their
CLABSI Toolkit • Explore use of the Electronic Medical Record for
documentation of the insertion checklist data and then leverage the electronic capture to produce reports on compliance
• Report compliance • Provide both metrics to frontline staff
Feed Back
• Opportunity• Insertion and maintenance audit data are collected,
but not routinely fed back to the frontline clinicians
• Recommendations• Utilize computer documentation to create reports to
provide the information to frontline staff• Feedback will inform staff of the gaps in practice
and progress of improvement efforts
Maintenance
• Opportunity• The facility does not have an annual competency
based training program for maintenance of central lines
• Recommendations• Consider the use of the NHSN CLABSI CAD to
target units for annual maintenance competency including return demonstration, particularly if surveillance data suggests CLABSIs are related to maintenance
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Prevention of Ventilator
Associated Events (VAE)
Training
• Opportunity• Formalized competency based training for
prevention of VAEs is not provided at hire or annually
• Recommendations• Collaborate with nursing and respiratory therapy to
develop a competency based training program for the prevention of VAEs
Injection Safety
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Training
• Opportunity• Staff do not receive training on safe injection
practices at hire or on an annual basis
• Recommendations• Patient safety component of Standard Precautions• CDC One and Only Campaign to initial and annual
training
Audits
• Opportunity• Safe injection practice audits are not completed
• Recommendations• Include injection safety tracers into environment of
care and/or regulatory rounds • Formal feedback to clinical staff and modify
education and competency to address identified gaps
• Random documented audits of scrub the hub protocols
• Engage unit champions to complete the audits • Provide feedback of the audits to frontline staff
Audit and Feed Back
• Opportunity• No formalized audit or feedback process has been
established for monitoring point of care testing or safe injection practices
• Recommendations• CDC-defined Training Programs and Audit
Processes section • Routinely share audit results with frontline staff. • Utilize the contracted pharmacy to assist with safe
injection practices audits
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Prevention of Clostridium difficle Infection (CDI)
• Opportunity• Recommended practices for prevention of CDI are
not audited
• Recommendations• Review the CDI CAD to focus improvement efforts• Discuss the use of best practices audits with the
CDI prevention team• Focusing audits on units with the highest CAD
• Identify gaps and allow for focused improvement initiatives
• Communicate feed back of audit results
Environmental Cleaning
• Opportunity• Surgery staff is responsible for cleaning and
disinfection of OR suites. Surgery staff have not received training for environmental cleaning and disinfection
• Recommendations• The EVS manager should provide education and
training to the surgery staff on how to use products and how to effectively clean and disinfect the OR space
• Document the training
Antibiotic Stewardship
• Opportunity• All clinical staff have not received antimicrobial
stewardship education
• Recommendations• Engage frontline staff • Educate them on the importance of antibiotic
stewardship and speaking up for judicious use of antibiotics
• Review the contract and roles/responsibilities of the pharmacist
• Research other possible resources to support stewardship
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StrengthsIdentified
During ICAR Visits
Training and Competency
• Each department performs an annual one-page risk assessment that includes but is not limited to
• High risk• High volume• Low volume • Pertinent data• Staff input to identify top three of ten competencies
per job code per year to target for education and training
Hand Hygiene
• The IP meets with all new employees and provides hand hygiene education during orientation
• Hand hygiene competency is assessed by return demonstration
• Glo Germ and ultraviolet light training tool • Annual training is provided by use of a
computer-based learning module
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Personal Protective Equipment (PPE)
• PPE use and compliance is being monitored by the secret shoppers who complete HH audits
• Infection preventionist has coined a saying, “no flourishing”
• The IP feels this has helped staff understand the concept of spreading germs or routes of transmission
• Prevention of CAUTI• Training and education for urinary catheter insertion
is done upon hire. Personnel are observed when they insert their first catheter
• Prevention of CLABSI• The central line insertion checklist is required to be
completed for all line insertions even if inserted by a CRNA or surgeon
• The IP receives all central line insertion checklists for review
• Any omissions or deviations are dealt with on an individual basis
Injection Safety
• The facility’s tracer team performs injection safety tracers in all clinical areas twice per year
• Tracer data are entered into a database for follow-up by appropriate managers
• Managers’ follow-up actions are tracked and trended
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Environmental Cleaning
• New EVS staff receive one-to-one training and shadow with a designated mentor until competency is demonstrated
• The IP uses Glo Germ powder and ultraviolet light technology to monitor surface cleaning
• The hospital has a well-developed orientation and training program for staff working in the environmental services (EVS) department
• New hires are paired with a trainer for one to two weeks
• The EVS manager validates skills
Ambulatory & Ambulatory Surgery Centers
• Training and Competency• All sterile reprocessing technicians are certified
through The International Association of Healthcare Central Service Material Management (IAHCSMM)
• Gastrointestinal (GI) endoscopy registered nurses (RNs) are cross-trained and rotate through pre/post, procedure and reprocessing areas. All training includes return demonstration
• Hand Hygiene• All HCP must demonstrate hand washing
competency during orientation
Questions?
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Resources
• Centers for Disease Control and Prevention. Infection Control Assessment Tool. https://www.cdc.gov/hai/prevent/infection-control-assessment-tools.html. Accessed April 18, 2017 Centers for Disease Control and Prevention. Infection Control Assessment Tool. https://www.cdc.gov/hai/prevent/infection-control-assessment-tools.html. Accessed April 18, 2017.
• Centers for Disease Control and Prevention. Sequence for Donning and Doffing Personal Protective Equipment. Available at: https://www.cdc.gov/HAI/pdfs/ppe/ppeposter148.pdf Accessed July 26, 2017.
• The University of Iowa. iScrub Lite. Available at: https://itunes.apple.com/us/app/iscrub-lite/id329764570?mt=8 Accessed August 11, 2017.
• The Joint Commission. National Patient Safety Goals, Hospital Accreditation Program. Goal 7, NPSG.07.06.01 EP1. January 2017. Available at: https://www.jointcommission.org/hap_2017_npsgs/ Accessed July 26, 2017.
• Centers for Disease Control and Prevention. The Targeted Assessment for Prevention (TAP) Strategy. Available at: https://www.cdc.gov/hai/prevent/tap.html Accessed July 20, 2017.
• The Joint Commission. National Patient Safety Goals, Hospital Accreditation Program. Goal 7, NPSG.07.06.01 EP1. January 2017. Available at: https://www.jointcommission.org/hap_2017_npsgs/ Accessed July 26, 2017.
• Centers for Disease Control and Prevention. The Targeted Assessment for Prevention (TAP) Strategy. Available at: https://www.cdc.gov/hai/prevent/tap.html Accessed July 20, 2017.
• The Joint Commission. CLABSI Toolkit- Chapter 3. Available at: https://www.jointcommission.org/topics/clabsi_toolkit__chapter_3.aspx Accessed July 27, 2017.
• Agency for Healthcare Research and Quality. Tools for Reducing Central Line-Associated Blood Stream Infections. Available at: https://www.ahrq.gov/professionals/education/curriculum-tools/clabsitools/index.html Accessed July 27, 2017.
• Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings Available at: https://www.cdc.gov/infectioncontrol/guidelines/isolation/ Accessed July 28, 2017.
• Centers for Disease Control and Prevention. One & Only Campaign. Available at: http://www.oneandonlycampaign.org/ Accessed July 20, 2017
• APIC professional and practice standards Tania N. Bubb, Corrianne Billings, Dorine Berriel-Cass, William Bridges, Lisa Caffery, Jennifer Cox, Moraima Rodriguez, Jessica Swanson, and others, American Journal of Infection Control, Vol. 44, Issue 7, p745–749 Published online: April 11, 2016