Surveillance Exercise Long-Term Care Ruth Anne Rye October, 2015.

Surveillance Exercise

Long-Term Care

Ruth Anne Rye

October, 2015

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New Hire Orientation All Employees Staff SpecificOngoing Regulatory Mandate Task-specific Facility-determined

Pre-placement evaluationRoutine screeningWork restrictions Exposure managementImmunizationPersonal hygiene

Blood Stream - Eyes, Ears & ThroatGastrointestinal, Genitourinary Tract -

SkinRespiratory Tract –

Central Nervous System

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Dental Service Dietary Services Equipment: Cleaning Disinfection/Sterilization Environmental Cleaning & Pest Management Emergency preparedness Facility operations; air, water construction/renovation Laboratory/Pathology Linen/Laundry Personal care services Rehabilitation Services Service animals; Pet therapy Waste management

EmployeeHealth

Prevention & Control

Body System Review

Leadership

Education

Clin

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Surveillance/PerformanceMeasurement

MI MODEL:INFECTION PREVENTIONPROGRAM

MSIPC Revised 2014

Scope: processes & outcomesPatient:: Community & Healthcare- Associated Infection (HAI)Personnel: Health & Injury Prevention Environment of Care (EOC)Outbreak and Sentinel Events

Philosophy-Authority-ResponsibilityPatient & Personnel Safety CultureOversight: Function and CommitteesPerformance ImprovementRegulatory ComplianceCommunity Standards of Care

Antimicrobial use AsepsisPatient Care PlanContinuum of careHand HygieneImmunizationPrecautions/Isolation

Surveillance/PerformanceMeasurement: What is it?

Surveillance is a systematic, active, ongoing method of collecting, consolidating, andanalyzing data concerning the distribution, and determinants of a given disease or event,followed by dissemination of that informationto those who can improve outcomes.

Surveillance/PerformanceMeasurement IS

• Essential component of effective programs designed to reduce the frequency of adverse effects such as infection.• Demonstration of quality health care that includes documentation of outcomes of care. • Comprehensive method of measuring outcomes, and related processes of care, analyzing the data and providing information to members of the health care team to assist in improving these outcomes

Why surveillance/performance measurement?

• Establish baselines• Prevent or improve outcomes and improve quality of care• Identify potential problems• Educate staff• Meet regulatory requirements

Types of Surveillance

• Outcome – infection (meeting surveillance definition/criteria)

Total S.– every resident, every day Targeted Surveillance

• Process: Standardized collection of data regarding the infection prevention practices used in the facility i.e adherence to policy, procedure, process, protocol

Surveillance/PerformanceMeasurement is NOT

• Medical diagnosis/clinical picture• Assessment of antibiotic use• Assessment of care • “Gut” feeling

PROCESS: Recommended Practice 1. Assess the population2. Select the outcome or process for surveillance3. Using surveillance definitions4. Collect surveillance data5. Calculate and analyze surveillance rates6. Applying risk stratification methodology7. Report and use surveillance information

Reference: APIC. 2007 Recommended practices for surveillance: Association for Professionals in Infection Control and Epidemiology (APIC), Inc

Step 1 – Assess population and environment

Patient demographics (age, gender, Patient demographics (age, gender, socioeconomic status)socioeconomic status)

Patient clinical characteristics (most frequent Patient clinical characteristics (most frequent diagnoses and co-morbidities, most frequent diagnoses and co-morbidities, most frequent and most rarely performed procedures, medical and most rarely performed procedures, medical treatments)treatments)

Characteristics of HCP (knowledge and training)Characteristics of HCP (knowledge and training) Facility characteristics (physical size, age, Facility characteristics (physical size, age,

condition, single or shared rooms, geographic condition, single or shared rooms, geographic location)location)

Do you have existing surveillance data?Do you have existing surveillance data?

Lee TB, et al. AJIC 2007

Step 2 – Select Indicators/Metrics to Measure: Process, Outcome…

Use facility-specific risk assessmentUse facility-specific risk assessment Search the literature for relevant studies that apply to Search the literature for relevant studies that apply to your patient populationyour patient population

– http://www.ncbi.nlm.nih.gov/pubmed What are most likely HAI issues?What are most likely HAI issues?

– Frequency, cost, reg./accred. requirement, PI projectFrequency, cost, reg./accred. requirement, PI project Examples:Examples:

ProcessProcess: % residents & HCP rec’d flu vax., % Abx use for: % residents & HCP rec’d flu vax., % Abx use forASB, Hand hygiene adherence, adherence to resident TSTASB, Hand hygiene adherence, adherence to resident TSTand vaccination policyand vaccination policyOutcome Outcome (infection)(infection): CAUTI, pneumonia, etc.: CAUTI, pneumonia, etc.

Lee TB, et al. AJIC 2007

Step 3 – Use Valid, Reproducible Surveillance Criteria

Acute & Ambulatory Care: CDC’s National Healthcare Acute & Ambulatory Care: CDC’s National Healthcare Safety Network (NHSN); ww.cdc.gov/nhsnSafety Network (NHSN); ww.cdc.gov/nhsn

Long Term Care: Revised McGeer;Stone ND, et al. Long Term Care: Revised McGeer;Stone ND, et al. Infect Control Hosp Epidemiol 2012;33:965-77 Infect Control Hosp Epidemiol 2012;33:965-77

Home Care & Hospice: APIC-HICPAC, 2008. Available Home Care & Hospice: APIC-HICPAC, 2008. Available from from http://www.apic.org

Consider performing a Consider performing a ““Point or period Point or period PrevalencePrevalence”” or even simple line listing to or even simple line listing to establish baseline frequency if existing data are establish baseline frequency if existing data are not availablenot available

Lee TB, et al. AJIC 2007

Key Terms & Concepts Term Definition

HAI An infection is considered an HAI if all elements of a CDC/NHSN site-specific infection criterion were first present togetheron or after the 3rd hospital day (day of hospital admission is day 1). For an HAI, an element of the infection criterion maybe present during the first 2 hospital days as long as it is also present on or after day 3. All elements used to meet theinfection criterion must occur within a timeframe that does not exceed a gap of 1 calendar day between elements.

Device-associated infection

An infection meeting the HAI definition is considered a device-associated HAI if the device was in place for >2 calendardays when all elements of a CDC/NHSN site-specific infection criterion were first present together. HAIs occurring on theday of device discontinuation or the following calendar day are considered device-associated HAIs if the device had beenin place already for >2 calendar days.

Date of Event For an HAI (excludes VAE), the date of event is the date when the last element used to meet the CDC/NHSN site-specificinfection criterion occurred

Key Terms & Concepts Term Definition

Transfer Rule If all elements of an HAI are present within 2 calendar days of transfer from one inpatient location to another in the same facility (i.e., on the day of transfer or the next day), the HAI is attributed to the transferring location.Likewise, if all elements of an HAI are present within 2 calendar days of transfer from one inpatient facility to another, the HAI is attributed to the transferring facility. Receiving facilities should share information about such HAIs with the transferring facility to enable reporting.

Step 4 – Collect HAI Data Data collectionData collection – S&S handout – S&S handout McGeer’s Revised definitionsMcGeer’s Revised definitions Selected CDC definitionsSelected CDC definitions Consider NHSN enrollment– LTCConsider NHSN enrollment– LTC (see NHSN LTC(see NHSN LTC handout)handout)

- EXERCISE EXERCISE HANDOUTHANDOUT - -

Surveillance definitions

“Surveillance definitions are not the same as clinical diagnosis.” (APIC LTC Text 2014)

ICD9 or (CD 10 codes) for infections differ from LTC standard definitions.

2012 Society for Healthcare Eidemiology of America (SHEA) and CDC updated McGeer’s criteria. “These definitions provide a reference standard for defining infections for surveillance purposes and provide the basis for any surveillance activities.”

Surveillance, continued

“ ….. Must apply criteria precisely. It should be noted that criteria used to define a case for surveillance purposes may be different than criteria used clinically for diagnosis and treatment. Surveillance definitions were developed for epidemiologic surveillance and not for diagnostic purposes”

Step 5 – Calculate and analyze surveillance rates

– HANDOUT - HANDOUT -

Step 6 – Apply Risk Stratification to Data

BenchmarkingBenchmarking – Comparing your data to – Comparing your data to other facilitiesother facilities Unless you are enrolled in NHSN LTC, or with a Unless you are enrolled in NHSN LTC, or with a group of similar facilities – definitions, training, group of similar facilities – definitions, training, over time, etc. there is no format for comparisonover time, etc. there is no format for comparison

Incorporate HAI data into facility and health Incorporate HAI data into facility and health system monthly/quarterly patient safety quality system monthly/quarterly patient safety quality reporting, and committee as applicablereporting, and committee as applicable

Reporting data to MDCH Sharp Unit & CMS Reporting data to MDCH Sharp Unit & CMS – Permit access to MI-Specific HAI experiencePermit access to MI-Specific HAI experience– Fulfills incentive-based reimbursement from Fulfills incentive-based reimbursement from

CMSCMS Be consistent in timelines for reporting to key Be consistent in timelines for reporting to key

personnel and other entities (all stakeholders)personnel and other entities (all stakeholders) The most important step in the surveillance The most important step in the surveillance

process – data for improvement at the local process – data for improvement at the local level is first step in improving carelevel is first step in improving care

Step 7 – Reporting & Using HAI Surveillance Data

Surveillanceaka Performance Measurement

Annual facility Surveillance Plan Definitions (criteria) of infections, include resource Process: data collection, recording - worksheet, log,

meet criteria?, analysis, display, reporting/sharing, action

Interviewer (me): Explain data collection. Most prevalent infection? What strategies have you used to prevent? What types of surveillance? How do you share with those who need to know – referred to as stakeholders?