Standardization Of Infection Control Protocols In The .

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Standardization of Infection Control Protocols inthe Ambulatory Surgery Center (ASC)MODERATED BY CATHY BRETT, ASC COMMUNICATIONS, INC.BECKER’S ASC REVIEWMARCH 14, 2013Funding Provided by CareFusion

TODAY’S PRESENTERSChuck Peck, MDTK Miller, MDManaging Director,Navigant ConsultingAssociate Professor of Surgery VirginiaTech/Carillion School of MedicineLeader of Clinical and OperationalEffectivenessMedical Director,Roanoke Ambulatory Surgery CenterMedical Director,Carillion Outpatient Surgery

“The overall burden of HAIs in outpatient settings is unknown; however, it isevident from the infections that have been identified that it is a significantproblem resulting from very basic infection control failures.”Health and Human Services press releaseJuly 2009

LEARNING OBJECTIVESDescribe howinfectionpreventionprotocols canhelp the ASCdemonstratequality of careReview currentinfectionpreventionguidelinesExplain how todesign andimplement astandardizedinfectionpreventionprotocol for yourASC thatcomplies withguidelinesUnderstand howto engage staffto promotecompliance withguidelines andspecificprotocols at yourfacilityImprove quality of patient care and cost effectiveness in ASC

THE HEALTHCARE-ASSOCIATED INFECTION (HAI) PROBLEM According to U.S. Centers for Disease Control and Prevention (CDC):– 1.7 million people acquire HAIs each year Result: approximately 271 deaths per day One-third of HAIs are considered preventableApproximately 566,000 preventable HAIs 100,000people

THE PROBLEM OF HAIS IN ASCS By the numbers:– 5,000 centers in the U.S.– 6 million surgeries annually performed More than three-quarters of all operations in the U.S. are performed on an outpatient basis CDC has noted an increase in HAIs in outpatient settings, which it attributed to“unsafe medical practices”

WHY ASCS SHOULD STANDARDIZEINFECTION PREVENTION PROTOCOLS A 2010 CDC report found among a sample of ASCs in 3 states, lapses in infectioncontrol were common and could potentially put patients at risk Standardization could help eliminate variability in processes and help HCPsimplement evidence-based, proven products that could result in:– Less waste– Fewer errors– Better quality outcomes– Increased cost effectiveness– Prevented medication errors and HAIs

CDC GUIDELINES OUTLINE EFFECTIVE APPROACH TOINFECTION CONTROL Patients should take an antiseptic shower or bath the day beforethe procedure If hair removal is deemed necessary, clip immediately beforesurgery The skin at the site of the incision should be prepared with anantiseptic; preferred agents should provide rapid, persistent,broad-spectrum antimicrobial activity Surgical team personnel should wash their arms and forearmswith an antiseptic solution before putting on sterile gloves andgowns Healthcare organizations must implement policies to preventtransmission from personnel to patients An antimicrobial prophylaxis should be administered before anoperation begins, typically via intravenous infusion

CDC PROVIDES ADMINISTRATIVE RECOMMENDATIONS FOR ASCS1.2.3.4.Develop and maintain infection prevention andoccupational programsAssure sufficient and appropriate supplies necessary foradherence to Precautions (e.g., hand hygiene personalprotective equipment, equipment)Assure at least one individual in infection prevention isregularly available to the facilityDevelop written infection policies and proceduresappropriate for the services provided, and based uponevidence-based regulations or standards

CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS)DEMAND INFECTION CONTROLIn May 2009 CMS began enforcing newConditions for Coverage for ASCs that require adherenceto several revised infection control practices

CMS CONDITIONS FOR COVERAGE The ASC must maintain an infection control program that seeks to minimize infections andcommunicable diseases (416.51) The Infection Control Plan must address all of the following: Maintenance of a sanitary environment (416.44a – Physical Environment)Development/implementation of IC measures related to ASC personnelMitigation of risks associated with patient infections present upon admissionMitigation of risks contributing to HAIsActive surveillanceMonitoring compliance with all policies/procedures/protocols and other program requirements(i.e., 416.48a – Administration of Drugs) Plan evaluation and revision when indicated Coordination as required by law with federal, state and local emergency preparedness and healthauthorities to address communicable and infectious disease threats and outbreaks Compliance with reportable disease requirements of the local health authority

CMS CONDITIONS FOR COVERAGE, CONTINUED 416.51(b) - Must designate in writing a qualified,licensed healthcare professional to lead theinfection control program Utilize a job description specifically for theInfection Control Officer Certification for the individual is not required(unless specified by State laws (e.g., NJ)) Must have documentation that this person has training that qualifies them to lead anInfection Control Program (e.g., ongoing education/training such as IC courses,participation in local and/or national meetings such as APIC) Questions to consider in your ASC: Is there documentation of the training that qualifies this individual to lead an infectioncontrol program? Do you have a log sheet that documents the time this person spends working on theinfection control program?

CHALLENGES IN STANDARDIZINGASC INFECTION CONTROL PROTOCOLS In ASCs, there is high risk of inconsistencies, which are a big threat in infectionprevention:– Many different doctors– Surgeries can span across many different sub-specialties Orthopaedic, OB/GYN, cardiology, vascular, urology– Sub-specialties may have different habits or methods Surveillance for outcome measures in ASCs is challenging because:– Patient encounters may be brief or sporadic– Evaluation and treatment of consequent infections mayinvolve different healthcare settings (e.g., hospitals)

ESTABLISH A COMPLETE APPROACH TOIMPLEMENTATION AND EVALUATION

4 PILLARS OF ESTABLISHING A STANDARDIZEDINFECTION CONTROL PROGRAM IN ASCS1. Understand the Culture of theCommunity2. Understand the Culture of the ASC3. Comply with Regulatory Guidelinesand Policies4. Monitor and Track Infections

1UNDERSTAND THE CULTURE OF THE COMMUNITY Survey and know your community to know where the high risk patientslive/frequent Make sure you avoid or take extra precautions with these patients

2UNDERSTAND THE CULTURE OF THE ASC Instill a culture of infection prevention–Exclude any infected wounds–Provide multiple hand cleaning stations–Ensure cleaning rooms follow HIPPA standards Maintain as close to cycle cleaning as possible, regardless of ASC setting–Reduce the number of people entering the surgery areas–Make sure IP is a part of all staff materials–Promote IP culture to all new staff and reinforce standards

2EMPLOYEE HEALTH IN THE ASC Infection prevention starts with the staff– Maintain current facility protocols pertaining to communicable diseases(i.e., potential flu outbreaks and employee immunizations) as well asP&P’s for “sick time”– Follow current state-specific & CDC guidelines for TB– If employee job functions change, perform another OSHA risk assessment– Revisit exposure control plan annually; ensure that facility policy/procedurespertaining to “exposure incidents” are reflective of current practice– Appropriate record keeping is a must!

3COMPLY WITH REGULATORY GUIDELINES AND POLICIESImportant areas for ongoing assessment: Basic elements of infection prevention––––Hand hygiene and surgical hand antisepsisNails, jewelry and glovesSkin antisepsisInjections, infusions and medications Role of the environment Cleaning, disinfection and sterilization

3

–Perioperative Standards and Recommended Practices (AORN) –Guidelines issues by a specialty surgical society/organization (List) 3 . HAND HYGIENE & SURGICAL HAND ANTISEPSIS ARE THE FIRST LINES OF DEFENSE Hand Hygiene: A general term that applies to either hand washing, antiseptic hand

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