HAI DE QIA a.k.a. “ I nfection W atch 2014 ”

1. HAI DE QIAa.k.a. “InfectionWatch2014” April 3rd & 4th, 2014

2. Objectives • Introduce focus facilities to Network 14 HAI team • What is the goal of InfectionWatch 2014? • Discuss how focus facilities were selected • Educate focus facilities to the project • Augment NHSN reporting rights • Review observation tools: • Hand Hygiene • Catheter Connection & Disconnection • AVF/G Cannulation • Best practices for reporting • Utilization of new technology *Please utilize the chat function for questions* 2

3. Network 14 team • Dana Sissung, RN, MSN • dsissung@nw14.esrd.net • Kelly Shipley, BS, RHIA • kshipley@nw14.esrd.net • Nathan Muzos, BS, MCSE, MCSD, MCDBA • nmuzos@nw14.esrd.net • AparnaBiradar, BDS, MPH • abiradar@nw14.esrd.net • Jason Simmington, BS, MHS • jsimmington@nw14.esrd.net 3

4. Goals of this project • Reduce blood stream infections (BSI) in dialysis facilities by correctly implementing/performing infection control. Network 14 will do this by: • Encouraging/promoting CDC established BSI prevention practices and resources • Identify areas for improvements • Engage staff with regular feedback • Increase familiarity with CDC-recommended practices • Encourage habitual attention to and assessment of practices • Identify and address barriers to recommended practices 4

5. Strategy to bring national emphasis 5

6. Bloodstream infections and the QIP 6

7. How facilities are selected The selection of your facility into this project means your facility fell into one of these 3 groups. 7

8. Monthly facility actions • ≥ 30 hand hygiene observations • Collect data using CDC audit tool or the iScrub app • Report data to Network via email using Table 1 or via NHSN • ≥ 10 catheter connection/disconnection observations • Collect data using CDC audit tool • Report data to Network via email using Table 1 • ≥ 10 fistula/graft cannulation observations • Collect data using CDC audit tool • Report data to Network via email using Table 1 8

9. Using nhsn for HH surveillance • All focus facilities must confer rights in NHSN • Users with administrator rights see new data sharing request upon login to NHSN • Must accept new “Confer Rights” to share these data • Facilities will report HH data in NHSN • May need to modify existing Reporting Plans to include “HH” • Report HH under “Summary Data” 9

10. Accept new Confer Rights in NHSN • Users with administrator rights will see the new data sharing request when they log in to NHSN. 10

11. Accept new confer rights to share hh data 11

12. Accept new confer rights to share hh data

13. Add “HH” to monthly reporting plans “HH” needs to be checked manually. When the dialysis location is selected, “DE” is checked automatically. *If a Plan has already been saved, it can be edited to include “HH.” 13

14. Report Hand hygiene data 14

15. Report hand hygiene data

16. Benefits of NHSN for Hand Hygiene Surveillance • Single location for data • Allows for tracking of hand hygiene adherence over time • With Dialysis Event rate data • Networks have easier access to the data • Analysis options will be available in August 2014 16

17. Resources for NHSN Prevention process measures (PPM) http://www.cdc.gov/nhsn/dialysis/prevention-process-measures.html 17

18. NHsn additional PPM • Collection of additional prevention process measure summary data (i.e., numerator/denominator) in NHSN are tentatively planned for January 2015 • Hemodialysis catheter connection/disconnection • Hemodialysis catheter exit site care • Fistula and graft cannulation/decannulation • Environmental surface disinfection 18

19. Hand Hygiene observations • Hand hygiene audit tool can be printed from: http://www.cdc.gov/dialysis/prevention-tools/index.html • Data collection option: iScrub app for (iPhone & iPod Touch) • ≥ 30 observations are required/facility/month • The audit tool has two pages: • Page 1: Facility auditor collects and tallies observations • 3 copies to collect 30 observations • Page 2: Guide to hand hygiene opportunities in dialysis • Note: unit of observation is a hand hygiene opportunity 19

20. Hh: what facilities submit to the network • Facility monthly process: • Facility uses the hand hygiene audit tool to collect a minimum of 30 observations • Tallies numerator/denominator and either: • Submits this information to the Network via email OR • Uses NHSN to report hand hygiene audit results (encouraged) Number of successful hand hygiene opportunities observed Total number of hand hygiene opportunities observed during audits Numerator = Denominator = 20

21. Hh audit tool: page 1 Numerator Denominator

22. Hh audit tool: page 2

23. Catheter Connection/Disconnection Observations • Catheter connection/disconnection audit tool can be printed from: http://www.cdc.gov/dialysis/prevention-tools/index.html • ≥ 10 observations required/facility/month • The audit tool has one page: • Facility auditor collects and tallies observations • 2 copies necessary to collect 10 observations 23

24. Cath Connect/Disconnect: What Facilities Submit to the Network • Facility monthly process: • Facility uses the catheter connection/disconnection audit tool to collect a minimum of 10 observations • Tallies numerator/denominator • Submits this information to the Network via email Number of procedures performed correctly Total number of procedures observed during audits Numerator = Denominator = 24

25. Audit tool corresponds to CDC checklist http://www.cdc.gov/dialysis/PDFs/collaborative/CL_Hemodialysis-Catheter-Connection-508.pdf http://www.cdc.gov/dialysis/PDFs/collaborative/CL-Hemodialysis-Catheter-Disconnection-508.pdf

26. Cath connect/disconnect audit tool C N P PPPP P P= P Numerator Denominator

27. Fistula/Graft Cannulation Observations • Fistula/ graft cannulation audit tool can be printed from: http://www.cdc.gov/dialysis/prevention-tools/index.html • ≥ 10 observations required/facility/month • The audit tool has two pages: • Page 1: Cannulation observations • 2 copies necessary to collect the minimum 10 observations • Facility auditor collects and tallies observations • Page 2: Decannulation observations • Decannulation auditing is NOT part of the QIA 27

28. Fistula/Graft Cannulation: What Facilities Submit to the Network • Facility monthly process: • Facility uses the fistula/graft cannulation audit tool to collect a minimum of 10 observations • Tallies numerator/denominator • Submits this information to the Network via email Number of procedures performed correctly Total number of procedures observed during audits Numerator = Denominator = 28

29. Audit Tool Corresponds to the cdc AVF/G Cannulation Checklist http://www.cdc.gov/dialysis/PDFs/collaborative/AV-Fistula-Graft-Cannulation-Observations.pdf

30. AVF/G cannulation audit tool T PPPPPPPPPP= P Numerator Denominator

31. How will you submit to the Network? 31

32. 32

33. Suggestions for Facility Auditors • First, understand the recommended steps and then practice using the tools • Auditors should try to ensure that observations are as representative as possible of normal practice at the facility • E.g., observe different staff members on different days and shifts • For hand hygiene • Consider observing during busy times, such as during shift change • Try to select an area of the unit where staff interactions with patients are clearly visible 33

34. Implementation Guidance • There are multiple methods of auditing practices • E.g., for hand hygiene, focusing closely on 1 - 2 patient stations at a time vs. broadly monitoring many stations at once • Covert monitoring may provide more realistic assessment of practices (for hand hygiene, e.g.) • But may be difficult or impossible to do for vascular access care audits • Auditors may have to experiment to find the observation methods that work best for them 34

35. Timeline for submissions 35

36. Most important • Facilities must submit the required data on or before the stated deadline. Failure to do so can result in a facility being reported to CMS for failure to support Network Goals. 36

37. Ongoing communication • Network 14 will be setting up a communication process such as “lunch & learn” conferences where facilities can learn from one another • Share any suggestions with us regarding best practices or even failures. We can all learn from each other. 37

38. New Technology: • iScrub Lite 1.5.1 • A free hand hygiene application for the Apple iPhone/iPod Touch. You many download the app directly from the iTunes app store via your device or download via iTunes. • Gives you the ability to both record observations and email them to a centralized account. (Not the Network) 38

39. Customizing the app 39

40. Recording observations 40

41. Notes can be added 41

42. Email observations to yourself or to a central account 42

43. Additional Resources for Facilities • Best Practices Video • Covers hand hygiene, catheter connection/disconnection, and fistula/graft cannulation • Procedure steps mirror the checklists • http://www.cdc.gov/dialysis/prevention-tools/training-video.html • Catheter Scrub-the-hub Protocol • Key step in catheter connection/disconnection • http://www.cdc.gov/dialysis/PDFs/collaborative/Hemodialysis-Central-Venous-Catheter-STH-Protocol.pdf • Checklist tools • http://www.cdc.gov/dialysis/prevention-tools/index.html • Hand Hygiene Observation Protocol • http://www.cdc.gov/dialysis/prevention-tools/Protocol-hand-hygiene-glove-observations.html 43

44. Thank you for participating The webinar and audit tools will be on the Network 14 website, on the NHSN page that can be found under the “Professionals” tab. Or you can use the following web address: http://www.esrdnetwork.org/professionals/NHSN.asp 44