Infection Prevention Assessment Visits

Jane Thornell RN, CICMassachusetts Department of Public Health

Central Line Measures

• Many programs are excited about their rates! • Majority of programs have process checklists in place.• Some had been tracking compliance of “bundle” data

for some time. • Many ICU/CCU’s have a dedicated Line Cart or an

all inclusive insertion kit.• Many programs have identified alternate resources to

aid in summary (denominator) data collection i.e. extenders, clinical resources, automated counts.

• Several programs began using device days as of July 1st 2008

VAP Process measures

• Majority of programs have process checklists in place.

• Some had been tracking compliance of “bundle” data for some time.

• All speak of difficulty with NHSN VAP definition and the lively discussions that ensue with the intensivists over this measure!

• NHSN provides the “Attachment A” for surveillance purposes

Hand Hygiene

• Variable rates of compliance • Data collection is challenging• Clever, economical and memorable approaches

to improve Hand Hygiene compliance• Hand Stations are very visible• Programs struggle to keep the approaches fresh,

new, and to involve staff (see the Monograph!)• Monitors include direct observations, product

volume, surveys of patient satisfaction results

Program Opportunities

• Environment of Care:-Antiquated buildings to “state of the art” facilities-Immaculate to very tired looking environments-Challenging, mixed use, or inadequate storage to central core supply stations and “Nurse Servers”

Equipment Cleaning:-Inconsistent or non-existent systems for identifying cleaned “rolling stock” equipment

• Compliance with Sharps Safety- Approximately 60% found to have non-safety products readily available-2000 Massachusetts law (HB 5794) that requires ‘the use, at all acute and non-acute hospitals of only such devices which minimize the risk of injury to health care workers from needle sticks and sharps. ” -New waiver procedure for select items

• Infection Control Risk Assessment (ICRA) Pre-construction -Some programs report inconsistent notification of projects

-Shaded the floor plan to indicate sensitive areas for project managers

• Education in Infection Prevention Standards-Many programs do not include Hospitalists in Infection Control and Prevention orientation

NHSN Reporting

• Keeping up two surveillance systems

• NHSN support staff is “responsive”

• Many programs entering individual surgical procedures manually!

• Some confusion in entering events

• Data Management varies widely

Infection Preventionist

Few programs meet Expert Panel recommendations for staffing.

Numerous programs with 1 ICP operation Limited, if any, discretionary funds for IP’s. Many IP’s with a variety of additional roles Universal concern with decreasing visibility of

Infection Preventionists Numerous hospitals in “right sizing” “re-

engineering” mode

Extraordinary professionals!Extraordinary professionals!