Core Interventions

February Rollout

Deb DeWalt MSN, RN Susan Swan-Blohm BS, OCDT

February 10, 2018

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p. 2

Agenda

Infection/ Sepsis

CDC Core Interventions /calendar of release

Hand Hygiene

Patient Engagement and Education

Catheter Care

Scrub the Hub

Patient Ambassadors

“Days Since Last Blood Stream Infection” Poster

p. 3

Infection An infection occurs when germs enter the body, increase in

number, and cause a reaction of the body.

Three things are necessary for an infection to occur:

• Source: is an infectious agent or germ and refers to a

virus, bacteria, or other microbe.

• Susceptible person: someone who is not vaccinated or

otherwise immune, or a person with a weakened immune

system who has a way for the germs to enter the body

• Transmission: refers to the way germs are moved to the

susceptible person

p. 4

Sepsis

• Sepsis is the body’s extreme response to an infection. It is

life-threatening and without timely treatment can rapidly

cause tissue damage, organ failure, and death.

• Sepsis is a medical emergency. Time matters

The Facts:

• 5% of all hospitalized patients will get an infection which

may lead to sepsis

• 12-25% of all diagnosed sepsis will end in death

• Over 80% of all sepsis deaths could be prevented

with rapid diagnosis and treatment

• Only 55% of all adults in the United States have heard of

sepsis

p. 5

Signs and symptoms Symptoms of sepsis can include a combination of any of

the following:

• Confusion or disorientation

• Shortness of breath

• High heart rate

• Fever, or shivering, or feeling very cold

• Extreme pain or discomfort

• Clammy or sweaty skin

• Hypotension (low blood pressure)

p. 6

What to

look

for……

Sepsis Identification https://www.cdc.gov/sepsis/get-ahead-of-sepsis/patient-resources.html

p. 7

NHSN Reportable Infection Processes

Three types of dialysis events that are reported

• IV antimicrobial start

• Positive blood culture

• Pus, redness, or increased swelling at the Vascular access site

p. 8

***One facility staff member must complete the

NHSN training an sign the attestation

May 1, 2018

https://nhsn.cdc.gov/nhsntraining/courses/2016/C18

CORE

Interventions

9 CDC Core Interventions

• Bloodstream infections are the number 2 killer of dialysis patients, and according to the CDC

• BSI could be reduced by half if dialysis facilities implemented the CDC Core Interventions for Dialysis Bloodstream Infection Prevention

• 75,000 people receive hemodialysis through a central line. Central lines have a higher risk of infection than a fistula or graft.

• The CDC estimates that 37,000 central line-associated bloodstream infections may have occurred in U.S. hemodialysis patients in 2008.

p. 10

Project Calendar / Core Interventions Rollout

p. 11

Month Core Intervention

February Patient Engagement/Handwashing

March Catheter Care/Scrub the Hub

April Vascular Access/NHSN Education

May Staff competency Audits/Antimicrobial Ointment

June Surface Disinfection/Chlorohexidine

Hand Hygiene

Hand Hygiene Observations

Perform observations of hand hygiene opportunities monthly and share

results with clinical staff. See Observation Protocols for Hand Hygiene &

Glove Use on the CDC website.

• Ten observation per month, document in NHSN

p. 13

Hand Hygiene Resources

CDC Clean Hands Campaign

https://www.cdc.gov/handhygiene/campaign/promotional.html

World Health Organization Five Moments for Hand Hygiene

CDC Clean Hands Save Lives

https://www.cdc.gov/handwashing/

p. 14

http://www.who.int/gpsc/tools/Five_moments/en/

Patient

Engagement /

Education

CDC Core Intervention – Patient education/engagement

Provide standardized education to all patients on infection

prevention topics including vascular access care, hand

hygiene, risks related to catheter use, recognizing signs of

infection, and instructions for access management when away from the dialysis unit. See Patient Education on this website.

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Look, Listen and Feel

• Protect the access you have

• Identify changes to your

access

p. 17

https://esrdncc.org/contentassets/188bfd9be4a7

4cfca354d9dad6ee407a/70.-patient-complete-

guide_508.pdf

Links to Patient Education Information

https://www.cdc.gov/dialysis/prevention-tools/core-interventions.html

https://www.cdc.gov/dialysis/coalition/index.html

Forms and Informational CDC Publications

https://wwwn.cdc.gov/pubs/CDCInfoOnDemand.aspx?ProgramID=137

p. 18

Catheter Care

Catheter Care

Perform observations of vascular access care and catheter accessing

quarterly. Assess staff adherence to aseptic technique when connecting

and disconnecting catheters and during dressing changes. Share results

with clinical staff.

• Perform 10 observations per month

• Catheter dressing change technique – includes correct performance of

hand hygiene, and use of gloves, and correct use of antiseptics

(proper application and allow drying, etc).

https://www.cdc.gov/dialysis/prevention-tools/audit-tools.html

p. 20

Scrub the Hub

Scrub the Hub Scrub catheter hubs with an appropriate antiseptic after cap is removed and before

accessing. Perform every time catheter is accessed or disconnected. If closed

needleless connector device is used, disinfect connector device per manufacturer’s

instructions

• greater than 0.5% chlorhexidine with alcohol, 70% alcohol, or 10%

povidone-iodine

https://www.cdc.gov/dialysis/prevention-tools/audit-tools.html

https://www.cdc.gov/dialysis/PDFs/collaborative/Protocol-Hub-Cleaning-FINAL-3-12.pdf

p. 22

Policy Review

• Identify Facility Vascular access policies

• Review with staff

• Establish and sign off competencies

p. 23

Patient

Ambassadors

Patient Ambassador

Patient Ambassador Role

Patient, family member, or care giver that participate as members of the health care team achieve better clinical outcomes more readily

Facility Requirement

Facility required to designate a minimum of one patient, or preferably, one patient per shift to assist with this QIA project.

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Role of the Patient Ambassador

• Become a vital member of the healthcare team

• Perform CDC Core intervention Audits, reporting findings to QAPI

team and facility management

• Distribute materials: Look Listen and Feel, Sepsis Identification

• Assist with lobby days

• Prepare an educational bulletin board

• Attend National LAN calls, PAC calls, or Network educational calls

and share the information with the facility team and patients in the

facility

• Update the facility “Days Since Last Bloodstream Infection Poster”

with the help of the facility management

p. 26

Patient Story

Larrine Redmond

Days Since Last

Infection Poster

Days Since Last BSI Poster

• Maintain unit records of all infections

• Report NHSN numerator and denominator

monthly

• Display and Update “Days Since Last Blood

Stream Infection” Poster

• Perform an RCA for each infection identified

• Discuss results of RCA with facility staff and

QAPI team

• Determine barriers and plan interventions for

success

https://www.cdc.gov/dialysis/coalition/

p. 29

Any Questions ?

p. 30

Thank You

for attending today’s

presentation

Deb DeWalt, MSN, RN Sue Swan-Blohm, BS, OCDT

Quality Improvement Director Quality Improvement Coordinator

216-755-3053 216-755-3054

ddewalt@nw9.esrd.net sswan-blohm@nw9.esrd.net

http://network9.esrd.ipro.org/