HAI DE QIA
A.K.A. “I NFECTION W ATCH 2014”
April 3 rd &
4 th , 2014
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*
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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
 Aparna Biradar, BDS, MPH
 abiradar@nw14.esrd.net
 Jason Simmington, BS, MHS
 jsimmington@nw14.esrd.net
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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
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STRATEGY TO BRING NATIONAL
EMPHASIS
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BLOODSTREAM INFECTIONS AND THE QIP
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HOW FACILITIES ARE SELECTED
The selection
of your facility
into this
project means
your facility
fell into one of
these 3
groups.
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MONTHLY FACILIT Y 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
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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”
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ACCEPT NEW CONFER RIGHTS IN NHSN
Users with
administrator rights
will see the new
data sharing
request when they
log in to NHSN.
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ACCEPT NEW CONFER RIGHTS TO SHARE
HH DATA
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ACCEPT NEW CONFER RIGHTS TO SHARE
HH DATA
ADD “HH” TO MONTHLY REPORTING
PLANS
When the dialysis
location is selected,
“DE” is checked
automatically.
*If a Plan has already been saved, it
can be edited to include “HH.”
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“HH” needs to
be checked
manually.
REPORT HAND HYGIENE DATA
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REPORT HAND HYGIENE DATA
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
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RESOURCES FOR NHSN PREVENTION
PROCESS MEASURES (PPM)
http://www.cdc.gov/nhsn/dialysis/prevention-process-measures.html
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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
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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
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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)
Numerator =
Number of successful hand hygiene
opportunities observed
Denominator =
Total number of hand hygiene
opportunities observed during audits
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HH AUDIT TOOL: PAGE 1
Numerator
Denominator
HH AUDIT TOOL: PAGE 2
CATHETER CONNECTION/DISCONNECTION
OBSERVATIONS
Catheter connection/disconnection audit tool
can be printed from:
http://www.cdc.gov/dialysis/preventiontools/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
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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
Numerator =
Denominator =
Number of procedures performed
correctly
Total number of procedures
observed during audits
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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
CATH CONNECT/DISCONNECT AUDIT TOOL
C
N
P
P
P P
P
P P
=P
Numerator
Denominator
FISTULA/GRAFT CANNULATION
OBSERVATIONS
 Fistula/ graft cannulation audit tool can be printed
from: http://www.cdc.gov/dialysis/preventiontools/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
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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
Numerator =
correctly
Denominator =
Total number of procedures
observed during audits
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AUDIT TOOL CORRESPONDS TO THE CDC
AVF/G CANNULATION CHECKLIST
http://www.cdc.gov/dialysis/PDFs/collaborative/AV-Fistula-Graft-Cannulation-Observations.pdf
AVF/G CANNULATION AUDIT TOOL
T
P
P
P
P
P
P
P
P
P P
=P
Numerator
Denominator
HOW WILL YOU SUBMIT TO THE
NETWORK?
Numerator
Denominator
OR
Hand Hygiene
Catheter
Connection/
Disconnection
Fistula/ Graft
Cannulation
# of Successful Hand
Hygiene Opportunities
Observed
# of Procedures
Performed
Correctly
# of Procedures
Performed
Correctly
Total # of Hand
Hygiene Opportunities
Observed During Audit
Total # of
Procedures
Observed During
Audit
Total # of
Procedures
Observed During
Audit
 NHSN Used
Comments (common breaches identified; challenges in implementing the audits):
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SUGGESTIONS FOR FACILIT Y 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
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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
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TIMELINE FOR SUBMISSIONS
HAI DE QIA FOCUS FACILITY (FF) TIMELINE
MAY
DUE
JUNE
DUE
JULY
DUE
AUG SEPT
DUE DUE
OCT NOV DEC
DUE DUE DUE
Hand Hygiene audit tallies due to NW
5/1
6/1
7/1
8/1
9/1
10/1 11/1 12/1
CVC audit tallies due to NW
5/1
6/1
7/1
8/1
9/1
10/1 11/1 12/1
AVF/G audit tallies due to NW
5/1
6/1
7/1
8/1
9/1
10/1 11/1 12/1
PHASE DESCRIPTION
HAI DE QIA Roll-Out Webinar
FF STAFF
RESPONSIBLE
APR
DUE
NW 14 & FF
4/3 &
4/4
FF deadline to accept Network 14 NHSN confer
rights template
4/7
FF Designate Auditors
4/7
FF Auditors Review CDC audit
protocols/guidelines
4/7
Focus Facility HAI QIA audits begin
4/7
HAI QIA Project Wrap Up (Webinar)
NW 14 & FF
12/18
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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.
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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.
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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)
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CUSTOMIZING THE APP
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RECORDING OBSERVATIONS
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NOTES CAN BE ADDED
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EMAIL OBSERVATIONS TO YOURSELF OR
TO A CENTRAL ACCOUNT
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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-hygieneglove-observations.html
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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
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