scholarly journals Surviving and Thriving Immediate Jeopardy in Infection Control from the Centers for Medicare and Medicaid

2020 ◽  
Vol 41 (S1) ◽  
pp. s400-s401
Author(s):  
Constance J Cutler
Keyword(s):  
Infection Control ◽  
Clinical Laboratory ◽  
Test Strip ◽  
Ambulatory Setting ◽  
List Type ◽  
Care Hospital ◽  
Patient Death ◽  
Large Hospital ◽  
Train The Trainer ◽  
Blood Bag

Background: Because of a patient death from a blood transfusion, a large hospital in Houston, Texas, underwent one of the largest unannounced CMS surveys in 2019. Methods: A 520-bed quaternary-care hospital was surveyed in one of the nation’s largest CMS surveys in March 2019, with a resurvey in June 2019. In an anticipated but unannounced arrival, ∼30 CMS surveyors evaluated the hospital and 10 Clinical Laboratory Improvement Amendments surveyors looked at the laboratory. They stayed for 11 consecutive days in March. On day 4, they declared that the hospital was in immediate jeopardy in infection control for the same observations noted by several surveyors. In addition, 11 CMS surveyors returned for a shorter resurvey in June. Results: The following 14 issues were listed under the infection control heading during the first survey, which led to the immediate jeopardy designation. The hospital’s infection prevention department committed to putting remediation processes, procedures, and audits in place during the first survey, which led to lifting the IJ before the surveyors left. The following shortcomings were recorded:(1)Inappropriate donning and doffing of personal protective equipment (PPE) for patients in isolationStandardized donning and doffing processes of PPE developed to include train-the-trainer and return demonstrations from >4,000 employees and providers followed by a minimum of fifty (50) audits/week with the goal of achieving 100% proper PPE donning and doffing for a minimum of three months, followed by a minimum of fifty (50) quarterly observations.(2)Environment Service (EVS) cleaning issues in isolation roomsTwo-person isolation room cleaning process developed, implemented, and audited a minimum of ten (10) times/week.(3)Incorrect set-up of dialysis machinesMinimum of five (5) dialysis machine set-ups audited/week.(4)Biohazard trash left in dialysis room between patientsMinimum random audits twice/week to look for biohazard trash.(5)Need for maintenance and cleanliness in the operating rooms (OR)Minimum three times/week audits of rotating ORs in all locations.(6)Rust noted on OR equipmentMinimum of twice/week audits looking for rust on OR equipment.(7)Insects noted in ORObservations for living insects will be audited twice/week.(8)Improper cleaning and high-level disinfection (HLD) of transvaginal probesMinimum of three times/week, cleaning and HLD processes of probes will be observed.(9)Matching patient to probes in their medical records needed clarificationMinimum of twice/week, logs will be audited to check that appropriate patient/probe linkage occurs.(10)Contaminated gloves used on a blood bag in ambulatory settingOnce/month, removal of blood bag from transport container will be observed to observe clean/dirty glove use(11)Lack of cleaning between patients of durable medical equipmentCleaning of DME will be observed for thoroughness a minimum of three times/week.(12)Sanitation and mislabeling issues in the kitchenA minimum of one (1) complete audit and two (2) abbreviated audits of kitchen sanitation and food labeling will be conducted per week.(13)Endoscopy misuse of test stripsTest strip audits showing appropriate labeling and use will be auditing a minimum of twice/week.(14)Process of air blowing of automatic endoscopic reprocessor (AER) needed improvement.Funding: NoneDisclosures: None

scholarly journals 868. Investigations of Healthcare-Associated Elizabethkingia Infections – United States, 2013-2019

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S472-S472
Author(s):  
Matthew B Crist ◽  
John R McQuiston ◽  
Maroya Spalding Walters ◽  
Elizabeth Soda ◽  
Heather Moulton-Meissner ◽  
...  
Keyword(s):  
Water Management ◽  
Infection Control ◽  
Acute Care ◽  
Local Health ◽  
Care Hospital ◽  
Patient Exposure ◽  
Management Plans ◽  
Water Management Plans ◽  
Healthcare Associated ◽  
Ventilated Patients

Abstract Background Elizabethkingia (EK) are non-motile gram-negative rods found in soil and water and are an emerging cause of healthcare-associated infections (HAIs). We describe Centers for Disease Control and Prevention (CDC) consultations for healthcare-associated EK infections and outbreaks. Methods CDC maintains records of consultations with state or local health departments related to HAI outbreaks and infection control breaches. We reviewed consultations involving EK species as the primary pathogen of concern January 1, 2013 to December 31, 2019 and summarized data on healthcare settings, infection types, laboratory analysis, and control measures. Results We identified 9 consultations among 8 states involving 73 patient infections. Long-term acute-care hospitals (LTACHs) accounted for 4 consultations and 32 (43%) infections, and skilled nursing facilities with ventilated patients (VSNFs) accounted for 2 consultations and 31 (42%) infections. Other settings included an acute care hospital, an assisted living facility, and an outpatient ear, nose, and throat clinic. Culture sites included the respiratory tract (n=7 consultations), blood (n=4), and sinus tract (n=1), and E. anophelis was the most commonly identified species. Six consultations utilized whole genome sequencing (WGS); 4 identified closely related isolates from different patients and 2 also identified closely related environmental and patient isolates. Mitigation measures included efforts to reduce EK in facility water systems, such as the development of water management plans, consulting water management specialists, flushing water outlets, and monitoring water quality, as well as efforts to minimize patient exposure such as cleaning of shower facilities and equipment, storage of respiratory therapy supplies away from water sources, and use of splash guards on sinks. Conclusion EK is an important emerging pathogen that causes HAI outbreaks, particularly among chronically ventilated patients. LTACHs and VSNFs accounted for the majority of EK consultations and patient infections. Robust water management plans and infection control practices to minimize patient exposure to contaminated water in these settings are important measures to reduce infection risk among vulnerable patients. Disclosures All Authors: No reported disclosures

scholarly journals Thermolabile drug storage in an ambulatory setting

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Fernando do Pazo-Oubiña ◽  
Bartomeu Alorda-Ladaria ◽  
Ana Gomez-Lobon ◽  
Bàrbara Boyeras-Vallespir ◽  
María Margalida Santandreu-Estelrich ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Statistical Treatment ◽  
Storage Conditions ◽  
Ambulatory Setting ◽  
Temperature Record ◽  
Care Hospital ◽  
Data Logger ◽  
Data Loggers ◽  
Ambulatory Patients ◽  
Clinical Consequences

AbstractMore thermolabile drugs are becoming available, and in most cases, these medications are dispensed to ambulatory patients. However, there is no regulation once medications are dispensed to patients and little is known with regard to what happens during transport and home storage. Previous studies suggest that these drugs are improperly stored. The present study was designed to determine the storage conditions of thermolabile drugs once they are dispensed to the patient in the Hospital Pharmacy Department. This is a prospective observational study to assess the temperature profile of 7 thermolabile drugs once they are dispensed to ambulatory patients at a tertiary care hospital. A data logger was added to the medication packaging. Temperature was considered inappropriate if one of the following circumstances were met: any temperature record less than or equal to 0 °C or over 25 °C; temperatures between 0–2 or 8–25 °C for a continuous period over 30 min. The time series of temperature measurements obtained from each data logger were analyzed as statistically independent variables. The data shown did not undergo any statistical treatment and must be considered directly related to thermal measurements. One hundred and fourteen patients were included and 107 patients were available for the analysis. On the whole, a mean of 50.6 days (SD 18.3) were measured and the mean temperature was 6.88 °C (SD 2.93). Three data loggers (2.8%) maintained all the measurements between 2 and 8 °C with less than 3 continuous data (< 30 min) out of this range but no data over 25 °C or below or equal to 0 °C. 28 (26.2%) data loggers had at least one measurement below zero, 1 data logger had a measurement greater than 25 °C and 75 (70.1%) were between 0 and 2 °C and/or between 8 and 25 °C for more than 30 min. In conclusion, once dispensed to patients, most thermolabile drugs are improperly stored. Future studies should focus on clinical consequences and possible solutions.

scholarly journals Aggressive Colonization Screening and Infection Control Measures in Containment of NDM-5 Carbapenemase-Producing CRE

2020 ◽  
Vol 41 (S1) ◽  
pp. s458-s459
Author(s):  
Ishrat Kamal-Ahmed ◽  
Kate Tyner ◽  
Teresa Fitzgerald ◽  
Heather Adele Moulton-Meissner ◽  
Gillian McAllister ◽  
...  
Keyword(s):  
Public Health ◽  
Infection Control ◽  
Acute Care Hospital ◽  
Healthcare Facility ◽  
The United States ◽  
Control Measures ◽  
Care Hospital ◽  
Clinical Culture ◽  
Medical Histories ◽  
Asymptomatic Case

Background: In April 2019, Nebraska Public Health Laboratory identified an NDM-producing Enterobacter cloacae from a urine sample from a rehabilitation inpatient who had recently received care in a specialized unit (unit A) of an acute-care hospital (ACH-A). After additional infections occurred at ACH-A, we conducted a public health investigation to contain spread. Methods: A case was defined as isolation of NDM-producing carbapenem-resistant Enterobacteriaceae (CRE) from a patient with history of admission to ACH-A in 2019. We conducted clinical culture surveillance, and we offered colonization screening for carbapenemase-producing organisms to all patients admitted to unit A since February 2019. We assessed healthcare facility infection control practices in ACH-A and epidemiologically linked facilities by visits from the ICAP (Infection Control Assessment and Promotion) Program. The recent medical histories of case patients were reviewed. Isolates were evaluated by whole-genome sequencing (WGS). Results: Through June 2019, 7 cases were identified from 6 case patients: 4 from clinical cultures and 3 from 258 colonization screens including 1 prior unit A patient detected as an outpatient (Fig. 1). Organisms isolated were Klebsiella pneumoniae (n = 5), E. cloacae (n = 1), and Citrobacter freundii (n = 1); 1 patient had both NDM-producing K. pneumoniae and C. freundii. Also, 5 case patients had overlapping stays in unit A during February–May 2019 (Fig. 2); common exposures in unit A included rooms in close proximity, inhabiting the same room at different times and shared caregivers. One case-patient was not admitted to unit A but shared caregivers, equipment, and devices (including a colonoscope) with other case patients while admitted to other ACH-A units. No case patients reported travel outside the United States. Screening at epidemiologically linked facilities and clinical culture surveillance showed no evidence of transmission beyond ACH-A. Infection control assessments at ACH-A revealed deficiencies in hand hygiene, contact precautions adherence, and incomplete cleaning of shared equipment within and used to transport to/from a treatment room in unit A. Following implementation of recommended infection control interventions, no further cases were identified. Finally, 5 K. pneumoniae of ST-273 were related by WGS including carriage of NDM-5 and IncX3 plasmid supporting transmission of this strain. Further analysis is required to relate IncX3 plasmid carriage and potential transmission to other organisms and sequence types identified in this study. Conclusions: We identified a multiorganism outbreak of NDM-5–producing CRE in an ACH specialty care unit. Transmission was controlled through improved infection control practices and extensive colonization screening to identify asymptomatic case-patients. Multiple species with NDM-5 were identified, highlighting the potential role of genotype-based surveillance.Funding: NoneDisclosures: Muhammad Salman Ashraf reports that he is the principal investigator for a study funded by an investigator-initiated research grant.

scholarly journals Infection Prevention Time Required for Construction and Design at a Large Tertiary-Care Hospital, 2019

2020 ◽  
Vol 41 (S1) ◽  
pp. s69-s70
Author(s):  
Angie Dains ◽  
Michael Edmond ◽  
Daniel Diekema ◽  
Stephanie Holley ◽  
Oluchi Abosi ◽  
...  
Keyword(s):  
Infection Control ◽  
Patient Care ◽  
Construction Projects ◽  
Small Scale ◽  
Care Hospital ◽  
Class Iii ◽  
Construction Sites ◽  
Wide Range ◽  
Time Required ◽  
Class Iv

Background: Including infection preventionists (IPs) in hospital design, construction, and renovation projects is important. According to the Joint Commission, “Infection control oversights during building design or renovations commonly result in regulatory problems, millions lost and even patient deaths.” We evaluated the number of active major construction projects at our 800-bed hospital with 6.0 IP FTEs and the IP time required for oversight. Methods: We reviewed construction records from October 2018 through October 2019. We classified projects as active if any construction occurred during the study period. We describe the types of projects: inpatient, outpatient, non–patient care, and the potential impact to patient health through infection control risk assessments (ICRA). ICRAs were classified as class I (non–patient-care area and minimal construction activity), class II (patients are not likely to be in the area and work is small scale), class III (patient care area and work requires demolition that generates dust), and class IV (any area requiring environmental precautions). We calculated the time spent visiting construction sites and in design meetings. Results: During October 2018–October 2019, there were 51 active construction projects with an average of 15 active sites per week. These sites included a wide range of projects from a new bone marrow transplant unit, labor and delivery expansion and renovation, space conversion to an inpatient unit to a project for multiple air handler replacements. All 51 projects were classified as class III or class IV. We visited, on average, 4 construction sites each week for 30 minutes per site, leaving 11 sites unobserved due to time constraints. We spent an average of 120 minutes weekly, but 450 minutes would have been required to observe all 15 sites. Yearly, the required hours to observe these active construction sites once weekly would be 390 hours. In addition to the observational hours, 124 hours were spent in design meetings alone, not considering the preparation time and follow-up required for these meetings. Conclusions: In a large academic medical center, IPs had time available to visit only a quarter of active projects on an ongoing basis. Increasing dedicated IP time in construction projects is essential to mitigating infection control risks in large hospitals.Funding: NoneDisclosures: None

scholarly journals Perilaku Kepatuhan Perawat Melaksanakan SOP Terhadap Kejadian Keselamatan Pasien di Rumah Sakit X Kendari

2017 ◽  
Vol 12 (1) ◽  
pp. 138
Author(s):  
Iriyanto Pagala ◽  
Zahroh Shaluhiyah ◽  
Baju Widjasena
Keyword(s):  
Patient Safety ◽  
Peer Support ◽  
Dominant Factor ◽  
Hospital Inpatient ◽  
Care Hospital ◽  
Patient Death ◽  
Cross Sectional ◽  
Patient Falls ◽  
Safety Event ◽  
Perception Of Support

ABSTRAKKeselamatan pasien adalah pasien bebas dari cedera yang tidak seharusnya terjadi atau bebas dari cedera yang potensial akan terjadi (penyakit,cedera fisik/sosial psikologis, cacat, kematian) terkait dengan pelayanan kesehatan. Di Rumah Sakit X Kendari  data kejadian keselamatan pasien pada tahun 2012 terdiri dari  kesalahan dalam pemeriksaan laborat,  pasien jatuh, salah pemberian seri kolf darah, pasien terbentur, salah dalam pemberian obat, kasus kematian pasien. Berdasarkan penentuan perioritas masalah yang akan di teliti yaitu pasien jatuh dari tempat tidur. Salah satu penyebabnya yaitu kurang patuhnya perawat dalam melaksanakan SOP resiko pasien jatuh. Tujuan penelitian ini adalah menganalisa faktor yang berhubungan antara karakteristik, pengetahuan, sikap, presepsi dukungan supervisior, presepsi dukungan sesama perawat, kenyamanan tempat/unit kerja dengan prilaku kepatuhan perawat dalam melaksanakan SOP resiko pasien jatuh terhadap terjadinya kejadian keselamatan pasien di Unit Rawat Inap Rumah Sakit X Kendari. Jenis penelitian yang digunakan adalah penelitian Explanatory Research dengan rancangan Cross sectional. Sampel dalam penelitian ini berjumlah 134 perawat ruang rawat inap. Hasil penelitian menunjukan terdapat 4 variabel yang berhubungan yaitu pengetahuan (p= 0,005), sikap (p = 0,035), persepsi dukungan supervisior (p= 0,000), persepsi dukungan sesama perawat (p= 0,003) dan faktor yang paling dominan berhubungan adalah persepsi dukungan supervisior (OR = 5,504).Kata Kunci : Perawat, Kepatuhan Melaksanakan SOP Compliance Behavior of Nurses Against Genesis SOP Implementing Patient Safety in Hospital X Kendari : The safety of patients were free of injury that is not supposed to happen or free from potential injury will occur (disease, physical injury / social psychological, disability, death) associated with health care. Hospital X Kendari patient safety event data in 2012 consisted of errors in laboratory examination, patient falls, one giving blood kolf series, patient knock, one in drug delivery, patient death cases. Based on the determination of the issues to be priorities in carefully which patients falling out of bed. One reason is lack of nurses in implementing SOP obedient, patient risk falling. The purpose of this study was to analyze factors related to the characteristics, knowledge, attitudes, perception supervisior support, perception of peer support nurse, comfort / unit with the behavior of nurses in implementing SOP compliance risk of the patient fell against the occurrence of patient safety in the Hospital Inpatient Unit X Kendari. This type of research is Explanatory Research research with cross sectional design. The sample in this study amounted to 134 inpatient room nurse. The results showed there were four variables related to that knowledge (p = 0.005), attitude (p = 0.035), perception of support supervisior (p = 0.000), perception of peer support nurses (p = 0.003) and the most dominant factor is the perception of support supervisior (OR = 5.504).Keywords: Nurses, SOP Implement Compliance

scholarly journals High-Level Disinfection in Ambulatory Care: Overcoming the Barriers of a Decentralized System through Auditing and Education

2021 ◽  
Vol 1 (S1) ◽  
pp. s11-s11
Author(s):  
Sonja Rivera Saenz
Keyword(s):  
Infection Control ◽  
Ambulatory Care ◽  
Inventory Management ◽  
Ambulatory Setting ◽  
Infection Control Team ◽  
Care Network ◽  
Standard Work ◽  
Increased Risk ◽  
Control Team ◽  
High Level

Background: High-level disinfection (HLD) of semicritical instruments in a multispecialty ambulatory care network has the potential for increased risk due to the decentralized instrument reprocessing and lack of a sterile processing department. Attention to HLD practices is an important part of device-borne outbreak prevention. Method: An HLD database was developed to identify specific departments and locations where HLD occurred across a 30-medical practice ambulatory care network in eastern Massachusetts, which included otolaryngology, urology, endoscopy, and obstetrics/gynecology departments. Based on qualitative feedback from managers and reprocessing staff, this database centralized information that included the supply inventory including manufacturer and model information, HLD methodology, standard work, and listing of competency evaluations. The infection control team then led audits to directly observe compliance with instrument reprocessing and a monthly-driven HLD calendar was developed to enforce annual competencies. Result: The results of the audits demonstrated variability across departments with gaps in precleaning, transportation of used instruments, the dilution of enzymatic cleaner, and maintenance of quality control logs. Given the uniqueness of shape and size of various ambulatory locations, proper storage and separation between clean and dirty spaces were common pitfalls. Auditing also revealed different levels of staff understanding of standard work and variable inventory management. Centralized education sessions held jointly by the infection control team and various manufacturers for the reprocessing staff helped to create and reinforce best practices. Conclusion: Decentralized HLD that occurs across multiple ambulatory care sites led to gaps in instrument reprocessing and unique challenges due to variable geography of sites, physical space constraints, and an independent approach to procuring medical supplies. Through the auditing and feedback of all areas that perform HLD, an effective and sustainable strategy was created to ensure practice improvement. Streamlining standard work, seeking direct input from frontline staff, and collective educational events were critical to our success in the ambulatory setting.Funding: NoDisclosures: None

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