2015 SASKPIC Fall Conference

Hot Topics In Infection Control!

According to the Provincial ICCs that is

Objectives

• Provide context for UTI prevention in Continuing Care settings

• Recommendations and tools to assist LTC facilities in adapting new guidelines

• SBAR as a provincial tool • Reprocessing concerns

UTI Prevention in Continuing Care

• Guideline for the Prevention and Treatment of Urinary Tract Infections(UTIs) in Continuing Care Settings released in April 2013

• Tools were developed to assist in

implementation and introduced at SASKPIC 2013 Fall conference

Saskatchewan Infection Prevention Program March 2014

Guidelines for the Prevention and Treatment of Urinary Tract Infections in

Continuing Care

Table of Contents Final Tools and Guideline on Ministry

of Health Website ABCs for Diagnosing UTIs in Continuing Care

Settings Antibiotic Information Brochure for

client/residents and their care givers Guidelines for the Prevention and Treatment

of UTIs in Continuing Care Settings Treating Asymptomatic Bacteriuria UTIs and Asymptomatic Bacturiuria

Power Points with Audio Introduction and Review of the Guideline for

the Prevention and Treatment of UTIs in Continuing Care Settings

Urinary Health Part 1: The Basics of UTI

Identification and Prevention Urinary Health Part 2: Strategies to Reduce

Cather Associated Urinary Tract Infections (CA-UTIs)

Power Points without Audio Introduction and Review of the Guideline for

the Prevention and Treatment of UTIs in Continuing Care Settings

Urinary Health Part 1: The Basics of UTI Identification and Prevention

Urinary Health Part 2: Strategies to Reduce

Cather Associated Urinary Tract Infections (CA-UTIs)

Tools in Progress Basics of Urinary Health (companion guide to

Part 1 ppt.) in both PDF and Microsoft Publisher

Strategies to Reduce CA-UTI (companion

Guide to Part 2 pp.) in both PDF and Microsoft Publisher

Sample Urinary Catheter Checklist – in both

PDF and Microsoft Word

2 Educational PPts with & Without Audio

Next steps

• TAG meeting: March 25th – critical incident discussion. A LTC resident admitted to hospital with urosepsis. – Catheter in poor condition – had been left in place from mid September until February

(approx. 5 months)

• Historically catheter changes were routinely q 4-6 wks

• UTI Prevention Guideline states do not routinely change, but as required based on client assessment

SBAR

As a mo

Sample Infection Control SBARs

Situation/Background

• Saskatchewan Infection Prevention and Control was asked to make a recommendation on the frequency of replacing long-term urinary catheters in continuing care settings.

• Routinely changing indwelling urinary catheters when there is

no medical reason (i.e. no evidence of infection or obstruction) increases the incidence of urinary tract infections in patients, residents and clients. Currently there are inconsistent practices in the frequency of indwelling urinary catheter replacement which may adversely affect care outcomes.

Assessment • In Canada, manufacturers recommend changing indwelling

urinary catheters when clinically indicated and routinely every 30 days in order to comply with licensing requirements of indwelling devices1. This is contrary to expert opinion and best practice guidelines which recommend long-term urinary catheter replacement should be based on clinical indications such as infection or evidence of obstruction(encrustations/blockage/leakage, etc.) , when the closed system has been compromised, or as per the recommended usage by the long-term catheter manufacturers (usually every 12 weeks). 2,3,4

• 1. Winnipeg Regional Health Authority, Infection Prevention & Control Manual, “Urinary Catheter Change Frequency”, January 10, 2013

• 2,3,4,- Refer to SBAR sheet

Primary Recommendation

Continuing Care Facilities should chose one of the following options regarding urinary catheter change frequency: • Follow best practice guidelines and change urinary catheters when there

is a clinical indication or before 12 weeks. Use a maintenance bundle checklist and catheter change record to determine individual care requirements, based on previous problems with blockages and encrustations.

OR • Follow the manufacturers’ licensing requirements that recommend

changing urinary catheters when medically indicated and routinely every 30 days. Develop tools to promote best practice and to identify whether there is a need for a catheter change prior to 30 day change date.

Secondary Recommendations to meet the Primary recommendation

1. Carefully evaluate the need for an indwelling urinary catheter on regular basis and consider using other types of long-term devices or incontinence products.

2. Complete a maintenance bundle checklist daily on each client with a

long-term indwelling catheter and incorporate the information into the client’s health record and care plan as required.

3. If urine drainage problems are identified, refer to a decision flow chart to determine what steps should be taken and record in the client’s record.

Insertion Bundle Check list (sample) YES NO Resident meets appropriate use for catheter use and reason was documented?

Hand hygiene and pre-cleansing of perineum was completed before insertion?

Appropriate sterile equipment (sterile gloves, drape, sponges, antiseptic solution) was used for insertion?

Aseptic technique was used by a HCW certified in this skill set?

A single use packet of lubricant jelly was used for insertion?

Catheter and tubing were secured to prevent movement and catheter bag is below the level of the bladder?

Maintenance Bundle Check list (daily) YES NO Hand hygiene was performed before client contact and gloves were used to manipulate catheter or drainage system?

Catheter and tubing are free of kinks and well secured?

Catheter has been continuously connected to tubing? If NO, document reason for the break and if it was managed aseptically.

Urine is draining well (e.g., no obstruction or blockages noted) ? if NO, use decision flow chart to determine what action may be required

Drainage bag is below level of the bladder and does not touch the floor?

Drainage bag was emptied regularly into a clean and client dedicated container, with no contact between the container and the drainage spout?

Perineal cleansing was provided at least once daily and after each bowel movement?

Is there a planned date for catheter replacement based on the 12 week maximum or the client’s catheter change record? if NO, review insertion date and/or initiate a catheter change record

Education Tool with Rationale for Maintenance Bundle

Secondary Recommendations to meet the Primary recommendation

4. Develop a client specific care regimen by tracking and reviewing the information collected on the catheter change record.

5. If CAUTI is suspected, change catheter prior to collecting a urine for C&S as per the protocol in the provincial UTI guideline.

Safety alert for Reprocessing of Endocavity Probes Nov 2014

Safety Alert for Endoscopic Retrograde Cholangiopancreatography (ERCP) Endoscopes

• Spring 2015 – safety alert issues following Outbreaks related to problems with the elevator mechanism

• Meticulous attention to detail and step-by-step precision in all steps of the cleaning/HLD process

• Do we know where ERCPs are being performed? How often? What kind of scopes you have? Who is doing the reprocessing? Are logs being kept?

• Is there a system in place to capture post-ERCP infections?? • Evaluating the effectiveness of your cleaning procedures:

Culturing of scopes Adenosine triphosphate (ATP)

Qualitative protein and blood testing

CDC Health Advisory – Sept 11/15 Immediate Need for Healthcare Facilities to Review Procedures

for Cleaning, Disinfecting, and Sterilizing Reusable Medical Devices

Recommendations: – HCF should ensure reprocessing procedures are being

done correctly and meeting manufacturers’ requirements – Ensure personnel who reprocess medical devices are

trained properly and maintain competence – Regularly audit (monitor & document) adherence to

cleaning, disinfection, sterilization and devices storage procedures.