Post on 03-Jul-2020
transcript
ASCRS ♦ ASOA Symposium & Congress
Technicians & Nurses Program
May 6-10, 2016 – New Orleans
1
ELETHIA DEAN RN, BSN, MBA, PHD
Infection Control in Ophthalmology
©ASC Compliance, LLC
Administration of Medications
Eye drops
Injections
Oral Medications
©ASC Compliance, LLC
Standard Precautions
©ASC Compliance, LLC
Standard precautions apply to:
Blood
All body fluids, secretions and
excretions EXCEPT sweat
Nonintact skin
Mucous membranes
In 1996 CDC expanded concept of “universal precautions” and changed the term to “standard precautions.”
2
Chain of Infection
©ASC Compliance, LLC
Infection Control Methods
©ASC Compliance, LLC
Infection control aims to break the chainof events causing the spread of infection
This can be achieved by: 1. eliminating the source of pathogens
2. decreasing host susceptibility
3. interrupting transmission routes
Risk Factors: Environmental Cleaning
©ASC Compliance, LLC
Before and after each procedure/patient –including visual inspection
End of day (terminal)
At times, during procedure (contain and confine)
All horizontal surfaces and lights
EPA registered hospital disinfection
3
Risk Factors
©ASC Compliance, LLC
Clean high traffic areas
Clean door handles
Know “kill” time for disinfectant used
Know manufacturer’s recommendations for cleaning supplies (some disinfectants may lead to surface break down of some medical devices)
Risk Factors
©ASC Compliance, LLC
Cleaning, Disinfection & Sterilization of instruments
Instrument Disinfection and Sterilization
©ASC Compliance, LLC
Cleaning and decontamination must occur first!!! Contained transport to decontamination area Up-to-date instructions from device manufacturer as well
as manufacturer of cleaning equipment Packaging Sterilization Automated vs. manual cleaning Inspection
NOTE: Any instrument opened in the OR should be decontaminated and reprocessed, even if not used.
4
TASS vs. Endophthalmitis
©ASC Compliance, LLC
TASS 12-24 hour onset
Painless
Hypopyon
Limited to anterior segment
Occur in clusters
Gram stain negative
Treated by ophthalmologist with topical steroids every one to two hours
Endophthalmitis Three to seven days onset
Painful
Hypopyon
Anterior and posterior segments
Occur individually
Gram stain could be positive or negative
Treatment by retina surgeon with antibiotics and/or steroids injections
Conducting an Infection Investigation
The primary components of the initial infection investigation include the following:
Confirming the presence of an infection
Alerting key partners about the investigation
Performing chart reviews
Establishing a preliminary case definition
Conducting an Infection Investigation
The primary components of the initial infection investigation include the following:
Developing a methodology for case finding
Preparing an initial line list and epidemic curve.
Observing and reviewing potential implicated patient care activities.
Considering whether environmental sampling should be performed
Implementing initial control measures
5
Outbreak Investigation
Gather and Compare Demographic Data Name
Medical record number
Age
Sex
Diagnosis
Surgeon
Anesthesia provider
Date of surgery
Vital signs (especially temperature)
Date of onset of symptoms
Outbreak Investigation
Gather and Compare Risk Factors Surgical procedure Operating room Duration of surgery Surgical personnel Anesthesia personnel Vascular access Catheters Endotracheal tubes Steroids Antibiotics IV medications, fluids, and blood Intracameral medications Intrathecal medications
Elements of a QAPI Study
1. Purpose:
A statement of the purpose of the QAPI activity that includes a description of the process or situation being reviewed, or a known or suspected problem, and explains why it is significant to the organization.
Briefly state the problem
Note why it is important to address this problem in your organization.
6
QAPI Study – Performance Goal
2. Performance Goal:
Identification of the performance goal against which the organization will compare its current performance in the area of the study.
Describe the level of performance your organization would like to achieve.
It is important to note that 0% or 100% may not be realistic targets when setting performance goals.
QAPI Study – Data Collection Plan
3. Description of the data that will be collected in order to determine the organization’s current performance in the area of the study:
Determine what data will be needed to verify: Whether the problem actually exists
The frequency and severity of the problem
The source of the problem
How the data will be collected
QAPI Study – Data Collection
4. Show evidence of data collection
May use tables, graphs, pie charts, etc.
Describe the data that was actually collected.
How was the data recorded?
This is not the area for analysis or conclusion –Describe only what was done to gather data.
7
QAPI Study – Data Analysis
5. Data analysis describes findings about the frequency, severity and source(s) of the problem(s).
Examine the data that was collected and analyze to address the problem studied.
Does the data actually describe that the suspected problem exists, if there is not a problem there cannot be a QAPI study (you must have a problem before you can design a solution).
If there is a problem, what does the data state about the frequency, severity and source of the problem.
Describe how the data was analyzed and how findings/conclusions were derived.
QAPI Study – Performance Goal Comparison
6. Compare the organization’s current performance in the area of the study against the previously identified performance goal.
Use the data collected to measure current performance to threshold that the organization should achieve.
QAPI Study - Implementation
7. Implementation of corrective action to resolve identified problem(s)
Utilizing information obtained during data collection and analysis regarding frequency, severity and source of the problem, identify corrective action(s) that must be taken to improve performance and achieve performance goal.
Implement the selected corrective action and determine appropriate length of time to measure effectiveness of corrective action (restudy).
8
QAPI Study - Restudy
8. Re-measurement (a second round of data collection and analysis) to objectively determine whether the corrective actions achieved and sustained demonstrable improvement.
At the previously determined restudy time, repeat the steps for data collection and analysis.
Measure identical items as those measured during original data collection and analysis
9. If the initial corrective action did not achieve and/or sustain the desired improved performance goal, implementation of additional corrective action(s) and continued re-measurement will be necessary until the problem is resolved.
QAPI Study - Communication
10. Communication of the findings of the quality improvement activities to the governing board and throughout the organization, as appropriate and incorporation of such findings into the organization’s educational activities (“closing the loop”)
A Word about Hand Hygiene
©ASC Compliance, LLC
9
Terminology
©ASC Compliance, LLC
Hand Hygiene: A general term that applies to either hand washing, antiseptic hand wash, antiseptic hand rub or surgical hand antisepsis.
Hand Antisepsis: Refers to either antiseptic hand wash or antiseptic hand rub
Terminology
©ASC Compliance, LLC
Alcohol based-hand rub: Alcohol based preparation (usually 60% to 95% ethanol or isopropranolol) for reducing number of viable organisms on the hands
Hand washing: Washing hands with plain soap (non antimicrobial) and water
Source: Centers for Disease Prevention and Control (CDC) Guideline for Hand Hygiene in Health-Care Settings. Morbidity and Mortality Weekly Reports, Oct. 2002
Hand washing Procedure(Soap & Water)
©ASC Compliance, LLC
1. Wet hands first with lukewarm water
2. Apply amount of product recommend by the product manufacturer
3. Rub hands together at least 15 seconds, covering all surfaces of hands and fingers
4. Rinse and dry thoroughly with paper towel
5. Use towel to turn off faucet Source: Centers for Disease Prevention and Control (CDC) Guideline for Hand Hygiene in Health-Care
Settings. Morbidity and Mortality Weekly Reports, Oct. 2002
10
©ASC Compliance, LLC
Natural nails no more than a quarter-inch long
No chipped nail polish in restricted area
No artificial nails in perioperative environment
No jewelry
Facility-approved hand lotion only used
…and don’t forget proper hand hygiene before and after every patient contact.
Source:AORN Perioperative Standards and Recommended Practices 2010 Edition.
REMEMBER!
©ASC Compliance, LLC
You should NOT provide direct patient care if you have:Cuts
Abrasions
Weeping dermatitis
Fresh tattoos on exposed skin
Source: AORN Perioperative Standards and Recommended Practices 2010 Edition.
Standard Universal Precautions
Consider all blood and body fluids potentially infectious.
Use Personal Protective Equipment (PPE) to prevent exposure.
©ASC Compliance, LLC
If it is wet and sticky and not yours,
DO NOT touch it…
without gloves!
11
©ASC Compliance, LLC
We Welcome Questions!
Elethia Dean RN, PhD: elethia@asccompliance.com937-478-1878