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7/6/2021 1 STAFF TRAINING AND COMPETENCY 2021 © RB Health Partners, Inc. Objectives 1 2
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STAFF TRAINING AND COMPETENCY
2021 © RB Health Partners, Inc.
Objectives
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Objectives
Identify chief areas for infection prevention training; Identify
Describe components of competency for hand hygiene, precautions, and cleaning; Describe
Discuss the role of competency and monitoring programs; andDiscuss
Identify how to report and evaluate training programsIdentify
Training Needs
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Who Needs Training?
• Hand hygiene
• PPE and Standard Precautions
• General Infection Prevention Policies
• Bloodborne pathogens
All staff types need training in one or more areas
New hires should get during onboarding
• Nursing (device safety, wound dressing, etc.)
• Housekeeping (cleaning/disinfection intensive)
• Dietary (food prep and safety)
• Laundry (safe handling)
• And others that are identified
Additional training depends on discipline:
Typical Components of IPC Training
Basic Prevention Strategies
• Hand hygiene, Standard Precautions and Bloodborne pathogens, Transmission-based precautions
Clinical Processes
• Devices, med safety, wound care, ADL
Cleaning, Disinfection, Sanitation
• Resident room cleaning, shared equipment, specialized equipment
Food Preparation and Delivery
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Identified Gaps
Identify gaps in education needs or in practice to determine where additional training may need to occur
Part of annual IPC program evaluation
Results of process measure surveillance
Survey results
Staff pulse
Risk Assessment
• Annual IPC risk assessment
• Contains training/education component score
• Use to identify risk areas
• Identify areas of education opportunity
• Where are the “1” scores for training/education?
• Where do those items rank in risk?
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Selecting Training Types
Online Recorded
Online Webinar
Formal In-person training
In-service type training
One-on-one competency demonstration
Engaging Staff in Training
• Select method that will work for your staff
• Not all staff are comfortable with online training
• Some topics are not quite interesting to all staff
• IP topics can be abstract at times
• Action and demonstration are typically needed for task based and competency based trainings
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Continuing and Annual Education
• Determine requirements based on regulation and state/local law for annual training
• What gaps have you identified?
• What new situations or services have started?
• Can sessions be bundled for efficiency?
• Typically needed annually: • Respirator/respiratory protection
• Hand hygiene/standard precautions/PPE
• Clinical skills (i.e. wound care, central line care, foley maintenance)
Training for Hand Hygiene
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Things to Include
• Overview
• WHO 5 Moments of Hand Hygiene
• Difference between alcohol-based hand rub and soap/water
• Steps for using ABHR
• Steps for handwashing
• Importance of resident hand hygiene
Hand Hygiene Facts
• One gram of human feces = over one trillion germs
• Handwashing in general can prevent:
• About 30% of diarrhea-related sickness
• About 20% of respiratory infections
• Healthcare providers may need to clean hands as many as 100 times per shift
Source: CDC
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WHO 5 Moments for Hand Hygiene15
When to Use
• Most clinical situations
• For routine hand hygiene when not soiled
• Quick and effective
• CDC’s preference for most situations
• When hands visibly soiled
• After using the restroom or eating
• When taking care of residents with C. diff or other infectious diarrhea
Alcohol-Based Hand Rub Soap and Water
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How Well Do You Clean?
Activity
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Resident Hand Hygiene
• Important part of overall infection prevention
• Educate staff on promoting hand hygiene among residents
• Train staff how to assist with hand washing before/after meals, toileting, etc for those who need assistance
• Train-the-trainer for clinical staff to teach residents
• Consider part of routine resident education on infection prevention measures
Training for Precautions
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What to Cover
• Types of Precautions
• When to Use
• PPE Selection
• Appropriate use of PPE
• Special cleaning or other considerations
Precautions
Contact
Droplet
Airborne
Enhanced Barrier
Special and CombinationDroplet + Contact
Special or Enhanced Droplet/Contact (i.e., COVID, etc)
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Donning & Doffing PPE25
CDC Donning PPE26
1. Identify and gather PPE
2. Perform hand hygiene using hand sanitizer
3. Put on isolation gown – Tie all of the ties on the gown
4. Put on NIOSH-approved N95 respirator or higher
5. Put on face shield or goggles
6. Perform hand hygiene and put on gloves –Gloves should cover the cuff of gown
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How to Don a Gown
• Select appropriate type and size
• Opening is in the back
• Secure at neck and waist
• If gown is too small, use two gowns
o Gown #1 ties in front
o Gown #2 ties in back
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From CDC PPE Use In Healthcare Settings
Respiratory PPE
Facemask – Mask ties should be secured on crown of head (top tie) and base of the neck (bottom tie). If mask has loops, hook them appropriately around your ears.
Respirator – Respirator straps should be placed on crown of head (top strap) and base of neck (bottom strap). Perform a user seal check each time you put on the respirator.
https://www.cdc.gov/coronavirus/2019-ncov/downloads/A_FS_HCP_COVID19_PPE.pdf
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How to Don a Mask
• Place over nose, mouth and chin
• Fit flexible nose piece over nose bridge
• Secure on head with ties or elastic (tie upper first then lower)
• Adjust to fit
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From CDC PPE Use In Healthcare Settings
How to Don a Respirator
• Select a fit tested respirator• Place over nose, mouth and chin• Fit flexible nose piece over nose
bridge• Secure on head with elastic• Adjust to fit• Perform a fit check
o Inhale – respirator should collapse
o Exhale – check for leakage around face
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From CDC PPE Use In Healthcare Settings
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https://www.cdc.gov/niosh/docs/2010-133/pdfs/2010-133.pdf
How to Don a Respirator
How to Don Eye and Face Protection
• Position goggles over eyes and secure to the head using the ear pieces or headband
• Position face shield over face and secure on brow with headband
• Adjust to fit comfortably
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From CDC PPE Use In Healthcare Settings
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How to Don Gloves
• Don gloves last
• Select correct type and size
• Insert hands into gloves
• Extend gloves over isolation gown cuffs
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From CDC PPE Use In Healthcare Settings
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Doffing PPE35
• Contaminated areas of PPE - Areas of PPE that have or are likely to have been in contact with body sites, materials, or environmental surfaces where the infectious organism may reside
o Exterior or outside in the front
• Clean area of PPE - Areas of PPE that are not likely to have been in contact with the infectious organism
o inside, outside back, ties on head and back
From CDC PPE Use In Healthcare Settings
CDC Doffing PPE36
1. Remove gloves.
2. Remove gown – Untie or gently break ties. Reach up to the shoulders and carefully pull gown down and away from the body. Rolling the gown down is an acceptable approach.
3. Healthcare worker exit patient room.
4. Perform hand hygiene.
5. Remove face shield or goggles.
6. Remove and discard respirator (or facemask).
7. Perform hand hygiene.
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How to Remove Gloves - 1
• Grasp outside edge near wrist
• Peel away from hand, turning glove inside-out
• Hold in opposite gloved hand
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From CDC PPE Use In Healthcare Settings
How to Remove Gloves - 2
• Slide ungloved finger under the wrist of the remaining glove
• Peel off from inside, creating a bag for both gloves
• Discard
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From CDC PPE Use In Healthcare Settings
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Removing Gown
• Unfasten ties
• Peel gown away from neck and shoulder
• Turn contaminated outside toward the inside
• Fold or roll into a bundle
• Discard
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From CDC PPE Use In Healthcare Settings
Remove Goggles or Face Shield
• Grasp ear or head pieces with ungloved hands
• Lift away from face
• Place in designated receptacle for resprocessing or disposal
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From CDC PPE Use In Healthcare Settings
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Remove Mask
• Ties• Untie the bottom, then top, tie• Remove from face• Discard• Elastic straps• Lift the bottom elastic over your
head first• Then lift off the top elastic• Discard
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From CDC PPE Use In Healthcare Settings
Doffing Respirator
• Follow manufacturer's instructions
• Do not touch mask
• Lean over slightly so that mask falls away from face
• Pull bottom strap out and over head first
• Then pull top strap out and over head
• Discard mask
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Training for Cleaning
What to Train
Importance of Cleaning
Products and Contact Time
Cleaning Medical Equipment
Cleaning Bundle for Rooms
Terminal Cleaning and Isolation Rooms
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Contact Time and Labels
• All staff should be able to state contact times or know where to find them
• Usually on the product label
o Note: some commonly used disinfectants have a 10 minute label contact time – ten minutes is a very long time to keep wet
• Important to train staff on different surfaces (i.e. hard, non-porous vs soft or porous)
• Often a focus for surveys
Glucometers
• One of the most cited cleaning issues
• Shared glucometers need to be cleaned appropriately
• Typically, before and after use each time using appropriate disinfectant – check IFU
• Dedicated glucometers should also be regularly cleaned to ensure proper function
• Have a POC testing or glucometer competency for staff that includes cleaning and proper handling
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Competency Development
Resources to Start
• Competencies already exist
• Modify as needed for your specific facility
• Use established processes as baseline
o CDC competencies
o APIC or other associations
o Consultant or QIO toolkits
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Tailoring to Your Facility
• Ensure competencies match your products
• Basic steps may remain the same but logistics may require modification of competency o Example: Gowns that untie vs gowns designed to rip
away
• Read manufacturer’s instructions for use (IFU)o Do not assume a product is cleaned or handled in
the same way as similar product
o Some products cannot be cleaned with certain disinfectants
Practice
• Use colleagues to see if the competency checklist makes sense
• Have someone use the tool to check you off
• Competency steps should be easy to follow
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Sample Competency
Sample Competency
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Sample Competency
Monitoring Performance
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Competency vs Observation
• Demonstration of skill
• Ensure each step is performed using check-off
• Annually or as needed
• Much like a test
• Real-work observation of skill
• Ensures steps applicable to situation are performed
• Monitored consistently
• Not a test, real world application
Competency Observation
Observations
• Set a system or schedule
• Train observers other than Infection Preventionist
• Use of “trained observers”
• Ensure data are collected and stratified by unit, role, or both
• Try to capture off shifts and support staff, not just daytime nursing
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Audit Tools
Observation Tool
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Performance Improvement59
• Feedback to staffo Immediate
o Show them the data
• On-going evaluation
• Checklists
• Assignments and responsibilities, including after hours
• Partnership with administration, resident care staff, and environmental services
Performance Feedback
• Immediate feedback helps drive change
• Make sure it’s constructive • Why was what they did not correct?
• Learning opportunity rather than discipline
• Incentive feedback for performing correctlyo Meal coupons
o Tokens
o Points
• Celebrate wins
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Reporting and Follow Up
Presentation
• Part of surveillance reporting
• Track and trend
• Present monthly to QAPI or IP committee
• Most suited to traditional line/bar graphs
• Part of program evaluation
• Keep track of attendance and topics
• Present to QAPI or IP committee as needed
Observations Competency
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Reporting to Staff
Observations should also be reported to staff
Part of a quality board or other feedback system
Present in aggregate or stratify by role
Gives staff the knowledge of where they stand
Helpful to also include improvement tips or programs that will be starting to increase compliance
Don’t forget outside vendors/contract staff such as therapy or LIP practices – they can also use feedback on practices
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Performance Observations for Compliance
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0%
20%
40%
60%
80%
100%
Q1 Q2 Q3 Q4
Percent Hand Hygiene Compliance by Unit 2020
Nurse CNA Housekeeping
Grid Presentation (Month/Quarter)66
Hand Hygiene TBP Compliance Glove Use Fingernail
TARGET 85% 90% 95% 95%
January 86% 81% 95% 100%
February 81% 86% 96% 98%
March 90% 90% 95% 100%
Q1 86% 86% 95% 99%
April 84% 90% 94% 100%
May 80% 92% 96% 96%
June 90% 95% 96% 100%
Q2 84% 92% 95% 99%
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Summary
Summary
• Staff training and education is a key component of an effective infection prevention program
• Identify needs as part of annual plan review as well as regulatory requirements
• Both initial training and ongoing/annual training are important
• Select the best method for each topic (online vs in-person)
• Monitor and report progress with observation and competency compliance through QAPI
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Questions???
Q & A
Thank you for your participation
To learn more about this topic please contact Jonathan Teter, MS, CIC, EMT-B Infection Prevention Advisor at [email protected] HERE for more info about this Presenter
2020 © RB Health Partners, Inc.
You may also contact Robin A. Bleier, President with regards to this or other services at [email protected] or call us at 727.786.3032. Click HERE for more info about this Presenter
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