technicians & nurses programascrs16.expoplanner.com/handouts_tn/000141...4 tass vs....

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


Standard Precautions


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


Infection Control Methods


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


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


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


Cleaning, Disinfection & Sterilization of instruments

Instrument Disinfection and Sterilization


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


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


9

Terminology


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


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)


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


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!


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.


If it is wet and sticky and not yours,

DO NOT touch it…

without gloves!

11


We Welcome Questions!

Elethia Dean RN, PhD: [email protected]

technicians & nurses programascrs16.expoplanner.com/handouts_tn/000141...4 tass vs....

Documents