InfectionPreventionandControlinHomeCareandHospice:

CommonComplianceIssuesPresentedby:MaryMcGoldrick,MS,RN,CRNIÒ

HomeCareandHospiceConsultantHomeHealthSystems,Inc.

www.webbertraining.com July9,2020

Objectives

Attheconclusionofthiswebinar,theparticipantwillbeableto:§ Recognizecommonproblemsandinfectionpreventionchallengesrelatedtoprovidingcareinthehomesetting.

§ Describemethodstoimplementinfectionpreventionandcontrolstrategiesinthehome.

§MoreeffectivelyprepareforahomecareandhospiceCMSandaccreditingorganizationsurvey.

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FederalRegulations:HomeHealth&HospiceConditionsofParticipation

§ §484.70HomeHealthCoP:Infectionpreventionandcontrol.§ §418.60HospiceCoP:Infectionpreventionandcontrol.

§ (a)Standard:Prevention.TheHHAmustfollowacceptedstandardsofpractice,includingtheuseofstandardprecautions,topreventthetransmissionofinfectionsandcommunicablediseases.

§ (b)Standard:Control.Maintainacoordinatedagency-wideprogramforthesurveillance,identification,prevention,control,andinvestigationofinfectiousandcommunicablediseasesthatisanintegralpartoftheQAPIprogram.Theinfectioncontrolprogrammustinclude:§ (1)Amethodforidentifyinginfectiousandcommunicablediseaseproblems;and§ (2)Aplanfortheappropriateactionsthatareexpectedtoresultinimprovementanddiseaseprevention.

§ (c)Standard:Education.TheHHAmustprovideinfectioncontroleducationtostaff,patients,andcaregiver(s).

Source:CentersforMedicare&MedicaidServices(CMS).(Jan.13,2017).ConditionsofParticipationforHomeHealthAgencies.FederalRegister,82(9),4504-4591.

CentersforMedicareandMedicaidServices(CMS).(June5,2008).ConditionsofParticipationforHospices. FederalRegister,73(109),32008-32220.

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FREQUENTLY CITED JOINT COMMISION HOME CARE STANDARDS

Source:TheJointCommission.(2020).TheJointCommissionPerspectives,40(4),13.4

*http://nursing.columbia.edu/research/InHome; #n=534

InHOMEStudy*:NationwideSurveyofHHCs

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TheHomeCareNursingBag

§Uniqueaspectofcareinthehome

§Noncriticalitem§ Fomiteforpotentiallypathogenicorganisms

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TheNursingBagasaFomiteforPathogenicMicroorganisms

§Outsidenurses’bags:§ 83.6%positiveforhumanpathogens;15.9%MDROs

§ Insidenurses’bag:§ 48.4%positiveforhumanpathogens;6.3%MDROs

§ Patientcareequipmentinsidenurses’bags:§ 43.7%positiveforhumanpathogens;5.6%MDROs

Source:Bakunas-Kenneley,I.,Madigan,L.(2009).Infectionpreventionand control inhomehealthcare:Thenurse'sbag.AmericanJournalofInfectionControl,37(8),687-8.

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“BagTechnique”:BestPractices

§Whennottobringinthehome§ Handhygiene§ Bagplacement:

§ Inthehome§ Duringinterimstorage

§ Routinesanitizing:§ Exterior§ Interior

§Managementofequipmentandsupplies:§ Storedinthebag§ Removedfromthebag

Source:McGoldrick,M.(2020).CleaningandDisinfection.HomeCareInfectionPreventionandControlProgram.

McGoldrick,M.(2019).Nursingbagsmanufacturedwithembeddedantimicrobials.HomeHealthcareNow,37(3),178-179;

McGoldrick,M.(2017).Bestpracticesforhomecare“bagtechnique”andtheuseofsurfacebarriers.HomeHealthcareNow, 35(9),478-484.

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COVID-19BagContents

• Personalprotectiveequipment• Disinfectantwipes• Surfacebarriers• Paperbags• Handhygienesupplies• Supplementaryitems:• Single-useitems• Reusableitems

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“BagTechnique”:CommonComplianceIssues

§ Handhygiene§ Personalprotectiveequipment§ Surfacebarrier

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HandHygiene:CommonComplianceIssues

• Indications• Technique• Productusageandstorage• Otherconsiderations

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IndicationsforPerformingHandHygiene:CommonComplianceIssues

Staff:• Beforeandafterhavingdirect

contactwithpatient• BeforedonningPPE• Beforeperforminganaseptic

procedure• Aftercontactwithpatient’s

immediateenvironment• Aftercontactwithbloodbody

fluids,orcontaminatedsurfaces• AfterremovingPPE

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Patientsreceivingfacility-basedhospicecare:• Beforemeals• Aftertoileting

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HandHygieneTechnique:CommonComplianceIssues

§ Soapandwater:§ Rubhandstogethervigorouslyforaminimumof20secondscoveringallsurfaces

§ Handdrying§ Usetoweltoturnofffaucet/tap

§ Alcohol-basedhandhygieneproduct:§ Coverallsurfacesofhands&fingers,untilhandsaredry

§WHOhandhygienetechniqueMcGoldrick,M.(2017).Handhygieneinthehomesetting:

Techniquematters. HomeHealthcareNow,35(9),454-455.

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HandHygieneProductUsageandStorage:CommonComplianceIssues

§ Handlotionorcreamaccess§ Partiallyemptycontainer§ Productused§ Alcohol-basedhandhygiene:

§ Storagelocation§ Expirationdating§Whennottouse

14Copyright©2014HomeHealthSystems,Inc.AllRightsReserved.14

“Other”HandHygieneCommonComplianceIssues

Policies:§ Rings§ Jewelry§Nailpolish§ Artificialnails§Nailtiplength§ Skincondition§ Bandagesandsplints

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DisinfectionComplianceIssues

• Surfacedisinfectiontechnique:• Vitalsignequipment• Bloodpressurecuff• Scale

• Point-of-caretestingequipment:• CoaguChekmachine

• ElectronicequipmentSource:McGoldrick,M.(2016).Prothrombinmonitoring:

Cleaninganddisinfectingprothrombinmonitoringequipment.HomeHealthcareNow,34(10),574;McGoldrick,M.(2016).Preventingcontaminationofportablecomputers.HomeHealthcareNow,34(4),221;

McGoldrick,M.(2016).Preventingthetransferofpathogenicorganismsfromtheuseofamobilephone.HomeHealthcareNow,34(1),45.

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InfectionPreventionAndControlBreachesCapturingThePatient’sSignature

• Patient’sskincontamination:• Tablet/laptop’smousepad/mobilephone

surfacesnotcleanedanddisinfectedpriortodirectcontactbythepatient

• Styletnotcleanedanddisinfectedpriortothepatient’suse

• Handhygienenotperformedaftercontact

• Equipmentcontamination:• Mobiledeviceplaceddirectlyona

surfaceinthehomeandnocleaninganddisinfectingafteruse

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HomeCareDisinfection:CommonComplianceIssues

• Storage:• Repackaging• Temperature• Closure

• Productselected:• Antisepticvs.disinfectant

• Personalprotectiveequipment:• Skincontact

• FirstaidSource:McGoldrick,M.(2016).Protectingthestaffwhenusingdisinfectantsinthe

home. HomeHealthcareNow,34(9),523.

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CompanionAnimalsintheHomeSetting

§ Domesticcompanionanimals:§ Dogs§ Cats

Source:McGoldrick,M.(2020).Methicillin-resistantStaphylococcusaureustransmissioninthehome.HomeHealthcareNow,38(2),360-361.

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COVID-19:FocusedInfectionControlSurveys

§ EffectivenessoftheInfectionPreventionandControlProgram(IPCP)§ IPCPpoliciesandprocedures§ Surveillanceactivities§ ImplementationofStandardandTransmission-BasedPrecautions§Qualityofpatientcarepractices,includingpatientswithCOVID-19§ Patient,familyandstaffeducation§ Staffhealthmonitoringandscreeningpractices§ Emergencymanagementpoliciesaddressingstaffingissues

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Summary

§ Commoninfectionpreventionandcontrolfindingsidentifiedduringhomecareandhospicesurveys

§ Infectionpreventionandcontrolstrategiestopreventcommonsurveycomplianceissuesinthehome

§ Continuetoself-assessandimprovetheinfectionpreventionandcontrolprogram

§Mostimportantly,preventinfectionsinbothstaffandhomecareandhospicepatients

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Questions?

MaryMcGoldrick,MS,RN,CRNIÒ

HomeCareandHospiceConsultantHomeHealthSystems,Inc.Phone:(800)961-7122Fax:(800)649-0017

E-mail:mary@homecareandhospice.comWeb:HomeCareandHospice.com

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