Princeton Place Did Not Always Comply With Care Plans for Residents Who Were Diagnosed With Urinary Tract Infections (A-06-17-02002)

Princeton Place did not always provide services to Medicaid-eligible residents diagnosed with UTIs in accordance with their care plans, as required by Federal regulations. Specifically, Princeton Place staff did not always document that they monitored the residents' urine appearance at the frequencies specified in their care plans. Princeton Place did not have policies and procedures to ensure that its staff provided services in accordance with its residents' care plans. As a result of Princeton Place not following residents' care plans, the residents were at increased risk for contracting UTIs and for incurring complications from UTIs, including requiring hospitalization.

EVS personnel play a critical role in preventing the spread of germs and healthcare-associated infections

“EVS and the Battle Against Infection” is an interactive graphic novel illustrating the important role of EVS personnel in the prevention of healthcare-associated infections. The online version of the training tool features real-world infection prevention and control scenarios and allows participants to choose options that affect the outcome of the story. 

Healthcare professionals are the first line of defense against healthcare-associated infections (HAIs) and the spread of germs in healthcare settings. CDC now offers a new online interactive infection control training, “Let’s Talk Patient Safety: Reducing HAI Transmission Risk,” to help healthcare professionals identify infection risks and prevent the spread of HAIs. The training provides free continuing education for healthcare professionals, including nurses, physician assistants, medical assistants, health educators, and other clinicians. (0.1 CEU and 0.6 CNE).

The free online training can be completed anywhere. It has two modules and takes approximately 30 minutes to complete the entire training.

Module 1: “What’s the Risk?” 

This interactive module transports healthcare professionals into a scenario where they must identify infection risks and take action to protect patients, colleagues, and visitors. 

Module 2: “Chain of Infection” 

This story-based interactive module challenges professionals to break the chain of infection in a busy healthcare environment and educates them on the consequences of not following infection prevention and control recommendations.

Please join Christine LaRocca, MD and the National Nursing Home Quality Improvement Campaign to learn more about sepsis, who is at risk and the signs and symptoms for early detection. In addition, we will:

·        Review examples of sepsis screening tools commonly used in hospital settings;

·        Learn what tools to use while recognizing the limitations of sepsis screening tools in the nursing home population; and

·        Understand the elements of evidence-based treatment for optimal outcomes.

Multidrug-resistant Candida auris:

Update on Current U.S. Epidemiology, Clinical Profile, Management, and Control Strategies

Candida auris (C. auris) is an emerging fungus that presents a serious global health threat. CDC is concerned about C. auris for 3 main reasons:

1. It is often multidrug-resistant, meaning multiple antifungal drugs are less or not at all effective in treating C. auris.
2. It is difficult to identify with standard laboratory methods, and it can be misidentified in labs without specific technology. Misidentification may lead to inappropriate management.
3. It has caused outbreaks in healthcare settings. It is important to quickly identify C. auris in a hospitalized patient so that healthcare facilities can take special precautions to stop its spread.

Most C. auris cases in the United States have been detected in the New York City area, New Jersey, and the Chicago area. Clusters of cases have also recently been described in Florida, Texas, and California. C. auris cases in the United States are originally a result of inadvertent introduction into the United States from a patient who had received healthcare in a country where C. auris has been reported. Most cases now are a result of local spread after such an introduction.

During this COCA Call, CDC presenters will

• Provide an update on the current status of C. auris
• Explain why it is a public health threat
• Review current U.S. epidemiology and resistance patterns to antifungal drugs
• Discuss clinical considerations when treating patients for C. auris
• Lay out steps for identifying and controlling C. auris.
• Date: Thursday, June 20, 2019
• Time: 2:00–3:00 p.m. (ET)
• Free continuing education (CE) is available for this COCA Call.  

Nursing home-specific guidance from the CDC

Nursing homes

Nursing homes should follow all of the same recommendations listed for general acute care hospitals and high acuity post-acute care settings. Additional considerations are as follows:

• In general, nursing home residents should be placed on Standard and Contact Precautions.
• Functional nursing home residents without wounds or indwelling medical devices (e.g., urinary and intravenous catheters and gastrostomy tubes) who can perform hand hygiene might be at lower risk of transmitting C. auris. Facilities could consider relaxing the requirement for Contact Precautions for these residents. However, in these instances, healthcare personnel should still use gowns and gloves when performing tasks that put them at higher risk of contaminating their hands or clothing. These tasks include changing wound dressings and linens and assisting with bathing, toileting, and dressing in the morning and evening.
• Nursing home residents with C. auris can leave their rooms as long as secretions and bodily fluids can be contained and the patient can perform hand hygiene prior to leaving their room.
• If residents with C. auris receive physical therapy or other shared services (e.g., physical therapy equipment, recreational resources), staff should not work with other patients while working with the affected patient. They should use a gown and gloves when they anticipate touching the patient or potentially contaminated equipment. Ideally, affected patients should be the last to receive therapy on a given day. Shared equipment should be thoroughly cleaned and disinfected after use.

National Healthcare Safety Network (NHSN) Training

Section Navigation2019 LTCF Annual Training

Join us Tuesday, July 9th – Thursday, July 11th, 2019 for the 2019 National Healthcare Safety Network’s (NHSN) Annual Training for Long-term Care Facilities held on the CDC campus in Atlanta, Georgia

The NHSN Long-term Care Facility (LTCF) training is open to current NHSN LTCF users, as well as LTCF facilities interested in enrolling in NHSN. The training will provide participants the information and tools necessary to identify, report, and analyze the following:

·        Clostridioides difficile infections (CDI)

·        Multi-drug Resistant Organisms (MDRO)

·        Urinary tract infections (UTI)

·        Prevention Process Measures – Adherence to gown and glove; hand hygiene adherence

Two hands-on lab sessions will be available for attendees who are interested in learning how to analyze data within the NHSN application. Space for these sessions are limited and require additional registration.

Attendees will also have the opportunity to hear various presenters discuss strategies to implement antibiotic stewardship, infection prevention, and internal data validation. The NHSN User Support team will join us during the week to offer attendees onsite support.

The CDC has begun using Clostridioides difficile instead of Clostridium difficile to refer to the bacterium that commonly causes infectious diarrhea.

The change followed a decision early last year by the Clinical and Laboratory Standards Institute (CLSI).

Given that laboratories and medical publications may be transitioning to the new name, the National Nursing Home Quality Improvement Campaign is making the transition when using the full name. However, the abbreviated form C. Diff is still applicable.

Strysko J, Fialkowski V, Marsh Z, et al. Notes from the Field: Outbreak of Multidrug-Resistant Shigella sonnei Infections in a Retirement Community — Vermont, October–November 2018. MMWR Morb Mortal Wkly Rep 2019;68:405–406. 

On October 22, 2018, the Vermont Department of Health (VDH) notified CDC’s Waterborne Disease Prevention Branch of an outbreak of diarrhea caused by Shigella sonnei among residents, visitors, and staff members of a retirement community in Chittenden County, the state’s most populous county. High-quality single nucleotide polymorphism (SNP) analysis predicted initial isolates were multidrug resistant (MDR), and were closely related to a concurrent multistate cluster (differing by 0–11 SNPs). In the United States, rates of MDR shigellosis are increasing (1); outbreaks of MDR shigellosis are more common among men who have sex with men and are rare in retirement community settings (2). CDC collaborated with VDH to identify additional cases, determine transmission routes, and recommend prevention and control measures.

CDC reminds clinicians to have a high suspicion for influenza and recommends rapid antiviral treatment of high-risk patients with suspected influenza.

From https://emergency.cdc.gov/han/han00419.asp

Summary
The Centers for Disease Control and Prevention (CDC) is issuing this health advisory to notify clinicians that influenza activity remains high in the United States, with an increasing proportion of activity due to influenza A(H3N2) viruses, continued circulation of influenza A(H1N1) viruses, and low levels of influenza B viruses. Influenza should be considered as a possible diagnosis for patients with respiratory illness while local influenza activity remains elevated. Because influenza A(H3N2) viruses may be associated with severe disease in older adults, this health advisory serves as a reminder that early empiric treatment with influenza antiviral medications is recommended for hospitalized and high-risk patients, especially those 65 years and older. Antiviral treatment should be started as soon as possible after illness onset and should not wait for laboratory confirmation.

Specialized Infection Prevention and Control Training for Nursing Home Staff in the Long-Term Care Setting is Now Available

The Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) collaborated on the development of a free on-line training course in infection prevention and control for nursing home staff in the long-term care setting.

The training provides approximately 19 hours of continuing education credits as well as a certificate of completion (i.e., free CME, CNE or CEUs).

The course introduces and describes how to use IPC program implementation resources including policy and procedure templates, audit tools, and outbreak investigation tools.

The course is made up of 23 modules and sub-modules that can be completed in any order and over multiple sessions.

The course covers:

• Core activities of effective IPC programs
• Recommended IPC practices to reduce
• Pathogen transmission
• Healthcare-associated infections
• Antibiotic resistance

All Cause Harm Prevention in Nursing Homes Applying Strategies from the New CMS Change Package

Thursday, January 24, 2019, 3:00pm ET (1 hour) Recording Available.

One-third of SNF residents experience an adverse or temporary harm event, and the majority of those are preventable. As part of CMS’s focus on raising awareness of nursing home safety and to support safer nursing home care across the nation, CMS and the Quality Innovation Network National Coordinating Center released a new resource: a Change Package to prevent all cause harm in nursing homes. The Change Package is a compendium of successful practices of high-performing nursing homes, illustrating how they prevent harm while honoring each resident’s rights and preferences.