Transcript Alden Estates of Barrington is 5 star rated facility that serves a

ILLINOIS SUMMIT ON ANTIMICROBIAL
STEWARDSHIP
2015
Julie Sopocy, RN, BS,
Director of Nursing
Alden Estates of Barrington
Skilled Nursing Facility
Our Facility
• Alden Estates of Barrington is 5 star rated facility that
serves a unique population of skilled nursing needs.
Our Population
• 150 dual certified bed capacity.
• Specialty
– Ventilator/respiratory unit
• Tracheostomy in place prior to admission to facility
• Either long term care ventilator or attempting to wean
• G-tube in place for enteral feeding if needed
– Newly placed LVAD
– Peripheral or Central lines for hydration or antibiotics.
• Short term rehabilitation unit
– Recent ortho surgeries
– Rehab after CVA
– Wound care
– Post general surgical, weak due to illness
• Long-term care unit
– Home for 50% of residents
Our Clinicians
• Primary Care Physicians
• Primary Care Nurse Practitioners
• Pulmonologists
• Infectious Disease
• Nephrologists
• Physiatrist
• Wound Care Doctors
• Psychiatrists
• Podiatrists
• Ophthalmologists
Who defines Infection?
• At our facility we use the McGeer’s1, 2 Infection Report
Form for all suspected infections.
1Infect
Control Hospital Epidemiology 2012;33:965-977
McGeer’s Criteria were developed as a surveillance tool to
identify and report evidence of infections in Long Term Care
Facilities and have not been validated as a clinical tool. These
criteria have become the national regulatory standard that
requires potentially infectious acute clinical changes be
documented and communicated to physicians in a timely
manner.
2
According to McGeer’s, any symptoms used to
qualify defining infection must be:
• New in onset or acutely worse
• Rule out other causes first
• Dehydration
• New medication
• Infection should not be identified by a single
piece of evidence
• Use microbial and radiology information
When to Treat?
• Infection report form helps define treatable infection
• It is important to treat active infections, NOT
asymptomatic colonizations
• Use microbial studies to help determine active infection.
• Infection
report
forms:
– Respiratory
tract
– Urinary
tract
– Gastrointes
tinal tract
– Skin
– Eye, ear,
nose,
mouth
Barriers to Best Practice
• Physicians:
-
use of prophylaxis treatment
maintenance use for chronic infection
treatment with broad spectrum antibiotics while a culture
is pending
not having qualifying diagnosis for use of foley
catheters
• Staff:
- improper technique (hand hygiene, use of PPE,
incontinent & catheter care)
Overcoming Barriers
• Education
– To prescribers on criteria for antibiotic treatment and qualifying
diagnoses for Foley Catheter use
– To staff on proper hand hygiene, use of PPE with patients on
precautions
Overcoming Barriers
• Communication
– With prescribers: develop relationships with practitioners, call and
ask for a culture or x-ray before treatment
– With staff:
– clinical rounds with interdisciplinary team and frontline staff twice daily to
update on change of condition
– use of interact tools; stop & watch, SBAR, care pathways.
Overcoming Barriers
• Observation
– Quality Assurance rounds by a team of disciplines to assure
procedures are being followed
References
• CDC – Centers for Disease Control, www.cdc.gov
• SHEA, The Society for Healthcare Epidemiology of
America, www.jstor.org
• NIH, National Institute of Health, www.ncbi.nlm.nih.gov
• Infect Control Hospital Epidemiology 2012;33:965-977