ICAP Updates for Local Health Departments - Presented by Nebraska ICAP
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ICAP Updates for Local Health Departments Presented by Nebraska ICAP
Housekeeping Guidance and responses were provided based on information known on 9.13.22 and may become out of date. Guidance is being updated rapidly, so users should look to CDC and NE DHHS guidance for updates. Slides and recording from this presentation will be available on the ICAP Website at: https://icap.nebraskamed.com/events/webinar-archive/ NE ICAP Team Salman Ashraf, MD Salman.ashraf@nebraska.gov Nicolas Cortes-Penfield, MD n.cortespenfield@unmc.edu Kate Tyner, RN, BSN, CIC ltyner@nebraskamed.com Lacey Pavlovsky, RN, MSN, CIC Lacey.Pavlovsky@nebraska.gov Jody Scebold EdD, MSN, RN, CIC joscebold@nebraskamed.com Josette McConville, RN, MSN, CIC jmcconville@nebraskamed.com Dan German dgerman@nebraskamed.com Marissa Chaney machaney@nebraskamed.com
Ne ICAP Program Updates
ICAP Updated Web Page https://icap.nebraskamed.com/
ICAP Updated Web Page https://icap.nebraskamed.com/events/webinar-archive/ How To Access Past Webinar Recordings_Video Instructions
Current Program Updates
Outpatient Program
• Monkeypox Resources added to webpage
• https://icap.nebraskamed.com/pathogens-of-
interest/monkeypox-resources-and-updates/
School Nurse program
• Kids Health Zone Newsletter-link on NE ICAP
School website
• CDC updated its guidance for K-12 and Early Care
Monkeypox Resources and Updates - ICAP (nebraskamed.com)
Post-Acute Care Staff Education Monkeypox Staff Education for Post Acute Care (LTC) - ICAP (nebraskamed.com)
Access to the school newsletter and sign up to be added to the email list can be found at: https://icap.nebraskamed.com/facilities /school/
CDC Guidance for K-12 Schools and Early
Care: Summary of Changes
• Removed recommendation to cohort
• Changed recommendation to conduct
screening testing to focus on high-risk
activities during high COVID-19
Community Level or in response to an
outbreak
• Removed recommendation to
quarantine, except in high-risk
congregate settings
• Removed information about Test to
Stay
• Added detailed information on when
to wear a mask, managing cases and
exposures, and responding to
outbreaks
Schools and Childcare Programs | COVID-19 | CDCCDC Recommendations
K-12 schools and ECE programs (e.g., center-based childcare, family
childcare, Head Start, or other early learning, early intervention
and preschool/pre-kindergarten programs delivered in schools,
homes, or other settings) should put in place a core set of
infectious disease prevention strategies as part of their normal
operations. The addition and layering of COVID-19- specific
prevention strategies should be tied to the COVID-19 Community
Levels and community or setting-specific context, such as
availability of resources, health status of students, and age of
population served. Enhanced prevention strategies also may be
necessary in response to an outbreak in the K-12 or ECE setting.
This CDC guidance is meant to supplement— not replace—any
federal, state, tribal, local, or territorial health and safety laws,
rules, and regulations with which schools and ECE programs must
comply.
*Operational Guidance for K-12 Schools and Early Care and
Education Programs to Support Safe In-Person Learning _
CDC.pdfCore Set of Infectious Disease Prevention Strategies Staying Up to Date on Vaccinations Staying Home When Sick Ventilation Hand Hygiene and Respiratory Etiquette Cleaning
Current Events and Updates
Nursing Home Strike Team Updates
Muhammad Salman Ashraf
Medical Director, NE DHHS HAI/AR Program
09/13/22
Helping People Live Better Lives.LTCF Strike Team Project 2022-2023
Support LTCF (SNF and ALF) throughout the state in getting >90% of their
staff fit tested.
Provide fit testing equipment
Hold one day of fit testing at each facility that need support
Train the trainer at each facility where no one currently is trained
Train LTCF staff in infection control principles and COVID-19 prevention
and containment measures to build internal capacity
Train new infection preventionists
Train infection control champions to ensure compliance with IC practice
Implement comprehensive respiratory protection program
Support LHD to promote collaborative efforts with NDHHS HAI/AR
Program for assisting healthcare facilities in the jurisdiction with their
infection control efforts.
Helping People Live Better Lives.Expense Reimbursement
The funds will be available to reimburse some of the LTCF cost related to
the following activities (for facilities that will agree to participate in the
project and complete its requirements):
➢ N-95 fit testing equipment and supplies
➢ Training of a few staff at each LTCF in performing N-95 fit testing
➢ Training cost and time spent in training for IPs and infection control
champions
➢ Fit testing >90% of staff
Funds will also be available for LHD staff to facilitate with project
implementation and coordination with NDHHS HAI/AR Program
Helping People Live Better Lives.Funding for LHD
Funds are set aside in the budget for some of the cost reimbursement
related to (maximum reimbursement will depend on the number of
facilities in the jurisdiction):
• Staff time spent in undergoing training
• Staff time spent on spending at least one day at each LTCF in the
jurisdiction
• Fit testing equipment for each of the local health department and every
LTCF
• LHD HAI/AR program lead for their efforts in coordinating the project
with NDHHS HAI/AR team and assisting facilities in their jurisdiction
Helping People Live Better Lives.Train the Trainer Dates for LHD Staff Helping People Live Better Lives.
The Case and Use of Enhanced
Barrier PrecautionsEnhanced Barrier Precautions – New CDC Recommendations Expected 7/2022 Considerations for Use of Enhanced Barrier Precautions in Skilled Nursing Facilities (cdc.gov)
Old way: Contact Precautions
in Long Term Care Settings
Adopt a person-centered approach: “only when necessary and
as long as necessary”
• Use transmission-based precautions, and discontinue when
no longer needed, based on evidence-based best practices
and facility policy.
• Do not over-isolate residents.
Consider transmission-based precautions on a case-by-case
basis as an indicator to “gown and glove up” when providing
direct personal care.
• If the resident cannot maintain clean hands, clean
clothes, and clean equipment
A Unit Guide To Infection Prevention for Long-Term Care Staff. Burdsdall, Schweon, Collier.
AHRQ project contract number HHSA290201000025I, task order 8, from the Agency for
Healthcare Research and Quality (AHRQ). March 2017Contact Precautions Contact Precautions are used when caring for residents who are actively infected with an MDRO – meaning they have symptoms or might even be on antibiotics for an infection. • require the use of a gown and gloves whenever entering the room • placing the resident in a single person room, • restricting them from all group activities.
The old way: what’s missing?
Infection
ColonizationThe Large Burden of MDROs in Nursing Homes
Facility Type Documented Actual MDRO
MDRO
Nursing Homes 17% 58%
(n = 14)
Ventilator-Capable Nursing 20% 76%
Homes
(n = 4)
McKinnell JA et al, Clin Infect Dis. 2019; 69(9):1566-1573Indications for Enhanced
Barrier Precautions
EBP are indicated for nursing home residents with any
of the following:
• Infection or colonization with an MDRO when
Contact Precautions do not otherwise apply
• Wounds and/or indwelling medical devices
EBP is not limited to outbreaks or specific MDROsEnhanced Barrier Precautions • Use of gown and gloves during high-contact resident care activities • No private room required • Residents can participate in group activities • Intended to be used for resident’s entire length of stay
Use a gown and gloves during high contact resident care activities Examples of high-contact resident care activities requiring gown and glove use for Enhanced Barrier Precautions include: • Dressing • Bathing/showering • Transferring • Providing hygiene • Changing linens • Changing briefs or assisting with toileting • Device care or use: central line, urinary catheter, feeding tube, tracheostomy/ventilator • Wound care: any skin opening requiring a dressing
Which activities are included under "providing hygiene"? • Providing hygiene refers to practices such as brushing teeth, combing hair, and shaving • Many of the high-contact resident care activities listed in the guidance are commonly bundled as part of morning and evening care for the resident rather than occurring as multiple isolated interactions with the resident throughout the day • Isolated combing of a resident’s hair that is not otherwise bundled with other high-contact resident care activities would not generally necessitate use of a gown and gloves
Why does MDRO colonization matter?
Example: Candida auris colonization
• Persists for many months
• There are currently no
decolonization strategies
• Primarily lives on the skin
• Nares
• Armpits
• groin
Prevention of Candida auris and Other Novel Multidrug-resistant Organisms in Healthcare Facilities. Los
Angeles County Department of Public Health and Centers for Disease Control and Prevention
https://www.cdph.ca.gov/Programs/CHCQ/HAI/CDPH%20Document%20Library/C_auris_AHR_CDC_CDP
HshareWebinarcCombined_ADA_121020.pdfCandida auris persists in the environment for a long time Prevention of Candida auris and Other Novel Multidrug-resistant Organisms in Healthcare Facilities. Los Angeles County Department of Public Health and Centers for Disease Control and Prevention https://www.cdph.ca.gov/Programs/CHCQ/HAI/CDPH%20Document%20Library/C_auris_AHR_CDC_CDP HshareWebinarcCombined_ADA_121020.pdf
Candida auris (C. auris) is an emerging multidrug-resistant yeast (a type of
fungus). It can cause severe infections and spreads easily between hospitalized
patients and nursing home residents.
WHAT YOU NEED TO KNOW
C. auris, first identified in 2009 in Asia, has quickly become a cause of severe infections
around the world.
C. auris is a concerning drug-resistant fungus:
✓ Often multidrug-resistant, with some strains (types) resistant to all three available
classes of antifungals
✓ Can cause outbreaks in healthcare facilities
✓ Some common healthcare disinfectants are less effective at eliminating it
✓ Can be carried on patients’ skin without causing infection, allowing spread to others
CDC info on C. aurisFrom a single introduction, Candida auris can spread rapidly Prevention of Candida auris and Other Novel Multidrug-resistant Organisms in Healthcare Facilities. Los Angeles County Department of Public Health and Centers for Disease Control and Prevention https://www.cdph.ca.gov/Programs/CHCQ/HAI/CDPH%20Document%20Library/C_auris_AHR_CDC_CDP HshareWebinarcCombined_ADA_121020.pdf
From a single introduction, Candida auris can spread rapidly, continued Prevention of Candida auris and Other Novel Multidrug-resistant Organisms in Healthcare Facilities. Los Angeles County Department of Public Health and Centers for Disease Control and Prevention https://www.cdph.ca.gov/Programs/CHCQ/HAI/CDPH%20Document%20Library/C_auris_AHR_CDC_CDP HshareWebinarcCombined_ADA_121020.pdf
Of the patients that are colonized with Candida auris, 5-10% develop bloodstream infections Mortality is more than 45% within the first 30 days. Prevention of Candida auris and Other Novel Multidrug-resistant Organisms in Healthcare Facilities. Los Angeles County Department of Public Health and Centers for Disease Control and Prevention https://www.cdph.ca.gov/Programs/CHCQ/HAI/CDPH%20Document%20Library/C_auris_AHR_CDC_CDP HshareWebinarcCombined_ADA_121020.pdf
Novel MDRO travel together Prevention of Candida auris and Other Novel Multidrug-resistant Organisms in Healthcare Facilities. Los Angeles County Department of Public Health and Centers for Disease Control and Prevention https://www.cdph.ca.gov/Programs/CHCQ/HAI/CDPH%20Document%20Library/C_auris_AHR_CDC_CDP HshareWebinarcCombined_ADA_121020.pdf
CDC Containment Strategy:
“Be on guard to contain the first spark.”
NE ICAP and DHHS HAI AR Team
DHHS HAI AR Team
and LHD
DHHS HAI AR TeamUpcoming Events
Upcoming Events
Acute Care Webinars
• Join us every 2nd and 4th Wednesday of the month for the Acute Care
webinar
• More info on how to join at: https://icap.nebraskamed.com/covid-19-
webinars/
LTC Webinars
• Join us every Thursday at 12:00 CST for the LTC and COVID-19 update
webinar
• More info on how to join at: https://icap.nebraskamed.com/covid-19-
webinars/
NICN Primary Infection Prevention Course Sept. 28 and 29
• Join us for a 2 day, in person Primary Infection Prevention course
• https://nicn.orgInfection Control Training
➢ Project Firstline is Infection Control (IC) training for your frontline
healthcare workers
➢ Why is it important? Infection Control:
➢ Works! The right practices can stop germs from spreading in healthcare
facilities.
➢ Is a Team Effort! Infection control is most effective when all team
members use it consistently.
➢ Matters! Infection control is a critical part of safe healthcare delivery in all
healthcare settings.
➢ To find out more or to schedule a training for your facility, scan the QR
code or visit: icap.nebraskamed.com/project-firstline/Where can you find us? Follow us on Facebook at @NebraskaICAP or https://www.facebook.com/NebraskaICAP/ Follow us on Twitter at @dirty_drinks and @Mouthy_IP Listen to Dirty Drinks and The Mouthy IP wherever you listen to podcasts! Find resources for all facility types at our website: https://icap.nebraskamed.com/
Nebraska DHHS HAI/AR Program Organizational Chart Notes: 1. This Organizational chart represents day-to-day workflow and reporting tree of the Nebraska DHHS HAI/AR Program which are different than organizations’ administrative reporting structure. At NDHHS, all HAI/AR program staff reports to “Deputy Director, Epidemiology, Informatics and Vitals Units” although HAI/AR Program Medical Director also has direct reporting responsibility to state epidemiologist. Similarly, UNMC and Nebraska Medicine employees (working for ICAP and ASAP) also have additional reporting responsibilities within their organizations. 2. The collaboration between UNMC, Nebraska Medicine and NDHHS allows the two different arms of HAI/AR Program (state and academia) working in sync. Administrative leaders for this collaboration are Matt Donahue and Felicia, Quintana-Zinn at NDHHS, Mark Rupp at UNMC ID-Division and Shelly Schwedhelm and Nebraska ICAP Administrator at Nebraska Medicine 3. The organizational chart only describes the primary responsibilities of the staff. Many staff members have secondary responsibilities of assisting other team members in their roles (that are not mentioned here) 4. Blue colored box indicates the staff primarily focused on activities at NDHHS and orange color box indicates that the staff primary responsibilities are either at ICAP, ASAP or both 5. HAI/AR Program IP also assist with some ICAP activities and in that role reports to the ICAP team supervisor
We’re here for you!
Nebraska ICAP is funded to answer infection
prevention and control questions from healthcare
settings, not just LTC
Feel free to contact us to be connected with an
Infection Preventionist and Medical Director to help
walk you through any questions you may havehttps://icap.nebraskamed.com/wp-content/uploads/sites/2/2022/02/ICAP-Decision-Tree.pdf
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