LTC Prev Process Measures Protocol

Prevention Process Measures Surveillance for Long Term Care Facilities

Background: Healthcare-associated infections (HAIs) can be prevented by adherence to infection prevention precautions. The CDC’s Healthcare Infection Control Practices Advisory Committee (CDC/HICPAC) Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings¹ recommends practices known to reduce the risk of HAIs. These practices include hand hygiene, glove use, and gown use. Despite evidence supporting these prevention measures, adherence to these practices is sub-optimal. Several facilities have found it useful to monitor adherence to these prevention practices as a method for identifying quality improvement opportunities and strategically targeting interventions. Feedback of adherence data has been a component of multifaceted interventions that have successfully reduced HAI rates.

Participation in NHSN Prevention Process Measures Surveillance is open to all types of long term care facilities (LTCF) including Nursing Homes/Skilled Nursing Facilities; intermediate/chronic care facilities for the developmentally disabled; Assisted Living Facilities and Residential Care Facilities. Participation enables facilities and CDC to:

• Monitor practices in facilities and provide aggregate adherence data for all participating facilities.

• Facilitate quality improvement by identifying specific gaps in adherence to recommended prevention practices, thereby helping to target intervention strategies for reducing HAI rates.

1: Healthcare Infection Control Practices Advisory Committee (HICPAC) Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Setting. Available at www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf

2: Smith et al. SHEA/APIC Guideline: Infection Prevention and Control in the Long-Term Care Facility. Infection Control and Hospital Epidemiology 2008;29:785-814.

1. Monitoring Adherence to Hand Hygiene

Introduction: This surveillance option will allow LTCFs to monitor adherence to hand hygiene after healthcare personnel (HCP) has contact with a resident or inanimate objects in the immediate vicinity of the resident. Research studies have reported data suggesting that improved after-contact hand hygiene is associated with reduced HAI transmission. While there are multiple opportunities for hand hygiene during resident care, for the purpose of this option, is to monitor hand hygiene only after contact with a resident or inanimate objects in the immediate vicinity of the resident will be observed and reported. (www.cdc.gov/handhygiene/ )

Requirements: Surveillance for adherence to hand hygiene in the LTCF for at least one calendar month as indicated in the Monthly Reporting Plan for LTCF (CDC 57.141). Perform at least 30 different unannounced observations after contact with residents for as many individual HCPs as possible. For example, try to observe all types of HCPs (physicians, nurses, technicians, aides, etc.) performing a variety of resident care tasks during the course of the month. No personal identifiers will be collected or reported.

Definitions:

Antiseptic handwash: Washing hands with water and soap or other detergents containing an antiseptic agent.

Antiseptic hand rub: Applying an antiseptic hand-rub product to all surfaces of the hands to reduce the number of microorganisms present.

Hand hygiene: A general term that applies to either: handwashing, antiseptic hand wash, antiseptic hand rub, or surgical hand antisepsis.

Handwashing: Washing hands with plain (i.e., non-antimicrobial) soap and water.

Numerator: Hand Hygiene Performed = Total number of observed contacts during which a HCP touched either the resident or inanimate objects in the immediate vicinity of the resident and appropriate hand hygiene was performed.

Denominator: Hand Hygiene Indicated = Total number of observed contacts during which a HCP touched either the resident or inanimate objects in the immediate vicinity of the resident and therefore, appropriate hand hygiene was indicated.

Hand hygiene process measure data are reported using the Prevention Process Measures Monthly Monitoring for LTCF form (CDC 57. 143). (See Tables of Instructions Table XX for completion instructions.)

Data Analysis: Data are stratified by time (e.g., month, quarter, etc.) and resident care location. Hand Hygiene Percent Adherence = Number of contacts for which hand hygiene was performed / Number of contacts for which hand hygiene was indicated X 100

II. Monitoring Adherence to Gown and Gloves Use as Part of Contact Precautions

Introduction: This option will allow facilities to monitor adherence to gown and gloves use when a HCP has contact with a resident or inanimate objects in the immediate vicinity of the resident, only when that resident is on Transmission-based Contact Precautions. While numerous aspects of adherence to Contact Precautions could be monitored, this surveillance option is only focused on the use of gown and gloves. (www.cdc.gov/hicpac/2007IP/2007ip_part1.html#2)

Requirements: Surveillance for adherence to gown and gloves use for at least one calendar month as indicated in the Monthly Reporting Plan for LTCF (CDC 57.141). Among residents on Transmission-based Contact Precautions, perform at least 30 unannounced observations. A total of thirty different contacts must be observed monthly among HCP of varied occupation types. For example, try to observe all types of HCP performing a variety of resident care tasks during the course of the month, not only nurses, or not only during catheter or wound care. Both gown and gloves must be donned prior to contact for compliance. No personal identifiers will be collected or reported.

Definitions:

Gown and gloves use: In the context of Transmission-based Contact Precautions, the donning of both a gown and gloves prior to contact with a resident or inanimate objects in the immediate vicinity of the resident. Both a gown and gloves must be donned prior to contact for compliance.

Numerator: Gown and Gloves Used = Total number of observed contacts between a HCP and a resident or inanimate objects in the immediate vicinity of the resident for which gown and gloves had been donned prior to the contact.

Denominator: Gown and Gloves Indicated = Total number of observed contacts between a HCP and a resident on Transmission-based Contact Precautions or inanimate objects in the immediate vicinity of the resident and therefore, gown and gloves were indicated.

Gown and gloves use process measure data are reported using the Prevention Process Measures Monthly Monitoring for LTCF form (CDC 57. 143). (See Instruction Table X for completion instructions.)

Data Analysis: Data are stratified by time (e.g., month, quarter, etc.).

Gown and Glove Use Percent Adherence = Number of contacts for which gown and gloves were used / Number of contacts for which gown and gloves were indicated X 100