Agenda Time Agenda Item 9 00 9 30

Agenda Time Agenda Item 9: 00 -9: 30 Reflection/Icebreaker/ Introductions 9: 30 – 9: 50 Background • HAI data/ cost • Region composition • IP staffing industry standards 9: 50 – 12: 00 Needs assessments • Hospital • Home Health/ Hospice • Ambulatory • Other 12: 00 – 12: 45 Lunch and math 12: 45 – 2: 00 Staffing model development 2: 00 – 2: 30 Creation of ideal and basic program options 2: 30 - 3: 30 Report out 10/16/2021 Leader 0

Know me, care for me, ease my way… …keep me safe Healthcare-acquired infections (HAI) are Tools to Prevent HAIs harming patients in our • Commitment to zero preventable care every day harm • Leadership alignment, involvement, and accountability • Accurate, transparent, actionable data More than Loss of trust 2, 000 patients and harm to harmed each reputation year $30 M in annual costs estimated and $5 M in payment penalties • Improvement capability and capacity • Competent, skilled and equipped workforce • A collaborative learning organization

Cost of Infections Infection Type Number Cost per Infection C. Diff $11, 285 MRSA BSI $14, 655 CLABSI $45, 814 CAUTI $896 SSI (NHSN reported procedures only) $20, 785 2015 Attributable Cost Total 10/16/2021 2

X Region – In scope/Out of scope § Acute care – # of tertiary care – # of community hospitals – # of CAHs § Ambulatory Clinics – # on TJC footprint – # not on footprint § Ambulatory Surgery Centers § Long term care facilities § Shared services /new locations?

IP Staffing Standards § Industry standards – Action OI (most recent, contains data from 119 facilities): Compare Group Percentile - 25 th Percentile - 50 th Percentile - 75 th Tot Op Beds 0 -50 0. 44 0. 69 Tot Op Beds 50 -100 0. 68 0. 92 1. 01 Tot Op Beds 100 -150 1 1. 02 1. 08 Tot Op Beds 150 -200 1 1. 26 1. 48 Tot Op Beds 200 -250 1. 3 1. 91 2. 51 Tot Op Beds 250 -300 2. 52 2. 7 3. 15 Tot Op Beds 300 -350 1. 34 1. 95 2. 52 Tot Op Beds 350 -400 2. 22 2. 59 2. 98 Tot Op Beds 400 -450 3. 36 3. 96 5. 98 Tot Op Beds 450 -500 5. 04 5. 58 6. 6 Tot Op Beds 500 -550 3. 42 6. 06 6. 85 Current State: 2. 8 FTE • • Average IP’s per 100 beds =. 81 -1. 02 • – – Delphi Study, 2002 – 1. 0 FTE per 100 beds NNIS Study, 2001 – 1. 0 FTE per 115 beds PNICE survey, 2011 – 1. 2 FTE per 100 beds Krein, et al, 2012 -. 67 -. 80 FTE per 100 beds • Guiding principles Centralized, regional IP program Regional leader/ cat herder Communication/collab oration amongst all participants and care settings

IP Staffing Standards – Ideal Work Mix Activity Prevention and Control of Infections Leadership Education and training of staff and patients Technical Other (email) 10/16/2021 IP Working Manager Regional Manager/ Director Analyst 40% 10% 30% 25% 35 -40% 0 0 30% 15% 5% 10% 5% 25% 5% 5% 20 -25% 10% 80% 10% 5

Hospitals – SURVEYS AND ROUNDS 10/16/2021 6

Hospital Breakdown - # of units Hospital Wards and Stepdown ICUs Inpatient Dialysis ED Hospital #1 Hospital #2 Hospital #3 Total 10/16/2021 7

Needs by Care Setting – Hospital Inpatient Rounding and Surveys Setting Activity Inpatient Units and stepdowns Isolation/ Rounding to Influence ICUs Isolation/ Rounding to Influence ED Isolation/ Rounding to Influence Inpatient Dialysis Isolation/ Rounding to Influence Inpatient Units and stepdowns Environment of Care (EOC) ICUs EOC ED EOC Inpatient Dialysis EOC Frequency Estimated hours per each # of units Hours per week

Needs by Care Setting – Hospital Ancillary Surveys Setting Larger Diagnostic Imaging Smaller Diagnostic Imaging Endoscopy Interventional Radiology Oncology Pharmacy Radiation Oncology Sleep Medicine Wound Care Small lab Comprehensive lab Sports Medicine PT/OT/Speech Etc… Hospital #1 Hospital #2 Hospital #3

Needs by Care Setting – Hospital Ancillary Surveys Setting Activity Larger DI EOC survey Smaller DI EOC survey Endoscopy EOC survey Interventional Radiology EOC survey Oncology EOC survey Pharmacy EOC survey Radiation Oncology EOC survey Sleep Medicine EOC survey Wound Care EOC survey Small lab EOC survey Comprehensive lab EOC survey Sports Medicine EOC survey PT/OT/Speech EOC survey # of units Frequency Estimated hours per each Hours per week

Needs by Care Setting – Hospital OR/Other Setting Cardiac OR C-section OR Main OR SDS Ped OR Outpatient Eye Surgery Cath Lab Interventional OR –aortic repair with fluoro HLD locations Sterilization locations Kitchens Tele. Health Hospital #1 Hospital #2 Hospital #3

Needs by Care Setting – Hospital OR /Other Surveys Setting Activity Cardiac OR EOC survey C-section OR EOC survey Main OR EOC survey SDS EOC survey Ped OR EOC survey Outpatient Eye Surgery EOC survey Cath Lab EOC survey EP lab EOC survey HLD locations EOC survey Sterilization locations EOC survey Kitchens EOC survey Interventional OR –aortic repair with fluoro EOC survey Telehealth EOC survey # of settings Frequency Estimated hours per each Hours per week

Ambulatory – SURVEYS AND ROUNDS 10/16/2021 13

Needs by Care Setting – Ambulatory Clinic Surveys Clinic Name Clinic Address Distance from nearest PH&S hospital (miles) Does the site conduct high level disinfection? (ex: Cidex OPA) Does the site conduct sterilization? Does the site perform use any type of surgical procedures (even endoscope? minor ones, like biopsies)? Travel Frequency Hours per visit Time calculation (hours per week) Clinic #1 On the foot print of the hospital campus y y y N 4 4 0. 31 Clinic #2 On the foot print of the hospital campus y y y N 4 4 0. 31 Clinic #3 On the foot print of the hospital campus y y y N 4 4 0. 31 On the foot print of the hospital campus y y N 4 4 0. 31 15 miles y y N 4 4 0. 31 On the foot print of the hospital campus y y N 4 4 0. 31

HH/Hospice – SURVEYS AND ROUNDS 10/16/2021 15

Needs by Care Setting –Surveys and Rounds Setting Activity Home Health Home visits with caregivers Hospice Home visits with caregivers Times per year Hours per each Hours per week

Long term Care Sites– SURVEYS AND ROUNDS 10/16/2021 17

Needs by Care Setting – Benedictine Survey and Rounds Setting Activity SNF unit Isolation/ Rounding to Influence TCU unit Isolation/ Rounding to Influence Times per year Estimated hours per each # of units Hours per week Isolation/ Rounding to Influence Environment of Care (EOC) EOC 10/16/2021 18

SURVEILLANCE 10/16/2021 19

Needs by Care Setting –Hospital Surveillance and Reporting Activity Lab review without data mining – initial sort Frequency Week days Enter into local database Deep dive HAI review Week days NHSN numerator Week days NHSN denominator Monthly Reportable diseases Week days Local reports and questions Week days Isolation verification and documenting Week days RCA Week days Estimated Time range per week Hrs per week

Needs by Care Setting – PSCS and Ambulatory Surveillance Activity Home Health Hospice LTC Ambulatory Times per year Hours per each Hours per week

Policies and Procedures 10/16/2021 22

Needs by Care Setting –Policy and Procedures Activity IP policy upkeep – hospital IP policy upkeep – ambulatory IP policy upkeep – home health/hospice IP policy upkeep – LTC Times per year Hours per week

EDUCATION 10/16/2021 24

Needs by Care Setting –Education Activity Times per year Hours per each Hours per week

CONSULTATION 10/16/2021 26

Needs by Care Setting – Hospital Consultation Activity Infectious disease exposure response and employee health support Ebola assessment center upkeep 24/7 call (currently unpaid) Construction System work Immediate response/ Special Pathogens – MERS, Ebola, Zika, leaks, disasters Times per year Hours per each Hours per week

Needs by Care Setting – Ambulatory Consultation Activity Infectious disease exposure response General Consultation Times per year Hours per each Hours per week

Needs by Care Setting – Home Health / Hospice Activity Infectious disease exposure response General Consultation Transitions of Care Times per year Hours per each Hours per week

Needs by Care Setting – LTC Activity Infectious disease exposure response General Consultation Transitions of Care Times per year Hours per each Hours per week

MEETINGS 10/16/2021 31

Needs by Care Setting – Hospital Meetings Activity Times per month Hours per each Hours per week

Needs by Care Setting – Ambulatory Meetings Activity Times per year Hours per each Hours per week

Needs by Care Setting – HH Meetings Activity Times per year Hours per each Hours per week

Needs by Care Setting – LTC Activity Times per year Hours per each Hours per week

MATH 10/16/2021 36

Executive, ORQMMSS Staffing Model Regional Director Regional Medical Directors System IP Director • • • Continuing education; development; paying for certification and training, APIC dues • On call Existing IP 10/16/2021 Existing IP Infection Prevention program manager Infection Prevention project manager Infection Preventionists Surveillance IPs Data Analysts Ambulatory IPs PSCS IPs Sterile processing/HLD IPs Admin support Existing IP. 6 Manager Acute IP (WF/ Milk) Sterile Processing/ HLD Admin Support Long-term/ Sub acute Ambulatory Surveillance Software Existing IP • 16. 76 FTE per Action OI 50 th Percentile • 16 FTE per needs assessment • 10. 6 FTE current state 37

Prioritization with less resources § Outpatient surveys significantly reduced § SNF surveys replaced significantly reduced § Inpatient rounding reduced § Reduced education 10/16/2021 38