INFECTION PREVENTION IN A PSYCHIATRIC SETTING Suzette Branscum

INFECTION PREVENTION IN A PSYCHIATRIC SETTING Suzette Branscum RN, B-C, CPHQ Chief Nursing Officer Vantage Point NWA Behavioral Health

ALL ABOUT ME…. .

BEHAVIORAL HEALTH IS WAY DIFFERENT

IN SOME WAYS ITS MUCH EASIER IN OTHER WAYS ITS MUCH HARDER

MOST PSYCH HOSPITALS THAT ARE NOT ATTACHED TO A MEDICAL HOSPITAL ARE STILL ON PAPER CHARTING!!!! THERE WAS A LOOP HOLE IN THE OBAMA LAW REQUIRING ELECTRONIC MEDICAL RECORD BY 2014!

OUR CORPORATE IS 150 HOSPITALS ACROSS THE USA, PUERTO RICO AND ENGLAND MOSTLY BEHAVIORAL HEALTH HOSPITALS

114 BEDS ON 5 UNITS • CHILD UNIT: 18 CHILDREN AGE 4 -8 • ACUTE ADOLESCENT UNIT: 24 PATIENTS AGE 918 • SUBACUTE ADOLESCENT UNIT: 26 PATIENTS AGE 9 -18 • ADULT PSYCH/DUAL DIAGNOSIS/DETOX UNIT: 16 PATIENTS • DEMENTIA UNIT: 30 GERIATRIC PATIENTS

CHILDREN AND ADOLESCENTS HAVE TWO LEVELS OF CARE ACUTE AND SUBACUTE

ACUTE STAY IS 7 -10 DAYS SUBACUTE STAY IS 3 -6 MONTHS

AFTER 30 DAYS SUBACUTE CHILD/ADOLESCENT PATIENTS GO ON PASS 4 TO 72 HOURS AT A TIME

PATIENTS ARE SUPPOSED TO BE MEDICALLY STABLE HOWEVER GERI PATIENTS COME WITH ALL THEIR COMORBIDITIES CHILD/ADOL SUBACUTES MAY BE HERE 3 -6 MONTHS AND BECOME ILL WITH ALL THE THINGS KIDS ROUTINELY GET

OUR PATIENTS ARE NOT DOWN THE HALL, IN THEIR ROOM WITH A CALL LIGHT

OUR PATIENTS LIVE, EAT AND RECEIVE TREATMENT IN A COMMUNITY SETTING. THEY ARE WALKING AROUND FREELY AND ARE USUALLY LOCKED OUT OF THEIR ROOMS IN THE DAY TIME FOR SAFETY REASONS

THE ASSUMPTION IS THAT ALL OUR PATIENTS ARE ACTIVELY SUICIDAL

WE HAVE NO ISOLATION TO SPEAK OF, EXCEPT CONTACT * SUICIDAL PATIENTS CAN’T BE LEFT ALONE IN THEIR ROOM *ISOLATION CARTS IN THE HALL PRESENT A DANGER

NO NEGATIVE AIR PRESSURE ROOMS NO ANTE ROOMS

LET’S TALK ABOUT LICE!

NO PLASTIC BAGS OF ANY KIND ARE ALLOWED AS THEY ARE A POTENTIAL CHOKING HAZARD NO RED BAGS NO BAGS IN TRASH CANS NO “WALMART BAGS”

THICK PAPER BAGS ARE USED IN TRASH CANS SPECIALLY TREATED LAUNDRY BAGS ARE USED ANYTHING WITH BODY FLUIDS ARE REMOVED FROM THE ROOM AND PLACED IN SPECIAL CONTAINERS IN LOCKED HOUSEKEEPING CLOSET

HAND HYGIENE PRODUCTS IN THE ROOM ARE OF NO HELP BECAUSE THE PATIENTS ARE NOT THERE * A SUICIDAL PATIENT OR ALCOHOL DETOX PATIENT WILL ATTEMPT TO DRINK HAND GEL IF LEFT UNATTENDED

PATIENTS PERSONAL HYGIENE PRODUCTS ARE DISTRIBUTED BY THE FACILITY WHY? A BAR OF SOAP IN A SOCK CAN BE A WEAPON RAZORBLADES CAN BE HIDDEN IN DEODORANT SHAMPOO BECOMES A SLIP AND SLIDE

BODY SOAP/SHAMPOO ARE DISTRIBUTED IN SMALL PAPER SOUFFLÉ CUPS

THE MAJORITY OF OUR DEMENTIA PATIENTS COME FROM NURSING HOMES

95% OF PATIENTS WHO COME TO THE DEMENTIA UNIT HAVE A SIMPLE UTI OR SOME OTHER MINOR INFECTION WHICH IS CAUSING THE SUDDEN CHANGE IN BEHAVIOR!

WE OCCASIONALLY HAVE GERIATRIC PATIENTS WHO ARE ADMITTED WITH VRE OR ESBL IN THEIR URINE THESE PATIENTS ARE NOT “ISOLATED” BUT REQUIRE GOOD HANDWASHING AND CAREFUL CLEANING OF EQUIPMENT

ON THE BRIGHT SIDE WE DON’T DO: SURGERY OR STERILE PROCESSING

WE HAVE NO CENTRAL LINES VERY FEW, IF ANY, FOLEY CATHETERS NO VENTILATORS REPORT ONLY ANNUAL FLU NUMBERS TO NHSN

HOW ARE INFECTIONS DISCOVERED AND TRACKED AND REPORTED? HOW ARE HAI DETERMINED? WHAT OTHER INFECTION PREVENTION ACTIVITIES ARE CONDUCTED?

THE FOLLOWING INFECTION PREVENTION ACTIVITIES AND EMPLOYEE HEALTH ACTIVITIES ARE CONDUCTED

• PATIENT AND EMPLOYEE INFECTION TRACKING • ANTIBIOTIC/ANTIFUNGAL USAGE TRACKING • INFESTATION TREATMENT AND TRACKING • REVIEW OF LAB RESULTS • HAI IDENTIFICATION USING CDC CRITERIA • PATIENT IMMUNIZATION: FLU, PNEUMONIA, TB • INFECTION PREVENTION ENVIRONMENTAL WALK THRU • REPORT AND COLLABORATE WITH THE HEALTH DEPARTMENT • EMPLOYEE HEALTH/IMMUNIZATIONS • FLU • TB • HEP B • STAFF EDUCATION • CLEAN/DIRTY • ISOLATION • MINIMUM OF 2 IN-SERVICES PER YEAR • 6 INFECTION PREVENTION MEETINGS / YR • NHSN PATIENT AND EMPLOYEE FLU DATA REPORTING

EVERY PATIENT AND EMPLOYEE INFECTION IS TRACKED AND REPORTED EACH MANAGER KEEPS A LOG FOR EACH TIME AN EMPLOYEE CALLS IN

INFECTIONS ARE REPORTED TO THE INFECTION PREVENTION NURSE VIA A LOG ON THE UNIT WHENEVER AN ANTIBIOTIC OR ANTIFUNGAL IS ORDERED. THE PHARMACY REPORT AND LAB REPORTS ARE ALSO REVIEWED

ALL INFECTIONS ARE EVALUATED FOR TRENDS PATIENTS ARE TRANSFERRED TO MEDICAL FACILITY IF INFECTION CAN NOT BE TREATED HERE.

PATIENTS ARE SCREENED PRIOR TO ADMIT USING AN INFECTION PREVENTION TOOL TO SCREEN OUT ALL PATIENTS WITH SERIOUS INFECTIONS OR RESPIRATORY INFECTIONS

ALL INFECTIONS ARE EVALUATED FOR HEALTHCARE ACQUIRED INFECTIONS USING CDC CRITERIA

EYE THIS GROUP GOES TOGETHER PICK ONE > 2 DAYS PICK AT LEAST ONE HAI AGE ROOM NAME M or F PICK TWO Follow up after a recent course of + OR antibiotics? Y / N +culture ADMIT ONSET from the DATE eye Eye Pain Visual Disturb Hypopyon (layer of pus in front anterior & chamber) + Lab on blood (H. Physician influenzae + Blood diagnosis of eye or culture infection S. pneumoniae antigen What Antibiotic x Days Y N W NO OTHER RECOGNIZED CAUSE

ASYPTOMATI C Cathed > 2 DAYS HAI PICK TWO PICK THREE OR Culture of >100, 000 CFU/ml < 2 species micro-organisms What Antibiotic x ? Days No more than 2 species micro-organisms +Culture of >100, 000 CFU/ml Follow up after a recent course of antibiotics? Y / N ROOM AGE M or F SYPTOMATIC ONSET DATE Indewll cath inserted present Str. Cath here on admit and during stay and >2 days total Y / N >2 days Y / N total Y / N ADMIT DATE NAME + Temp >104 or <96. 8 suprapubic tendernes, costoverteberal angle pain or tenderness, Lethargy, apnea bradycardia dysuria or vomiting Y N

Redness or swelling of decubitus wound edges & +Culture of needle aspiration of fluid or biopsy of tissue * see note + Culture from Blood Purulent drainage, pustules, vesicles or boils & Purulent drainage @ affected site or Pain or Tenderness Redness Heat NAME & AGE M / ROO F M ADMIT ONSET DATE + PICK TWO PICK ONE OR MORE PICK ONE & PICK TWO + lab on blood or urine SKIN + Blood Culture + Culture from tissue or draiage PICK ONE + lab on tissue or blood + Blood Culture DECUBITUS + Culture of aspirate or drainage Redness or heat Localized swelling Pain or Tenderness SKIN SOFT TISSUE > 2 DAYS PICK ONE HAI Antibiotic x how many days Y N

FOLLOWING AREAS ARE THE ONLY AREAS WE HAVE INFECTIONS AND FOR WHICH WE HAVE CDC HAI SPREADSHEETS MADE C DIFF SKIN EYE UTI LOWER RESP UPPER RESP

HAND HYGIENE DIRECT OBSERVATION EACH NURSE MANAGER AND EACH SUPERVISOR MUST DO 1 OBSERVATION MONTHLY INCLUDING PHYSICIANS REMEMBER THAT ONE OBSERVATION CAN INCLUDE UP TO 30 PATIENTS AT ONE TIME.

ENVIRONMENTAL ROUNDS ARE DONE BY EACH UNIT MANAGER OF THEIR OWN UNIT EACH MONTH AND THE INFECTION PREVENTION NURSE DOES ALL OTHER AREAS ON A SCHEDULE ALL HOSPITAL AREAS INCLUDING UNITS, DIETARY ETC. MONTHLY ADMINISTRATIVE AREAS ON A QUARTERLY SCHEDULE.

INFECTION PREVENTION NURSE MINIMUM OF 2 IN-SERVICES/YR PROVIDES INPUT TO PATIENTS BEING ADMITTED WITH POSSIBLE INFECTIONS CONSULTS PREVENTING THE SPREAD OF INFECTION PROVIDES EMPLOYEE HEALTH AND MONITORING INTERFACES WITH DEPARTMENT OF HEALTH COLLECTS AND ANALYSES DATA CONSULTS WITH THE MEDICAL DIRECTOR

REMEMBER WHAT I TELL STUDENTS…. .

MY CONTACT INFO SUZETTE. BRANSCUM@VANTAGEPOINTNWA. COM CELL: 479 -651 -6912