Training Staff on CarbapenemResistant Enterobacteriaceae Maintaining staff alertness

Training Staff on Carbapenem-Resistant Enterobacteriaceae: Maintaining staff “alertness” Presentation to: Learning Session 3 participants Presented by: Michelle Nelson, RN, MSN Date: July 24, 2014

CRE Collaborative Outcome and Process Measures CRE STAFF TRAINING

Collaborative Measures Links with Collaborative Staff Training Outcome measures: • Number of Carbapenem-resistant organisms identified in your facility each month • Number of 30 -day Readmissions/month to hospital • Number of hospital transfers/month from LTCF

Staff Training Link Process measure: % staff adherent to appropriate gown/glove use during care of people known to be colonized with Carbapenem-resistant organisms

Establishing the Problem Magnitude Training q Jeanne Negley with DPH began setting the tone to establish the magnitude of the CRE problem during the March 5 th Leadership meeting when she addressed § Federal and State initiatives to address Healthcare Associated Infections (HAIs) § Readmissions and HAIs § Long-Term Care is a vital link in the continuum of care Source “A Call for Action: The Atlanta Regional CRE Continuum of Care Collaborative”, Jeanne Negley

Establishing the Problem Magnitude Training q Dr. Alex Kallen with the CDC helped us to understand the scope of the CRE problem during the same March 5 th meeting when he shared on § Epidemiology of carbapenem-resistant Enterobacteriaceae (CRE) in the United States § Measures necessary to halt transmission § Recognizing the importance of a regional approach to CRE control Source “National Overview if Carbapenem. Resistant Enterobacteriaceae”, Dr. Alex Kallen

Establishing the Problem Magnitude Training q Denise Flook, now with Eastside Medical Center, further articulated the problem and the need to address the Metro Atlanta regional problem of CRE using a Continuum-of-Care approach by focusing on § The national movement for the triple aim to Put Patients First and make patient care: • safer • more reliable • less costly § Making Care Safer. Reducing preventable hospitalacquired conditions by 40% compared to 2010. § Improving Care Transitions Source “”Healthcare Community Partnerships Across the Continuum“, Denise Flook

Establishing the Problem Magnitude Training q Jessica Reno with the Georgia EIP kept us focused on the regional data which first demonstrated the magnitude of the problem here in Georgia thru sharing data such as § Surveillance trends between August 2011 and December 2013 § The species distribution for the same timeframe § Sources and species for 2013, § Other community level data… Source “Multi-site Gram-negative Surveillance Initiative (Mu. GSI)”, Jessica Reno

Establishing the Problem Magnitude Training q Michelle Nelson worked to extend the understanding of the magnitude of the CRE problem in the Metro Atlanta area from the collaborative participants attending learning sessions to front line staff by sharing site training on § § Why CRE is important to control Reasons why CRE requires a regional approach CDC core measures to prevent CRE transmission Number of CRE cases in your facility during the baseline period Source “Carbapenem-Resistant Enterobacteriaceae (CRE): Understanding the Basics”, Michelle Nelson

Mortality in CRE Bacteremia Percent of subjects 60 50 40 P <0. 001 Carbapenemresistant 30 Carbapenemsusceptible 20 10 0 Overall Mortality Attributable Mortality Jesse Jacob Presentation: Patel G et al. Infect Control Hosp Epidemiol 2008; 29: 1099 -1106.

The CRE Basics and Prevention q Dr. Jesse Jacob with the University of Emory started the 1 st learning session by helping us to begin drilling down to understanding CRE basics such as § Understanding the context of CRE among resistant among gram negative bacteria § Recognizing the epidemiology and national threat of CRE § Integrating the approaches to CRE prevention Source “Carbapenem-resistant Enterobacteriaceae (CRE): A Bird’s Eye View from the US”, Dr. Jesse Jacob

The CRE Basics and Prevention q Dr. Nimalie Stone with the CDC continued drilling down on CRE basics to improve our understanding on § An overview microbiology and antibiotics Antibiotic resistant organisms with a focus on carbapenem-resistance § How/why resistant organisms spread in healthcare settings § Identifyng the core prevention strategies for reducing the emergence and transmission of resistance Source “Understanding multidrugresistance: Focus on Carbapenems”, Dr. Nimalie Stone

The CRE Basics and Prevention q Nancy Fendler with Alliant GMCF provided us training on how to apply the CRE basics training using Plan~Do~Study~Act § The model for improvement § How to apply PDSA cycles § Selecting measures for their improvement efforts § Having strategies for more successful tests Source “Plan~Do~Study~Act”, Nancy Fendler

The CRE Basics and Prevention q Front line staff received training that incorporated the CRE basics and prevention strategies that included training on § § § How CRE happened Why CRE requires a regional approach CRE is a serious public health concern CDC 8 core prevention core measures Hand hygiene first CRE transmission strategy Source “Carbapenem-Resistant Enterobacteriaceae (CRE): Understanding the Basics”, Michelle Nelson

Learning from inside the Collaborative q We learned from each other… § Identification and Management of Patients with MDROs. Emory § Grady Health System De-escalation Plan for MDROs Source Atlanta Regional Carbapenem-Resistant Enterobacteriaceae Continuum-of-Care Collaborative Learning Session 2 Agenda

Success Stories from Regional Collaboratives q We learned about the effectiveness of using the collaborative approach to implement successful regional health care initiatives such as our CRE collaborative § CIRCAL: Community Infection Reduction Collaborative across Acute and Long-term Care. Well. Star § Vermont HAI MDRO Collaborative Source Atlanta Regional Carbapenem-Resistant Enterobacteriaceae Continuum-of-Care Collaborative Learning Session 2 Agenda

Michelle Nelson RN, MSN, CCP Program Consultant III CRE Collaborative 2 Peachtree St. NW, Atlanta GA. , 30303 Georgia Department of Public Health 404 -657 -3102 Michelle. nelson@dph. ga. gov