ILLINOIS SUMMIT ON ANTIMICROBIAL STEWARDSHIP 2015

Julie Sopocy, RN, BS, Director of NursingAlden Estates of Barrington Skilled Nursing Facility

Our Facility

• Alden Estates of Barrington is 5 star rated facility that serves a unique population of skilled nursing needs.

Our Population• 150 dual certified bed capacity.

• Specialty– Ventilator/respiratory unit

• Tracheostomy in place prior to admission to facility• Either long term care ventilator or attempting to wean• G-tube in place for enteral feeding if needed

– Newly placed LVAD– Peripheral or Central lines for hydration or antibiotics.

• Short term rehabilitation unit – Recent ortho surgeries– Rehab after CVA– Wound care – Post general surgical, weak due to illness

• Long-term care unit– Home for 50% of residents

Our Clinicians• Primary Care Physicians• Primary Care Nurse Practitioners• Pulmonologists• Infectious Disease• Nephrologists• Physiatrist• Wound Care Doctors• Psychiatrists• Podiatrists• Ophthalmologists

Who defines Infection?

• At our facility we use the McGeer’s1, 2 Infection Report Form for all suspected infections.

1Infect Control Hospital Epidemiology 2012;33:965-977

2McGeer’s Criteria were developed as a surveillance tool to identify and report evidence of infections in Long Term Care Facilities and have not been validated as a clinical tool. These criteria have become the national regulatory standard that requires potentially infectious acute clinical changes be documented and communicated to physicians in a timely manner.

According to McGeer’s, any symptoms used to qualify defining infection must be:

• New in onset or acutely worse

• Rule out other causes first• Dehydration• New medication

• Infection should not be identified by a single piece of evidence

• Use microbial and radiology information

When to Treat?

•Infection report form helps define treatable infection

•It is important to treat active infections, NOT asymptomatic colonizations

• Use microbial studies to help determine active infection.

• Infection report forms:– Respiratory

tract – Urinary

tract– Gastrointes

tinal tract– Skin– Eye, ear,

nose, mouth

Barriers to Best Practice• Physicians:

- use of prophylaxis treatment- maintenance use for chronic infection- treatment with broad spectrum antibiotics while a culture

is pending - not having qualifying diagnosis for use of foley

catheters

• Staff: - improper technique (hand hygiene, use of PPE,

incontinent & catheter care)

Overcoming Barriers• Education

– To prescribers on criteria for antibiotic treatment and qualifying diagnoses for Foley Catheter use

– To staff on proper hand hygiene, use of PPE with patients on precautions

Overcoming Barriers• Communication

– With prescribers: develop relationships with practitioners, call and ask for a culture or x-ray before treatment

– With staff: – clinical rounds with interdisciplinary team and frontline staff twice daily to

update on change of condition– use of interact tools; stop & watch, SBAR, care pathways.

Overcoming Barriers

• Observation– Quality Assurance rounds by a team of disciplines to assure

procedures are being followed

References• CDC – Centers for Disease Control, www.cdc.gov• SHEA, The Society for Healthcare Epidemiology of

America, www.jstor.org• NIH, National Institute of Health, www.ncbi.nlm.nih.gov• Infect Control Hospital Epidemiology 2012;33:965-977