>> Hello everyone.
Thank you all for joining the Long-Term Care Facility presentation
for the Prevention Process Measures Module.
My name is Ti McCray, and I am an Infection Preventionist contractor with the CDC.
As your presenter, I will provide an overview of the prevention process measures for hand hygiene
and gown and glove use event reporting in long-term care facilities.
In today's presentation, I will introduce the Prevention Process Measures Module.
I will explain the protocol and definitions, provide instructions and illustrations on how
to collect and report the data,
as well as identify the resources to assist with data collection.
The Long-Term Care Facility Component Prevention Process Measures Module allows facilities
to monitor adherence to prevention practices, including hand hygiene after contact
with a resident or surfaces in immediate vicinity of the resident and gown and glove use
in the context of transmission-based precautions.
I will now cover the Prevention Process Measures Module for hand hygiene.
There are multiple opportunities for hand hygiene during resident care,
but our protocol is to monitor and record successful opportunities or missed opportunities
of hand hygiene practices, whether it's washing with soap and water or antiseptic process
of healthcare personnel, physicians, nurses, certified nursing assistants, therapists,
technicians, etc., only after contact of performing resident care services.
So, for example, that can occur within a resident's room
or handled with equipment doing therapy.
Surveillance for hand hygiene adherence must include
at least 30 different unannounced observations of varied healthcare personnel after contact
with residents or performed in a variety
of resident-care tasks during the course of the month.
No personal identifiers will be collected or reported.
While most of us know when to perform hand hygiene in our personal activities,
it is expected for healthcare personnel
to perform this task multiple times throughout an encounter.
As you will see, there are five moments in hand hygiene,
which occurs frequently in your daily practice.
I will share with you what qualifies for NHSN reporting
within the Prevention Process Measures Module.
So, for a quick example of the knowledge check, I would like to ask,
how many unannounced observations are suggested to be performed each month?
A) 10, B) 15, or C) 30?
The correct answer is C, and the reason is the observer should perform
at least 30 unannounced observations of varied healthcare personnel after contact
with residents or inanimate objects in residents' vicinity each month.
Next, we will discuss the reporting of gown and glove use.
Multi-drug-resistant organisms, known MDROs, are increasingly common causes of colonization
and infection in long-term care, which can be spread from resident
to resident by healthcare personnel.
Therefore, the gown and gloves surveillance option will allow facilities
to monitor adherence to gown and glove use
when healthcare use personnel utilizes appropriate practice, which is donning
and doffing when that resident is on transmission-based contact precautions.
Again, we recommend that you perform at least 30 different unannounced observations
for as many individual healthcare personnel as possible.
Try to observe all types of healthcare personnel.
That can include physicians, nurses, therapists, aides, etc., performing a variety
of resident-care tasks during the course of the month of which gown and gloves were used.
Please note, both gown and gloves must be donned prior to contact for compliance, and again,
no personal identifiers should be collected or reported.
Policies and procedures may vary between facilities.
Therefore, let's move forward with another scenario
to determine what qualifies for NSHN reporting.
What is considered the appropriate practice of gown and glove use by healthcare personnel?
A) Use of gown during interactions with residents who are placed on contact precautions.
B) Only when gloves are used, or C) Donning of both gown and gloves prior to contact
with a resident or surfaces' objects in the vicinity of resident placed
in transmission-based contact precautions.
The correct answer is C. Appropriate gown and gloves use is the donning of both a gown
and gloves prior to contact with the resident or inanimate surfaces
or objects in the vicinity of resident.
If gloves are used without a gown, it would not count as appropriate use
when the resident is placed in transmission-based contact precautions.
Next, I will spend a little time talking about the data collection process and tools for NHSN.
Healthcare-associated infections can be reduced with adherence to infection prevention measures.
These practices include hand hygiene, gown use, and glove use.
We have found it useful to monitor adherence to these prevention practices by ensuring
that observations should be discreet.
Observations are as representative as possible of normal practice at the facility and focused
on an area of unit or staff interaction with residents are clearly visible.
Most importantly, this exercise should not be a punitive process
but utilized as a teaching moment.
Before I begin illustrating the process on how to enter the data,
let's review the Prevention Process Measures resources.
Forms are available on the Long-Term Care webpage and can be accessed by clicking
on the individual module and then selecting Data Collection Form tab once you click
on these two links, you will be taken to the materials
for Enroll Facilities page to Review Resources.
NHSN form and accompanying instructions are available all
of the data collection opportunities in the NHSN application.
The form parallels the required data elements in the NSHN application and is customizable,
which means users are able to add additional data collection elements
that are important to their individual facilities.
Some important notes that I will mention.
The PPM Monthly Monitoring form should not be used as an observation tool.
This form should only be utilized for the person entering the aggregate data,
which are the monthly totals, into the NSHN application.
Here is an example of some observation tools that some facilities may utilize.
These are not necessarily NSHN observation tools, but these are some that are used in order
to collect their monthly observations of hand hygiene and gown and glove use.
Next, we will continue on the reporting requirements
for the Prevention Process Measures Module.
Before you can begin reporting in the Prevention Process Measures Module,
users must include this option on their facility's Monthly Reporting Plan.
Facilities must indicate hand hygiene or gown and glove use surveillance
in the monthly reporting plan by selecting that option.
You must perform at least 30 unannounced observations
of healthcare personnel interactions, and again, we strongly recommend surveillance
to be reported at least six consecutive months to provide meaningful measures.
The Monthly Reporting Plan informs NHSN what modules a facility is following during a
given month.
So, in order to get started with your monthly reporting plan,
you must click Reporting Plan then Add, and I must mention,
your reporting location includes all facility-wide inpatient units
within your facility.
Two, you would indicate a month and the year of what you're collecting, and three,
you would choose the Hand Hygiene Gown and Glove checkbox
under the Prevention Process Measure Module, and then you will click Save
for your entry for the Monthly Reporting Plan.
I'd like to also mention, although you may have a reporting plan in place,
you still have the option to edit your monthly reporting plan.
To do so, you will need to select reporting plan, find, and you can identify the month
and the year of which monthly reporting plan that you are choosing to edit.
Please note, if an event of data has already been entered for a selected month,
the plan may not be deleted unless the event is also deleted.
Therefore, we recommend, if you're choosing to edit your monthly reporting plan,
make sure you have a note of all the information that was entered
for the event before changes take place.
This is an example of a completed Monthly Reporting Plan
for the Prevention Process Measure Surveillance options, and as you can see hand hygiene
and gown and glove use were both selected for the Monthly Reporting Plan.
For every month in which a Monthly Reporting Plan is set up,
facilities must also report denominator data into the application,
also referred to as summary data.
This must be done even if the facility did not identify and report events during that month.
When reporting summary data, please note only aggregate data is entered
into the NHSN application.
Summary data is only reported after the month ends, and the best practice is
to enter this data within 30 days after the end of the month.
This is an example of a completed monthly summary data
for the prevention process measure module reporting.
How is this data meaningful?
The data analysis options within the application allows users to calculate rates of adherence,
performance among healthcare personnel in the facility.
The NHSN data can be used to provide feedback to healthcare personnel on their adherence
to hand hygiene and/or gown and glove use, and this data provides the ability
to assess the impacts of efforts on a facility level, which can be used to demonstrate trends
and improvements of -- or areas of opportunity.
Here's an example of what the prevention process measures analysis report would look
like for rate table in a line listing.
I'd like to point out, analysis reports can be generated by the quarter,
the year, half a year, and every month.
Here's a recap of what we covered for the prevention process measures.
You can perform monitoring of hand hygiene or gown and glove use, or both.
To get the most from your data, we recommend minimal reporting
of six months during a calendar year.
Monitoring should include all types of healthcare personnel throughout the facility
and enter a minimum of 30 observations per month to provide meaningful measures.
It's also good to know that long-term staff can be trained to perform the observations,
to collect the required data elements, and to analyze the data,
and staff can include professional nursing staff, your infection prevention
and control staff, and even your primary contact or facility administrator.
Next, I would like to share some resources.
The long-term care component has various resources such as training materials,
our protocols, our data collection forms, and etc. If you need additional assistance,
you can reach out, submit your inquiries to nhsn@cdc.gov
if those resources do not provide an adequate response that you may need.
This concludes our presentation.
Again, if you need to submit your question or your inquiry to NHSN, please send nshn@cdc.gov
and add "PPM Reporting" to your subject line in order to have your inquiry routed
to the appropriate subject matter expert.
We will be happy to assist.