Educational Webinar: The age of virulence & the future of infection control & prevention

Good afternoon everyone. My name is Brandon Martin. I'm the customer engagement manager with McKesson Medical surgical. I'm pleased to welcome you to today's webinar Wednesday event, the age of violence and the future of infection control and prevention is presented to you by med trainer. Our speakers today are brian Williams, vice president of compliance and learning and Emily Wolfe lead nurse planner with med trainer. We have a lot to cover today so we're going to dive right in. If time allows, we will hold a Q and A at the conclusion of the presentation. So if you have a question for brian or Emily feel free to post throughout the hour, simply locate the Q and a panel in the lower left corner of your console. Type your question in the text box and click send A recording of today's presentation and a copy of the slides will be sent to you within 48 hours via email once again, thank you so much for joining us today and please join me in welcoming brian Williams and Emily Wolfe thank you Brandon, much appreciated. We do offer continuing nursing education for this um webinar. So I wanted to provide a conflict of interest statement and disclaimer. Um I disclosed that both Emily and I are employed by med trainer and we have no conflict of interest in the planning of this activity. Um we strive to provide our customers excellent in educational materials and we've not received any commercial sponsorship for today's webinar. Um as with most things of this nature, please do not take this as legal advice. Um if if it applies to your facility, please make sure that you're meeting your own state and federal requirements. And if you have any questions or concerns regarding this presentation, please send an email um with your um concern to compliance at men trainer dot com or as continue education. We are accredited by the american nursing credentialing center and add a search for dental. So if you do want to get a certificate of attendance, please send your information including license number state and a phone number we can reach you at at compliance of med trainer dot com as well. Thank you. So today's topic. This is an unfortunate but very exciting topic for me to present today because it's something I've been looking at for quite some time. Um in in the October of 2019. Uh I did a webinar on disaster preparedness and I've mentioned be the the necessity of being prepared for multiple disasters simultaneously. And certainly we've seen that in the past few years in the age of virulence in health care, there are many factors that determine how virulent um a um german is and it's the path of gender, ethnicity of infections and there's highly virulent pathogens. And then we also overlay that antibiotic resistance and those two together are very problematic as they determine host susceptibility. The modes of pathogen shedding the host routes of entry modes of transmission are all very important factors that we need to consider. We also need to consider local and global issues such as chronic illnesses are aging population were not the only country that has 10,000 people turning 65 or older every day. Um Our health care disparities we'll talk a little bit about that throughout the discussion the environment in which people live poverty, connectivity, access to health care all contribute to this age of violence. And one thing I'd say is the Pollack sources prevention. I have a slide on that to kind of set the tone for our talk today. Um This is something that that the C. D. C. Um I think it's finally embraced and that U. S. And global threats are connected and the interconnected threat of antibiotic resistance affects humans, animals and the environment. And so if we think about how is that how is that? So you know antibiotic germs um resistant germs can spread person to person on surfaces in the environment. There are what's called nightmare bacteria um uh carpet. I never can pronounce these but I know they are um resistant CRE which can survive and grow in sink drains and health care facilities. And certainly antibiotic resistant germs can spread in the environment like aspergillus common mold. That makes people very sick with weak immune systems one moment. And of those the most urgent antibiotic resistant threats also coincide with very large health disparities. Candida rates are twice as higher in black persons and the C. D. C. Notes that there could be different to the other underlying medical conditions and other factors. Um C diff low income foreign born non english speaking populations at home. Uh staph aureus um briefs when compared with whites are higher in in blacks and other minorities. This is that word I can't pronounce carpet penny um resistant. Um CRE uh certainly a major impact on infants, pregnant women's and uh higher prevalence in black populations regardless of age and persons with diabetes. And uh again drug resistant gonorrhea. These are five urgent threats that um coincide. And it's important that when we look at the health disparities and we're trying to address these threats that we understand the value of taking care of the community and providing access education and resources. Uh We'll talk more about this throughout the presentation because um the sepsis Alliance what is sepsis um It's basically our body is overwhelming and life threatening response to infection and it's serious. It's the number one leading cause of death in hospitals it's a leading cause of hospital readmissions the single biggest cost but it's not contagious right? It's something to consider because according to the sepsis alliance um health care workers About 72% of Americans can identify stroke symptoms. Nearly 12 can identify most common sepsis symptoms. And then this next slide perspective to consider after providing that that webinar On disaster preparedness and talking about preparing for multiple uh disaster simultaneously. I remember my years in healthcare over 25 where we um basically went over of, you know, pandemic every month and hand hygiene every month. But when something happens, you really see what changes and regardless of the the pathogen early in the outbreak. The responses driven generally by fear of politics rather than science or public health. And this pattern according to Dr. Subedi who um Laura Salah High and Dr CBD in 2018 calls this the outbreak culture. And so as a kind of a setting of tone here are their politics within your organization, preventing infection prevent preparedness. And um I think that that's an important factor because no matter what you do about getting back to uh back to infection control and prevention basics you have to understand there's also this culture that may or may not lend assistance to uniformity. Next we're going to take a poll and let me move over to there. And what we're trying to accomplish in this survey is just to see how prepared your organization is um to deal with these emerging threats and uh and and and respond to them and protect workers as well as patients. And I wanna be. I wanna be very clear that your organizations um is not identified. You're not identified were simply, you know, gathering up some numbers. So take a few moments and go through the questions and then we'll go over them briefly have a few more minutes and we'll share the survey here. All right, we'll wrap it up here. So the first one, um your organizations in fact control prevention strategy to effectively handle outbreaks inside your facility rating um being very prepared. High, highly prepared. four, medium 3 low too and not ready one. We see that we have we have 27 percent, 25 27.5 that feel they're highly prepared, Followed by 60 that are medium or moderately prepared and 12.5 that are um not quite ready or low preparedness. And one of the context I want to put this in is you know, we live in a healthcare continuum from home to hospital to long term care facility to assisted living, those handoffs right. If you're handing off to a organization that's not prepared, you may not know that because your organization is so prepared and certainly an area that we can improve on. We'll talk about later. The same results to handle outbreaks within your community. You'll notice a of a larger percent of of facilities are are not as prepared and most are somewhat prepared. But here you have some that are not at all. And I think again, that's the same context of how do we get the whole community to be prepared? Our employees to be prepared and to integrate into the community, those resources that are needed. Last question here, um the organizational culture to adhere to infection through policies that may be publicly controversial. right? And um here we have again, a pretty similar split, but I think it underscores the importance of um identifying those issues, educating and discussing them and putting a plan in place that can minimize those differences across organizations, whether it be in your organization, in your community and working with other facilities. Move on here, one moment. So let's talk a little bit about what what can be done about health equities and antibiotic resistance. And the Cbc has outlined some goals for health equity and they are. And if you look at CMS, if you look at CDC, if you look at National Healthcare Safety Network and these others, um this is a top priority and it's embedded in the strategic plan going forward with C. M. S. Expand the collection of disparities and equity focused data characterize health inequities and linking with indicators support states with antibiotic resistant pathogens and antibiotic use and addressing educational needs and the diverse these of health care workers and then especially the addressing disparities in quality of care and long term care. And we look at what CDCs goals are. Um as well as Medicare, we're going to start to see more infection control and prevention standards being um uh calculated into uh rates that that organizations get. So um solving these two problems uh eventually here will will uh have an impact on revenue and there's other consequences sequences here around the world, there's this sepsis and antibiotic resistance effects 49 million people worldwide. Um as of 2020, I believe, most common killer of Children, 1.7 million adults are diagnosed in the us One in every 20 seconds, with a high mortality rate of 15.9%,, mortality rate for Children is also high. And again, I mentioned earlier that one in three patients of hospitals, patients and hospitals died from sepsis In 87% of the cases start outside of the hospital. So in our health care continuum, um we really need to look at the whole continuum, not just hospitals for this information. You know, what are we doing to identify those patients in our centers, in our facilities in our homes. And I thought this was also interesting when I was doing the research for this topic, that sepsis and antibiotic stewardship are two sides of the same coin and in in one uh in promoting antibiotic stewardship um it, you know, it's all about, you know, reducing the use of antibiotics and using them appropriately receptions is concerned. One of the most major treatments for that is antibiotics. And so what that this study found was that when those campaigns are run simultaneously, it tends to confuse health care workers and I think that can be easily clarified with some tools and things. We have a little bit later here, oops what's being done in the United States to reduce antibiotic resistance and sepsis. Um this is the, if you haven't seen it before, it's division of the CDC, it's a national center for emerging and zoonotic infectious diseases and they have a strategic plan that runs through next year in really what they're trying to do is strengthen public health fundamentals, implement high impact prevention and intervention techniques, enhance preparedness detection and response and innovate to stop emerging and Joanna confections wherever they exist. And um let's see here go here and the C. D. C. Is building this capacity and global partnerships and I think it's going to be a while before we see this but I think it's an admirable target, you know a collaborative same framework educational framework for when we're uh you know medical school, nursing school and others. Um A core curriculum about this integration of all antimicrobial users, harmonization of accreditation standards, um continue education, experiential learning. All of these are will fundamentally help um combat this problem. We're not there yet but think about it in your own facilities? You know, are things collaborative? Are they in line? Do you have expert um um continue education. Do you have education that needed for your workforce And then of course how do you monitor outcomes? The C. D. C. Has a number of of tools. So does the World Health Organization. Um Hip pack um There's quite a few of these out there but I thought this one was particularly helpful because it's simple right. The core elements of antibiotic stewardship for nursing homes probably has the highest prevalence of risk for sepsis. Right? So understanding what that checklist is and using it and coming up with a plan um to ensure that patients that need antibiotics because of sepsis, Right? And and they're identified, but at the same time we're reducing the use of antibiotics. I think there's a challenge for every facility out there. Um it has been noted there's been a 40% improvement Um since this campaign of antibiotic stewardship. And so 40% improvement is great. But where we really need a much greater um emphasis on it because 40% if I got that on a report card would be not passing. It's um it's going to take every organization to really work through these things and why why is that? Um you know, I'm sure that our audience, those that are in the health care environment have received patients or have sent patients that have not been doing well. And you know, common approach patients transferred back and forth from facilities without all the communication necessary or the infection control actions in place. And so this is an ongoing uh issue that really affects the patient and those that care for them. And you know, most, most organizations have a champion, somebody who, you know, an independent effort where some workers or maybe even a whole department or even the whole facility that are um enhanced enhancing infection control practices, but they're not alerted to certain things and they lack shared information from other facilities that they that they that they receive patients from or even community members. And so uh control actions are not always taken. Germs spread to other patients and health care workers. Um As as we look for a coordinated approach which is what's needed. Um We see that as communication, understanding of patient handoffs improved. So does the ability of each organization to prepare and react and minimize and reduce risk. No, I think that um is very important as as part of the solution set. Um Now I'd like uh for Emily to go through getting back to the basics. Good Emily. Thank you. So getting back to the basics of infection prevention is applying these principles to all patients, regardless of diagnosis or presumed infection status. Standard percussions. Those involve washing hands before and after patient use whether gloves are worn or not. Um The use of soap and water to wash your hands or utilizing hand sanitizer when it's appropriate. Um Having health care workers stay up to date on vaccinations, um antibiotic stewardship um kind of brian talked about previously appropriate use of indwelling devices such as catheters, endotracheal tubes, feeding tubes and vascular access devices, measures taken to perform injections in the safest manner possible. Wearing protective PPE when contact with bodily fluids such as blood, urine. Your saliva may occur. Uh For example when completing a wound cleaning flashback may occur. Um Is the healthcare professional wearing um gown gloves, masks, goggles to protect from bodily fluids that could splash back regardless of known or unknown infection. Um, want to make sure that there's cleanliness of the environment and and equipment. Um From my previous experience in the hospital, it was unacceptable to even have cords from pumps and machines such as ventilators, scraping on the dripping on the ground or into garbage cans. As these were pathways for transmission use of isolation. In addition to standard precautions have indicated and then identifying infection risk in the environment. These are the basic principles um for infection prevention practices that apply to all patients and all health care settings. So, when identifying risk in any care setting, it's very important to do so, Risk are a part of life, and risk recognition is seeing the potential for a problem to happen. A game of state and precautions. You're treating everything as potentially infectious and utilizing the basic principles. Um But there's more to performing the actions of standard precautions that help to prevent infection. And that's the identification of infection risk. So, kind of taking a peek at this image here. Why is identifying infection risk in the health care so important? Let's take a look risk for germs to spread in healthcare are different than other settings. Um This is because settings um for healthcare facilities um patients come here because they're sick, patients mail to be more vulnerable or susceptible to infection. Um there's closer contact and interactions between patients and providers. Those are different um methods that can increase risk recognizing risks such as when the hand sanitizers empty or when there is broken skin such as an I. V. Or a wound things left such as open needles, all these leave risk and opportunity for injury and infection in that environment even when practicing standard precautions. So it's important to recognize where germs may live and how they can get from place to place or to people recognizing infection risk and how germs spread and susceptibility throughout the workday can protect patients yourself and co workers no matter the situation. So the C. D. C. Has come with tools for risk and methods for infection prevention. So the human body is full of reservoirs or places where germs live. These tools help to identify risk and methods of infect of prevention and go beyond standard precautions to choose the right actions for protection. So the C. D. C. Has developed tools that have identified a focus on risk prevention on transmission regarding blood and bodily fluids. The various reservoirs in the body that these tools focus on include the skin, the gut, the respiratory system and blood. There are common practices among these reservoirs with the use of barriers and precautions but going to step further, how can we prepare, prepare frontline workers to identify risk and take action with regard to populations or disease pathways. So um kind of bringing it back as a nurse. I worked in the neonatal intensive care unit. Um It was required for staff and families to complete a two minute hand wash from fingertips to elbows while removing any jewelry and nail polish prior to entering the unit. Um Why was this important? So this became a standard because an infection risk was identified and actions were taken to prevent the transmission of germs within that population. So with different um conditions and diseases, additional infection prevention measures may be taken in addition to standard precautions to prevent the spread of infection or identify infection risk. Looking at that if we only consider universal standard precautions are the methods of prevention the same. A bit of a trick question. However, standard precautions are a set of infection control practices used to prevent the transmission of diseases and we know that these measures are used when providing care to all patients. And the specific practices me very slightly just depending on the reservoir of risk and the infection control actions to reduce risk. Um However identification of populations in any setting or risk can help to prepare and take action to understand the what the how and the why of infection and implement methods. In addition to standard precautions for infection prevention measures um kind of bringing it back to non contagious diseases such as sepsis as brian talked about. You can't spread or catch sepsis. However an infection can lead to sepsis learning to recognize in practice is very is very important because disease virulence is not dependent on how it spreads but on the degree of pathology caused by the organism. Recognition is an important tool for prevention. Um As he kind of talked about earlier substances, the body is extreme and overwhelming response to an infection. Anyone can get an infection and almost any infection can lead to sepsis. As he noted earlier, there is a high burden of sepsis um according to the CDC um with over 1.7 million adult sepsis cases occurring annually in the US accounting for over 270,000 deaths. And those patients that do survive um have long term suffering as well associated with that. Um And that can also be because of the challenges of the clinical presentation of sepsis to it can be settled initially and can be highly variable depending on the ideology. But the most common sites of infection are again respiratory genital urinary, gastrointestinal in the skin, similar as the reservoirs. Um that were discussed in the C. D. Tools for risk and methods of prevention. So healthcare professionals, patients and family members can work as a team to prevent infection and be alert to signs of sepsis. Um and helping to reduce those risks by utilizing tools and I'll bring it back to your brand. I'll get off here. Um One note on this this Subsys just backing up for a second is knowing the signs and symptoms. Um And you know whether somebody can be shivering from a fever may not necessarily be sepsis extreme pain or discomfort clamming sweaty skin, high heart rate, short breaths, confusion or disorientation. These are markers that we should teach our healthcare workers about to make sure that they're identifying it as well as family members. Um When my dad was alive I had to learn about substance because he was susceptible to it. So thank you Emily. That was very good. Um A few last topics to talk about here is really disease resurgence, right place, right time. Um We are whether or not you believe in um or support or don't support global warming. There there are trends that show that weather patterns have changed here in California. There's a severe drought. All of these things can help to preserve or re energize a disease. Um Monkeypox is a good example um With the C. D. C. Is tracking multiple cases that have been reported in several countries that don't normally report monkeypox including the United States. And we look at you know where this disease started. It was first isolated in animals in 1958. First human cases were 1970 It was declared eradicated in 1980 until the first outbreak outside of Africa in 2003. I think it's important for us to understand that disease resurgence again can be tied to our environment to animals and to our practices within our healthcare organizations and our homes and other diseases worldwide like Ebola is showing some resurgence typhoid fever becoming more resistant to antibiotics. So it's an uphill fight and we really need to train and and make sure that our staff have the tools that they need um to address these issues. Um One moment, here we go. Um one thing you can do is subscribe for CDC alerts um if it's a health alert um it'll come in red and it'll provide time sensitive information, health advisory. It's just specific information about an incident or situation recommendations. Simple updates and info service. Um But I think this is something our health care workers may not be aware of. Something you can have on your phone and something again to use tools that are available to educate. Um This is one of the things I wanted Emily to mention also in her experience as a nurse when there's doubt because these symptoms are often very similar and difficult to differentiate Emily you want to make a mention on this one, yep. Um so really this it's the importance of when in doubt reach out. Right, so um what kind of infection is this? Is it viral? Is it bacterial? Um Would there be antibiotics needed for that infection? Um So does your facility have a resource like this available for your staff? Um If they don't have this resource available? Um who can they reach out to? What are their resources? Are there different guidelines available? Are there policies um and infection prevention ist um What do staff have available? Excuse me. Um When they have questions regarding um decisions that require immediate action um We want to make sure that these types of resources are available for staff because it's very important to have time sensitive responses in response to infection prevention and infection control. Um I know that it's very important um to uh to have this available. Um And whether that's kind of on um virtual um policy or whatever that might be for your facility or having a physical person resource person that is skilled in these areas to be available for team members. Thank Emily. Um infection preparedness models are emerging and changing because they're being integrated conceptually with emergency and disaster preparedness. And we really look at at the asper Tracey which is the healthcare emergency preparedness information gateway. If you've never I've seen this resource, there is a ton of things on Tracy that you could find whether it be a plan um a disaster drill um resources on what to what to do locally, what to do in your community. And we really start with you know what what does the um coalition or the state, how do they manage and coordinate um infection preparedness and disaster preparedness and you can go to your county and look up county and disaster preparedness plan 2022 to see how prepared your county is in your state. Um You can see what their policies are, how they make decisions um whether or not their strategy strategies for allocation of resources and whether or not they're really plugged into being prepared. Um And those guidelines and educational resources of slow down to facilities and systems depending on the size of your facility, you might need to have an incident command center depending on how you may have to shelter in place. But also we've seen with COVID-19 and infections um it affected the workforce as much as it did the the residents and so having um having a facility system in place with the knowledge and policies for clinical decisions. Clinical guidelines and a surge policy is super important and then we get to the provider and that provider can be a physician, can be nurse, can be a family member, can be a medical assistant, you know, what do they know? What current evidence evidence, ethical issues are they going to be faced with? What resources do they have and how do they make decisions in the usual scope of practice? They really need to have available policies and resources. So you know, I with 25 years of healthcare background, I created a lot of policy manuals but I didn't read them as a method of of understanding. I would take a policy, I would look at what else I could use to train the staff and what exercises can be done. Not everybody is going to read the policy, but they certainly should have it put together and to make sure that we have good references here. I've got a ton of resources here that could be helpful to your facility um in links here as well as additional resources here. Um crisis and emergency risk, communication manual on email updates. How to get those foodborne outbreaks we didn't talk about today, but food, foodborne and waterborne are also things we need to look out for. Um and sepsis, there's a sepsis World Sepsis day for um generating awareness. That might be a great campaign to have um at your facility and then certainly the international um more here. And this will be included in the presentation. Um I hope this was helpful and I'll turn it back over to our moderator uh two talk a little bit more about McKesson resources. Thank you. Thank you so much brian And Emily as well, thank you all so much for for um uh for your topic today. I do uh we do have a few minutes. So if you do have any questions you'd like to ask the team, uh we'll give you a couple of minutes to to populate those also want to mention uh as you see on the screen here, uh you can browse our upcoming webinars uh at mm s dot McKesson dot com slash educational webinars. We have a list of upcoming webinars including our age of violence. Part two will welcome brian back Next month for uh on July 20 for our Webinar Wednesday presentation. You can sign up for that at M M S dot McKesson dot com. I'm not seeing any questions come in brian any closing notes that you'd like to share. Sure. And thank you again for having us here today. Uh as most people know, we're still in under the emergency declaration for COVID-19 and it was expected to be um uh expired in July and just the other day it was noted that it will be continued again because there are a lot of funding issues that are attached attached to that that I don't think the medical community is um prepared, you know, uh to handle. But more importantly is as the when it does expire and if it whether it does or doesn't it will expire. Um we're gonna see a stronger um compliance focus from OSHA and others on on infection control and prevention. And I said before the pandemic, they're really looking to marry the two. And so we all often see OSHA referring to C. D. C. Standards. Um but not necessarily enforcing them. I think that's really changing. And if you um didn't have a COVID-19 plan prior or during uh you may want to get one in place. There's we'll talk more about that and some of the changes that will happen as a result of the exploration of the emergency order. Excellent, well thank you so much. I'm gonna uh click here. Uh if you do need to reach us, we have some contact information available. Uh This webinar will be available as a replay uh within say 48 hours we will send you a link to the replay um and uh other information. Um I just want to thank thank you so much brian and Emily and thank you to everyone for attending. Today's webinar. Do please watch your inbox for that replay link and upcoming invitations for our Age of Violence Part two presentation on july 20th brian. Emily. Once again, thank you so much for your time and sharing your expertise on this fascinating topic again, thank you all for attending and I do hope everyone has an excellent day. Take care.