Respirator Use in a Hospital Setting: Establishing Surveillance Metrics. Mary Yarbrough, MD, MPH

Transcription

1 Respirator Use in a Hospital Setting: Establishing Surveillance Metrics Mary Yarbrough, MD, MPH

2 Objectives Create a safer workplace for healthcare personnel (HCP) by enhancing Personal Protective Equipment (PPE). Develop measures of respirator use and supply that Provide benchmarking data to hospitals Guide manufacturers and distributors Inform policy for Government agencies Establish a national surveillance system for measures of preparedness, responsiveness, and outcomes related to PPE 2

3 The National Institute for Occupational Safety and Health 3

4 Types of PPE in Healthcare Respirators and Head Coverings Masks Face Shields Respirators Hoods Helmets Garments Gowns Aprons Coveralls Hands Gloves / Extended Gloves with cuffs Feet Shoe covers Boot covers 4

5 Evolution of PPE to Protect HCP 1760s - Gloves used for obstetric exams 1890s The Treatment of Wounds Dr. William Halstead 1980 s: BBF 1990 s: TB 21 st Century H1N1 Emerging highly contagious diseases MERS /SARS Ebola Virus Disease 5

6 H1N1 - Respirators CDC issued guidance for respirator use during the H1N1 pandemic Hospitals followed these guidelines inconsistently No insight to understand respirator supply ( adequacy, availability, or use) or if respirators were being used according to guidelines 6

7 Emerging Infectious Diseases: Ebola Virus Disease (EVD) The importance of effective use: Healthcare Workers times more likely to acquire EVD WHO reported healthcare workers survival rate 37% 25.9% of U.S. healthcare workers surveyed were unwilling to provide care to patients with EVD 7

8 PPE Guidance, Regulation, and Certification Guidance CDC establishes guidelines for clinical care Regulations FDA regulates medical devices, including PPE OSHA standards for PPE program management Certification and Evaluation NPPTL certifies respirators 8

9 How do we evaluate nationally? Supply: Availability, Accessibility, and Adequacy? Using PPE effectively? HCP Knowledge, Attitudes, Beliefs? 9

10 What guidance is available for PPE? Over 30 guidelines and regulations identifying activities that affect hospital airborne pathogen safety programs Activities Preventive (prior to patient care) Patient Care Infection Surveillance 10

11 Analysis of Respirator Related Guidelines and Standards 11

12 Identifying Stakeholders of Activity Categories????? 1. R e s p i r a t o r P r o g r a m A d m i n i s t r a t i o n 2. R e s p i r a t o r S e l e c t i o n 3. R e s p i r a t o r P u r c h a s i n g 4. R e s p i r a t o r Tr a i n i n g 5. R e s p i r a t o r F i t Te s t i n g 6. H C P I m m u n i z a t i o n s 7. H C P M e d i c a l S u r v e i l l a n c e 8. H o s p i t a l P a t i e n t A i r b o r n e I s o l a t i o n 9. I d e n t i f y a n d R e p o r t H o s p i t a l P a t h o g e n s 10.H C P E x p o s u r e E v e n t E v a l u a t i o n 11.H o s p i t a l E m e r g e n c y S t o c k p i l e 12.H o s p i t a l D e m o g r a p h i c s 12 Categorization

13 Metric Categorization by Stakeholders Environmental Health & Safety Occupational (Employee) Health Infection Control & Prevention Emergency Preparedness Central Supply (Purchasing) Department of Finance Respirator Program Administration and Evaluation Respirator Selection Respirator Fit Testing Respirator Training HCP Immunizations HCP Medical Surveillance HCP Exposure Events Evaluation Identify and Report Hospital Pathogens Hospital Patient Airborne Isolation Hospital Emergency Stockpile Respirator Purchasing Hospital Demographics 13 Categorization

14 PRO Strategy Monitor PPE Supply & Effective Use in Hospitals Preparedness (Feed Forward Metrics) Responsiveness (Concurrent Metrics) Outcomes (Feedback Metrics) Aligns PPE Activities Across Hospitals Workflow Prevention Patient Care Infection Are we ready Surveillance for an event? Are prescribed safety protocols being followed? Did we avoid exposure and prevent disease? 14

15 Answer Questions about PPT Supply and Effective Use Preparedness Responsiveness Outcomes PRO Supply Effective Use 15

16 Data Elements Summary Preparedness Respirators selected Respirator supply HCP in respirator program ready-to-wear (trained and fit tested) Number of AIIRs Response Patients isolated Days of patient isolation Confirmed patient pathogens Unprotected exposure events HCP Knowledge, Attitudes, and Beliefs Outcomes Surveillance programs Occupational infections Cultural Confounders : Hand hygiene and immunizations Hospital statistics 16

17 Feasibility table Task 1 -Single hospital (Vanderbilt) -Profile and monthly data collection -Validation of data metrics -Demonstration of reportable data in dashboards -Stakeholder review Task 2 -Multiple hospitals -Profile and periodic data collection -Validate data integrity and representativeness -Refine dashboard reports and drill-down capabilities -Stakeholder review and input 17

18 Task 1: Pilot Workflow Project Team 1. Develop and Revise Data Collection Tool 2. Collect and Update Public Data (e.g. AHA Dataset) 3. Collect and Update Hospital Baseline Data 4. Collect Monthly Hospital Data 18

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21 Task 2: Multiple Hospitals Emergency Preparedness 4 Pilot Locations Supply Chain Occupational Health Infection Control Environmental Health & Safety 21

22 Preparedness 22

23 Responsiveness 23

24 Outcomes 24

25 PRO Employee Health Protection Surveillance System 25

26 Feedback and Questions 26