Management and Communication of the IPAC Program Flashcards
What are the phases of emergency preparedness?
-pre emergency planning: preparations for personnal and resources, emergency communication and education, training, drills, resident evac and relocation
-preparedness: outlines what should be done upon receiving an internal or external warning of emergency
-response: outlines actions administrator or disease coordinator should taken in response to emergency.
-recovery: actions that should be taken immediately after the situation.
what is the basis of all emergency plans in the US?
the incident command system (ICS)
what is the ICS?
the US Federal Emergency Management Agency (FMEA) defines the ICS as a standardized management tool for meeting the depends of small or large emergency or nonemergency situations
what are disaster scope types?
- pandemics
- bioterrorism
- chemical: can occur accidentally or as part of a bioterrorism event
describe the bioterrorism categories
category A: high morbidity and risk of transmissibility (anthrax)
category B: moderate morbidity and risk of transmission (Brucellosis)
category C: emerging pathogens (hantavirus)
when does the CMS require an IPC risk assessment?
annually or when plans for a change or affect the assessment results
describe a community wide (all hazards approach) risk assessment tool
FEMA’s Threat and Hazard Identification and Risk Assessment (THIRA)
describe a facility wide risk assessment tool that focuses solely on LTC facilities
The Quality Improvement Organizations (QIOs) Facility Asssessment tool (identifies what is necessary for quality patient care)
describe IPC program and procedure risk assessments
-CDC ICAR tool for LTC facilities
-APIC IPC risk assessment tool
define standards
-requirements that must be followed
-sets quantifiable measures
define guidelines
-recommendations and usually not enforced with legal penalties but can be written to comply with regulations and accrediation standards
-formed by expert consensus and current best evidence
what are the 3 branches of federal (national) regulations?
- legislative
- executive: most agencies that impact LTCFs and regulates nursing homes
- judicial
define state (provincial) regulations
multiple departments that parallel the functions of federal agencies (health, environment)
define local (municipal) regulations
county or city may expand upon regulation issued by a higher authority
describe the CDC/HICPAC recommendation categories
1a: strongly recommended for implementation. strongly supported by well designed studies.
1B: strongly recommended for implementation. support by some studies and strong theoretical rationale.
1C: required for implementation. Mandated by federal and/or state regulation standard.
II: suggested for implementation. supported by suggestive studies or theoretical rationale.
what are the CMS approved accreditation agencies?
- TJC
- NIOSH
- OSHA
what are some CMS responsibilities?
-oversees and reimburse the medicare and medicaid programs
-maintains specific requirements for an IPC program and enforce compliance with CoPs (conditions of participation) and conditions for covrages (CFCs) for their programs
what did the omnibus budget reconcilation act (OBRA) of 1987 mandate?
quality of care standards, survey and enforcement system for all CMS funded facilities
what are some NIOSH responsibilities?
-lab research on occ hazards
-tehcnical assistance and recommendations to OSHA
-decisions on PPE
-training OSH experts
describe fedral regulatory groups (F-tags)
-related to one area of the CFR
-used by the state and CMS to assess areas of compliance
-F880: IPAC
F881: ASP
F882: IP qualifications/role
F883: Influenza and pneumonia vaccines
F886: COVID-19 testing residents and staff
F887: covid immunization
describe CLIA (clinical laboratory improvement amendments)
regulates all lab testing, performed on humans except research
what are some FDA regulations?
-single use devices and reprocessing
-blood safety
-chemical germicides
-medical device act and safe medical device act
what responsibiltiies does the FDA have?
-implements, monitors, and enfiroes standards for safety, efficacy, and labeling of all drugs and biologicals for human use
-PPE, chemical germicides on medical devices, food, blood, radiological devices
describe SHEA (Society for healthcare epidemiology of America) contributions
-educational programs, develops position papers, produces scientific journal
-partner in development of two conensus documents outlining infrastructure requirements for IPC program
-reference guide: surveillance defintions and outbreaks investigation guides
describe some contributors of the US Department of Health and Human Services (HHS)
-principal agency for protecting the health of all americans
-priority goal: HAI elimination
describe implemenetation science
the scientific study of methods/strategies to promote adoption and use of evidence based interventions and practices in real-world clinical and public health settings to improve quality of care
adult learners are
-autonomous
-self directed
-need to be treated with respect
-goal orientated
-relevancy oriented
-foundation of life experiences and knowledge
what are some adult learning principles?
-adult learning framework by Malcolm knowles
-Blooms taxonomy
-three types of learning
describe the adult learning principles by Malcolm Knowles
-feel the need to learn
-learn differently than children
-learning environment is chacrterized by physical comfort, mutural respect, trust, expression, helpfullness, freedom of expression, acceptance of differences
-align their goals with the goals of the learning experience
-share the responsibility for planning and operating the learning experience
-participate actively
-relate to and makes use of their experience
-progress towards their own goals
describe Blooms taxonomy from lowest to highest
- remembering
- understanding
- applying
- analyzing
- evaluating
- creating
what are the 3 types of learning?
- cognitive
- affective
- physochomoter
what are Gasha’s teaching styes?
-expert
-formal authority
-demonstrator or personal model
-facilitator
-delegator
define competency
describe worker skills, knowledge, and the mindset necessary to achieve effective job performance
competency based educationcan be used as a basis for what?
can be used as a basis for assessing training needs from a didactic approach and in support of classroom and hands on learning approach
what is the hawthorne effect?
practice improves when participants are aware they are being watched
define a literature review
the process of evaluating publications with a critical lens to determine the value of the aithors conclusions
what is the function of research?
-describe current knowledge
-determine additional areas of interest to address uncertainties
If the researcher assgins exposures it is an ____ study; if they do not it is an ___ study
experimental; observational
what are the types of experimental studies
RCT (random allocation) and non randomized controlled study (no random allocation)
what types of observational study has no comparison group?
descriptive study
describe cross sectional studies
outcome and exposure happen at the same time
describe case control studies
outcome then exposure
describe cohort studies
exposure then outcome
what are advantages and disadvantages of descriptive studies?
-advan: preliminary exploring a phenomenon; quick and easy; useful in hypothesis formulation
-disadvan: no controls comparison and risk factors cannot be estimated
what are some advantages and disadvntages of cross sectional studies
-advan: affordable and quick; describe extent of exposure; invstigate prevalence changes
-disadvan: incidence cant be determined; selection bias
which study design is the best to use to establish efficacy of treatment or intervention?
RCT
describe case control studies
look for individuals with and without the outcome then compared for exposure to one or more potential risk factors
what are some advantages and disadvantages of case control studies
-advan: quicker and cheaper than cohort espeically for rare outcomes or long latency period; useful in studying multiple risk factors
-disadvan: recall bias; selection of proper controls difficult; measure exposure rate not exposure specific incidence
describe the basic deign of cohort studies
population of individuals with and without exposure to risk factors are identified and followed to compare the incidence of the outcome in each group
what are some advantages and disadvanages of cohort studies?
-advan: exposure specific incidence can be easily measured; less bias in patient selection; useful in studying outcomes with short latency period; strongest evidence for a direct causal association
-disadvan: lost to follow-up; longer expensive to conduct long incubation period post exposure; if outcome is rare and larger study size is needed outcome determination may be biased
what are the 2 categories of statistics?
- descriptive
- inferential
what are descriptive statistics
-provide numerical information about variables
-uses number to describe the characteristics of a data set
what are inferential statistics
makes an assumption about a population based on a sample or calculates the strength of the association between causes and effect.
Does not prove or disprove anything.
describe normal distribution
when the mean, median, and mode are all equal
which measure of central tendency determines the height of a curve?
mode (the most)
which measure of central tendency is most affected by outliers?
mean
define kurtosis
a measure of tailedness of distribution
define leptokurtic
tall and skinny. rapid risk and fall in cases
define platykurtic
long drawn out outbreaks
define skewness
a measure of symmetry (or asymmetry)
what are the types of skewness
-positive
-negative
-zero skew (normal)
when the mean and median are less than the mode, which skewness results?
negative or positive
define a confidence interval
the probability (confidence) that the parameter will fall between a certain value.
why calculate a confidence interval?
to compensate for the margin of error (difference between the same and the population mean) a range called the CI is calculated
define level of confidence
the certainty the researcher has that the outcome did not occur by change (usually 95%)
how is CI expressed?
as the sample mean +/- a certain value (as a value within a range)
which calculation describes the probability of acquiring a HAI during hospitalization
attack rate
what are the two outcomes of hypothesis testing?
accept or reject the null hypothesis
what is the null hypothesis?
-stated to be rejected
-intervention has no effect
what is the alternative hypothesis?
-desired result
-intervention has an affect
true or false. rejecting the null proves the alternative hypothesis is true
false
if chance is unlikely for the difference between the intervention and control group what would you do?
reject the null hypothesis
what is the p-value?
a statistical measure used to determine the likelihood that an observed outcome is the result of chance
a low p-value means what?
its good. means chance causing results is unlikely
what does a p-value less than <0.05 means?
that there is a 5% probability the rsult could have occured by chance alone
what is a type 1 error?
false positive
reject the null when it is true
concluding there is a difference when there is not
what is a type 2 error?
false negative
accpeting the null when it is falose
concluding there is no difference when there is
what is relative risk?
a measure of the strength of association used in prospective and experimental studies.
which type of studies can RR be used for?
cohort
relative risk is the probability of what?
developing a disease if the risk factor is present divided by the probability of developing a disease is the risk factor is not present
what is an odds ratio?
the probability of having a particular risk factor if a condition or disease is present divided by the probability of having the risk factor if the disease or condition is not present
For what types of studies is odds ratio calculated?
all studies with nominal data but mostly retrosecptive (case-control) and cross sectional
define correlation (r)
calculates the direction and magnitude of a relationship between two variables
calculated values can range between +1 and -1
the closer r is to +1 the stronger the relationship
what is a positive correlation?
when one variable increase, do does the other (i.e., longer duration of catheter=higher chance of UTI)
what is a negative correlation)
when one vraiable increases, the other decreases (i.e., increased handwashing=less infections)
what is a weak association?
when values are near 0
what value is no correlation?
0
describe FMEA
a prospective approach where teams predict failures in a process, and anticipate the consequences. A preventative approach.
describe an RCA
a retrospective proces for identifying the cause of sentinel events. They avoid blame and consider humans factors and analyzes redesign for a safer system. Ishikawa (fishbone) diagrams are often used to organize the analysis.
describe PDSA
quality improvement is a cyclical activity that ensures all policies and procedures have planning, implementation (D and A), and evaluation phases (s).
Evaluation (study) portion includes RCA and FMEA
what are 3 performance indicators to achieve key outcomes?
- reproducibility
- leading indicators
- lagging indicators
describe reproducability
when findings can be consistently repeated if applied to new populations (i.e., vaccines decrease illness in many populations)
describe leading indicators
metrics that inform whether or not the program is performing effectively.
I.e., process measures (increased HH compliance is indicative of decreased ARO transmission)
describe lagging indicators
metrics that alert to a failure in the IPAC program, the existence of a hazard
i.e. outcome measures (increased ARO diagnoses-poor hand hygiene) and hospitalizations (indicative of increased transmission of infectious agents)
what is a culture of safety?
the fostering of a space where staff feel supported in reporting errors or near misses, even when committed by themselves, knowing leadership will take a non-punitive approach to reporting the incident.
what is the key to enabling a culture of safety?
stratifying how errors/risks are perceived
what are human engineering factors related to the culture of safety?
slips: an external failure in a plan due to reduced intentionality.
lapse: an internal failure occuring from lapse of memory
what are some requirements for a culture of safety?
open door policy (no blame and shame)
cross shift/cross department communications
track changes in patient safety over time
what does product evluation begin with?
evaluation of a need
what are some examples of product and process evaluation?
cost benefit analysis
eficacy studies
standardization of products and processes
what is a cost benefit asessment?
-determining what products are worth additional costs-
-Product Evaluation Committee is responsible for reviewing, evaluating, and selecting products for use
describe efficacy studies
-cost effective for facility and resident
-decisions are data driving by leverging clinical, quality, and organizational data and including post implementation review
describe standardization of products and processes
-saves resources by eliminating duplication
-standardization improves inventory control , allows efficient use of space (less products stocked), less staff training, fewer errors
what are some leadership styles?
-directive leaders
-authoritative leaders
-transformational leaders
-servant leaders
-participative leaders
what are directive leaders
-coercive management
-power from top
-followers delegated tasks
-collaboration not encouraged
-consistent but inflexible
what are transformational leaders
-most important for ipac
-inspire being open, honest, new ideas
-feedback by empoweering staff to have a higher purpose
-aligning team with organizational needs so that changes are more likely to succeed
-higher productivity
describe authoritative leaders
hierarchal with power from top
-clearly explain roles as they relate to the organizations vision
-leader leads by example
-good ideas not valued unless they come from the top
describe servant leaders
-algin staff to organizations mission, vision, and values
-support HCP by being their servant so they are enabled not blocked
-fosters a culture of trust, empowerment, and equity
describe participative leaders
-democratic in team consensus, compromising and collaborative
-voice given to all team members, building trust and empathy
-empty (seeking others perspectives) is essential for innovation
-needs to feel free to think independently and take risks
what are 3 areas of professional development?
-continuous education
-certification
-licensure
what is certification?
a standardized measure for healthcare workers to demonstrate competency required for individuals practicing IPAC
describe licensure
government recognition that an individual meets the minimum requirements to practice (CNAO-RN)
Define association
as one variable changes, there is a resultant change in the quantity or quality of another variable
-established via observational studies
-chance, random error, bias
-indirect or confounding
define causation
evidence indicates that one factor is clearly shown to increase the probability of the occurence of a disease
-established with Hills criteria or RCT
what is a ratio?
one value divded by another value (RR or OR)
what is a proportion?
numerator is a subset of denominator (attack rate, %)
what is a rate>
numerator is a subset of denominator for a time interval (incidence or prevalence rate)
what does a rate measure?
the probability of occurence in a population of an event at a given time
what are some measures of dispersion
-variance
-stanard deviation
-range
define percentile
relative position of a value within a data set
define measure
a valid and reliable indicator used to monitor
define valid
the extent to which a measure accurately refelcts the construct it is intended to measure
define reliable
the ability of the indicator to accurately and consistently identify the events it was designed to identify across multiple healthcare settings
what are the 3 ways performance measures can be calculated
rate, variable, ratio
define risk adjustment or stratification
a statistical process for reducing, removing, or clarifying influences of confounding factors that differ among comparison groups
mostly used for outcome measures
what is the first thing you must determine when evaluting performance measures
how the data will be used
what are some methods of determining educational needs of the learner population?
-interest finder surveys
-test development
-focus group discussion
-learner self assessment
-personal interviews
-job analysis and performance review
-review of internal repors
-observational studies
define goals
the itnent of the circiculum which provide a diretion for planning
define objectives
define learner outcomes in measureable terms and use action verbs
what training method is used when large numbers of staff need to be educated in a short period of time?
train the trainer
which learning method is used to bridge the gap between theiry and actual practice?
case studies
define expert teaching style
ICP used their knowledge to inform learners and challenge them to be well prepared. Intimidating to learner
define formal authority teaching style
ICP in charge of learners knowledge acquisition. Not concerned with relationships but focuses on content to be delivered
define demonstrator or personal model teaching style
coaches, demonstrates, and encourages a more active learning style
define facilitator teaching style
learner-centred, active learning encouraged. Accountability for learning is placed on the learner
define delegator teaching style
ICP is a consultant and learners direct learning project
what are characteristics of an assessment
-emphasis on taching process and progress
-focus on teacher or student activity
-critiques, interviews, surveys, reviews
-improve teaching and learning process
-formative
what are characteristics of an evaluation
-emphasis on mastery of competency
-focus on student or techer performance
-tests, demonstrations, projects
-purpose is to assign a grade
-summative
the gap between what HCP know and what they do can be defined as
positive deviance
what is posirive deviance?
individuals whose uncommon behaviours enable them to find better solutions than their peers while having same access to resources. Asset-based and problem solving
what are smart networks?
networks with large core of voerlapping clusters or individuals from different units within an organization
what do members of smart networks do?
collaborate to eliminate barriers to IPAC and discover ways to ensure adherence
what are 5 network maps?
-initial
-current
-innovation
-project
-potential
what are the metrics by Valdis Krebs used to measure network health?
-awareness
-connector
-integration
what is a formative evaluation?
conducting during planning of education session to provide immedaite feedback and allow changes to be made
what is a summative evaluation?
-occurs after the program is completed to determine impact and effectiveness
data gathering tools such as checklists and questionnaires are an example of what method of determining educational needs?
interest-finder surveys
learning needs assessed in small groups with members assisting each other to clarify needs are an example of what method of determining educational needs?
focus group discussion
learner developing a self-achievement model and comparing present situation to the standard are an example of what method of determining educational needs?
learner self-assessment
what are boolean operators?
AND, OR, NOT
AND
narrow search. finds apges with all terms used
OR broadens search
finds pagges with at least one search term. connects two or more similar concepts
NOT
excludes pages with the second term
what do quotation marks do
return pages with exact matches
which component of research studys places the problem in the context of past knowledge
literature review
true or false. authors tend to cite views that support their own
true
what does study deign depend on?
- available data or participants
- frequency of exposures and outcomes in the same population
- populations available for study
why are cohort studies considered the gold standard?
because events can be recorded as they occur
cohort data reflects what?
the cause-effect temporal sequence of events
which type of study is generally used for hyptohesis generation?
cross sectional
describe the Err is Human
-developed by the institute of Medicine in 1996 to improve nation’s healthcare quality
-focused on number of Americans who die each year because of medical errors
-6 aims of care: safety, effectiveness, patient centredness, timeliness, efficiency, and equity
describe a strategic plan and its steps
determines the direction an organization will go in the future and what the organization must do to reach the goal, mission, or vision.
steps: analysis of the organization, forming conclusions about what to do for issues, action planning
what is a gap analysis?
a technique used to compare best with current practices and determines steps to take to move from current to desired future state
what is an RCA and how is information collected?
-takes a retrospective look at adverse outcomes and determines what and why it happened and what prevention can be done.’
-collect info from documents, interviews, and field observations
what are some RCA limitations?
-team must delve deep into adverse cause of problem to determine process change
-expensive, time consuming, labor intensive
-team members may requires training before participating in the rca
True or false. Fishbone or Ishikawa diagram is used for RCA?
True
describe FMEA
-a proactive, preventive approach to identify potential opportunities for error
-identify problems before they occur
whych QI initiate points out what the organization should plan for, and how to use resources and guide efforts within a formal framework
SWOT
what is multivoting?
-prioriitze a large list of topics to a final selecion for performance improvement
-team members vote, rank selection in order of priority, votes are tallied and they decide on which project they will work on
-can occur multiple times
what are goal directed checklists?
-used in aviation
-follow simple steps to eliminate hazards
describe run charts
-used to identify how processes change over time
-allow for mean to be determine and show changes in the mean
-demonstrate special cause variation when a steady pattern of observations falls above or below the mean in an equal pattern
describe affinity diagrams
-gather large amounts of language data and creatively group the data based on lines of natural relationships
-data are usually collected from brainstorming or customer surveys
describe pareto charts
-series of vertical charts arranged and sorted in descending order of height from left to right with a cumulative percent line on the y-axis
-allow team to identify where effrots produce the greateset value, plying that 80% of benefits will stem from 20% of causes
what is the primary focus of the 6 signma and lean approach?
-minimize process variation which produces defects
-concentrate on precision and accuracy that leads to defect free products and services
what strategies does the siz signma lean aproach utilize?
-value stream mapping
-transactional mapping
-just in time training
six signma uses DMAIC format to create a data-driven quality strategy for improving processes. what does DMAIC stand for?
-define
-measure
-analyze
-improve
-control
descibr each step of PDSA
P: identifying program responsibilities, gap anaylsis or process mapping
D: execute plan/implement strategies, conduct surveillance, communication, staff education
S: analysis of actions, RCA, FMEA, data display like benchmarking
A: instituting strategies and measuring the effect of the action on the project
describe HICPAC
-gudiance to CDC and others on IPAC practices, sruveillance, HAIs, antmicrobial resistance
-periodically updates guidelines
-guidelines developed in collaboration with affilated professional organizations
OSHA may enforce IPAC issues under what?
the Genreal Duty Clause of the Occupational Health and Safety Act
what are 4 pricniple functions of an IPAC program?
- develop and recommended policies and procedures
- education HCP, patients, caregivers
- directl intervene to prevent transmission andinfections
- obtain and manage critical data include infection surveillance
what is the difference between cost benefit and cost effectiveness?
effectiveness looks at the outcome of care (lives saved, diseases prevented) cost benefit looks at outcomes in terms of cost (including malpractice claims, protecting employees from injury)
define mortality
a measure of the frequency of death in a population during a specified time (usually a year)
what does crude mortality measure
the proportion of the population dying each year from all causes
what does the cause specific mortality rate measure
mortality from a specified cause for a population
what is the k value for crude mortality rate?
1,000
what is the k value when calculating cause specific mortality rate?
100,000
what is the standardized infection ratio
a summary measure that compares HAI rates over time among one or more groups of patients to that of a standard population
what is the SIR formula?
observed number of infections/expected number of infections
SIR is ____ specific and based on what?
procedure specific and based on specific patient risk factors
how is the SIR interpreted?
SIR =1: rates are same as expected
SIE>1: facility rates are higher than NHSN benchmark
SIR <1: facility rates are better than the NSHN benchmark
how can the risk ratio (relative risk) be interpreted?
-RR=1 no signficant assocation
RR>1: positive assocation (worse outcome)
RR<1: negative assication (protective effect)
how can correlation values be interpreted?
the closer r is to +1 the stronger the relationship
a positive correlation exists when as one variable increases, so does the other (longer catheter is in place=greater UTI risk)
negative correlation is as one variable increases the other decreases
As r approaches 0, the less the association between two variables
with a value of 0 there is no correlation
if the p value is equal to or greater than the significance level, what would you do with the null hypothesis?
fail to reject
