Why You Should Attend "Targeting Zero Infections": a NTDS Webinar Event on May 23

By Jerry W. Jackson, MD, FACP

dialysis CDC logo - Copy_1.jpg

NTDS Educational Agenda

An extensive program is already being planned for the 2017 Kidney Week, including an all-day Early Program workshop (“The Dialysis Infection Crisis in the United States: A Call to Action”), a 2-hour session during the regular meeting, and a focus group session.

NTDS is now an active Learning Community of ASN, allowing interactive dialog among nephrologists to share experiences, resources, and the progress of NTDS.

In addition to that platform for interactive dialog, NTDS members have already published articles connected to the NTDS strategies, including two Kidney News Online articles— “Leadership, Motivation, and Transformational Change: What’s In It for Nephrologists?” by Dr. Leslie Wong and “Improving Care for Children on Dialysis” by Drs. Brad Warady and Alicia Neu.

NTDS will develop outreach and education for nephrologists in strategic areas for improvement. These areas include adherence to recommended practices, improvement of screening for and detection of infections, and preparation for emerging threats. The CDC adds to these strategic areas with its own tools and expertise in investigation, surveillance, HAI prevention guidelines, and interventions.

The second webinar in the series, “Targeting Zero Infections: Combating Blood Borne Pathogens”, will focus on Antimicrobial Stewardship.

The webinar is planned for September 27, 2017 and will offer CME and CE credits. Stay tuned to Kidney News Online to find more information in the coming months.

 

The webinar on May 23, titled “Targeting Zero Infections: Where Do We Begin?” takes place from 12-1 pm ET and will be the first in a series of educational webinars on the full range of topics comprising the strategic initiatives of Nephrologists Transforming Dialysis Safety (NTDS).

Please register to secure your attendance.

To give more detail on the event, I’ve elaborated on several reasons why this webinar will be beneficial to you and your practice.

  1. Leadership and Systems Thinking as they relate to strengthening the ability of the nephrologist to change culture and formulate effective action plans for infection prevention will be presented. The CDC learned much from the Ebola crisis of importance to nephrologists, making us think about the extreme vulnerability of the dialysis population to future infectious outbreaks. The first webinar will use a case-based approach (centered around an outbreak of Hepatitis C in a facility) to show you leadership strategies that can be combined with specific tools to enhance infection prevention at your facility.  This webinar will be motivational, inviting you to go much deeper in learning cultural and clinical pathway approaches to the critical responsibility of infection prevention.
  2. Sadly, there is a certain complacency or at least a sense of inevitability of infections involving dialysis patients.  We know that infection rate (specifically, BSI rate) by facility is a new metric being included in the QIP for the first time in 2017.  Like all metrics, there will be an established rate, and below that rate will be considered “acceptable”.  Subjectively, we hear many dialysis care providers express the belief that some level of infection is “just part of the business of doing dialysis”. But is this necessarily true? The NTDS has set its goal and purpose as “targeting zero infections” and means this literally. Such a stretch goal will require a new way of thinking and an organized way of overcoming barriers to infection prevention. And it falls within the role of the Medical Director to overcome complacency among all dialysis care providers at the facility, to be a champion and leader for excellence in infection prevention.
  3. The CMS Conditions for Coverage (CfC) give us guidance and direction as well as regulatory oversight.  That document informs us that the Medical Director is the leader of the QAPI process, that the QAPI process must focus on indicators related to improved health outcomes and the prevention and reduction of medical errors, and must give priority to improvement activities that affect clinical outcomes and patient safety. And the CFC states that Medical Directors must ensure that actions are taken to immediately correct any identified problems that threaten the health and safety of patients. For infection control, there must be analysis and documentation of infections with establishment of facility baseline and trending of infections over time. Action plans must be established to minimize infection transmission and to reduce future incidents.
  4. The Conditions for Coverage should not be thought of as a regulatory burden but rather as an empowerment document for medical directors. Why do I say this? This document has final regulatory authority over the practices and operations of the facility and it clearly states that the Medical Director leads the QAPI process and that this process must set a priority on patient safety in general and on infection reduction (and by extension, prevention) specifically. This empowers and charges the Medical Director with ensuring good staff education, oversight, and accountability for practices within the facility, and facilitation of infection prevention. Overcoming barriers to infection control, adherence to guidelines such as those of the CDC and as expressed through Policies and Procedures, supervising the activities of other nephrologists and mid-level practitioners, and building a facility culture that supports this is all part of the role and responsibilities of the Medical Director. And there is an urgency involved here. The Value Based Purchasing system sets a strong degree of accountability for us. More importantly, the NTDS considers virtually all infections to be preventable and this makes us aware of the ethical imperative to avoid harm to every patient under our charge.
  5. What does the data show since the Conditions for Coverage was updated in 2008?  Infections remain the second leading cause of death among dialysis patients. Infections remain a frequent cause of hospitalizations and a leading cause of 30-day readmission for dialysis patients. Since 2005, while all cause hospitalization rate has gradually declined, that for infections is the same or slightly worse. It has been estimated that 15% of all MRSA infection in the US originates in ambulatory hemodialysis facilities and that MRSA is 100 times more common in dialysis patients compared to the general population. For all cases of invasive MRSA, 90% require hospitalization and 20% of those admissions result in patient mortality. Many of the survivors have significantly increased debility, and the global cost of MRSA is staggering. But MRSA is only one of many infectious concerns. VRE and MDR GNR infections are common in this population. There is an 8% prevalence of HCV in dialysis facilities with periodic cluster outbreaks of HCV—with the Case Study in this first webinar being a great example.

All this is to point out the challenges to good infection control in the dialysis facility, resulting in little or even lack of improvement in overall infection rates over a period of years. This first webinar in the planned series will offer practical ways you can accelerate this improvement process in your dialysis facility. Please consider attending this webinar.

Register to secure your attendance to the webinar event.

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dialysis CDC logo - Copy_1.jpg

NTDS Educational Agenda

An extensive program is already being planned for the 2017 Kidney Week, including an all-day Early Program workshop (“The Dialysis Infection Crisis in the United States: A Call to Action”), a 2-hour session during the regular meeting, and a focus group session.

NTDS is now an active Learning Community of ASN, allowing interactive dialog among nephrologists to share experiences, resources, and the progress of NTDS.

In addition to that platform for interactive dialog, NTDS members have already published articles connected to the NTDS strategies, including two Kidney News Online articles— “Leadership, Motivation, and Transformational Change: What’s In It for Nephrologists?” by Dr. Leslie Wong and “Improving Care for Children on Dialysis” by Drs. Brad Warady and Alicia Neu.

NTDS will develop outreach and education for nephrologists in strategic areas for improvement. These areas include adherence to recommended practices, improvement of screening for and detection of infections, and preparation for emerging threats. The CDC adds to these strategic areas with its own tools and expertise in investigation, surveillance, HAI prevention guidelines, and interventions.

The second webinar in the series, “Targeting Zero Infections: Combating Blood Borne Pathogens”, will focus on Antimicrobial Stewardship.

The webinar is planned for September 27, 2017 and will offer CME and CE credits. Stay tuned to Kidney News Online to find more information in the coming months.

 

The webinar on May 23, titled “Targeting Zero Infections: Where Do We Begin?” takes place from 12-1 pm ET and will be the first in a series of educational webinars on the full range of topics comprising the strategic initiatives of Nephrologists Transforming Dialysis Safety (NTDS).

Please register to secure your attendance.

To give more detail on the event, I’ve elaborated on several reasons why this webinar will be beneficial to you and your practice.

  1. Leadership and Systems Thinking as they relate to strengthening the ability of the nephrologist to change culture and formulate effective action plans for infection prevention will be presented. The CDC learned much from the Ebola crisis of importance to nephrologists, making us think about the extreme vulnerability of the dialysis population to future infectious outbreaks. The first webinar will use a case-based approach (centered around an outbreak of Hepatitis C in a facility) to show you leadership strategies that can be combined with specific tools to enhance infection prevention at your facility.  This webinar will be motivational, inviting you to go much deeper in learning cultural and clinical pathway approaches to the critical responsibility of infection prevention.
  2. Sadly, there is a certain complacency or at least a sense of inevitability of infections involving dialysis patients.  We know that infection rate (specifically, BSI rate) by facility is a new metric being included in the QIP for the first time in 2017.  Like all metrics, there will be an established rate, and below that rate will be considered “acceptable”.  Subjectively, we hear many dialysis care providers express the belief that some level of infection is “just part of the business of doing dialysis”. But is this necessarily true? The NTDS has set its goal and purpose as “targeting zero infections” and means this literally. Such a stretch goal will require a new way of thinking and an organized way of overcoming barriers to infection prevention. And it falls within the role of the Medical Director to overcome complacency among all dialysis care providers at the facility, to be a champion and leader for excellence in infection prevention.
  3. The CMS Conditions for Coverage (CfC) give us guidance and direction as well as regulatory oversight.  That document informs us that the Medical Director is the leader of the QAPI process, that the QAPI process must focus on indicators related to improved health outcomes and the prevention and reduction of medical errors, and must give priority to improvement activities that affect clinical outcomes and patient safety. And the CFC states that Medical Directors must ensure that actions are taken to immediately correct any identified problems that threaten the health and safety of patients. For infection control, there must be analysis and documentation of infections with establishment of facility baseline and trending of infections over time. Action plans must be established to minimize infection transmission and to reduce future incidents.
  4. The Conditions for Coverage should not be thought of as a regulatory burden but rather as an empowerment document for medical directors. Why do I say this? This document has final regulatory authority over the practices and operations of the facility and it clearly states that the Medical Director leads the QAPI process and that this process must set a priority on patient safety in general and on infection reduction (and by extension, prevention) specifically. This empowers and charges the Medical Director with ensuring good staff education, oversight, and accountability for practices within the facility, and facilitation of infection prevention. Overcoming barriers to infection control, adherence to guidelines such as those of the CDC and as expressed through Policies and Procedures, supervising the activities of other nephrologists and mid-level practitioners, and building a facility culture that supports this is all part of the role and responsibilities of the Medical Director. And there is an urgency involved here. The Value Based Purchasing system sets a strong degree of accountability for us. More importantly, the NTDS considers virtually all infections to be preventable and this makes us aware of the ethical imperative to avoid harm to every patient under our charge.
  5. What does the data show since the Conditions for Coverage was updated in 2008?  Infections remain the second leading cause of death among dialysis patients. Infections remain a frequent cause of hospitalizations and a leading cause of 30-day readmission for dialysis patients. Since 2005, while all cause hospitalization rate has gradually declined, that for infections is the same or slightly worse. It has been estimated that 15% of all MRSA infection in the US originates in ambulatory hemodialysis facilities and that MRSA is 100 times more common in dialysis patients compared to the general population. For all cases of invasive MRSA, 90% require hospitalization and 20% of those admissions result in patient mortality. Many of the survivors have significantly increased debility, and the global cost of MRSA is staggering. But MRSA is only one of many infectious concerns. VRE and MDR GNR infections are common in this population. There is an 8% prevalence of HCV in dialysis facilities with periodic cluster outbreaks of HCV—with the Case Study in this first webinar being a great example.

All this is to point out the challenges to good infection control in the dialysis facility, resulting in little or even lack of improvement in overall infection rates over a period of years. This first webinar in the planned series will offer practical ways you can accelerate this improvement process in your dialysis facility. Please consider attending this webinar.

Register to secure your attendance to the webinar event.