directly caring for the patient and responsible for infection prevention are aware the resident has CRE. Review the importance of meticulous environmental cleaning with the housekeepers. This includes at a minimum, daily room and bathroom cleaning and attention to “high-touch” surfaces such as light switches, door knobs and bathroom handrails. Two long-term care facility environmental cleaning checklists, one for resident rooms and one for common areas, can be found in the appendix or the OPSC website at . If a CRE-infected or CRE-colonized resident is discharged home, ensure they are aware of their CRE colonization and notify the resident’s primary care provider of the diagnosis. This will potentially help the individual during future medical treatment and assist public health in tracking CRE on subsequent facility admissions. Educate staff, affected residents and their visitors about CRE. Education helps to reduce the spread of CRE. Notify appropriate clinicians (medical director, director of nursing, pharmacist, etc.) of CRE in the facility. Specific goals: Limit use of catheters, tubes and other invasive devices in all residents. Stop unnecessary antibiotic use in all residents, especially those who are CRE-positive. Review monthly antibiotic use, and culture orders and susceptibility patterns to evaluate appropriate antibiotic use and identify if unnecessary antibiotics and cultures were ordered. Contact MDPH for information on antimicrobial stewardship programs in long-term care facilities. Additional recommendations on the results of carbapenemase testing: For non-CP-CRE: no additional measures are required. Refer to the section titled “When and how to apply contact precautions for CRE-positive residents in SNFs” for a discussion of how to determine whether contact precautions should be used. For CP-CRE, implement the following additional measures: Notify MDPH, in addition to the receiving facility, upon resident transfer. Notify facility administration. Prevention of spread to be an institutional priority, which requires leadership and monetary support. Review your facility’s microbiology records within the past 12 months to identify any suspect CP-CRE cases and work with your laboratory to assure that appropriate testing for
Unit: Date: Hand Hygiene Observation Tool Observer Name: DIRECTIONS - If you believe you observed ‘no hand hygiene’ or are unsure, please confirm with staff privately; remind if applicable. (Some staff members carry their own hand sanitizer. Remember to observe ‘hands full’ process in its entirety). FORM UPDATES: 'Nursing’ is now ‘Nursing (RN)’, Nursing (CNA)’ and Nursing (Tech) ‘Students’ are now ‘Student (Nursing)’, ‘Student (CNA)’, ‘Student (Medical)’, ‘Student (Other)’. The ‘OTHER’ section is alphabetized and ‘Cath Lab’ (personnel) has been added. Surgeons and Medical Providers are divided by specialty – record by #. Role of Observed Person Observed Behavior Nursing (RN) Nursing (CNA) Nursing (Tech) Surgeon Cardiac General OB/Gyn Orthopedic Plastics Urology Other Unknown Prov (Medical) Cardiology Emergency Fam Practice GI Internal Med Nephrology Neurology Oncology Pediatrics Psychiatry Radiology Unknown Provider (Hospitalist) Provider (Anesthesia) Provider (PA/NP) Provider (CNM) Provider (Resident/Fellow) Provider (Unknown) Student (Nursing) Student (CNA) Student (Medical) Student (Other) OTHER – use # 1 Admitting Cath Lab Clergy Engineering EVS Imaging Lab Nutr Services Pharmacy PT-OT-ST Resp Therapy SS/Case Mgmt Transport Unknown Circle ONE Blocked view/ unsure Used hand sanitizer Hand washing w/ soap and water No hand hygiene – ask remind Comments – record name of observed staff member, feedback given, response, etc. 1 IN OUT 2 IN OUT 3 IN OUT 4 IN OUT 5 IN OUT 6 IN OUT 7 IN OUT 8 IN OUT 9 IN OUT 10 IN OUT 11 IN OUT 12 IN OUT 13 IN OUT 14 IN OUT 15 IN OUT 16 IN OUT