Quick tips for collecting infectious disease data
It’s tricky business, but experts give guidance
So you’ve decided which infection control data you want to collect. Now what? Figuring out how to collect data is not an easy task.
"The hardest thing is to come up with a system that works for you," says Sharon Link, RN, BSN, quality management supervisor for Allied Home Health of Scranton, PA. "Everybody has that problem."
Link and other quality managers who have been collecting such data offer these guidelines:
• Educate nurses on using infection reports.
Tell nurses why they need to collect this data; tell them why the agency has to track infections, Link suggests.
An agency could require nurses to fill out infection reports, but if they’re not given good explanations for why this is so important, they might get busy and forget, she adds.
• Match the infection reports against CDC or other criteria.
Link is the infection control "point person" for Allied Home Health. All infection reports are sent to her, and she matches them against infection criteria developed by the Atlanta-based Centers for Disease Control and Prevention to make sure they’re true infections. (See example of criteria in guide to TB, VRE, and MRSA, p. 111.)
"A nurse might report a patient has the signs and symptoms of a urinary tract infection, but the culture might not be back yet," Link explains. So she waits for the culture, and if it comes back positive, she includes the case in her infectious disease data. She doesn’t include negative results in the data.
An infection control nurse might make the same determination at other agencies.
• Ask nurses to list their patients on antibiotics on a weekly log.
These data are useful because they can help the quality manager decide whether a patient contracted an infection in the hospital or during home care, says Stella M. Dotson, RN, MS, continuous quality improvement coordinator for Columbia Homecare Oklahoma in Claremore, OK.
The patients who were put on antibiotics while in the hospital or within 10 days of being released probably contracted an infection in the hospital, she explains.
Dotson says this is never 100% conclusive, but it could be used as an indicator if a quality manager benchmarked the infection control data. (See story on creating indicators, p. 109.)
• Have nurses assess patients for symptoms of infection.
"Make sure that nurses pull specimens of urine every time they visit the home," Dotson advises.
"And if it’s a respiratory patient, have them note the type of sputum and whether the cough is productive or nonproductive," she adds.
They also should note any increased drainage for wound patients. Dotson says Columbia Homecare has a standardized assessment form it uses, and the nurses are taught how to accurately document these symptoms.
"Keep the infection control forms plain and simple because home health nurses generate voluminous paperwork," Link suggests.
"We had to design infection reporting forms for our nurses to use, and they have to hand-write them and submit them," she says.
• Enter the data into a spreadsheet or database at least once a month.
Link uses a computerized spreadsheet and collects the numbers once a month. Other agencies might have clerks type in the data directly from nurses’ infection reports.
• Analyze the data monthly, looking for trends and clusters.
Link checks to see if any infection problems need to be addressed immediately. An example of a problem would be if an agency had a high cluster of urinary tract infections for patients using a specific catheter, Link says. If such a cluster is found, then the quality manager should look for possible causes.
These could include the following:
Nurses haven’t successfully taught patients and caregivers how to take care of the catheter.
Home health aides might be spreading infection because they are not following catheter care procedures.
The family was taught properly, but has not followed the nurse’s instructions.
Address problems with inservices
A solution would be to give an inservice to nurses to show them how to teach patients and families about catheter care. Or, the agency could have a supervisor follow home health aides into the homes, observe their catheter care technique, and correct any mistakes they might be making.
If the family is the problem, then the nurse needs to teach them once again about catheter care.
• Educate staff on ways to keep data consistent and reliable.
"Getting compliance for that is tricky, so you have to sell your staff on why you’re doing it and why it’s important," Link says.
Again, inservices are the key to encouraging staff compliance.
First, Allied Home Health held a large inservice on infection control for the entire staff. The agency covered the issues of why it’s tracking this information and what the impact on the staff will be.
"I always think in terms of what’s in it for them," Link says. "What can I say to them that would make them think they can do this, and how will it make them give better care to their patients?"
As a result, the agency’s infection control education for patients has improved, she says.
Dotson says her company will hold extensive staff education once the benchmarking indicators are chosen.
"We’ll bring in a wound care specialist and a respiratory therapist to make a presentation," Dotson says.
"Reinforce the catheter care technique and have the therapist check it off during nurse orientation," she advises.