Advanced Practice Nursing (Infection Control) Certification Program

Hong Kong College of Medical Nursing

Advanced Practice Nursing (Infection Control) Certification Program

Fellow Membership Examination

Clinical Log Book

Endorsed on 1Oct 2017

Name of Candidate ______

Advanced Practice Nursing (Infection Control) Certification Program

Fellow Membership Examination

Content
1.GENERAL INSTRUCTIONS FOR CANDIDATE / 3
2.PURPOSE OF THE LOG BOOK / 3
3.RESPONSIBILITES OF THE CANDIDATE / 3-4
4.RESPONSIBILITES OF THE MENTOR / 4
5.PERSONAL DATA OF THE CANDIDATE / 5
6.RECORD OF EXPERIENCES / 6-12
7.RECORD OF CASE STUDY AND/OR PRESENTATION / 13
8.FACILITATE CHANGE & EVIDENCE-BASED PRACTICE / 13
9.INITIATE IMPROVEMENT STRATEGIES / 13
10.CLINICAL LOG SHEET / 14
11.EVALUTION FORM / 15
12 REFERENCE – COMPETENCE FRAMEWORK / 16

1. General Instructions for the Candidate

The Candidate should regularly read and access information related to Specialty Training published by the Hong Kong College of Medical Nursing as updated on website.

2.The Purpose of the Log Book

1. To assist the Candidate in reflecting the learning opportunities in clinical practices
2. Tofacilitate the Mentor to assess the clinical competence of the Candidate and provide support andguidance to accomplish the Certification Program

3.Responsibilities of the Candidate

1. Each Candidate, upon enrollment, will be issued with the Log Book at the commencement of Advanced Practice Nursing (Infection Control) Certification Program training. It will be the property of the Candidate.
2. The Candidate should recordthe followings:

-All supervised surveillance of infection outbreak

- All supervised infection control training and activities

- All supervised audit of infection control practices

- All supervised assessment on the patients

-All supervised interventions on the patients

-All special encounters with the patients/families

-All nursing activities in Patient Support Group

-Case conferences

-Research activity

-Journal reading and reflection

-Continuous Professional Activities

-Attending/leading Continuous Nursing Education activities

-Case presentations

-Nurses rounds

-Attending/presentation in conferences or seminars

-Speaker or author in nursing education seminars / conference / journal paper

-Leading Patient Safety activity

-Leading Staff Occupational Safety activities

-Leading Risk Management and Quality improvement activities

The above list is not exhaustive as the log book serves as a means that demonstrate reflective learning of the Candidate.

1. The Candidate is strongly advised to keep the Log Book with him/her at all times and to fill in relevant information on a regular basis. Patient(s) MUST NOT be identified by names or Hong Kong Identity Card numbers. Cases should be recorded using patients’ initials and/or hospital numbers.
2. The Candidate should discuss his/her progress as documented in the Log Book must be signed by the mentor. This dialogue serves an opportunity for the Candidate to reflect on the learning and growth in the nursing profession. This regular assessment allows deficiencies in experience to be remedied early in the course of the training. An evaluation form should be signed by the Chairman of Examination and Accreditation Committee before recommendation to the Hong Kong Academy of Nursing for admission to fellow Member.
3. The Candidate should seek the mentor’s endorsement and Accreditation Committee.
4. The Candidate should complete at least 70% of the Log Book (Fulfill the mandatory requirement) beforefinal assessment.

4.Responsibilities of the Mentor

1. The Mentor facilitates the Candidate to map learning opportunities in the clinical practices to the competence framework
2. The Mentor has the responsibility to guide the Candidate to reflect on encounters in the clinical areas by asking what happened, why and what is the learning point?
3. The Mentor is to facilitate the Candidate to identify opportunities to develop the leadership abilities to lead the team.
4. The Mentor is to polish the Candidate’s presentation and writing skills and encourage him/her to present cases and papers.
5. The Mentor is to encourage the Candidate to be active team players in clinical round.
6. The Mentor should not take more than three Candidates at the same work place.
7. The Mentor should not hold Trainer status in more than 2 specialties.
8. The Mentor has the responsibility to guide the Candidate to prepare for the Training Program.

5.Personal Data of the Candidate

Name of the Candidate ______Sex______

Chinese Name ______

Registration Number of the Candidate ______

Date of entry into the training program ______

Address ______

______

Email ______Telephone number ______

Mentor’s Name ______Title / Rank ______

Institution / Department / Unit ______

Supervision Period ______

6.Record of Experience

(* = Mandatory)

1. *Surveillance

A1Objective of surveillance (3 scenarios)

Practice Surveillance and identify health-care associated infections, the process of surveillance must incorporate four key stages: data must be collected, validated, analyzed and interpreted, and feedback for improvement .Through the above, an effective infection prevention control program is maintained in the health care facility.

Date / Experience / Mentor’s sign

A2Method of surveillance (3 scenarios)

Identify different methods of surveillance. The type of surveillance method depends on the local factors: size of hospital, case mix, availability of resources, etc.

Date / Experience / Mentor’s sign

A3Surveillance - Devices Associated Infections (DAI)(5 scenarios)

Practice DAIs surveillance including intravascular catheter-related infections, Catheter-associated urinary tract infections and Ventilator-associated pneumonias including collection, interpretation and evaluation of data.

Date / Experience / Mentor’s sign

A4Surgical Site Infection (SSI)(5 scenarios)

Practice SSI surveillance including collection, interpretation and evaluation of data.

Date / Experience / Mentor’s sign

1. *Outbreak and Clustering Management

B1Identify the case definitions in outbreakand clustering including confirm the existence of the outbreak and clustering of diagnosis. (7 scenarios)

Date / Experience / Mentor’s sign

B2Create a case definition including line listings, epidemic curve, generating hypothesis to implement the control measure. (7 scenarios)

Date / Experience / Mentor’s sign

B3Implementing control measures including clinical level, communication and reporting. (7 scenarios)

Date / Experience / Mentor’s sign

C.*Laboratory Surveillance(5 scenarios)

Interpretation of laboratory data to assist in the prevention and control of infections: (e.g. Bacteria, viruses, fungi, protozoa, helminthes or prions)

Date / Experience / Mentor’s sign

D.*Control of Multi-Drug Resistant Organisms (MDROs) (5 scenarios)

Identify Multi-drugresistant bacterial infections encountered in the health care setting. E.g. MRSA, VRE, CPE, MRAB, MRPA.

Date / Patient initials / Experience / Mentor’s sign

E.*Hand Hygiene (5 scenarios)

Participate in Hand Hygiene Promotion Program including observation, monitoring, feedback and evaluation.

Date / Experience / Mentor’s sign

F.*Isolation Precautions (5 scenarios)

Appropriate isolation of patients infected with communicable disease including Standard Precautions for all patients and Transmission Based Precautions for other pathogens.

Date / Experience / Mentor’s sign

G.*Disinfection and sterilization (5 scenarios)

• Distinguish between levels of risk presented by individuals, equipment and the environment. Select appropriate methods and products for disinfection or sterilization.
• Assessment of new disinfectant and sterilant.
• Provide support upon procurement of new product in the aspect of infection control like what the level of risk and the method of disinfection / sterilization required.

Date / Experience / Mentor’s sign

H.Management of clinical waste (Not less than 3 scenarios)

Identify waste that represents a sufficient risk of causing infection duringhandling and after disposal.

Date / Experience / Mentor’s sign

I.Linen and Laundry services (Not less than 3 scenarios)

Participate in monitoring linen and laundry services including linen categories, washing processes, choice of laundry bags, segregation, sorting, transport and storage.

Date / Experience / Mentor’s sign

J.Food handling (Not less than 2 scenarios)

Participate in monitoring food servicesin the facilities and identifying any mishandling of food which may lead to outbreaks of food poisoning.

Date / Experience / Mentor’s sign

K.*Construction, renovation and demolition (Not less than 3 scenarios)

Participate in planning and conducting theInfection Control RiskAssessment processand compliance monitoring ofthe renovation project.

Date / Experience / Mentor’s sign

L.Environmental monitoring (Not less than 3 scenarios)

Participate in environmental sampling (e.g. Air quality), results interpretation and give appropriate advice.Evaluate and monitoring of environmental cleaning and disinfection practices.

Date / Experience / Mentor’s sign

M.Staff health

1*Management of Percutaneous and Mucosal Exposures (5 scenarios)

Participate in the management of Percutaneous and Mucosal Exposure incidents including investigation, prevention, reporting and post-exposure prophylaxis.

Date / Experience / Mentor’s sign

2. VaccinationPrograms for health care workersincluding providing advices upon new staff employment, influenza vaccination (Not less than 3 scenarios)

Participate in vaccination related activities in the facilities.

Date / Experience / Mentor’s sign

N. Guideline formulation, review and updating (3scenarios)

Assist or lead in thereview literature,formulation or updating, preparation for the training / education

Date / Experience / Mentor’s sign

O.Audits e.g. Hand Hygiene audit, appropriate use of PPE,gowning and degowning audit(Not less than 3 scenarios)

Performing audits on infection control practices and evaluating performance.

Date / Experience / Mentor’s sign

P.Infection control education & training e.g. Orientation Program, ad hoc education , guideline refreshment , appropriate use of PPE, infection control in specialties like ICU, OT (Not less than 5 scenarios)

Deliver infection control training to employees, upon employment and regular update.

Date / Experience / Mentor’s sign

Q.Continuous Quality Improvement Project:(Not less than 2 scenarios)

Example:Contributing to reducing Antimicrobial Resistance, reduction of Healthcare Associated Infection like SSI, and Blood and body fluids exposure.

Date / Experience / Mentor’s sign

R.Drill exercise on control and prevention of emerging & re-emergingInfectious Diseases e.g. Avian Flu, MERS, Ebola, novel infection (Not less than 2 scenarios)

Participate inplanning, organizing, implementing and evaluatinga drill exercise

Date / Experience / Mentor’s sign

S. Implementation of new infection control programs including participating or assisting to implement the new program.(at least one scenario)

Date / Experience / Mentor’s sign

T. Other(not listed above) Infection control training / projects involved

Date / Experience / Mentor’s sign

7.Case study and / or presentation

(Not less than 2 cases, please refer to clinical Log Sheet at the back as a reference format)

8.*Facilitate change and adopt evidence-based practices in nursing care (Not less than 2 activities)

Date / Activity / Mentor’s Sign

9.Initiate improvement strategies in quality and risk management (Not less than 2 activities)

Date / Activity / Mentor’s Sign

END

1. Clinical Log Sheet

This is a suggested format to facilitate mentor mentee discussion.

Session date:
Level of care the candidate provided:
□Observation only □Primarily mentor managed □Independent care with presentation to mentor agreement
Client information:
Initial Sex/Age Occupation
Social background
Diagnosis / Past medical history / Infection status
IC risk assessment
Relevant medical conditions, epidemiological linkage and other parameters
Intervention, advice, care plan and education:
Management and education provided
Reflection / learning:
Mentee signature / Date
Mentor Comment
Mentee signature / Mentor signature
Date / Date

1. Evaluation form to be completed by the Mentor for recommending to attend assessment leading to award of HKAN Fellow Member

Name of Mentee
Supervising Period
EVALUATION
Subject areas / Grading
Clinical knowledge & Professional judgment / Pass / Needs improvement / Borderline fail / Fail
Meeting the domain of competence
Managed patient with complex clinical profile
Established therapeutic relationship with patient/family
Led CQI activity
Assisted to / Developed clinical practice guidelines
Led nursing team and demonstrated leadership abilities
Overall rating
Recommendation:
□recommended as qualified and competent
□not recommended
Additional comments (use additional sheet if necessary)
______ / ______
Name of Mentor / Signature
Fellow number:
□endorsed
□not endorsed
______ / ______
Chairman of Examination & Accreditation Committee / Signature
Date:

1. Reference – Competence Framework

Subject areas / Domains
1 / 2 / 3 / 4 / 5 / 6 / 7
1.1 Identification of infectious disease processes /  /  /  /  /  / 1
1.2 Surveillance and epidemiologic investigation
1.2.1 Design of surveillance systems /  /  /  /  /  / 1
1.2.2 Collection and compilation of surveillance data /  /  /  /  /  / 1
1.2.3 Interpretation of surveillancedata /  /  /  /  /  / 1
1.2.4 Outbreak investigation /  /  /  /  /  /  / 1
1.3 Preventing/ controlling the transmission of infectious agents
1.3.1 Develop evidence-based / informed infection prevention and control policies and control policies and procedures /  /  /  /  /  / 1
1.3.2 Collaborate with relevant groups and agencies in planning community / facility responses to biologic threats and disasters (e.g. Public health, anthrax, influenza) /  /  /  /  /  /  / 1
1.3.3 Identify and implement infection prevention and control strategies /  /  /  /  /  /  / 1
1.4 Employee/occupational health /  /  /  /  /  /  / 1
1.5 Management and communication
1.5.1 Planning /  /  /  /  /  /  / 1
1.5.2 Communication and feedback /  /  /  /  /  /  / 1
1.5.3 Quality performance improvement and patient safety /  /  /  /  / 1
1.6 Education and research
1.6.1 Education /  /  /  /  / 1
1.6.2 Research /  /  /  /  / 1
1.7 Environment of care (ventilation, renovation & construction, hygiene) /  /  /  /  /  / 1
1.8 Cleaning, sterilization, disinfection & asepsis /  /  /  /  /  / 1

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Infection Control Nursing Log Book 2017