Mha using measurement to inform and improve
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Mha using measurement to inform and improve

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    Mha using measurement to inform and improve Mha using measurement to inform and improve Presentation Transcript

    • Maureen Spencer, RN, M.Ed., CIC Infection Control Manager New England Baptist Hospital, Boston, MA
    • Objectives
      • Demonstrate how one hospital used the new CDI surveillance definitions to identify an increase of CDI on one nursing unit.
      • Describe enhanced environmental controls to reduce transmission of CDI
      • Describe the new Clostridium difficile Infection (CDI) Collaborative Definition
    • June 2008
      • Received the CDI Surveillance Working Group CDI definitions at the APIC Conference
      • Presented the new surveillance definitions to the Infection Control Committee
      • Reclassified cases in July 2008
      • Identified one nursing unit with 76% of the cases of HA-CDI
      • Several of the patients had also been in the ICU and were transferred in an ICU bed rather than stretcher, and often went back and forth between the two units in the same bed
      • Patients were being removed from Special Contact Precautions after diarrhea stopped, prior to discharge – housekeeping didn’t know the room needed to be cleaned with bleach or cubicle curtains changed
    • New Surveillance Definitions
    • Initial Investigation August 2008
      • • FY08 = 24 Patients with positive C.difficile titers
        • – 3 from outpatient locations
        • – 21 from inpatients (87.5%)
        •  
      • • Nursing Unit - Developed Signs and Symptoms:
        • – J4 East 16/21 cases (76%)
        • – L 5 1/21 cases ( 5%)
        • – 5 East 3/21 cases (14%)
        • – ICU 1/21 cases ( 5%)
        •  
      • 3 of 16 Jenks4East cases were in room 465
          • - 2 of the CA-CDI (community-acquired) cases were in room 465  
    • Poster we presented at APIC 2007 showing CDI with room association – 28 patients had been in 42 rooms!
    • FY2008 - NEBH Cases Per New Definitions
    • C.Difficile Team - August 08
      • Formation of C.Difficile Team:
        • Dr. Camer (Chief of Surgery) Dr. Lui (Chief of Gastroenterology), Sharon Connolly, RN – Nurse Manager, Sue Cohen,MT (ASCP) Microbiology Supervisor, Pam Dejoie, Maureen Spencer, RN, Infection Control
        • Met weekly, reviewed literature, formulated control measures, designed a retrospective case review, and educational offerings
      • Instituted Use of Chlorox Bleach Wipes
      • Enhanced Education for Staff
      • Changed patient transfer procedure
        • Stretcher (not in bed)
      • Retrospective Case Review of all CDI cases
    • Enhanced Education Transfers between units on stretchers versus contaminated bed Green tag flagging system for cleaned equipment Dinamap baskets with sanicloths and not allowed in precautions rooms Spatial Separation of precaution cases Bleach wipes for all precaution rooms Enhanced cleaning of equipment
    • Nursing Unit Decontamination
      • Decontaminated 19 rooms with dri-mist particle generator that breaks down disinfectant into microscopic, negatively charged ion particulates.
      • These particulates are smaller than one micron in diameter and can access ALL surfaces of a room.
      • Particulates are negatively charged and stick to positively charged contaminants
      • Some evidence it will kill spores
      • Three day period – lease arrangement with company
      • Cost: ~$5000.00 for 19 rooms
      • Issues: set off smoke detectors, prep time to seal ventilation and doors
    • Comparison of Rates 2008-2009 FY08 Total HAI 21 Patient Days 28914 Rate/10,000 PtDays 7.3     Hospital Onset 13 Rate/10,000 PtDays 4.5     Comm Onset - HA 8 Rate/10,000 PtDays 2.8 FY09 Total HAI 13 Patient Days 28382 Rate/10,000 PtDays 4.6     Hospital Onset 10 Rate/10,000 PtDays 3.5     Comm Onset - HA 3 Rate/10,000 PtDays 1.1
    • Retrospective Case Review FY2008 N=34
      • Proton pump inhibitors 13 (67%)
      • Cancer 12 (35%)
      • Fluorquinolone use 9 (26%)
      • Obesity 9 (26%)
      • CT Scan before onset 6 (18%)
      • MRSA Colonization 5 (15%)
      • VRE Colonization 3 ( 9%)
      • Diabetes 3 ( 9%)
    •  
    • Healthcare Facility Acute Care Hospital Rehabilitation Facility Nursing Home Other Chronic Care A case of C. difficile is defined as a case with the symptom of diarrhea without other known etiology. The stool sample will yield a positive result for laboratory assay for C. difficile toxin A and/or B. For purposes of this collaborative, C. difficile is limited to laboratory confirmed cases. This collaborative will track healthcare facility associated C. difficile C. difficile (CDI) Collaborative Definition
    • C. difficile (CDI) Collaborative Definition A patient classified as having a case of healthcare facility associated C. difficile is defined as a patient who develops diarrhea more than 48 hours after admission OR A patient classified as having any symptoms that develop within 48 hours after discharge to another healthcare facility . OR A patient discharged to home with lab confirmed C.diffIcile within 28 days from the day of discharge and no intervening admissions. . (Day of discharge counts as day 0) Also counts if C.difficile is identified on readmission to your facility. If the time of admission and/ or the time of diarrhea onset and/or the time stool was collected are not available, CDI can be considered to be healthcare facility onset if onset of diarrhea, with a positive stool occurs on or after the third calendar day after the day of admission (which is day zero). 
    • EACH PATIENT ONLY COUNTS ONCE Within 8 weeks of index diagnosis C. difficile (CDI) Collaborative Definition A patient readmitted after 8 weeks counts as a new patient /case (E.g. Monday admit, day 4 = Thursday) FACILITY HA-CDI RATE # HA CDI cases / 10,000 Patient Days (exclude NICU days)
    • Objectives
      • Demonstrate how one hospital used the new CDI surveillance definitions to identify an increase of CDI on one nursing unit.
      • Describe enhanced environmental controls to reduce transmission of CDI
      • Describe the new Clostridium difficile Infection (CDI) Collaborative Definition
    • THE END THANK YOU