Community Health Center Caught Red-Handed Improving Hand Hygiene Compliance

Community Health Center Caught Red-Handed Improving Hand Hygiene Compliance

Poster Abstracts / American Journal of Infection Control 47 (2019) S15−S50 RESULTS: Results showed that urinalyses being re-flexed to culture dropped ...

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Poster Abstracts / American Journal of Infection Control 47 (2019) S15−S50

RESULTS: Results showed that urinalyses being re-flexed to culture dropped from 60% (77 of 128) in February 2017 to 50% (78 of 156) in May 2017. In addition, cultures with bacteria colony counts >100,000 dropped from 63% (22 of 35) to 37% (13/35) respectively. The number of CAUTIs reported was reduced from 11 in the first quarter of 2017 to 5 in the first quarter of 2018. CONCLUSIONS: This study found that implementing urine preservative tubes for specimen collection from Foley catheters improves the accuracy of urine test results. This occurred by reducing erroneous triggers of reflex cultures, falsely elevated colony counts, and fewer Foley patients requiring evaluation for CAUTI, therefore reducing the number of CAUTIs reported.

Presentation Number QA-99 Utilizing Performance Improvement methodologies to create a central lineassociated bloodstream infection surveillance process for ambulatory pediatric patients Hillary Hei MPH CIC, The Children’s Hospital of Philadelphia; Marisse Plaras BSN, RN, The Children’s Hospital of Philadelphia; Lauren Satchell, The Children’s Hospital of Philadelphia; Lori Handy MD, MSCE, The Children’s Hospital of Philadelphia BACKGROUND: Central line-associated bloodstream infections (CLABSI) are the most common device-associated infections in hospitalized children. Surveillance and prevention are standard in inpatient hospital settings, but comparable processes are less robust for ambulatory patients with central lines. Our institution lacked a unified and consistent process for surveillance and review of ambulatory CLABSI. Utilizing performance improvement (PI) methodologies, we sought to create a comprehensive and sustainable process for collecting CLABSI surveillance and event review data on complex patient populations across ambulatory disciplines. METHODS: We assembled key stakeholders by identifying services with the majority of patients discharged with central lines and utilized the Six Sigma methodology of DMADV (Define, Measure, Analyze, Design, and Verify) to understand and improve current processes. We performed current state analysis of infection tracking and data collection through process-mapping and utilized fishbone diagrams to identify root causes of inefficacies. Following value analysis, the team developed a future state process map and utilized Failure Modes Effects Analysis to identify and mitigate potential risks to the process. RESULTS: We identified variable CLABSI data collection methods between our stakeholder ambulatory divisions. Upon completion, our PI work resulted in one process that: 1) provides CLABSI surveillance for ambulatory divisions; 2) creates a singular data infrastructure for confirmed infections; 3) streamlines communication to all divisions and homecare providers involved in the? patient’s ambulatory care; and 4) promotes responsive learning through a multidisciplinary event review that highlights potential risk factors and generates proactive infection prevention measures. CONCLUSIONS: Utilizing PI methodology, we created a lean and standardized process to consistently track ambulatory CLABSI and support effective communication across divisions and providers. Next steps include optimization of the event review tool, integration with inpatient CLABSI PI efforts, and tests of change based on event review data that ultimately shift attention to patient safety in the ambulatory setting.

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Presentation Number QA-100 Novel intervention to monitor and improve neutropenic precautions compliance in immunocompromised cancer patients Ellen Evashwick RN BA CIC CRCST, Cedars-Sinai Medical Center; Sandra Rome RN, MN, AOCN, Cedars-Sinai Medical Center; Kimako Desvignes MSN, NE-BC, CMSRN, Cedars-Sinai Medical Center; Teresa Tandoc RN, MSN, OCN; Pearl Joy Gonzales BSN, OCN; Gregg Sannes RN, MSN; Jenny Jessup RN, BSN, BMT; Armyla Epstein BSN, Gerontological (RN-BC); Elsa Gonzalo BSN, Med-Surg (RN-BC); Jolly Cabili-Tagab RN, MSN, Gerontological (RN-BC); Rosalie Pallasigui RN, BSN, OCN; Maria Elena Nuqui RN, BSN; Sneha Krishna Masters of Science in Health Informatics; Matthew Almario MPH; Sharon Fawcett MSN, RN, CIC; Michael Ben-Aderet MD; Jonathan Grein MD BACKGROUND: Infections cause significant morbidity and mortality in patients with chemotherapy-induced neutropenia. Nursing practices exist that are proven to reduce infections in this population, however compliance with them is not routinely monitored. METHODS: A quality improvement project was designed to monitor compliance with established Neutropenic Precautions (NP-bundle) for inpatient neutropenic cancer patients on an Oncology Unit from July 2015 through September 2018. A novel auditing tool was developed which included a patient interview, observation, and evaluation of the environment. Audits were scored by the infection preventionist IP) for compliance. The project was organized into four time-periods: Baseline period: All audits performed by IP to determine feasibility and areas of focus. Phase I was educating staff and fixing gaps discovered in the baseline period. Unit nurses trained to perform all audits. Phase II, unit leadership engagement and enforcement of mandatory number of audits to add accountability of auditing frequency. Phase III was the Sustainment period with reduction in unit leadership involvement. RESULTS: Audit scores significantly increased between baseline period (mean= 60%) and Phase I (mean= 82%, p<0.0001 by t-test). Engagement of leadership during Phase II was associated with significant increases in both the number of audits performed as well as mean audit score (97%, p<0.001). The largest improvements were observed in patient knowledge around proper bathing product use, increasing from 20% at baseline to 94%; and patient-reported Hand Hygiene compliance, increasing from 0% to 97%. During Phase III (sustainment), audit volume declined though mean audit scores remained high (98%). CONCLUSIONS: We developed a novel tool to assess compliance with key elements of neutropenic precautions. Education and peer auditing was associated with improved compliance. Engagement of unit leadership and increasing audit volume correlated with further improvement with compliance, which was sustainable with less direct leadership involvement.

Presentation Number QA-101 Community Health Center Caught Red-Handed Improving Hand Hygiene Compliance Amber Owens RN, BSN, CIC, West Oakland Health BACKGROUND: Hand hygiene practices are ever evolving and studies show that poor hand hygiene practices have been linked to an increase in adverse outcomes. Despite the evidence, “adherence... to recommended hand-hygiene procedures has been poor, with mean baseline rates of 5%-81% (overall average 40%)” (CDC, 2002 P.22). “Compared to impatient care settings, outpatient settings

APIC 46th Annual Educational Conference & International Meeting| Philadelphia, PA | June 12-14 2019

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Poster Abstracts / American Journal of Infection Control 47 (2019) S15−S50

have traditionally lack infrastructure and resources to support infection prevention and surveillance activities” (CDC, 2016). This study researched the impact of an educational program with a focus on employee safety using a multi-modal approach that incorporated visual aids to increase awareness and compliance with hand hygiene. METHODS: This study used a quasi-experimental designed study with 83 outpatient clinic employee participants. The study ran over 90?days (2/6/2018-5/11/2018) with the incorporation of an independent variable of luminescent lotion that mimics germs and a dependent variable of hand washing. Results were measured both pre & post education by visual inspection of hands using a luminescent lotion and a black light. The data was evaluated using percentage, mean, standard deviation and t-test. Statistical significance determined using a p-value of <0.05 or less. RESULTS: The pre-education group applied the luminescent lotion to their hands and wash hands as normal, 41 out of 83 (49%) subjects accomplished effective hand washing. Post educational training, the subjects re- applied the luminescent lotion and washed hands, resulting in 76 out of 83 (92%) performing effective hand washing. Using Statcrunch 2018, pre-education group mean was 0.48, the post-education group was 0.90. Using a t-test to analyze the groups, data shows a t-stat of -6.58 with a p-value of <0.0001. CONCLUSIONS: This study found that emphasizing the risks of nonadherence for the employee with the incorporating visual aids increased the effectiveness of hand hygiene.

Presentation Number QA-102 Methodology to Reduce Healthcare Associated Infections at a Large MultiHospital Health System Lisa K. Sturm MPH, CIC, FAPIC, Ascension; Karl Saake MPH; Phillip Roberts BS; Mohamad Fakih MD, MPH; Tina jacobs, Ascension BACKGROUND: In this changing landscape of healthcare, Infection Prevention (IP) programs need to demonstrate their value to their institutions. One way to do this is through the reduction of healthcare associated infections (HAI). This improves patient outcomes and can also provide value through the avoidance of hospital acquired condition (HAC) penalties. METHODS: The reduction of HAIs at the system level of a 151-hospital health system became a top priority necessitating a structured approach. Beginning in January 2017, clear expectations of what is submitted to the National Healthcare Safety Network (NHSN) and reporting deadlines were defined. Next, HAI targets were established. Data is accessed from NHSN by the analytics department via Group Administrator rights. Analysis of standardized infection ratios (SIR), standardized utilization ratios (SUR) and Cumulative Attributable Differences (CADS) relative to system targets is conducted. Follow-up with hospitals having the highest CADS begins with a discussion with the IP team. Then, collaboration and feedback with the local team continues and efforts are escalated up to and including the C-suite and may culminate in a site visit if needed. The role and engagement of the Chief Quality Officer (CQO) is critical throughout the process. RESULTS: Since establishing this methodology, the HAI outcomes have approved in six of the eight categories. In the past year (October? 2017-September 2018) Clostridium difficile reduced 12%, central line associated bloodstream infection (CLABSI) 16%, catheter?associated urinary tract infection (CAUTI) 11%, abdominal hysterectomy surgical site infections (SSI) 46%, colon surgery SSI?19% and hip arthroplasty SSI 15%. In addition, HAC penalties were reduced.

CONCLUSIONS: This methodology has been very effective in reducing the HAIs across the health system. Also, the feedback from the stakeholders is positive because it results in collaboration and often brings needed attention to an area they have been struggling with.

Presentation Number QA-103 Reduction of Healthcare-Associated Infections (HAIs) by 83% in a long-term acute care setting (LTAC) MaureenBunch MSN, BSN CIC, Vibra Hospital BACKGROUND: HAIs impose significant patient safety consequences. LTACs provide extended medical and rehabilitative care to patients with clinically complex problems. LTAC patients have an average of three to six concurrent active diagnoses and multiple acute complexities with a 28?day average length of stay. Our objectives were to reduce HAI rates through process improvement. METHODS: We focused on prevention bundles to reduce HAIs. Catheter?-associated urinary track infection (CAUTI) bundle included nurse-driven urinary catheter removal and hand hygiene protocols. Clostridium difficile infection (CDI) bundle included hand hygiene, personal protective equipment and transportation protocols, preemptive isolation and antibiotic stewardship. Central line-associated bloodstream infection (CLABSI) bundle included nurse-driven device removal and hand hygiene protocols. HAI champions served as role models for change through education and audits. RESULTS: These implementations created change in our facility that decreased HAIs from 53 in 2013 to 9 in 2018. The CAUTI rate decreased from 5.4 per 1,000 line days (31 CAUTIs) to 1.8 (3 CAUTIs), SIR= 0.697. The incidence density rate (IDR) p-value was 0.0085. The urinary catheter line days decreased 61.6% from 5765 to 2213. The CDI rate decreased from 14.4 per 10,000 patient days (15 CDIs) to 4.1 (3 CDIs), SIR= 0.370. The IDR p-value was 0.0312. The CLABSI rate decreased from 1.04 per 1000 line days (7 CLABSIs) to 0.59 (2 CLABSIs), SIR= 0.296. The IDR p-value was 0.0312. The central line days decreased 49.8% from 6709 to 3367. Hand hygiene compliance increased 45% from 62% compliance to 90% compliance. CONCLUSIONS: HAIs are a major concern in the LTAC setting. Focusing on prevention of HAIs was effective in reducing our rate by 83% with a significance level of p=0.0001. Although statistical significance was not reached, the reduction in HAIs was significant for our patients.

Presentation Number QA-104 Creation of an Evidence-based Operating Room Observation Tool to Improve Infection Prevention Perioperative Practices Patrick S. Gordon RN, BSN, CIC, Beth Israel Deaconess Medical Center; Robin Kalaidjian RN, CIC; Sharon Wright MD, MPH, Beth Israel Deaconess Medical Center BACKGROUND: Direct observation has been effective in improving many behaviors critical to infection prevention, such as hand hygiene, but is applied infrequently in the operating room (OR) setting. National Patient Safety Goal 07.05.01 recommended direct observation of evidence-based practices within the OR to reduce surgical site infections (SSIs) but provided little guidance for implementation. We created a standardized OR observation tool for use by infection preventionists (IPs) and perioperative staff to identify variation in

APIC 46th Annual Educational Conference & International Meeting| Philadelphia, PA | June 12-14 2019