experiences in mrsa
Download
Skip this Video
Download Presentation
Experiences in MRSA

Loading in 2 Seconds...

play fullscreen
1 / 23

Experiences in MRSA - PowerPoint PPT Presentation


  • 307 Views
  • Uploaded on

Experiences in MRSA. Successful Implementation of a Hospital Wide Admission Screening Protocol Cindi Leigh Wigston Infection Prevention and Control Coordinator/Quality Leader Orillia Soldiers’ Memorial Hospital. Orillia Soldiers’ Memorial Hospital. Large Community Hospital

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Experiences in MRSA' - Jeffrey


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
experiences in mrsa

Experiences in MRSA

Successful Implementation of a Hospital Wide Admission Screening Protocol

Cindi Leigh Wigston

Infection Prevention and Control Coordinator/Quality Leader

Orillia Soldiers’ Memorial Hospital

orillia soldiers memorial hospital
Orillia Soldiers’ Memorial Hospital
  • Large Community Hospital
  • 218 in-patient beds
  • Regional Programs
    • Dialysis
    • High Risk Maternal
    • Paeds/NICU
    • SADV
    • CCC/Rehab
    • Psychiatry (Form 1 Facility)
the osmh experience
The OSMH Experience
  • November 2000
    • 3 patients identified on transfer to other facility
    • Review of current policy and procedure
    • Review of lab reports
    • Review of staff practice
    • Point prevalence screen of medical unit (60 beds)
  • December 2000
    • Audit of screening results
initial findings
Initial Findings
  • December2000
    • 147 “high risk” admits
    • 19.7% Screened within 24 hours
    • 9.5% Screened within 24-48 hours
    • 38% Screened after 72 hours
    • 32.6% Discharged prior to screening
finding the findings
Finding the Findings!
  • Daily review of admission list for previous 24 hours
  • Utilizing CIS Patient system to determine risk factors (limitation!)
  • Utilizing laboratory reports (paper copies!)
  • Writing “Infection Prevention and Control Suggests” orders on patient charts (limitation!)
next steps january to march 2001
Next Steps January to March 2001
  • Met with Senior Management
  • Met with Nursing Management
  • Met with IT Staff
  • Built data set
  • Developed and implemented staff education
  • Continued audit of screening compliance
january to march 2001 findings
January to March 2001 Findings
  • 34.1% ‘High Risk’ Admits
    • 21.4% Screened within 24 hours
    • 13.8% Screened within 24-48 hours
    • 30.4% Screened after 72 hours
    • 34.2% Discharged prior to screening
now what
Now What?
  • Goals
    • Increase staff knowledge regarding MRSA
    • Increase staff awareness of risk of MRSA colonization = INFECTION
    • Increase staff compliance with Additional Precautions
    • Increase staff compliance with Admission Screening of High Risk Patients
    • INTEGRATION OF SCREENING INTO PRACTICE - GOAL 80%
meeting objectives
Meeting Objectives
  • Identified champions
  • Nursing management acceptance
  • Senior management acceptance
  • MAC acceptance
  • Education
  • Unit Challenges
  • Visibility
why is screening important
Why is Screening Important?
  • Approximately 54% of MRSA cases in hospital were identified through admission screening

(CJIC 2005;20(1):36-37)

  • Active admission screening protocols are integral to control

(Lancet Infect Dis. 2005;5(10)653-663)

  • Early Screening = Early Identification = Less Isolation and Bed Movement!!!
colonization infection
Colonization = Infection?
  • Increased risk of infection in colonized patients
    • “4 fold increase in infection”

(Safdar, AJM 2008;121(4):310-315)

    • “23% developed infection”

(Huang, IDSA 2008, July 3)

    • “In 16 of the 28 patients with MRSA bacteraemia and MRSA colonization, the MRSA colonization was identified more than seven days before the bacteraemia”

(Roghman, Journal Hosp Infect 2007;47(2):98-103

patient consequences
Patient Consequences
  • Patients in isolation received less direct care
  • Tests are often postponed/cancelled
  • Unable to transfer to alternative level of care
  • “STIGMA”
hospital consequences
Hospital Consequences
  • Multiple bed moves
  • Blocked beds
  • Increased LOS
  • Increased cost
    • Isolation supplies
    • Antibiotic therapy
    • Dialysis Patients (OSMH)
  • Patient Cost is Immeasurable
and then came bob
And Then Came **Bob** . . .
  • 52 year old dialysis patient
  • Admit post BKA
  • Admission screens negative
  • Day 14 nasal/rectal MRSA positive
  • Unable to discharge home as satellite dialysis unit unable to provide dialysis to MRSA patient
  • Decolonization/abx therapy not effective
  • Remained positive in weekly follow up
  • Repeated infections, repeated surgeries
  • Remained in-patient for 14 months
  • Blood culture positive MRSA - died
reviewed and updated existing protocol
Reviewed and Updated Existing Protocol
  • All patients meeting ‘high risk’ criteria to be screened within 24 hours
    • Previous hospital admission
    • Direct hospital transfer
    • Prior admission to nursing care facility (LTC, group home)
    • Unit contacts of identified positive patients
    • Previously identified positive patients
    • Admission from correctional facility
    • Dialysis patients
    • Patients being transferred to CCC/Rehab
    • Patients being transferred from ICU
simplified process
Simplified Process
  • Added screening questions to Nursing History
  • Involved ER in screening activities
  • Entered unit contacts into CIS system
  • Unit helpers ensured that “screening kit” was in each room
  • Daily “ARO Screening Required” email from IP&C team
  • Ongoing education
  • Ongoing compliance audits
  • Changed micro media
challenges
Challenges
  • Staff perception of need
  • Lack of integrated IT
  • Cost
  • Time commitment
  • ‘Spoon feeding’ vs TAKING OWNERSHIP!
  • Integrating into practice
in summary
In Summary
  • Have patience!
  • Assess current status and build from there
  • Set small goals!
  • Celebrate achievement!
  • Provide timely feedback
  • Use “teaching moments”
  • Shift ownership to staff
questions
Questions?

Cindi Wigston, IP&C Coordinator/Quality Leader

Orillia Soldiers’ Memorial Hospital

[email protected]

705 325-2201 ext 3390

ad