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The Kentucky MRSA Collaborative: Reviewing Progress Made During 2009

The Kentucky MRSA Collaborative: Reviewing Progress Made During 2009. Ruth Carrico PhD RN CIC Assistant Professor School of Public Health and Information Sciences University of Louisville. Objectives. Review elements of the MRSA Collaborative including the program goals and toolkit

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The Kentucky MRSA Collaborative: Reviewing Progress Made During 2009

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  1. The Kentucky MRSA Collaborative: Reviewing Progress Made During 2009 Ruth Carrico PhD RN CIC Assistant Professor School of Public Health and Information Sciences University of Louisville

  2. Objectives • Review elements of the MRSA Collaborative including the program goals and toolkit • Review data from the Collaborative • Utilize data to identify improvements for the 2010 journey to infection elimination

  3. Collaboration • Brings groups together to work on shared problems • Encourages and enables the sharing of experiences and discovery of new ways to do old things • Steeped in the experiences of social networking • Collective intelligence allows greater opportunities than individual ideas and activities • Success of the collaboration is hinged upon involvement, recognition of its value, and devotion to continuous improvement • Each participating hospital is responsible for their own improvement activities

  4. Toolkit and Benchmarking • Developed through Advisory Board and infection preventionist from across the state • Contains evidence basis, sample documents, tools and evaluation resources • Benchmarking through secured Web site to collect data on hand hygiene, room cleaning and MRSA rates

  5. Toolkit Format • Evidence basis • Compendium, Infection prevention competencies, CDC guidelines, IHI • Sample documents • Policies, checklists, isolation signs • Tools and resources • APIC Elimination Guide, videos, grids • Evaluation metrics • Observation methods, description of outcome measures with definitions

  6. Toolkit Components • How to implement and use the toolkit • Risk assessment • Tools and resources • Cleaning (environment and equipment) • Isolation • Hand hygiene • Fact sheets • Antimicrobial stewardship • Outcomes measures

  7. Sample Risk Assessment • Encourages multidisciplinary approach • Builds accountability and collaboration • Identifies risks across the organization and prioritizes so there is alignment with the goals/resources of the organization • Begins dialogue regarding priorities

  8. Practice Observations • Environmental cleanliness • Hand hygiene

  9. Impact of the Environment • Patients colonized or infected with healthcare-associated pathogens frequently contaminate items in their immediate vicinity • These pathogens may remain viable on surfaces for days to weeks • Healthcare workers can contaminate their hands by touching contaminated surfaces • These pathogens on HCW hands can be transmitted to other patients, surfaces, and themselves if hands are not cleansed properly

  10. Impact of the Environment • Routine cleaning of patient rooms is often suboptimal • Inadequate cleaning of rooms after discharging a patient with MRSA or VRE puts subsequent patients admitted to that room at risk of acquisition of the organism • Improved cleaning and disinfection of the environment can reduce the risk of patients acquiring multidrug-resistant pathogens • Monitoring the effectiveness of environmental cleaning is necessary

  11. The Inanimate Environment Can Facilitate Transmission Xrepresents Multidrug resistant organism culture positive sites ~ Contaminated surfaces increase cross-transmission ~ Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+) Patient Environment. Hayden M, ICAAC, 2001, Chicago, IL.

  12. Environments Contaminated with MRSA • Percent of surfaces contaminated with MRSA varied among pts colonized or infected • 6% of surfaces when patient colonized in nares • 36% if MRSA in wound or urine • 59% if heavy GI colonization • 19% in outpatient clinic contaminated with MRSA Boyce JM et al ICHE 1997 18:622 Johnson et al ICHE 2006 27:1133

  13. Common Items Contaminated in Healthcare Patient Rooms • Common • Bedrails • Bedside tables • Blood pressure cuffs • Floors • Light swtches, faucets handles • Less common • IV pumps • Bed control buttons • Pulse oximetry units • Urine containers • Computer keyboards

  14. Viability in the Environment • MRSA 2-9 weeks • VRE 1-12 weeks • C difficile spores days to 5 months • Acinetobacter 3-33 days • Norovirus hours to 12 days Hota B et al CID 2004; 39:1182 Kramer A et al BMC Infect Dis 2006; 2:130

  15. Improving Practice • Housekeepers and nursing staff often do not agree on who should clean what • Housekeepers do not always understand • Which disinfectant to use • What concentration • How often to change cleaning cloths/mop heads • Principles of clean v. dirty • Determine competencies, then monitor and provide feedback • Develop policies regarding who should clean what • American Society for Healthcare Environmental Services (www.ashes.org)

  16. Methods for Assessing Cleaning practices • Visual inspection • Checklists to assure surfaces have been wiped • Marking with fluorescent dye and checking to see if marker was moved (P Carling CID 2006;42:385) • Culturing surfaces (NOT a good idea) • ATP bioluminescence assays to measure cleanliness

  17. Outcomes Measure Positive blood cultures identifying MRSA • Numerator Definition: Number of patients with MRSA bloodstream infection during the calendar month • Numerator Exclusions: • Patients with a length of stay of 2 days or less • Patients with MRSA bloodstream infection identified from blood cultures collected in the first 2 days of the patient’s stay • Denominator Definition: Total number of admissions or patient days in calendar month • Denominator Exclusions: • Patients with a length of stay of 2 days or less • Patients with MRSA bloodstream infection identified from blood cultures collected in the first 2 days of the patient’s stay

  18. Outcomes Measure Positive blood cultures identifying MRSA • Denominator Definition: Total number of admissions or patient days in calendar month • Denominator Exclusions: • Patients with a length of stay of 2 days or less • Patients with MRSA bloodstream infection identified from blood cultures collected in the first 2 days of the patient’s stay • If using patient days, need to subtract the number of days from each patient stay after they are identified as having a positive blood culture for MRSA from the total

  19. Key Practices • Optimal skin preparation before invasive techniques (e.g., central line insertion, surgical incisions) • Disinfection of IV access sites (scrub the hub with alcohol 15 seconds) • Proper technique when drawing blood cultures • Hand hygiene • Environmental cleaning and disinfection

  20. Participating Hospitals • 126 licensed hospitals in KY • Commitment from 95% • Critical Access Hospitals (≤ 25 beds) 29 • Hospitals less than 100 beds 27 • Hospitals 100-250 beds 20 • Hospitals >250 beds 24 • Specialty Hospitals 14

  21. 2009 Results: MRSA BSIs

  22. 2009 Results: Hand Hygiene

  23. 2009 Results: Room Cleaning

  24. Continuous Improvement • Check to make sure the data you enter into the system is correct • If reporting period closes, you can still provide data. Contact KHA for assistance • The goal is still elimination so continue improvement efforts • Increase participation across more KY hospitals • Provide feedback and discuss results with other departments • Provide feedback regarding how the Collaborative can assist with improvement activities

  25. Shared Knowledge Websites http://info.kyha.com/MRSA/default.htm http://www.infectionpreventiontools.com

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