The Prevention of MDRO Transmission in Behavioral Health Settings

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The Prevention of MDRO Transmission in Behavioral Health Settings

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1. 1mbk The Prevention of MDRO Transmission in Behavioral Health Settings Melanie Benge Koch, BSN, RN, CIC Infection Preventionist Parkview Health System Fort Wayne, Indiana, USA

2. 2mbk Parkview Behavioral Health (PBH) 107 beds, off campus of acute care facility Inpatient mental health and chemical dependency services Outpatient services available for post discharge follow-up

3. 3mbk

4. 4mbk Problem Theoretical increase in individuals infected or colonized with MDRO’s in the behavioral health setting Contact precautions as a barrier to therapeutic behavioral health treatment

5. 5mbk Observation of PBH Practices Transmission based precaution policies same as acute care units Co-workers unaware of patient’s MDRO status MDRO status “ignored”

6. 6mbk Literature Review No resources related to control of MDRO’s in the behavioral health setting found CDC Review of Literature of MDRO transmission in various settings, 1984-2005 APIC list serve

7. 7mbk Goal To prevent the transmission of MDRO’s in the behavioral health setting. To provide therapeutic comprehensive inpatient behavioral health services.

8. 8mbk Plan Implement Modified Contact Precautions (MCP’s) at PBH Conduct research to demonstrate efficacy

9. 9mbk Who? Patients have a positive screen or culture while @ PBH Patients who state they have a history of MRSA Patients flagged in Electronic Medical Record

10. 10mbk

12. 12mbk Modified Contact Precautions (MCP’s) Risk Assessment is done every 24 hours by RN Communicate changes in MCP status To patient To staff Document in EMR that assessment was done daily

13. 13mbk Contact Precautions Private Room Staff/visitors will perform hand hygiene before entering and upon leaving room Staff/visitors will wear gloves within patient room. Staff/visitors will wear gown within patient room. Limit patient transport to essential purposes only. When possible, dedicate the use of medical equipment to single patient only. When not possible, adequately clean and disinfect them before use with another patient. Do not take chart into patient room.

14. 14mbk MCP’s-Level 1 Must have close supervision at all times outside of patient room Private Room Staff/visitors will perform hand hygiene before entering and upon leaving room When possible, dedicate the use of medical equipment to single patient only. When not possible, adequately clean and disinfect them before use with another patient. Do not take chart into patient room. Patient must bathe daily. Patient must wear clean clothes daily; clothing shall be changed immediately when visibly soiled. Patient must wash hands upon entering and leaving patient room, before and after meals, before initiation of every group activity, and as needed due to visible soil. Patient may attend all group, individual, educational, and spiritual sessions deemed therapeutically appropriate for the patient’s treatment plan.

15. 15mbk What is close supervision? An assigned individual will watch patient and offer guidance and reminders as needed A patient in MCP’s should be considered higher acuity

16. 16mbk MCP’s – Level 2 Private Room Staff/visitors will perform hand hygiene before entering and upon leaving room When possible, dedicate the use of medical equipment to single patient only. When not possible, adequately clean and disinfect them before use with another patient. Do not take chart into patient room. Patient must bathe daily. Patient must wear clean clothes daily; clothing shall be changed immediately when visibly soiled. Patient must wash hands upon entering and leaving patient room, before and after meals, before initiation of every group activity, and as needed due to visible soil. Patient may attend all group, individual, educational, and spiritual sessions deemed therapeutically appropriate for the patient’s treatment plan.

17. 17mbk Research Overview Implementation Date of January 19, 2009 Completion Date of ~April 19, 2009

18. 18mbk Hypothesis MCP’s on the Senior Care Unit of PBH will not result in transmission of Methicillin Resistant Staphylococcus Aureus (MRSA) to other inpatients residing on this unit at concurrent times.

19. 19mbk Subjects Clients admitted to thee Senior Care Unit between January 19 – April 19, 2009. > 54 years old

20. 20mbk Subjects 67 individuals agreed to participation 16 refused all MRSA nasal swabs 4 were admitted more than one time during study Average LOS was 14 days

21. 21mbk Procedure MRSA nasal swab upon admission MRSA nasal swab every Monday MRSA nasal swab upon discharge Concurrent implementation of MCP’s

22. 22mbk Definition of Transmission Negative screening upon admission AND Positive subsequent screen (weekly or discharge) AND Present on unit during a time of MCP implementation of another patient on the unit or 2 days following the cessation of MCP’s on the unit AND Received no antibiotic treatment prior to change in MRSA colonization status

23. 23mbk Data 3 of 67 patients had a history of MRSA upon admission (4.4%) Total of 960 patient study days 22 patient study days with MCP implementation (2.3%) 1 patient had a change in MRSA colonization status

24. 24mbk Epidemiology

25. 25mbk Relative Risk Basically, this is NOT a statistically significant difference. You can either be on the unit during MCP’s or not, and have virtually a similar risk to contractive a MRSA colonization. Spoke with Steven Streed over the weekend, statistician and IP from FL, who confirmed this.Basically, this is NOT a statistically significant difference. You can either be on the unit during MCP’s or not, and have virtually a similar risk to contractive a MRSA colonization. Spoke with Steven Streed over the weekend, statistician and IP from FL, who confirmed this.

26. 26mbk Summary Less incidence of MRSA on the senior care unit than anticipated More resistance to consenting to MRSA screening than anticipated Algorithm easily understood and implemented when necessary Transmission likely did not occur No new MRSA infections were identified on the unit during the study period

27. 27mbk Hypothesis, revisited MCP’s on the Senior Care Unit of PBH will not result in transmission of Methicillin Resistant Staphylococcus Aureus (MRSA) to other inpatients residing on this unit at concurrent times. I DO NOT REJECT the hypothesis.

28. 28mbk Future Directions Planning formal implementation in Continuing Care Center and Rehab Unit

29. 29mbk

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