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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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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

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


Collaboration

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


Toolkit and benchmarking

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


Toolkit format

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


Toolkit components

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


Sample risk assessment

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


Practice observations

Practice Observations

  • Environmental cleanliness

  • Hand hygiene


Impact of the environment

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


Impact of the environment1

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


The kentucky mrsa collaborative reviewing progress made during 2009

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.


Environments contaminated with mrsa

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


Common items contaminated in healthcare patient rooms

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


Viability in the environment

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


Improving practice

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)


Methods for assessing cleaning practices

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


Outcomes measure

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


Outcomes measure1

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


Key practices

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


Participating hospitals

Participating Hospitals

  • 126 licensed hospitals in KY

  • Commitment from 95%

    • Critical Access Hospitals (≤ 25 beds)29

    • Hospitals less than 100 beds27

    • Hospitals 100-250 beds20

    • Hospitals >250 beds24

    • Specialty Hospitals14


2009 results mrsa bsis

2009 Results: MRSA BSIs


2009 results hand hygiene

2009 Results: Hand Hygiene


2009 results room cleaning

2009 Results: Room Cleaning


Continuous improvement

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


Shared knowledge websites

Shared Knowledge Websites

http://info.kyha.com/MRSA/default.htm

http://www.infectionpreventiontools.com


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