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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

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 During 2009

  • 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 During 2009

  • 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 During 2009

  • 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 During 2009

  • 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 During 2009

  • 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 During 2009

  • 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 During 2009

  • Environmental cleanliness

  • Hand hygiene


Impact of the environment
Impact of the Environment During 2009

  • 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 During 2009

  • 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 During 2009

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 During 2009

  • 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 During 2009

  • 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 During 2009

  • 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 During 2009

  • 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 During 2009

  • 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 During 2009

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 During 2009

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 During 2009

  • 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 During 2009

  • 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





Continuous improvement
Continuous Improvement During 2009

  • 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 During 2009

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

http://www.infectionpreventiontools.com