C. Difficile Prevention Partnership Collaborative:

Bringing Together Hospitals and Skilled Nursing Facilities

Audio Conference Call

October 25, 2011www.macoalition.org

Agenda

 Introduction to C. Difficile Prevention Collaborative

CDI Management in Healthcare Facilities: Preview

Successful Infection Prevention Through Hospital/Long Term Care Collaboration

Learning By Looking, Asking

Susanne Salem-Schatz, Sc.D.Collaborative Director

Gail Bennett, MSN, RN, CIC

Sally Hess, MPH, CIC Fletcher Allen Health CareLisa Gallant, RNGreen Mountain Nursing CenterCarolyn Terhune , MT (ASCP), CICFletcher Allen Health Care

Sharon Benjamin, Ph.D. Collaborative Consultant

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Background

Increasing concern about multi drug resistant organisms including clostridium difficile (CDI)

2 year partnership between Coalition and DPH with CDC funding to support CDI prevention in acute care hospitals

Opportunity to expand work to include settings across the continuum of care (bugs don’t pay attention to facility boundaries!)

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Our Team

Massachusetts Coalition for the Prevention of Medical Errors

Paula Griswold, MS

Executive Director Susanne Salem-Schatz Sc.D.

Collaborative Director

Massachusetts Senior Care Foundation Helen Magliozzi, RN, BSN

Director of Regulatory Affairs Laurie Herndon, MSN, GNP-BC

ANP-BC, Director of Clinical Quality

Masspro • Denise Selfridge, LPN, CPHQ

Massachusetts Department of Public Health

Al DeMaria, MD, Medical Director, Bureau of Infectious Disease

Eileen Mchale BSN, HAI Coordinator Nora McElroy, MS, Epidemiologist

Expert Consultants Gail Bennett, MSN, RN, CIC

Infection Prevention Sharon Benjamin, Ph.D.

Organizational Change

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Your Teams

Skilled Nursing Facilities Staff person in charge of infection

control Administrator Director of nurses Environmental services manager/staff Front line staff (nurse, CNA) Social worker (or whoever manages

your admissions) Medical director or nurse practitioner Consultant pharmacist

Hospitals Infection Preventionist Environmental services staff Nursing representative Microbiologist Infectious disease specialist Pharmacist Case Management (or whoever

manages your care transitions)

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To Do List:

Send a List of Your Team Members: Name, role, and email address Identify team leader, measurement contact If someone does not have access to email on

a regular basis, let me know so we can work out a communication system.

(Susanne Salem-Schatz, sss@hcqi.com)

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Program PreviewOctober 2011 – July 2012

Program-wide Events

Kickoff Call…………………………….

Statewide Learning Sessions…………….

Regional ½ Day Workshops…………….

Antibiotic Stewardship…………………

Cluster ActivitiesTo be determined by cluster participant

MeasurementMonthly reporting of CDI rates

Tracking of hospital admissions over time

Dates

October 25, 2011

November 15, 2011

June 2012

January 2012

April 2012

January2012---?

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What We Will Bring

Content expertise Process expertise Program structure including opportunities for

shared learning and measurement Coaching and support for practice changes and

reporting Desire to learn from the experts on the front lines

and to share discoveries across the collaborative

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What We Hope You Will Bring

Expertise from the front lines of care A strong desire to improve infection prevention

and patient outcomes Readiness to learn new approaches to test engage

staff at all levels and test changes in your organization

Willingness to make time, work hard and have some fun along the way

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Will, Ideas, Execution

Will: the desire to make changes and improve care for patients and residents

Ideas: includes both best practices or expert content, AND your expertise about how to make change in your organization

Execution: purposeful efforts to engage staff, identify changes to try, test and implement changes including measurement and reflection

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Clostridium difficile Management in

Healthcare Facilities

Preview November 15, 2011

Gail Bennett, RN, MSN, CIC

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Topics to be Discussed

Clostridium difficile inection (CDI) Colonization vs. infection Risk factors Antibiotics most frequently associated

with CDI Rates of recurrence Testing for CDI Treatment

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Strategies for Preventing Transmission

Hand hygieneHand hygiene Contact precautionsContact precautions Identification of casesIdentification of cases Environmental disinfection Appropriate use of antibiotics

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With Emphasis on C. difficile in Acute vs. Non-acute Settings

Examples of Challenges in Managing CDI Cases

Maintaining appropriate contact precautions

Rooming arrangements LTC residents socializing

outside the room Environmental

decontamination Using recommended

practices Monitoring compliance

…and others

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Looking forward to meeting with you –November 15, 2011!

The Vermont MDRO Prevention

Collaborative: A Hospital & Long Term Care Facility

Partnership Sally Hess, Infection Prevention Manager, Fletcher Allen Health Care

Lisa Gallant, Infection Control, Green Mountain Nursing Center

Carolyn Terhune, Infection Preventionist, Fletcher Allen Health Care

Hospitals and long-term care facilities serving the same community, working together to form a larger team.

What is a Healthcare Cluster?

(H)

(L)

(L)

(L)Burlington Cluster

=

Hospital + 6 LTC

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Burlington ClusterAccomplishments

1. Evaluated current LTC and acute care practices re: isolation & patient placement.

2. Reviewed housekeeping practices, discussed best practices.

3. Shared an environmental services best practice checklist.

4. Developed an inter-facility communication/transfer form.

5. Revised the hospital Transition of Care form to include all key elements of the transfer form.

6. Reviewed the California enhanced precautions document – discussed & compared local practices and recommended changes to the State of Vermont – Goal is to “publish” a Vermont document.

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Burlington ClusterAccomplishments

7. LTC IP education, networking & open forum with Q&A.

8. Identified infection prevention learning needs, developed and presented LTC staff education.

9. MRSA screening on admission to hospital.10. CHG bathing on admission to hospital.11. LTC facility education and enrollment in NHSN.12. Successfully transmitted hospital MDRO and C.

diff data to NHSN via WHONET.

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Statewide Challenges Different cultures / approaches Lack of administrative engagement LTC IP “wears many hats” Limited personnel resources / time Staff turnover Little control over environmental

services Limited computer skills & access Implementing changes in all facilities in

a cluster – not one-size-fits-all

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Statewide Successes Networking…..LTC & Acute Hospital. Improved communication between

facilities. Sharing information, knowledge & policies Inter-facility transfer form

Recognizing Environmental Services needs.

Physician involvement in cluster meetings and discussions about interventions.

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Statewide Successes Enhanced standard precautions. MDRO patient/family educational

information. Active selective surveillance for

MRSA. Hand hygiene observations. Evaluation algorithm for suspected

UTIs. Statewide NHSN training.

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GOOD LUCK!

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Learning by Looking, Asking

Today’s call is to launch our first important activity:

Hospitals visit one of your Skilled Nursing Facility partners

Sharon Benjamin, Ph.D.,

Collaborative Consultant

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Purpose of Visit

Your visit is to explore and understand the overlaps and differences between hospitals and skilled nursing facilities (SNFs)

Start creating a map of potential improvements: so hospitals can improve hospital practice and SNFs can improve SNF practice

Practice seeing with “beginners’ mind” Bring back ideas to share

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What this Visit is NOT

An accreditation visit

We are not visiting to judge, teach or correct

We are not visiting to confirm our existing beliefs

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What To Do on theVisit Take a tour of the facility as an interested guest If possible, visit patient rooms and baths, and

shower rooms, spend time in the cafeteria and physical therapy

Notice how structure, process and needs shape practice and behavior

Take notes but not pictures

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What to Ask

Questions of genuine curiosity : Why do you do that? Why? Why? Why? How does that work? Can you show me? Can you tell me what’s happening here? Is this normal? Is this unusual?

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What to Take with You

√ Curiosity (so that when you notice yourself judging instead of learning you can get more curious)

√ Wide open eyes and ears√ Open hearts and minds√ Notes handout√ Notebook (for jotting down questions, ideas things

you notice, wonder about and things that concern you)

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What to Bring BackTo help you organize your notes we’ve created a handout (see attached)

Notes: When, Where, Who & What

What: Be objective.

What do you see, hear, witness, experience?

Was there a moment that captured the experience?

Avoid interpretations.

So What? Why is what you are seeing important?

Now What? What hunches for actions or prototypes do your observations spark?

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Final Thoughts

Be a good guest – make it easy for your hosts! Stay focused on patient needs Try to see naïvely with “childlike eyes.” Be wildly curious asking, “why, why, why, how, how, how, & can you show me?” Practice humility. You are studying at the feet of the

people who can make and sustain critical changes.

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Next Steps Cluster Contact Information

Current Expanded

Schedule Measurement Call Register for November 15th Workshop

http:www.regonline.com/cdifficilepreventionworkshopnovember152011 Questions?

Registration: Fiona Roberts, froberts@macoalition.org Everything else: Susanne Salem-Schatz, sss@hcqi.com

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