Merrimack Health GroupMarlborough Hills Health Care Center

ObjectivesIdentify at least 3 practical ways to improve

overall facility infection control

State at least 3 interdisciplinary measures to

reduce the incidence of CDI

Identify at least 3 practical ways to implement

environmental changes in your facility

How we Began our Journey…

MA Senior Care NewsletterCDI Hospital SNF Collaborative

Contacted MA Coalition for Prevention of Medical Errors

Our Marlboro facility assigned to partner with MWMC

First SNF-Hospital CDI Collaborative meetingAdditional Collaborative meetings and

conference calls

November 2011

MWMC-SNF CDI Team:Individual Team Assessment

Prepared by MWMC Infection Control Practitioner

Mechanism to start our in house assessmentIdentified facility team members and role in

facilityReassessed the number of cases of CDI last year Reviewed corporate nursing & infection control

policies and procedures Examined environmental supplies and practicesAssessed whether visitors follow proper infection

control guidelines

The TeamAdministratorDONSenior Director of

Clinical Services for Merrimack Health Group

Regional Clinical Consultant for Merrimack Health Group

SDCCase ManagerNPDirector of Rehab

Unit ManagersDirector of Social

ServiceDirector of DietaryActivities DirectorDirector of

MaintenanceDirector of

Environmental Services

Front line staff: CNA’s from LTC and subacute units

In House MeetingsInitially whole team met every 2 weeks Interdisciplinary subcommittees established

Infection Control CommitteeEducation CommitteeEnvironmental CommitteeHealthy Hands & Aesthetics CommitteeAntibiotic Stewardship Committee

Much progress made and was tested in February when we had a GI outbreak… stay tuned

Infection Control and Education CommitteesNew evidenced based corporate policies and

procedures with clinical competencies CdiContact Plus PrecautionsHand Hygiene-Glitter Bug a huge hit!

Alcohol based hand rubs Soap and water

MHG Hand washing & CDI Needs AssessmentExpanded upon MWMC questionnaireDistributed to all Directors of Nursing/SDC’sResults/assessment to Regional Clinical ConsultantDON/SDC inserviced before p&p rolled out in

facilities

Infection Control and Education Committees:

MHG Hand washing & CDI Needs AssessmentExpanded upon MWMC questionnaireDistributed to all Directors of Nursing/SDC’sGuide to assess if facility compliant with newest p&pReview education, audits, equipment, suppliesReview environmental servicesAssess antibiotic usage in the facility

Results/assessment to Regional Clinical ConsultantDON/SDC then educated prior to implementation of

new hand washing and cdi programs

Infection Control and Education CommitteesStarted reviewing all infections daily @ skilled meetingCompleted inventory of infection control equipment in

facilityContact Precaution & Contact Plus signs revised “Report to Nurse” stop signs revisedOrdered disposable equipment for CDI patient rooms

Blood pressure cuffsStethoscopesThermometersGlucometersGait belts different color

Instituted neon green colored interdepartmental infection communication forms

Learned effectiveness of cohorting patients with cdi

Infection Control and Education CommitteesBased interventions & programs on the

“Practice Opportunities for CDI Prevention” hand out

“Jasper Palmer Method” as seen on Youtube Developed CDI FAQ brochures

Staff version also available in Spanish & PortuguesePatient and visitor version

Developed Infection Control FAQ brochurePut into patient welcome bags

Community outreach:Q & A Cable program for Marlboro Seniors

Infection Control and Education CommitteesEducation for environmental services

Translators were available at time of inservice Communication Cards created

Facilitate clear communication between departments

Spanish and Portuguese with English equivalent

Mandatory Inservice Fair for all staffNew P & P’sCompetencies were completed

Environmental CommitteeSDC audited housekeeping & laundry Assessed practice opportunities for cdi

preventionEquipmentEnvironmentCleaning solution options

Implemented “CDC environment checklist for monitoring terminal cleaning:”Helped to identify high touch room surfaces

Microfiber mops purchasedStill exploring UV disinfection systemBleach wipes readily available

Healthy Hands and Aesthetics CommitteeHand wipes for patients to use before mealsHand washing at patient activitiesHand washing audits Fun & unique hand washing framed signs

Used ideas from collaborativeCommode liners very effective

Containing the cdiReduced odorStaff ease of use

Antibiotic Stewardship CommitteePharmacy antibiotic records reviewedCollated meds by prescriber; then used to

identify: Prescribing patternsOpportunities for re-educationNumber of patients with cdi

Initial Recurrent

Results given to DON’s/SDC’s for their review

What happened in February…Many patients admitted with gastroenteritisSubsequent new cases of concomittant cdi

CDC –gastroenteritis predisposes patients to cdi!

Put all departments new skills to the testYellow gowns became a fashion statement

Found that cohorting was an important part of eradicating cdi

After the “invasion…”Only 2 cases of facility acquired cdi

(antibiotic use)We continue to meet as a team monthlyTrack cdi as a part of our CQI

We are so appreciative for all that we have learned from being a part of the CDI collaborative!

Our Journey continues…&We wish you luck with yours!

Questions?

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