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Environmental Services Microsystems Team. Cooley Dickinson Hospital Daniel English Linda Riley October, 2011. Objective. On completion of this session, participants will be able to: State 3 strategies to engage Environmental Services staff in infection prevention - PowerPoint PPT Presentation
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Environmental ServicesMicrosystems Team
Cooley Dickinson Hospital
Daniel EnglishLinda Riley
October, 2011
Objective
• On completion of this session, participants will be able to:– State 3 strategies to engage Environmental
Services staff in infection prevention– List 3 interventions that will improve
environmental cleanliness– Demonstrate the effectiveness of UV light in
reducing CDI
Hospital Associated C-Diff Rates
1.160.88
0.56 0.67
1.21
0.75
1.110.88
1.33
0.800.93
0.71
0.0
0.5
1.0
1.5
Q1
2008 Q2
2008 Q3
2008 Q4
2008 Q1
2009 Q2
2009 Q3
2009 Q4
2009 Q1
2010 Q2
2010 Q3
2010 Q4
2010Rate pe
r 100
0 Pa
tient
Day
s
C-Diff Rate Trendline
One Patient’s Story
• 72 yrs of age, diagnosis pneumonia, prescribed antibiotics
• CDI, decreased urine output, kidney failure with hemodialysis for remainder of her life
• OR for colectomy - colon removed, wears a bag• Slow recovery, CCU, on ventilator• Stroke, speech and mobility issues• Readmitted three times• Family members assist with care
Anne
Causative Factors
• How healthcare facilities contribute to CDI:– Insufficient hand hygiene– Insufficient environmental cleanliness– Poor antibiotic stewardship
• Patient risk factors:– Advanced age and underlying illness– Certain medications– Immunosuppression
Two studies highlight contamination of hospital environment with C. diff. spores as a major risk factor.
Dubberke and colleagues, 2003Shaughnessy and colleagues, 2006
• “Both studies raise the issue of contamination of the hospital environment with C. diff. spores as a - if not THE – major risk factor for nosocomial CDI. This issue deserves much greater attention than it has received in the past.
Richard Ellison, MD
Learned About Our Microsystems by Assessing Our 5 P Data –
Patients, Professional, Purpose, Patterns, Processes
• Expectations for work performance not clear to staff
• Difficult to hold staff accountable• Staff received little training • Staff feels no power to improve work• Communication processes cumbersome
Workflow - Fishbone
Work areas are notdefined and haveno task lists or
frequencies
MATERIALS PROCESS
PEOPLE ENVIRONMENT
Do not have correct equipment
In disrepair
Tight budget
Unclear expectations
New approaches are needed
Poor training, needs updateCommunication
customers unawaare
Outdated job flows
Lack of a sense of accountability
Different levels of urgency
Staff set in their ways
Lack of trust in supervisors
Staff overwhelmed
Communication
Short staff at times
Focus on area
Different skill levels
Perception of unfair workload
Carpet hard to clean
BuildingNo laundry chutesSmall soiled rooms
Large floor area
Changes in location of deptswith no notice
Staff Engagement• Daily Huddles• Patient stories• Making improvements, raising the level of
professionalism• Invite Infection Prevention to your meetings• Data: Infections by unit, Patient survey results• Bulletin board turned into ‘Staff Feedback’• Include EVS staff in hospital and community
news letters• By getting them involved…ask for their opinion
30+ Initiatives Accomplished• Fresh eyes• Communication• Dept aim statement• Job flows• Inspections• Chemical Inventory reduced• Confidential trash• Sharps containers• Instigated daily huddles• ED Turnaround• Seven step cleaning
process• Code of conduct • Patient interaction scripts• Reduce clutter• Equipment storage• Blood borne pathogens• Patient room work flow
• Standards and Regulations, OSHA, TJC, DPH,
• Precaution room process• C’diff room communication with
Infection Prevention• TB and Negative Pressure Rooms• Soiled Linen bags• ED Cleaning, working together• Uniform switch over• 2 % below budget initiative• ESCt program • Micro-fiber cleaning products• Relocate the department• Meeting room furniture• Pass codes, keys and pagers• Stairwell cleaning schedule• Steam cleaning
Improvements targeting C-diff• Trained in the 9 step cleaning process • ESCt room management system• Increased ES staff by 2 FTEs• Average turn around time from 65 to 48 Mins• Education on chemical efficacy and dwell time• Cleaning time from 14 mins to 24 mins• Microfiber cloths/mops• Restroom cleanliness, Bleach in all
Bathrooms / ED / Cdiff rooms• PX-UV Light treatment
Focus on the Environment
PX-UV Light
Xenex PX-UV Light : Taking Disinfection to the Next Level
• Destroys all major classes of microorganisms that cause hospital-acquired infections.
• Uses high intensity broad spectrum UV light to penetrate the cell walls, fusing their DNA, leading to instant damage and the inability to reproduce or mutate.
• 99.99% of germs and spores are killed.• Goal: Flash all discharged patient rooms;
Flash OR’s & ED daily.
Implementation
• Attention• Intention• What does it mean for my work?• Accountability• System support
Challenges
• 1st Step• Contract• Early adopter of new technology• Flow • Procedure and Equipment• Sustaining Change
Outcomes
Rate of CDH Acquired C. diff., MRSA and VRE Q1-Q3, 2006 through 2011 YTD
0
0.5
1
1.5
2
2.5
2006 2007 2008 2009 2010 2011Year
Rat
e pe
r 100
0 pa
tient
day
s 64% decrease in CDH acquired
Infections
Number of Patients with Poor Outcomes after Acquiring C. diff. at CDH2009- June 2011
8
6
0
1
3
00
1
2
3
4
5
6
7
8
9
2009 2010 2011Year
# Pa
tient
s
DeathsColectomies
100% Decrease in Poor Outcomes
2011 YTD
Thank you.
Questions?