Slides for Israel HAI for PSPH.ppt by KevenMealamu

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									American Arab Israeli
American-Arab-Israeli International
  Collaborative on Patient Safety
        Jerusalem, I
        J      l         l
                    Israel

  Reducing Health Care-Associated
          Infection (HAI)
   Marly Christenson, MSN, RN, FNP, CPHQ
                Director
         System Director, Clinical Transformation
      Providence Health & Services, Seattle, WA, USA
                   September 4, 2008
Providence
P p i t ACT
Preparing to
Five hospitals joined the IHI IMPACT HAI Community in May 2007
• Holy Family Hospital, Spokane, WA
                               Center Anchorage
• Providence Alaska Medical Center, Anchorage, AK
• Providence St. Peter Hospital, Olympia, WA
• Sacred Heart Hospital and Medical Center, Spokane, WA
• Saint Patrick Hospital and Health Sciences Center, Missoula, MT

       p         p
Participation helped them achieve successful reductions in select HAI
• Creating HAI Change package for publication September 2008
• Planning HAI Summit in October 2008
• Embarking on spread and adoption across PH&S ministries
Providence St
Pro idence St. Peter Hospital
               p
           Olympia, WA

Partners in the IHI IMPACT HAI Community
                     2008
                    to…
With Special Thanks to
 Jim Leonard
 Ji L       d
 Chief Executive
              St
 Providence St. Peter Hospital
 Jim.leonard@providence.org

 Lou Hilken, RN, MN, CIC
 Infection Control Preventionist
 Quality S i     Providence St. Peter Hospital
 Q li Services, P id          S P     H i l
 Lou.hilken@providence.org
Selecting The Team
        HAI Core Team Members                                           Basis for Selection
Executive Sponsor for quality strategic plan   Provide resources to enact elements of change package
OE facilitators                                Help design process and meetings to be effective
Performance Improvement                        Integration with quality measurement
Microbiologist – Laboratory representatives    Active screening cultures
Nurse representatives- leadership and staff    Patient care responsibilities and process integration
                                (    )
Infection Control Practitioners (ICPs)            j             p
                                               Subject matter experts
Physicians                                     Patient care responsibilities and champion with medical staff
Respiratory therapy- leadership and staff      Patient care responsibilities and process integration
Environmental services                                       decontamination,
                                               Environmental decontamination PPE responsibility
Laundry services
Educational services                           Communication and dissemination of process change

Materials management                           Isolation supplies
Sterile Processing                             Decontamination of isolation carts
Original AIMs

  • To reduce hospital-acquired Clostridium difficile
                y        y p              ,
    infections by >30% by September 30, 2008
    on the Medical/Renal Unit (4th floor)
                      yg         p
  • To achieve hand hygiene compliance of 95%
  • To achieve adherence to proper contact
    p
    precautions of 95%
  • To achieve appropriate room cleaning at 90%
                                      Identify patients with ASC

                                      Use contact precautions for
                     Prevention of   colonized or infected patients
                     T       i i
                     Transmission
                                     Use appropriate room cleaning
                                           and disinfection
 Reduce Infections
from MRSA, VRE,                       Use dedicated equipment for
and C. diff by 30%                   colonized and infected patients

                                      Reliable hand hygiene

                     Prevention of
                     P      i    f    Comply with all central
                       Infection     line bundle components
                                     Comply with all ventilator
                                       bundle
                                       b dl components
Key Changes

•   Pre-printed orders for isolation
•                            g
    Color-coded isolation signs
•   EVS on improvement team
•                     p
    EVS dedicated to pilot unit
•   Housekeeping checklist
•   Consistent room cleaning g
•   Hand hygiene observation data as screen savers
Barriers

  • Hand hygiene behaviors are tough to change and
    sustain,
    sustain particularly with the physicians
  • Need more front-line nursing staff at the table
  • Change in personnel on pilot unit (
          g    p             p          (HUC & EVS) )
  • Data collection burdensome
                       Percent of Patient Encounters with Compliance for Hand Hygiene

          100
          90
          80
          70
          60
  rcent




          50
Per




          40                                   Average for all other hospitals
          30

          20
          10
           0
                Apr-   May- Jun-   Jul-   Aug- Sep- Oct-    Nov- Dec- Jan-       Feb- Mar- Apr- May-
                 07     07   07     07     07   07   07      07   07   08         08   08   08   08

                ALL OTHERS            HFH         PAMC           SHMC            PSPH        SPH
                   H dH i       Adh
              PSPH Hand Hygiene Adherence
                                                                      Goal = 95%
100%
 90%
 80%
 70%
 60%
 50%
 40%
 30%
 20%
 10%
  0%
       Nov
       Nov-   Dec Jan 08 Feb
              Dec- Jan-08 Feb-   Mar
                                 Mar-   Apr
                                        Apr-     May June
                                                 May- June-   July-
                                                              July    Aug-
                                                                      Aug
        07     07          08     08     08       08    08     08      08

                             MD     Other      Total
       Percent of Patient Rooms with 75% or More of High Touch Surfaces Disinfected


   %
100%
                                                                     Goal = 98%
90%

80%

70%

60%

50%

40%

30%

20%

10%

 0%
          May - 08            June - 08                July - 08      Aug - 08

                           4th Floor       8th Floor
                              Occupied patient room cleaning checklist

                                        Barriers/Exemptions

                             S = Sleeping
                             B = Patient Busy (Nurses/Doctors in room)
                             C = Clean room
                             D = Patient Discharge
                             R = Patient refused
                             U = Cluttered surfaces



   1. Check room box when ALL tasks are completed.
   2. Document any barriers for completing any of the tasks in the space provided below.

             401                                      419
             402                                      420
             403                                      421
             404                                      422
             405                                      423
             406                                      424
             412                                      425
             413                                      426
             414                                      427
             415                                      428
             417                                      429
             418                                      430

References:
♦Bed side rails & controls         ♦Over bed table (top only)              ♦Sink, faucet handles
♦Call bell/TV control              ♦Top of night stand                     ♦Shelf above sink
♦Telephone                         ♦Bedside commode & handles              ♦Toilet
♦IV pole                           ♦Door handles                           ♦Shower
                   Hospital-Acquired Clostridium Difficile
                               M di l Renal
                         PSPH Medical R n l Unit
 1
0.9
08
0.8                                                             Target = 0.36
0.7
0.6
0.5
0.4
0.3
0.2
0.1
           0.00                                         0.00 0.00 0.00 0.00 0.00 0.00
 0
      Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul-
       07 07 07 07 07 07 07 07 07 08 08 08 08 08 08 08
                                       RATE       MEAN
Lessons Learned
   Engage E i
 • E                       l Services l in h l i
            Environmental S i early i the planning process
 • Conduct hand hygiene observation “under cover” and post findings
   openly for best results
 • Improve availability and accessibility of PPE through use of isolation
   carts, etc.
 • Increase compliance with active surveillance culture by early identification
                                                 systems
   of target populations (using clinical and ADT systems, etc.)
 • Data reporting requirement ensures commitment to the project
   (ACCOUNTABILITY)
 • Celebrate successes

 The team recognizes they still need to make this the way they do business on
    all units every day no matter who is watching - the tough part comes next
    in the diffusion!
Providence Al sk Medic l
Pro idence Alaska Medical Center
                   g
            Anchorage, AK

   Partners in the IHI IMPACT HAI Community
                        2008
Original AIM


   To d     h i l        i d       infections
 • T reduce hospital-acquired MRSA i f i
   by >30% at PAMC compared to previous year
                                      Identify patients with ASC

                                      Use contact precautions for
                     Prevention of   colonized or infected patients
                     T       i i
                     Transmission
                                     Use appropriate room cleaning
                                           and disinfection
 Reduce Infections
from MRSA, VRE,                       Use dedicated equipment for
and C. diff by 30%                   colonized and infected patients

                                      Reliable hand hygiene

                     Prevention of
                     P      i    f    Comply with all central
                       Infection     line bundle components
                                     Comply with all ventilator
                                       bundle
                                       b dl components
Key Changes
 Hand hygiene
 • New tool and procedure for data collecting
 • Extensive survey and sensing sessions for engagement
   and success

 Decontamination of environment and equipment
 D        i i      f   i          d    i
 • EVS education and engagement
 • OE facilitation

          g       p
 ASC of high risk patients
 • FMEA analysis and computer alerts
INFECTION CONTROL NOTE Room#____________
Date_____________________ Mr/Mrs_______________________ is a
Re-admit for Methicillin-Resistant Staph Aureus (MRSA)
Last positive date_________________ from _____________________
                   Methicillin-Resistant
Newly diagnosed Methicillin Resistant Staph Aureus
Date positive____________________ from ______________________
Your patient will be placed in Contact Precautions Droplet Precautions.
To discontinue precautions, your patient should:
     b off anti-MRSA antibiotics f 48 h
     be ff      i MRSA ibi i for hours b f                    l i
                                                before re-culturing,
     have a negative culture from the previously positive site (wound and sputum)
     have a negative nares culture

Please contact Infection Control at ext. 4829 if any questions.
Infection Control Practitioner
                       Percent of Patient Encounters with Compliance for Hand Hygiene

          100
          90
          80
          70
          60
  rcent




          50
Per




          40                                   Average for all other hospitals
          30

          20
          10
           0
                Apr-   May- Jun-   Jul-   Aug- Sep- Oct-    Nov- Dec- Jan-       Feb- Mar- Apr- May-
                 07     07   07     07     07   07   07      07   07   08         08   08   08   08

                ALL OTHERS            HFH         PAMC           SHMC            PSPH        SPH
Providence Alaska Medical Center
Rate of MRSA/1000 Pt Days
      Over 280 Days since last MRSA Infection
Common Success Elements

 •   Leadership
 •               g
     Vertical alignment
 •   Organizational support
 •                 y                 p
     Accountability for behavior and performance
 •   Patient focus
 •   Staff focus
 •   Effective teams
 •                   j
     Tools to do the job
        p
Next Steps

Spread and adoption across PH&S ministries
• Creating HAI change package for release this month
• Conducting HAI Summit in October 2008
• Submitted grant application for participation in HAI
  Positive D i      I ii i
  P i i Deviance Initiative
What is Positive
Deviance?

• An approach used to solve problems requiring
  social and behavioral change

• Achieves sustainable results by changing cultural
  norms
Premise of Positive
Deviance
       y            y
In every community there are
  certain individuals whose
  uncommon practices/
               p        /
  behaviors enable them to find
  better solutions to problems
                      p
  than their neighbors who have
  access to the same resources.

                                        proof             unit
                 The focus is on social proof, within the unit,
                   embodied in tacit and latent behaviors.
The “Cultural”
Bundle
B dl
• Act your way into a new way of thinking
  – Experiences that allow self-discovery
• Make the invisible visible
  Solutions are co-created and owned
• S l i                  d d       d
• Reinforce with feedback
A True Measure of a Successful Project
      Questions?


marly.christenson@providence.org

								
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