Elaine Crittenton, RN, Director of Infection Prevention, Employee Health and Wellness Katherine Steele, RN, Infection Preventionist Carteret General Hospital , Morehead City, NC
As in nursing and other healthcare professions, true success is dependent not only upon intellectual understanding and technical expertise, but upon the art of care-giving and compassion. There is a true art to being an infection preventionist!
Initiation of Protocols
Make sure information is shared across the organization Present facts, NOT perceptions Strive for transparency Eliminate SILOS and TURF ISSUES Then PDSA Plan, Do, Study, Act
Overview of the 100,000 Lives Campaign December 2004 The names of the patients whose lives we save can never be known. Our contribution will be what did not happen to them. And, though they are unknown, we will know that mothers and fathers are at graduations and weddings they would have missed, and that grandchildren will know grandparents they might never have known, and holidays will be taken, and work completed, and books read, and symphonies heard, and gardens tended that, without our work, would never have been.
Donald M. Berwick, MD, MPP Former President and CEO Institute for Healthcare Improvement
We invite you to join a campaign to make healthcare safer and more effective to ensure that hospitals achieve the best possible outcomes for all patients.
JOIN FORCES
IHI presented opportunities to collaborate and benchmark on three infection prevention targets, CLABSI, SSI and VAP.
Administration saw value in this approach and supported participation. IHI provided tools, such as bundles and staff education, to assist in the organization and operationalization of the effort.
WINS
Significant improvement was seen in all three targets. VAP rates were initially reduced by half and we currently average one per year Central line insertions were reduced by two thirds, CLABSIs were almost entirely eliminated. Over the past 23 quarters only 7 CLABSIs have occurred. PICC lines are largely preferred at this time. SSI reduction was also noted and SCIP efforts assisted with this effort. We did have a brief spike in the first half of 2008 when our SSI rate climbed to 2.13. It has steadily declined since that time with a last quarter SSI rate of .28%! This success fueled the desire to do more
Employee Orientation
Each new employee must attend a comprehensive orientation where we stress: Development of an interactive relationship with all employees to provide resources and guidance in infection prevention and to promote a culture of safety Importance of hand hygiene compliance in the healthcare setting Prevention of health acquired infections, CLABSIs, CAUTIs, SSIs, VAPs, etc. Bloodborne pathogen education introduction to the hospitals engineering and work practice controls and exposure control Transmission based precautions: Contact Precautions, Special Enteric/Contact Precautions, Droplet Precautions, Airborne Infection Isolation Precautions, Special Airborne Isolation Precautions, and Protective Isolation (Neutropenic) Precautions
Transmission Based Precautions (Signs are laminated with disease processes listed on the back)
KEEP IT FRESH!
Be proactive NOT reactive Find new ways to deliver old information Keep your sense of humor and share it with others
Memorable IP Activities
1000 hand-shaped cookies to launch our mandatory hand hygiene policy in 2006
Skits with an infection prevention theme during IP week with inhouse education credit Fall Festival for International Infection Prevention week, paired with quality with in-house education credit Ice cream cart, going from unit to unit, asking IP questions and rewarding correct answers.
International Infection Prevention Week National Healthcare Quality Week Fall Festival
COLLABORATE
Todays infection prevention environment provides many challenges and many opportunities to build your program and your practice. You will quickly recognize your worth to your facility and, hopefully, they will too! Take every opportunity to share your successes and keep the value of your program high. Collaborate as much as possible. While the requirements of a formal collaborative may seem daunting, there are always incredible benefits to joining such as: ~ Networking with peers ~ Access to valuable tools ~ Staying on schedule with data collection and reporting ~ Help changing your facilitys culture, if needed ~ Access to experts on evidence based practice ~ The opportunity to mentor others
COLLABORATIVE COMPONENTS In-person meetings Teleconferences Comprehensive toolkit Secure on-line data collection Collaborative website List serve Open office-hours calls Technical support
Internal Partnerships
Environmental Services The environment is a significant concern for IP and is being closely evaluated during surveys. We are partnering with EVS in environmental monitoring using an ATP device and this information will be reported quarterly. This is a great teaching tool for EVS staff.
Internal Partnerships
Materials Management Purchasing can be a boon or bust for infection prevention programs. Some devices that engineer risk out of invasive procedures can be significantly more expensive than standard products. The purchasing department can be a major ally when they see the whole picture, the breadth and depth of the IP program. This relationship was essential in obtaining a medicated central line, a silver coated indwelling catheter, hand hygiene stations, and other supportive products. IP is always called to the table when products are being evaluated. Money is NOT always the determining factor in decision making.
Internal Partnerships
Engineering/Facilities Maintenance Friends or Foes? Key players in environment of care issues. Teach them the importance of the IPs presence in project planning Make it easy for them -- policies, ICRAs, facility upkeep Help them see the IP in a positive light, not an intrusive one
Internal Partnerships
Education Resource to extend IP capabilities Help with employee IP performance Integrate IP with orientation, including documentation requirements, to facilitate reports needed for IP measures Assist with development of educational tools for patients and families Survey staff and plan requested/needed educational offerings
Internal Partnerships
Risk Management Expect the Unexpected! Assist with Investigation of serious safety events and near misses Assist with improving the safety culture of the facility Partners with IP in times of disaster , i.e., hurricanes, tornadoes, floods, etc. Supports unpopular IP decisions such as restriction of visitation Partners with IP for regulatory compliance
Internal Partnerships
Quality Eliminate redundancy Collects data for various quality measures, some of which is useful to IP Assists with the link between departments which is need for collaborative participation Usually manages the required reporting of core measures, etc. to CMS may help with NHSN requirements Another watch dog to keep compliance on track
Internal Partnerships
Information Technology Your new best friend Keep them informed of IP requirements, especially regarding mandatory reporting Garner their buy-in to IP needs so you will be fairly represented in IT purchases and upgrades Be sure any hospital-wide system is IP friendly and that EMR and surveillance software will interface properly, providing surveillance benefit Keep your equipment current and ask for classes if your computer skills need polishing
HENS Hospital Engagement Networks State Hospital Association State APIC chapter National APIC Regional Collaboratives
How many Foley catheters are inserted in the Emergency Department at CGH?
October 2010
510 Foley Catheters were inserted at CGH
2010
250 202 200
153 150
155
126
113
123
100
44%
50
reduction
26%
reduction
150
70%
reduction
103 92 94
103
50%
reduction
44%
reduction
0 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11
3,651
3,510
10 9
8 7
E D E d u c a t i o n N o v 2
6.96
6
5 4 3 2 1 0
5.5
1.07
As we say at the coast.Red sky at night, sailors delight Happy sailing to all fellow IPs!.....................Elaine and Kathy