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A Lean Six Sigma Approach to Improving the Discharge Room Cleaning Process
Poster Abstracts / American Journal of Infection Control 42 (2014) S29-S166
local hospital IPs produce HAI data reports that demonstrated NHSN analysis capabilities. This led to discussion and assistance with strategies for prevention interventions and sustainability. A total of 71 "commitments to action" were made by participating hospitals. Post-visit follow-up and support by Liaison IPs continue. LESSON LEARNED: State public health assistance on the use of HAI data for targeting prevention helped educate and encourage IPs in their local efforts. Effective Publications to hospital committees, staff, and stakeholders to demonstrate prevention gaps depend on the validity and interpretation of data being presented. Even experienced IPs were not always aware of the potential to maximize use of their data as a tool for making the case for support of infection prevention resources.
Publication Number 9-316 A Lean Six Sigma Approach to Improving the Discharge Room Cleaning Process
S143
trained on new roles and responsibilities for discharge room cleaning. RESULTS: A standardized “ready to clean” process for discharge room cleaning was established, and defined roles and responsibilities were created to address gaps contributing to inefficiencies in the old process. The training modules created with the pilot medical surgical unit were used by the multidisciplinary team to train all clinical unit staff house-wide on responsibilities in preparing a room for the housekeeper. Housekeeping was trained to clean additional unit equipment in the patient room that were identified throughout the team’s evaluation as having no owners for cleaning. By defining and training each service on roles and responsibilities and creating communication between housekeeping and the clinical unit staff, the Number of “cannot be cleaned” beds entered by housekeeping significantly dropped and all surfaces and equipment were accounted for with trained owners for cleaning.
Erica Rossi RN, BSN, CIC, Infection Preventionist, UC Irvine Health; Dianna Mann, Lean Six Sigma Analyst, UC Irvine Health; Brooke Baldwin-Rodriguez RN, MSN, Nurse Manager, UC Irvine Health; Henry Alvarez MHA, MBB, Master Black Belt, UC Irvine Health ISSUE: Environmental healthcare disinfection is critically important in reducing infections caused by transmission in the hospital setting. Lack of clear discharge room cleaning roles and responsibilities among clinical and housekeeping staff in our large academic hospital contributed to equipment and surfaces in patient rooms not consistently being cleaned. In addition, 10.1% of rooms ordered to be cleaned after a patient discharge were not prepared by the unit staff for the housekeeper to begin cleaning with items such unemptied bedpans, urinals, commodes, and medications still hanging on IV poles. The housekeeper provided no communication to the unit and entered these rooms into a “cannot be cleaned” state, dispatching the housekeeper to another room in a different location, delaying room turnover and wasting transit time e all having potential impacts on patient throughput. PROJECT: A multi-disciplinary team from Housekeeping, Nursing, Lean Six, Infection Prevention, Bed Management, and Patient Care Equipment Pool was established to evaluate and improve the discharge room cleaning process. Utilizing the Lean Six methodology, clinical unit and housekeeping staff were observed on one pilot medical surgical unit to create a current state discharge room cleaning process map. The process map helped visualize each service’s role in preparing and cleaning a discharge room, and helped the team identify failures preventing efficient and thorough room turnover. The team then defined the role and duties of the clinical staff for getting the room in a ready to clean state prior to ordering a room to be cleaned. In addition, a process and communication structure was created for housekeeping staff to follow if they arrived to a room that was not in a ready to clean state. The team created training modules and revised process maps. With the help of charge nurses over a 2 week period, all clinical unit staff on the pilot unit, and 176 housekeepers were
LESSON LEARNED: Large delays in turnover of patient rooms and inconsistent cleaning practices were occurring due to lack of
APIC 41st Annual Educational Conference & International Meeting j Anaheim, CA j June 7-9, 2014
S144
Poster Abstracts / American Journal of Infection Control 42 (2014) S29-S166
knowledge of cleaning roles and responsibilities, and lack of communication between the services. Creating a multi-disciplinary team to look at the discharge room cleaning process from start to finish, several opportunities were found that were inhibiting efficient and thorough room cleaning after a patient was discharged. This Project allowed collaboration among several disciplines to define roles and establish together an ideal and standard discharge room cleaning process. Collegiality among clinical staff and housekeeping has improved with knowledge and training of cleaning expectations.
Publication Number 9-317 The Control Plan for Total Joint Arthroplasty Surgical Site Infections: “Protect the Walkers” Angela D. Dickson BSN, RN, CIC, LSSBB, Infection Preventionist, PeaceHealth St John Medical Center ISSUE: Total Joint Arthroplasty (TJA) Surgical Site Infections (SSIs) carry a significant source of morbidity and mortality, are devastating to the patient and costly to treat. Preventing TJA SSIs is a national priority and strategic goal for our healthcare system. In 2011 our TJA SSIs were three times higher than the nation. Using Lean Six Sigma (LSS) methodology we reduced TJA SSI Standardized Infection Ratio (SIR) by 43%, yet it remained > 1.0. PROJECT: In late 2012 we entered the control phase of our LSS Project and developed a control plan to ensure sustainability of efforts. The control plan included next steps, innovative approaches, and risk reduction strategies that were centered on protecting the patient through the entire perioperative continuum of care The specific steps implemented in 2013 included real-time data reporting, having staff complete deep dives of each SSI, addition of betadine nasal ointment and chlorhexidine oral care to the preoperative chlorhexidine cloth bath done in preop, switched to
disposable microfiber cleaning cloths, and standardized postoperative wound care with advanced dressings. RESULTS: As of 10/31/13, our TJA SSI SIR was no longer statistically significantly higher than the nation at 0.443 (p-value 0.1721, confidence interval 0.054, 1.601). SSI counts dropped from 10 to 2, a 65% reduction, p-value 0.0381 (chart 1). Utilizing case cost of $50,000, an estimated $350,000 savings was calculated. None of the SSIs were knees. Deep dives of the two SSIs indicated that both were hips. One hip SSI was post fracture and prior to the standardized postoperative wound care with advanced dressings. The other hip SSI likely seeded from a urinary tract infection. LESSON LEARNED: We did not include acutely injured patients or the inpatient arena when implementing the betadine nasal ointment and chlorhexidine oral care in preop. It is important to consider and include acute patients and the inpatient arena when expanding specific next steps. Implementation science is an important strategy when considering gaps between theory and practice. Including staff in deep dives is important in improving electronic data capture and data integrity.
APIC 41st Annual Educational Conference & International Meeting j Anaheim, CA j June 7-9, 2014
local hospital IPs produce HAI data reports that demonstrated NHSN analysis capabilities. This led to discussion and assistance with strategies for prevention interventions and sustainability. A total of 71 "commitments to action" were made by participating hospitals. Post-visit follow-up and support by Liaison IPs continue. LESSON LEARNED: State public health assistance on the use of HAI data for targeting prevention helped educate and encourage IPs in their local efforts. Effective Publications to hospital committees, staff, and stakeholders to demonstrate prevention gaps depend on the validity and interpretation of data being presented. Even experienced IPs were not always aware of the potential to maximize use of their data as a tool for making the case for support of infection prevention resources.
Publication Number 9-316 A Lean Six Sigma Approach to Improving the Discharge Room Cleaning Process
S143
trained on new roles and responsibilities for discharge room cleaning. RESULTS: A standardized “ready to clean” process for discharge room cleaning was established, and defined roles and responsibilities were created to address gaps contributing to inefficiencies in the old process. The training modules created with the pilot medical surgical unit were used by the multidisciplinary team to train all clinical unit staff house-wide on responsibilities in preparing a room for the housekeeper. Housekeeping was trained to clean additional unit equipment in the patient room that were identified throughout the team’s evaluation as having no owners for cleaning. By defining and training each service on roles and responsibilities and creating communication between housekeeping and the clinical unit staff, the Number of “cannot be cleaned” beds entered by housekeeping significantly dropped and all surfaces and equipment were accounted for with trained owners for cleaning.
Erica Rossi RN, BSN, CIC, Infection Preventionist, UC Irvine Health; Dianna Mann, Lean Six Sigma Analyst, UC Irvine Health; Brooke Baldwin-Rodriguez RN, MSN, Nurse Manager, UC Irvine Health; Henry Alvarez MHA, MBB, Master Black Belt, UC Irvine Health ISSUE: Environmental healthcare disinfection is critically important in reducing infections caused by transmission in the hospital setting. Lack of clear discharge room cleaning roles and responsibilities among clinical and housekeeping staff in our large academic hospital contributed to equipment and surfaces in patient rooms not consistently being cleaned. In addition, 10.1% of rooms ordered to be cleaned after a patient discharge were not prepared by the unit staff for the housekeeper to begin cleaning with items such unemptied bedpans, urinals, commodes, and medications still hanging on IV poles. The housekeeper provided no communication to the unit and entered these rooms into a “cannot be cleaned” state, dispatching the housekeeper to another room in a different location, delaying room turnover and wasting transit time e all having potential impacts on patient throughput. PROJECT: A multi-disciplinary team from Housekeeping, Nursing, Lean Six, Infection Prevention, Bed Management, and Patient Care Equipment Pool was established to evaluate and improve the discharge room cleaning process. Utilizing the Lean Six methodology, clinical unit and housekeeping staff were observed on one pilot medical surgical unit to create a current state discharge room cleaning process map. The process map helped visualize each service’s role in preparing and cleaning a discharge room, and helped the team identify failures preventing efficient and thorough room turnover. The team then defined the role and duties of the clinical staff for getting the room in a ready to clean state prior to ordering a room to be cleaned. In addition, a process and communication structure was created for housekeeping staff to follow if they arrived to a room that was not in a ready to clean state. The team created training modules and revised process maps. With the help of charge nurses over a 2 week period, all clinical unit staff on the pilot unit, and 176 housekeepers were
LESSON LEARNED: Large delays in turnover of patient rooms and inconsistent cleaning practices were occurring due to lack of
APIC 41st Annual Educational Conference & International Meeting j Anaheim, CA j June 7-9, 2014
S144
Poster Abstracts / American Journal of Infection Control 42 (2014) S29-S166
knowledge of cleaning roles and responsibilities, and lack of communication between the services. Creating a multi-disciplinary team to look at the discharge room cleaning process from start to finish, several opportunities were found that were inhibiting efficient and thorough room cleaning after a patient was discharged. This Project allowed collaboration among several disciplines to define roles and establish together an ideal and standard discharge room cleaning process. Collegiality among clinical staff and housekeeping has improved with knowledge and training of cleaning expectations.
Publication Number 9-317 The Control Plan for Total Joint Arthroplasty Surgical Site Infections: “Protect the Walkers” Angela D. Dickson BSN, RN, CIC, LSSBB, Infection Preventionist, PeaceHealth St John Medical Center ISSUE: Total Joint Arthroplasty (TJA) Surgical Site Infections (SSIs) carry a significant source of morbidity and mortality, are devastating to the patient and costly to treat. Preventing TJA SSIs is a national priority and strategic goal for our healthcare system. In 2011 our TJA SSIs were three times higher than the nation. Using Lean Six Sigma (LSS) methodology we reduced TJA SSI Standardized Infection Ratio (SIR) by 43%, yet it remained > 1.0. PROJECT: In late 2012 we entered the control phase of our LSS Project and developed a control plan to ensure sustainability of efforts. The control plan included next steps, innovative approaches, and risk reduction strategies that were centered on protecting the patient through the entire perioperative continuum of care The specific steps implemented in 2013 included real-time data reporting, having staff complete deep dives of each SSI, addition of betadine nasal ointment and chlorhexidine oral care to the preoperative chlorhexidine cloth bath done in preop, switched to
disposable microfiber cleaning cloths, and standardized postoperative wound care with advanced dressings. RESULTS: As of 10/31/13, our TJA SSI SIR was no longer statistically significantly higher than the nation at 0.443 (p-value 0.1721, confidence interval 0.054, 1.601). SSI counts dropped from 10 to 2, a 65% reduction, p-value 0.0381 (chart 1). Utilizing case cost of $50,000, an estimated $350,000 savings was calculated. None of the SSIs were knees. Deep dives of the two SSIs indicated that both were hips. One hip SSI was post fracture and prior to the standardized postoperative wound care with advanced dressings. The other hip SSI likely seeded from a urinary tract infection. LESSON LEARNED: We did not include acutely injured patients or the inpatient arena when implementing the betadine nasal ointment and chlorhexidine oral care in preop. It is important to consider and include acute patients and the inpatient arena when expanding specific next steps. Implementation science is an important strategy when considering gaps between theory and practice. Including staff in deep dives is important in improving electronic data capture and data integrity.
APIC 41st Annual Educational Conference & International Meeting j Anaheim, CA j June 7-9, 2014