- Email: [email protected]
Bundling Up Against Clostridium Difficile in Surgical Oncology
Poster Abstracts / American Journal of Infection Control 44 (2016) S28-S82
9-184 Assessing the Patient Perception about Hand Hygiene: A Step Toward Patient Safety and Empowerment Bianca Grassi de Miranda, MD, Infection Control Physician, Hospital Samaritano de São Paulo; Daiane Cais, MSN, Infection Control Team Leader, Hospital Samaritano; Juliana Nunes, RN, Infection Control Team, Hospital Samaritano; Lanuza Duarte, RN, Infection Control Team, Hospital Samaritano; Maria Luisa Moura, MD, Infection Control Team, Hospital Samaritano; Juliana Pinto, Nurse in Training, Hospital Samaritano; Analu Costa, RN, Infection Control Team, Hospital Samaritano BACKGROUND: Despite continued efforts on staff education and availability of alcoholic preparations, hand hygiene (HH) adhesion rates remain poor. One of the new strategies suggested for successful promotion of HH is ensure patient empowerment (PE), defined as “the process that allows the patients to gain the knowledge, skills, and attitude needed to make choices about their care”. The aim of this study was to evaluate the feasibility of this strategy as part of multimodal program to improve HH. METHODS: We performed an interviewer-administered survey to assess HH knowledge and intentions regarding PE among hospitalized patients in a 300-bed private hospital in Brazil. Infection Control Nurses evaluated orientation received by patients about HH at hospital admission; if they recognize the importance of HH for their recovery; if they were aware if healthcare worker (HCW) had performed HH and if they would feel comfortable to ask HCW to perform HH. RESULTS: Six hundred and sixteen patients were interviewed from February to November/2015, 43% from surgical and 57% from clinical wards. Almost all patients (99.9%) recognized HH importance for their recovery, although only 41% reported to have received orientation about it. Most of patients (89%) reported to be aware if HH was performed, but only 60% said they would feel comfortable to ask HCW to perform it. Patients from onco-hematology wards received more information about HH (P < .00001) and would feel more comfortable to request the HCW to perform it (P = .03) compared to patients for other clinical and surgical wards. CONCLUSIONS: Patients understand the importance of HH and demonstrate willingness to be empowered, but do not feel comfortable to ask HCW about HH compliance. Next steps should be identify if patients notice behavioral differences between HCW categories and examine the perception of HCW regarding to PE strategy.
9-185 Bundling Up Against Clostridium Difficile in Surgical Oncology Sherry S. Cantu, MT (ASCP), MPH, CIC, Infection Preventionist, M.D. Anderson Cancer Center; Robbie Thompson, MSN, RN, Clinical Nurse Leader, M.D. Anderson Cancer Center; Tessy Siby, MSN, RN, Clinical Nurse Leader, M.D. Anderson Cancer Center; Shashank S. Ghantoji, MD, MPH, Research Scientist, M.D. Anderson Cancer Center; Linda Graviss, MT (ASCP), CIC, Manager, Infection Control, M.D. Anderson Cancer Center; Roy F. Chemaly, MD, MPH, FIDSA, FACP, Professor, M.D. Anderson Cancer Center BACKGROUND: C.difficile Infection (CDI) is one of the most common causes of Hospital Acquired Infections (HAI) in U.S. Hospitals. Cancer
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patients can be particularly susceptible to CDI due to prolonged and/ or frequent hospitalization, exposure to multiple antibiotics and chemotherapy regimens, and surgical procedures. In 2014, a steadily increasing burden of CDI among patients with gastrointestinal (GI) cancers was observed in our hospital. We implemented a collaborative “bundled” approach to reduce the incidence and spread of CDI among these susceptible patients. METHODS: In collaboration with nursing, a bundled approach was implemented in the GI surgical oncology inpatient unit. This bundle included education of staff, patients, and family/caregivers. In addition, we developed checklists to aid with consistency and accountability of staff. Focus of education was on proper isolation, personal protective equipment (PPE), hand washing, environmental cleaning of noncritical patient care items (i.e. glucometers), as well as the patient room environment. In addition, each room was treated with UV-C disinfection after terminal cleaning, as bleach is not routinely used by environmental services staff (EVS) in our hospital. Patients are immediately placed on contact precautions upon development of signs and symptoms of CDI, and testing is promptly initiated. RESULTS: Between September 2014 through March 2015, there were a total of 13 nosocomial CDI (NHSN definition) on the GI surgical unit at a rate of 22.3 infections per 10,000 patient-days. Education and interventions were completely implemented by March 2015 and the number of nosocomial CDI decreased to 5, at a rate of 8.38 infections per 10,000 patient- days (P-value = .057; 95% CI, 0.9486-7.463). CONCLUSIONS: Implementation of checklists, increased education, multidisciplinary team collaboration, along with the use of UV-C light technology, had a significant impact on the incidence of nosocomial CDI in the GI surgical oncology unit.
9-186 Catheter-Associated Urinary Tract Infection Reduction in the Emergency Department as a Result of Dual Personnel Urinary Catheter Insertion Yonatan Breiter, MSN, RN, CNL, ER Clinical Nurse Specialist, Tampa General Hospital; Linda Benson, DNP ACNP-BC CCRN CPHQ, Nursing Clinical Quality Specialist, Tampa General Hospital; Chaz Rhone, MPH, CIC, Infection Preventist, Tampa General Hospital; Mary Kutash, PhD ARNP, Nursing Research Specialist, Tampa General Hospital; Heather Petri, Sr Quality Data Analyst, Tampa General Hospital; Reyah Pineda-Ocasion, RN BSN CEN, Clinical Unit-Based Educator-ER, Tampa General Hospital; Colton Miller, RN BSN, Nurse Manager ER, Tampa General Hospital; Melissa Cole, MSN, ARNP, ANP-BC, Director of Emergency and Trauma Services, Tampa General Hospital; Peggy Thompson, RN BSN CIC, Director of Infection Prevention, Tampa General Hospital; Carmen Murphy, RN BSN CIC, Infection Preventist, Tampa General Hospital BACKGROUND: The Healthcare Infection Control Practices Advisory Committee (HICPAC) Guideline for Prevention of CatheterAssociated Urinary Tract Infections (CAUTI) focuses on the following prevention strategies: appropriate indication for insertion and timely removal, proper insertion, and proper maintenance. A review of the facility CAUTI data demonstrated that an opportunity to reduce insertion-related CAUTIs existed and the majority of urinary catheters were inserted in the Emergency Department (ED). Therefore, a multidisciplinary team that included representatives from the ED, Infection Prevention Department, and the Nursing Clinical Quality and Research Specialists collaborated on strategies to reduce insertion-related CAUTIs.
APIC 43rd Annual Educational Conference & International Meeting | Charlotte, NC | June 11-13, 2016
9-184 Assessing the Patient Perception about Hand Hygiene: A Step Toward Patient Safety and Empowerment Bianca Grassi de Miranda, MD, Infection Control Physician, Hospital Samaritano de São Paulo; Daiane Cais, MSN, Infection Control Team Leader, Hospital Samaritano; Juliana Nunes, RN, Infection Control Team, Hospital Samaritano; Lanuza Duarte, RN, Infection Control Team, Hospital Samaritano; Maria Luisa Moura, MD, Infection Control Team, Hospital Samaritano; Juliana Pinto, Nurse in Training, Hospital Samaritano; Analu Costa, RN, Infection Control Team, Hospital Samaritano BACKGROUND: Despite continued efforts on staff education and availability of alcoholic preparations, hand hygiene (HH) adhesion rates remain poor. One of the new strategies suggested for successful promotion of HH is ensure patient empowerment (PE), defined as “the process that allows the patients to gain the knowledge, skills, and attitude needed to make choices about their care”. The aim of this study was to evaluate the feasibility of this strategy as part of multimodal program to improve HH. METHODS: We performed an interviewer-administered survey to assess HH knowledge and intentions regarding PE among hospitalized patients in a 300-bed private hospital in Brazil. Infection Control Nurses evaluated orientation received by patients about HH at hospital admission; if they recognize the importance of HH for their recovery; if they were aware if healthcare worker (HCW) had performed HH and if they would feel comfortable to ask HCW to perform HH. RESULTS: Six hundred and sixteen patients were interviewed from February to November/2015, 43% from surgical and 57% from clinical wards. Almost all patients (99.9%) recognized HH importance for their recovery, although only 41% reported to have received orientation about it. Most of patients (89%) reported to be aware if HH was performed, but only 60% said they would feel comfortable to ask HCW to perform it. Patients from onco-hematology wards received more information about HH (P < .00001) and would feel more comfortable to request the HCW to perform it (P = .03) compared to patients for other clinical and surgical wards. CONCLUSIONS: Patients understand the importance of HH and demonstrate willingness to be empowered, but do not feel comfortable to ask HCW about HH compliance. Next steps should be identify if patients notice behavioral differences between HCW categories and examine the perception of HCW regarding to PE strategy.
9-185 Bundling Up Against Clostridium Difficile in Surgical Oncology Sherry S. Cantu, MT (ASCP), MPH, CIC, Infection Preventionist, M.D. Anderson Cancer Center; Robbie Thompson, MSN, RN, Clinical Nurse Leader, M.D. Anderson Cancer Center; Tessy Siby, MSN, RN, Clinical Nurse Leader, M.D. Anderson Cancer Center; Shashank S. Ghantoji, MD, MPH, Research Scientist, M.D. Anderson Cancer Center; Linda Graviss, MT (ASCP), CIC, Manager, Infection Control, M.D. Anderson Cancer Center; Roy F. Chemaly, MD, MPH, FIDSA, FACP, Professor, M.D. Anderson Cancer Center BACKGROUND: C.difficile Infection (CDI) is one of the most common causes of Hospital Acquired Infections (HAI) in U.S. Hospitals. Cancer
S59
patients can be particularly susceptible to CDI due to prolonged and/ or frequent hospitalization, exposure to multiple antibiotics and chemotherapy regimens, and surgical procedures. In 2014, a steadily increasing burden of CDI among patients with gastrointestinal (GI) cancers was observed in our hospital. We implemented a collaborative “bundled” approach to reduce the incidence and spread of CDI among these susceptible patients. METHODS: In collaboration with nursing, a bundled approach was implemented in the GI surgical oncology inpatient unit. This bundle included education of staff, patients, and family/caregivers. In addition, we developed checklists to aid with consistency and accountability of staff. Focus of education was on proper isolation, personal protective equipment (PPE), hand washing, environmental cleaning of noncritical patient care items (i.e. glucometers), as well as the patient room environment. In addition, each room was treated with UV-C disinfection after terminal cleaning, as bleach is not routinely used by environmental services staff (EVS) in our hospital. Patients are immediately placed on contact precautions upon development of signs and symptoms of CDI, and testing is promptly initiated. RESULTS: Between September 2014 through March 2015, there were a total of 13 nosocomial CDI (NHSN definition) on the GI surgical unit at a rate of 22.3 infections per 10,000 patient-days. Education and interventions were completely implemented by March 2015 and the number of nosocomial CDI decreased to 5, at a rate of 8.38 infections per 10,000 patient- days (P-value = .057; 95% CI, 0.9486-7.463). CONCLUSIONS: Implementation of checklists, increased education, multidisciplinary team collaboration, along with the use of UV-C light technology, had a significant impact on the incidence of nosocomial CDI in the GI surgical oncology unit.
9-186 Catheter-Associated Urinary Tract Infection Reduction in the Emergency Department as a Result of Dual Personnel Urinary Catheter Insertion Yonatan Breiter, MSN, RN, CNL, ER Clinical Nurse Specialist, Tampa General Hospital; Linda Benson, DNP ACNP-BC CCRN CPHQ, Nursing Clinical Quality Specialist, Tampa General Hospital; Chaz Rhone, MPH, CIC, Infection Preventist, Tampa General Hospital; Mary Kutash, PhD ARNP, Nursing Research Specialist, Tampa General Hospital; Heather Petri, Sr Quality Data Analyst, Tampa General Hospital; Reyah Pineda-Ocasion, RN BSN CEN, Clinical Unit-Based Educator-ER, Tampa General Hospital; Colton Miller, RN BSN, Nurse Manager ER, Tampa General Hospital; Melissa Cole, MSN, ARNP, ANP-BC, Director of Emergency and Trauma Services, Tampa General Hospital; Peggy Thompson, RN BSN CIC, Director of Infection Prevention, Tampa General Hospital; Carmen Murphy, RN BSN CIC, Infection Preventist, Tampa General Hospital BACKGROUND: The Healthcare Infection Control Practices Advisory Committee (HICPAC) Guideline for Prevention of CatheterAssociated Urinary Tract Infections (CAUTI) focuses on the following prevention strategies: appropriate indication for insertion and timely removal, proper insertion, and proper maintenance. A review of the facility CAUTI data demonstrated that an opportunity to reduce insertion-related CAUTIs existed and the majority of urinary catheters were inserted in the Emergency Department (ED). Therefore, a multidisciplinary team that included representatives from the ED, Infection Prevention Department, and the Nursing Clinical Quality and Research Specialists collaborated on strategies to reduce insertion-related CAUTIs.
APIC 43rd Annual Educational Conference & International Meeting | Charlotte, NC | June 11-13, 2016