- Email: [email protected]
Effectiveness and costs of interventions in a c. difficile outbreak
114
Abstracts
A STRATEGY FOR THE SUCCESSFUL IMPLEMENTATION OF A WASTE MANAGEMENT PLAN. L. Cox,* SM (ASCP). CIC. L. Joyce. RN. BSN. N. Rae. MD, FACP. Shadyside Hospital, Pittsburgh, PA.
EFFECTIVENESS AND COSTS OF INTERVENTIONS IN A C. DIFFlC1L.E OUTBREAK. B. M&y,* RN, CIC, D. McCullough, RN, MSN, CIC, L. Lewis. RN, MSN. Seton Medical Center, Austin. TX.
Numerous problems can arise when a new program is first implemented “in the real world” of the hospital community. Our experience with institution of a comprehensive waste management program was no exception. Our written comprehensive waste management plan complies with the Medical Waste Tracking Act of 1988. We experienced difficulty with material selection and approprialion of adequate supplies and there were major pmblems with personnel compliance with appropriate handling and disposal guidelines, such t3.3: l Sharps in inappropriate containers l Metal and glass in inappropriate bags l Overfilled bags l Bags leaking blood and other fluids l Unused items inappropriately discarded
In 1990, a dramatic increase in nosocomiai C. difficik y&Uw~lteritis cases occurred in a 475&d community hospital fmm 2-S caseshnonch to 15-20 (1.6 per 1CXNdischarges m 6.2/1@Xl discharges). Community-acquired cases also rose pmIxmionatcIy from I-Z/month to s-10. Investigation of the cases revealed no con-elation bchvcen staff. pmcedule or antibiotic type. Most patients acquired C d@kcNe during or after antibiolics, on General Surgery and Oncology units. Cases have also occurred on post-pattum. post-day surgery and endoswpy, in Nursery/Neonatal and even employees. While most cases have responded to treatment and recovered, significant morbidity, monality and hospital expense has occurred. C. diffrcile has been the mam focus of the Infection Control Department, replacing most other surveillance and activities. Some effective interventions reported by teaching hospitals an: generally less available, affordable or acceptable in the community hospital; i.e., antibiotic controls, phage or serotyping to determine toxigenie strains for tracking, cohorxing patients, case control studies, patient de-colonization. or staff and physician culturing. To combat this problem, mulliple strategies have been apphed. This has included numerous inservices. posters. signs, newsletters. a handwashing study, special cleaning and training for housekeeping staff, Grand Rounds for physicians, C. difjkik information sbcets for chat& pocket cards for physicians. and a new isolation category (Enteric Precautions-CD) requiring mandatory gloving and other details. With no decrease in rates by November, we began closing units with frequent cases for total environmental cleaning ‘k.ith a buffered chlorine solution. This process involved many services. mectings and ovenime for many staff. Preliminary lrsults arc tematively promising: Unit 1 has had a reduction fmm 2-3 cases/month to I in 2 months. Next, a community prevalence study and ch!&xxidine handwashing arc planned. The total cost of such an outbreak can only be estimated and arc continuing; 1 patient’s non-reimbursed costs were $66,ooO. Intcrven. tions have cost over $15,000 to date. Although significant, no amount of money can compare to the true cost of patienr morbidity
To assure successbl implementation, we utilized a strategy consisting of these key elements: A) An interdiscipliiary “team” approach involving Risk Management, Safety, Engineming, Housekeeping, Medical Staff and Administration. B) Education via “Show and Tell.” Slides and photographs 01 improper waste disposal were utilizd by Risk Management at “Train the Trainer” programs. C) Compliance monitoring via “Trash Rounds” conducted by the Infection Control team on a routine basis. D) Problem solving and reevaluation. The educational programs graphically represented our cause and heightened employee awareness. Monitoring documented improved employee compliance. with the actual number of waste-related incidents decreasing fmm 24 incidents per 50,844 lbs. of solid waste to 2 incidents per 45,867 lbs. of solid waste in the first two months following plan implementation.
ENSURING APPROPRIATE GLUTBRALDEHYDE USE: COLLABORATION BY JNFBCllON CONTROL AND HAZARWUS MATERIALS PROGRAMS. P. Newsome,’ MSN. M. Thompson, BSN. Egleston Children’s Hospital at Emory University, Atlanta, GA. PUFp0.W. When gluteraldehyde is used by several different depamnents it may be difficult to ensure quality contml. Our Infection Control Program recognized the need to assess institution-wide use of gluteraldehyde. At the same time the Hazardous Materials Program was about to introduce safety guidelines for gluteraldehyde. An approach that yielded quality results was instituted in collaboration by both program dinxlax. Objecdves: I. Document departments using gluteraldehyde 2. Assess adequacy of use 3. Minimize potential chemical exposure 4. Correct misuse 5. Eliminate need for gluteraidehyde use when appropriate Method: A survey was sent to 18 departments assessing infection corm& and safety procedures for ghnerakkhyde. On-site visits were made to observe those areas reponing use. Findings: 8 departments used gluterrddehyde. 4 departments were not using the chemical acmrding to label directions. 7 deparhnents were not in compliance with safety guidelines as defined by NIOSH. 2 depanments were able to discontinue use. Departments using glutemldehyde incorrectly were instructed about following label directions and material safety data sheet information. In order to control future misuse, distribution restrictions were imposed to prevent other departments from obtaining this product without proper instruction. The end result of this collaborative approach achieved quality control in the conect use and awareness of safety precautions for gluteraldehyde in our institution.
MICROBIOLOGY, INFECI’ION CONTROL. IMMUNIZATIONS AND INFECTIOUS DISEASE EXPOSURE: EDUCATION AND PRACXICES IN U.S. NURSING SCHOOLS. A. Goetz.* RN, MNEd. CM. Yu, R.R. Muder. MD. VA Medical Center, Pittsburgh, PA. 765 (of 1164) U.S. Nursing Schools were surveyed to ascertain education requirements, immunization practices, and infectious diseases (ID) post-exposure follow-up. A microbiology course was tequired by 96.1%; 49% offered the course prior to clinical experience. ID/communicable disease nursing coumes were offered by 65%. while 31% integrated these topics into other courses. Clinical experience in the operating room was given by 16.396, with a mean of 13.3 hours of OR clinical time. Infection control concepts wem taup)lt by infection control practitioners in 28.8% and universal precautions were included in 98% of the curricula. Several schools did not assign pregnant students to care for patients with ID in&ding legionetla 1.7%. and AIDS, 1.4% 10.8% scho& required the hepatitis B vaccine and 2% tie yearly inlucnza vaccine. In contrast, 77% required tetanus and 67% mquircd diphtheria immunizations. 77% schools had student health service available, but onIy 18.7% utilizd it for post-exposure ID follow-up. 86% diploma schools had written policies for expr;ums to ID compared to 29% associate programs and 31% baccalaureate programs, p=O.wx)l. 95% diploma programs utilized appropriate agencies for post-exposure follow-up as compared to 65% of associate degree and 74% of baccalaureate degree programs. p=O.ooOl. The expertise of infection contml practitioners is underutilized by nursing schools. A microbiology course prior to clinical experjence should be encouraged. Immunization policies and ID post-exposure follow-up in nursing schools appear inadequate and should be reevaluated.
Abstracts
A STRATEGY FOR THE SUCCESSFUL IMPLEMENTATION OF A WASTE MANAGEMENT PLAN. L. Cox,* SM (ASCP). CIC. L. Joyce. RN. BSN. N. Rae. MD, FACP. Shadyside Hospital, Pittsburgh, PA.
EFFECTIVENESS AND COSTS OF INTERVENTIONS IN A C. DIFFlC1L.E OUTBREAK. B. M&y,* RN, CIC, D. McCullough, RN, MSN, CIC, L. Lewis. RN, MSN. Seton Medical Center, Austin. TX.
Numerous problems can arise when a new program is first implemented “in the real world” of the hospital community. Our experience with institution of a comprehensive waste management program was no exception. Our written comprehensive waste management plan complies with the Medical Waste Tracking Act of 1988. We experienced difficulty with material selection and approprialion of adequate supplies and there were major pmblems with personnel compliance with appropriate handling and disposal guidelines, such t3.3: l Sharps in inappropriate containers l Metal and glass in inappropriate bags l Overfilled bags l Bags leaking blood and other fluids l Unused items inappropriately discarded
In 1990, a dramatic increase in nosocomiai C. difficik y&Uw~lteritis cases occurred in a 475&d community hospital fmm 2-S caseshnonch to 15-20 (1.6 per 1CXNdischarges m 6.2/1@Xl discharges). Community-acquired cases also rose pmIxmionatcIy from I-Z/month to s-10. Investigation of the cases revealed no con-elation bchvcen staff. pmcedule or antibiotic type. Most patients acquired C d@kcNe during or after antibiolics, on General Surgery and Oncology units. Cases have also occurred on post-pattum. post-day surgery and endoswpy, in Nursery/Neonatal and even employees. While most cases have responded to treatment and recovered, significant morbidity, monality and hospital expense has occurred. C. diffrcile has been the mam focus of the Infection Control Department, replacing most other surveillance and activities. Some effective interventions reported by teaching hospitals an: generally less available, affordable or acceptable in the community hospital; i.e., antibiotic controls, phage or serotyping to determine toxigenie strains for tracking, cohorxing patients, case control studies, patient de-colonization. or staff and physician culturing. To combat this problem, mulliple strategies have been apphed. This has included numerous inservices. posters. signs, newsletters. a handwashing study, special cleaning and training for housekeeping staff, Grand Rounds for physicians, C. difjkik information sbcets for chat& pocket cards for physicians. and a new isolation category (Enteric Precautions-CD) requiring mandatory gloving and other details. With no decrease in rates by November, we began closing units with frequent cases for total environmental cleaning ‘k.ith a buffered chlorine solution. This process involved many services. mectings and ovenime for many staff. Preliminary lrsults arc tematively promising: Unit 1 has had a reduction fmm 2-3 cases/month to I in 2 months. Next, a community prevalence study and ch!&xxidine handwashing arc planned. The total cost of such an outbreak can only be estimated and arc continuing; 1 patient’s non-reimbursed costs were $66,ooO. Intcrven. tions have cost over $15,000 to date. Although significant, no amount of money can compare to the true cost of patienr morbidity
To assure successbl implementation, we utilized a strategy consisting of these key elements: A) An interdiscipliiary “team” approach involving Risk Management, Safety, Engineming, Housekeeping, Medical Staff and Administration. B) Education via “Show and Tell.” Slides and photographs 01 improper waste disposal were utilizd by Risk Management at “Train the Trainer” programs. C) Compliance monitoring via “Trash Rounds” conducted by the Infection Control team on a routine basis. D) Problem solving and reevaluation. The educational programs graphically represented our cause and heightened employee awareness. Monitoring documented improved employee compliance. with the actual number of waste-related incidents decreasing fmm 24 incidents per 50,844 lbs. of solid waste to 2 incidents per 45,867 lbs. of solid waste in the first two months following plan implementation.
ENSURING APPROPRIATE GLUTBRALDEHYDE USE: COLLABORATION BY JNFBCllON CONTROL AND HAZARWUS MATERIALS PROGRAMS. P. Newsome,’ MSN. M. Thompson, BSN. Egleston Children’s Hospital at Emory University, Atlanta, GA. PUFp0.W. When gluteraldehyde is used by several different depamnents it may be difficult to ensure quality contml. Our Infection Control Program recognized the need to assess institution-wide use of gluteraldehyde. At the same time the Hazardous Materials Program was about to introduce safety guidelines for gluteraldehyde. An approach that yielded quality results was instituted in collaboration by both program dinxlax. Objecdves: I. Document departments using gluteraldehyde 2. Assess adequacy of use 3. Minimize potential chemical exposure 4. Correct misuse 5. Eliminate need for gluteraidehyde use when appropriate Method: A survey was sent to 18 departments assessing infection corm& and safety procedures for ghnerakkhyde. On-site visits were made to observe those areas reponing use. Findings: 8 departments used gluterrddehyde. 4 departments were not using the chemical acmrding to label directions. 7 deparhnents were not in compliance with safety guidelines as defined by NIOSH. 2 depanments were able to discontinue use. Departments using glutemldehyde incorrectly were instructed about following label directions and material safety data sheet information. In order to control future misuse, distribution restrictions were imposed to prevent other departments from obtaining this product without proper instruction. The end result of this collaborative approach achieved quality control in the conect use and awareness of safety precautions for gluteraldehyde in our institution.
MICROBIOLOGY, INFECI’ION CONTROL. IMMUNIZATIONS AND INFECTIOUS DISEASE EXPOSURE: EDUCATION AND PRACXICES IN U.S. NURSING SCHOOLS. A. Goetz.* RN, MNEd. CM. Yu, R.R. Muder. MD. VA Medical Center, Pittsburgh, PA. 765 (of 1164) U.S. Nursing Schools were surveyed to ascertain education requirements, immunization practices, and infectious diseases (ID) post-exposure follow-up. A microbiology course was tequired by 96.1%; 49% offered the course prior to clinical experience. ID/communicable disease nursing coumes were offered by 65%. while 31% integrated these topics into other courses. Clinical experience in the operating room was given by 16.396, with a mean of 13.3 hours of OR clinical time. Infection control concepts wem taup)lt by infection control practitioners in 28.8% and universal precautions were included in 98% of the curricula. Several schools did not assign pregnant students to care for patients with ID in&ding legionetla 1.7%. and AIDS, 1.4% 10.8% scho& required the hepatitis B vaccine and 2% tie yearly inlucnza vaccine. In contrast, 77% required tetanus and 67% mquircd diphtheria immunizations. 77% schools had student health service available, but onIy 18.7% utilizd it for post-exposure ID follow-up. 86% diploma schools had written policies for expr;ums to ID compared to 29% associate programs and 31% baccalaureate programs, p=O.wx)l. 95% diploma programs utilized appropriate agencies for post-exposure follow-up as compared to 65% of associate degree and 74% of baccalaureate degree programs. p=O.ooOl. The expertise of infection contml practitioners is underutilized by nursing schools. A microbiology course prior to clinical experjence should be encouraged. Immunization policies and ID post-exposure follow-up in nursing schools appear inadequate and should be reevaluated.