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Impact of Automated Hand-hygiene Monitoring in a Solid Organ Transplant Unit: Improving Hand-hygiene Compliance and Infection Rates
Poster Abstracts / American Journal of Infection Control 42 (2014) S29-S166
S125
Leadership support is essential in implementing a plan Staff education must be a top priority Staff competency must be assessed initially and annually High turn-over of staff is a challenge to the sustainment of standardized practices
Publication Number 9-281 Impact of Automated Hand-hygiene Monitoring in a Solid Organ Transplant Unit: Improving Hand-hygiene Compliance and Infection Rates Lisa H. Moore RN, BSN, CPHRM, Director, Risk Management, Infection Prevention, Patient Relations, Baptist Memorial Hospital Memphis BACKGROUND/OBJECTIVES: Leaders of a 723- bed hospital leveraged technology to improve patient care by implementing an automated hand-hygiene (HH) monitoring system in a solid organ transplant unit. Significant improvements resulted from a combination of technology, a clear executive mandate, active unit leadership, goal-setting and a caregiver awareness/engagement campaign. Individual accountability and transparency increased HH compliance and reduced healthcare associated infection (HAI) rates in this high risk patient population. METHODS: The team installed wireless HH monitoring in the 12bed CPTU to monitor 26 soap and 22 sanitizer dispensers and 49 employees including nurses, patient care assistants, and unit clerks. The 20 month analysis included over 81,313 hours of care delivery, 199,054 caregiver-patient interactions and 523,442 hand cleansings. Success was measured using HH solution dispensing, HH compliance and HAI rates. By applying the technology alone, soap and sanitizer use increased 36% and 61.5% respectively. In July 2012, leadership became actively involved by setting unit-level goals, initiating targeted employee education, and implementing a feedback and accountability campaign.
RESULTS: Following leadership engagement, HH solution dispensing increased an additional 42.9% and HH compliance improved another 65.9%. Individual HH compliance rate increases were statistically significant (Student’s t-test, paired t ¼ 5.77416 (33), p ¼ 1.8764E-06, SAS). Over the full 20 month study HH solution dispenses per patient day increased 104.3% and HH compliance rates increased 178.1% (p < .0001). Ventilator-associated pneumonia, central line-associated bloodstream infection, catheter-associated urinary tract infection and C.difficile rates declined 73.9%, 69.5%, 66.3% and 81.1% (p ¼ .016) respectively. These reductions saved more than $463,000 in direct cost and 236 days length of stay.
CONCLUSIONS: Emerging technologies offer promising tools to improve patient safety and address historic healthcare challenges. However the full potential of the technology can only be achieved through the thoughtful and dedicated application of leadership, goal-setting, education, and engaged caregivers. A combination of these elements resulted in the successful deployment of an automated hand hygiene system as evidenced by improved employee adherence to hand hygiene protocol, significant HAI reductions and cost savings.
Publication Number 9-282 Investigation and Management of a Mycobacterium Fortuitum Pacemaker Surgical Site Infection Outbreak in the Electrophysiology Lab Donna Lee BSN, RN, Infection Preventionist, NCH Healthcare System; Georgine Kruedelbach MSN, RN, CIC, Director Infection Prevention, NCH Healthcare System; Stephen Cooke BS, RN, RCIS, Director, Cardiac Cath Lab, NCH Healthcare System ISSUE: Our hospital identified three M. Fortuitum Pacemaker Implant Surgical Site Infections (SSI) between July and October of 2013, per CDC NHSN surveillance criteria. The hospital implants approximately 1660 pacemakers annually. This cluster of M. Fortuitum infected implants was placed between April and July 2013. To address this outbreak, an interdisciplinary team was organized to investigate circumstances that could have led to this occurrence and applied interdisciplinary behavioral and environmental interventions to mitigate further infections. PROJECT: An assessment of the conditions in the Electrophysiology Lab took place by Infection Prevention, the Director, and Manager of the Electrophysiology Lab. Environmental findings included extraneous equipment with potential to harbor bacteria, HVAC service due, scrub sink with potential for bacterial contamination, no opened or outdated fluids or injection vials, and the suite being in need of a deep clean. Behavioral findings included staff mid procedure suite entry through a side door entrance and improper use of PPE. RESULTS: The Electrophysiology Lab staff performed a de-clutter, removing unnecessary equipment and supplies. Facilities Management performed minor cabinet repairs and serviced the HVAC system. An initial deep clean by Environmental Services (EVS) took place, including the sink outside of the suite. Subsequent deep cleaning now occurs weekly with Electrophysiology Lab staff supplementing EVS workers. All staff were instructed in proper traffic flow and PPE use in the suite, and is monitored by the Manager. The
APIC 41st Annual Educational Conference & International Meeting j Anaheim, CA j June 7-9, 2014
S125
Leadership support is essential in implementing a plan Staff education must be a top priority Staff competency must be assessed initially and annually High turn-over of staff is a challenge to the sustainment of standardized practices
Publication Number 9-281 Impact of Automated Hand-hygiene Monitoring in a Solid Organ Transplant Unit: Improving Hand-hygiene Compliance and Infection Rates Lisa H. Moore RN, BSN, CPHRM, Director, Risk Management, Infection Prevention, Patient Relations, Baptist Memorial Hospital Memphis BACKGROUND/OBJECTIVES: Leaders of a 723- bed hospital leveraged technology to improve patient care by implementing an automated hand-hygiene (HH) monitoring system in a solid organ transplant unit. Significant improvements resulted from a combination of technology, a clear executive mandate, active unit leadership, goal-setting and a caregiver awareness/engagement campaign. Individual accountability and transparency increased HH compliance and reduced healthcare associated infection (HAI) rates in this high risk patient population. METHODS: The team installed wireless HH monitoring in the 12bed CPTU to monitor 26 soap and 22 sanitizer dispensers and 49 employees including nurses, patient care assistants, and unit clerks. The 20 month analysis included over 81,313 hours of care delivery, 199,054 caregiver-patient interactions and 523,442 hand cleansings. Success was measured using HH solution dispensing, HH compliance and HAI rates. By applying the technology alone, soap and sanitizer use increased 36% and 61.5% respectively. In July 2012, leadership became actively involved by setting unit-level goals, initiating targeted employee education, and implementing a feedback and accountability campaign.
RESULTS: Following leadership engagement, HH solution dispensing increased an additional 42.9% and HH compliance improved another 65.9%. Individual HH compliance rate increases were statistically significant (Student’s t-test, paired t ¼ 5.77416 (33), p ¼ 1.8764E-06, SAS). Over the full 20 month study HH solution dispenses per patient day increased 104.3% and HH compliance rates increased 178.1% (p < .0001). Ventilator-associated pneumonia, central line-associated bloodstream infection, catheter-associated urinary tract infection and C.difficile rates declined 73.9%, 69.5%, 66.3% and 81.1% (p ¼ .016) respectively. These reductions saved more than $463,000 in direct cost and 236 days length of stay.
CONCLUSIONS: Emerging technologies offer promising tools to improve patient safety and address historic healthcare challenges. However the full potential of the technology can only be achieved through the thoughtful and dedicated application of leadership, goal-setting, education, and engaged caregivers. A combination of these elements resulted in the successful deployment of an automated hand hygiene system as evidenced by improved employee adherence to hand hygiene protocol, significant HAI reductions and cost savings.
Publication Number 9-282 Investigation and Management of a Mycobacterium Fortuitum Pacemaker Surgical Site Infection Outbreak in the Electrophysiology Lab Donna Lee BSN, RN, Infection Preventionist, NCH Healthcare System; Georgine Kruedelbach MSN, RN, CIC, Director Infection Prevention, NCH Healthcare System; Stephen Cooke BS, RN, RCIS, Director, Cardiac Cath Lab, NCH Healthcare System ISSUE: Our hospital identified three M. Fortuitum Pacemaker Implant Surgical Site Infections (SSI) between July and October of 2013, per CDC NHSN surveillance criteria. The hospital implants approximately 1660 pacemakers annually. This cluster of M. Fortuitum infected implants was placed between April and July 2013. To address this outbreak, an interdisciplinary team was organized to investigate circumstances that could have led to this occurrence and applied interdisciplinary behavioral and environmental interventions to mitigate further infections. PROJECT: An assessment of the conditions in the Electrophysiology Lab took place by Infection Prevention, the Director, and Manager of the Electrophysiology Lab. Environmental findings included extraneous equipment with potential to harbor bacteria, HVAC service due, scrub sink with potential for bacterial contamination, no opened or outdated fluids or injection vials, and the suite being in need of a deep clean. Behavioral findings included staff mid procedure suite entry through a side door entrance and improper use of PPE. RESULTS: The Electrophysiology Lab staff performed a de-clutter, removing unnecessary equipment and supplies. Facilities Management performed minor cabinet repairs and serviced the HVAC system. An initial deep clean by Environmental Services (EVS) took place, including the sink outside of the suite. Subsequent deep cleaning now occurs weekly with Electrophysiology Lab staff supplementing EVS workers. All staff were instructed in proper traffic flow and PPE use in the suite, and is monitored by the Manager. The
APIC 41st Annual Educational Conference & International Meeting j Anaheim, CA j June 7-9, 2014