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Infection Prevention—The Best of Intentions
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Abstracts / Biol Blood Marrow Transplant 23 (2017) S18–S391
Figure 1. Improve project executive summary.
V—Validate the improvements E—Evaluate over time Using multi-disciplinary teams to ensure buy-in and commitment to the change initiative, the BMT program reviewed patient care related issues weekly and prioritized the issues as projects. Almost all projects originated from PSI reports filed by staff members. Results: The MUSC BMT team resolves, on an average, two IMPROVEs per month. Several IMPROVE projects have led to significant change and some have received national recognition. Examples of the projects with positive change include the following:
• • • • • • •
Increasing Hand Hygiene Compliance from 82% to 100% Decrease in CLABSI Rate to Below Average Preventing Spread of Infectious Disease through Family/ Visitor/Caregiver Screening Creation of an Annual BMT Multi-Disciplinary Educational Conference Improving Communication between the ICU and BMT Teams Correct Use of Secondary Tubing (see Figure 1) Reduction in the Number of Patients Coming to Clinic Without an Appointment
Figure 2. PSI events for BMT locations.
Conclusion: IMPROVE methodology combined with the UHC PSI reporting process created a culture of change that motivated staff to look for areas of potential change. Prior to the IMPROVE process, the staff hesitated to submit PSI reports due to fear of reprisal as well as cynicism that the reports were being reviewed or making an impact. In the years following implementation of the IMPROVE methodology, PSI reporting increased by 310% (see Figure 2). Additionally it has proven useful in trend analysis, audit reporting, has improved patient satisfaction, and validated both clinical and non-clinical staff through careful analysis of reported events and concerns.
503 Infection Prevention—The Best of Intentions Elizabeth J. Williams 1, Michelle Hudspeth 2, Cindy Kramer 1. 1 Blood and Marrow Transplant Program, Medical University of South Carolina, Charleston, SC; 2 Pediatric Hematology/ Oncology, Medical University of South Carolina, Charleston, SC Introduction: Preventing the spread of infectious diseases in a Blood and Marrow Transplant (BMT) inpatient unit is challenging but has been shown to save lives. Inpatient units are under constant threat from outside contagions in the form of visitors and caregivers. Screening each visitor to determine their degree of appropriateness for visiting from an infectious diseases standpoint requires a staffing model that is hard to implement. The challenge is how to identify and reduce infectious risks to our immunocompromised and/or immunosuppressed BMT patient population. Problem Analysis: The inpatient unit does not have dedicated intake staff and front desk staff are not able to provide screening services. Visitors and caregivers do not want to delay their visits despite their potential contagion, often without realizing the threat their sickness may pose to their loved ones as well as to other patients on the unit. Visitors, caregivers, as well as the patients themselves, are often reluctant to wear a mask (Figures 1 and 2). Remedy: A multi-disciplinary round table discussion was held with the registration staff, clinical staff, Infection Control, Risk Management, and Quality Control. An educational rollout was implemented for staff to emphasize use of masks, hand hygiene and isolation, adherence to universal precautions, droplet precautions and precautions during aerosol-generating procedures, and environmental cleaning and disinfection per
Abstracts / Biol Blood Marrow Transplant 23 (2017) S18–S391
S361
Figure 3. Sign details.
Figure 1. Outpatient sign.
Conclusion: The stickers were found to be an effective tool for self-screening. The staff was not additionally burdened and found it easy to identify those who might be an infectious risk to the unit. The process was extended to the outpatient units with signs placed at the entrance to each space. The process proved an effective tool for screening and reinforced the education given to guests, families, caregivers, and patients about the importance of prevention of infections.
504 Program Process Improvement: Identification of Apheresis Staff Hire and Training Needs to Maintain BMT Quality Metrics, Patient Safety and Product Quality Michelle P. Zeller 1, Kirsten D. Lind 2, Xiujin Xia 1, Yordanka N. Koleva 1, Hana Safah 3. 1 Blood & Marrow Transplant, Tulane Medical Center, New Orleans, LA; 2 Apheresis, TUHC, New Orleans, LA; 3 Hematology and Medical Oncology, Tulane Medical Center, New Orleans, LA
Figure 2. Inpatient sign with stickers.
established protocols. Large, free standing signs were placed at the entrance to the units asking guests to read through the list of symptoms and potential threats (per FACT standard B2.2—See Figure 3). If free from any of the symptoms or threats listed, guests were asked to take one of the stickers provided that announce “I am safe to visit”. The color of the sticker changed each day of the week ensuring visitors (including caregivers who may spend the night on the unit) were re-screened daily. Employees had access to stickers and were instructed to stop anyone on the floor without a visible sticker on their person.
Background/Objective: Since 2013, the Collection, Apheresis service provider at Tulane University Hospital & Clinic (TUHC) was a contracted vendor, functioning in conjunction with TUHC Standard Operating Procedures (SOPs). This competent staff had a collection failure rate near zero. On two occasions, they improved the pre-collection peripheral blood/ post-collection product Absolute CD34+ correlation from 68% to 80% and 78% to 86%. This met and exceeded our 80% Expected Performance Level (EPL). This competence continued for 3 quarters, at which time 50% of this high functioning staff resigned. The contracted vendor transferred six staff into Apheresis for HCT training and short-term contracted two experienced staff. One-third of the newly trained staff decided to continue with HCT collecting, providing quality data reports to the BMT Quality team. When next quarter data was presented, the CD34+ collection correlation had gone from 87% to 78%. The BMT Quality Coordinator monitored 100% of Apheresis HCT collection data for trending of the CD34+ collection correlation and analyzed for process improvements. Data was reported at BMT Quality Management Committee meetings at least quarterly. The Program needed the contracted vendor to provide well-trained staff, competent & proficient in HCT collections to ensure patient safety, provide accurate collections for successful validation of newly acquired machines and high quality product for transplants. Patients and Methods: Retrospective/concurrent data were collected over 18 months from successful HCT patient (n = 58,
Abstracts / Biol Blood Marrow Transplant 23 (2017) S18–S391
Figure 1. Improve project executive summary.
V—Validate the improvements E—Evaluate over time Using multi-disciplinary teams to ensure buy-in and commitment to the change initiative, the BMT program reviewed patient care related issues weekly and prioritized the issues as projects. Almost all projects originated from PSI reports filed by staff members. Results: The MUSC BMT team resolves, on an average, two IMPROVEs per month. Several IMPROVE projects have led to significant change and some have received national recognition. Examples of the projects with positive change include the following:
• • • • • • •
Increasing Hand Hygiene Compliance from 82% to 100% Decrease in CLABSI Rate to Below Average Preventing Spread of Infectious Disease through Family/ Visitor/Caregiver Screening Creation of an Annual BMT Multi-Disciplinary Educational Conference Improving Communication between the ICU and BMT Teams Correct Use of Secondary Tubing (see Figure 1) Reduction in the Number of Patients Coming to Clinic Without an Appointment
Figure 2. PSI events for BMT locations.
Conclusion: IMPROVE methodology combined with the UHC PSI reporting process created a culture of change that motivated staff to look for areas of potential change. Prior to the IMPROVE process, the staff hesitated to submit PSI reports due to fear of reprisal as well as cynicism that the reports were being reviewed or making an impact. In the years following implementation of the IMPROVE methodology, PSI reporting increased by 310% (see Figure 2). Additionally it has proven useful in trend analysis, audit reporting, has improved patient satisfaction, and validated both clinical and non-clinical staff through careful analysis of reported events and concerns.
503 Infection Prevention—The Best of Intentions Elizabeth J. Williams 1, Michelle Hudspeth 2, Cindy Kramer 1. 1 Blood and Marrow Transplant Program, Medical University of South Carolina, Charleston, SC; 2 Pediatric Hematology/ Oncology, Medical University of South Carolina, Charleston, SC Introduction: Preventing the spread of infectious diseases in a Blood and Marrow Transplant (BMT) inpatient unit is challenging but has been shown to save lives. Inpatient units are under constant threat from outside contagions in the form of visitors and caregivers. Screening each visitor to determine their degree of appropriateness for visiting from an infectious diseases standpoint requires a staffing model that is hard to implement. The challenge is how to identify and reduce infectious risks to our immunocompromised and/or immunosuppressed BMT patient population. Problem Analysis: The inpatient unit does not have dedicated intake staff and front desk staff are not able to provide screening services. Visitors and caregivers do not want to delay their visits despite their potential contagion, often without realizing the threat their sickness may pose to their loved ones as well as to other patients on the unit. Visitors, caregivers, as well as the patients themselves, are often reluctant to wear a mask (Figures 1 and 2). Remedy: A multi-disciplinary round table discussion was held with the registration staff, clinical staff, Infection Control, Risk Management, and Quality Control. An educational rollout was implemented for staff to emphasize use of masks, hand hygiene and isolation, adherence to universal precautions, droplet precautions and precautions during aerosol-generating procedures, and environmental cleaning and disinfection per
Abstracts / Biol Blood Marrow Transplant 23 (2017) S18–S391
S361
Figure 3. Sign details.
Figure 1. Outpatient sign.
Conclusion: The stickers were found to be an effective tool for self-screening. The staff was not additionally burdened and found it easy to identify those who might be an infectious risk to the unit. The process was extended to the outpatient units with signs placed at the entrance to each space. The process proved an effective tool for screening and reinforced the education given to guests, families, caregivers, and patients about the importance of prevention of infections.
504 Program Process Improvement: Identification of Apheresis Staff Hire and Training Needs to Maintain BMT Quality Metrics, Patient Safety and Product Quality Michelle P. Zeller 1, Kirsten D. Lind 2, Xiujin Xia 1, Yordanka N. Koleva 1, Hana Safah 3. 1 Blood & Marrow Transplant, Tulane Medical Center, New Orleans, LA; 2 Apheresis, TUHC, New Orleans, LA; 3 Hematology and Medical Oncology, Tulane Medical Center, New Orleans, LA
Figure 2. Inpatient sign with stickers.
established protocols. Large, free standing signs were placed at the entrance to the units asking guests to read through the list of symptoms and potential threats (per FACT standard B2.2—See Figure 3). If free from any of the symptoms or threats listed, guests were asked to take one of the stickers provided that announce “I am safe to visit”. The color of the sticker changed each day of the week ensuring visitors (including caregivers who may spend the night on the unit) were re-screened daily. Employees had access to stickers and were instructed to stop anyone on the floor without a visible sticker on their person.
Background/Objective: Since 2013, the Collection, Apheresis service provider at Tulane University Hospital & Clinic (TUHC) was a contracted vendor, functioning in conjunction with TUHC Standard Operating Procedures (SOPs). This competent staff had a collection failure rate near zero. On two occasions, they improved the pre-collection peripheral blood/ post-collection product Absolute CD34+ correlation from 68% to 80% and 78% to 86%. This met and exceeded our 80% Expected Performance Level (EPL). This competence continued for 3 quarters, at which time 50% of this high functioning staff resigned. The contracted vendor transferred six staff into Apheresis for HCT training and short-term contracted two experienced staff. One-third of the newly trained staff decided to continue with HCT collecting, providing quality data reports to the BMT Quality team. When next quarter data was presented, the CD34+ collection correlation had gone from 87% to 78%. The BMT Quality Coordinator monitored 100% of Apheresis HCT collection data for trending of the CD34+ collection correlation and analyzed for process improvements. Data was reported at BMT Quality Management Committee meetings at least quarterly. The Program needed the contracted vendor to provide well-trained staff, competent & proficient in HCT collections to ensure patient safety, provide accurate collections for successful validation of newly acquired machines and high quality product for transplants. Patients and Methods: Retrospective/concurrent data were collected over 18 months from successful HCT patient (n = 58,