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Sustained Improvement in Environmental Cleaning at an Academic Medical Center
American Journal of Infection Control June 2011
E200
Table 1. Comparison between Hospital Report and HAI Program Staff Reviewer from 2007-2009 Colon Audit in New York State 2007
2008
2009
# Inconsistencies # MRs % Match # Inconsistencies # MRs % Match # Inconsistencies # MRs % Match ASA score* Wound Class* Procedure Duration* SSI Extent of Infection Gender General anesthesia Date of Birth Procedure date Trauma NHSN Procedure When Detected Primary Closure Emergency Scope Overall Accuracy
55 119 327 69 33
639 669 623 642 168
20 46 51 9 22 16 29 75
651 658 669 657 689 170 665 657
871
7557
91.4 82.2 47.5 89.3 80.4 N/A 96.9 93.0 92.4 98.6 96.8 90.6 95.6 88.6 N/A 88.5
74 188 249 24 40 7 12 16 22 32 56 43 94 90 133 1080
1762 1762 1762 1762 400 1911 1762 1911 1911 1762 1911 393 1911 1762 1762 24444
95.8 89.3 85.7 98.6 89.9 99.6 99.3 99.2 98.8 98.2 97.1 89.1 95.1 94.9 92.4 95.6
53 126 95 66 25 11 11 22 27 22 36 13 93 68 113 781
1324 1324 1324 1324 283 1324 1324 1324 1324 1324 1438 283 1438 1324 1324 19330
96.0 90.5 92.8 95.0 91.2 99.2 99.2 98.3 98.0 98.3 97.5 95.4 93.5 94.9 91.5 95.7
*These criteria are used for NHSN risk adjustment.
reporting SSI (89% vs. 95%) and extent of infection superficial, deep, organ/space (80% vs. 91%) has also improved. Conclusions: Between 2007 and 2009, hospitals have been able to improve the accuracy of data reported to the NHSN. The most common reason for discrepancies between reported data and the audit data has consistently been misinterpretation of the NHSN definitions, and inadequate surveillance resources or methods. For these reasons, audits are an essential component of the NYS HAI program to help hospitals evaluate their surveillance methods, verify use of the NHSN criteria and validate hospital reported rates.
Presentation Number 113
Sustained Improvement in Environmental Cleaning at an Academic Medical Center Susan D. Page, MT, MS, CIC, Infection Preventionist; Cristal A. VeStrand, CHESP, Manager Environmental Services; Penny A. Thompson, CHESP, Coordinator Environmental Services Training; Fletcher Allen Health Care Center, Burlington, VT Issue: Recognizing the importance of a contaminated environment in transmission of healthcare-associated pathogens (HAPs), the organization’s 2009 goal of getting to zero healthcare-associated infection (HAIs) included the Environmental Services (ES) Department. Opportunities for improvement included education of ES staff, standardizing cleaning protocols, routine efficacy testing of the disinfectant and environmental marking to evaluate efficacy of cleaning. Project: With a culturally diverse staff speaking 37 different languages, innovative education and training materials were developed for both initial and continued ES education focused on the role of the environment in transmission of HAPs. Cleaning routines were standardized and included the 14 high touch environmental surfaces. Cotton cloths were replaced by micro-fiber products. Supervisors tested the efficacy of disinfectant used throughout each shift. Supervisors also used a fluorescent lotion to evaluate
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thoroughness of cleaning the 14 high touch surfaces. Goals for improvement in the percent of surfaces cleaned were set quarterly with ES staff involvement. Administrative support allowed a substantial monthly monetary incentive program for individual staff members and supervisors as well as twice yearly department celebrations. Results: The percent of individual high touch surfaces cleaned improved from 42% at project initiation to 75% at the end of the first quarter of 2009. The goal of 82.5% for the second quarter of 2009 was achieved and by the fourth quarter of 2010, the goal of 95% of all surfaces cleaned had been met. Press Ganey patient satisfaction mean scores for room cleanliness improved from 80.3% at project initiation to 85.6% in November 2010. In addition to improvements in environmental cleanliness, the organization’s goal of getting to zero HAIs included mandatory resident education and developing a nursing infection prevention advocate program. A composite measure consisting of three HAIs was developed to evaluate the success of these initiatives. After the first year a reduction of 16% was achieved in the composite measure. This reduction continued in the second year to 38% when compared to project initiation. Lessons Learned: Sustained improvement in environmental cleanliness can be achieved by educating ES staff, evaluating practices, monitoring processes, involving ES staff in goal setting and using a financial reward system. Presentation Number 114
Patient Factors Associated with Adverse Events of Hospitalized Veterans in Infection Control Isolation Patti G. Grota, PhD, CNS-M-S, CIC, Infection Prevention Specialist, South Texas Veterans Healthcare System, San Antonio, TX Background: Public concern for safety exists for patients who are in infection control isolation supported by reports of psychological, social, and physical changes and adverse events. Objectives: The aims were: (1) describe characteristics of hospitalized veterans in contact precautions isolation in a private room (CPI) and contact precautions isolation in a non private room (CP), (2) describe differences in the incidence of adverse events between hospitalized veterans in CPI and CP, and (3) predict the probability that a veteran will experience an adverse event in CPI versus CP. Methods: An electronic surveillance system was used to retrieve computerized medical records from April 2009 through March 2010. Records (N5316) were assigned to CPI (220/316) or CP (96/316) using culture results and room numbers. A retrospective cohort methodology was applied to conduct structured record reviews. Research assistants reviewed 20% of the records with high inter-rater agreement (k5.97). Adverse events were validated by a physician reviewer (k51.0). Results: The sample was 97% male, 63% white, and 44% 65 years or older. There were no significant differences in patient characteristics between the CPI and CP groups. Adverse events (N5104) were identified in 23% (74/316) of the patients; 7% (22/316) of the patients had two or more adverse events. The most frequent adverse events were health care associated infections (20%), falls (16%), and behavioral changes (16%). Adverse events were not found to be significantly associated with CPI or CP. Predictors associated with adverse events (p# .01) were entered into a logistic regression equation. Close observation (negatively associated), peripheral vascular disease (negatively associated) and fall risk score (positively associated) had significant partial effects on adverse events, independent of CPI or CP accounting for 19% of the variance. The model successfully classed 79% of the veterans.
E200
Table 1. Comparison between Hospital Report and HAI Program Staff Reviewer from 2007-2009 Colon Audit in New York State 2007
2008
2009
# Inconsistencies # MRs % Match # Inconsistencies # MRs % Match # Inconsistencies # MRs % Match ASA score* Wound Class* Procedure Duration* SSI Extent of Infection Gender General anesthesia Date of Birth Procedure date Trauma NHSN Procedure When Detected Primary Closure Emergency Scope Overall Accuracy
55 119 327 69 33
639 669 623 642 168
20 46 51 9 22 16 29 75
651 658 669 657 689 170 665 657
871
7557
91.4 82.2 47.5 89.3 80.4 N/A 96.9 93.0 92.4 98.6 96.8 90.6 95.6 88.6 N/A 88.5
74 188 249 24 40 7 12 16 22 32 56 43 94 90 133 1080
1762 1762 1762 1762 400 1911 1762 1911 1911 1762 1911 393 1911 1762 1762 24444
95.8 89.3 85.7 98.6 89.9 99.6 99.3 99.2 98.8 98.2 97.1 89.1 95.1 94.9 92.4 95.6
53 126 95 66 25 11 11 22 27 22 36 13 93 68 113 781
1324 1324 1324 1324 283 1324 1324 1324 1324 1324 1438 283 1438 1324 1324 19330
96.0 90.5 92.8 95.0 91.2 99.2 99.2 98.3 98.0 98.3 97.5 95.4 93.5 94.9 91.5 95.7
*These criteria are used for NHSN risk adjustment.
reporting SSI (89% vs. 95%) and extent of infection superficial, deep, organ/space (80% vs. 91%) has also improved. Conclusions: Between 2007 and 2009, hospitals have been able to improve the accuracy of data reported to the NHSN. The most common reason for discrepancies between reported data and the audit data has consistently been misinterpretation of the NHSN definitions, and inadequate surveillance resources or methods. For these reasons, audits are an essential component of the NYS HAI program to help hospitals evaluate their surveillance methods, verify use of the NHSN criteria and validate hospital reported rates.
Presentation Number 113
Sustained Improvement in Environmental Cleaning at an Academic Medical Center Susan D. Page, MT, MS, CIC, Infection Preventionist; Cristal A. VeStrand, CHESP, Manager Environmental Services; Penny A. Thompson, CHESP, Coordinator Environmental Services Training; Fletcher Allen Health Care Center, Burlington, VT Issue: Recognizing the importance of a contaminated environment in transmission of healthcare-associated pathogens (HAPs), the organization’s 2009 goal of getting to zero healthcare-associated infection (HAIs) included the Environmental Services (ES) Department. Opportunities for improvement included education of ES staff, standardizing cleaning protocols, routine efficacy testing of the disinfectant and environmental marking to evaluate efficacy of cleaning. Project: With a culturally diverse staff speaking 37 different languages, innovative education and training materials were developed for both initial and continued ES education focused on the role of the environment in transmission of HAPs. Cleaning routines were standardized and included the 14 high touch environmental surfaces. Cotton cloths were replaced by micro-fiber products. Supervisors tested the efficacy of disinfectant used throughout each shift. Supervisors also used a fluorescent lotion to evaluate
www.ajicjournal.org Vol. 39 No. 5
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thoroughness of cleaning the 14 high touch surfaces. Goals for improvement in the percent of surfaces cleaned were set quarterly with ES staff involvement. Administrative support allowed a substantial monthly monetary incentive program for individual staff members and supervisors as well as twice yearly department celebrations. Results: The percent of individual high touch surfaces cleaned improved from 42% at project initiation to 75% at the end of the first quarter of 2009. The goal of 82.5% for the second quarter of 2009 was achieved and by the fourth quarter of 2010, the goal of 95% of all surfaces cleaned had been met. Press Ganey patient satisfaction mean scores for room cleanliness improved from 80.3% at project initiation to 85.6% in November 2010. In addition to improvements in environmental cleanliness, the organization’s goal of getting to zero HAIs included mandatory resident education and developing a nursing infection prevention advocate program. A composite measure consisting of three HAIs was developed to evaluate the success of these initiatives. After the first year a reduction of 16% was achieved in the composite measure. This reduction continued in the second year to 38% when compared to project initiation. Lessons Learned: Sustained improvement in environmental cleanliness can be achieved by educating ES staff, evaluating practices, monitoring processes, involving ES staff in goal setting and using a financial reward system. Presentation Number 114
Patient Factors Associated with Adverse Events of Hospitalized Veterans in Infection Control Isolation Patti G. Grota, PhD, CNS-M-S, CIC, Infection Prevention Specialist, South Texas Veterans Healthcare System, San Antonio, TX Background: Public concern for safety exists for patients who are in infection control isolation supported by reports of psychological, social, and physical changes and adverse events. Objectives: The aims were: (1) describe characteristics of hospitalized veterans in contact precautions isolation in a private room (CPI) and contact precautions isolation in a non private room (CP), (2) describe differences in the incidence of adverse events between hospitalized veterans in CPI and CP, and (3) predict the probability that a veteran will experience an adverse event in CPI versus CP. Methods: An electronic surveillance system was used to retrieve computerized medical records from April 2009 through March 2010. Records (N5316) were assigned to CPI (220/316) or CP (96/316) using culture results and room numbers. A retrospective cohort methodology was applied to conduct structured record reviews. Research assistants reviewed 20% of the records with high inter-rater agreement (k5.97). Adverse events were validated by a physician reviewer (k51.0). Results: The sample was 97% male, 63% white, and 44% 65 years or older. There were no significant differences in patient characteristics between the CPI and CP groups. Adverse events (N5104) were identified in 23% (74/316) of the patients; 7% (22/316) of the patients had two or more adverse events. The most frequent adverse events were health care associated infections (20%), falls (16%), and behavioral changes (16%). Adverse events were not found to be significantly associated with CPI or CP. Predictors associated with adverse events (p# .01) were entered into a logistic regression equation. Close observation (negatively associated), peripheral vascular disease (negatively associated) and fall risk score (positively associated) had significant partial effects on adverse events, independent of CPI or CP accounting for 19% of the variance. The model successfully classed 79% of the veterans.