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Tackling MRSA: An Orthopedic Infection Prevention Bundle
www.ajicjournal.org Vol. 39 No. 5
E47
Methods: Several Gram-positive and Gram-negative organisms were studied for susceptibility to kill by 405 nm light at long (1 hour) and short (5 minute) illumination times. Tracheal epithelial tissue culture with MTT (mitochondrial reductase) assay was used to assess phototoxicity of light sources used. Results: The following organisms were killed at greater than 4 logs using 405nm light at 1 hour exposure time; Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Pseudomonas aeruginosa, Enterococcus faecalis, and Streptococcus pneumoniae. Illumination at 405nm for 3 hours at 5m W/cm2 of S. aureus and P. aeruginosa gave . 6 logs kill. Tracheal epithelial tissue illuminated at this condition remained viable as shown by MTT assay. Conclusions: 405nm light has broad-spectrum microbiocidal activity. Our results suggest that a therapeutic window may exist for treatment of some infections in human tissues using 405 nm light. Presentation Number 13-158
Measuring the Effect of a Multifactorial Intervention to Decrease CAUTI in the Acute Care Setting Marc Chavez, RN, BSN, Carol Williams, RN, Carmen Sincerbeaux, RN, Lee Rieken, RN, Marian Wilson, RN, Ashley English, RN, Kootenai Health, Coeur d’Alene, ID Background/Objectives: Use of indwelling urinary catheters can place patients at high risk for catheter associated urinary tract infection (CAUTI). Infections can prolong hospitalization, increase healthcare costs, and may result in sepsis or death. Evidence-based guidelines have been developed to standardize care and reduce risk, however, no clear consensus exists on the most effective implementation. This study aims to evaluate the effects of a hospital-wide intervention by measuring 1) CAUTI rates, 2) rate of device (indwelling urinary catheter) days, and 3) percentage of devices removed by postoperative day two. Methods: A pre-test post-test intervention study design was used to evaluate outcomes. The multifactorial intervention was based on current evidence for CAUTI prevention and included: policy revision, daily medical necessity documentation, a computerized education module, and systematic surveillance and feedback. Data were collected from 9 inpatient units at a 246-bed community-owned hospital during the 9-month intervention period April 2010 through December 2010. These were compared to data collected retrospectively from the 12-month preintervention period March 2009 through March 2010. Descriptive statistics and independent t-tests were computed to examine the effect pre- and post-intervention. Results: The mean device days per month, in the 12 month pre-intervention period was 18.2. It decreased significantly to 14.8 in the 9-month intervention period (p,.001). The mean CAUTI rate in the pre-intervention period was 2.0. It decreased to 1.4 in the intervention period, but this did not reach the level of significance set at 0.05 (p 5 0.68). The percentage of devices removed by postoperative day two in the pre-intervention period data was 82%. The percentage increased to 88% in the post-intervention period, but this did not reach the level of significance set at 0.05 (p 5 0.11). Conclusions: Implementation of a multifactorial facility-wide approach may result in changes in recorded device days, CAUTI rates and postoperative catheter removal performance. Examination of study results identified variation among units in degree of compliance with the applied interventions. This was associated with variation in effects. Further research is needed to examine whether increased compliance with evidence-based practices can increase positive results. Presentation Number 13-159
Tackling MRSA: An Orthopedic Infection Prevention Bundle Michelle Vignari, RN, CIC, Infection Preventionist, Rochester General Hospital, Rochester, NY Issue: Infection of a joint prosthesis often requires removal of the infected hardware and prolonged intravenous antimicrobial therapy. MRSA infections are more difficult to treat because of limited antibiotic choices. The additional cost of ONE case of post-operative MRSA in the orthopedic patient is in excess of $50,000.
E48
American Journal of Infection Control June 2011
In 2008 we had a recorded 0.4% MRSA infection rate for Knee Arthroplasty patients and 1.2% MRSA infection rate for Hip Arthroplasty patients. Upon further retrospective review, it was found that .60% of all our Orthopedic infections were due to MRSA. In addition, public reporting of hip infection rates was planned to occur during 2009. Project: We instituted an action plan to reduce MRSA and Surgical Site infections in our orthopedic population. This comprehensive approach required extensive teamwork and collaboration using a multidisciplinary approach: Surgeons, perioperative and postoperative staff received extensive education. This program consisted of skin preparation with Chlorhexidine impregnated cloths the night before and morning of surgery, preoperative screening for MRSA colonization, addition of intravenous vancomycin to the standard antibiotic prophylaxis protocol for identified carriers, chlora-prep surgical skin prep and administration of intranasal mupirocin ointment to all patients, regardless of colonization status for five days, beginning the day before surgery. In addition, several environmental factors such as disinfectant wipes in all rooms and patient dedicated equipment were instituted. All orthopedic charts were monitored concurrently until discharge from the Orthopedic Service. After discharge, post op surveillance continued for thirty days postoperatively and one full year for any patient with an implantable. Results: The institution of a Comprehensive Orthopedic Infection Elimination Program showed a significant decrease resulting in 350 Days with No MRSA Orthopedic Surgical Site Infection!
Lessons Learned: Quality Improvement, Patient Safety and Infection Prevention begins at the bedside and interdisciplinary collaboration is essential. Processes ‘‘Hardwired’’ into everyday standard of care can drive change and patient outcomes.
Presentation Number 13-160
Sustaining Zero: Central Line Associated Bloodstream Infection Prevention through Innovation, Accountability and Evidence-Based Practice Wilma Joy Vollers, RN, NE-BC, CIC, Infection Prevention and Control Manager; Amelia Wright, RN, Anna Mall, RN, CCRN, Critical Care Unit; Durham Regional Hospital, Durham, NC Issue: Central Line Associated Bloodstream Infections (CLABSI) continue to result in mortality, morbidity and increased healthcare costs. Retrospective analysis of CLABSI rates since 2008 in our Critical Care Unit (CCU) demonstrated marked variability despite practice changes and continued staff education. Unit nurses
E47
Methods: Several Gram-positive and Gram-negative organisms were studied for susceptibility to kill by 405 nm light at long (1 hour) and short (5 minute) illumination times. Tracheal epithelial tissue culture with MTT (mitochondrial reductase) assay was used to assess phototoxicity of light sources used. Results: The following organisms were killed at greater than 4 logs using 405nm light at 1 hour exposure time; Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Pseudomonas aeruginosa, Enterococcus faecalis, and Streptococcus pneumoniae. Illumination at 405nm for 3 hours at 5m W/cm2 of S. aureus and P. aeruginosa gave . 6 logs kill. Tracheal epithelial tissue illuminated at this condition remained viable as shown by MTT assay. Conclusions: 405nm light has broad-spectrum microbiocidal activity. Our results suggest that a therapeutic window may exist for treatment of some infections in human tissues using 405 nm light. Presentation Number 13-158
Measuring the Effect of a Multifactorial Intervention to Decrease CAUTI in the Acute Care Setting Marc Chavez, RN, BSN, Carol Williams, RN, Carmen Sincerbeaux, RN, Lee Rieken, RN, Marian Wilson, RN, Ashley English, RN, Kootenai Health, Coeur d’Alene, ID Background/Objectives: Use of indwelling urinary catheters can place patients at high risk for catheter associated urinary tract infection (CAUTI). Infections can prolong hospitalization, increase healthcare costs, and may result in sepsis or death. Evidence-based guidelines have been developed to standardize care and reduce risk, however, no clear consensus exists on the most effective implementation. This study aims to evaluate the effects of a hospital-wide intervention by measuring 1) CAUTI rates, 2) rate of device (indwelling urinary catheter) days, and 3) percentage of devices removed by postoperative day two. Methods: A pre-test post-test intervention study design was used to evaluate outcomes. The multifactorial intervention was based on current evidence for CAUTI prevention and included: policy revision, daily medical necessity documentation, a computerized education module, and systematic surveillance and feedback. Data were collected from 9 inpatient units at a 246-bed community-owned hospital during the 9-month intervention period April 2010 through December 2010. These were compared to data collected retrospectively from the 12-month preintervention period March 2009 through March 2010. Descriptive statistics and independent t-tests were computed to examine the effect pre- and post-intervention. Results: The mean device days per month, in the 12 month pre-intervention period was 18.2. It decreased significantly to 14.8 in the 9-month intervention period (p,.001). The mean CAUTI rate in the pre-intervention period was 2.0. It decreased to 1.4 in the intervention period, but this did not reach the level of significance set at 0.05 (p 5 0.68). The percentage of devices removed by postoperative day two in the pre-intervention period data was 82%. The percentage increased to 88% in the post-intervention period, but this did not reach the level of significance set at 0.05 (p 5 0.11). Conclusions: Implementation of a multifactorial facility-wide approach may result in changes in recorded device days, CAUTI rates and postoperative catheter removal performance. Examination of study results identified variation among units in degree of compliance with the applied interventions. This was associated with variation in effects. Further research is needed to examine whether increased compliance with evidence-based practices can increase positive results. Presentation Number 13-159
Tackling MRSA: An Orthopedic Infection Prevention Bundle Michelle Vignari, RN, CIC, Infection Preventionist, Rochester General Hospital, Rochester, NY Issue: Infection of a joint prosthesis often requires removal of the infected hardware and prolonged intravenous antimicrobial therapy. MRSA infections are more difficult to treat because of limited antibiotic choices. The additional cost of ONE case of post-operative MRSA in the orthopedic patient is in excess of $50,000.
E48
American Journal of Infection Control June 2011
In 2008 we had a recorded 0.4% MRSA infection rate for Knee Arthroplasty patients and 1.2% MRSA infection rate for Hip Arthroplasty patients. Upon further retrospective review, it was found that .60% of all our Orthopedic infections were due to MRSA. In addition, public reporting of hip infection rates was planned to occur during 2009. Project: We instituted an action plan to reduce MRSA and Surgical Site infections in our orthopedic population. This comprehensive approach required extensive teamwork and collaboration using a multidisciplinary approach: Surgeons, perioperative and postoperative staff received extensive education. This program consisted of skin preparation with Chlorhexidine impregnated cloths the night before and morning of surgery, preoperative screening for MRSA colonization, addition of intravenous vancomycin to the standard antibiotic prophylaxis protocol for identified carriers, chlora-prep surgical skin prep and administration of intranasal mupirocin ointment to all patients, regardless of colonization status for five days, beginning the day before surgery. In addition, several environmental factors such as disinfectant wipes in all rooms and patient dedicated equipment were instituted. All orthopedic charts were monitored concurrently until discharge from the Orthopedic Service. After discharge, post op surveillance continued for thirty days postoperatively and one full year for any patient with an implantable. Results: The institution of a Comprehensive Orthopedic Infection Elimination Program showed a significant decrease resulting in 350 Days with No MRSA Orthopedic Surgical Site Infection!
Lessons Learned: Quality Improvement, Patient Safety and Infection Prevention begins at the bedside and interdisciplinary collaboration is essential. Processes ‘‘Hardwired’’ into everyday standard of care can drive change and patient outcomes.
Presentation Number 13-160
Sustaining Zero: Central Line Associated Bloodstream Infection Prevention through Innovation, Accountability and Evidence-Based Practice Wilma Joy Vollers, RN, NE-BC, CIC, Infection Prevention and Control Manager; Amelia Wright, RN, Anna Mall, RN, CCRN, Critical Care Unit; Durham Regional Hospital, Durham, NC Issue: Central Line Associated Bloodstream Infections (CLABSI) continue to result in mortality, morbidity and increased healthcare costs. Retrospective analysis of CLABSI rates since 2008 in our Critical Care Unit (CCU) demonstrated marked variability despite practice changes and continued staff education. Unit nurses