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Tuberculosis control implementation
108
AJIC April 1995
Abstracts
Conclusion: After installing sinks, Xanthomonas maltophilia acquired by patients (11-14) belonged to a different genotype. After implementing HME filters, there was no further acquisition of Xanthomonas maltophilia, terminating outbreak #2. Isolating Xanthomonas mahophilia from the interior of a humidifier used on a patient who was not colonized or infected with the organism suggests that this outbreak may have been caused by both a common source and cross-infection of patients. Availabilityof DNA typing is a necessary tool for infection control personnel conducting epidemiological investigations. 4,~4, TUBERCULOSIS CONTROL IMPLEMENTATION. J. Ahmed, RN, BS, CIC,* M. E. Kay, RN, BSN, CIC, R. E D'Amato, PhD, A. E. Glatt, MD. Catholic Medical Center of Brooklyn and Queens Inc., Jamaica, NY. The Catholic Medical Center of Brooklyn & Queens is a multihospital system comprised of four acute care hospitals, two skilled nursing facilities, the largest home health care agency in the country and multiple satellite facilities. The Infection Control Department is centralized and provides services for all CMC facilities. The dramatic increase in tuberculosis (especially multiple dose resistant strains) in our geographical area necessitated the development and implementation of centetwide policies to address this problem. The following steps were taken: • Appointed a TB Ad Hoc Committee comprised of Infection Control, Microbiology, Infectious Diseases, Pulmonary Medicine, Respiratory Therapy, Engineering, Nursing, and Administration. • Reviewed draft guidelines from CDC, N.Y. State Department of Health, other regulatory agencies, and peer-reviewed literature. • Defined the scope of the project to be undertaken. • Descriptions of safety products were reviewed and company representatives were brought in to discuss these items. • Developed health care workers risk for exposure by the task performed and by the work site. • Assessed patient care areas for the need to utilize additional engineering controls such as ultraviolet lights, HEPA filter units and sputum induction booths. • Selected the appropriate respirator. • Developed a medical assessment tool. • Developed a particulate filter mask and fit testing protocol. • Coordinated classes and monitored compliance. • Instituted routine Mantoux Skin Testing to monitor employee conversion rates. • Developed a monitoring tool to assess program effectiveness. To date, we have had no documented nosocomial transmission of Mycobacterium tuberculosisin our health care worker population.
P E R F O R M A N C E IMPROVEMENT OF A TUBERCULIN SKIN TESTING PROGRAM AT A UNIVERSITY MEDICAL CENTER. K. Posey, BSN, MPH, CIC, K. Nouri, RN, BSN, M. Pokrywka, MS, CIC,* S. Krystofiak, MS, MT, L. Kerr, MT, CIC, B. McCoy, BSN, MNEd. University of Pittsburgh Medical Center, Pittsburgh, PA. A tuberculin (PPD) skin testing program developed and managed by infection control practitioners (ICPs) was implement-
ed for a 1100-bed university medical center after a chart audit revealed that only 70% of PPDs ordered were actually being placed by the physicians. Of those PPDs placed, less than 45% were read and recorded. ICPs collaborated with pharmacy to standardize antigen preparation and with the medical center's information management system (Sunquest/Clinipac) to provide a comprehensive computerized PPD ordering and reporting process. Orders for PPDs and anergy panels are entered into the Clinipac system on the patient unit. ICPs print and review patient PPD orders daily in conjunction with routine culture surveillance. Test placement and reading of the skin tests is performed by the ICPs, providing the opportunity to assess the patient's medical status and potential need for AFB isolation or additional interventions. Skin testing results are entered into the Sunquest system, generating a report for the patient's medical record. The effectiveness of the program was evaluated after 1 year. A total of 702 assessments were performed and PPDs were placed on 609 patients. Test performance improved approximately threefold, with 93% of PPDs read and documented in the medical record. One unsuspected case of pulmonary TB was identified. We conclude that the ICP managed program has significantly improved the reliability and reporting of tuberculin testing performance at our institution,
USING CQI PRINCIPLES: A MULTIDISCIPLINARY TEAM APPROACH TO THE DEVELOPMENT OF A TUBERCULOSIS CONTROL PROGRAM. L. Becker, RN, BSN, MPH*, C. Baer-Arter, RN, BS, C.I. Skivington III, BS, MBA, V. Willett, BS. Kaiser Permanente Medical Center, Fontana, CA. A multidiseiplinary team was formed to design and implement a comprehensive proactive TB Control Program to ensure patient and health care worker safety. The team assessed Medical Center compliance with Centers for Disease Control Tuberculosis Control guidelines and regulatory agency requirements. Team members consisted of representatives from 14 involved departments, which included physicians, nurses, therapists and other health care workers. Areas of compliance and opportunities for improvement were identified, reviewed and prioritized for implementation using a combination of CQI tools and the Centers for Disease Control hierarchy of control. Cross functional teams were empowered to implement process and system changes. Changes included monitoring of structural ventilation, increased Mantoux testing in high-risk areas and establishment of a procedure for obtaining Public Health Officer approval for discharge. Responsibility to assure ongoing compliance yeas assigned. Implemented changes were successful due to adherence to CQI principles, communication at all levels, empowerment and endorsement from senior management.
ASSESSING IMPLEMENTATION OF APPROPRIATE PLACEMENT OF PATIENTS WITH TUBERCULOSIS TO CONTROL THE SPREAD. D. Mazon, RN, CIC,* A. Bell, LPN, W. Hierholzer, MD. Yale-New Haven Hospital, New Haven, CT. Over the past 2 years, Yale-New Haven Hospital (YNHH) developed extensive tuberculosis (TB) control measures to reduce the risk of exposure of TB to health care workers (HCW), patients and visitors.
AJIC April 1995
Abstracts
Conclusion: After installing sinks, Xanthomonas maltophilia acquired by patients (11-14) belonged to a different genotype. After implementing HME filters, there was no further acquisition of Xanthomonas maltophilia, terminating outbreak #2. Isolating Xanthomonas mahophilia from the interior of a humidifier used on a patient who was not colonized or infected with the organism suggests that this outbreak may have been caused by both a common source and cross-infection of patients. Availabilityof DNA typing is a necessary tool for infection control personnel conducting epidemiological investigations. 4,~4, TUBERCULOSIS CONTROL IMPLEMENTATION. J. Ahmed, RN, BS, CIC,* M. E. Kay, RN, BSN, CIC, R. E D'Amato, PhD, A. E. Glatt, MD. Catholic Medical Center of Brooklyn and Queens Inc., Jamaica, NY. The Catholic Medical Center of Brooklyn & Queens is a multihospital system comprised of four acute care hospitals, two skilled nursing facilities, the largest home health care agency in the country and multiple satellite facilities. The Infection Control Department is centralized and provides services for all CMC facilities. The dramatic increase in tuberculosis (especially multiple dose resistant strains) in our geographical area necessitated the development and implementation of centetwide policies to address this problem. The following steps were taken: • Appointed a TB Ad Hoc Committee comprised of Infection Control, Microbiology, Infectious Diseases, Pulmonary Medicine, Respiratory Therapy, Engineering, Nursing, and Administration. • Reviewed draft guidelines from CDC, N.Y. State Department of Health, other regulatory agencies, and peer-reviewed literature. • Defined the scope of the project to be undertaken. • Descriptions of safety products were reviewed and company representatives were brought in to discuss these items. • Developed health care workers risk for exposure by the task performed and by the work site. • Assessed patient care areas for the need to utilize additional engineering controls such as ultraviolet lights, HEPA filter units and sputum induction booths. • Selected the appropriate respirator. • Developed a medical assessment tool. • Developed a particulate filter mask and fit testing protocol. • Coordinated classes and monitored compliance. • Instituted routine Mantoux Skin Testing to monitor employee conversion rates. • Developed a monitoring tool to assess program effectiveness. To date, we have had no documented nosocomial transmission of Mycobacterium tuberculosisin our health care worker population.
P E R F O R M A N C E IMPROVEMENT OF A TUBERCULIN SKIN TESTING PROGRAM AT A UNIVERSITY MEDICAL CENTER. K. Posey, BSN, MPH, CIC, K. Nouri, RN, BSN, M. Pokrywka, MS, CIC,* S. Krystofiak, MS, MT, L. Kerr, MT, CIC, B. McCoy, BSN, MNEd. University of Pittsburgh Medical Center, Pittsburgh, PA. A tuberculin (PPD) skin testing program developed and managed by infection control practitioners (ICPs) was implement-
ed for a 1100-bed university medical center after a chart audit revealed that only 70% of PPDs ordered were actually being placed by the physicians. Of those PPDs placed, less than 45% were read and recorded. ICPs collaborated with pharmacy to standardize antigen preparation and with the medical center's information management system (Sunquest/Clinipac) to provide a comprehensive computerized PPD ordering and reporting process. Orders for PPDs and anergy panels are entered into the Clinipac system on the patient unit. ICPs print and review patient PPD orders daily in conjunction with routine culture surveillance. Test placement and reading of the skin tests is performed by the ICPs, providing the opportunity to assess the patient's medical status and potential need for AFB isolation or additional interventions. Skin testing results are entered into the Sunquest system, generating a report for the patient's medical record. The effectiveness of the program was evaluated after 1 year. A total of 702 assessments were performed and PPDs were placed on 609 patients. Test performance improved approximately threefold, with 93% of PPDs read and documented in the medical record. One unsuspected case of pulmonary TB was identified. We conclude that the ICP managed program has significantly improved the reliability and reporting of tuberculin testing performance at our institution,
USING CQI PRINCIPLES: A MULTIDISCIPLINARY TEAM APPROACH TO THE DEVELOPMENT OF A TUBERCULOSIS CONTROL PROGRAM. L. Becker, RN, BSN, MPH*, C. Baer-Arter, RN, BS, C.I. Skivington III, BS, MBA, V. Willett, BS. Kaiser Permanente Medical Center, Fontana, CA. A multidiseiplinary team was formed to design and implement a comprehensive proactive TB Control Program to ensure patient and health care worker safety. The team assessed Medical Center compliance with Centers for Disease Control Tuberculosis Control guidelines and regulatory agency requirements. Team members consisted of representatives from 14 involved departments, which included physicians, nurses, therapists and other health care workers. Areas of compliance and opportunities for improvement were identified, reviewed and prioritized for implementation using a combination of CQI tools and the Centers for Disease Control hierarchy of control. Cross functional teams were empowered to implement process and system changes. Changes included monitoring of structural ventilation, increased Mantoux testing in high-risk areas and establishment of a procedure for obtaining Public Health Officer approval for discharge. Responsibility to assure ongoing compliance yeas assigned. Implemented changes were successful due to adherence to CQI principles, communication at all levels, empowerment and endorsement from senior management.
ASSESSING IMPLEMENTATION OF APPROPRIATE PLACEMENT OF PATIENTS WITH TUBERCULOSIS TO CONTROL THE SPREAD. D. Mazon, RN, CIC,* A. Bell, LPN, W. Hierholzer, MD. Yale-New Haven Hospital, New Haven, CT. Over the past 2 years, Yale-New Haven Hospital (YNHH) developed extensive tuberculosis (TB) control measures to reduce the risk of exposure of TB to health care workers (HCW), patients and visitors.