HAI Prevention. Beyond the Bundle. March 18, 2016

Transcription

1 HAI Prevention Beyond the Bundle March 18, 2016 Krystyna Strozewski Director of Quality Lake Health System Karen Mrazik Infection Preventionist Tripoint Medical Center Elizabeth Reed Infection Preventionist West Medical Center

2 Objectives Describe best practices in HAI prevention through leadership, culture, physician support and utilizing Lean Methodologies. Discuss HAI prevention strategies beyond the bundle, hardwiring to ensure compliance

3 Lake Health: A Regional Copy Healthcare title System 3

4 Two Hospitals TriPoint Medical Center Concord, OH West Medical Center Willoughby, OH

5 Best Practices in HAI Prevention Strong Physician and Executive Leadership Physician Champions Zero Harm Patient Safety Culture Strategic Initiatives include HAI Prevention Leadership Goals include Reducing Patient Harm Use of High Level Risk Reduction Strategies Use of Lean Methodologies

6 Maintaining Compliance with HAI Prevention Daily Patient Safety Huddles for Leadership Simpler Lean Methodology Managing for Daily Improvement Boards High Level Risk Reduction Strategies

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8 Countermeasures Goal: Prevent the issue from recurring Sensory Feedback Visual aids and standard work at point of use Re-educating individuals/teams is least effective Chastising the person who is trying to comply

9 Infection Prevention Approaches Vertical : aimed at reducing a specific pathogen Active surveillance MRSA, VRE Contact precautions MRSA, Cdiff Decolonization MRSA Vaccination Influenza, Tdap Horizontal: reduces all infections and is not pathogen specific Standard Precautions Hand Hygiene, cough etiquette Environmental Hygiene Antimicrobial Stewardship Bundles of care CHG bathing Behavior modification

10 HAI Prevention Strategies Bundles CLABSI, CAUTI, VAP CLABSI - Insertion and Maintenance Bundle Horizontal strategies: daily CHG bathing, hand hygiene compliance SSI strategies - CHG pre-op bathing, CHG surgical prep, nasal decolonization

11 Use of Lean to Lower HAIs Lean project in response to increase of C. diff infections in 1 st quarter 2015 Reported at completion of project with 90 Day Follow-up to Organization including Senior Leaders & to the Board

12 Gap Analysis No. Gaps Root Cause 1 EVS inconsistent cleaning practices No standard work for isolation room cleaning no mechanism to monitor effectiveness 2 Inconsistent documentation of diarrhea stool charting No standard work for stool charting 3 Isolation precautions not followed appropriately No standard work for isolation precautions Visitors not following isolation precautions ; lack of patient/visitor education Lack of hand off to ancillary departments; unaware of C. diff precautions Delay in C. diff specimen collection ; Nurse driven protocol not followed; unaware of pending tests Lack of communication from RN to PCA and PT for sample collection No visual cue for visitors lack of enforcement & education No standard Work regarding hand offs No standard work No standard work 8 Antibiotic over-use; lack of de-escalation Lack of antibiotic stewardship program Delay in entering Isolation Order in Soarian and Biohazard symbol in Soarian Financials PPE not available on Isolation cart/caddy ; Isolation sign not posted. Equipment not dedicated : lack of cleaning with bleach after patient care. Single use equipment cleaned and re-used. Lack of consumer and physician education on antibiotic stewardship No standard work No standard work for stocking No standard work 12 Lack of consumer & physician education

13 4. Gap Analysis GAP ANALYSIS 13

14 Solution Approach Gap No. Solution (If We): Expected Outcome (Then): 1 Create EVS Isolation Standard Work including enhanced cleaning and microfiber mops/cloths Correct disinfectant and enhanced cleaning will occur to decrease C. diff spores in environment 2, 3, 4, 6, 8, 9,10,11 Create C. difficile Isolation Standard Work Improve compliance with timely specimen collection, adherence to isolation precautions and use of PPE, hand off communication 3,10 Employ visual cue (stop sign) for visitors Improve compliance with use of PPE for visitors 8 Educate physicians on antibiotic stewardship Lessen the pressure for selection of C. difficile infection Educate patient/visitor on C. diff isolation precautions include in Standard Work Create standard work for Isolation Standard Work for Ancillary Departments Educate PT regarding notification of PCA/RN when patient has diarrhea for sample collection Improve compliance with Isolation PPE Improve compliance with Isolation precautions, cleaning & disinfection of equipment Improve timeliness of specimen collection 10 Revise Standard work for Isolation Cart/Caddy Improve compliance with Isolation precautions and PPE supplies 6 If Lab can identify pending C. diff tests Improve compliance with collection of sample and testing.. 12 If consumer and physician are educated on appropriate antibiotic use Decrease antibiotic over-use 14

15 Standard Work and Skill Matrix

16 90 Day Follow-up HAI Prevention C. difficile Category Metric Baseline Target 30 day 60 Day 90 Day Andon HD HD Compliance with Isolation Compliance w/ Isolation PPE GloGerm compliance with EVS cleaning 8% 100% 95% 92% 100% 0% 100% 77% 97% 96% 80% 43% 67% 83% Q Number of HA C. diff infections 26 thru May Av 5.5/mo 3 per mo T Timely specimen collection AV 5 days < 3 Days 0.5 Days C Cost of C. diff infections $232,694 thru May $74,039 misclassified $698,082 Current run rate $507,696 $338,464 $391,349 $111,158 savings $ $133,975 savings 16

17 90 Day Follow-up HAI Prevention C. difficile Glogerm EVS Compliance with Cleaning Countermeasures Problem Statement Root Cause Owner Due Date Improvement Action Areas not adequately cleaned Not following standard work EVS manager 9/15 Re-education of staff on standard work Status 1. Documented Std. Wk. Yes Where? TP Med/Tel 2. Trained doers on Std. Wk. Yes Adhering to Std. Wk.? No 3. Std. Wk. improved or revised? No Rev. #? 1 (Used Team Work, A3 Thinking, Lean Solutions) - Yes GO - SEE

18 Hand Hygiene Campaign Observations internal & external Transparency posting of compliance for physicians & team members Additional alcohol dispensers Team member & physician handwashing photos Hand hygiene screen saver Hand hygiene mirror clings Recognition for physician and team members Hand hygiene giveaways

19 Unit-Specific Campaigns

20 Hand Hygiene Journey PfP Audits 2015 YTD 2014 YTD 2013 YTD 2012 YTD Benchmark TriPoint 84.68% 78.23% 60.89% 39.86% % West 83.19% 81.43% 64.46% 40.74% % Combined 83.97% 80.05% 62.87% 40.30% %

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22 Hand Hygiene Compliance Hand Hygiene Audit Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec YTD PfP Observer 85.5% 84.8% 89.5% 89.6% 91.6% 84.6% 87.8% 90.8% 48.2% 81.1% 84.7% 82.6% 83.4% EOC Rounds 91.5% 91.4% 92.1% 93.1% 93.3% 96.5% 94.8% 95.1% 98.5% 99.0% 98.0% 98.4% 95.0% IP Observations 81.5% 88.4% 85.7% 90.4% 90.0% 86.5% 84.2% 93.3% 93.6% 90.9% 90.6% 92.1% 89.6% Total Compliance 90.9% 90.1% 91.6% 92.4% 92.9% 94.3% 93.3% 94.3% 90.1% 94.9% 94.9% 94.7% 92.9% Physician s Only 91.3% 91.6% 95.4% 97.9% 96.2% 97.2% 95.0% 95.2% 93.4% 97.9% 92.5% 92.8% 94.8%

23 Questions?