Decreasing Nosocomial C. diff

Transcription

1 Decreasing Nosocomial C. diff Our journey to decreasing nosocomial C. diff Jennifer Conti BSN, RN, CIC Nicole Rabic MSN, RN, CIC

2 Nosocomial C. diff Use of the CDC standardized definition Review CDC definition for Fac WideIN Follow the 14 day rule There should be 14 days with no C diff positive laboratory result before another C. diff lab event is entered Community acquired events must occur on hospital day 1, 2 or 3 Hospital acquired events are when the day of the event is on or after hospital day 4

3 C. Diff Costs 439 non-surgical patients who were hospitalized > 48 hours at Barnes-Jewish Hospital analyzed Patients who acquired a c-diff infection cost on average $6522 more Estimated yearly total attributable cost: $2,863,045 - cost above and beyond care of non-cdiff patients Dubberke E. Attributable Cost of Clostridium difficile-associated Disease in Non-Surgical Inpatients abstract, SHEA 2006

4 Background: Pathogenesis of CDI 1. Ingestion of spores transmitted from other patients via the hands of healthcare personnel and environment 3. Altered lower intestine flora (due to antimicrobial use) allows proliferation of C. difficile in colon 4. Toxin A & B Production leads to colon damage +/- pseudomembrane 2. Germination into growing (vegetative) form Sunenshine et al. Cleve Clin J Med. 2006;73:

5 C. difficile Transmission C. difficile can be acquired from contact with contaminated surfaces (e.g., bedrails, commode, floors, bed pans) or by fecal-oral transmission from colonized individuals. Cross-transmission on hands of healthcare workers and patients

6 Our journey to success Signage Letters to physician Cleaning protocol Bed board Who cleans what list Isolation duration of stay C-diff list sent out and on DSB Root cause presented at Infection Prevention meeting Infection Control orientation with environmental services Antibiotic Stewardship Program Automatic isolation when sample sent Hand Hygiene Observer

7 Signage All contact isolation signs were the same C. diff and MDROS

8 Signage added to hygiene dispensers

9 Letters to Physicians Each time a nosocomial C. diff is found an is sent to the staff who cared for the patient Highlighting details and a review of the case Findings are mentioned in the Diarrhea on admission from OSH Sample sent after multiple stool softeners started Repeat samples sent Same operating rooms or procedures Common equipment

10 Cleaning Protocol Rooms are dotted by EVS supervisor daily and monitored Infection Prevention tags C. diff patients on bed board Pager system goes to EVS to alert C. diff room EVS then is aware of the specialized cleaning protocol EVS double cleans the room and then UV lights the room Curtains are changed Room is checked for dots

11 Dotting the Surfaces

12 CDI DAILY & DISCHARGE CLEANING: PERCENT TOTAL MARKERS REMOVED 100.0% 95.0% 90.0% GOAL 100% 96.0% 88.7% 88.2% 93.8% 91.0% 97.5% 95.6% 93.8% 94.2% 93.9% 90.9% 98.1% 95.8% 96.8% 95.6% 94.8% 95.6% 93.3% 91.4% 85.0% 80.0% 80.0% 75.0% 70.0% 65.0% 60.0% 55.0% 58.6% 56.3% 50.0% Q1-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 DAILY DISCHARGE 12

13 UV light or Bioquell UV LIGHT Bioquel

14 INFECTION PREVENTION Changing Curtains Change curtains when patient is discharged or transferred from a contact precautions room

15 Who Cleans What?

16 C. DIFF Rooms must be double cleaned and UV lighted upon transfer or discharge of patient.

17 Root Cause Review A root cause analysis is conducted on each nosocomial c-diff case EVS Respiratory Nursing Physicians Electronic Medical Record staff Supply Chain Quality Infection Control Together we review the case and look for opportunities

18 Antibiotic Stewardship Team Goals Increase appropriate use of antibiotics Use fewer antibiotics Reduce days on multiple antibiotics 24% reduction of overall antibiotic use 55% reduction in use of meropenem and imipenem Benefits Fewer patients with MDRO Reduce cost of isolation and Tx of MDRO Reduce infections caused by MDRO Reduce antibiotic costs 18

19 Hand Hygiene Observer s Role Daily visits to the C. diff rooms Monitors for PPE compliance and hand hygiene compliance Monitors C. diff rooms daily Provides on the spot coaching

20 Hand Hygiene by floor by job class

21 Future Ideas Daily Cleaning of patient s hands Alerts to notify infection control when duplicate samples sent Alerts to notify nurse when diarrhea is noted multiple times on a flow sheet without c-diff order controversial More influence on hand hygiene by all visitors who enter each unit

22 Teamwork!!! = Success